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Factors predicting prolonged empirical antifungal treatment in critically ill patients
Mohamed Zein, Erika Parmentier-Decrucq, Amer Kalaoun
1Pôle de Réanimation Médicale, CHRU de Lille, Hôpital Salengro, Lille, France. s-nseir@chru-lille.fr.
Objective:
To determine the incidence, risk factors, and impact on outcome of prolonged empirical antifungal treatment in ICU patients.
Methods:
Retrospective observational study performed during a one-year period. Patients who stayed in the ICU >48 h, and received empirical antifungal treatment were included. Patients with confirmed invasive fungal disease were excluded. Prolonged antifungal treatment was defined as percentage of days in the ICU with antifungals > median percentage in the whole cohort of patients.
Results:
Among the 560 patients hospitalized for >48 h, 153 (27%) patients received empirical antifungal treatment and were included in this study. Fluconazole was the most frequently used antifungal (46% of study patients). Median length of ICU stay was 19 days (IQR 8, 34), median duration of antifungal treatment was 8 days (IQR 3, 16), and median percentage of days in the ICU with antifungals was 48% (IQR 25, 80). Seventy-seven patients (50%) received prolonged empirical antifungal treatment. Chemotherapy (OR [95% CI] 2.6 [1.07-6.69], p = 0.034), and suspected infection at ICU admission (3.1 [1.05-9.48], p = 0.041) were independently associated with prolonged empirical antifungal treatment. Duration of mechanical ventilation and ICU stay were significantly shorter in patients with prolonged empirical antifungal treatment compared with those with no prolonged empirical antifungal treatment. However, ICU mortality was similar in the two groups (46 versus 52%, p = 0.62).
Conclusion:
Empirical antifungal treatment was prescribed in a large proportion of study patients. Chemotherapy, and suspicion of infection at ICU admission are independently associated with prolonged empirical antifungal treatment.
Insights
Prolonged empirical antifungal treatment was common in ICU patients, associated with chemotherapy and suspected infection. This treatment did not impact ICU mortality but shortened hospital stays.
Area of Science:
- Critical Care Medicine
- Infectious Diseases
- Pharmacology
Background:
- Empirical antifungal treatment is frequently used in intensive care units (ICUs).
- Understanding the factors influencing prolonged use and its outcomes is crucial for optimizing patient care.
Purpose of the Study:
- To determine the incidence, risk factors, and impact on outcome of prolonged empirical antifungal treatment in ICU patients.
- To identify predictors for extended use of antifungals in critically ill patients.
Main Methods:
- Retrospective observational study of ICU patients receiving empirical antifungal treatment.
- Defined prolonged treatment as antifungal use exceeding the median percentage of ICU days.
- Excluded patients with confirmed invasive fungal disease.
Main Results:
- 27% of ICU patients received empirical antifungals; 50% of these had prolonged treatment.
- Chemotherapy and suspected infection at ICU admission were associated with prolonged treatment.
- Prolonged treatment correlated with shorter mechanical ventilation and ICU stays, but not ICU mortality.
Conclusions:
- Empirical antifungal treatment is widely prescribed in ICUs.
- Chemotherapy and suspected infection predict prolonged empirical antifungal use.
- Prolonged empirical antifungal treatment did not affect ICU mortality in this cohort.
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