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Empiric antifungal and outcome in ICU patients
Background:
The management of invasive candidiasis (IC) remains a major challenge in intensive care units (ICU). On the one hand, it becomes admitted that delayed antifungal is an independent mortality factor. In the other hand, the unreasonable administration of antifungal agents is implicated in emergence of resistant Candida strains. Aim: to evaluate whether empirical antifungal therapy (EAFT) improves survival at day 28 and prevents a new episode of candidemia in septic patients without proven Candida infection.
Methods:
a 8-years retrospective double cohort, monocentric study, comparing two arms of ICU non neutropenic septic patients without proven fungal infection according to administration or not of an EAFT. The primary outcome was the 28-day mortality and the second was the occurrence of candidemia. The analysis was adjusted on Acute Physiology And Chronic Health Evaluation II (APACHE II) score, Candida score, invasive ventilation and central catheterisation.
Results:
247 patients were included (EAFT group, n=125 and non EAFT group, n=122). No improvement of 28-day survival was found. These results were in accordance both in crude analysis and after adjusting on factors mentioned above. No preventing effect on a new episode of candidemia. Nevertheless, a beneficial effect of EAFT on survival was found in patients with an APACHE II score<16: OR=0.68; CI 95% [0.53-0.87]; p=0.002.
Conclusions:
no beneficial impact of an EAFT on 28- day survival neither in preventing the occurrence of candidemia in non neutropenic septic critically patients. In patients with APACHE II score less than 16, there was a beneficial effect on survival.
Insights
Empirical antifungal therapy (EAFT) did not improve survival for septic patients in intensive care units (ICUs). However, EAFT showed a survival benefit in patients with a lower APACHE II score, indicating a potential subgroup benefit.
Area of Science:
- Critical Care Medicine
- Infectious Diseases
- Pharmacology
Background:
- Invasive candidiasis (IC) management in ICUs is challenging due to delayed treatment mortality and antifungal resistance.
- Balancing timely treatment with appropriate antifungal use is crucial.
Purpose of the Study:
- To assess if empirical antifungal therapy (EAFT) improves 28-day survival in septic patients without proven fungal infection.
- To determine if EAFT prevents new episodes of candidemia in this patient group.
Main Methods:
- Retrospective double cohort study of 247 non-neutropenic septic ICU patients.
- Comparison of outcomes between patients receiving EAFT and those not receiving it.
- Analysis adjusted for APACHE II score, Candida score, ventilation, and catheterization.
Main Results:
- EAFT did not improve 28-day survival or prevent candidemia in the overall study population.
- A significant survival benefit was observed with EAFT in patients with an APACHE II score < 16 (OR=0.68).
Conclusions:
- EAFT offers no overall survival benefit or candidemia prevention in non-neutropenic septic ICU patients.
- EAFT may benefit specific subgroups, particularly those with lower severity scores (APACHE II < 16).
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