Related Experiment Video

Updated: Jul 12, 2026

A Contemporary Warming/Restraining Device for Efficient Tail Vein Injections in a Murine Fungal Sepsis Model
06:02

A Contemporary Warming/Restraining Device for Efficient Tail Vein Injections in a Murine Fungal Sepsis Model

Published on: November 6, 2020

Antifungal use with and without fungal diagnoses in septic shock across U.S. hospitals, 2022-2024

Robert J Flick1, Li Yan1, Anica C Law2

  • 1Division of Pulmonary and Critical Care Medicine, School of Medicine, Johns Hopkins University, Baltimore, Maryland.

Medrxiv : the Preprint Server for Health Sciences
|July 10, 2026
PubMed

Insights

Fungal septic shock has high mortality. Antifungal treatment is often not aligned with fungal diagnosis, leading to delayed or inappropriate use, impacting patient outcomes.

Area of Science:

  • Critical Care Medicine
  • Infectious Diseases
  • Pharmacology

Background:

  • Septic shock from fungal infections presents significant mortality and diagnostic challenges.
  • Effective management requires timely and accurate diagnosis and appropriate antifungal administration.

Purpose of the Study:

  • To analyze the patterns of antifungal use and fungal diagnoses in adult patients with septic shock requiring vasopressors.
  • To identify the temporal relationship between antifungal initiation and fungal diagnosis in this high-risk population.

Main Methods:

  • Retrospective analysis of the Premier Healthcare Database from October 2022 to July 2024.
  • Inclusion criteria: adults with septic shock requiring vasopressors.
  • Analysis of antifungal therapy initiation relative to vasopressor initiation and fungal diagnosis, including a subgroup with culture-confirmed candidemia.

Main Results:

  • Out of 554,948 septic shock encounters, 2.1% had a fungal diagnosis, with 31.3% receiving same-day antifungals.
  • 5.5% of all septic shock patients received antifungals within one day of vasopressor initiation, but only 12.2% were ultimately diagnosed with fungal infection.
  • In culture-confirmed candidemia cases, only 43.8% received antifungals within one day, highlighting treatment delays.

Conclusions:

  • A significant disconnect exists between antifungal prescribing and confirmed fungal diagnoses in septic shock.
  • Timely and precise administration of antifungals is crucial for improving outcomes in fungal septic shock.
  • Enhanced strategies are needed for accurate empiric antifungal selection in septic shock to improve patient safety and stewardship.
Keywords:
candidemiasepsis

Related Concept Videos

Antifungal Agents01:15

Antifungal Agents

Amphotericin B is a broad-spectrum antifungal agent that exploits structural differences between fungal and mammalian cell membranes. Its amphipathic structure—featuring a hydrophobic polyene-lactone ring and a hydrophilic region containing mycosamine and carboxylic acid groups—enables selective binding to ergosterol, a sterol predominantly found in fungal plasma membranes. This selective interaction underlies the drug’s antifungal activity, although weak binding to cholesterol contributes to...
Cryptococcal Meningitis01:27

Cryptococcal Meningitis

Cryptococcal meningitis is a life-threatening opportunistic infection predominantly associated with HIV/AIDS, accounting for over 100,000 deaths annually worldwide. However, it also affects individuals with other forms of immunosuppression, including those undergoing immunosuppressive therapy, organ transplant recipients, patients with innate immunodeficiencies, and individuals with hematological disorders. The infection is caused mainly by Cryptococcus neoformans and Cryptococcus gattii,...
Impact of Pharmacokinetic–Pharmacodynamic Models: Regulatory Decisions01:15

Impact of Pharmacokinetic–Pharmacodynamic Models: Regulatory Decisions

PK–PD modeling has significantly influenced FDA regulatory decisions, particularly drug approval, dosage optimization, and labeling. These models integrate pharmacokinetics (PK) and pharmacodynamics (PD) to predict drug behavior and effects, aiding in optimizing dosing regimens and enhancing the probability of clinical trial success.One notable example is Nesiritide (Natrecor®), a recombinant human brain natriuretic peptide for treating acute decompensated congestive heart failure (CHF).
Healthcare Associated Infections II: Preventive Measures01:22

Healthcare Associated Infections II: Preventive Measures

Essential infection prevention measures are based on the knowledge of the infection chain, the modes of transmission in healthcare settings, and the use of the best practices in all healthcare settings. Compulsory public reporting of healthcare-associated infection rates is needed to allow individuals and the community to make informed choices regarding selecting a healthcare facility.
The best practices for preventing healthcare-associated infections include hand hygiene, patient risk...
Antimicrobial Effectiveness01:28

Antimicrobial Effectiveness

The effectiveness of antimicrobial agents depends on various factors influencing their ability to eliminate microbial populations. Larger microbial populations require more time for complete eradication, emphasizing the importance of population size analysis when evaluating antimicrobial efficacy.Microbial resistance to antimicrobial agents varies significantly. Highly resilient microorganisms include endospores, gram-negative bacteria, and non-enveloped viruses, while prions are exceptionally...
Factors Affecting the Risk of Infection01:26

Factors Affecting the Risk of Infection

The hosts' susceptibility to infection depends on several factors. The integrity of the skin and mucous membranes helps protect the body against microbial attacks. When the skin is altered, the chance of infection, limb loss, and even death increases.
The integrity and count of the white blood cells help the body resist pathogens and fight infection. When impaired, it reduces the body's resistance to pathogens. The acidic pH levels of the gastrointestinal, genitourinary tracts, and skin create...