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- Title
Antifungal de-escalation was not associated with adverse outcome in critically ill patients treated for invasive candidiasis: post hoc analyses of the AmarCAND2 study data.
- Authors
Bailly, Sébastien; Leroy, Olivier; Montravers, Philippe; Constantin, Jean-Michel; Dupont, Hervé; Guillemot, Didier; Lortholary, Olivier; Mira, Jean-Paul; Perrigault, Pierre-François; Gangneux, Jean-Pierre; Azoulay, Elie; Timsit, Jean-François
- Abstract
<bold>Purpose: </bold>Systemic antifungal therapy (SAT) of invasive candidiasis needs to be initiated immediately upon clinical suspicion. Controversies exist about adequate time and potential harm of antifungal de-escalation (DE) in documented and suspected candidiasis in ICU patients. Our objective was to investigate whether de-escalation within 5 days of antifungal initiation is associated with an increase of the 28-day mortality in SAT-treated non-neutropenic adult ICU patients.<bold>Methods: </bold>From the 835 non-neutropenic adults recruited in the multicenter prospective observational AmarCAND2 study, we selected the patients receiving systemic antifungal therapy for a documented or suspected invasive candidiasis in the ICU and who were still alive 5 days after SAT initiation. They were included into two groups according to the occurrence of observed SAT de-escalation before day 6. The average causal SAT de-escalation effect on 28-day mortality was evaluated by using a double robust estimation.<bold>Results: </bold>Among the 647 included patients, early de-escalation at day 5 after antifungal initiation occurred in 142 patients (22%), including 48 (34%) patients whose SAT was stopped before day 6. After adjustment for the baseline confounders, early SAT de-escalation was the solely factor not associated with increased 28-day mortality (RR 1.12, 95% CI 0.76-1.66).<bold>Conclusion: </bold>In non-neutropenic critically ill adult patients with documented or suspected invasive candidiasis, SAT de-escalation within 5 days was not related to increased day-28 mortality but it was associated with decreased SAT consumption. These results suggest for the first time that SAT de-escalation may be safe in these patients.
- Subjects
FRANCE; ANTIFUNGAL agents; CATASTROPHIC illness; INTENSIVE care units; LONGITUDINAL method; MEDICAL care; EVALUATION of medical care; MEDICAL cooperation; SCIENTIFIC observation; PATIENTS; PEPTIDES; RESEARCH; SURVIVAL analysis (Biometry); COMORBIDITY; LOGISTIC regression analysis; SEVERITY of illness index; DISEASE progression; HOSPITAL mortality; FLUCONAZOLE; INVASIVE candidiasis; PREVENTION; DIAGNOSIS; THERAPEUTICS
- Publication
Intensive Care Medicine, 2015, Vol 41, Issue 11, p1931
- ISSN
0342-4642
- Publication type
journal article
- DOI
10.1007/s00134-015-4053-1