Comparison between micafungin and caspofungin for the empirical treatment of severe intra-abdominal infections in surgical intensive care patients

Abstract

To compare the efficacy and safety of micafungin with caspofungin for the empirical treatment of severe intra-abdominal infections in surgical intensive care patients. This was a retrospective cohort study.From May 1 st 2012 to April 30 2015, 47 patients with severe intra-abdominal infection complicated with specific risk of Intra-abdominal invasive candidiasis (IAC) receiving empirical treatment of echinocandins were enrolled in Department of Critical Care Medicine, Peking University First Hospital. Micafungin and caspofungin substituted each other every six months. The baseline information, risk factors of IAC, characteristics of intra-abdominal infections, antifungal treatment and other intra-abdominal infections(IAI) related treatment information, clinical outcome were collected and compared between the micafungin and caspofungin groups. Forty-seven patients met inclusion/exclusion criteria. The average score of APACHE Ⅱ was (19.0±7.7), the incidence of IAC was 23.4%. The patients were divided into the micafungin group (n=26) and the caspofungin group (n=21). The average therapeutic course was 10 (5, 13) days.There were no significant differences in the baseline information, risk factors of IAC, characteristics of intra-abdominal infections and other IAI related treatment informations between the two groups. SOFA score, body temperature, persistence of extra-gastrointestinal fungal colonization significantly improved from the baseline in both groups. The leukocyte count decrease was different between the micafungin group and the caspofungin group respectively[(12.5±5.4)10(9)/L vs (9.8±4.3) 10(9)/L, P=0.013; (12.9±5.4) 10(9)/L vs (10.4±4.7) 10(9)/L, P=0.134]. There were no significantly differences in the recovery of GI function, the incidence of breakthrough IC, the incidence of newly developed organ failure, the 30-day mortality, the length of ICU stay and hospitalization period or the incidence of alternative antifungal therapy between the micafungin group and the caspofungin group. No drug-related adverse event requiring echinocandins discontinuation occurred. The empirical treatment of echinocandins for patients with severe intra-abdominal infection and specific risk factors of IAC may be effective. The empirical treatment of micafungin and caspofungin were equally effective and safe.