Abstract
Echinocandins are recommended as a first-line empiric treatment for fungal infections of patients in an intensive care unit (ICU) with critical illness. The primary aim of the study was to compare outcomes among ICU patients treated with empiric anidulafungin (ANI), caspofungin (CASPO), or micafungin (MICA). A retrospective cohort study in a mixed adult ICU. Patient demographics, reason for ICU admission, ICU risk scores and organ support therapies were analyzed. Outcome parameters included ICU and hospital stay, 30-day mortality and 1-year mortality. Empiric echinocandin therapy was given to 367 patients (ANI; 73 patients, CASPO; 84 patients, and MICA; 210 patients) with a median duration of 3days in an ICU. Patient median age was 60.7years. As a first-line therapy, 52% of patients received fluconazole. Positive Candida cultures were found in the following samples: blood, 16 (4.4%); central line, 27 (7.4%); deep site, 92 (25.1%). Median ICU stay (ANI 6.4days, CASPO 5.3days, MICA 8.1days), hospital stay (ANI 33days, CASPO 30days, MICA 30days), 30-day mortality (ANI 27%, CASPO 32%, MICA 32%), and 1-year mortality (ANI 33%, CASPO 44%, MICA 45%) did not differ between the groups . The cost of antifungal therapy during the ICU period was similar in the three echinocandin groups (ANI; €1 872, CASPO; €1 799, and MICA; €1783). Our results show that ICU, hospital stay, and mortality (hospital, 30-day and 1-year) did not differ among patients with empiric anidulafungin, caspofungin, or micafungin treatment in a mixed adult ICU.
Highlights
Fungal infections are an increasing problem in intensive care, and contribute significantly to morbidity and mortality as well as costs.14 Prophylaxis with fluconazole in high-risk, critically ill patients has reduced the incidence of invasive fungal infections and mortality.[5]Blood culture is the "gold standard" for the diagnosis of invasive candidiasis (IC)
The primary aim of this retrospective study was to compare outcomes among intensive care unit (ICU) patients treated with empiric anidulafungin (ANI), caspofungin (CASPO), or micafungin (MICA) in an adult mixed ICU
There were no differences between the groups regarding the standardized mortality ratio (SMR) calculated according to the APACHE simplified acute physiology score (II) score (ANI 0.645 [95%CI 0.209-1.505]; CASPO 0.855 [95% 0.344- 1.762]; MICA 1.034 [95%CI 0.622-1.538]) or SAPS II score (ANI 0.675 [95%CI 0.219-1.575]; CASPO 0.837 [95%CI 0.337-1.725]; and MICA 0.986 [95% CI 0.631-1.466]) in cases with culture-proven Candida infections
Summary
Fungal infections are an increasing problem in intensive care, and contribute significantly to morbidity and mortality as well as costs.14 Prophylaxis with fluconazole in high-risk, critically ill patients has reduced the incidence of invasive fungal infections and mortality.[5]. Echinocandins (caspofungin, micafungin, and anidulafungin) are recommended for first-line empiric treatment for critically ill patients in the ICU.[10] They have less severe side effects than amphotericin B, the gold standard of antifungal agents.11-13 The echinocandins are semisynthetic lipopeptides which inhibit the synthesis of the 1,3-beta-D -glucan component of the fungal cell wall.[14] They have rather similar pharmacological and efficacy profiles, as well as few drug-drug interactions.[15]. Anidulafungin has been shown to be non-inferior to fluconazole in the treatment of invasive candidiasis.[16] Recent studies have not shown the superiority of caspofungin or micafungin over fluconazole prophylaxis for high- risk patients in the ICU.17-20. The primary aim of this retrospective study was to compare outcomes among ICU patients treated with empiric anidulafungin (ANI), caspofungin (CASPO), or micafungin (MICA) in an adult mixed ICU
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