De-escalation of antifungal treatment in critically ill patients with suspected invasive Candida infection: incidence, associated factors, and safety

• DOI: 10.1186/s13613-018-0392-8
• Publication Date: 2018-04-19T09:17:30Z
• Authors: Karim Jaffal; Julien Poissy; Anahita Rouze; Sébastien Preau; Boualem Sendid; Marjorie Cornu; Saad Nseir
• Keywords: Posaconazole

Antifungal treatment is common in critically ill patients, but only a small proportion of patients receiving antifungals have proven fungal infection. However, antifungal has side effects such as toxicity, emergence resistance, and high cost. Moreover, empirical still matter for debate these patients. Our study aimed to determine the incidence, associated factors, safety de-escalation patients.This retrospective was conducted 30-bed mixed ICU, from January 2012 through 2013. Patients hospitalized > 5 days treated with first suspected or invasive Candida infection were included. Exclusion criteria prophylactic antifungals, aspergillosis, neutropenia. De-escalation defined switch initial systemic (except fluconazole) triazoles, stopping drugs within following their initiation.One hundred ninety empirical, preemptive, targeted 55, 27, 24% respectively. Caspofungin (53%), fluconazole (43%), voriconazole (4%), liposomal amphotericin B (0.5%) more frequently used antifungals. performed 38 (20%) Invasive mechanical ventilation independently lower rates (OR 0.25 [95% CI 0.08-0.85], p = 0.013). Total duration significantly shorter de-escalation, compared those no (med [IQR] 6 (5, 18) vs. 13 (7, 25), 0.023). No significant difference found (22 [5-31] 20 [10-35], 0.43), length ICU stay (25 [14-40) 25 [11-40], 0.99), mortality (45 59%, 0.13), 1-year (55 64%, 0.33) between respectively.De-escalation 20% Mechanical de-escalation. seems be safe