Failure of empirical systemic antifungal therapy in mechanically ventilated critically ill patients

American Journal of Respiratory and Critical Care Medicine
Sébastien BaillyJean-François Timsit

Abstract

Systemic antifungal treatments are empirically administered to the sickest critically ill patients, often without documented invasive fungal infection. To estimate the impact of systemic antifungal treatment on 30-day survival of patients suspected to have invasive candidiasis. All nonneutropenic, nontransplant recipients managed in five intensive care units intubated for at least 5 days, and free of invasive candidiasis, were included. To account for differences in patients' characteristics recorded daily before study end point, a causal model for longitudinal data was used to assess benefits from antifungal treatment. The composite primary end point was hospital mortality or occurrence of invasive candidiasis. Among 1,491 patients, 100 (6.7%) received antifungal treatment for a suspected infection. Patients treated with antifungals were more severely ill than untreated patients. Within the 30-day follow-up period, 363 (24.3%) patients died, and 22 (1.5%) exhibited documented invasive candidiasis. After adjustment on baseline and time-dependent confounders (underlying illness, severity, invasive procedures, Candida colonization), and using a marginal structural model for longitudinal data, treatment was not associated with a d...Continue Reading

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