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Use and outcome of empiric echinocandins in critically ill patients
Author(s) -
Ylipalosaari Pekka,
AlaKokko Tero I.,
Koskenkari Juha,
Laurila Jouko J.,
Ämmälä Sirpa,
Syrjälä Hannu
Publication year - 2021
Publication title -
acta anaesthesiologica scandinavica
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.738
H-Index - 107
eISSN - 1399-6576
pISSN - 0001-5172
DOI - 10.1111/aas.13783
Subject(s) - medicine , anidulafungin , micafungin , echinocandin , intensive care unit , caspofungin , renal replacement therapy , intensive care medicine , fluconazole , antifungal , dermatology
Background 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). Methods 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. Results Empiric echinocandin therapy was given to 367 patients (ANI; 73 patients, CASPO; 84 patients, and MICA; 210 patients) with a median duration of 3 days in an ICU. Patient median age was 60.7 years. 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 6.4 days, CASPO 5.3 days, MICA 8.1 days), hospital stay (ANI 33 days, CASPO 30 days, MICA 30 days), 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). Conclusion 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.