Purpose To determine whether combinations of antifungal drugs are effective and safe for patients in intensive-care units. Methods This study compared the efficacy and safety of caspofungin (CAS), voriconazole (VOR), amphotericin B liposome (L-AmB), CAS+VOR, and CAS+L-AmB as empirical, preemptive, and targeted therapies for invasive fungal infection (IFI). Results Comparing the CAS, VOR, and CAS+VOR groups revealed that there were no differences in response rates between all therapy types, IFI-associated death within 90 days was less common in the CAS+VOR group (1.8%) than the VOR group (14.3%), and there were more adverse events in the VOR group than in the CAS group ( P < 0.05). For empirical or preemptive therapy, the CAS group had a better response rate (80.0%) than the CAS+VOR group (47.1%), and there were more adverse events in the VOR group than in the CAS group ( P < 0.05). For targeted therapy, no differences were found for efficacy and safety. There were no differences among the CAS, L-AmB, and CAS+L-AmB groups in efficacy and safety. Conclusion Patients who received CAS monotherapy as an empirical or preemptive therapy could achieve good outcomes. Patients who received CAS+VOR or CAS+L-AmB achieved almost the same outcomes when compared with those who received CAS, VOR, and L-AmB monotherapy as targeted therapies, but those who received CAS+VOR had a lower IFI mortality rate than did those who received VOR monotherapy.

Background Dural tear and subsequent cerebrospinal fluid leakage are frequent complications during lumbar spine surgery. This retrospective study aimed to investigate the risk factors and the use of prophylactic antibiotics in patients with fever after drainage removal (FDR) following lumbar dural tear during lumbar spinal surgery. Material/Methods The authors retrospectively analyzed 2812 patients who underwent different spinal surgical procedures from January 2015 to December 2017. The basic information of patients was obtained to analyze the risk factors of dural tear and FDR. The patients were divided into 5 groups according to their antibiotic strategies for FDR (no antibiotics, ceftriaxone, vancomycin, ceftriaxone+vancomycin, other antibiotics). Body temperature, laboratory test results, and pathogen profiles were collected for analysis. Results There were 326 cases diagnosed as dural tear, including 198 cases of FDR. Sex, age, type of disease, and previous lumbar surgery played significant roles in the dural tear rate ( P <0.05). Patients older than 60 years old had a higher incidence of FDR after dural tear ( P <0.05). There was no significant difference in the incidence of surgical site infection among the various treatment groups ( P >0.05). Conclusions Age has obvious effect on dural tear and FDR, whereas sex, revision surgery, primary diagnosis, and procedure type only affect the rate of dural tear. The prophylactic use of antibiotics has no effect on the incidence of surgical site infection when fever after drainage removal occurred in patients with dural tear.

Differences in pharmacokinetics/pharmacodynamics (PK/PD) target attainment are rarely considered when antifungals are switched in critically ill patients. This study intends to explore whether the antifungal de-escalation treatment strategy and the new intermittent dosing strategy of echinocandins in critically ill patients are able to achieve the corresponding PK/PD targets. The published population PK models of antifungals in critically ill patients and a public data set from the MIMIC-III database ( n  = 662) were employed to evaluate PK/PD target attainment of different dosing regimens of antifungals.

Purpose This study aimed to investigate the prevalence of antimicrobial de-escalation (ADE) strategy and assess its effect on 14-day mortality among intensive care unit patients. Methods A single-center retrospective cohort study was conducted on patients admitted to the intensive care unit (ICU) with infectious diseases between January 2018 and December 2020. Patients were stratified into three groups based on the initial treatment regimen within 5 days of antimicrobial administration: ADE, No Change, and Other Change. Confounders between groups were screened using one-way ANOVA and Chi-square analysis. Univariate and multivariate analyses were performed to identify risk factors for 14-day mortality. Potential confounders were balanced using propensity score inverse probability of treatment weighting (IPTW), followed by multivariate logistic regression analysis to evaluate the effect of ADE strategy on 14-day mortality. Results A total of 473 patients met the inclusion criteria, with 53 (11.2%) in the ADE group, 173 (36.6%) in the No Change group, and 247 (52.2%) in the Other Change group. The 14-day mortality rates in the three groups were 9.4%, 11.6%, and 21.9%, respectively. After IPTW, the adjusted odds ratio for 14-day mortality comparing No Change with ADE was 1.557 (95% CI 1.078–2.247, P = 0.0181) while comparing Other Change with ADE was 1.282(95% CI 0.884–1.873, P = 0.1874). Conclusion The prevalence of ADE strategy was low among intensive care unit patients. The ADE strategy demonstrated a protective effect or no adverse effect on 14-day mortality compared to the No Change or Other Change strategies, respectively. These findings provide evidence supporting the implementation of the ADE strategy in ICU patients.

Purpose Whether the clinical pharmacist services (CPS) improve ICU physicians' compliance with venous thromboembolism (VTE) prophylaxis guidelines remains unclear, and its impact on VTE incidence and mortality in ICU patients should also be investigated.Methods ICU patients were assigned to CPS group or control group according to the medical arrangements of the day of patient admission without any intervention. The impact of CPS on guideline compliance, VTE incidence, and mortality was assessed.Results A total of 338 patients were included. With pharmacist intervention, ICU physicians' compliance with VTE prophylaxis guideline was improved by 7%–25% (p < 0.001). The incidences of VTE (9% vs 17%, p = 0.037) and bleeding events (5% vs 11%, p = 0.042) were both lower in the CPS group than in the control group. Multivariate Cox regression model showed that CPS was an independent risk factor for VTE events (HR = 0.438, 95% CI = 0.224–0.857, p = 0.016) and 14-day mortality (HR = 0.416, 95%CI = 0.25–0.692, p = 0.001).Conclusion CPS could significantly improve ICU physician compliance with VTE prophylaxis guidelines and reduce the incidence of VTE events and mortality in ICU patients. Clinical pharmacists should be involved in the daily management of ICU patients as an important member.