Antifungal therapy for patients with proven or suspected Candida peritonitis: Amarcand2, a prospective cohort study in French intensive care units

Abstract

In summary, only 56.6% of ICU patients receiving SAT had CP. Most strains were susceptible to SAT. A similar 28-day mortality rate was observed among groups; the late administration of SAT significantly worsened the prognosis of patients with less severe CP.

Cost Effectiveness of Candida Polymerase Chain Reaction Detection and Empirical Antifungal Treatment among Patients with Suspected Fungal Peritonitis in the Intensive Care Unit

“…The prevalence of peritoneal candidiasis in the target population (patients with empirical antifungal treatment) was taken from a published study based on this pathology [11]. The proportions of different Candida and fluconazole-resistant species were obtained from a subgroup of patients with peritonitis from the AmarCand study [9].…”

“…Mortality related to candidiasis in the literature varies from 5% to 71%, depending on the population and study design [35]. The data for mortalities of patients with and without peritoneal candidiasis used in our model were taken from a study on Candida peritonitis (subgroup from the AmarCand2 study) [11].…”

“…We considered the effectiveness of antifungal therapy on a sensitive Candida strain to be similar between caspofungin and micafungin [37] and between the echinocandins and fluconazole [38]. In our model, the effectiveness of early antifungal therapy was defined by a reduction in mortality, which was estimated for patients with peritoneal candidiasis using data from the Amar-Cand2 study [11]. The probability of mortality of early treated patients was the probability of mortality of patients who were treated for peritoneal candidiasis multiplied by the decrease in mortality in case of early treatment.…”

“…Over several decades, invasive candidiasis in intensive care units (ICUs) has become a significant cause of morbidity and mortality [1][2][3], including for non-neutropenic patients [4][5][6]. This observation particularly concerns Candida peritonitis [7][8][9][10][11]. When invasive candidiasis is suspected, a delay in initiating antifungal therapy and inappropriate treatments are associated with increased mortality [12][13][14][15], increased hospital stay, and extra supportive costs [16].…”

What is the role of empirical treatment for suspected invasive candidiasis in non-neutropenic non transplanted patients in the intensive care unit?—Empiricus strikes back!

“…Nevertheless, several questions may warrant further investigations. (I) Gastrointestinal surgical patients and/or those admitted for necrotizing pancreatitis may constitute a higher risk group that was under-represented in that study (17,18); (II) the study excluded immuno-compromised patients including solid organ transplant or hematopoietic stem cell recipients, which is logical regarding the specificities of fungal infections among that population (19). These immuno-compromised patients are frequently hospitalized in the ICU and represent a challenge for both diagnosis and treatment of fungal infections (20)(21)(22); (III) the lack of use of selective digestive decontamination in the French ICUs may have been balanced with prior exposure to broad spectrum antibiotic therapy.…”