Discontinuation of empirical antifungal therapy in ICU patients using 1,3-β-d-glucan

Abstract

Early discontinuation of empirical echinocandin therapy in high-risk ICU patients based on consecutive negative BDG tests may be a reasonable strategy, with great potential to reduce the overuse of echinocandins in ICU patients. Prospective studies with a higher number of patients are needed.

T2Candida MR as a predictor of outcome in patients with suspected invasive candidiasis starting empirical antifungal treatment: a prospective pilot study

“…In the last decade, strategies including biomarkers [b-D-glucan (BDG) or Candida albicans germ tube antibodies (CAGTA)], surveillance cultures or predictive scores have been investigated not only for starting [7][8][9] but also for discontinuing empirical antifungals. 10,11 Our own data, and those of Nucci et al…”

Intensive care medicine research agenda on invasive fungal infection in critically ill patients

“…None of these studies have shown a survival benefit as none of them have been powered to do so; however, the standard of care at this time is utilizing a clinical prediction rule such as the Candida score [18] or the MSG-01 rule [15] to identify high-risk hosts and then monitor serum biomarkers such as BDG or PCR for biomarkerbased pre-emptive therapy or the clinical prediction rules themselves as triggers for empirical therapy. A recent study has also shown that the negative predictive value of BDG can be used to stop empirical therapy as part of an antifungal stewardship intervention [19].…”

“…In the challenging scenario of early diagnosis of IC, recent studies have demonstrated the diagnostic value of BDG and CAGTA [19,[38][39][40][41][42]. Although the use of BDG measurement in daily practice for establishing the indication or the withdrawal of ESAT should be defined, recent observational studies [41,42] showed that negativity of the BDG assay may be used as a strategy to discontinue ESAT because of the high sensitivity and negative predictive value of the test.…”

Evaluación del rendimiento de 1,3-β-d-glucano como apoyo diagnóstico de infecciones invasoras por Candida spp. en pacientes críticos adultos

“…De hecho, recientemente Nucci y cols., publicaron una serie en que pacientes críticos en riesgo de EFI por Candida que habían iniciado empíricamente equinocandinas, en caso de obtener hemocultivos y BDG negativos en muestras sucesivas, suspendieron el antifúngico sin deterioro clínico de los pacientes ni evidencias posteriores de candidemia 32 .…”