Empirical Fluconazole versus Placebo for Intensive Care Unit Patients

Schuster, Mindy G.; Edwards, John E.; Sobel, Jack D.; Darouiche, Rabih O.; Karchmer, Adolf W.; Hadley, Susan; Slotman, Gus J.; Panzer, Helene; Biswas, Pinaki; Rex, John H.

doi:10.7326/0003-4819-149-2-200807150-00004

Cited by 188 publications

(102 citation statements)

References 25 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Biomarker-guided pre-emptive therapy with echinocandins triggered by elevated serum β-1 → 3-d-glucan (BDG) has also been shown to reduce the incidence of proven disease and to target antifungals for patients that would be most likely to benefit from them [15]. While fluconazole has not been shown to be effective for empirical therapy [16], a recent study has shown that empirical therapy with micafungin in highrisk hosts also decreased the incidence of proven disease [17]. 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.…”

Section: Invasive Candidiasismentioning

confidence: 99%

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

et al. 2017

View full text Add to dashboard Cite

Purpose:To describe concisely the current standards of care, major recent advances, common beliefs that have been contradicted by recent trials, areas of uncertainty, and clinical studies that need to be performed over the next decade and their expected outcomes with regard to Candida and Aspergillus infections in non-neutropenic patients in the ICU setting. Methods:A systematic review of the medical literature taking account of national and international guidelines and expert opinion. Results:Severe invasive fungal infections (IFIs) are becoming increasingly frequent in critically ill patients. Approximately 80% of IFIs are due to Candida spp. and 0.3-19% to Aspergillus spp. Recent observations emphasize the necessity of building a worldwide sentinel network to monitor the emergence of new fungal species and changes in susceptibility. Robust data on the attributable mortality are essential for the design of clinical studies with mortality endpoints. Although early antifungal therapy for Candida has been recommended in patients with risk factors, sepsis of unknown cause, and positive Candida serum biomarkers [β-1 → 3-d-glucan (BDG) and Candida albicans germ tube antibody (CAGTA)], its usefulness and influence on outcome need to be confirmed. Future studies may specifically address the optimal diagnostic and therapeutic strategies for patients with abdominal candidiasis. Better knowledge of the pharmacokinetics of antifungal molecules and tissue penetration is a key issue for intensivists. Regarding invasive aspergillosis, further investigation is needed to determine its incidence in the ICU, its relationship with influenza outbreaks, the clinical impact of rapid diagnosis, and the significance of combination treatment. Conclusions:Fundamental questions regarding IFI have to be addressed over the next decade. The clinical studies described in this research agenda should provide a template and set priorities for the clinical investigations that need to be performed.

show abstract

Section: Invasive Candidiasismentioning

confidence: 99%

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

et al. 2017

View full text Add to dashboard Cite

show abstract

“…This strategy, although largely adopted in the setting of patients with hematologic malignancies, did not show consistent efficacy in ICU patients. Schuster et al [15] compared high-dose intravenous fluconazole (800 mg) to placebo in persistently febrile ICU patients not responding to antibacterial therapy. Quite unexpectedly, no difference was documented between the two treatment groups.…”

mentioning

confidence: 99%

Treatment of invasive candidiasis: between guidelines and daily clinical practice

Tagliaferri

Menichetti

2015

Expert Review of Anti-infective Therapy

View full text Add to dashboard Cite

“…Esto lo reporta Schuster y cols 15 , en su artículo de 2008 donde encontraron que el inicio empírico de fl uconazol comparado con placebo no mostró benefi cio en dichos desenlaces (resolución de fi ebre, ausencia de infección fúngica, ausencia de reacciones tóxicas, no cambio a otros antifúngicos sistémicos). Esto apoya nuestra conclusión sobre la necesidad de pruebas diagnósticas tempranas sensibles que nos permitan iniciar dichos tratamientos en quienes realmente se necesiten.…”

Section: Discussionunclassified

Métodos diagnósticos en candidemia: una revisión sistemática de la literatura con meta-análisis

Cortés

et al. 2011

Rev. chil. infectol.

View full text Add to dashboard Cite

Candidemia is a disease with high morbidity and mortality especially in critical care patients. Early diagnosis enables early treatment. Objectives: To conduct a systematic review of the literature in order to establish the best laboratory tests for the diagnosis of candidemia in critical patients. Materials and Methods: We conducted a systematic review of available literature in PubMed. Serological studies were subjected to meta-analysis in metadisk-Beta 1.1.1. Results: 4 studies of 1286 reviewed were included. Three were about serological tests and one about molecular testing (RT-PCR). The sensitivity and specifi city for RT-PCR, antibody testing and antigen and antibody tests were 87% and 100%, 47.5% and 82.6%, 96% and 81%, respectively. Diagnostic Odds Ratio of antigenemia was 1.51 (95% CI = 0,032-70,964, p = 0.001). Conclusions: RT-PCR has better diagnostic performance, measuring antigenemia plus antibodies improves sensitivity, specifi city, LR + and LR-¬. There is insuffi cient evidence to support this.Key words: Fungemia, candidemia, molecular diagnostic techniques, serology, systematic reviews. Palabras clave: Fungemia, candidemia, técnicas de diagnóstico molecular, serología, revisión sistemática. Universidad Nacional deColombia, Bogotá, Colombia. Departamento de MedicinaInterna (JAC, ACM, LECT). Departamento de Epidemiología (JSC).Realizado en la Universidad Introducción L a candidiasis sistémica es una patología con alta morbilidad y mortalidad 1,2 . Ésta se presenta con una alta frecuencia en la población hospitalizada, especialmente aquella sometida a servicios de cuidado crítico 2 . Esto genera no sólo un elevado impacto en los indicadores de morbilidad y mortalidad en los servicios de atención sanitaria, sino un impacto creciente en el costo asociado a esta entidad 1 . Algunos factores como las largas hospitalizaciones en unidades de cuidados intensivos (UCI), la inmunosupresión subyacente en los pacientes (Ej. enfermedades auto-inmunes, quimioterapia, administración de corticoesteroides, malignidad hematológica o tumor sólido, neutropenia y trasplante de órganos), la terapia antimicrobiana, los factores mecánicos que interfi eren las barreras naturales (Ej. quemaduras, uso de catéteres, implante de prótesis, ventilación mecánica), son factores asociados a la emergencia de esta patología 2,3 . En Colombia, datos del grupo para el control de la resistencia bacteriana (GREBO) muestran que entre 2 y 5% de los aislados del torrente sanguíneo en UCI son ocasionadas por especies de Candida 4 . En general, se ha demostrado que Candida albicans es la especie asociada con mayor frecuencia a infecciones sistémicas del torrente sanguíneo, pero que su frecuencia en las UCI ha disminuido en el tiempo 5 . Dado el impacto clínico y la frecuencia de presentación de candidemias, especialmente en pacientes gravemente comprometidos, se hace necesario disponer de herramientas diagnósticas, que permitan una rápida y adecuada determinación de la candidemia y que faciliten la tipifi cación etiológica entre las especies...

show abstract

Empirical Fluconazole versus Placebo for Intensive Care Unit Patients

Abstract: In critically ill adults with risk factors for invasive candidiasis, empirical fluconazole did not clearly improve a composite outcome more than placebo.

Cited by 188 publications

References 25 publications

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

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

Treatment of invasive candidiasis: between guidelines and daily clinical practice

Métodos diagnósticos en candidemia: una revisión sistemática de la literatura con meta-análisis

Contact Info

Product

Resources

About