Impact of echinocandin on prognosis of proven invasive candidiasis in ICU: a post-hoc causal inference model using the AMARCAND2 study

Autor: Olivier Lortholary, Demory, Gouin, Tellier, Saliba, Cabaret, Karoubi, Diconne, Houissa, Carpentier, Hraiech, Mateu, Bretonnière, Cousson, Zogheib, Cinotti, Montcriol, Gally, Gette, Quinart, Lamhaut, Bonadona, Argaud, Jean-Pierre Gangneux, Angel, Thevenot, Ruiz, Van Grunderbeek, Chabanne, Ammenouche, Merle, Kherchache, Mira, Constantin, Guelon, Schmitt, Lepape, Brocas, Luyt, Elie Azoulay, Jung, Megarbane, Dubost, Grossmith, Gaudard, Hssain Aait, Kaidomar, Mootien, Perrigault, Badetti, Lemaire, Brua, Roquilly, Sejourne, Blasco, Allaouchiche, Bruder, Quintard, Seguin, Brunin, Lesieur, Wiramus, Lambiotte, Mahul, Vincent, Cerf, Delpierre, Tonnelier, Didier Guillemot, Bastien, Cheval, Dumenil, Mahe, Jean-Paul Mira, Plantefeve, Geffe, Guerin-Robardey, Navellou, Bollaert, Charles, Hervé Dupont, Lepoivre, Durand, D. du Cheyron, Forel, Jean-François Timsit, Gergaud, Lebreton, Baudin, Pierre-François Perrigault, Launoy, Hayl-Slayman, Baldesi, Foucher-Lezla, Ichai, Jean-Michel Constantin, Olivier Leroy, Girault, Goubaux, Sébastien Bailly, Barthet, Bellec, Duroy, Lefrant, Petitpas, Hilbert, Leroy, Guervilly, Samba, Adda, Philippe Montravers, Ragonnet, Fratea, Cohen, Ouattara, Grenot, Cartier
Přispěvatelé: Infection, Anti-microbiens, Modélisation, Evolution (IAME (UMR_S_1137 / U1137)), Université Paris 13 (UP13)-Université Paris Diderot - Paris 7 (UPD7)-Université Sorbonne Paris Cité (USPC)-Institut National de la Santé et de la Recherche Médicale (INSERM), Hôpital Chatiliez, Medical ICU, Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Groupe Hospitalier Saint Louis - Lariboisière - Fernand Widal [Paris], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Service d'anesthésie - réanimation chirurgicale, Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-AP-HP - Hôpital Bichat - Claude Bernard [Paris], Service d'Anésthésie Réanimation [CHU Clermont-Ferrand], CHU Estaing [Clermont-Ferrand], CHU Clermont-Ferrand-CHU Clermont-Ferrand, CHU Amiens-Picardie, Biostatistique, Biomathématique, Pharmacoépidémiologie et Maladies Infectieuses (B2PHI), Université de Versailles Saint-Quentin-en-Yvelines (UVSQ)-Institut Pasteur [Paris]-Institut National de la Santé et de la Recherche Médicale (INSERM), Centre d'infectiologie Necker-Pasteur [CHU Necker], Institut Pasteur [Paris]-CHU Necker - Enfants Malades [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Centre National de Référence des Mycoses invasives et antifongiques - Mycologie moléculaire (CNRMA), Institut Pasteur [Paris]-Centre National de la Recherche Scientifique (CNRS), Service de médecine d'urgence [CHU Cochin], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpital Cochin [AP-HP], CHU Montpellier, Centre Hospitalier Régional Universitaire [Montpellier] (CHRU Montpellier), CHU Pontchaillou [Rennes], Hôpital Bichat - Claude Bernard, This work was supported by a grant from MSD France. The analysis was conducted independently by the AmarCAND2 Scientific Committee., Infection, Antimicrobiens, Modélisation, Evolution ( IAME ), Université Paris Diderot - Paris 7 ( UPD7 ) -Université Paris 13 ( UP13 ) -Université Sorbonne Paris Cité ( USPC ) -Institut National de la Santé et de la Recherche Médicale ( INSERM ), Assistance publique - Hôpitaux de Paris (AP-HP)-Groupe Hospitalier Saint Louis - Lariboisière - Fernand Widal [Paris], Assistance publique - Hôpitaux de Paris (AP-HP)-AP-HP - Hôpital Bichat - Claude Bernard [Paris], Département anesthésie et réanimation, CHU Clermont-Ferrand-Hôpital d'Estaing, Centre hospitalier universitaire d'Amiens ( CHU Amiens-Picardie ), Biostatistique, Biomathématique, Pharmacoépidémiologie et Maladies Infectieuses ( B2PHI ), Université de Versailles Saint-Quentin-en-Yvelines ( UVSQ ) -Institut Pasteur [Paris]-Institut National de la Santé et de la Recherche Médicale ( INSERM ), Assistance publique - Hôpitaux de Paris (AP-HP)-CHU Necker - Enfants Malades [AP-HP], Centre National de Référence des Mycoses invasives et antifongiques - Mycologie moléculaire ( CNRMA ), Institut Pasteur [Paris]-Centre National de la Recherche Scientifique ( CNRS ), Assistance publique - Hôpitaux de Paris (AP-HP)-CHU Cochin [AP-HP], Centre Hospitalier Régional Universitaire [Montpellier] ( CHRU Montpellier ), Université de Versailles Saint-Quentin-en-Yvelines (UVSQ)-Institut Pasteur [Paris] (IP)-Institut National de la Santé et de la Recherche Médicale (INSERM), Institut Pasteur [Paris] (IP)-CHU Necker - Enfants Malades [AP-HP], Institut Pasteur [Paris] (IP)-Centre National de la Recherche Scientifique (CNRS), Institut National de la Santé et de la Recherche Médicale (INSERM)-Université Paris 13 (UP13)-Université Paris Diderot - Paris 7 (UPD7)-Université Sorbonne Paris Cité (USPC), CHU Necker - Enfants Malades [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Institut Pasteur [Paris], Jonchère, Laurent
Jazyk: angličtina
Rok vydání: 2017
Předmět:
0301 basic medicine
Microbiology (medical)
Azoles
Male
medicine.medical_specialty
Antifungal Agents
Echinocandin
030106 microbiology
03 medical and health sciences
Echinocandins
0302 clinical medicine
[SDV.MHEP.MI]Life Sciences [q-bio]/Human health and pathology/Infectious diseases
Internal medicine
medicine
polycyclic compounds
Humans
Candidiasis
Invasive
030212 general & internal medicine
Prospective Studies
Aged
Candida
Septic shock
business.industry
Confounding
Candidiasis
[ SDV.SP.PHARMA ] Life Sciences [q-bio]/Pharmaceutical sciences/Pharmacology
Invasive candidiasis
Middle Aged
medicine.disease
Prognosis
bacterial infections and mycoses
3. Good health
Surgery
Intensive Care Units
[ SDV.MHEP.MI ] Life Sciences [q-bio]/Human health and pathology/Infectious diseases
Infectious Diseases
Causal inference
[SDV.SP.PHARMA] Life Sciences [q-bio]/Pharmaceutical sciences/Pharmacology
Cohort
[SDV.MHEP.MI] Life Sciences [q-bio]/Human health and pathology/Infectious diseases
[SDV.SP.PHARMA]Life Sciences [q-bio]/Pharmaceutical sciences/Pharmacology
Female
business
Fluconazole
medicine.drug
Zdroj: Journal of Infection
Journal of Infection, WB Saunders, 2017, 74 (4), pp.408-417. ⟨10.1016/j.jinf.2016.12.016⟩
Journal of Infection, WB Saunders, 2017, 74 (4), pp.408-417. 〈10.1016/j.jinf.2016.12.016〉
Journal of Infection, 2017, 74 (4), pp.408-417. ⟨10.1016/j.jinf.2016.12.016⟩
ISSN: 0163-4453
Popis: International audience; Objective: guidelines recommend first-line systemic antifungal therapy (SAT) with echinocandins in invasive candidiasis (IC), especially in critically ill patients. This study aimed at assessing the impact of echinocandins compared to azoles as initial SAT on the 28-day prognosis in adult ICU patients.Methods: From the prospective multicenter AmarCAND2 cohort (835 patients), we selected those with documented IC and treated with echinocandins (ECH) or azoles (AZO). The average causal effect of echinocandins on 28-day mortality was assessed using an inverse probability of treatment weight (IPTW) estimator.Results: 397 patients were selected, treated with echinocandins (242 patients, 61%) or azoles (155 patients, 39%); septic shock: 179 patients (45%). The median SAPSII was higher in the ECH group (48 [35; 62] vs. 43 [31; 58], p = 0.01). Crude mortality was 34% (ECH group) vs. 25% (AZO group). After adjustment on baseline confounders, no significant association emerged between initial SAT with echinocandins and 28-day mortality (HR: 0.95; 95% CI: [0.60; 1.49]; p = 0.82). However, echinocandin tended to benefit patients with septic shock (HR: 0.46 [0.19; 1.07]; p = 0.07).Conclusion: Patients who received echinocandins were more severely ill. Echinocandin use was associated with a non-significant 7% decrease of 28-day mortality and a trend to a beneficial effect for patient with septic shock.
Databáze: OpenAIRE
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