A practice-based observational study on the use of micafungin in Surgical Critical Care Units
| Autor: | Emilio, Maseda, Carlos A, García-Bernedo, Isabel, Frías, José-Alejandro, Navarro, Jesús, Rico, Reyes, Iranzo, Juan-José, Granizo, María-José, Villagrán, Enric, Samsó, Fernando, Gilsanz, M L, Giménez |
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| Rok vydání: | 2015 |
| Předmět: |
Adult
Male Cross Infection Critical Care Multiple Organ Failure Length of Stay Middle Aged Severity of Illness Index Shock Septic Echinocandins Intensive Care Units Lipopeptides Postoperative Complications Treatment Outcome Mycoses Spain Micafungin Humans Candidiasis Invasive Female Hospital Mortality Fungemia Diagnosis-Related Groups Aged Retrospective Studies |
| Zdroj: | Revista espanola de quimioterapia : publicacion oficial de la Sociedad Espanola de Quimioterapia. 28(3) |
| ISSN: | 1988-9518 |
| Popis: | Echinocandins are first-line therapy in critically ill patients with invasive Candida infection (ICI). This study describes our experience with micafungin at Surgical Critical Care Units (SCCUs).A multicenter, observational, retrospective study was performed (12 SCCUs) by reviewing all adult patients receiving 100 mg/24h micafungin for ≥72h during ad-mission (April 2011-July 2013). Patients were divided by ICI category (possible, probable + proven), 24h-SOFA (7, ≥7) and outcome.72 patients were included (29 possible, 13 probable, 30 proven ICI). Forty patients (55.6%) presented SOFA ≥7. Up to 78.0% patients were admitted after urgent surgery (64.3% with SOFA7 vs. 90.3% with SOFA ≥7, p=0.016), and 84.7% presented septic shock. In 66.7% the site of infection was intraabdominal. Forty-nine isolates were recovered (51.0% C. albicans). Treatment was empirical (59.7%), microbiologically directed (19.4%), rescue therapy (15.3%), or anticipated therapy and prophylaxis (2.8% each). Empirical treatment was more frequent (p0.001) in possible versus probable + proven ICI (86.2% vs. 41.9%). Treatment (median) was longer (p=0.002) in probable + proven versus possible ICI (13.0 vs. 8.0 days). Favorable response was 86.1%, without differences by group. Age, blood Candida isolation, rescue therapy, final MELD value and %MELD variation were significantly higher in patients with non-favorable response. In the multivariate analysis (R2=0.246, p0.001) non-favorable response was associated with positive %MELD variations (OR=15.445, 95%CI= 2.529-94.308, p=0.003) and blood Candida isolation (OR=11.409, 95%CI=1.843-70.634, p=0.009).High favorable response was obtained, with blood Candida isolation associated with non-favorable response, in this series with high percentage of patients with intraabdominal ICI, septic shock and microbiological criteria for ICI. |
| Databáze: | OpenAIRE |
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