Erschienen in:
30.06.2022 | Editorial
Is (1,3)-β-d-glucan useless to guide antifungal therapy in ICU?
verfasst von:
Anahita Rouzé, Ángel Estella, Jean-François Timsit
Erschienen in:
Intensive Care Medicine
|
Ausgabe 7/2022
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Excerpt
Over the past decades, the incidence of invasive candidiasis has increased among critically ill patients, without improvement in outcomes [
1]. Risk factors include long duration of stay, invasive devices such as central venous catheter, parenteral nutrition, complicated digestive surgery, and broad-spectrum antibiotic therapy. The European EUCANDICU project reports a crude 30-day mortality of 71% for candidemia and 25% for intra-abdominal candidiasis [
2]. Early initiation of antifungal treatment, together with adequate source control, are among the key levers for decreasing the mortality in patients with septic shock [
3]. But we are still far from performing well enough in this matter. In a French prospective cohort including 835 critically ill patients with proven or suspected invasive candidiasis, antifungal treatment was early and appropriate in 13%, delayed in 35%, and unnecessary in 52% of cases [
4]. Importantly, unnecessary antifungals were maintained for more than 10 days in median because of diagnostic uncertainties. These findings can be explained in several ways. Blood and sterile-site cultures, the current diagnostic gold standards, are limited by poor sensitivity and long delay to positivity [
5]. Prophylactic antifungal therapy, mostly used in surgical settings, is ineffective to reduce mortality among immunocompetent patients, despite decreasing secondary invasive candidiasis rates [
6]. Similarly, empirical antifungal treatment failed to demonstrate a benefit on survival, even in patients with sepsis acquired in intensive care unit (ICU), multiple Candida colonization and multiple organ failure [
7]. …