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Tang Y, Hu W, Jiang S, Xie M, Zhu W, Zhang L, Sha J, Wang T, Ding M, Zeng J, Jiang J. Effect of empirical antifungal treatment on mortality in non-neutropenic critically ill patients: a propensity-matched retrospective cohort study. Eur J Clin Microbiol Infect Dis 2022; 41:1421-1432. [PMID: 36255537 DOI: 10.1007/s10096-022-04507-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Accepted: 10/06/2022] [Indexed: 11/03/2022]
Abstract
To evaluate the effect of empirical antifungal treatment (EAFT) on mortality in critically ill patients without invasive fungal infections (IFIs). This was a single-center propensity score-matched retrospective cohort study involving non-transplanted, non-neutropenic critically ill patients with risk factors for invasive candidiasis (IC) in the absence of IFIs. We compared all-cause hospital mortality and infection-attributable hospital mortality in patients who was given EAFT for suspected IC as the cohort group and those without any systemic antifungal agents as the control group. Among 640 eligible patients, 177 patients given EAFT and 177 control patients were included in the analyses. As compared with controls, EAFT was not associated with the lower risks of all-cause hospital mortality [odds ratio (OR), 0.911; 95% CI, 0.541-1.531; P = 0.724] or infection-attributable hospital mortality (OR, 1.149; 95% CI, 0.632-2.092; P = 0.648). EAFT showed no benefit of improvement of infection at discharge, duration of mechanical ventilation, and antibiotic-free days. However, the later initiation of EAFT was associated with higher risks of all-cause hospital mortality (OR, 1.039; 95% CI, 1.003 to 1.076; P = 0.034) and infection-attributable hospital mortality (OR, 1.046; 95% CI, 1.009 to 1.085; P = 0.015) in patients with suspected IC. This effect was also found in infection-attributable hospital mortality (OR, 1.042; 95% CI, 1.005 to 1.081; P = 0.027) in septic patients with suspected IC. EAFT failed to decrease hospital mortality in non-neutropenic critically ill patients without IFIs. The timing may be critical for EAFT to improve mortality in these patients with suspected IC. ChiCTR2000038811, registered on Oct 3, 2020.
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Affiliation(s)
- Yue Tang
- Department of Critical Care Medicine, Shandong Provincial Hospital Affiliated to Shandong First Medical University, No. 324 Jingwu Road, Jinan, 250021, Shandong, People's Republic of China
| | - Wenjing Hu
- Department of Endocrinology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, No. 324 Jingwu Road, Jinan, 250021, Shandong, People's Republic of China
| | - Shuangyan Jiang
- Department of Critical Care Medicine, Shandong Provincial Hospital Affiliated to Shandong First Medical University, No. 324 Jingwu Road, Jinan, 250021, Shandong, People's Republic of China
| | - Maoyu Xie
- Department of Emergency, Shandong Provincial Hospital Affiliated to Shandong First Medical University, No. 324 Jingwu Road, Jinan, 250021, Shandong, People's Republic of China
| | - Wenying Zhu
- Department of Critical Care Medicine, Shandong Provincial Hospital Affiliated to Shandong First Medical University, No. 324 Jingwu Road, Jinan, 250021, Shandong, People's Republic of China
| | - Lin Zhang
- Department of Critical Care Medicine, Shandong Provincial Hospital Affiliated to Shandong First Medical University, No. 324 Jingwu Road, Jinan, 250021, Shandong, People's Republic of China
| | - Jing Sha
- Department of Critical Care Medicine, Shandong Provincial Hospital Affiliated to Shandong First Medical University, No. 324 Jingwu Road, Jinan, 250021, Shandong, People's Republic of China
| | - Tengfei Wang
- Department of Critical Care Medicine, Shandong Provincial Hospital Affiliated to Shandong First Medical University, No. 324 Jingwu Road, Jinan, 250021, Shandong, People's Republic of China
| | - Min Ding
- Department of Critical Care Medicine, Shandong Provincial Hospital Affiliated to Shandong First Medical University, No. 324 Jingwu Road, Jinan, 250021, Shandong, People's Republic of China
| | - Juan Zeng
- Department of Critical Care Medicine, Shandong Provincial Hospital Affiliated to Shandong First Medical University, No. 324 Jingwu Road, Jinan, 250021, Shandong, People's Republic of China.
| | - Jinjiao Jiang
- Department of Critical Care Medicine, Shandong Provincial Hospital Affiliated to Shandong First Medical University, No. 324 Jingwu Road, Jinan, 250021, Shandong, People's Republic of China.
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Cortegiani A, Russotto V, Raineri SM, Gregoretti C, De Rosa FG, Giarratano A. Untargeted Antifungal Treatment Strategies for Invasive Candidiasis in Non-neutropenic Critically Ill Patients: Current Evidence and Insights. CURRENT FUNGAL INFECTION REPORTS 2017. [DOI: 10.1007/s12281-017-0288-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Cortegiani A, Russotto V, Raineri SM, Gregoretti C, Giarratano A. Should we Administer Antifungal Drugs Before the Diagnosis of Invasive Fungal Infection in Non-Neutropenic Critically Ill Patients? Turk J Anaesthesiol Reanim 2017; 44:276-278. [PMID: 28058135 DOI: 10.5152/tjar.2016.0010] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Affiliation(s)
- Andrea Cortegiani
- Department of Biopathology and Medical Biotechnologies (DIBIMED). Section of Anesthesia, Analgesia, Intensive Care and Emergency. Policlinico P. Giaccone. University of Palermo, Italy
| | - Vincenzo Russotto
- Department of Biopathology and Medical Biotechnologies (DIBIMED). Section of Anesthesia, Analgesia, Intensive Care and Emergency. Policlinico P. Giaccone. University of Palermo, Italy
| | - Santi Maurizio Raineri
- Department of Biopathology and Medical Biotechnologies (DIBIMED). Section of Anesthesia, Analgesia, Intensive Care and Emergency. Policlinico P. Giaccone. University of Palermo, Italy
| | - Cesare Gregoretti
- Department of Biopathology and Medical Biotechnologies (DIBIMED). Section of Anesthesia, Analgesia, Intensive Care and Emergency. Policlinico P. Giaccone. University of Palermo, Italy
| | - Antonino Giarratano
- Department of Biopathology and Medical Biotechnologies (DIBIMED). Section of Anesthesia, Analgesia, Intensive Care and Emergency. Policlinico P. Giaccone. University of Palermo, Italy
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Cortegiani A, Russotto V, Raineri SM, Gregoretti C, Giarratano A. Uncertainty about the evidence on untargeted antifungal treatment. Eur J Intern Med 2017; 37:e18-e19. [PMID: 27595418 DOI: 10.1016/j.ejim.2016.08.029] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2016] [Accepted: 08/24/2016] [Indexed: 01/05/2023]
Affiliation(s)
- Andrea Cortegiani
- Department of Biopathology and Medical Biotechnologies (DIBIMED), Section of Anesthesia Analgesia Intensive Care and Emergency, Policlinico P. Giaccone, University of Palermo, Italy.
| | - Vincenzo Russotto
- Department of Biopathology and Medical Biotechnologies (DIBIMED), Section of Anesthesia Analgesia Intensive Care and Emergency, Policlinico P. Giaccone, University of Palermo, Italy
| | - Santi Maurizio Raineri
- Department of Biopathology and Medical Biotechnologies (DIBIMED), Section of Anesthesia Analgesia Intensive Care and Emergency, Policlinico P. Giaccone, University of Palermo, Italy
| | - Cesare Gregoretti
- Department of Biopathology and Medical Biotechnologies (DIBIMED), Section of Anesthesia Analgesia Intensive Care and Emergency, Policlinico P. Giaccone, University of Palermo, Italy
| | - Antonino Giarratano
- Department of Biopathology and Medical Biotechnologies (DIBIMED), Section of Anesthesia Analgesia Intensive Care and Emergency, Policlinico P. Giaccone, University of Palermo, Italy
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Cortegiani A, Russotto V, Raineri SM, Gregoretti C, Giarratano A. Dying with or Because of Invasive Fungal Infection? The Role of Immunity Exhaustion on Patient Outcome. Turk J Anaesthesiol Reanim 2016; 44:285-286. [PMID: 28058138 DOI: 10.5152/tjar.2016.0013] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Affiliation(s)
- Andrea Cortegiani
- Department of Biopathology and Medical Biotechnologies (DIBIMED), Section of Anesthesia, Analgesia, Intensive Care and Emergency, Policlinico P. Giaccone, University of Palermo, Italy
| | - Vincenzo Russotto
- Department of Biopathology and Medical Biotechnologies (DIBIMED), Section of Anesthesia, Analgesia, Intensive Care and Emergency, Policlinico P. Giaccone, University of Palermo, Italy
| | - Santi Maurizio Raineri
- Department of Biopathology and Medical Biotechnologies (DIBIMED), Section of Anesthesia, Analgesia, Intensive Care and Emergency, Policlinico P. Giaccone, University of Palermo, Italy
| | - Cesare Gregoretti
- Department of Biopathology and Medical Biotechnologies (DIBIMED), Section of Anesthesia, Analgesia, Intensive Care and Emergency, Policlinico P. Giaccone, University of Palermo, Italy
| | - Antonino Giarratano
- Department of Biopathology and Medical Biotechnologies (DIBIMED), Section of Anesthesia, Analgesia, Intensive Care and Emergency, Policlinico P. Giaccone, University of Palermo, Italy
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Russotto V, Cortegiani A, Raineri SM, Gregoretti C, Giarratano A. Antifungal Stewardship in Light of the Updated Evidence on Untargeted Antifungal Treatment in Critically Ill Patients. CURRENT CLINICAL MICROBIOLOGY REPORTS 2016. [DOI: 10.1007/s40588-016-0050-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Cortegiani A, Russotto V, Raineri SM, Gregoretti G, Giarratano A. Should we continue to use prediction tools to identify patients at risk of Candida spp. infection? If yes, why? Crit Care 2016; 20:351. [PMID: 27794360 PMCID: PMC5086411 DOI: 10.1186/s13054-016-1521-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Affiliation(s)
- A Cortegiani
- Department of Biopathology and Medical Biotechnologies (DIBIMED), Section of Anesthesia, Analgesia, Intensive Care and Emergency. Policlinico P. Giaccone, University of Palermo, Via del Vespro 129, 90127, Palermo, Italy.
| | - V Russotto
- Department of Biopathology and Medical Biotechnologies (DIBIMED), Section of Anesthesia, Analgesia, Intensive Care and Emergency. Policlinico P. Giaccone, University of Palermo, Via del Vespro 129, 90127, Palermo, Italy
| | - S M Raineri
- Department of Biopathology and Medical Biotechnologies (DIBIMED), Section of Anesthesia, Analgesia, Intensive Care and Emergency. Policlinico P. Giaccone, University of Palermo, Via del Vespro 129, 90127, Palermo, Italy
| | - G Gregoretti
- Department of Biopathology and Medical Biotechnologies (DIBIMED), Section of Anesthesia, Analgesia, Intensive Care and Emergency. Policlinico P. Giaccone, University of Palermo, Via del Vespro 129, 90127, Palermo, Italy
| | - A Giarratano
- Department of Biopathology and Medical Biotechnologies (DIBIMED), Section of Anesthesia, Analgesia, Intensive Care and Emergency. Policlinico P. Giaccone, University of Palermo, Via del Vespro 129, 90127, Palermo, Italy
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