ArticleIntensive care medicine2015
Antifungal de-escalation was not associated with adverse outcome in critically ill patients treated for invasive candidiasis: post hoc analyses of the AmarCAND2 study data.
Article in Intensive care medicine, 2015. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 32 papers, 2 of them syntheses that pooled it.
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Who cites it
32 citing papers in PubMed, 2 syntheses or guidelines pooled it, 61 citations in OpenAlex.
- Intensive care medicine research agenda on invasive fungal infection in critically ill patients.Intensive care medicine · 2017Pooled it
- Brazilian guidelines for the diagnosis and treatment of candidemia and invasive candidiasis in adults and children.The Brazilian journal of infectious diseases : an official publication of the Brazilian Society of Infectious DiseasesGuideline
- Biomarker-based strategy for early discontinuation of empirical antifungal treatment in critically ill patients: a randomized controlled trial.Intensive care medicine · 2017Trial
- Early de-escalation of antifungal treatment in critically ill immunocompromised patients with proven or probable invasive candidiasis: A retrospective multicentre study.Annals of intensive care · 2026Article
- Invasive Candidiasis in the Intensive Care Unit: Where Are We Now?Journal of fungi (Basel, Switzerland) · 2025Review
- Review
- Optimized Treatment of Nosocomial Peritonitis.Antibiotics (Basel, Switzerland) · 2023Review
- Observational
- Effect of antimicrobial de-escalation strategy on 14-day mortality among intensive care unit patients: a retrospective propensity score-matched cohort study with inverse probability-of-treatment weighting.BMC infectious diseases · 2023Article
- Antifungal stewardship in critically ill patients.Intensive care medicine · 2023Article
- Pharmacokinetic/Pharmacodynamic Target Attainment of Different Antifungal Agents in De-escalation Treatment in Critically Ill Patients: a Step toward Dose Optimization Using Monte Carlo Simulation.Antimicrobial agents and chemotherapy · 2022Article
- A multisite evaluation of antifungal use in critical care: implications for antifungal stewardship.JAC-antimicrobial resistance · 2022Article
- Retrospective Evaluation of Risk Factors for InvasiveInfectious diseases & clinical microbiology · 2022Article
- Learning Causal Effects From Observational Data in Healthcare: A Review and Summary.Frontiers in medicine · 2022Review
- Early Stepdown From Echinocandin to Fluconazole Treatment in Candidemia: A Post Hoc Analysis of Three Cohort Studies.Open forum infectious diseases · 2021Article
- Invasive candidiasis in critical care: challenges and future directions.Intensive care medicine · 2020Review
- Article
- ESICM/ESCMID task force on practical management of invasive candidiasis in critically ill patients.Intensive care medicine · 2019Article
- Diagnostic and therapeutic approach to infectious diseases in solid organ transplant recipients.Intensive care medicine · 2019Review
- The most recent concepts for the management of bacterial and fungal infections in ICU.Intensive care medicine · 2018Article
Corrections and comments
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Authors and funding
12 authors at 9 institutions in 1 country.
Funding
No grant is acknowledged in the PubMed record.
Abstract
purposeSystemic antifungal therapy (SAT) of invasive candidiasis needs to be initiated immediately upon clinical suspicion. Controversies exist about adequate time and potential harm of antifungal de-escalation (DE) in documented and suspected candidiasis in ICU patients. Our objective was to investigate whether de-escalation within 5 days of antifungal initiation is associated with an increase of the 28-day mortality in SAT-treated non-neutropenic adult ICU patients.
methodsFrom the 835 non-neutropenic adults recruited in the multicenter prospective observational AmarCAND2 study, we selected the patients receiving systemic antifungal therapy for a documented or suspected invasive candidiasis in the ICU and who were still alive 5 days after SAT initiation. They were included into two groups according to the occurrence of observed SAT de-escalation before day 6. The average causal SAT de-escalation effect on 28-day mortality was evaluated by using a double robust estimation.
resultsAmong the 647 included patients, early de-escalation at day 5 after antifungal initiation occurred in 142 patients (22%), including 48 (34%) patients whose SAT was stopped before day 6. After adjustment for the baseline confounders, early SAT de-escalation was the solely factor not associated with increased 28-day mortality (RR 1.12, 95% CI 0.76-1.66).
conclusionIn non-neutropenic critically ill adult patients with documented or suspected invasive candidiasis, SAT de-escalation within 5 days was not related to increased day-28 mortality but it was associated with decreased SAT consumption. These results suggest for the first time that SAT de-escalation may be safe in these patients.
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