Trial reportIntensive care medicine2017
Biomarker-based strategy for early discontinuation of empirical antifungal treatment in critically ill patients: a randomized controlled trial.
Trial report in Intensive care medicine, 2017. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to trial NCT02154178 (Fungal Biomarkers to Reduce Duration of Empirical Antifungal Therapy), which is not on this map. Cited by 47 papers, 3 of them syntheses that pooled it.
What it found
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Fungal Biomarkers to Reduce Duration of Empirical Antifungal Therapy: a Randomized Comparative Study
Who cites it
47 citing papers in PubMed, 3 syntheses or guidelines pooled it.
- Pooled it
- Pooled 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
- Diagnostic performance of β-(1→3)-D-glucan, twoJournal of clinical microbiology · 2026Trial
- (1 → 3)-β-D-Glucan-guided antifungal therapy in adults with sepsis: the CandiSep randomized clinical trial.Intensive care medicine · 2022Trial
- (1,3)-β-D-Glucan-based empirical antifungal interruption in suspected invasive candidiasis: a randomized trial.Critical care (London, England) · 2020Trial
- Decision-Rule Architecture in Fungal Biomarker-Guided Antifungal Stewardship for Critically Ill Adults: A Systematic Review andJournal of fungi (Basel, Switzerland) · 2026Review
- DAMPs, PAMPs, and Alarmins: From Mechanism to Therapy.MedComm · 2026Review
- Invasive Candidiasis in Critically Ill Patients: Fundamental Concepts and Future Directions.Chest · 2026Review
- Surviving Sepsis Campaign: international guidelines for management of sepsis and septic shock 2026.Intensive care medicine · 2026Article
- 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
- Candidemia: An Update on Epidemiology, Risk Factors, Diagnosis, Susceptibility, and Treatment.Pathogens (Basel, Switzerland) · 2025Review
- Fungi under fire: diagnostic capacities and antifungal availability in Peruvian healthcare facilities.Microbiology spectrum · 2025Observational
- Invasive Candidiasis in the Intensive Care Unit: Where Are We Now?Journal of fungi (Basel, Switzerland) · 2025Review
- The Japanese Clinical Practice Guidelines for Management of Sepsis and Septic Shock 2024.Journal of intensive care · 2025Article
- Reevaluating the Value of (1,3)-β-D-Glucan for the Diagnosis of Intra-Abdominal Candidiasis in Critically Ill Patients: Current Evidence and Future Directions.Journal of fungi (Basel, Switzerland) · 2025Article
- Invasive fungal infections in non-neutropenic patients.Intensive care medicine · 2024Article
- Prediction of candidemia with machine learning techniques: state of the art.Future microbiology · 2024Review
- Fungal infections in immunocompromised critically ill patients.Journal of intensive medicine · 2024Review
- A Diagnostic Stewardship Intervention to Improve Utilization of 1,3 β-D-Glucan Testing at a Single Academic Center: Five-Year Experience.Open forum infectious diseases · 2024Article
Corrections and comments
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Authors and funding
8 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
purposeThe aim of this study was to determine the impact of a biomarker-based strategy on early discontinuation of empirical antifungal treatment.
methodsProspective randomized controlled single-center unblinded study, performed in a mixed ICU. A total of 110 patients were randomly assigned to a strategy in which empirical antifungal treatment duration was determined by (1,3)-β-D-glucan, mannan, and anti-mannan serum assays, performed on day 0 and day 4; or to a routine care strategy, based on international guidelines, which recommend 14 days of treatment. In the biomarker group, early stop recommendation was determined using an algorithm based on the results of biomarkers. The primary outcome was the percentage of survivors discontinuing empirical antifungal treatment early, defined as a discontinuation strictly before day 7.
resultsA total of 109 patients were analyzed (one patient withdraw consent). Empirical antifungal treatment was discontinued early in 29 out of 54 patients in the biomarker strategy group, compared with one patient out of 55 in the routine strategy group [54% vs 2%, p < 0.001, OR (95% CI) 62.6 (8.1-486)]. Total duration of antifungal treatment was significantly shorter in the biomarker strategy compared with routine strategy [median (IQR) 6 (4-13) vs 13 (12-14) days, p < 0.0001). No significant difference was found in the percentage of patients with subsequent proven invasive Candida infection, mechanical ventilation-free days, length of ICU stay, cost, and ICU mortality between the two study groups.
conclusionsThe use of a biomarker-based strategy increased the percentage of early discontinuation of empirical antifungal treatment among critically ill patients with suspected invasive Candida infection. These results confirm previous findings suggesting that early discontinuation of empirical antifungal treatment had no negative impact on outcome. However, further studies are needed to confirm the safety of this strategy. This trial was registered at ClinicalTrials.gov, NCT02154178.
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.