Observational studyCritical care medicine2018
Initial Antifungal Strategy Reduces Mortality in Critically Ill Patients With Candidemia: A Propensity Score-Adjusted Analysis of a Multicenter Study.
Observational study in Critical care medicine, 2018. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 31 papers, 1 of them a synthesis 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.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
31 citing papers in PubMed, 1 synthesis or guideline pooled it, 55 citations in OpenAlex.
- 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
- Early-Onset Candidemia in Adult Intensive Care Units.Diagnostics (Basel, Switzerland) · 2025Review
- Fungal Infections in People Who Use Drugs.Open forum infectious diseases · 2025Review
- Invasive Candidiasis in the Intensive Care Unit: Where Are We Now?Journal of fungi (Basel, Switzerland) · 2025Review
- Prognostic factors of invasive fungal infections in pediatric intensive care units and changes in treatment outcomes before and after the COVID-19 pandemic: a multicenter retrospective study.Frontiers in microbiology · 2025Article
- Candidemia in an Orthopedic Patient Detected Coincidentally by Peripheral Blood Smear.Diagnostics (Basel, Switzerland) · 2024Article
- Initial micafungin treatment does not improve outcomes compared to fluconazole treatment in immunocompromised and critically ill patients with candidaemia.The Journal of antimicrobial chemotherapy · 2024Article
- Antimicrobial De-Escalation in Critically Ill Patients.Antibiotics (Basel, Switzerland) · 2024Review
- Reappraisal of intra-abdominal candidiasis: insights from peritoneal fluid analysis.Intensive care medicine experimental · 2023Article
- Pharmacist Involvement in Sepsis Response and Time to Antibiotics: A Systematic Review.Journal of the American College of Clinical Pharmacy : JACCP · 2023Article
- Evaluation of Fluconazole versus Echinocandins for Treatment of Candidemia Caused by Susceptible CommonJournal of fungi (Basel, Switzerland) · 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
- Mortality-associated factors of candidemia: a multi-center prospective cohort in Turkey.European journal of clinical microbiology & infectious diseases : official publication of the European Society of Clinical Microbiology · 2022Observational
- A Predictive Model for 30-Day Mortality of Fungemia in ICUs.Infection and drug resistance · 2022Article
- Timing of antibiotic therapy in the ICU.Critical care (London, England) · 2021Review
- Initial antimicrobial management of sepsis.Critical care (London, England) · 2021Review
- Early Stepdown From Echinocandin to Fluconazole Treatment in Candidemia: A Post Hoc Analysis of Three Cohort Studies.Open forum infectious diseases · 2021Article
- Candidemia in intensive care units over nine years at a large Italian university hospital: Comparison with other wards.PloS one · 2021Article
- ICU Patients' Antibiotic Exposure and Triazole-Resistance in Invasive Candidiasis: Parallel Analysis of Aggregated and Individual Data.Frontiers in pharmacology · 2021Article
- Impact of Loading Dose of Caspofungin in Pharmacokinetic-Pharmacodynamic Target Attainment for Severe Candidiasis Infections in Patients in Intensive Care Units: the CASPOLOAD Study.Antimicrobial agents and chemotherapy · 2020Article
Corrections and comments
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Authors and funding
12 authors at 8 institutions in 2 countries.
Funding
No grant is acknowledged in the PubMed record.
Abstract
objectiveThe objective of this study was to evaluate the impact of the empirical therapy with fluconazole or an echinocandin on 30- and 90-day mortality in critically ill patients with candidemia. The outcome of patients in whom the empirical echinocandin was deescalated to fluconazole was also assessed.
designRetrospective, observational multicenter study.
settingMedical and surgical ICUs in nine Spanish hospitals. PATIENTS: Adult patients (≥ 18 yr) with an episode of Candida bloodstream infection during ICU admission from January 2011 to April 2016.
interventionsPatient characteristics, infection-related variables, therapeutic interventions, and metastatic complications were reviewed. A propensity score-adjusted multivariable analysis was performed to identify the risk factors significantly associated with 30-day and 90-day mortality. MEASUREMENTS AND MAIN
resultsA total of 294 patients were diagnosed of candidemia in the participant ICUs. Sixty patients were excluded (other antifungals in the primary therapy or the patient died without empirical antifungal therapy). The study group comprised 115 patients who received fluconazole (30-day mortality, 37.4%) and 119 patients treated empirically with an echinocandin (30-day mortality, 31.9%). The use of an echinocandin in the empirical therapy was a protective factor for 30-day (odds ratio, 0.32; 95% CI, 0.16-0.66; p = 0.002) and 90-day mortality (odds ratio, 0.50; 95% CI, 0.27-0.93; p = 0.014) in the propensity score- adjusted multivariable analysis. Deescalation of the empirical echinocandin to fluconazole was not associated with a higher mortality or the occurrence of long-term complications.
conclusionsEmpirical use of an echinocandin in critically ill patients with documented candidemia reduces mortality at 30 and 90 days significantly. Deescalation of the empirical echinocandin to fluconazole is safe and effective in fluconazole-susceptible infections.
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