ArticleAnnals of intensive care2018
De-escalation of antifungal treatment in critically ill patients with suspected invasive Candida infection: incidence, associated factors, and safety.
Article in Annals of intensive care, 2018. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 14 papers.
What it found
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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.
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Who cites it
14 citing papers in PubMed, 19 citations in OpenAlex.
- (1,3)-β-D-Glucan-based empirical antifungal interruption in suspected invasive candidiasis: a randomized trial.Critical care (London, England) · 2020Trial
- 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
- French intensive care physicians' practices for the management of high-risk patients with invasive candidiasis: results from the multicenter INSPIRE survey.Annals of intensive care · 2026Article
- Antifungal treatment strategies and their impact on resistance development in clinical settings.The Journal of antimicrobial chemotherapy · 2025Review
- Invasive candidiasis in intensive care medicine: shaping the future of diagnosis and therapy.Intensive care medicine · 2025Review
- Invasive Candidiasis in the Intensive Care Unit: Where Are We Now?Journal of fungi (Basel, Switzerland) · 2025Review
- Review
- Antifungal stewardship in critically ill patients.Intensive care medicine · 2023Article
- Evaluation of Systemic Antifungal Prescribing Knowledge and Practice in the Critical Care Setting among ICU Physicians and Clinical Pharmacists: A Cross-Sectional Study.Antibiotics (Basel, Switzerland) · 2023Article
- Impact of the Disk Diffusion Test on Fluconazole De-Escalation in Patients with Candidemia.Journal of fungi (Basel, Switzerland) · 2022Article
- A multisite evaluation of antifungal use in critical care: implications for antifungal stewardship.JAC-antimicrobial resistance · 2022Article
- Can Beta-D-Glucan testing as part of the diagnostic pathway for invasive fungal infection reduce anti-fungal treatment costs?Medical mycology · 2022Article
- Invasive candidiasis in critical care: challenges and future directions.Intensive care medicine · 2020Review
- Article
Corrections and comments
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Authors and funding
7 authors at 2 institutions in 1 country.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundAntifungal treatment is common in critically ill patients, but only a small proportion of patients receiving antifungals have a proven fungal infection. However, antifungal treatment has side effects such as toxicity, emergence of resistance, and high cost. Moreover, empirical antifungal treatment is still a matter for debate in these patients. Our study aimed to determine the incidence, associated factors, and safety of de-escalation of antifungals in critically ill patients.
methodsThis retrospective study was conducted in a 30-bed mixed ICU, from January 2012 through January 2013. Patients hospitalized for > 5 days and treated with antifungals for first suspected or proven invasive Candida infection were included. Exclusion criteria were prophylactic antifungals, suspected invasive aspergillosis, and neutropenia. De-escalation was defined as switch from initial systemic antifungals (except fluconazole) to triazoles, or stopping initial drugs within the 5 days following their initiation.
resultsOne hundred and ninety patients were included. Antifungal treatment was empirical, preemptive, and targeted in 55, 27, and 24% of study patients, respectively. Caspofungin (53%), fluconazole (43%), voriconazole (4%), and liposomal amphotericin B (0.5%) were the more frequently used antifungals. De-escalation was performed in 38 (20%) patients. Invasive mechanical ventilation was independently associated with lower rates of de-escalation (OR 0.25 [95% CI 0.08-0.85], p = 0.013). Total duration of antifungal treatment was significantly shorter in patients with de-escalation, compared with those with no de-escalation (med [IQR] 6 (5, 18) vs. 13 days (7, 25), p = 0.023). No significant difference was found in duration of mechanical ventilation (22 [5-31] vs. 20 days [10-35], p = 0.43), length of ICU stay (25 [14-40) vs. 25 days [11-40], p = 0.99), ICU mortality (45 vs. 59%, p = 0.13), or 1-year mortality (55 vs. 64%, p = 0.33) between patients with de-escalation and those with no de-escalation, respectively.
conclusionsDe-escalation was performed in 20% of patients receiving systemic antifungals for suspected or proven invasive Candida infection. Mechanical ventilation was independently associated with lower rates of de-escalation. De-escalation of antifungal treatment seems to be safe in critically ill patients.
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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.