ArticleIntensive care medicine2025
Are contemporary antifungal doses sufficient for critically ill patients? Outcomes from an international, multicenter pharmacokinetics study for Screening Antifungal Exposure in Intensive Care Units-the SAFE-ICU study.
Article in Intensive care medicine, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to trial NCT03136926 (An International, Multi-centre Prospective Pharmacokinetic Evaluation of Antifungal Drug Exposure in Intensive Care Unit Patients Receiving Conventional Dosing Regimens), which is not on this map. Cited by 26 papers, 2 of them syntheses that pooled it.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
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.
An International, Multi-centre Prospective Pharmacokinetic Evaluation of Antifungal Drug Exposure in Intensive Care Unit Patients Receiving Conventional Dosing Regimens
Who cites it
26 citing papers in PubMed, 2 syntheses or guidelines pooled it.
- Factors affecting voriconazole pharmacokinetic variability in critically ill patients: a systematic review.Critical care (London, England) · 2025Pooled it
- Guideline
- Trial
- Posaconazole Target Attainment in Critically Ill Children: A 15-Year Single-Center Retrospective Analysis.Clinical and translational science · 2026Article
- Therapeutic Failure in Invasive Fungal Infections: Beyond Antifungal Resistance-A Narrative Review.Journal of fungi (Basel, Switzerland) · 2026Review
- Micafungin Sequestration and Late Release During Continuous Renal Replacement Therapy with Polyacrylonitrile- and Polysulfone-Derived Filters.Infectious diseases and therapy · 2026Article
- Invasive Candidiasis in Critically Ill Patients: Fundamental Concepts and Future Directions.Chest · 2026Review
- Challenges and opportunities in the management of severe pneumonia. Key concepts from the Seventh Annual Meeting of Spanish Experts 2025.Revista espanola de quimioterapia : publicacion oficial de la Sociedad Espanola de Quimioterapia · 2026Review
- Adsorption of caspofungin by polyacrylonitrile membranes during continuous kidney replacement therapy.Intensive care medicine · 2026Article
- Shifting Epidemiology and Antifungal Susceptibility Patterns of Clinical Fungal Isolates in an Intensive Care Unit (ICU) from Bucharest, Romania: A Retrospective Observational Study.Antibiotics (Basel, Switzerland) · 2026Article
- Empirical Antifungal Treatment of Critically Ⅲ Patients With Influenza-Associated Acute Respiratory Distress Syndrome: A Propensity Score Weighted Observational Study.Clinical infectious diseases : an official publication of the Infectious Diseases Society of America · 2026Observational
- A Pharmacokinetic Analysis of Intravenous Fluconazole in Adult Patients Undergoing Mechanical Circulatory Support Device Implantation.Clinical pharmacokinetics · 2026Article
- Update on infection: from prevention to diagnosis and management.Intensive care medicine · 2026Article
- Article
- Primary Therapy for Invasive Aspergillosis With Triazoles or L-AmB: A Multicenter Retrospective Study.Open forum infectious diseases · 2026Article
- Temporal changes in fungal epidemiology in ICU post-operative peritonitis cases.European journal of clinical microbiology & infectious diseases : official publication of the European Society of Clinical Microbiology · 2026Article
- Unravelling Voriconazole's Hepatic Metabolism: A Narrative Review on Factors Impacting Voriconazole-N-Oxide Exposure.Mycoses · 2026Review
- Invasive pulmonary aspergillosis in the ICU: the corticosteroid link.Pneumonia (Nathan Qld.) · 2026Review
- From the Petri dish to the patient's bedside: interpretingFrontiers in immunology · 2026Article
- Five things the intensivist cannot forget in the management of invasive candidiasis.Critical care science · 2026Article
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
20 authors.
Funding
Abstract
purposeAppropriate antifungal therapy is a major determinant of survival in critically ill patients with invasive fungal disease. We sought to describe whether contemporary dosing of antifungals achieves therapeutic exposures in critically ill patients.
methodsIn a prospective, open-label, multicenter pharmacokinetic study, intensive care unit (ICU) patients prescribed azoles, echinocandins, or polyene antifungals for treatment or prophylaxis of invasive fungal disease were enrolled. Blood samples were collected on two occasions, with three samples taken during a single dosing interval on each occasion. Total concentrations were centrally measured using validated chromatographic methods. Pharmacokinetic parameters were estimated using noncompartmental methods. Antifungal dosing adequacy was assessed using predefined PK/PD targets.
resultsWe included 339 patients from 30 ICUs across 12 countries. Median age 62 (interquartile range [IQR], 51-70) years, median APACHE II score 22 (IQR, 17-28), and 61% males. Antifungal therapy was primarily prescribed for treatment (80.8%). Fluconazole was the most frequently prescribed antifungal (40.7%). The most common indication for treatment was intra-abdominal infection (30.7%). Fungi were identified in 45% of patients, of which only 26% had a minimum inhibitory concentration available. Target attainment was higher for patients receiving prophylaxis (> 80% for most drugs). For patients receiving treatment, low target attainment was noted for voriconazole (57.1%), posaconazole (63.2%), micafungin (64.1%) and amphotericin B (41.7%).
conclusionThis study highlights the varying degrees of target attainment across antifungal agents in critically ill patients. While a significant proportion of patients achieved the predefined PK/PD targets, wide variability and subtherapeutic exposures persist.
trial registrationClinicalTrials.gov Identifier: NCT03136926, 2017-04-21.
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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.