Timely selection of adequate antifungal therapy for candidemia in the critically ill: Don't let the yeast rise!

摘要

In this issue of Critical Care Medicine, Labelle et al. (1) examine the impact of treatment-related variables for Candida species bloodstream infection on hospital mortality. They undertook a retrospective cohort study on all candidemic patients at their hospital receiving antifungal therapy over a two and half year period. Patients admitted to the intensive care unit were analyzed as a separate subgroup. Clinical and microbiologic data were obtained from separate databases. In total, they identified 245 candidemic patients, of whom 111 (45.3%) needed intensive care unit management, Crude mortality was 29.4% in the hospital cohort and 36% in those admitted to intensive care unit. Binary logistic regression analysis identified as independent predictors of hospital mortality: 1) increments in Acute Physiology and Chronic Health Evaluation II score; 2) corticosteroid use at the time a positive blood culture was drawn; 3) inadequate initial fluconazole dosing; and 4) central venous catheter retention. Theyconcluded that optimization of initial antifungal therapy and centra! venous catheter removal were important management steps to improve outcomes.