Hasan Md Jahidul, Neelotpol Sharmind, Rabbani Raihan
Clinical Pharmacy Service, Department of Pharmacy, Square Hospitals Ltd, Dhaka, Bangladesh.
Department of Pharmacy, BRAC University, Dhaka, Bangladesh.
J Crit Care Med (Targu Mures). 2022 May 12;8(2):89-99. doi: 10.2478/jccm-2022-0006. eCollection 2022 Apr.
Invasive candidiasis (IC) in critically ill patients is a serious infection with high rate of mortality. As an empirical therapy, like antibiotics, the use of antifungals is not common in intensive care units (ICUs) worldwide. The empirical use of echinocandins including anidulafungin is a recent trend.
The objective of this study was to assess the impact of empirical anidulafungin in the development of invasive candidiasis in critically ill patients in ICU.
This retrospective case-control study was conducted on 149 patients with sepsis with/without septic shock and bacterial pneumonia. All the patients were divided into two groups. The 'control group' termed as 'NEAT group' received no empirical anidulafungin therapy and the 'treated group' termed as 'EAT group' received empirical anidulafungin therapy in early hospitalization hours.
Seventy-two and 77 patients were divided into the control and the treated group, respectively. Patients in EAT group showed less incidences of IC (5.19%) than that of the NEAT group (29.17%) (p = 0.001). Here, the relative risk (RR) was 0.175 (95% CI, 0.064-0.493) and the risk difference (RD) rate was 24% (95% CI, 12.36%-35.58%). The 30-day all-cause mortality rate in NEAT group was higher (19.44%) than that of in EAT group (10.39%) (p = 0.04). Within the first 10-ICU-day, patients in the EAT group left ICU in higher rate (62.34%) than that in the NEAT group (54.17%).
Early empirical anidulafungin within 6 h of ICU admission reduced the risk of invasive candidiasis, 30-day all-cause mortality rate and increased ICU leaving rate within 10-day of ICU admission in critically ill patients.
重症患者侵袭性念珠菌病（IC）是一种严重感染，死亡率很高。作为一种经验性治疗方法，与抗生素一样，抗真菌药物在全球重症监护病房（ICU）中的使用并不普遍。包括阿尼芬净在内的棘白菌素的经验性使用是最近的一种趋势。
本研究的目的是评估经验性使用阿尼芬净对ICU重症患者侵袭性念珠菌病发生的影响。
本回顾性病例对照研究针对149例伴有或不伴有感染性休克的脓毒症患者以及细菌性肺炎患者开展。所有患者被分为两组。“对照组”称为“NEAT组”，未接受经验性阿尼芬净治疗；“治疗组”称为“EAT组”，在住院早期接受经验性阿尼芬净治疗。
分别有72例和77例患者被分入对照组和治疗组。EAT组患者的IC发生率（5.19%）低于NEAT组（29.17%）（p = 0.001）。此处，相对风险（RR）为0.175（95%可信区间，0.064 - 0.493），风险差异（RD）率为24%（95%可信区间，12.36% - 35.58%）。NEAT组患者的30天全因死亡率较高（19.44%），高于EAT组（10.39%）（p = 0.04）。在入住ICU的前10天内，EAT组患者离开ICU的比例（62.34%）高于NEAT组（54.17%）。
入住ICU后6小时内早期经验性使用阿尼芬净可降低重症患者侵袭性念珠菌病风险、30天全因死亡率，并提高入住ICU 10天内离开ICU的比例。
