Antifungal use in immunocompetent, critically ill patients with pneumonia does not improve clinical outcomes

• Published in: Heart & lung Vol. 45; no. 6; pp. 538 - 543
• Main Authors: Griffin, Meagan, PharmD, Kosmisky, Desiree E., PharmD, Templin, Megan A., MPH, MS, Huynh, Toan, MD, McCurdy, Lewis H., MD, Pasquale, Timothy R., PharmD, Martin, Kelly E., PharmD
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.11.2016; Elsevier Science Ltd
• Subjects: Adult; Antifungal agents; Antifungal Agents - therapeutic use; Bronchoscopy; Candida; Cardiovascular; Clinical outcomes; Critical Care; Critical Illness; Drug therapy; Female; Fungal infections; Hospital Mortality - trends; Hospitalization; Humans; Immunocompromised Host; Immunology; Male; Middle Aged; Mortality; Pneumonia; Pneumonia, Ventilator-Associated - drug therapy; Pneumonia, Ventilator-Associated - microbiology; Pneumonia, Ventilator-Associated - mortality; Prognosis; Pulmonary/Respiratory; Respiration, Artificial - adverse effects; Retrospective Studies; United States - epidemiology; Yeast; United States > US; Bronchoscopy; Pneumonia; Yeast; Candida; Antifungal agents
• DOI: 10.1016/j.hrtlng.2016.08.002
• ISSN: 0147-9563

Abstract Purpose To determine if treating bronchoalveolar lavage (BAL) culture-positive patients with antifungal therapy impacted mortality compared to not treating due to presumed colonization. Methods We conducted a retrospective study of immunocompetent, critically ill adult patients from 2010 to 2014. Patients with a BAL culture-positive for Candida or unspeciated yeast and a clinical suspicion of pneumonia were included. The treatment group received an antifungal agent for at least 5 days, and the control group received either no antifungal therapy or an antifungal agent for less than 48 h. Recruitment occurred in a 2:1 ratio of untreated versus treated patients. Results Seventy-five patients were included. In-hospital mortality was similar between treated and untreated groups (24% vs. 26%, P  = 0.85). Length of stay and duration of mechanical ventilation also did not differ between the two groups. Conclusion We did not observe a difference in mortality or clinical outcomes in patients treated with antifungal agents. Presumptive antifungal therapy for BAL-positive Candida or yeast in immunocompetent patients did not result in improved clinical outcomes.