Does Empirical Micafungin Improve Survival in Critically Ill Patients?
(HealthDay News) — Empirical treatment with micafungin seems not to increase invasive fungal infection (IFI)-free survival at 28 days for patients with intensive care unit (ICU)-acquired sepsis with Candida colonization, according to a study published online Oct. 5 in the Journal of the American Medical Association. The research was published to coincide with the European Society of Intensive Care Medicine Annual Congress, held from Oct. 1 to 5 in Milan.
Jean-Francois Timsit, M.D., Ph.D., from the Hôpital Bichat-Claude-Bernard in Paris, and colleagues enrolled 260 nonneutropenic, nontransplanted, critically ill patients with ICU-acquired sepsis, multiple Candida colonization, multiple organ failure, and had been exposed to broad spectrum antibacterial agents. Patients were treated with micafungin (131 patients) or placebo (129 patients). Two hundred fifty-one patients were included in the modified intent-to-treat analysis.
The researchers found that 68 percent of patients in the micafungin group and 60.2 percent in the placebo group were alive and IFI-free at day 28 (hazard ratio, 1.35; 95 percent confidence interval, 0.87 to 2.08). Similar results were seen for patients with a (1-3)-β-D-glucan level >80 pg/mL (hazard ratio, 1.41; 95 percent confidence interval, 0.85 to 2.33). There was no between-group difference in day-28 IFI-free survival for patients with a high Sequential Organ Failure Assessment score (hazard ratio, 1.69; 95 percent confidence interval, 0.96 to 2.94).
"Empirical treatment with micafungin, compared with placebo, did not increase fungal infection-free survival at day 28," the authors write.
Several authors disclosed financial ties to pharmaceutical companies, including Astellas, which manufactures micafungin and provided study funding.