Fungal Infection-Free Survival Not Improved with Empirical Micafungin Treatment
Treatment was tested in critically ill patients with ICU-acquired sepsis, multiple Candida colonization, and multiple organ failure.
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 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 October 1-5 in Milan.
Jean-Francois Timsit, MD, PhD, 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% of patients in the micafungin group and 60.2% in the placebo group were alive and IFI-free at day 28 (hazard ratio [HR], 1.35; 95% confidence interval [CI], 0.87-2.08). Similar results were seen for patients with a (1-3)-β-D-glucan level >80 pg/mL (HR, 1.41; 95% CI, 0.85-2.33). There was no between-group difference in day-28 IFI-free survival for patients with a high Sequential Organ Failure Assessment score (HR, 1.69; 95% CI, 0.96-2.94).
"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.
- Timsit J-F, Azoulay E, Schwebel C, et al. Empirical micafungin treatment and survival without invasive fungal infection in adults with ICU-acquired sepsis, Candida colonization, and multiple organ failure. The EMPIRICUS randomized clinical trial. JAMA. 2016. doi: 10.1001/jama.2016.14655
- Siddharthan T, Karakousis PC, Checkley W. Empirical antifungal therapy in critically ill patients with sepsis. Another case of less is more in the ICU. JAMA. 2016. 10.1001/jama.2016.13801