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Effect of empirical antifungal treatment on mortality in non-neutropenic critically ill patients: a propensity-matched retrospective cohort study

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Abstract

To evaluate the effect of empirical antifungal treatment (EAFT) on mortality in critically ill patients without invasive fungal infections (IFIs). This was a single-center propensity score–matched retrospective cohort study involving non-transplanted, non-neutropenic critically ill patients with risk factors for invasive candidiasis (IC) in the absence of IFIs. We compared all-cause hospital mortality and infection-attributable hospital mortality in patients who was given EAFT for suspected IC as the cohort group and those without any systemic antifungal agents as the control group. Among 640 eligible patients, 177 patients given EAFT and 177 control patients were included in the analyses. As compared with controls, EAFT was not associated with the lower risks of all-cause hospital mortality [odds ratio (OR), 0.911; 95% CI, 0.541–1.531; P = 0.724] or infection-attributable hospital mortality (OR, 1.149; 95% CI, 0.632–2.092; P = 0.648). EAFT showed no benefit of improvement of infection at discharge, duration of mechanical ventilation, and antibiotic-free days. However, the later initiation of EAFT was associated with higher risks of all-cause hospital mortality (OR, 1.039; 95% CI, 1.003 to 1.076; P = 0.034) and infection-attributable hospital mortality (OR, 1.046; 95% CI, 1.009 to 1.085; P = 0.015) in patients with suspected IC. This effect was also found in infection-attributable hospital mortality (OR, 1.042; 95% CI, 1.005 to 1.081; P = 0.027) in septic patients with suspected IC. EAFT failed to decrease hospital mortality in non-neutropenic critically ill patients without IFIs. The timing may be critical for EAFT to improve mortality in these patients with suspected IC. ChiCTR2000038811, registered on Oct 3, 2020.

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Data availability

The data analyzed during the current study may be made available upon written request to the corresponding author.

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Acknowledgements

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Funding

This cohort study was funded by grants from the National Natural Science Foundation of China (No: 81800466) and the Specific Fund of Clinical Medical Research of the Shandong Society of Critical Care Medicine (No: 2021BS001).

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Authors and Affiliations

  1. Department of Critical Care Medicine, Shandong Provincial Hospital Affiliated to Shandong First Medical University, No. 324 **gwu Road, **an, 250021, Shandong, People’s Republic of China

    Yue Tang, Shuangyan Jiang, Wenying Zhu, Lin Zhang, **g Sha, Tengfei Wang, Min Ding, Juan Zeng & **jiao Jiang

  2. Department of Endocrinology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, No. 324 **gwu Road, **an, 250021, Shandong, People’s Republic of China

    Wen**g Hu

  3. Department of Emergency, Shandong Provincial Hospital Affiliated to Shandong First Medical University, No. 324 **gwu Road, **an, 250021, Shandong, People’s Republic of China

    Maoyu **e

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Contributions

Yue Tang, Wen**g Hu, Shuangyan Jiang, and Maoyu **e contributed to collecting the clinical data and drafting the manuscript. Wenying Zhu, Lin Zhang, **g Sha, and Tengfei Wang contributed to the study design and the statistical analysis. Min Ding, Juan Zeng, **jiao Jiang, and Yue Tang participated in the interpretation of data and drafting and reviewing the manuscript. All authors read and approved the final manuscript. All authors had full access to all the data and accept responsibility for the decision to submit for publication.

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Correspondence to Juan Zeng or **jiao Jiang.

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Ethical approval was waived by the Ethics Committee of Shandong Provincial Hospital in view of the retrospective nature of the study, and all the procedures being performed were part of the routine care.

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The requirement of informed consent was waived for this study by the Ethics Committee of Shandong Provincial Hospital due to the retrospective nature of this study.

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Tang, Y., Hu, W., Jiang, S. et al. Effect of empirical antifungal treatment on mortality in non-neutropenic critically ill patients: a propensity-matched retrospective cohort study. Eur J Clin Microbiol Infect Dis 41, 1421–1432 (2022). https://doi.org/10.1007/s10096-022-04507-3

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