Biomarker-based strategy for early discontinuation of empirical antifungal treatment in critically ill patients: a randomized controlled trial

Abstract

The use of a biomarker-based strategy increased the percentage of early discontinuation of empirical antifungal treatment among critically ill patients with suspected invasive Candida infection. These results confirm previous findings suggesting that early discontinuation of empirical antifungal treatment had no negative impact on outcome. However, further studies are needed to confirm the safety of this strategy. This trial was registered at ClinicalTrials.gov, NCT02154178.

Diagnosis and Treatment of Candidemia in the Intensive Care Unit

“…Early discontinuation of antifungals occurred more frequently in the biomarker strategy group (29/54, 54%) than in the routine strategy group (1/55, 2%) (odds ratio [OR]: 63; 95% CI: 8-486). 102 No differences were detected in subsequent probable/proven IC, subsequent antifungal treatments, length of ICU stay, and mortality. 102 Other RCTs evaluating the impact of BDG results on early therapeutic choices are ongoing or have been recently completed (NCT02734550, NCT03117439, NCT03090334, and NCT03538912).…”

“…102 No differences were detected in subsequent probable/proven IC, subsequent antifungal treatments, length of ICU stay, and mortality. 102 Other RCTs evaluating the impact of BDG results on early therapeutic choices are ongoing or have been recently completed (NCT02734550, NCT03117439, NCT03090334, and NCT03538912). 103 Their results are awaited to ultimately firmly delineate the impact of BDG results on pre-emptive therapeutic choices in ICU patients with suspected candidemia.…”

“…117 In the previously cited RCT conducted by Rouzé and colleagues, decisions regarding continuation or discontinuation of antifungals were based on a combination of BDG and Mn/A-Mn testing, but their separated impact was not evaluated. 102 In the discussion, the authors reported that the decision of continuing antifungals was only based on Mn/A-Mn in three cases. 102 Other Antigen/Antibody-Based Tests…”

“…101 In an unblinded, single-center RCT, Rouzé and colleagues assessed the percentage of early discontinuation for reasons other than death in patients with risk factors for IC and receiving empirical antifungals for a consistent clinical presentation. 102 Patients were randomized in two groups: (1) biomarker strategy (discontinuation of empirical antifungals in case of negative BDG, mannan (Mn), and antimannan tests);…”

Biomarker-guided antifungal therapy in patients with suspected invasive candidiasis: Ready for prime time?

“…In a recent issue of Intensive Care Medicine, Rouzé et al [17] reported the results of the first RCT evaluating the impact of a complex algorithm based on serial levels of BDG, mannan-Ag and mannan-Ab measured at different time-points. The proposed decision tree is based on the respective predictive values of each biomarker according to previously published data and unpublished data from their group.…”