Antifungal stewardship in critically ill patients

Pascale, Gennaro De; Martín‐Loeches, Ignacio; Nseir, Saad

doi:10.1007/s00134-023-07034-7

Cited by 7 publications

(3 citation statements)

References 17 publications

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“…Among the non-culture-based diagnostic tests, (1,3)-β-D-glucan (BDG) is commonly used as a biomarker for the prompt diagnosis of invasive candidiasis. Although false-positive results have been documented in many situations, decreasing the overall specificity (60%) and positive predictive value (<15%) of the test in patients at low-intermediate risk, BGD has been demonstrated to be superior to colonization indexes, with high sensitivity (74-86%) and negative predictive value (>95%), in settings with low pre-test probability (IC rate < 5%) [55,56].…”

Section: Antifungal De-escalationmentioning

confidence: 99%

Antimicrobial De-Escalation in Critically Ill Patients

Tanzarella,

Cutuli,

Lombardi

et al. 2024

Antibiotics

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Antimicrobial de-escalation (ADE) is defined as the discontinuation of one or more antimicrobials in empirical therapy, or the replacement of a broad-spectrum antimicrobial with a narrower-spectrum antimicrobial. The aim of this review is to provide an overview of the available literature on the effectiveness and safety of ADE in critically ill patients, with a focus on special conditions such as anti-fungal therapy and high-risk categories. Although it is widely considered a safe strategy for antimicrobial stewardship (AMS), to date, there has been no assessment of the effect of de-escalation on the development of resistance. Conversely, some authors suggest that prolonged antibiotic treatment may be a side effect of de-escalation, especially in high-risk categories such as neutropenic critically ill patients and intra-abdominal infections (IAIs). Moreover, microbiological documentation is crucial for increasing ADE rates in critically ill patients with infections, and efforts should be focused on exploring new diagnostic tools to accelerate pathogen identification. For these reasons, ADE can be safely used in patients with infections, as confirmed by high-quality and reliable microbiological samplings, although further studies are warranted to clarify its applicability in selected populations.

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Section: Antifungal De-escalationmentioning

confidence: 99%

Antimicrobial De-Escalation in Critically Ill Patients

Tanzarella,

Cutuli,

Lombardi

et al. 2024

Antibiotics

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“…BDG testing has a sensitivity of 74-86% for the diagnosis of invasive fungal infections [29]. BDG levels typically rise during an invasive fungal infection and decrease after the commencement of antifungal therapy.…”

Section: Invasive Candidiasis and 13-b-d-glucanmentioning

confidence: 99%

“…Clearly, the use of BDG as a standalone biomarker has limitations, including its poor specificity (60%) and low positive predictive value (<15%) in patients with low-intermediate invasive candidiasis risk [29]. BDG can be elevated in non-fungal conditions like bacterial infections, inflammatory bowel disease and exposure to some medications, which can lead to false-positive results.…”

Section: Invasive Candidiasis and 13-b-d-glucanmentioning

confidence: 99%

Therapeutic Drug Monitoring and Biomarkers; towards Better Dosing of Antimicrobial Therapy

Wehbe,

Patanwala,

et al. 2024

Pharmaceutics

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Due to variability in pharmacokinetics and pharmacodynamics, clinical outcomes of antimicrobial drug therapy vary between patients. As such, personalised medication management, considering both pharmacokinetics and pharmacodynamics, is a growing concept of interest in the field of infectious diseases. Therapeutic drug monitoring is used to adjust and individualise drug regimens until predefined pharmacokinetic exposure targets are achieved. Minimum inhibitory concentration (drug susceptibility) is the best available pharmacodynamic parameter but is associated with many limitations. Identification of other pharmacodynamic parameters is necessary. Repurposing diagnostic biomarkers as pharmacodynamic parameters to evaluate treatment response is attractive. When combined with therapeutic drug monitoring, it could facilitate making more informed dosing decisions. We believe the approach has potential and justifies further research.

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