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This article is part of the supplement: 33rd International Symposium on Intensive Care and Emergency Medicine

Poster presentation

Impact of echinocandins as first-choice therapy in cardiothoracic high-risk patients with candidemia

G Langebartels*, Y Choi, J Catteleans and T Wahlers

  • * Corresponding author: G Langebartels

Author Affiliations

University of Cologne, Germany

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Critical Care 2013, 17(Suppl 2):P85  doi:10.1186/cc12023


The electronic version of this article is the complete one and can be found online at: http://ccforum.com/content/17/S2/P85


Published:19 March 2013

© 2013 Langebartels et al.; licensee BioMed Central Ltd.

This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Introduction

Invasive candidemia is a major cause of increased mortality among ICU patients. Antifungal agents like liposomale amphotericin B and azoles could not accomplish the claim to be first choice in the treatment of invasive fungal infection (IFI) because of side effects and effectiveness. Especially, cardiothoracic surgery patients as a group of high-risk patients are in a focus for new strategies and agents. A new class of antimycotic agents, the echinocandins, with a low profile of side effects, low interactive potential and high effectiveness in the treatment of candidemia, is a powerful option in the treatment of IFI. We report our single-center experience with a modified clinical treatment approach based on clinical score of Leon and using echinocandins as first-line therapy for proven and suspected fungal infection.

Methods

From May 2011 to October 2012, 2,844 patients were treated on our cardiothoracic ICU. We evaluated 37 cardiothoracic postoperative patients with proven or suspected IFI or prophylaxis (Figure 1). The records were evaluated for cardiothoracic procedures, microbiological and yeast date, cardiothoracic surgery score (CASUS), ICU and clinical data.

thumbnailFigure 1. Cologne antifungal strategy.

Results

Mean age was 67.4 years with 64% male patients. Most patients had combined CABG and valve procedure (n = 20), other groups were HTX and LTX (n = 4), assist therapy (n = 4), TAVI (n = 3) and other procedures. Mean predicted mortality using the logarithmic CASUS score at the onset of IFI was 59%. C. albicans was isolated in 73%, C. glabrata in 21%. Length of antifungal treatment using micafungin in 30 cases was 14 ± 5 days. Eradication of yeast was successful in 79% but mortality of all patients remains high at 36.8% but was lower than predicted in the CASUS score. Mortality was not yeast related.

Conclusion

Our described treatment approach shows encouraging results for the treatment of IFI especially in high-risk cardiothoracic patients.

References

  1. Eggiman , et al.: Invasive Candida infections in the ICU.

    Mycoses 2012, 55(Suppl):65-72. OpenURL

  2. Andes , et al.: Impact of treatment strategy on outcomes in patients with candidemia and other forms of invasive candidiasis: a patient-level quantitative review of randomized trials.

    Clin Infect Dis 2012, 54:1110-1122. PubMed Abstract | Publisher Full Text OpenURL