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October 18, 2016

Empirical Antifungal Therapy in Critically Ill Patients With Sepsis: Another Case of Less Is More in the ICU

Author Affiliations
  • 1Division of Pulmonary and Critical Care, School of Medicine, Johns Hopkins University, Baltimore, Maryland
  • 2Division of Infectious Diseases, School of Medicine, Johns Hopkins University, Baltimore, Maryland

Copyright 2016 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Restrictions Apply to Government Use.

JAMA. 2016;316(15):1549-1550. doi:10.1001/jama.2016.13801

Candida species are the most common cause of invasive fungal infections, accounting for 70% to 90% of hospital cases.1,2 Although the overall US incidence of candidemia is low among nonneutropenic, critically ill adults (approximately 2/1000 intensive care unit [ICU] admissions), candidemia results in a longer length of stay (≤1 month), costs in excess of $40 000 per case, and a 30-day mortality greater than 50%.1-3 Moreover, mortality from invasive fungal infection has been increasing over the past decade, suggesting that advances in the management for invasive fungal infection have lagged behind those for bacterial septic shock.4 In light of the high mortality associated with invasive fungal infection, particularly among critically ill patients, a number of guidelines have focused on empirical treatment with antifungal echinocandins and surveillance for Candida either through culture or diagnostic biomarkers.5,6 Accordingly, the use of echinocandins has increased from 4.6% to 48.5% in some settings.7 Yet little was previously known about mortality benefits from prophylactic antifungal therapy.