Title : Use of antifungal agents in non-neutropenic critically ill patients to decrease invasive fungal infections versus placebo: A systematic review and meta-analysis
Abstract:
Background: Invasive candidiasis is considered the third most common bloodstream infection in critical care units, and can lead to increased morbidity and mortality. Invasive fungal infections can be deadly if not recognized early in the course of the disease. Reaching a diagnosis can be challenging, making optimal treatment difficult. The controversy has always been whether to treat empirically once there is a high index of suspicion or choose to use a pre-emptive strategy once diagnosis is made, especially among critically ill patients.
Methods: PubMed, Scopus, and Cochrane databases were searched for randomized controlled trials that compared the prophylactic /pre-emptive use of antifungal agents in non-neutropenic critically ill patients versus placebo. Reported outcomes were: (1) reduction of the incidence of invasive fungal infections, (2) mortality (3) adverse events. A random-effects model was used to pool risk ratios across studies.
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Results: We included six (6) randomized controlled trials (RCTs). Invasive fungal infections occurred in 23 of 610 patients in the antifungal group and 68 of 590 in the placebo group (RR = 0.35; 95% CI: 0.22–0.55). Adverse events were reported in 202 of 378 patients receiving antifungals and 188 of 362 receiving placebo (RR = 1.03; 95% CI: 0.95–1.13). There were 145 out of 625 deaths in the intervention group vs 132 out of 608 in the placebo group, with (RR = 1.05; 95% CI: 0.86–1.29).
Conclusion: These findings suggest that pre-emptive /prophylactic antifungal treatment in critically ill patients decreased invasive fungal infections but did not affect mortality or adverse events.
