Hemodynamic changes in surgical intensive care unit patients undergoing echinocandin treatment.
Aged
Antifungal Agents
/ therapeutic use
Cohort Studies
Critical Care
/ methods
Critical Illness
/ therapy
Echinocandins
/ therapeutic use
Female
Hemodynamics
/ drug effects
Humans
Intensive Care Units
Male
Middle Aged
Postoperative Care
/ methods
Retrospective Studies
Surgery Department, Hospital
Treatment Outcome
Adverse drug reaction
Cardiac output
Cardiac toxicity
Echinocandins
Journal
International journal of clinical pharmacy
ISSN: 2210-7711
Titre abrégé: Int J Clin Pharm
Pays: Netherlands
ID NLM: 101554912
Informations de publication
Date de publication:
Feb 2020
Feb 2020
Historique:
received:
26
10
2018
accepted:
08
11
2019
pubmed:
22
11
2019
medline:
22
1
2021
entrez:
22
11
2019
Statut:
ppublish
Résumé
Background Echinocandins are well-established agents for the treatment of patients with fungal infections, but growing evidence questions their safety in special patient populations prone to systemic inflammatory responses. Objective The study aimed to analyse early hemodynamic changes during echinocandin therapy in critically ill surgical patients. Setting The study was conducted at the surgical intensive care unit at the University Hospital of Giessen, Germany. Methods This single-centre retrospective study includes data from critically ill patients who underwent primary antifungal treatment during 2009-2013. Main outcome measures Hemodynamic parameters, need for vasopressor/inotropic therapy, and dose of vasopressor/inotropic therapy were recorded 2 h before and 2 h after the onset of antifungal treatment. Comparisons of echinocandins to azoles and analysis of a combined endpoint (decrease of mean arterial pressure ≥ 10 mmHg and/or new or increased dosages of norepinephrine, epinephrine, or dobutamine) were performed. Results We found 342 episodes of intravenous antifungal treatment (33 [9.6%] anidulafungin, 116 [33.9%] caspofungin, 132 [38.6%] fluconazole, 17 [5%] micafungin, 44 [12.9%] voriconazole). Group comparisons revealed no significant differences of hemodynamic parameters, need for vasopressor/inotropic therapy, and dose of vasopressor/inotropic therapy, expect for a decreased dose of norepinephrine in the fluconazole group (p < 0.001). The combined endpoint occurred in 58 (50%) caspofungin-, 16 (48.5%) anidulafungin-, 4 (23.5%) micafungin-, 23 (17.4%) fluconazole-, and 15 (34.1%) voriconazole treatment episodes. Secondary analysis of the combined anidulafungin/caspofungin group to the azoles group (fluconazole, voriconazole) showed a significant decrease of mean arterial pressure ≥ 10 mmHg (n = 37 [25%] vs. n = 27 [15%], OR = 1.8, p = 0.04), increased use of norepinephrine (n = 38 [26%] vs. n = 12 [7%], OR = 4.7, p ≤ 0.001), increased use of dobutamine (n = 12 [8%] vs. n = 4 [2%], OR = 3.8, p = 0.02), and the combined endpoint (n = 74 [50%] vs. n = 38 [21%], OR = 3.6, p ≤ 0.001). Conclusion Our retrospective data might demonstrate clinically relevant hemodynamic-depressing effects of anidulafungin and caspofungin. Further prospective acquisition of clinical data will be necessary to evaluate their impact on hemodynamic function.
Identifiants
pubmed: 31748967
doi: 10.1007/s11096-019-00939-8
pii: 10.1007/s11096-019-00939-8
doi:
Substances chimiques
Antifungal Agents
0
Echinocandins
0
Types de publication
Journal Article
Observational Study
Langues
eng
Sous-ensembles de citation
IM
Pagination
72-79Subventions
Organisme : Deutsches Zentrum für Infektionsforschung
ID : Clinical Leave Stipend
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