(1 → 3)-β-D-Glucan-guided antifungal therapy in adults with sepsis: the CandiSep randomized clinical trial.
(1 → 3)-β-D-Glucan
Antifungal therapy
Biomarker
Invasive Candida infection
Sepsis
Journal
Intensive care medicine
ISSN: 1432-1238
Titre abrégé: Intensive Care Med
Pays: United States
ID NLM: 7704851
Informations de publication
Date de publication:
07 2022
07 2022
Historique:
received:
20
02
2022
accepted:
07
05
2022
pubmed:
17
6
2022
medline:
14
7
2022
entrez:
16
6
2022
Statut:
ppublish
Résumé
To investigate whether (1 → 3)-β-d-Glucan (BDG)-guidance shortens time to antifungal therapy and thereby reduces mortality of sepsis patients with high risk of invasive Candida infection (ICI). Multicenter, randomized, controlled trial carried out between September 2016 and September 2019 in 18 intensive care units enrolling adult sepsis patients at high risk for ICI. Patients in the control group received targeted antifungal therapy driven by culture results. In addition to targeted therapy, patients in the BDG group received antifungals if at least one of two consecutive BDG samples taken during the first two study days was ≥ 80 pg/mL. Empirical antifungal therapy was discouraged in both groups. The primary endpoint was 28-day-mortality. 339 patients were enrolled. ICI was diagnosed in 48 patients (14.2%) within the first 96 h after enrollment. In the BDG-group, 48.8% (84/172) patients received antifungals during the first 96 h after enrollment and 6% (10/167) patients in the control group. Death until day 28 occurred in 58 of 172 patients (33.7%) in the BDG group and 51 of 167 patients (30.5%) in the control group (relative risk 1.10; 95% confidence interval, 0.80-1.51; p = 0.53). Median time to antifungal therapy was 1.1 [interquartile range (IQR) 1.0-2.2] days in the BDG group and 4.4 (IQR 2.0-9.1, p < 0.01) days in the control group. Serum BDG guided antifungal treatment did not improve 28-day mortality among sepsis patients with risk factors for but unexpected low rate of IC. This study cannot comment on the potential benefit of BDG-guidance in a more selected at-risk population.
Identifiants
pubmed: 35708758
doi: 10.1007/s00134-022-06733-x
pii: 10.1007/s00134-022-06733-x
pmc: PMC9273538
doi:
Substances chimiques
Antifungal Agents
0
Glucans
0
beta-Glucans
0
Banques de données
ClinicalTrials.gov
['NCT02734550']
Types de publication
Journal Article
Multicenter Study
Randomized Controlled Trial
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
865-875Subventions
Organisme : Bundesministerium für Bildung und Forschung
ID : 01EO1502
Organisme : Deutsche Forschungsgemeinschaft
ID : 390713860
Organisme : Deutsche Forschungsgemeinschaft
ID : PU219/2-3
Investigateurs
Ulrich Jaschinski
(U)
Christian Putensen
(C)
Matthias Drüner
(M)
Ixchel Castellanos
(I)
Stefanie Schmidt
(S)
Andreas Wehrfritz
(A)
Diana Kränzlein
(D)
Jürgen Held
(J)
Kai Zacharowski
(K)
Haitham Mutlak
(H)
Simone Lindau
(S)
Carolin Wiedenbeck
(C)
Onnen Mörer
(O)
Sven-Olaf Kuhn
(SO)
Matthias Gründling
(M)
Stephan Kluge
(S)
Geraldine de Heer
(G)
Dominik Jarczak
(D)
Johann Motsch
(J)
Daniel Richter
(D)
Markus A Weigand
(MA)
Frank Bloos
(F)
Michael Bauer
(M)
Daniel Thomas-Rüddel
(D)
Peter Schlattmann
(P)
Thomas Lehmann
(T)
Norbert Weiler
(N)
Dirk Schädler
(D)
Oliver A Cornely
(OA)
Philipp Simon
(P)
Gunther Hempel
(G)
Raphael Weiss
(R)
Alexander Zarbock
(A)
Ulf Günther
(U)
Georg Rohe
(G)
Andreas Weyland
(A)
Oliver Kurzai
(O)
Grit Walter
(G)
Patrick Meybohm
(P)
Philipp Helmer
(P)
Commentaires et corrections
Type : CommentIn
Informations de copyright
© 2022. The Author(s).
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