Cargando…

(1 → 3)-β-d-Glucan-guided antifungal therapy in adults with sepsis: the CandiSep randomized clinical trial

PURPOSE: 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). METHODS: Multicenter, randomized, controlled trial carried out between September 2016 and Septemb...

Descripción completa

Detalles Bibliográficos
Autores principales: Bloos, Frank, Held, Jürgen, Kluge, Stefan, Simon, Philipp, Kogelmann, Klaus, de Heer, Geraldine, Kuhn, Sven-Olaf, Jarczak, Dominik, Motsch, Johann, Hempel, Gunther, Weiler, Norbert, Weyland, Andreas, Drüner, Matthias, Gründling, Matthias, Meybohm, Patrick, Richter, Daniel, Jaschinski, Ulrich, Moerer, Onnen, Günther, Ulf, Schädler, Dirk, Weiss, Raphael, Putensen, Christian, Castellanos, Ixchel, Kurzai, Oliver, Schlattmann, Peter, Cornely, Oliver A., Bauer, Michael, Thomas-Rüddel, Daniel
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Springer Berlin Heidelberg 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9273538/
https://www.ncbi.nlm.nih.gov/pubmed/35708758
http://dx.doi.org/10.1007/s00134-022-06733-x
_version_ 1784745099289165824
author Bloos, Frank
Held, Jürgen
Kluge, Stefan
Simon, Philipp
Kogelmann, Klaus
de Heer, Geraldine
Kuhn, Sven-Olaf
Jarczak, Dominik
Motsch, Johann
Hempel, Gunther
Weiler, Norbert
Weyland, Andreas
Drüner, Matthias
Gründling, Matthias
Meybohm, Patrick
Richter, Daniel
Jaschinski, Ulrich
Moerer, Onnen
Günther, Ulf
Schädler, Dirk
Weiss, Raphael
Putensen, Christian
Castellanos, Ixchel
Kurzai, Oliver
Schlattmann, Peter
Cornely, Oliver A.
Bauer, Michael
Thomas-Rüddel, Daniel
author_facet Bloos, Frank
Held, Jürgen
Kluge, Stefan
Simon, Philipp
Kogelmann, Klaus
de Heer, Geraldine
Kuhn, Sven-Olaf
Jarczak, Dominik
Motsch, Johann
Hempel, Gunther
Weiler, Norbert
Weyland, Andreas
Drüner, Matthias
Gründling, Matthias
Meybohm, Patrick
Richter, Daniel
Jaschinski, Ulrich
Moerer, Onnen
Günther, Ulf
Schädler, Dirk
Weiss, Raphael
Putensen, Christian
Castellanos, Ixchel
Kurzai, Oliver
Schlattmann, Peter
Cornely, Oliver A.
Bauer, Michael
Thomas-Rüddel, Daniel
author_sort Bloos, Frank
collection PubMed
description PURPOSE: 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). METHODS: 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. RESULTS: 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. CONCLUSIONS: 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. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1007/s00134-022-06733-x.
format Online
Article
Text
id pubmed-9273538
institution National Center for Biotechnology Information
language English
publishDate 2022
publisher Springer Berlin Heidelberg
record_format MEDLINE/PubMed
spelling pubmed-92735382022-07-13 (1 → 3)-β-d-Glucan-guided antifungal therapy in adults with sepsis: the CandiSep randomized clinical trial Bloos, Frank Held, Jürgen Kluge, Stefan Simon, Philipp Kogelmann, Klaus de Heer, Geraldine Kuhn, Sven-Olaf Jarczak, Dominik Motsch, Johann Hempel, Gunther Weiler, Norbert Weyland, Andreas Drüner, Matthias Gründling, Matthias Meybohm, Patrick Richter, Daniel Jaschinski, Ulrich Moerer, Onnen Günther, Ulf Schädler, Dirk Weiss, Raphael Putensen, Christian Castellanos, Ixchel Kurzai, Oliver Schlattmann, Peter Cornely, Oliver A. Bauer, Michael Thomas-Rüddel, Daniel Intensive Care Med Original PURPOSE: 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). METHODS: 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. RESULTS: 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. CONCLUSIONS: 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. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1007/s00134-022-06733-x. Springer Berlin Heidelberg 2022-06-16 2022 /pmc/articles/PMC9273538/ /pubmed/35708758 http://dx.doi.org/10.1007/s00134-022-06733-x Text en © The Author(s) 2022 https://creativecommons.org/licenses/by-nc/4.0/Open AccessThis article is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License, which permits any non-commercial use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by-nc/4.0/ (https://creativecommons.org/licenses/by-nc/4.0/) .
spellingShingle Original
Bloos, Frank
Held, Jürgen
Kluge, Stefan
Simon, Philipp
Kogelmann, Klaus
de Heer, Geraldine
Kuhn, Sven-Olaf
Jarczak, Dominik
Motsch, Johann
Hempel, Gunther
Weiler, Norbert
Weyland, Andreas
Drüner, Matthias
Gründling, Matthias
Meybohm, Patrick
Richter, Daniel
Jaschinski, Ulrich
Moerer, Onnen
Günther, Ulf
Schädler, Dirk
Weiss, Raphael
Putensen, Christian
Castellanos, Ixchel
Kurzai, Oliver
Schlattmann, Peter
Cornely, Oliver A.
Bauer, Michael
Thomas-Rüddel, Daniel
(1 → 3)-β-d-Glucan-guided antifungal therapy in adults with sepsis: the CandiSep randomized clinical trial
title (1 → 3)-β-d-Glucan-guided antifungal therapy in adults with sepsis: the CandiSep randomized clinical trial
title_full (1 → 3)-β-d-Glucan-guided antifungal therapy in adults with sepsis: the CandiSep randomized clinical trial
title_fullStr (1 → 3)-β-d-Glucan-guided antifungal therapy in adults with sepsis: the CandiSep randomized clinical trial
title_full_unstemmed (1 → 3)-β-d-Glucan-guided antifungal therapy in adults with sepsis: the CandiSep randomized clinical trial
title_short (1 → 3)-β-d-Glucan-guided antifungal therapy in adults with sepsis: the CandiSep randomized clinical trial
title_sort (1 → 3)-β-d-glucan-guided antifungal therapy in adults with sepsis: the candisep randomized clinical trial
topic Original
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9273538/
https://www.ncbi.nlm.nih.gov/pubmed/35708758
http://dx.doi.org/10.1007/s00134-022-06733-x
work_keys_str_mv AT bloosfrank 13bdglucanguidedantifungaltherapyinadultswithsepsisthecandiseprandomizedclinicaltrial
AT heldjurgen 13bdglucanguidedantifungaltherapyinadultswithsepsisthecandiseprandomizedclinicaltrial
AT klugestefan 13bdglucanguidedantifungaltherapyinadultswithsepsisthecandiseprandomizedclinicaltrial
AT simonphilipp 13bdglucanguidedantifungaltherapyinadultswithsepsisthecandiseprandomizedclinicaltrial
AT kogelmannklaus 13bdglucanguidedantifungaltherapyinadultswithsepsisthecandiseprandomizedclinicaltrial
AT deheergeraldine 13bdglucanguidedantifungaltherapyinadultswithsepsisthecandiseprandomizedclinicaltrial
AT kuhnsvenolaf 13bdglucanguidedantifungaltherapyinadultswithsepsisthecandiseprandomizedclinicaltrial
AT jarczakdominik 13bdglucanguidedantifungaltherapyinadultswithsepsisthecandiseprandomizedclinicaltrial
AT motschjohann 13bdglucanguidedantifungaltherapyinadultswithsepsisthecandiseprandomizedclinicaltrial
AT hempelgunther 13bdglucanguidedantifungaltherapyinadultswithsepsisthecandiseprandomizedclinicaltrial
AT weilernorbert 13bdglucanguidedantifungaltherapyinadultswithsepsisthecandiseprandomizedclinicaltrial
AT weylandandreas 13bdglucanguidedantifungaltherapyinadultswithsepsisthecandiseprandomizedclinicaltrial
AT drunermatthias 13bdglucanguidedantifungaltherapyinadultswithsepsisthecandiseprandomizedclinicaltrial
AT grundlingmatthias 13bdglucanguidedantifungaltherapyinadultswithsepsisthecandiseprandomizedclinicaltrial
AT meybohmpatrick 13bdglucanguidedantifungaltherapyinadultswithsepsisthecandiseprandomizedclinicaltrial
AT richterdaniel 13bdglucanguidedantifungaltherapyinadultswithsepsisthecandiseprandomizedclinicaltrial
AT jaschinskiulrich 13bdglucanguidedantifungaltherapyinadultswithsepsisthecandiseprandomizedclinicaltrial
AT moereronnen 13bdglucanguidedantifungaltherapyinadultswithsepsisthecandiseprandomizedclinicaltrial
AT guntherulf 13bdglucanguidedantifungaltherapyinadultswithsepsisthecandiseprandomizedclinicaltrial
AT schadlerdirk 13bdglucanguidedantifungaltherapyinadultswithsepsisthecandiseprandomizedclinicaltrial
AT weissraphael 13bdglucanguidedantifungaltherapyinadultswithsepsisthecandiseprandomizedclinicaltrial
AT putensenchristian 13bdglucanguidedantifungaltherapyinadultswithsepsisthecandiseprandomizedclinicaltrial
AT castellanosixchel 13bdglucanguidedantifungaltherapyinadultswithsepsisthecandiseprandomizedclinicaltrial
AT kurzaioliver 13bdglucanguidedantifungaltherapyinadultswithsepsisthecandiseprandomizedclinicaltrial
AT schlattmannpeter 13bdglucanguidedantifungaltherapyinadultswithsepsisthecandiseprandomizedclinicaltrial
AT cornelyolivera 13bdglucanguidedantifungaltherapyinadultswithsepsisthecandiseprandomizedclinicaltrial
AT bauermichael 13bdglucanguidedantifungaltherapyinadultswithsepsisthecandiseprandomizedclinicaltrial
AT thomasruddeldaniel 13bdglucanguidedantifungaltherapyinadultswithsepsisthecandiseprandomizedclinicaltrial
AT 13bdglucanguidedantifungaltherapyinadultswithsepsisthecandiseprandomizedclinicaltrial