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(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...
Autores principales: | , , , , , , , , , , , , , , , , , , , , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Springer Berlin Heidelberg
2022
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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 |
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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 |
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