title: Factors predicting prolonged empirical antifungal treatment in critically ill patients.
abstract: OBJECTIVE
  To determine the incidence, risk factors, and impact on outcome of prolonged empirical antifungal treatment in ICU patients.
  
  
  METHODS
  Retrospective observational study performed during a one-year period. Patients who stayed in the ICU >48 h, and received empirical antifungal treatment were included. Patients with confirmed invasive fungal disease were excluded. Prolonged antifungal treatment was defined as percentage of days in the ICU with antifungals > median percentage in the whole cohort of patients.
  
  
  RESULTS
  Among the 560 patients hospitalized for >48 h, 153 (27%) patients received empirical antifungal treatment and were included in this study. Fluconazole was the most frequently used antifungal (46% of study patients). Median length of ICU stay was 19 days (IQR 8, 34), median duration of antifungal treatment was 8 days (IQR 3, 16), and median percentage of days in the ICU with antifungals was 48% (IQR 25, 80). Seventy-seven patients (50%) received prolonged empirical antifungal treatment. Chemotherapy (OR [95% CI] 2.6 [1.07-6.69], p = 0.034), and suspected infection at ICU admission (3.1 [1.05-9.48], p = 0.041) were independently associated with prolonged empirical antifungal treatment. Duration of mechanical ventilation and ICU stay were significantly shorter in patients with prolonged empirical antifungal treatment compared with those with no prolonged empirical antifungal treatment. However, ICU mortality was similar in the two groups (46 versus 52%, p = 0.62).
  
  
  CONCLUSIONS
  Empirical antifungal treatment was prescribed in a large proportion of study patients. Chemotherapy, and suspicion of infection at ICU admission are independently associated with prolonged empirical antifungal treatment.
authors.forename: Mohamed
authors.initials: M
authors.lastname: Zein
authors.forename: Erika
authors.initials: E
authors.lastname: Parmentier-Decrucq
authors.forename: Amer
authors.initials: A
authors.lastname: Kalaoun
authors.forename: Olivier
authors.initials: O
authors.lastname: Bouton
authors.forename: Frédéric
authors.initials: F
authors.lastname: Wallyn
authors.forename: Anne
authors.initials: A
authors.lastname: Baranzelli
authors.forename: Dia
authors.initials: D
authors.lastname: Elmanser
authors.forename: Boualem
authors.initials: B
authors.lastname: Sendid
authors.affiliation: Pôle de Réanimation Médicale, CHRU de Lille, Hôpital Salengro, Lille, France. s-nseir@chru-lille.fr.
authors.forename: Saad
authors.initials: S
authors.lastname: Nseir
mesh_terms: D000328:Adult; D000935:Antifungal Agents / Q000627:therapeutic use*; D016638:Critical Illness; D005260:Female; D006801:Humans; D015994:Incidence; D007362:Intensive Care Units; D008297:Male; D009181:Mycoses / Q000188:drug therapy* / Q000453:epidemiology*; D012189:Retrospective Studies; D012307:Risk Factors; D016896:Treatment Outcome
chemical_list: D000935:Antifungal Agents