title: [Patients treated with micafungin during their stay in intensive care unit].
abstract: OBJECTIVE
  To determine the reasons of prescription, the characteristics of patients and factors that affected the outcome of critically ill patients treated with micafungin (MCF) during their stay in Spanish ICUs.
  
  
  METHODS
  Observational, retrospective and multicenter study. Patients admitted to the ICU between March 2011 and October 2012 (20-month period) treated with MCF for any reason were included in the study. Severity of patients at the beginning of treatment was measured with the APACHE II, SOFA, Child-Pugh and MELD scores. Reasons for the use of MCF were classified as prophylaxis, preemptive treatment, empirical treatment and directed treatment. Continuous variables are expressed as mean and standard deviation or median, and categorical variables as percentages. A multivariate analysis was performed to identify variables related to intra-ICU mortality.
  
  
  RESULTS
  The study population included 139 patients admitted to 19 Spanish ICUs, with a mean age of 57.3 (17.1) years, 89 (64%) men, with surgical (53.2%) and/or medical (44.6%) conditions, APACHE II score of 20.6 (7.7) and SOFA score of 8.4 (4.3), with 84.2% of patients requiring mechanical ventilation, 59% parenteral nutrition, 37.4% extrarenal depuration procedures and 37.4% treatment with steroids. MCF was indicated as empirical treatment of a proven infection in 51 (36.7%) cases, pre-emptive treatment in 50 (36%) especially as a result of the application of the Candida score (32 cases), directed treatment of fungal infection in 23 (16.5%) and as prophylactic treatment in 15 (10.8%) cases. In 108 (77%) cases, a daily dose of 100mg was administered, with a loading dose in only 9 cases (6.5%). The mean duration of treatment was 13.1 (13) days. A total of 59 (42.4%) patients died during their stay in the ICU and 16 after ICU discharge (hospital mortality 53.9%). Independent risk factors for intra-ICU mortality were the Child-Pugh score (OR 1.45, 95% CI 1.162-1.813; P=.001) and the MELD score (OR 1.05, 95% CI 1.011-1.099; P=.014).
  
  
  CONCLUSIONS
  MCF is usually administered at a dose of 100mg/day, without loading dose and in 72.7% of cases as pre-emptive or empirical treatment. Factors that better predicted mortality were indicators of liver insufficiency at the time of starting treatment.
authors: Servicio de Medicina Intensiva, Hospital del Mar, Parc de Salut Mar, Barcelona, España. Electronic address: Falvarez@parcdesalutmar.cat.
authors: F
authors: F
authors: Álvarez-Lerma
authors: Servicio de Farmacia, Hospital del Mar, Parc de Salut Mar, Barcelona, España.
authors: S
authors: S
authors: Grau
authors: Servicio de Medicina Intensiva, Hospital Vall d'Hebrón, Barcelona, España.
authors: C
authors: C
authors: López
authors: Servicio de Medicina Intensiva, Hospital Don Benito, Villanueva Badajoz, España.
authors: J D
authors: JD
authors: Jiménez
authors: Servicio de Medicina Intensiva, Hospital Infanta Cristina, Badajoz, España.
authors: M V
authors: MV
authors: Trasmonte
authors: Servicio de Medicina Intensiva, Hospital Clínico San Carlos, Madrid, España.
authors: M
authors: M
authors: Nieto
authors: Servicio de Medicina Intensiva, Hospital La Vega, Murcia, España.
authors: G
authors: G
authors: Parra
authors: Servicio de Medicina Intensiva, Hospital Torrevieja Salud, Torrevieja, Alicante, España.
authors: E
authors: E
authors: Herrero
mesh_terms: D000328:Adult; D000368:Aged; D000935:Antifungal Agents / Q000627:therapeutic use*; D003131:Combined Modality Therapy; D003422:Critical Care / Q000379:methods*; D054714:Echinocandins / Q000627:therapeutic use*; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D007362:Intensive Care Units; D007902:Length of Stay; D055666:Lipopeptides / Q000627:therapeutic use*; D017093:Liver Failure / Q000150:complications; D008297:Male; D000077551:Micafungin; D008875:Middle Aged; D009181:Mycoses / Q000188:drug therapy* / Q000517:prevention & control; D011183:Postoperative Complications / Q000188:drug therapy; D012189:Retrospective Studies; D012720:Severity of Illness Index; D013030:Spain / Q000453:epidemiology
chemical_list: D000935:Antifungal Agents; D054714:Echinocandins; D055666:Lipopeptides; D000077551:Micafungin
keywords: Critically ill patients; Factores pronóstico; Indicaciones; Indications; Intensive care unit; Micafungin; Micafungina; Paciente crítico; Prognostic factors; Unidad de cuidados intensivos