title: A practice-based observational study on the use of micafungin in Surgical Critical Care Units.
abstract: BACKGROUND
  Echinocandins are first-line therapy in critically ill patients with invasive Candida infection (ICI). This study describes our experience with micafungin at Surgical Critical Care Units (SCCUs).
  
  
  METHODS
  A multicenter, observational, retrospective study was performed (12 SCCUs) by reviewing all adult patients receiving 100 mg/24h micafungin for ≥72h during ad-mission (April 2011-July 2013). Patients were divided by ICI category (possible, probable + proven), 24h-SOFA (<7, ≥7) and outcome.
  
  
  RESULTS
  72 patients were included (29 possible, 13 probable, 30 proven ICI). Forty patients (55.6%) presented SOFA ≥7. Up to 78.0% patients were admitted after urgent surgery (64.3% with SOFA <7 vs. 90.3% with SOFA ≥7, p=0.016), and 84.7% presented septic shock. In 66.7% the site of infection was intraabdominal. Forty-nine isolates were recovered (51.0% C. albicans). Treatment was empirical (59.7%), microbiologically directed (19.4%), rescue therapy (15.3%), or anticipated therapy and prophylaxis (2.8% each). Empirical treatment was more frequent (p<0.001) in possible versus probable + proven ICI (86.2% vs. 41.9%). Treatment (median) was longer (p=0.002) in probable + proven versus possible ICI (13.0 vs. 8.0 days). Favorable response was 86.1%, without differences by group. Age, blood Candida isolation, rescue therapy, final MELD value and %MELD variation were significantly higher in patients with non-favorable response. In the multivariate analysis (R2=0.246, p<0.001) non-favorable response was associated with positive %MELD variations (OR=15.445, 95%CI= 2.529-94.308, p=0.003) and blood Candida isolation (OR=11.409, 95%CI=1.843-70.634, p=0.009).
  
  
  CONCLUSIONS
  High favorable response was obtained, with blood Candida isolation associated with non-favorable response, in this series with high percentage of patients with intraabdominal ICI, septic shock and microbiological criteria for ICI.
authors.affiliation: Emilio Maseda, Anesthesiology and Surgical Critical Care Department, Hospital Universitario La Paz, Paseo de la Castellana 261, 28046 Madrid, Spain. emilio.maseda@gmail.com.
authors.forename: Emilio
authors.initials: E
authors.lastname: Maseda
authors.forename: Carlos A
authors.initials: CA
authors.lastname: García-Bernedo
authors.forename: Isabel
authors.initials: I
authors.lastname: Frías
authors.forename: José-Alejandro
authors.initials: JA
authors.lastname: Navarro
authors.forename: Jesús
authors.initials: J
authors.lastname: Rico
authors.forename: Reyes
authors.initials: R
authors.lastname: Iranzo
authors.forename: Juan-José
authors.initials: JJ
authors.lastname: Granizo
authors.forename: María-José
authors.initials: MJ
authors.lastname: Villagrán
authors.forename: Enric
authors.initials: E
authors.lastname: Samsó
authors.forename: Fernando
authors.initials: F
authors.lastname: Gilsanz
mesh_terms: D000328:Adult; D000368:Aged; D058365:Candidiasis, Invasive / Q000188:drug therapy / Q000453:epidemiology; D003422:Critical Care / Q000706:statistics & numerical data*; D003428:Cross Infection / Q000188:drug therapy* / Q000453:epidemiology; D003953:Diagnosis-Related Groups; D054714:Echinocandins / Q000627:therapeutic use*; D005260:Female; D016469:Fungemia / Q000188:drug therapy / Q000453:epidemiology; D017052:Hospital Mortality; D006801:Humans; D007362:Intensive Care Units / Q000706:statistics & numerical data*; D007902:Length of Stay / Q000706:statistics & numerical data; D055666:Lipopeptides / Q000627:therapeutic use*; D008297:Male; D000077551:Micafungin; D008875:Middle Aged; D009102:Multiple Organ Failure / Q000453:epidemiology; D009181:Mycoses / Q000188:drug therapy* / Q000517:prevention & control; D011183:Postoperative Complications / Q000188:drug therapy* / Q000453:epidemiology; D012189:Retrospective Studies; D012720:Severity of Illness Index; D012772:Shock, Septic / Q000188:drug therapy / Q000453:epidemiology; D013030:Spain / Q000453:epidemiology; D016896:Treatment Outcome
chemical_list: D054714:Echinocandins; D055666:Lipopeptides; D000077551:Micafungin