Antifungal use in immunocompetent, critically ill patients with pneumonia does not improve clinical outcomes.
OBJECTIVE
To determine if treating bronchoalveolar lavage (BAL) culture-positive patients with antifungal therapy impacted mortality compared to not treating due to presumed colonization.


METHODS
We conducted a retrospective study of immunocompetent, critically ill adult patients from 2010 to 2014. Patients with a BAL culture-positive for Candida or unspeciated yeast and a clinical suspicion of pneumonia were included. The treatment group received an antifungal agent for at least 5 days, and the control group received either no antifungal therapy or an antifungal agent for less than 48 h. Recruitment occurred in a 2:1 ratio of untreated versus treated patients.


RESULTS
Seventy-five patients were included. In-hospital mortality was similar between treated and untreated groups (24% vs. 26%, P = 0.85). Length of stay and duration of mechanical ventilation also did not differ between the two groups.


CONCLUSIONS
We did not observe a difference in mortality or clinical outcomes in patients treated with antifungal agents. Presumptive antifungal therapy for BAL-positive Candida or yeast in immunocompetent patients did not result in improved clinical outcomes.
Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY 10065, USA.
Meagan
M
Griffin
Carolinas HealthCare System, Charlotte, NC 28203, USA.
Desiree E
DE
Kosmisky
Carolinas HealthCare System, Charlotte, NC 28203, USA.
Megan A
MA
Templin
Carolinas Medical Center, 1000 Blythe Boulevard, Charlotte, NC 28203, USA.
Toan
T
Huynh
Carolinas Medical Center, 1000 Blythe Boulevard, Charlotte, NC 28203, USA.
Lewis H
LH
McCurdy
Carolinas Medical Center, 1000 Blythe Boulevard, Charlotte, NC 28203, USA.
Timothy R
TR
Pasquale
Carolinas Medical Center, 1000 Blythe Boulevard, Charlotte, NC 28203, USA. Electronic address: Kelly.Martin@CarolinasHealthcare.org.
Kelly E
KE
Martin
D000328:Adult; D000935:Antifungal Agents / Q000627:therapeutic use*; D016638:Critical Illness; D005260:Female; D017052:Hospital Mortality / Q000639:trends; D006801:Humans; D016867:Immunocompromised Host; D008297:Male; D008875:Middle Aged; D053717:Pneumonia, Ventilator-Associated / Q000188:drug therapy* / Q000382:microbiology / Q000401:mortality; D011379:Prognosis; D012121:Respiration, Artificial / Q000009:adverse effects; D012189:Retrospective Studies; D014481:United States / Q000453:epidemiology
D000935:Antifungal Agents
Antifungal agents; Bronchoscopy; Candida; Pneumonia; Yeast