title: Micafungin versus anidulafungin in critically ill patients with invasive candidiasis: a retrospective study.
abstract: In critically ill patients the incidence of invasive fungal infections caused by Candida spp. has increased remarkably. Echinocandins are recommended as initial treatment for invasive fungal infections. The safety and efficacy of micafungin compared to caspofungin is similar, but no comparison is made between anidulafungin and micafungin concerning safety and efficacy. We therefore performed a retrospective study to assess these aspects in critically ill patients with invasive candidiasis.
  
  
  
  All patients in the intensive care unit (ICU) with invasive candidiasis, who were only treated with anidulafungin or micafungin, between January 2012 and December 2014 were retrospectively included. Baseline demographic characteristics, infection characteristics and patient courses were assessed.
  
  
  
  A total of 63 patients received either anidulafungin (n = 30) or micafungin (n = 33) at the discretion of the attending intensivist. Baseline characteristics were comparable between the two groups, suggesting similar risk for developing invasive candidiasis. Patients with invasive candidiasis and liver failure were more often treated with anidulafungin than micafungin. Response rates were similar for both groups. No difference was observed in 28-day mortality, but 90-day mortality was higher in patients on anidulafungin. Multivariable cox regression analysis showed that age and serum bilirubin were the best parameters for the prediction of 90-day mortality, whereas APACHE II, Candida score and antifungal therapy did not contribute (P > 0.05). None of the patients developed impaired liver function related to antifungal use and no differences were seen in prothrombin time, serum transaminases and bilirubin levels between the groups, after exclusion of patients with liver injury or failure.
  
  
  
  Micafungin can be safely and effectively used in critically ill patients with invasive candidiasis. The observed increased 90-day mortality with anidulafungin can be explained by intensivists unnecessarily avoiding micafungin in patients with liver injury and failure.
authors.affiliation: Department of Intensive Care Medicine, Erasmus University Medical Center, 's Gravendijkwal 230, 3015 CE, Rotterdam, The Netherlands. p.vandergeest@erasmusmc.nl.
authors.forename: Patrick J
authors.initials: PJ
authors.lastname: van der Geest
authors.affiliation: Department of Intensive Care Medicine, Erasmus University Medical Center, 's Gravendijkwal 230, 3015 CE, Rotterdam, The Netherlands.|Department of Pharmacy, Erasmus University Medical Center, 's Gravendijkwal 230, Rotterdam, 3015 CE, The Netherlands.
authors.forename: Nicole G M
authors.initials: NG
authors.lastname: Hunfeld
authors.affiliation: Department of Intensive Care Medicine, Erasmus University Medical Center, 's Gravendijkwal 230, 3015 CE, Rotterdam, The Netherlands.
authors.forename: Sophie E
authors.initials: SE
authors.lastname: Ladage
authors.affiliation: Department of Intensive Care Medicine, Erasmus University Medical Center, 's Gravendijkwal 230, 3015 CE, Rotterdam, The Netherlands.
authors.forename: A B Johan
authors.initials: AB
authors.lastname: Groeneveld
mesh_terms: D018806:APACHE; D000077612:Anidulafungin; D000935:Antifungal Agents / Q000191:economics / Q000627:therapeutic use*; D058365:Candidiasis, Invasive / Q000188:drug therapy*; D016638:Critical Illness; D054714:Echinocandins / Q000191:economics / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D007362:Intensive Care Units; D055666:Lipopeptides / Q000191:economics / Q000627:therapeutic use*; D008099:Liver / Q000187:drug effects / Q000201:enzymology; D008111:Liver Function Tests; D008297:Male; D000077551:Micafungin; D008875:Middle Aged; D012044:Regression Analysis; D012189:Retrospective Studies; D016896:Treatment Outcome
chemical_list: D000935:Antifungal Agents; D054714:Echinocandins; D055666:Lipopeptides; D000077612:Anidulafungin; D000077551:Micafungin
keywords: Anidulafungin; Critically ill; Invasive candidiasis; Micafungin