title: Impact of echinocandin on prognosis of proven invasive candidiasis in ICU: A post-hoc causal inference model using the AmarCAND2 study.
abstract: guidelines recommend first-line systemic antifungal therapy (SAT) with echinocandins in invasive candidiasis (IC), especially in critically ill patients. This study aimed at assessing the impact of echinocandins compared to azoles as initial SAT on the 28-day prognosis in adult ICU patients.
  
  
  
  From the prospective multicenter AmarCAND2 cohort (835 patients), we selected those with documented IC and treated with echinocandins (ECH) or azoles (AZO). The average causal effect of echinocandins on 28-day mortality was assessed using an inverse probability of treatment weight (IPTW) estimator.
  
  
  
  397 patients were selected, treated with echinocandins (242 patients, 61%) or azoles (155 patients, 39%); septic shock: 179 patients (45%). The median SAPSII was higher in the ECH group (48 [35; 62] vs. 43 [31; 58], p = 0.01). Crude mortality was 34% (ECH group) vs. 25% (AZO group). After adjustment on baseline confounders, no significant association emerged between initial SAT with echinocandins and 28-day mortality (HR: 0.95; 95% CI: [0.60; 1.49]; p = 0.82). However, echinocandin tended to benefit patients with septic shock (HR: 0.46 [0.19; 1.07]; p = 0.07).
  
  
  
  Patients who received echinocandins were more severely ill. Echinocandin use was associated with a non-significant 7% decrease of 28-day mortality and a trend to a beneficial effect for patient with septic shock.
authors.affiliation: Inserm UMR 1137 - IAME Team 5 - DeSCID: Decision Sciences in Infectious Diseases, Control and Care INSERM/ Paris Diderot, Sorbonne Paris Cité University, Paris, France.
authors.forename: Sébastien
authors.initials: S
authors.lastname: Bailly
authors.affiliation: Medical ICU, Chatiliez Hospital, Tourcoing, France.
authors.forename: Olivier
authors.initials: O
authors.lastname: Leroy
authors.affiliation: Medical ICU, Saint-Louis University Hospital, Paris, France.
authors.forename: Elie
authors.initials: E
authors.lastname: Azoulay
authors.affiliation: Paris Diderot Sorbonne Cite University, and Anesthesiology and Critical Care Medicine, Bichat-Claude Bernard University Hospital, APHP, Paris, France.
authors.forename: Philippe
authors.initials: P
authors.lastname: Montravers
authors.affiliation: Perioperative Medicine Department, Clermont-Ferrand University Hospital, Clermont-Ferrand, France.
authors.forename: Jean-Michel
authors.initials: JM
authors.lastname: Constantin
authors.affiliation: Surgical ICU, Amiens University Hospital, Amiens, France.
authors.forename: Hervé
authors.initials: H
authors.lastname: Dupont
authors.affiliation: Inserm UMR 1181, Biostatistics, Biomathematics, Pharmacoepidemiology and Infectious Diseases, (B2PHI), F-75015, Paris, France.
authors.forename: Didier
authors.initials: D
authors.lastname: Guillemot
authors.affiliation: University Paris Descartes, Necker Pasteur Center for Infectious Diseases, Necker Enfants-Malades Hospital, IHU Imagine, Paris, France; Pasteur Institute, National Reference Center for Invasive Mycoses and Antifungals, CNRS URA3012, Paris, France.
authors.forename: Olivier
authors.initials: O
authors.lastname: Lortholary
authors.affiliation: Medical ICU, Cochin University Hospital, APHP, and Paris Descartes, Sorbonne Paris Cité University, Paris, France.
authors.forename: Jean-Paul
authors.initials: JP
authors.lastname: Mira
authors.affiliation: Medical-surgical ICU, Montpellier University Hospital, Montpellier, France.
authors.forename: Pierre-François
authors.initials: PF
authors.lastname: Perrigault
authors.affiliation: Mycology, Rennes University Hospital, Rennes, France.
authors.forename: Jean-Pierre
authors.initials: JP
authors.lastname: Gangneux
authors.affiliation: Inserm UMR 1137 - IAME Team 5 - DeSCID: Decision Sciences in Infectious Diseases, Control and Care INSERM/ Paris Diderot, Sorbonne Paris Cité University, Paris, France; Medical ICU, Paris Diderot University/Bichat University Hospital, APHP, Paris, France.
authors.forename: Jean-François
authors.initials: JF
authors.lastname: Timsit
mesh_terms: D000368:Aged; D000935:Antifungal Agents / Q000009:adverse effects / Q000627:therapeutic use*; D001393:Azoles / Q000627:therapeutic use; D002175:Candida / Q000302:isolation & purification; D002177:Candidiasis / Q000175:diagnosis / Q000188:drug therapy* / Q000382:microbiology / Q000401:mortality; D058365:Candidiasis, Invasive / Q000175:diagnosis / Q000188:drug therapy* / Q000382:microbiology / Q000401:mortality; D054714:Echinocandins / Q000009:adverse effects / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D007362:Intensive Care Units; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D011446:Prospective Studies
chemical_list: D000935:Antifungal Agents; D001393:Azoles; D054714:Echinocandins
keywords: Echinocandin; Fluconazole; IPTW estimator; Invasive candidiasis; Patient prognosis