Treatment of candidemia and invasive candidiasis in the intensive care unit: post hoc analysis of a randomized, controlled trial comparing micafungin and liposomal amphotericin B. Critical care (London, England) [Crit Care] Journal article | | Title | Treatment of candidemia and invasive candidiasis in the intensive care unit: post hoc analysis of a randomized, controlled trial comparing micafungin and liposomal amphotericin B. | | Author(s) | Dupont BF, Lortholary O, Ostrosky-Zeichner L, Stucker F, Yeldandi V | | Source | Crit Care 2009 Oct 5; 13(5):R159. | | Abstract | ABSTRACT:
INTRODUCTION: Invasive candidiasis and candidemia are life-threatening nosocomial infections in intensive care patients.
METHODS: A post hoc analysis of a Phase 3 trial assessing micafungin (100 mg/day for subjects >40 kg; 2 mg/kg/day for subjects [less than or equal to]40 kg) versus liposomal amphotericin B [3 mg/kg/day]. Subgroups were defined according to the type of ward on the first day of treatment: ICU or non-ICU. Multivariate regression was performed to identify factors associated with treatment success at end of therapy and all-cause mortality at days 8 and 30.
RESULTS: In non-ICU subjects, treatment success was significantly higher for micafungin versus liposomal amphotericin B (85% [n = 108/127] versus 72.1% [n = 98/136]; P = 0.0113). However, for ICU subjects, treatment success rates for micafungin versus liposomal amphotericin B were similar (62.5% [n = 75/120] versus 66.4% [n = 73/110]; P = 0.5828). Overall, treatment success was significantly lower in ICU subjects compared with non-ICU subjects (64.3% [n = 148/230] versus 78.3% [n = 206/263]; P = 0.0006). Multivariate regression analysis revealed a lower likelihood of treatment success for: ICU versus non-ICU subjects; persistent neutropenia; and high versus low APACHE II scores. However, when interactions between potential explanatory factors were included in the analysis model, ICU status no longer emerged as a significant associated variable but the association between APACHE II score and treatment outcome remained. Further analyses indicated that the likelihood of mortality at day 8 and day 30 was lower for subjects with lower APACHE II scores. Renal function was significantly better in micafungin versus liposomal amphotericin B subjects: a difference (liposomal amphotericin B micafungin) in mean peak change in estimated glomerular filtration rate (mL per min per 1.73 m2) of 18.2 (P < 0.0001) and 17.7 (P = 0.0124) in non-ICU and ICU subjects, respectively.
CONCLUSIONS: Overall, ICU subjects had lower treatment success rates than non-ICU subjects for both liposomal amphotericin B and micafungin. Multivariate regression after controlling for potential confounding factors suggested APACHE II score remained a potential explanatory factor associated with treatment success, mortality at day 8, and mortality at day 30. Trial registration: Post hoc analysis - clinicaltrials.gov trial NCT00106288. | | Language | ENG | | Pub Type(s) | JOURNAL ARTICLE
| | PubMed ID | 19804626 |
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