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<publisher>HAL CCSD</publisher>
<title lang=en>Systemic antifungal therapy for proven or suspected invasive candidiasis: the AmarCAND 2 study</title>
<creator>Leroy, Olivier</creator>
<creator>Bailly, Sébastien</creator>
<creator>Gangneux, Jean-Pierre</creator>
<creator>Mira, Jean-Paul</creator>
<creator>Devos, Patrick</creator>
<creator>Dupont, Hervé</creator>
<creator>Montravers, Philippe</creator>
<creator>Perrigault, Pierre-François</creator>
<creator>Constantin, Jean-Michel</creator>
<creator>Guillemot, Didier</creator>
<creator>Azoulay, Élie</creator>
<creator>Lortholary, Olivier</creator>
<creator>Bensoussan, Caroline</creator>
<creator>Timsit, Jean-François</creator>
<contributor>Institut d'oncologie/développement Albert Bonniot de Grenoble (INSERM U823) ; Université Joseph Fourier - Grenoble 1 (UJF) - CHU Grenoble - EFS - Institut National de la Santé et de la Recherche Médicale (INSERM)</contributor>
<contributor>Institut de recherche, santé, environnement et travail [Rennes] (Irset) ; Université d'Angers (UA) - Université des Antilles et de la Guyane (UAG) - Université de Rennes 1 (UR1) - École des Hautes Études en Santé Publique [EHESP] (EHESP) - Institut National de la Santé et de la Recherche Médicale (INSERM) - Structure Fédérative de Recherche en Biologie et Santé de Rennes ( Biosit : Biologie - Santé - Innovation Technologique )</contributor>
<contributor>Service de Parasitologie-Mycologie [Rennes] ; Université de Rennes 1 (UR1) - Hôpital Pontchaillou - CHU Pontchaillou [Rennes]</contributor>
<contributor>Institut Cochin (UM3 (UMR 8104 / U1016)) ; Université Paris Descartes - Paris 5 (UPD5) - Institut National de la Santé et de la Recherche Médicale (INSERM) - Centre National de la Recherche Scientifique (CNRS)</contributor>
<contributor>Service de Réanimation polyvalente ; Assistance publique - Hôpitaux de Paris (AP-HP) - CHU Cochin [AP-HP] - Université Paris Descartes - Paris 5 (UPD5)</contributor>
<contributor>Département de biostatistiques ; Université de Lille, Droit et Santé</contributor>
<contributor>CHU Amiens-Picardie</contributor>
<contributor>Service d'anesthésie - réanimation chirurgicale ; Assistance publique - Hôpitaux de Paris (AP-HP) - Hôpital Bichat - Claude Bernard [Paris] - Université Paris Diderot - Paris 7 (UPD7)</contributor>
<contributor>Département anesthésie et réanimation ; CHU Clermont-Ferrand - Hôpital d'Estaing</contributor>
<contributor>Pharmacoépidémiologie et maladies infectieuses (PhEMI) ; Institut Pasteur [Paris] - Institut National de la Santé et de la Recherche Médicale (INSERM)</contributor>
<contributor>Hôpital Raymond Poincaré</contributor>
<contributor>Hopital Saint Louis Paris ; CHU</contributor>
<contributor>Centre d’Infectiologie Necker Pasteur ; Assistance publique - Hôpitaux de Paris (AP-HP) - Université Paris Descartes - Paris 5 (UPD5) - CHU Necker - Enfants Malades [AP-HP]</contributor>
<contributor>Imagine - Institut des maladies génétiques (IMAGINE - U1163) ; Institut National de la Santé et de la Recherche Médicale (INSERM) - Université Paris Descartes - Paris 5 (UPD5) - Centre National de la Recherche Scientifique (CNRS)</contributor>
<contributor>Unité de Soins Intensifs et de Maladies Infectieuses ; Assistance publique - Hôpitaux de Paris (AP-HP) - Hôpital Bichat - Claude Bernard [Paris]</contributor>
<description>International audience</description>
<source>ISSN: 2110-5820</source>
<source>Annals of Intensive Care</source>
<publisher>BioMed Central</publisher>
<identifier>hal-01259216</identifier>
<identifier>https://hal-univ-rennes1.archives-ouvertes.fr/hal-01259216</identifier>
<source>https://hal-univ-rennes1.archives-ouvertes.fr/hal-01259216</source>
<source>Annals of Intensive Care, BioMed Central, 2016, 6 (1), pp.2. 〈10.1186/s13613-015-0103-7〉</source>
<identifier>DOI : 10.1186/s13613-015-0103-7</identifier>
<relation>info:eu-repo/semantics/altIdentifier/doi/10.1186/s13613-015-0103-7</relation>
<identifier>PUBMED : 26743881</identifier>
<relation>info:eu-repo/semantics/altIdentifier/pmid/26743881</relation>
<language>en</language>
<subject lang=en>Candida</subject>
<subject lang=en> Candidaemia</subject>
<subject lang=en> Candidiasis</subject>
<subject lang=en> Cohort study</subject>
<subject lang=en> Critically ill</subject>
<subject lang=en> Intensive Care</subject>
<subject>[SDV] Life Sciences [q-bio]</subject>
<type>info:eu-repo/semantics/article</type>
<type>Journal articles</type>
<description lang=en>BACKGROUND: In the context of recent guidelines on invasive candidiasis (IC), how French intensive care units (ICUs) are managing IC? METHODS: This is a prospective observational multicenter cohort study. During 1 year (2012-2013), 87 French ICUs enrolled consecutive patients with suspected or proven IC (SIC or PIC) and receiving systemic antifungal therapy (SAT). Data were collected up to 28 days after inclusion. RESULTS: We studied 835 patients, 291 with PIC and 544 with SIC. At SAT initiation, patients with SIC were significantly more severe (SAPS II 50.1 ± 18.7 vs. 46.2 ± 18.0). Severe sepsis or septic shock prompted to initiate empiric SAT in 70 % of SIC. Within 4 days in median, the initial SAT was modified in 49 % of patients with PIC vs. 33 % patients with SIC. Modifications were most often motivated by mycological results, and de-escalation was the most frequent change. Regarding compliance to IC management guidelines, echinocandin was used for 182 (62.5 %) patients with PIC, and 287 (52.7 %) of those with SIC; central venous catheter was removed in 87 (54.3 %) of patients with candidaemia, and 43 of the remaining patients received echinocandin; and de-escalation was undertaken after 5 days of SAT in 142 patients, after 10 days in 13 patients. As 20.6 % of SIC were secondarily documented, 403/835 (48 %) patients had finally a proven IC. Candida albicans was the main pathogen (65.3 %), then Candida glabrata (15.9 %). The 28-day mortality rates were 40.0 % in candidaemia, 25.4 % in cIAI, and 26.7 % in deep-seated candidiasis. In the overall population of patients with proven IC, four independent prognostic factors were identified: immunosuppression (Odds Ratio (OR) = 1.977: 1.03-3.794 95 % confidence interval (CI), p = 0.04), age (OR = 1.035; 1.017-1.053 95 % CI; p extless 0.001), SAPS extgreater46 on ICU admission (OR = 2.894; 1.81-4.626 95 % CI; p extless 0.001), and surgery just before or during ICU stay (OR = 0.473; 0.29-0.77 95 % CI; p extless 0.001). CONCLUSION: When SAT is initiated in French ICUs, the IC is ultimately proven for 48 % of patients. Empiric SAT is initiated in severely ill ICU patients. The initial SAT is often adapted, with de-escalation to fluconazole when possible. Mortality rate remains high</description>
<date>2016-12</date>
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