We read with interest the article from Shanin et al. about the Fungal Infection Risk Evaluation (FIRE) study [1] aiming to 'describe the incidence of IFD in UK critical care units and to develop and validate a clinical risk prediction tool to identify non-neutropenic, critically ill adult patients at risk of IFD'. The investigators should be congratulated for the way they collected a huge amount of data from 96 adult intensive care units (ICUs), managed the FIRE database, and developed and validated the risk model. However, they stated that the prediction model would help to identify patients who may benefit from antifungal prophylaxis and that a number of randomized controlled trials (RCTs) demonstrated a beneficial effect of antifungal prophylaxis and/or empiric treatment in terms of incidence of invasive fungal disease (IFD) and mortality. This statement is not supported by available evidence from RCTs. A recent Cochrane Systematic Review including 22 RCTs evaluating prophylaxis, pre-emptive, and empiric antifungal treatment with any antifungal drugs in 2761 non-neutropenic critically ill patients showed no significant effect on mortality (risk ratio (RR) 0.93, 95 % confidence interval (CI) 0.79 to 1.09) and a significant reduction in the risk of invasive fungal infection (IFI) (RR 0.57, 95 % CI 0.39 to 0.83) [2, 3]. In the subgroup analysis for type of intervention, antifungal prophylaxis was not associated with a significant mortality reduction but with a significant reduction of IFI [4]. This systematic review was the update of the one cited in the manuscript and published in 2006 including 12 RCT and 1606 patients.

Cortegiani, A., Russotto, V., Raineri, S., Gregoretti, G., & Giarratano, A. (2016). Should we continue to use prediction tools to identify patients at risk of Candida spp. infection? If yes, why?. CRITICAL CARE, 20(1) [10.1186/s13054-016-1521-0].

Should we continue to use prediction tools to identify patients at risk of Candida spp. infection? If yes, why?

Russotto V.;
2016

Abstract

We read with interest the article from Shanin et al. about the Fungal Infection Risk Evaluation (FIRE) study [1] aiming to 'describe the incidence of IFD in UK critical care units and to develop and validate a clinical risk prediction tool to identify non-neutropenic, critically ill adult patients at risk of IFD'. The investigators should be congratulated for the way they collected a huge amount of data from 96 adult intensive care units (ICUs), managed the FIRE database, and developed and validated the risk model. However, they stated that the prediction model would help to identify patients who may benefit from antifungal prophylaxis and that a number of randomized controlled trials (RCTs) demonstrated a beneficial effect of antifungal prophylaxis and/or empiric treatment in terms of incidence of invasive fungal disease (IFD) and mortality. This statement is not supported by available evidence from RCTs. A recent Cochrane Systematic Review including 22 RCTs evaluating prophylaxis, pre-emptive, and empiric antifungal treatment with any antifungal drugs in 2761 non-neutropenic critically ill patients showed no significant effect on mortality (risk ratio (RR) 0.93, 95 % confidence interval (CI) 0.79 to 1.09) and a significant reduction in the risk of invasive fungal infection (IFI) (RR 0.57, 95 % CI 0.39 to 0.83) [2, 3]. In the subgroup analysis for type of intervention, antifungal prophylaxis was not associated with a significant mortality reduction but with a significant reduction of IFI [4]. This systematic review was the update of the one cited in the manuscript and published in 2006 including 12 RCT and 1606 patients.
Articolo in rivista - Articolo scientifico
Scientifica
Candida spp; Invasive fungal infections; Sepsis;
Candida spp; Invasive fungal infections; Sepsis; Antifungal Agents; Candida; Humans; Risk Factors; Candidiasis; Mycoses
English
Cortegiani, A., Russotto, V., Raineri, S., Gregoretti, G., & Giarratano, A. (2016). Should we continue to use prediction tools to identify patients at risk of Candida spp. infection? If yes, why?. CRITICAL CARE, 20(1) [10.1186/s13054-016-1521-0].
Cortegiani, A; Russotto, V; Raineri, S; Gregoretti, G; Giarratano, A
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Utilizza questo identificativo per citare o creare un link a questo documento: http://hdl.handle.net/10281/275149
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