Antifungal use in immunocompetent, critically ill patients with pneumonia does not improve clinical outcomes

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Abstract

Purpose

To determine if treating bronchoalveolar lavage (BAL) culture-positive patients with antifungal therapy impacted mortality compared to not treating due to presumed colonization.

Methods

We conducted a retrospective study of immunocompetent, critically ill adult patients from 2010 to 2014. Patients with a BAL culture-positive for Candida or unspeciated yeast and a clinical suspicion of pneumonia were included. The treatment group received an antifungal agent for at least 5 days, and the control group received either no antifungal therapy or an antifungal agent for less than 48 h. Recruitment occurred in a 2:1 ratio of untreated versus treated patients.

Results

Seventy-five patients were included. In-hospital mortality was similar between treated and untreated groups (24% vs. 26%, P = 0.85). Length of stay and duration of mechanical ventilation also did not differ between the two groups.

Conclusion

We did not observe a difference in mortality or clinical outcomes in patients treated with antifungal agents. Presumptive antifungal therapy for BAL-positive Candida or yeast in immunocompetent patients did not result in improved clinical outcomes.

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