Key Factors Associated With Pulmonary Sequelae in the Follow-Up of Critically Ill COVID-19 Patients.

INTRODUCTION: Critical COVID-19 survivors have a high risk of respiratory sequelae. Therefore, we aimed to identify key factors associated with altered lung function and CT scan abnormalities at a follow-up visit in a cohort of critical COVID-19 survivors. METHODS: Multicenter ambispective observational study in 52 Spanish intensive care units. Up to 1327 PCR-confirmed critical COVID-19 patients had sociodemographic, anthropometric, comorbidity and lifestyle characteristics collected at hospital admission; clinical and biological parameters throughout hospital stay; and, lung function and CT scan at a follow-up visit. RESULTS: The median [p25-p75] time from discharge to follow-up was 3.57 [2.77-4.92] months. Median age was 60 [53-67] years, 27.8% women. The mean (SD) percentage of predicted diffusing lung capacity for carbon monoxide (DLCO) at follow-up was 72.02 (18.33)% predicted, with 66% of patients having DLCO<80% and 24% having DLCO<60%. CT scan showed persistent pulmonary infiltrates, fibrotic lesions, and emphysema in 33%, 25% and 6% of patients, respectively. Key variables associated with DLCO<60% were chronic lung disease (CLD) (OR: 1.86 (1.18-2.92)), duration of invasive mechanical ventilation (IMV) (OR: 1.56 (1.37-1.77)), age (OR [per-1-SD] (95%CI): 1.39 (1.18-1.63)), urea (OR: 1.16 (0.97-1.39)) and estimated glomerular filtration rate at ICU admission (OR: 0.88 (0.73-1.06)). Bacterial pneumonia (1.62 (1.11-2.35)) and duration of ventilation (NIMV (1.23 (1.06-1.42), IMV (1.21 (1.01-1.45)) and prone positioning (1.17 (0.98-1.39)) were associated with fibrotic lesions. CONCLUSION: Age and CLD, reflecting patients' baseline vulnerability, and markers of COVID-19 severity, such as duration of IMV and renal failure, were key factors associated with impaired DLCO and CT abnormalities.

Prognostic implications of comorbidity patterns in critically ill COVID-19 patients: A multicenter, observational study.

Background: The clinical heterogeneity of COVID-19 suggests the existence of different phenotypes with prognostic implications. We aimed to analyze comorbidity patterns in critically ill COVID-19 patients and assess their impact on in-hospital outcomes, response to treatment and sequelae. Methods: Multicenter prospective/retrospective observational study in intensive care units of 55 Spanish hospitals. 5866 PCR-confirmed COVID-19 patients had comorbidities recorded at hospital admission; clinical and biological parameters, in-hospital procedures and complications throughout the stay; and, clinical complications, persistent symptoms and sequelae at 3 and 6 months. Findings: Latent class analysis identified 3 phenotypes using training and test subcohorts: low-morbidity (n=3385; 58%), younger and with few comorbidities; high-morbidity (n=2074; 35%), with high comorbid burden; and renal-morbidity (n=407; 7%), with chronic kidney disease (CKD), high comorbidity burden and the worst oxygenation profile. Renal-morbidity and high-morbidity had more in-hospital complications and higher mortality risk than low-morbidity (adjusted HR (95% CI): 1.57 (1.34-1.84) and 1.16 (1.05-1.28), respectively). Corticosteroids, but not tocilizumab, were associated with lower mortality risk (HR (95% CI) 0.76 (0.63-0.93)), especially in renal-morbidity and high-morbidity. Renal-morbidity and high-morbidity showed the worst lung function throughout the follow-up, with renal-morbidity having the highest risk of infectious complications (6%), emergency visits (29%) or hospital readmissions (14%) at 6 months (p<0.01). Interpretation: Comorbidity-based phenotypes were identified and associated with different expression of in-hospital complications, mortality, treatment response, and sequelae, with CKD playing a major role. This could help clinicians in day-to-day decision making including the management of post-discharge COVID-19 sequelae. Funding: ISCIII, UNESPA, CIBERES, FEDER, ESF.

Consensus Statement on Hemostatic Management, Anticoagulation, and Antiplatelet Therapy in Liver Transplantation.

Anticoagulation and antiplatelet therapies are increasingly used in liver transplant (LT) candidates and recipients due to cardiovascular comorbidities, portal vein thrombosis, or to manage posttransplant complications. The implementation of the new direct-acting oral anticoagulants and the recently developed antiplatelet drugs is a great challenge for transplant teams worldwide, as their activity must be monitored and their complications managed, in the absence of robust scientific evidence. In this changing and clinically heterogeneous scenario, the Spanish Society of Liver Transplantation and the Spanish Society of Thrombosis and Haemostasis aimed to achieve consensus regarding the indications, drugs, dosing, and timing of anticoagulation and antiplatelet therapies initiated from the inclusion of the patient on the waiting list to post-LT surveillance. A multidisciplinary group of experts composed by transplant hepatologists, surgeons, hematologists, transplant-specialized anesthesiologists, and intensivists performed a comprehensive review of the literature and identified 21 clinically relevant questions using the patient-intervention-comparison-outcome format. A preliminary list of recommendations was drafted and further validated using a modified Delphi approach by a panel of 24 transplant delegates, each representing a LT institution in Spain. The present consensus statement contains the key recommendations together with the core supporting scientific evidence, which will provide guidance for improved and more homogeneous clinical decision making.

The evolution of the ventilatory ratio is a prognostic factor in mechanically ventilated COVID-19 ARDS patients.

BACKGROUND: Mortality due to COVID-19 is high, especially in patients requiring mechanical ventilation. The purpose of the study is to investigate associations between mortality and variables measured during the first three days of mechanical ventilation in patients with COVID-19 intubated at ICU admission. METHODS: Multicenter, observational, cohort study includes consecutive patients with COVID-19 admitted to 44 Spanish ICUs between February 25 and July 31, 2020, who required intubation at ICU admission and mechanical ventilation for more than three days. We collected demographic and clinical data prior to admission; information about clinical evolution at days 1 and 3 of mechanical ventilation; and outcomes. RESULTS: Of the 2,095 patients with COVID-19 admitted to the ICU, 1,118 (53.3%) were intubated at day 1 and remained under mechanical ventilation at day three. From days 1 to 3, PaO2/FiO2 increased from 115.6 [80.0-171.2] to 180.0 [135.4-227.9] mmHg and the ventilatory ratio from 1.73 [1.33-2.25] to 1.96 [1.61-2.40]. In-hospital mortality was 38.7%. A higher increase between ICU admission and day 3 in the ventilatory ratio (OR 1.04 [CI 1.01-1.07], p = 0.030) and creatinine levels (OR 1.05 [CI 1.01-1.09], p = 0.005) and a lower increase in platelet counts (OR 0.96 [CI 0.93-1.00], p = 0.037) were independently associated with a higher risk of death. No association between mortality and the PaO2/FiO2 variation was observed (OR 0.99 [CI 0.95 to 1.02], p = 0.47). CONCLUSIONS: Higher ventilatory ratio and its increase at day 3 is associated with mortality in patients with COVID-19 receiving mechanical ventilation at ICU admission. No association was found in the PaO2/FiO2 variation.

Deploying unsupervised clustering analysis to derive clinical phenotypes and risk factors associated with mortality risk in 2022 critically ill patients with COVID-19 in Spain.

BACKGROUND: The identification of factors associated with Intensive Care Unit (ICU) mortality and derived clinical phenotypes in COVID-19 patients could help for a more tailored approach to clinical decision-making that improves prognostic outcomes. METHODS: Prospective, multicenter, observational study of critically ill patients with confirmed COVID-19 disease and acute respiratory failure admitted from 63 ICUs in Spain. The objective was to utilize an unsupervised clustering analysis to derive clinical COVID-19 phenotypes and to analyze patient's factors associated with mortality risk. Patient features including demographics and clinical data at ICU admission were analyzed. Generalized linear models were used to determine ICU morality risk factors. The prognostic models were validated and their performance was measured using accuracy test, sensitivity, specificity and ROC curves. RESULTS: The database included a total of 2022 patients (mean age 64 [IQR 5-71] years, 1423 (70.4%) male, median APACHE II score (13 [IQR 10-17]) and SOFA score (5 [IQR 3-7]) points. The ICU mortality rate was 32.6%. Of the 3 derived phenotypes, the A (mild) phenotype (537; 26.7%) included older age (< 65 years), fewer abnormal laboratory values and less development of complications, B (moderate) phenotype (623, 30.8%) had similar characteristics of A phenotype but were more likely to present shock. The C (severe) phenotype was the most common (857; 42.5%) and was characterized by the interplay of older age (> 65 years), high severity of illness and a higher likelihood of development shock. Crude ICU mortality was 20.3%, 25% and 45.4% for A, B and C phenotype respectively. The ICU mortality risk factors and model performance differed between whole population and phenotype classifications. CONCLUSION: The presented machine learning model identified three clinical phenotypes that significantly correlated with host-response patterns and ICU mortality. Different risk factors across the whole population and clinical phenotypes were observed which may limit the application of a "one-size-fits-all" model in practice.

Impact of Source Control in Patients With Severe Sepsis and Septic Shock.

OBJECTIVES: Time to clearance of pathogens is probably critical to outcome in septic shock. Current guidelines recommend intervention for source control within 12 hours after diagnosis. We aimed to determine the epidemiology of source control in the management of sepsis and to analyze the impact of timing to source control on mortality. DESIGN: Prospective observational analysis of the Antibiotic Intervention in Severe Sepsis study, a Spanish national multicenter educational intervention to improve antibiotherapy in sepsis. SETTING: Ninety-nine medical-surgical ICUs in Spain. PATIENTS: We enrolled 3,663 patients with severe sepsis or septic shock during three 4-month periods between 2011 and 2013. INTERVENTIONS: Source control and hospital mortality. MEASUREMENTS AND MAIN RESULTS: A total of 1,173 patients (32%) underwent source control, predominantly for abdominal, urinary, and soft-tissue infections. Compared with patients who did not require source control, patients who underwent source control were older, with a greater prevalence of shock, major organ dysfunction, bacteremia, inflammatory markers, and lactic acidemia. In addition, compliance with the resuscitation bundle was worse in those undergoing source control. In patients who underwent source control, crude ICU mortality was lower (21.2% vs 25.1%; p = 0.010); after adjustment for confounding factors, hospital mortality was also lower (odds ratio, 0.809 [95% CI, 0.658-0.994]; p = 0.044). In this observational database analysis, source control after 12 hours was not associated with higher mortality (27.6% vs 26.8%; p = 0.789). CONCLUSIONS: Despite greater severity and worse compliance with resuscitation bundles, mortality was lower in septic patients who underwent source control than in those who did not. The time to source control could not be linked to survival in this observational database.

Mucormicosis diseminadas en pacientes sin inmunodeficiencias: una enfermedad que también existe / Disseminated mucormycosis in immunocompetent patients: A disease that also exists

Las mucormicosis son infecciones generalmente agudas, angioinvasivas, que provocan necrosis difusas no supurantes y gran destrucción tisular. Representan el 1,6% de todas las infecciones fúngicas invasivas, y predominan en pacientes inmunodeprimidos con factores de riesgo. Su incidencia se ha incrementado de forma significativa, incluso en pacientes sin inmunodeficiencias. A propósito de un caso de mucormicosis diseminada producida por Rhizomucor pusillus en un paciente joven sin inmunodeficiencias conocidas, hemos realizado una revisión bibliográfica de los casos de mucormicosis en pacientes adultos sin inmunodeficiencias reportados en PubMed, según sus principales localizaciones anatómicas y con referencia especial a los casos de mucormicosis diseminadas. Se revisan los principales factores de riesgo y la patogenia de la enfermedad, las formas clínicas de presentación y sus posibilidades diagnósticas, incidiendo en las técnicas de diagnóstico precoz, y la terapia actual disponible, discutiendo la indicación del tratamiento de combinación de antifúngicos y el pronóstico. Además, se revisa la taxonomía actual del género Mucor y su clasificación (AU)

Mucormycosis is usually an acute angioinvasive infections, which leads to non-suppurative necrosis and significant tissue damage. It represents 1.6% of all the invasive fungal infections and predominates in immunosuppressed patients with risk factors. Incidence has been significantly increased even in immunocompetent patients. Due to finding a case of disseminated mucormycosis caused by Rhizomucor pusillus in a young immunocompetent patient, a systematic review was carried out of reported cases in PubMed of mucormycosis in immunocompetent adults according to the main anatomic locations, and especially in disseminated cases. A review of the main risk factors and pathogenicity, clinical manifestations, techniques of early diagnosis, current treatment options, and prognosis is presented. Taxonomy and classification of the genus Mucorhas also been reviewed (AU)

Infección fúngica invasiva mixta por Rhizomucor pusillus y Aspergillus niger en un paciente inmunocompetente / Mixed invasive fungal infection due to Rhizomucor pusillus and Aspergillus niger in an immunocompetent patient

Antecedentes. Las mucormicosis son infecciones poco frecuentes en pacientes inmunocompetentes, y se han descrito muy pocos casos de mucormicosis asociadas a aspergilosis en pacientes no hematológicos. Caso clínico. Un varón de 17 años, inmunocompetente y sin factores de riesgo previamente conocidos, ingresó en el hospital tras presentar crisis convulsivas 11 días después de sufrir un accidente de moto. Presentó un curso clínico tórpido por infección fúngica invasiva mixta, con afectación pulmonar por Aspergillus niger y mucormicosis diseminada por Rhizomucor pusillus (diagnóstico histopatológico y microbiológico en varios lugares no contiguos). Fue tratado con anfotericina B liposomal durante 7 semanas (dosis total acumulada > 10 g) y precisó múltiples reintervenciones quirúrgicas. El paciente sobrevivió y fue dado de alta de UCI tras 5 meses de evolución y múltiples complicaciones. Conclusiones. El tratamiento con anfotericina B liposomal y el manejo quirúrgico agresivo consiguió la erradicación de la infección fúngica invasiva mixta, pero alertamos de la necesidad de mantener un mayor grado de sospecha clínica y de realizar técnicas de diagnóstico precoz de infecciones fúngicas invasivas en pacientes no inmunodeprimidos para evitar la diseminación de la enfermedad y el mal pronóstico asociado (AU)

Background. Mucormycosis infections are rare in immunocompetent patients, and very few cases of mucormycosis associated with aspergillosis in non-haematological patients have been reported. Case report. A 17-year-old male, immunocompetent and without any previously known risk factors, was admitted to hospital due to a seizure episode 11 days after a motorcycle accident. He had a complicated clinical course as he had a mixed invasive fungal infection with pulmonary involvement due to Aspergillus niger and disseminated mucormycosis due to Rhizomucor pusillus (histopathological and microbiological diagnosis in several non-contiguous sites). He was treated with liposomal amphotericin B for 7 weeks (total cumulative dose > 10 g) and required several surgical operations. The patient survived and was discharged from ICU after 5 months and multiple complications. Conclusions. Treatment with liposomal amphotericin B and aggressive surgical management achieved the eradication of a mixed invasive fungal infection. However, we emphasise the need to maintain a higher level of clinical suspicion and to perform microbiological techniques for early diagnosis of invasive fungal infections in non-immunocompromised patients, in order to prevent spread of the disease and the poor prognosis associated with it (AU)

[Disseminated mucormycosis in immunocompetent patients: A disease that also exists]. / Mucormicosis diseminadas en pacientes sin inmunodeficiencias: una enfermedad que también existe.

Mucormycosis is usually an acute angioinvasive infections, which leads to non-suppurative necrosis and significant tissue damage. It represents 1.6% of all the invasive fungal infections and predominates in immunosuppressed patients with risk factors. Incidence has been significantly increased even in immunocompetent patients. Due to finding a case of disseminated mucormycosis caused by Rhizomucor pusillus in a young immunocompetent patient, a systematic review was carried out of reported cases in PubMed of mucormycosis in immunocompetent adults according to the main anatomic locations, and especially in disseminated cases. A review of the main risk factors and pathogenicity, clinical manifestations, techniques of early diagnosis, current treatment options, and prognosis is presented. Taxonomy and classification of the genus Mucor has also been reviewed.

[Mixed invasive fungal infection due to Rhizomucor pusillus and Aspergillus niger in an immunocompetent patient]. / Infección fúngica invasiva mixta por Rhizomucor pusillus y Aspergillus niger en un paciente inmunocompetente.

BACKGROUND: Mucormycosis infections are rare in immunocompetent patients, and very few cases of mucormycosis associated with aspergillosis in non-haematological patients have been reported. CASE REPORT: A 17-year-old male, immunocompetent and without any previously known risk factors, was admitted to hospital due to a seizure episode 11 days after a motorcycle accident. He had a complicated clinical course as he had a mixed invasive fungal infection with pulmonary involvement due to Aspergillus niger and disseminated mucormycosis due to Rhizomucor pusillus (histopathological and microbiological diagnosis in several non-contiguous sites). He was treated with liposomal amphotericin B for 7 weeks (total cumulative dose >10 g) and required several surgical operations. The patient survived and was discharged from ICU after 5 months and multiple complications. CONCLUSIONS: Treatment with liposomal amphotericin B and aggressive surgical management achieved the eradication of a mixed invasive fungal infection. However, we emphasise the need to maintain a higher level of clinical suspicion and to perform microbiological techniques for early diagnosis of invasive fungal infections in non-immunocompromised patients, in order to prevent spread of the disease and the poor prognosis associated with it.

Profilaxis antifúngica en receptores de trasplante hepático VIH seropositivos / Antifungal prophylaxis in HIV-seropositive liver transplant recipients

Antecedentes. Los pacientes seropositivos para el virus de la inmunodeficiencia humana (VIH) presentan una elevada prevalencia de hepatopatía crónica terminal para los que el trasplante hepático supone la única terapéutica posible. El riesgo de infección fúngica en esta población puede ser muy elevado. Caso clínico. Se presenta el curso clínico del periodo postoperatorio inicial de un paciente coinfectado por VIH y virus de la hepatitis C sometido a trasplante hepático. Se valoran las indicaciones de la profilaxis antifúngica, y los fármacos de elección en relación a su eficacia y perfil de seguridad. Se describe el tratamiento médico general y se comentan las posibles interacciones farmacocinéticas. Conclusiones. La profilaxis antifúngica con anidulafungina ha demostrado ser eficaz y no ha presentado efectos adversos significativos en un paciente de alto riesgo de infección fúngica y múltiples factores de riesgo de interacciones medicamentosas(AU)

Background. Seropositive human immunodeficiency virus (HIV) patients have a high prevalence of chronic liver disease for which liver transplantation is the only possible treatment. Risk of fungal infection in this population may be very high. Case report. We describe the clinical course of the early postoperative period in a patient coinfected with HIV and hepatitis C virus undergoing liver transplantation. We discuss antifungal prophylaxis indications and drugs of choice in relation to their efficacy and safety profile. Other medical treatments are described, as well as possible pharmacokinetic interactions. Conclusions. Antifungal prophylaxis with anidulafungin has proven effective and has presented no significant adverse effects on a patient at high risk of fungal infection and multiple risk factors for drug interactions(AU)

[Invasive candidiasis in liver transplant recipient: early rescue antifungal treatment]. / Candidiasis invasora en un receptor de trasplante hepático: tratamiento antifúngico de rescate precoz.

BACKGROUND: Some liver transplant recipients could be at risk for candidemia or invasive candidiasis during the immediate postoperative period after transplantation. Prophylaxis is the best strategy to reduce the incidence of invasive fungal infection caused by Candida species in high-risk liver transplant recipients (HR-LTR), but in cases of suspected breakthrough invasive fungal infection due to Candida, both a rapid diagnosis process and early antifungal treatment are the most important factors impacting on the prognosis. CLINICAL CASE: We report a case of early rescue treatment with anidulafungin in a HR-LTR with complicated postoperative course. We discuss risk factors, prophylaxis, sensitivity of biomarkers, and characteristics of antifungal management. CONCLUSIONS: Early rescue antifungal treatment using candins improves the prognosis in HR-LTR suffering from invasive candidiasis.

[Antifungal prophylaxis in HIV-seropositive liver transplant recipients]. / Profilaxis antifúngica en receptores de trasplante hepático VIH seropositivos.

BACKGROUND: Seropositive human immunodeficiency virus (HIV) patients have a high prevalence of chronic liver disease for which liver transplantation is the only possible treatment. Risk of fungal infection in this population may be very high. CASE REPORT: We describe the clinical course of the early postoperative period in a patient coinfected with HIV and hepatitis C virus undergoing liver transplantation. We discuss antifungal prophylaxis indications and drugs of choice in relation to their efficacy and safety profile. Other medical treatments are described, as well as possible pharmacokinetic interactions. CONCLUSIONS: Antifungal prophylaxis with anidulafungin has proven effective and has presented no significant adverse effects on a patient at high risk of fungal infection and multiple risk factors for drug interactions.

Papel de daptomicina en el tratamiento empírico y dirigido de infecciones por cocos grampositivos del paciente crítico / Role of daptomycin in the empirical and directed therapy of infections caused by Grampositive bacteria in the critically ill patient

Las infecciones graves causadas por bacterias grampositivas son un problema grave y que se asocia a una elevada mortalidad. Entre ellas, hay que resaltar las causadas por Staphylococcus aureus resistente a meticilina siendo la bacteriemia primaria o asociada a catéter o a endocarditis las principales presentaciones. Vancomicina ha sido tradicionalmente el tratamiento de elección para estas infecciones pero su actividad no es satisfactoria especialmente en caso de SARM con concentración mínima inhibitoria (CMI) > 1mg/L. Daptomicina es un antibiótico lipopéptido cuyo espectro de acción son las bacterias grampositivas incluyendo SARM y Enterococcus spp resistente a glucopéptido. Destacar también que frente a S. aureus sensible a meticilina, daptomicina es rápidamente bactericida y más activo que vancomicina y al menos tan activo como las penicilinas isoxazólicas, En el presente artículo se discute el papel de este antibiótico en el tratamiento empírico y dirigido de las infecciones por bacterias grampositivas que afectan a los pacientes críticos(AU)

Infections caused by Gram-positive bacteria are a serious problem and is associated with high mortality. Among them, we should highlight those caused by methicillin-resistant Staphylococcus aureus (MRSA). Primary bacteremia, catheterrelated bloodstream infections and constitute the main presentations. Vancomycin has traditionally been the treatment of choice for these infections, but its activity is not satisfactory especially in cases of MRSA with minimum inhibitory concentration (MIC) > 1 mg/L. Daptomycin is a lipopeptide antibiotic active against Gram-positive bacteria including MRSA and glycopeptide-resistant Enterococcus spp. It is worth mentioning that daptomycin is rapidly bactericidal against methicillin-sensitive S. aureus, more potent than vancomycin and at least as active as isoxazole penicillins. This article discusses the role of this antibiotic in the empirical treatment of infections and directed by Gram-positive bacteria affecting critically ill patients(AU)

[Clinical use of micafungin for the treatment of invasive candidiasis in critical ill patients]. / Utilidad clínica de la micafungina en el tratamiento de las candidiasis invasoras en el paciente crítico.

BACKGROUND: Over the last 30 years a significant increase of Candida spp. invasive disease has been observed in non-neutropenic critical ill patients. Both fluconazole and amphotericin B have been considered first line treatment for invasive (proven and probable) Candida spp. disease, although the mortality rate is still high. OBJECTIVES: To review the current data on the use of micafungin for the treatment of Candida invasive disease in critical ill patients. METHODS: The pharmacologic, mycological and clinical properties of micafungin are reviewed based on current published data. The use and efficacy of micafungin for the treatment of Candida invasive disease in critical ill patients is discussed. RESULTS AND CONCLUSIONS: To reduce the rate of mortality more effective antifungals and pre-emptive treatment strategies are currently warranted. Candins achieve better results for the treatment of invasive Candida disease in non-neutropenic critical ill patients. Micafungin has a good safety profile (similar to fluconazole). Micafungin is a first line drug for the treatment of invasive Candida disease and may be used as a pre- emptive approach followed by a de-escalating strategy with azoles.

Utilidad clínica de la micafungina en el tratamiento de las candidiasis invasoras en el paciente crítico / Clinical use of micafungin for the treatment of invasive candidiasis in critical ill patients

Antecedentes: En las últimas 3 décadas se ha observado un incremento significativo de la enfermedad fúngica invasora producida por Candida en pacientes críticos no neutropénicos. El fluconazol y la anfotericina B se han considerado tratamientos de primera línea de la enfermedad (probada y probable) producida por Candida, aunque la mortalidad sigue siendo muy elevada. Objetivo: Revisar el uso de la micafungina en el tratamiento de la enfermedad fúngica invasora producida por Candida en pacientes críticos no neutropénicos. Método: Valorar el uso clínico y la eficacia de la micafungina en estos pacientes, a partir de sus propiedades farmacológicas, micológicas y de los resultados clínicos de los estudios publicados. Resultados y conclusiones: Actualmente es necesario reducir la mortalidad utilizando antifúngicos más eficaces e instaurando tratamientos más precoces. Las candinas parecen obtener resultados mejores en el tratamiento de enfermedad invasora por Candida en pacientes críticos. La micafungina es eficaz y tiene un perfil de seguridad semejante al fluconazol, es una opción de primera línea para el tratamiento de la candidemia y/o de las candidiasis invasoras, y puede utilizarse en el tratamiento anticipado seguido de una estrategia de desescalada con azoles (AU)

Background: Over the last 30 years a significant increase of Candida spp. invasive disease has been observed in non-neutropenic critical ill patients. Both fluconazole and amphotericin B have been considered first line treatment for invasive (proven and probable) Candida spp. disease, although the mortality rate is still high. Objectives: To review the current data on the use of micafungin for the treatment of Candida invasive disease in critical ill patients. Methods: The pharmacologic, mycological and clinical properties of micafungin are reviewed based on current published data. The use and efficacy of micafungin for the treatment of Candida invasive disease in critical ill patients is discussed. Results and conclusions: To reduce the rate of mortality more effective antifungals and pre-emptive treatment strategies are currently warranted. Candins achieve better results for the treatment of invasive Candida disease in non-neutropenic critical ill patients. Micafungin has a good safety profile (similar to fluconazole). Micafungin is a first line drug for the treatment of invasive Candida disease and may be used as a pre-emptive approach followed by a de-escalating strategy with azoles (AU)