Study summary: Empirical Micafungin Treatment and Survival Without Invasive Fungal Infection in Adults With ICU-Acquired Sepsis, Candida Colonization, and Multiple Organ Failure

In critically ill patients with non-neutropenic sepsis, multiple Candida colonisation and multi organ failure, does empirical micafungin therapy increase invasive fungal infection-free survival at day 28 compared with placebo?

Among non-neutropenic critically ill patients with ICU acquired sepsis, Candida species colonisation at multiple sites, and multiple organ failure, empirical treatment with micafungin compared with placebo did not increase fungal infection-free survival at day 28

Large study investigating the effect of empirical anti-fungal treatment
Multicentre performed across university-affiliated and non-university hospitals, adding to it’s external validity
Appropriately powered
Allocation concealment
Blinding achieved by pharmacy producing opaque bags containing micafungin or placebo
Statistical analyses used on secondary end points were predefined
No patients lost to follow up
Registered on clinicaltrials.gov
An homogenous group of patients were selected, which improves the internal validity of the trial

Such an homogenous group of patients is highly selective and fairly uncommon; demonstrated by the fact it took 19 ICUs 3 years to recruit 260 patients – which averages at 4 patients per site per year
General ICU management (such as lung protective ventilation) was not standardised between groups or between units – affecting the internal and external validity of the trial

This study does not support empirical anti-fungal therapy with micafungin in a select group of intensive care patients at high risk of invasive candidiasis

Read the full summary here.