BACKGROUND: @entity3 ( @entity3 ) is a life-threatening ICU-acquired @entity281 . A strong correlation between time to @entity34 ( @entity34 ) administration and outcome has been established. Empirical therapy benefit should be balanced with the risk of @entity5637 overuse. We assessed therefore a decision rule that aimed at guiding empirical therapy. METHODS: A 45-month prospective cohort study in a teaching medical ICU. All of the @entity1 with suspected @entity3 (uncontrolled @entity295 despite broad spectrum antibiotics without any bacterial proven @entity281 in @entity1 with Candida score >=  3 points including multifocal Candida sp. colonization) were eligible. The primary endpoint was proven @entity3 diagnosis (i.e., @entity4963 ) following treatment onset. Timing of @entity34 administration was also investigated in those latter patients. Antifungal therapy step-down and discontinuation was done according to international guidelines in @entity1 with @entity4963 . Otherwise, @entity5637 discontinuation was encouraged in @entity1 without proven @entity3 , excepting when a clinical improvement was achieved without any other explanation that antifungals initiation (i.e., probable @entity3 ). In addition, a survival multivariate analysis using a Cox model was conducted. RESULTS: Fifty-one @entity1 were given an @entity5637 with respect to our decision rule. Among them, @entity4963 was diagnosed thereafter in 9 @entity1 . Over the same period, @entity34 was triggered by @entity4963 announcement (i.e., definite therapy) in 12 @entity1 who did not fulfill criteria for empirical therapy before. Time elapsed from @entity4963 onset to @entity5637 therapy initiation was shortened (0.4 [0.5] vs. 2.4 [2.8] hours; p = 0.04) when it was given empirically. In addition, 18 @entity1 clinically improved under empirical @entity34 without any obvious other explanation, despite @entity3 remained unproven. Moreover, @entity5637 exposure duration was independently related to survival in those @entity1 . Over the same period, our predefined criteria for empirical therapy were overruled in 55 cases. None of them develop @entity3 thereafter. Finally, Our decision rule allowed @entity3 early recognition of proven/probable @entity3 with sensitivity, specificity, positive and negative predictive value of 69.2%, 82.1%, 69.2% and 82.1%, respectively. CONCLUSION: Implementation of pragmatic guidelines for empirical @entity34 based on CS and fungal colonization assessment could be useful in selecting @entity1 who really benefit from an @entity5637 .

Empirical XXXX with an @entity5637 in critically-ill @entity1 : prospective evaluation of a pragmatic Candida score-based strategy in one medical ICU.

@entity1 :: ('9606', 'Species') :: ['patients'] @entity295 :: ('MESH:D018805', 'Disease') :: ['sepsis'] @entity4963 :: ('MESH:D058387', 'Disease') :: ['candidemia'] @entity5637 :: ('CHEBI:57248', 'Chemical') :: ['echinocandin'] @entity281 :: ('MESH:D007239', 'Disease') :: ['infection'] @entity3 :: ('MESH:D009362', 'Disease') :: ['Invasive candidiasis', 'IC'] @entity34 :: ('MESH:D016609', 'Disease') :: ['antifungal therapy', 'AFT']
@entity34 :: (MESH:D016609,Disease) :: ['antifungal therapy']
