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This study of 554,948 septic shock patients across 886 U.S. hospitals found a significant mismatch between antifungal treatment and fungal diagnoses. Only 2.1% of patients received a fungal diagnosis, yet 5.5% received early antifungal therapy, with 88% of those treated having no documented fungal infection. Among patients with confirmed candidemia bloodstream infections, less than half received antifungal treatment within one day, rising to only 79% within seven days.
Why it matters
The findings reveal both overtreatment of patients without fungal infections and dangerous undertreatment of patients with confirmed fungal bloodstream infections. This indicates urgent need for better diagnostic tools and treatment protocols to improve patient outcomes while reducing unnecessary antifungal exposure and antimicrobial resistance.
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⚠️ Preprint – Noch nicht peer-reviewed
Dieser Artikel wurde noch nicht von unabhängigen Experten begutachtet. Die Ergebnisse sind vorläufig und sollten mit Vorsicht interpretiert werden.
Septic shock caused by fungal organisms is characterized by high mortality and diagnostic complexity. We used the Premier Healthcare Database to characterize antifungal use and fungal diagnoses among adults with septic shock requiring vasopressors admitted between October 2022 through July 2024. Among 12.8 million admission at 886 hospitals, 554,948 met septic shock criteria and were included for analysis. A fungal diagnosis was established in 11,405 (2.1%) of encounters; of these, 3,565 (31.3%) received intravenous antifungal therapy within one day of vasopressor initiation. In the overall cohort, antifungal therapy was initiated in 29,824 (5.5%) within one day of vasopressor initiation; of these, 3,656 (12.2%) were ultimately diagnosed with a fungal infection. In the 116 hospitals reporting microbiological data, a subgroup of 489 encounters with septic shock and culture-confirmed candidemia was identified. In this subgroup, intravenous antifungal therapy was initiated in 43.8% within one day, 63.8% within three days, and 78.9% within seven days. These findings highlight a profound decoupling between fungal diagnosis and treatment–few patients receiving antifungals were diagnosed with an infection that would be treated by these agents, while less than half of patients with septic shock and candidemia received timely treatment. Strategies for greater precision in empiric antifungal use in septic shock are needed to improve safety, stewardship, and outcomes.
Source: Antifungal use with and without fungal diagnoses in septic shock across U.S. hospitals, 2022-2024