Failure of Empirical Systemic Antifungal Therapy in Mechanically Ventilated Critically Ill Patients

Rationale: Systemic antifungal treatments are empirically administered to the sickest critically ill patients, often without documented invasive fungal infection.Objectives: To estimate the impact of systemic antifungal treatment on 30-day survival of patients suspected to have invasive candidiasis.Methods: All nonneutropenic, nontransplant recipients managed in five intensive care units intubated for at least 5 days, and free of invasive candidiasis, were included. To account for differences in patients’ characteristics recorded daily before study end point, a causal model for longitudinal data was used to assess benefits from antifungal treatment. The composite primary end point was hospital mortality or occurrence of invasive candidiasis.Measurements and Main Results: Among 1,491 patients, 100 (6.7%) received antifungal treatment for a suspected infection. Patients treated with antifungals were more severely ill than untreated patients. Within the 30-day follow-up period, 363 (24.3%) patients died, and...