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Review
. 2022 Oct 29;8(11):1146.
doi: 10.3390/jof8111146.

Survival Outcome of Empirical Antifungal Therapy and the Value of Early Initiation: A Review of the Last Decade

Souha S Kanj  1 , Ali S Omrani  2   3 , Hail M Al-Abdely  4 , Ahmad Subhi  5 , Riad El Fakih  6 , Ibraheem Abosoudah  7 , Hazar Kanj  8 , George Dimopoulos  9
Affiliations
Review

Survival Outcome of Empirical Antifungal Therapy and the Value of Early Initiation: A Review of the Last Decade

Souha S Kanj et al. J Fungi (Basel). .

Abstract

Aim: This rapid systematic review aimed to collect the evidence published over the last decade on the effect of empirical antifungal therapy and its early initiation on survival rates.

Methods: A systematic search was conducted in PubMed, Cochrane, Medline, Scopus, and Embase, in addition to a hand search and experts' suggestions.

Results: Fourteen cohort studies and two randomized clinical trials reporting the survival outcome of empirical antifungal therapy were included in this review. Two studies reported the association between early empirical antifungal therapy (EAFT) and survival rates in a hematological cancer setting, and fourteen studies reported the outcome in patients in intensive care units (ICU). Six studies reported that appropriate EAFT decreases hospital mortality significantly; ten studies could not demonstrate a statistically significant association with mortality rates.

Discussion: The inconsistency of the results in the literature can be attributed to the studies' small sample size and their heterogeneity. Many patients who may potentially benefit from such strategies were excluded from these studies.

Conclusion: While EAFT is practiced in many settings, current evidence is conflicting, and high-quality studies are needed to demonstrate the true value of this approach. Meanwhile, insights from experts in the field can help guide clinicians to initiate EAFT when indicated.

Keywords: antifungal agents; empirical therapy; intensive care; invasive aspergillosis; invasive candidiasis.

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Conflict of interest statement

Souha S. Kanj: Speaker honorarium and advisory board for Pfizer, MSD, Gilead, Astellas, Menarini. Ali S. Omrani: Honoraria from Gilead, Pfizer, and MSD. Ahmad Subhi: Speaker honorarium and advisory board for Pfizer, MSD, Gilead, Hikma, Abbott, Roche. Riad El Fakih: Consultancy, Advisory Board and Speakers-Bureau honoraria at AZ, Roche, Janssen, Novartis, Biologix, Newbridge, Gilead, BMS, MSD, Abbvie, Kyowa Kirin, Hikma, Pfizer, Sanofi, Servier, Amgen, Takeda. No financial relationships or commercial interest with any of these entities. George Dimopoulos: Speaker honorarium and advisory board for Pfizer, Gilead, 3M, Menarini, InfectoPharm, Biomerieux.

Figures

Figure A1
Figure A1
Search strategy on Ovid MEDLINE(R) and In-Process, In-Data-Review & Other Non-Indexed Citations.
Figure A2
Figure A2
Search strategy on PubMed Central.
Figure A3
Figure A3
Search strategy on Embase (Elsevier).
Figure A4
Figure A4
Search strategy on Cochrane Central Register of Controlled Trials.
Figure A5
Figure A5
Search strategy on Scopus (Elsevier).
Figure A6
Figure A6
JBI Critical Appraisal Tool used for RCTs.
Figure A7
Figure A7
JBI Critical Appraisal Tool used for Cohort Studies.
Figure 1
Figure 1
Definitions adopted in this review for the classification of antifungal therapy based on the certainty of the diagnosis.
Figure 2
Figure 2
PRISMA Flow diagram of the search and screening results.
See this image and copyright information in PMC

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