Are contemporary antifungal doses sufficient for critically ill patients? Outcomes from an international, multicenter pharmacokinetics study for Screening Antifungal Exposure in Intensive Care Units—the SAFE-ICU study
Authors' conclusion
This study highlights the varying degrees of target attainment across antifungal agents in critically ill patients. While a significant proportion of patients achieved the predefined PK/PD targets, wide variability and subtherapeutic exposures persist.
Study context
- Population
- Intensive care unit (ICU) patients prescribed azoles, echinocandins or polyene antifungals for treatment or prophylaxis of invasive fungal disease
- Participants
- 339 patients · 30 ICUs · 12 countries
- Outcome
- Antifungal dosing adequacy (attainment of predefined PK/PD targets)
Methodological detailsopen-label, international
- Open-label
- International
Main finding
As reported in the abstract
PK/PD target attainment
- Target attainment, prophylaxis (most drugs)
- > 80%
- Target attainment, treatment: voriconazole
- 57.1%
- Target attainment, treatment: posaconazole
- 63.2%
- Target attainment, treatment: micafungin
- 64.1%
- Target attainment, treatment: amphotericin B
- 41.7%
Observational data: associations, not effects.
Further findings
Prescribing and microbiology
- Prescribed for treatment
- 80.8%
- Fluconazole most frequently prescribed
- 40.7%
- Intra-abdominal infection most common treatment indication
- 30.7%
- Fungi identified
- 45%
- Of these, minimum inhibitory concentration available
- 26%
Original publication
Are contemporary antifungal doses sufficient for critically ill patients? Outcomes from an international, multicenter pharmacokinetics study for Screening Antifungal Exposure in Intensive Care Units—the SAFE-ICU study. Intensive Care Med. Published 3 February 2025. doi:10.
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