Micafungin Use

Background There are few publications describing empiric echinocandin use in clinical practice. Empiric use is directed at early disseminated infection characterized by incubating fungemia. We sought to show the determinants of micafungin use and whether patients derived benefit from empiric therapy. Methods We identified the first 100 patients receiving micafungin at our 749-bed urban hospital (December 2009 to July 2010) and performed a retrospective chart review. We collected demographic information; risk factors for fungal disease; prior, concurrent, and subsequent antifungal therapy; culture results; and survival to discharge. Results Of 100 micafungin prescriptions, 62 were empiric. None of these patients had incubating candidemia on blood cultures drawn before micafungin initiation. Although all of these patients were on antibacterial therapy, 45% were eventually diagnosed with bacterial infection. Overall inpatient mortality rate was 52%. Twenty-five micafungin prescriptions were for treatment of documented, invasive fungal disease including 20 of 23 bouts of candidemia that were treated during the study period. Thirteen prescriptions were for solid organ transplant prophylaxis. Conclusions Empiric micafungin use was more common than treatment and prophylaxis use combined. None of the empirically treated patients had incubating candidemia, and nearly half were ultimately shown to have bacterial infection.