Drug design, development and therapy · 2025
Optimizing Micafungin Dosing in Patients with Critically Ill Candidemia and Trends of Candida Species Causing Bloodstream Infections in a Tertiary Hospital in Thailand: A Monte Carlo Simulation Approach.
СтатьяНазвание и аннотация: Перевод в очереди
Обработка статьи · этапы, ошибки и управление
Загрузка состояния…
Ошибки и ограничения
История · было → стало
Состояние обновляется каждые 5 секунд, пока блок открыт. Процент показывается только там, где известен объём работы. Пауза останавливает продолжение этапа; текущий запрос к источнику может завершиться.
Watcharasuwanseree Jutharat, Chueansuwan Worawong, Suwantarat Nuntra, Santimaleeworagun Wichai, Juntanawiwat Piraporn, Sangchankoom Adisak, Saelim Weerayuth
Аннотация
PURPOSE: This study aimed to determine the optimal micafungin dosage for treating candidemia in critically ill adult patients using Monte Carlo simulation.
PATIENTS AND METHODS: Clinical Candida isolates were obtained from blood cultures collected between September 2023 and December 2024 at Phramongkutklao Hospital, Thammasat University Hospital, and Udonthani Hospital. Susceptibility testing was performed using the Sensititre® YeastOne® system, applying a broth microdilution method in 96-well plates to determine minimum inhibitory concentrations (MICs). Monte Carlo simulations were conducted to identify optimal micafungin dosing regimens, using cumulative fraction of response (CFR) and probability of target attainment (PTA) as key parameters.
RESULTS: In total, 128 clinical Candida isolates were identified. Candida tropicalis was the most frequently isolated species (32%), followed by C. albicans (22.7%), C. parapsilosis (16.4%), C. glabrata (Nakaseomyces glabrata) (12.5%), and C. auris (Candidozyma auris) (9.4%). The micafungin MIC ranges were as follows: C. tropicalis, 0.015-0.25 µg/mL; C. albicans, 0.008-0.015 µg/mL; C. parapsilosis, 0.5-2 µg/mL; C. glabrata, 0.015->8 µg/mL; and C. auris, 0.12-0.25 µg/mL. Pan-echinocandin-resistant C. glabrata was also detected. A standard micafungin dose (100 mg/day) may be effective for C. tropicalis infections when MIC is ≤0.015 µg/mL. In patients with Sequential Organ Failure Assessment scores >10 and alanine aminotransferase >120 U/L, the standard micafungin dose adequate CFR for empirical therapy and PTA for documented treatment at MICs up to 0.03 µg/mL, with the target threshold set at ≥90%. However, in the absence of MIC data and with increasing MIC trends, a higher empirical dose (up to 400 mg/day) may be warranted.
CONCLUSION: Non-albicans Candida bloodstream infections are increasing, along with higher MIC trends, signaling emerging resistance. Standard dosing may be insufficient in critically ill patients. Empirical high-dose micafungin could improve treatment efficacy.
PATIENTS AND METHODS: Clinical Candida isolates were obtained from blood cultures collected between September 2023 and December 2024 at Phramongkutklao Hospital, Thammasat University Hospital, and Udonthani Hospital. Susceptibility testing was performed using the Sensititre® YeastOne® system, applying a broth microdilution method in 96-well plates to determine minimum inhibitory concentrations (MICs). Monte Carlo simulations were conducted to identify optimal micafungin dosing regimens, using cumulative fraction of response (CFR) and probability of target attainment (PTA) as key parameters.
RESULTS: In total, 128 clinical Candida isolates were identified. Candida tropicalis was the most frequently isolated species (32%), followed by C. albicans (22.7%), C. parapsilosis (16.4%), C. glabrata (Nakaseomyces glabrata) (12.5%), and C. auris (Candidozyma auris) (9.4%). The micafungin MIC ranges were as follows: C. tropicalis, 0.015-0.25 µg/mL; C. albicans, 0.008-0.015 µg/mL; C. parapsilosis, 0.5-2 µg/mL; C. glabrata, 0.015->8 µg/mL; and C. auris, 0.12-0.25 µg/mL. Pan-echinocandin-resistant C. glabrata was also detected. A standard micafungin dose (100 mg/day) may be effective for C. tropicalis infections when MIC is ≤0.015 µg/mL. In patients with Sequential Organ Failure Assessment scores >10 and alanine aminotransferase >120 U/L, the standard micafungin dose adequate CFR for empirical therapy and PTA for documented treatment at MICs up to 0.03 µg/mL, with the target threshold set at ≥90%. However, in the absence of MIC data and with increasing MIC trends, a higher empirical dose (up to 400 mg/day) may be warranted.
CONCLUSION: Non-albicans Candida bloodstream infections are increasing, along with higher MIC trends, signaling emerging resistance. Standard dosing may be insufficient in critically ill patients. Empirical high-dose micafungin could improve treatment efficacy.