Résumé
Invasive fungal infection due to Candida are common in intensive care unit (ICU) and have a major impact in terms of mortality. Echinocandin are the recommended first line treatment for these infections however multiple covariates can alter their pharmacokinetics and reduce their efficacity. We realised a systematic review, by using the PRISMA guidelines, on the use of Micafungin in ICU and to determinate the covariates responsible of non-attainment of therapeutic goals and synthetize the data we found to see how it may influence treatment effectiveness and how to adjust the dosage to avoid therapeutic failure. This search was carried out on the MEDLINE database until January 2023, the keywords used were (micafungin AND ICU) or (Micafungin AND intensive care unit), the inclusion criteria were clinical or PK study realised in ICU with Micafungin used for curative treatment and written in English. A qualitative methodological evaluation was then conducted from the selected articles using ClinPK checklist. 157 articles were extracted from our research, and we retained 18 articles in our analysis. Methodological quality between studies was heterogenous. The covariates identified were body weight (BW) (n=10), albumin level (n=8), organ failure scores (n=6), burn patient (n=2), renal dysfunction (n=5) and other causes (n=5). The mean to assess the efficacity of treatment is AUC/MIC which is variable according to candida species. The alteration of some of these factors seems to lead to underexposure except for renal replacement therapy which did not affect PK Micafungin but for the other covariates there is not a consensus between the studies. To avoid under exposure certain studies recommend increasing the dosage of Micafungin or even carry out a loading dose with a maintenance dose. Most of these studies were PK studies and patients' clinical progress was not necessarily monitored, it is necessary to realise a clinical study on a large cohort to better assess the impact of alteration of these covariates. Therapeutic drug monitoring (TDM) can be a means to better adjust dosage especially for ICU patients but there is no recommendation on the use of this method for Micafungin.