Anti-fungal Strategies in Acute-on-Chronic Liver Failure Patients

"Participants will be randomly allocated in a 1:1 ratio after meeting eligibility criteria to either early empiric or pre-emptive strategy of treatment with antifungals. The antifungal treatment initiation will be at the time of allocation in the empiric group. The treatment initiation rules in the pre-emptive group will include~1. Fungal Biomarkers positivity (Beta-D Glucan\>150 pg/ml, Galactomannan index\>1.0)~2. Mycological evidence of fungal infection on fungal cultures from a non-sterile site~3. Radiological evidence of fungal infection~4. Other Investigations suggestive of fungal infection viz. endophthalmitis, vegetations suspicious of fungal infection, Vegetations on echocardiography with negative blood cultures for bacteria that is non-responsive to appropriate antibiotics, refractory culture-negative spontaneous bacterial peritonitis~Treatment duration will be guided by serum biomarkers (BDG and GM) and fungal cultures."