Antifungal Stewardship in Oncology Patients

Maricela Valerio, MD Patricia Muñoz, PhD Alicia Hidalgo, MD Victor Vazquez, MD Ana Fernandez-Cruz, PhD Antonio Vena, MD Carmen Rodriguez, PharmD Maria Sanjurjo, PharmD Emilio Bouza, MD, PhD PROMULGA and COMIC

Abstract: 

Background. Oncological patients with invasive fungal infections (IFI) have a high mortality. Many of them are treated empirically with wide spectrum antifungals (AF). They are an interesting target for antifungal stewardship programs. The aims of our study were to analyze the characteristics and appropriateness of the use of restricted antifungals (used as empirical and targeted therapy) in oncologic patients and to identify potential targets for antifungal stewardship (AFS) interventions. Methods. We performed a retrospective study, including all patients receiving candins, voriconazole, posaconazole and L-AmB, during suspicion of an IFI episode from September 2011 until September 2014 in a tertiary care center. Patients receiving fluconazole were excluded. To evaluate the adequacy of AF use, we scored from 0 to 10 considering: indication, drug selection, dosage, adjustment to microbiological results, switch to oral route and duration of therapy according to local guidelines. Results. In our study, we evaluated 28 patients: 16 (57.1%) were male and had a median age of 58y (interquartile range [IQR] 40–68). Reasons for starting AFs were empirical: 10 (35.7%) and targeted treatment: 18 (64.3%). AFs for which the patient was evaluated were as follows: 5 (17.9%) anidulafungin, 7 (25%) micafungin, 10 (35.7%) caspofungin, 4 (14.3%) voriconazole, 2 (7.1%) L-AmB. In terms of adequacy of AF treatment, the evaluation revealed that 2 (7.1%) of the prescriptions were unnecessary, 6 (21.4%) were not the recommended option, 7 (25%) received an inadequate dosage, 7 (25%) were not adjusted after microbiological results and 15 (53.6%) had an inadequate duration of therapy. Overall, the median length of AF-therapy was 15.5 days (IQR 6.25–36.75). The median total score of appropriateness was 8.0 (IQR 7–9.75). After the final evaluation, 15 (53.6%) patients had an IFI (11 invasive candidiasis or candidemia and 4 invasive aspergillosis). The final outcome of such patients was as follows: 17 (60.7%) died, 3 (10.7%) of which were IFI related. Conclusion. Main inadequacies regarding AF treatment in oncological patients are: length of therapy, lack of AF adjustment (after receiving microbiological results) and inadequate dose adjustment. There are opportunities for improvement in antifungal stewardship in Oncological patients. (This study was partially financed by PROMULGA Project. Instituto de Salud Carlos III. PI1002868.) Disclosures. All authors: No reported disclosures.
2015

Full conference title: 

IDWeek 2015 San Diego, CA
    • IDWeek 2015

Antifungal stewardship