Impact of a multidisciplinary approach of invasive fungal infections from diagnosis to treatment

F. Lieutier, V. Mondain, M. Gari-Toussaint, L. Hasseine, A. Sirvent, M. Poirée, T. Dantin, N. Mounier, A. Mousnier

Author address: 

Nice, FR

Abstract: 

Invasive fungal infections (IFI) are severe diseases affecting immuno-compromised patients. In France, since 2007, the cost of expensive recommended antifungal treatments (AFT) is not included in the normal per-case payment and each suspected IFI must be systematically documented during interdisciplinary team meetings (ITM) including an infectious disease specialist, a haematologist, a mycologist and a pharmacist, when AFT are discussed. Objective: to evaluate the impact of our ITM. Methods: in 2008, 179 advices were provided in real time to prescribing doctors concerning 109 patients receiving AFT. This was done during 31 ITM. From January to September 2009, 192 advices were provided during 27 ITM, Each patient's condition was documented according to clinical presentation including emergency high resolution computed tomography (CT) of the chest and abdomen and microbiological data as Aspergillus galactomannan antigen assay twice a week, pan-fungal PCR, and mycological analysis of various samples (Bronchoalveolar fluid, blood culture "¦). Results: in 2008, 8 cases of probable and 2 of possible invasive aspergillosis (IA) were diagnosed (all in a haematology department, with one paediatric case). Four patients died: in one case IA may have been a causative factor. Incidence rate for IA was 4.7% among patients with acute leukaemia and stem-cell transplantation, which seems low compared to the literature. Advices were followed in 90% of cases. In 2008 and 2009 (until september), 95% of treatments involving added costs, were in line with provisions for marketing authorization. Number of empirical AFT: First half the year 2003 19/41 (46%) First half the year 2008 7/23 (30%) First half the year 2009 9/39 (23%) To conclude, currently, 100% of patients benefit from a radiological and biological monitoring, in order to optimize the diagnosis and AFT. Thus, the empirical's antifungal (AF) number has been reduced from 46 to 23%. Indeed, we observed a 17% drop in added AF costs and 12% for other systemic AF (2007 versus 2008). A good compliance with the suggested advices shows that prescribing doctors are in favour of the scheme. The consumption of AF expressed in Daily Defined Dose will allow further assessment of practice trends.
2010

abstract No: 

P807

Full conference title: 

20th European Congress of Clinical Microbiology and Infectious Diseases
    • ECCMID 20th (2010)