Objectives: This was a quality- control study, aiming to identify possible misuse of antifungal agents and to improve antifungal treatment.
Methods: A multicenter, observational, one day, point prevalence study was carried out in one Military and four University hospitals all over Greece. The use of antifungal drugs for the treatment of hospitalized adult patients, between 25 and 30 of June 2015 was evaluated. Demographics and information about diagnoses and treatment indications were also evaluated.
Results: Seventy-three patients, 45 males (62%), with median age 64 years (range: 20 - 87), receiving antifungals on the study day have been identified and evaluated. Antifungals were given for the treatment of an infection in 24 patients (33%), while for prophylaxis in 49 (67%). Immunocompromised were 39 patients (53%). Among them 23 had leukemia (59%), 5 lymphoma (13%) and 11 solid tumors (28%). On the study day 21 patients were on chemotherapy (29%). Prior exposure to antifungals had 14 patients (19%) and 37 (51%) to broad spectrum antimicrobials. In the ICU were treated 18 patients (25%). Septic shock were suffering 14 patients (19%). An infectious diseases consultant had the initiative for antifungal treatment in 27 patients (37%).The main infection sites identified were the respiratory (10%) and the urinary tract (8%). In most patients (64%) the infection site was not identified. Candida species were isolated in 16 out of 18 microbiologically documented cases, with C. albicans being most frequently isolated (67%), followed by C. parapsilosis (17%). The most frequently used antifungal was fluconazole (30%), followed by micafungin and anidulafungin (20% each). Only two patients were receiving antifungal combination (3%), while most patients were receiving antifungal–antibacterial combinations (92%). Ultimately, antifungal treatment has been considered unnecessary in 12 patients (17%). The most used agent in medical departments was fluconazole (30%), followed by micafungin (25%), while in the surgical ones fluconazole and anidulafungin were equally used (36%). Anidulafungin was preferable in the ICU (38%). Finally, fluconazole was the agent given most frequently as prophylaxis (35%).
Conclusions: Echinocandins and fluconazole were the antifungals administered most frequently for an identified or presumptive fungal infection, while fluconazole was given most frequently for prophylaxis. Most patients received an antifungal as prophylaxis. Antifungal treatment has been, ultimately, proven unnecessary in 17%. This observation identifies a target for quality improvement.
Full conference title:
- ECCMID 26th (2016)