Evaluation of antifungals in the surgical intensive care unit: a multi-institutional study

Authors: Garey, Kevin W.¹; Neuhauser, Melinda M.¹; Bearden, David T.²; Cannon, Joan P.³; Lewis, Russell E.¹; Gentry, Layne O.⁴; Kontoyiannis, Dimitrios P.⁵

Source: Mycoses, Volume 49, Number 3, May 2006 , pp. 226-231(6)

Publisher: Wiley-Blackwell

Abstract:

Summary

In the USA, >50% of candidemia episodes occur in medical or surgical intensive care units (SICU). However, studies focused on patterns and rationale for antifungal use are lacking. The objective of this study was to evaluate systemic antifungal usage in SICU patients. Retrospective audit of SICU patients receiving antifungal therapy from four American hospitals. Medical records were reviewed for demographics, hospital variables, microbiology results, antifungal regimens and indications for therapy. A total of 2411 patient-days of antifungal use were evaluated in 225 patients. Fluconazole was the most frequently prescribed antifungal (1846 patient-days) followed by amphotericin B deoxycholate (251 patient-days), lipid formulations of amphotericin B (201 patient-days), itraconazole (71 patient-days), and caspofungin (42 patient-days). Antifungals were prescribed empirically (44%), for preemptive therapy in critically ill patients colonised with Candida (43%), or for candidiasis (12%). Candida species were recovered from 98% of patients with positive fungal cultures most commonly from pulmonary (53%) or urinary sources (17%). Fluconazole is the most frequently prescribed antifungal agent in SICUs and is most often prescribed for empiric or preemptive indications. Research efforts to identify patients who warrant preemptive antifungal therapy for invasive candidiasis could dramatically change antifungal prescribing patterns in the SICU.

Keywords: antifungal; fluconazole; intensive care unit; pharmacoepidemiology

Document Type: Research article

DOI: http://dx.doi.org/10.1111/j.1439-0507.2006.01222.x

Affiliations: 1: Departments of Clinical Science and Administration, University of Houston College of Pharmacy, Houston, TX 2: College of Pharmacy at OHSU, Oregon State University, Portland, OR 3: Department of Pharmacy, Edward Hines VA Hospital, Hines, IL 4: Infectious Disease Section, St Luke's Episcopal Hospital, Houston, TX 5: Department of Infectious Diseases, Infection Control and Employee Health, The University of Texas M. D. Anderson Cancer Center, Houston, TX, USA

Publication date: 2006-05-01

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