Clinical and economic burden of invasive fungal diseases in Europe: focus on pre-emptive and empirical treatment of Aspergillus and Candida species

Abstract

Invasive fungal diseases (IFDs) have been widely studied in recent years, largely because of the increasing population at risk. Aspergillus and Candida species remain the most common causes of IFDs, but other fungi are emerging. The early and accurate diagnosis of IFD is critical to outcome and the optimisation of treatment. Rapid diagnostic methods and new antifungal therapies have advanced disease management in recent years. Strategies for the prevention and treatment of IFDs include prophylaxis, and empirical and pre-emptive therapy. Here, we review the available primary literature on the clinical and economic burden of IFDs in Europe from 2000 to early 2011, with a focus on the value and outcomes of different approaches.Electronic supplementary materialThe online version of this article (doi:10.1007/s10096-013-1944-3) contains supplementary material, which is available to authorized users.

Hospital resource use of patients receiving isavuconazole vs voriconazole for invasive mold infections in the phase III SECURE trial

“…Invasive fungal disease is an economic burden for hospitals [5][6][7][8][9] and hospital LOS is the main determinant of hospital costs 9,25 .…”

“…Patients with invasive aspergillosis have longer LOS in hospitals and higher costs of care compared with similar patients without this disease 6,8,9 . Therefore, efficacy with reduced hospital LOS and costs are clearly desirable characteristics of new antifungal agents.…”

“…Despite current treatment options and advances in diagnostic testing, these infections remain associated with significant morbidity and mortality 4 . As a consequence, the financial burden of IMD is high [5][6][7][8][9] , especially as many patients require protracted hospital stays 5,6,8,9 . Patients with a primary diagnosis of invasive aspergillosis are calculated to spend an average of 12.0 days in the hospital and incur an average cost of US$33,253 per inpatient episode 10 .…”

Mycoses and Antifungals: reviewing the basis of a current problem that still is a biotechnological target for marine products

“…Candida species are classified as the fourth leading cause of bloodstream infections in hospitals, causing a high mortality (35-45%) according to epidemiological studies (Wisplinghoff, 2004;Drgona et al, 2014). In addition, non-albicans Candida species are now also associated with pertinent infections such as C. glabrata, C. krusei, C. parapsilosis and C. tropicalis, C. dubliniensis, have also emerged as causative agents of infections (Jordán et al, 2014).…”

Treatment Principles for the Management of Mold Infections

“…Mold infections are associated with substantial healthcare utilization (Tong et al 2009;Drgona et al 2013b), and high crude and attributable mortality rates (Pfaller and Diekema 2010). Invasive fungal infections are also associated with poorer outcomes of underlying diseases, as hematologists or transplant physicians are often less reluctant to proceed with lifesaving immunosuppressive chemotherapy or transplantation in the setting of active fungal disease (Cordonnier et al 2004;Even et al 2011).…”