Evaluation of Systemic Antifungal Use in a Latin American General Care Hospital: A Retrospective Study

Abstract

Background: Invasive fungal infections significantly contribute to mortality and morbidity rates. Despite the presence of all four major classes of antifungal medications, it is estimated that these infections result in the death of 1.5 million people each year, and death rates are increasing at an alarming rate. With increasing concerns about the emergence of antifungal resistance, there is a growing consideration in many countries to incorporate antifungal stewardship into existing antimicrobial stewardship programs. This approach aims to address issues hindering the appropriate use of antifungal drugs and to optimize their utilization. Methods: An analytical retrospective study of 48 hospitalized patients was conducted to assess factors related to the use of systemic antifungals and develop and implement an internal protocol to improve its use. Results: All patients with severe comorbidity had SOFA scores linked with a mortality risk of more than 10%. Based on 48 evaluations of antifungal orders, 62.5% were considered appropriate, 14.6% were considered debatable, and 22.9% were considered inappropriate. Infectious disease physicians made most of the prescriptions considered appropriate in this study. Conclusions: Comorbidities and risk factors in patients receiving systemic antifungals can be associated with the development of more serious fungal infections; hence, the implementation of antifungal stewardship as a complement to antimicrobial stewardship programs can help facilitate decision-making when dealing with a suspected case of fungal infection.

An Analysis of the Use of Systemic Antifungals (Fluconazole, Itraconazole, and Terbinafine) in Galicia, Spain, between 2019 and 2022

“…Fungal infections, also known as mycoses, are traditionally demarcated as superficial (when they are limited to the skin, hair, nails, and mucous membranes), subcutaneous (when a granulomatous response of the skin and subcutaneous tissue occurs at the inoculation site), and systemic (when the infection is deep and affects internal organs) [1]. In recent decades, there has been a notable increase in their incidence due to the increase in immunosuppressed patients with cancer or undergoing solid organ transplantation, the AIDS and type 2 diabetes epidemic, and the use of broad-spectrum antimicrobials and drugs that alter the natural defense mechanisms [2,3].…”