Premium
Evaluation of antifungals in the surgical intensive care unit: a multi‐institutional study
Author(s) -
Garey Kevin W.,
Neuhauser Melinda M.,
Bearden David T.,
Can Joan P.,
Lewis Russell E.,
Gentry Layne O.,
Kontoyiannis Dimitrios P.
Publication year - 2006
Publication title -
mycoses
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.13
H-Index - 69
eISSN - 1439-0507
pISSN - 0933-7407
DOI - 10.1111/j.1439-0507.2006.01222.x
Subject(s) - fluconazole , medicine , caspofungin , itraconazole , amphotericin b , intensive care unit , antifungal , intensive care medicine , flucytosine , dermatology
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.