Comparison of antifungal therapy in intensive care unit and oncological patients
Abstract number: P1036
Luethi B., Sasse J., von Both U., Ruef C.
Objectives. New antifungal agents have enlarged treatment options for invasive fungal infections. However, these drugs are more expensive than older agents such as fluconazole (FLU) or amphotericin B (AmB). The purpose of this study is to describe antifungal therapy (AFT) in ICU and oncological patients at a European tertiary care hospital.
Methods: Prospective observational, non-interventional study on 3 ICUs and 1 oncology ward (ONC) to assess AFT, reasons for treatment changes and clinical outcome in 50 consecutive patients (48% female, median age 53.5, range 2374 yrs; 36 ICU, 14 ONC). Standard criteria for the diagnosis of invasive fungal infections (IFI) were used.
Results: Mean length of hospitalisation was 59 days, the mean length of ICU stay 25 days. Overall mortality was 30%, without statistical difference between ICU and ONC patients. The following risk factors for IFI were highly prevalent: neutropenia (58%), use of broad-spectrum antibiotics (94%), total parenteral nutrition (18%), intraabdominal surgery (24%). We evaluated a total of 58 AFT cycles (1582 treatment days), including 103 courses (data for initial courses in table). Mean duration of treatment was 8.4 days (amB) 15.4 (CAS), and 14.7 (VOR).
Modification of initial AFT was necessary in 50% of cycles. Rates of premature change (PC) of AFT for individual agents were: AmB (73.3% overall, 53.3% due to adverse events (AE)/20% due to treatment failure), FLU (31.3, 12.5/18.8), VOR (70, 50/20), CAS (28.6, 0/28.6). The rate of PC due to AE was significantly higher with AmB and VOR than with FLU and CAS.
Conclusion: AFT in oncology is still predominantly based on AmB, which has been replaced in ICU patients by newer agents (VOR, CAS). In oncology patients indication for AFT is rarely based on probable or proven IFI, while this diagnosis is more often established in ICU pts. Premature discontinuation of AFT is frequent with AmB and VOR and is usually caused by AE.
|Session name:||18th European Congress of Clinical Microbiology and Infectious Diseases|
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