Systemic antifungal therapy in European hospitals. Data from the ESAC point prevalence surveys 2008 and 2009
Abstract number: O477
Zarb P., Amadeo B., Muller A., Vankerckhoven V., Davey P., Goossens H.
Objectives: To determine the variability of antifungal treatment in European hospitals and to identify targets for quality improvement in antifungal prescribing.
Methods: The European Surveillance of Antimicrobial Consumption (ESAC) Point Prevalence Survey (ESAC-PPS) was carried out during a maximum of two weeks in 50 European hospitals in 2008 and in 134 hospitals in 2009. A web-based application was developed for online data entry by the hospitals. Antimycotic prescriptions were recorded using the WHO ATC classification including 'antimycotics for systemic use' (J02) and terbinafine (D01BA02). Demographic data on treated patients, indications, and diagnoses were collected.
Results: From a total of over 85,000 admitted patients, 25,201 (29%) received antimicrobials. Patients receiving antifungals amounted to 1,309 (3.8% of all antimicrobials) receiving a total of 3,125 therapies (mean 2.4, range 17). Dual therapy was used in 487 (37%) patients, and triple therapy in 24% of patients. The most commonly prescribed antifungal was fluconazole, accounting for 60% of all antifungal therapy followed by caspofungin (10%). The most frequently used antifungal-antibacterial combinations included fluconazole plus either a quinolone or a b-lactam, mainly for medical prophylaxis. The proportion of parenteral use within the total antimycotic prescriptions was 47%. The oral route accounted for 60% of fluconazole prescriptions. In 38% of cases the site of infection was undefined whilst the most common sites were respiratory (20%), gastro-intestinal (16%) and ENT (4%). The medical specialty accounted for the majority (69%) of antifungal use. Hospital acquired infections represented 46% of all the indications followed by medical prophylaxis at 30%.
Conclusion: These ESAC-PPS results showed minimal variation in treatment for fungal infections. This was mainly observed in the predominance of fluconazole. However, high use of fluconazole can increase the prevalence of other fungi, e.g., Candida glabrata, and therefore increase the need for newer antifungals which are active against inherently resistant pathogens. Ongoing surveillance will enhance efforts to limit the extent of antifungal use and resistance. Antifungal prophylaxis in the immunocompromised host needs further exploration. ESAC-PPS methodology is the right tool for such analysis.
|Session name:||Abstracts 20th European Congress of Clinical Microbiology and Infectious Diseases|
|Location:||Vienna, Austria, 10 - 13 April 2010|
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