Evaluation of Candida bloodstream infection and antifungal utilization in a tertiary care hospital

Tatiana Aporta Marins,Paula Kiyomi Onaga Yokota,Marines Dalla Valle Martino,Marcelino Souza Durão Junior,Michael B Edmond,Ana Carolina Cintra Nunes Mafra,Alexandre R Marra

doi:10.1186/s12879-018-3094-9

Abstract

BackgroundCandida bloodstream infections carry a significant mortality risk, justifying the importance of adequate antifungal therapy. This study describes trends in antifungal consumption using the Defined Daily Dose (DDD) and Days of Therapy (DOT) metrics, identifies the microbiological profile, the time to initiation of empirical therapy, the adjustment after positive blood culture results for Candida, and the impact on in-hospital mortality rate in patients with candidemia.MethodsAn analysis of antifungal consumption from 2008 to 2016, and of candidemia cases from 2012 to 2016 was carried out in a private tertiary hospital.ResultsA total of 11,273 admissions were identified with a prescription for at least one type of antifungal therapy. Fluconazole was the most prescribed antifungal drug in terms of general consumption. Through the DDD and DOT metrics, we observed that over time, there was an increase in the consumption of liposomal amphotericin B, micafungin and voriconazole. Candida albicans was the most isolated species in blood cultures. Regarding candidemia, we analyzed samples from 115 patients. Empirical therapy was started within 24 h of blood culture in 44.3% of the cases, and in 81.7% of the cases, the antifungal was deemed to be adequate based in antifungal susceptibility testing, both of which were not associated with the in-hospital mortality rate.ConclusionsOur study reinforces the importance of monitoring the consumption of antifungal agents, which helps in proposing actions that lead to their rational use and, consequently, reduces the appearance of resistant strains.

Highlights

Candida bloodstream infections carry a significant mortality risk, justifying the importance of adequate antifungal therapy
The goal of this study is to describe and analyze antifungal consumption trends through the Defined Daily Dose (DDD) and Days of Therapy (DOT) metrics in patients who were admitted to Hospital Israelita Albert Einstein, and identify the microbiological profile, time of onset of empirical antifungal therapy, antifungal adequacy and the impact on in-hospital mortality in patients with candidemia
We found high correlation between the DDD and the study period indicating that there was a significant increase in the consumption of amphotericin B over time, the liposomal formulation, micafungin, and intravenous voriconazole

Summary

Introduction

Candida bloodstream infections carry a significant mortality risk, justifying the importance of adequate antifungal therapy. Candida albicans remains the most commonly isolated microorganism among Candida, candidemia caused by non-albicans species has increased worldwide, C. tropicalis, C. glabrata, C. parapsilosis and C. krusei [4, 5]. The severity of these infections poses a significant morbidity and mortality risk [6]. Regarding the timing of initiation of empiric treatment, studies are still controversial, with some showing that mortality was lower in patients who received the antifungal early [10, 11] and others indicating that there was no significant difference in in-hospital mortality [12, 13]

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