Pharmacoeconomic Analysis of Antifungal Drug Use in the Intensive Care Unit.

Abstract

to investigate changing of Candida species (C. spp) distribution and expenditure for antimicrobial drugs in the intensive care unit (ICU). from 1.01.11 to 30.07.13 there were 200 patients with Candida spp positive samples in the ICU. We followed up antifungal drugs susceptibility of different C. spp. and evaluated expenditure for antifungal drugs. C spp was detected in 200 patients (12,2% of ICU microbiota). In 2011: 47 (19,3%); in 2012: 50 (9,3%); in 2013: 103 (12,1%) patients. The predominant species, detected during period of investigation was Candida albicans (C. a. ), which was isolated in 21 (44,7%), 21 (42%) and 52 (50,5%) patients in 2011,2012 and 2013 accordingly. Candida parapsilosis (C. p. ) was on second place and frequency of this fungus detecting increased: 1 (2,1%); 12 (24%); 31 (30,1%) patients. Candida tropicalis (C. t. ) was detected: in 5 (10,6%); 6 (12%); 10 (9,7%) patients. Candida glabrata (C. g. ): in 9 (19,1%); 3 (6%); 2 (1,9%). Candida krusei (C. k. ): in 6 (12,8%); 1 (2%); 1 (1%). Candida lusitaniae (C. l. ): in 2 (4,3%); 2 (4%); 3 (2,9%). Fluconazole susceptibility was: for C. a.: 100%; 89%; 97%; C. t. 82%; 94%, 92%, C. g 18%; 46%; 0% in 2011,2012 and 2013 accordingly; for C. p.: in 2012; 29%: in 2013: 23%. Changing of C. spp species distribution led to increasing of expenditure for antifungal drugs in ICU: 52% of expenditure for antimicrobial drugs in 2011; 72% in 2012; 78% in 2013. Echinocandines determined 44%; 65% and 70% of ICU expenditure for antimicrobial drugs in 2011; 2012; 2013 accordingly. Our data coordinate with modern tendency in C. spp changing in ICUs. Increasing of C. spp proportion, resistant to fluconazole requires more frequent echinocandines use, that leads to rise of hospital expenditure.