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Intensive care unit-related fluconazole use in Spain and Germany: patient characteristics and outcomes of a prospective multicenter longitudinal observational study

Authors Wissing H, Ballus J, Bingold T, Nocea G, Krobot K, Kaskel P, Kumar R, Mavros P

Received 9 October 2012

Accepted for publication 28 November 2012

Published 30 January 2013 Volume 2013:6 Pages 15—25

DOI https://doi.org/10.2147/IDR.S38945

Checked for plagiarism Yes

Review by Single-blind

Peer reviewer comments 3

Heimo Wissing,1 Jose Ballus,2 Tobias M Bingold,1 Gonzalo Nocea,3 Karl J Krobot,4 Peter Kaskel,4 Ritesh N Kumar,5 Panagiotis Mavros5

1Department of Anesthesiology, Intensive Care, and Pain Therapy, Johann Wolfgang Goethe University Hospital, Frankfurt am Main, Germany; 2Bellvitge University Hospital, L'Hospitalet del Llobregat (Barcelona), Barcelona, Spain; 3Merck Sharp and Dohme, Madrid, Spain; 4MSD SHARP & DOHME GMBH, Outcomes Research, Haar, Germany; 5Merck and Co, Outcomes Research, Whitehouse Station, NJ, USA

Background: Candida spp. are a frequent cause of nosocomial bloodstream infections worldwide.
Objective: To evaluate the use patterns and outcomes associated with intravenous (IV) fluconazole therapy in intensive care units in Spain and Germany.
Patients and methods: The research reported here was a prospective multicenter longitudinal observational study in adult intensive care unit patients receiving IV fluconazole. Demographic, microbiologic, therapy success, length of hospital stay, adverse event, and all-cause mortality data were collected at 14 sites in Spain and five in Germany, from February 2004 to November 2005.
Results: Patients (n = 303) received prophylaxis (n = 29), empiric therapy (n = 140), preemptive therapy (n = 85), or definitive therapy (n = 49). A total of 298 patients (98.4%) were treated with IV fluconazole as first-line therapy. The treating physicians judged therapy successful in 66% of prophylactic, 55% of empiric, 45% of preemptive, and 43% of definitive group patients. In the subgroup of 152 patients with proven and specified Candida infection only, 32% suffered from Candida specified as potentially resistant to IV fluconazole. The overall mortality rate was 42%.
Conclusion: Our study informs treatment decision makers that approximately 32% of the patients with microbiological results available suffered from Candida specified as potentially resistant to IV fluconazole, highlighting the importance of appropriate therapy.

Keywords: antifungal agents, Candida, fungal infection, therapy

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