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
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
This work is published and licensed by Dove Medical Press Limited. The full terms of this license are available at https://www.dovepress.com/terms.php and incorporate the Creative Commons Attribution - Non Commercial (unported, v3.0) License. By accessing the work you hereby accept the Terms. Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Limited, provided the work is properly attributed. For permission for commercial use of this work, please see paragraphs 4.2 and 5 of our Terms.Download Article [PDF] View Full Text [HTML][Machine readable]