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KMID : 0869620190360010097
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Journal of Korean Society of Hospital Pharmacists
2019 Volume.36 No. 1 p.97 ~ p.107
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Current Status and Clinical Outcomes of Combination Antifungal Therapy in Intensive Care Units
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Nam Hyo-Joo
Jung Sun-Mi
Kim Jae-Song
Kim Soo-Hyun
Son Eun-Sun
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Abstract
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Background : Invasive fungal infections are major infections that increase morbidity and mortality in intensive care units (ICUs). Most infected patients are immunosuppressed or critically ill. In 2016, the Infectious Diseases Society of America (IDSA) guidelines recommended a combination of voriconazole and echinocandins for patients with invasive aspergillosis. The purpose of this study was to analyze the clinical efficacy of combination antifungal therapy in ICUs of tertiary-care hospitals and to provide reference information for future treatment of fungi.
Methods : We respectively reviewed the electronic medical records (EMRs) of patients who had been treated with combination antifungal therapy more than three days in ICUs from January 1 to December 31, 2016. To analyze the current status of combination antifungal therapy, we analyzed the type of concomitant medications, the dosage, and the periods of administration. The reasons the drugs were given were categorized into four groups, and efficacy was also assessed.
Results : A total of 21 patients were enrolled in this study. The combination of voriconazole and caspofungin was the most administered medication. The average duration of administration was 13.67±16.22 days. One patient (5%) received antifungal treatment for prophylactic purposes, seven patients (33%) were treated for empirical reasons, four patients (19%) for predictive purposes, and nine patients (43%) for therapeutic purposes. The drugs were effective in nine patients (43%), ineffective in four patients (19%), and eight patients (38%) died before assessment.
Conclusions : This study confirmed that a combination of antifungal agents was effective in ICU patients. Future research is necessary to further establish effectiveness.
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KEYWORD
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Intensive care units, Combination antifungal therapy, Invasive fungal infections
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