Antifungal Consumption, Indications And Selection Of Antifungal Drugs In Paediatric Tertiary Hospitals in Turkey: Results from The First National Point Prevalence Survey
Tarih
2018Yazar
Caglar, Ilknur
Devrim, Ilker
Ozdemir, Halil
Sahbudak, Zumrut
Sonmez, Gulsum
Buyukcam, Ayse
Gulhan, Belgin
Kara, Ahu
Aygun, Deniz F.
Bayram, Nuri
Celebi, Solmaz
Cetin, Benhur
Nepesov, Merve, I
Yilmaz, Ayse T.
Kepenekli, Eda
Ciftdogan, Dilek Yilmaz
Acar, Manolya K.
Yayla, Burcu Cura
Okumus, Canan
Ecevit, Zafer
Hatipoglu, Nevin
Kuyucu, Necdet
Kosker, Muhammed
Sen, Semra
Karbuz, Adem
Sutcu, Murat
Duramaz, Burcu Bursal
Ozen, Metehan
Ciftci, Ergin
Alabaz, Derya
Kurugol, Zafer
Kara, Ates
Kanik, Saliha
Kilic, Omer
Oncel, Selim
Somer, Ayper
Tapisiz, Anil
Belet, Nursen
Akcan, Ozge Metin
Turel, Ozden
Ozkaya, Aslinur
Tezer, Hasan
Cengiz, Ali Bulen
Ince, Erdal
Camcioglu, Yildiz
Kocabas, Emine
Arisoy, Emin S.
Salman, Nuran
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Objectives: The aim of this point prevalence survey was to evaluate the consumption, indications and strategies of antifungal therapy in the paediatric population in Turkey.
Methods: A point prevalence study was performed at 25 hospitals. In addition to general data on paediatric units of the institutes, the generic name and indication of antifungal drugs, the presence of fungal isolation and susceptibility patterns, and the presence of galactomannan test and high-resolution computed tomography (HRCT) results were reviewed.
Results: A total of 3338 hospitalised patients were evaluated. The number of antifungal drugs prescribed was 314 in 301 patients (9.0%). Antifungal drugs were mostly prescribed in paediatric haematology and oncology (PHO) units (35.2%), followed by neonatal ICUs (NICUs) (19.6%), paediatric services (18.3%), paediatric ICUs (PICUs) (14.6%) and haematopoietic stem cell transplantation (HSCT) units (7.3%). Antifungals were used for prophylaxis in 147 patients (48.8%) and for treatment in 154 patients (50.0%). The antifungal treatment strategy in 154 patients was empirical in 77 (50.0%), diagnostic-driven in 29 (18.8%) and targeted in 48 (31.2%). At the point of decision-making for diagnostic-driven antifungal therapy in 29 patients, HRCT had not been performed in 1 patient (3.4%) and galactomannan test results were not available in 12 patients (41.4%). Thirteen patients (8.4%) were receiving eight different antifungal combination therapies.
Conclusion: The majority of antifungal drugs for treatment and prophylaxis were prescribed in PHO and HSCT units (42.5%), followed by ICUs. Thus, antifungal stewardship programmes should mainly focus on these patients within the availability of diagnostic tests of each hospital. (C) 2018 International Society for Chemotherapy of Infection and Cancer. Published by Elsevier Ltd. All rights reserved.