Second Infectious Diseases Division, National Institute for Infectious Diseases, "Lazzaro Spallanzani", Rome, Italy.
Ther Clin Risk Manag. 2011 Jan 13;7:13-20. doi: 10.2147/TCRM.S11895.
Fungi are a frequent cause of nosocomial infections, with an incidence that has increased significantly in recent years, especially among critically ill patients who require intensive care unit (ICU) admission. Among ICU patients, postsurgical patients have a higher risk of Candida infections in the bloodstream. In consideration of the high incidence of fungal infections in these patients, their strong impact on mortality rate, and of the difficulties in Candida diagnosis, some experts suggest the use of antifungal prophylaxis in critically ill surgical patients. A clinical benefit from this strategy has been demonstrated, but the economic impact of the use of antifungal prophylaxis in surgical patients has not been systematically evaluated, and its cost-benefit ratio has not been defined. Whereas the costs associated with treating fungal infections are very high, the cost of antifungal drugs varies from affordable (ie, the older azoles) to expensive (ie, echinocandins, polyenes, and the newer azoles). Adverse drug-related effects and the possibly increased incidence of fluconazole resistance and of isolates other than Candida albicans must also be taken into account. From the published studies of antifungal prophylaxis in surgical patients, a likely economic benefit of this strategy could be inferred, but its usefulness and cost-benefits should be evaluated in light of local data, because the available evidence does not permit general recommendations.
真菌是医院感染的常见原因，近年来发病率显著上升，尤其是在需要入住重症监护病房（ICU）的重症患者中。在 ICU 患者中，手术后患者血液中念珠菌感染的风险更高。鉴于这些患者真菌感染的发生率很高，对死亡率的影响很大，以及念珠菌诊断的困难，一些专家建议对重症手术患者使用抗真菌预防。该策略已显示出临床获益，但尚未系统评估抗真菌预防在手术患者中的使用对经济的影响，也未确定其成本效益比。虽然治疗真菌感染的相关费用非常高，但抗真菌药物的价格从负担得起（即较老的唑类）到昂贵（即棘白菌素类、多烯类和较新的唑类）不等。还必须考虑药物相关不良反应以及氟康唑耐药和非白念珠菌分离株发生率增加的可能性。从已发表的外科患者抗真菌预防研究中，可以推断出该策略可能具有经济效益，但应根据当地数据评估其有用性和成本效益，因为现有证据不允许做出一般性建议。
