Pharmacy Department, Lille University Hospital, Tourcoing Hospital, Lille, France.
J Clin Pharm Ther. 2011 Apr;36(2):152-60. doi: 10.1111/j.1365-2710.2010.01166.x.
Invasive fungal infections (IFI) are associated with high rates of morbidity and mortality, particularly in onco-haematology patients. We aimed to study the epidemiology of IFI in neutropenic patients and estimate the economic impact of treatment of those infections.
All patients hospitalized in onco-haematology, and treated with antifungal agents, in 2005 were investigated. Four features were studied: the diagnosis for each patient, the antifungal drugs used, the thoracic densitometry reports and the sero-mycological data. Infectious episodes were stratified according to the EORTC 2008 classification criteria (10).
Of the 1130 patients surveyed, 192 patients received systemic antifungal agents. Of these 46% had acute leukaemia, 29% bone-marrow allografts, 7% lymphoma and 18% other malignant haemopathies. Using the EORTC 2008 criteria (10), there were 8 proved IFI (3 aspergillosis, 3 candidosis and 2 other IFI), 17 probable IFI (11 aspergillosis, 6 candidosis) and 16 possible aspergillosis. The incidence of IFI was 2·1%. Eighty patients (41·7%) had received prophylaxis: 56 with fluconazole and 24 with voriconazole. Treatment was most often empirical (n = 127, 66·1%). Combination of two antifungals was used in 17 cases. The mean duration of prophylactic, empirical, proved/probable aspergillosis-directed, candidaemia-directed and combination treatment was 19, 19, 46, 32 and 27 days, respectively. The cost of antifungal treatment in 2005 reached almost 2,000,000 €, including 427,000 € for documented infections (proved and probable), 1,246,000 € for empirical treatment and 58,300 € for prophylaxis.
The incidence of IFI is low but the pharmacoeconomic impact is extremely high. Improved strategies are required to reduce the frequency and duration of empirical treatment without compromising beneficial outcome.
侵袭性真菌感染（IFI）与高发病率和死亡率相关，尤其是在血液恶性肿瘤患者中。我们旨在研究中性粒细胞减少症患者IFI 的流行病学，并估计治疗这些感染的经济影响。
研究了 2005 年在血液恶性肿瘤住院并接受抗真菌药物治疗的所有患者。研究了四个特征：每位患者的诊断、使用的抗真菌药物、胸部密度测定报告和血清学数据。根据 EORTC 2008 分类标准（10）对感染事件进行分层。
在调查的 1130 名患者中，有 192 名患者接受了全身抗真菌药物治疗。其中 46%患有急性白血病，29%接受骨髓移植，7%患有淋巴瘤，18%患有其他恶性血液病。使用 EORTC 2008 标准（10），有 8 例确诊的 IFI（3 例曲霉病、3 例念珠菌病和 2 例其他 IFI），17 例疑似 IFI（11 例曲霉病、6 例念珠菌病）和 16 例可能的曲霉病。IFI 的发病率为 2.1%。有 80 名患者（41.7%）接受了预防治疗：56 名接受氟康唑，24 名接受伏立康唑。治疗多为经验性（n=127，66.1%）。有 17 例使用了两种抗真菌药物的联合治疗。预防性、经验性、确诊/疑似曲霉病定向、念珠菌血症定向和联合治疗的平均持续时间分别为 19、19、46、32 和 27 天。2005 年抗真菌治疗的费用达到近 200 万欧元，其中包括 42.7 万欧元用于有记录的感染（确诊和疑似）、124.6 万欧元用于经验性治疗和 58.3 万欧元用于预防。
IFI 的发病率虽然较低，但药物经济学影响极高。需要改进策略，以减少经验性治疗的频率和持续时间，同时不影响有益的结果。
