Department of Medical Microbiology, Post Graduate Institute of Medical Education and Research, Chandigarh, India.
Department of Microbiology, AIIMS Bathinda, Bathinda, Punjab, India.
Mycoses. 2022 Oct;65(10):935-945. doi: 10.1111/myc.13514. Epub 2022 Aug 16.
Antifungal stewardship is a less explored component of antimicrobial stewardship programmes, especially in developing countries.
We aimed to determine antifungal prescription practices in a tertiary centre of a developing country to identify the challenges for antifungal stewardship programmes.
Four single-day point prevalent surveys were performed in inpatient units and data were collected from medical records. Antifungal use was recorded in terms of consumption, therapeutic strategies and appropriateness.
We found a 2.42%-point prevalence of antifungal prescriptions. Antifungal use was higher in children than adults (4.1% vs. 2.03%), medical than surgical units (3.7% vs. 1.24%) and ICUs than general wards (5.8% vs. 1.9%). The highest antifungal use was observed in the haematology-oncology units (29.3%) followed by emergency (16.2%) and gastroenterology units (11.6%). Among 215 prescriptions, amphotericin B was the most commonly prescribed (50.2%) followed by fluconazole (31.6%). The targeted antifungal therapy was practised more commonly (31.5%) than empiric (29.1%), pre-emptive (22.6%) and prophylactic (16.8%) therapy. Amphotericin B was commonly used for pre-emptive (p = .001) and targeted (p = .049) therapy, while fluconazole (p = .001) and voriconazole (p = .011) for prophylaxis. The prescriptions were inappropriate in 25.1% due to the wrong choice of antifungal (44.4%), indication (27.7%) and dosage (24%). The overall mean antifungal consumption was 2.71 DDD/1000 PD and 8.96 DOT/1000 PD.
We report here the low prevalence of antifungal use at a tertiary care centre in a developing country. Though training for antifungal use would be important for antifungal stewardship, the challenge would remain with the affordability of antifungals.
抗真菌药物管理是抗菌药物管理计划中一个研究较少的领域，尤其是在发展中国家。
我们旨在确定发展中国家一家三级中心的抗真菌药物处方实践，以确定抗真菌药物管理计划面临的挑战。
在住院病房进行了四次为期一天的点 prevalence 调查，并从病历中收集数据。抗真菌药物的使用情况根据消耗量、治疗策略和适宜性进行记录。
我们发现抗真菌药物处方的 prevalence 为 2.42%。儿童的抗真菌药物使用率高于成人（4.1%比 2.03%），内科比外科（3.7%比 1.24%），重症监护病房比普通病房（5.8%比 1.9%）高。血液肿瘤科的抗真菌药物使用率最高（29.3%），其次是急诊（16.2%）和消化内科（11.6%）。在 215 张处方中，两性霉素 B 的使用最为广泛（50.2%），其次是氟康唑（31.6%）。靶向抗真菌治疗（31.5%）比经验性（29.1%）、抢先（22.6%）和预防性（16.8%）治疗更为常见。两性霉素 B 常用于抢先（p=0.001）和靶向（p=0.049）治疗，而氟康唑（p=0.001）和伏立康唑（p=0.011）用于预防。由于抗真菌药物选择不当（44.4%）、适应证不当（27.7%）和剂量不当（24%），25.1%的处方不合适。总的平均抗真菌药物消耗量为 2.71 DDD/1000 PD 和 8.96 DOT/1000 PD。
我们在此报告了在发展中国家的一家三级医疗中心抗真菌药物使用的低 prevalence。虽然对抗真菌药物使用进行培训对抗真菌药物管理很重要，但挑战仍然在于抗真菌药物的可负担性。
