Atashgar Haura, Khalili Hossein, Salehi Mohammadreza, Mohammadi Mostafa
Department of Clinical Pharmacy, Faculty of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran.
Research Center for Antibiotic Stewardship and Antimicrobial Resistance, Tehran University of Medical Sciences, Tehran, Iran.
J Infect Dev Ctries. 2023 Mar 31;17(3):411-417. doi: 10.3855/jidc.16828.
Early diagnosis and appropriate management of fungal infections are critical for reducing complications and mortality in hospitalized patients. Due to the lack of appropriate local management protocols as well as the unavailability and cost of advanced tests for diagnosis of fungal infections, the irrational use of antifungals is a concern in developing countries.
This study was designed to evaluate diagnosis and management of fungal infections in hospitalized patients.
In a retrospective cross-sectional study, the use of parenteral antifungal medications among hospitalized patients was evaluated according to the prepared protocols adapted from the international guidelines.
Among 151 patients, diagnostic approaches were appropriate and inappropriate in 90 and 61 patients respectively. Indications for antifungal drug administration were empiric therapy (80.1%) followed by targeted therapy (19.2%) and prophylaxis (0.7%). The indications were appropriate and inappropriate in 123 and 28 patients respectively. Selection of antifungals was appropriate in 117 patients, inappropriate in 16 patients, and was not assessable in other cases. The doses of antifungal medications were appropriate and inappropriate in 111 and 14 patients respectively. Among 151 patients, the duration of treatment was appropriate just in 33 cases. The techniques for antifungal administration were appropriate in 133 patients and inappropriate in 18 cases.
Due to limited access to diagnostic tests, most parenteral antifungal medications were administered as empiric therapy. The diagnostic workups, treatment monitoring, and follow-up were inadequate in most patients. Development of local diagnostic and management protocols for invasive fungal infections and considering a stewardship program for antifungal medications are essential for each medical center.
真菌感染的早期诊断和恰当管理对于降低住院患者的并发症及死亡率至关重要。由于缺乏合适的局部管理方案，以及用于真菌感染诊断的先进检测方法难以获取且成本高昂，在发展中国家，抗真菌药物的不合理使用令人担忧。
本研究旨在评估住院患者真菌感染的诊断与管理情况。
在一项回顾性横断面研究中，根据参照国际指南制定的方案，对住院患者使用肠外抗真菌药物的情况进行了评估。
在151例患者中，诊断方法恰当的有90例，不恰当的有61例。抗真菌药物给药的指征依次为经验性治疗（80.1%）、靶向治疗（19.2%）和预防性治疗（0.7%）。指征恰当的有123例患者，不恰当的有28例。117例患者抗真菌药物的选择恰当，16例不恰当，其他情况无法评估。抗真菌药物剂量恰当的有111例患者，不恰当的有14例。在151例患者中，仅33例治疗疗程恰当。抗真菌药物给药技术恰当的有133例患者，不恰当的有18例。
由于诊断检测手段有限，大多数肠外抗真菌药物作为经验性治疗使用。大多数患者的诊断检查、治疗监测及随访不足。各医疗中心制定侵袭性真菌感染的局部诊断和管理方案，并考虑实施抗真菌药物管理计划至关重要。
