A multicentre pharmacoepidemiological study of therapeutic practices in invasive fungal infections in France during 1998-1999.
OBJECTIVE
To study the pharmacoepidemiology of the prescription of systemic antifungal agents in 48 French haematology, intensive care and infectious diseases units.


METHODS
Cases of invasive fungal infections (IFI) were identified retrospectively over a 1 year period. Data on underlying condition, IFI diagnosis, antifungal treatment and outcome were collected on the last five cases in each centre. Factors associated with first line therapy and with death were identified by multivariate analysis.


RESULTS
Two hundred and nine cases were included (102 aspergillosis, 86 candidiasis, 15 cryptococcosis). Amphotericin B, in different formulations, was the first line therapy in 60%, azoles in 32%, combinations in 8%. Haematological malignancies and neutropenia were associated with less frequent initial prescription of azoles [OR = 0.3 (0.1-0.8) and OR = 0.3 (0.1-0.9), respectively]. In aspergillosis, younger age and neutropenia were associated with less frequent initial prescription of azoles [OR = 0.03 (0.002-0.6) and OR = 0.09 (0.03-0.3), respectively] and previous history of IFI was associated with a higher probability of azole prescription [OR = 17.2 (2.4-124.3)]. In candidiasis, haematological malignancy and co-prescription of nephrotoxic agents were associated with a less frequent initial prescription of azoles [OR = 0.1 (0.04-0.4) and OR = 0.2 (0.06-0.9), respectively]. Three factors were associated with a lower risk of death: cryptococcosis [OR = 0.16 (0.03-0.98)], hospitalization in infectious diseases units [OR = 0.40 (0.16-0.97)] and recent surgery [OR = 0.26 (0.08-0.80)]. Severe renal insufficiency was associated with a higher probability of death [OR = 8.77 (1.97-38.97)].


CONCLUSIONS
Our results emphasize factors associated with the antifungal therapeutic decision and with the outcome of IFI.
Lortholary
Olivier
O
Centre National de Référence Mycologie et Antifongiques, Institut Pasteur, Paris and Hôpital Necker, Paris, France.
Charlemagne
Agnès
A
Bastides
Frédéric
F
Chevalier
Patrick
P
Datry
Annick
A
Gonzalves
Marie-France
MF
Michel
Gérard
G
Tilleul
Patrick
P
Veber
Benoît
B
Herbrecht
Raoul
R
D000293:Adolescent; D000328:Adult; D000368:Aged; D000935:Antifungal Agents / Q000627:therapeutic use*; D000970:Antineoplastic Agents / Q000009:adverse effects; D001228:Aspergillosis / Q000188:drug therapy / Q000453:epidemiology / Q000382:microbiology; D002177:Candidiasis / Q000188:drug therapy / Q000453:epidemiology / Q000382:microbiology; D002648:Child; D003453:Cryptococcosis / Q000188:drug therapy / Q000453:epidemiology / Q000382:microbiology; D004363:Drug Utilization; D005260:Female; D005602:France / Q000453:epidemiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009181:Mycoses / Q000188:drug therapy* / Q000453:epidemiology* / Q000382:microbiology; D009503:Neutropenia / Q000150:complications; D017891:Pharmacoepidemiology; D051437:Renal Insufficiency / Q000150:complications; D012189:Retrospective Studies; D016019:Survival Analysis; D016896:Treatment Outcome
D000935:Antifungal Agents; D000970:Antineoplastic Agents