title: [Trends in systemic antifungal use in critically ill patients. Multicenter observational study, 2006-2010].
abstract: BACKGROUND
  There are limited data about the use of antifungal agents (AF) in critically ill patients and treatment trends since the inclusion of the new generation AF. The use of these agents may have a significant influence on the development of new resistances.
  
  
  METHODS
  Observational prospective study of the systemic use of AF in patients admitted to Spanish intensive care units (ICU) participating in the ENVIN-HELICS register, from 2006 to 2010. The annual use, the indications that led to that use and, the intra-ICU infections, the AF employment related to the hospital size, and per 1000 patients/day, were compared.
  
  
  RESULTS
  Of the 8240 prescriptions for AF, fluconazole and caspofungin were the most often employed (55% and 19.5%, respectively). An increase in use was observed to the year 2008, with subsequent stabilisation. A decrease in the use of fluconazole and an increase in echinocandins consumption was observed over time. As regards the intra-ICU infections, the AF were ordered empirically in 47.9% of the indications. Fluconazole was more frequently used in medium size hospitals than in the large ones (60.4% versus 53.3%; P=.036) and the opposite occurred in the case of caspofungin (15.8% versus 21.8%; P<.001). Fluconazole was more prematurely employed (median 12 days since ICU admission) and the duration of the therapy was similar to the other AF (median 8 days). The total therapy days were 39.51 per 1000 patient/day, with predominance in fluconazole use (21.48 per 1000 patients/day).
  
  
  CONCLUSIONS
  Fluconazole is the most used antifungal agent in critically ill patients in any of the indications, although a progressive decrease in its use is observed, with a proportional increase in the use of echinocandins.
authors.affiliation: Servicio de Medicina Intensiva, Hospital Galdakao-Usansolo, Vizcaya, España. pedromaria.olaecheaastigarrag@osakidetza.net
authors.forename: Pedro M
authors.initials: PM
authors.lastname: Olaechea-Astigarraga
authors.forename: Francisco
authors.initials: F
authors.lastname: Alvarez-Lerma
authors.forename: Mercedes
authors.initials: M
authors.lastname: Palomar-Martínez
authors.forename: Josu
authors.initials: J
authors.lastname: Insausti-Ordeñana
authors.forename: M Jesús
authors.initials: MJ
authors.lastname: López-Pueyo
authors.forename: Iratxe
authors.initials: I
authors.lastname: Seijas-Betolaza
authors.forename: Juan José
authors.initials: JJ
authors.lastname: Otal-Entraigas
authors.forename: Ricardo
authors.initials: R
authors.lastname: Gimeno-Costa
authors.forename: María Pilar
authors.initials: MP
authors.lastname: Gracia-Arnillas
mesh_terms: D000666:Amphotericin B / Q000627:therapeutic use; D000935:Antifungal Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D000077336:Caspofungin; D017714:Community-Acquired Infections / Q000188:drug therapy / Q000453:epidemiology; D016638:Critical Illness; D003428:Cross Infection / Q000188:drug therapy / Q000453:epidemiology; D011307:Drug Prescriptions / Q000706:statistics & numerical data; D004363:Drug Utilization / Q000706:statistics & numerical data / Q000639:trends; D054714:Echinocandins / Q000627:therapeutic use; D005260:Female; D015725:Fluconazole / Q000627:therapeutic use; D006742:Hospital Bed Capacity; D006801:Humans; D016867:Immunocompromised Host; D007362:Intensive Care Units / Q000706:statistics & numerical data; D055666:Lipopeptides; D008297:Male; D008875:Middle Aged; D009181:Mycoses / Q000188:drug therapy / Q000453:epidemiology / Q000517:prevention & control; D009503:Neutropenia / Q000150:complications; D011446:Prospective Studies; D012042:Registries; D013030:Spain / Q000453:epidemiology
chemical_list: D000935:Antifungal Agents; D054714:Echinocandins; D055666:Lipopeptides; D000666:Amphotericin B; D015725:Fluconazole; D000077336:Caspofungin