title: Echinocandin use in hospitalized patients: a multi-institutional study.
abstract: BACKGROUND
  The echinocandin antifungals are recommended as initial therapy in hospitalized patients with candidemia. Contemporary usage rates and indication for use of echinocandins have not been studied in the United States. The purpose of this study was to evaluate echinocandin usage patterns in community and academic teaching hospitals over time and to evaluate dose, duration of therapy and indications for use.
  
  
  METHODS
  This study used hospital pharmacy databases from academic and community hospitals to collect information on adult inpatients given systemic antifungal agents from 2008 to 2012. Patient medical information was also obtained from randomly selected patients given an echinocandin over the same time period.
  
  
  RESULTS
  Echinocandin use was determined for 4 academic and 34 community hospitals. A significant increase in echinocandin use was observed in academic and community hospitals during the time period (P < 0.001). Two hundred forty-two randomly selected patients receiving an echinocandin were retrospectively reviewed. Indications for echinocandin use did not change during the time period and included empiric therapy in a high-risk patient without subsequent mycologic confirmation from a normally sterile site (55%), systemic candidiasis (43%) and prophylactic (2%). Fifty-six percent of patients had at least 1 anatomic site of mycologic growth; most commonly urine only (14%), respiratory only (12%) or blood only (7%). In patients with candidemia, the hospital treatment course with an echinocandin averaged 8.4 ± 7.9 days (range, 1-35 days).
  
  
  CONCLUSIONS
  This study provides useful benchmark data on antifungal use and indications for use that could be used for antifungal stewardship program comparisons.
authors.affiliation: Department of Clinical Sciences and Administration (KWG, SLA, AD, NDB, KK), University of Houston College of Pharmacy, Houston, Texas; Merck & Co, Inc (YX), Whitehouse Station, New Jersey; and Section of Infectious Diseases (HLK), Baylor College of Medicine, Houston Texas.
authors.forename: Kevin W
authors.initials: KW
authors.lastname: Garey
authors.forename: Samuel L
authors.initials: SL
authors.lastname: Aitken
authors.forename: Anthony
authors.initials: A
authors.lastname: Dima-Ala
authors.forename: Nicholas D
authors.initials: ND
authors.lastname: Beyda
authors.forename: Kristi
authors.initials: K
authors.lastname: Kuper
authors.forename: Yang
authors.initials: Y
authors.lastname: Xie
authors.forename: Hoonmo L
authors.initials: HL
authors.lastname: Koo
mesh_terms: D000046:Academic Medical Centers / Q000706:statistics & numerical data; D000935:Antifungal Agents / Q000627:therapeutic use*; D058387:Candidemia / Q000188:drug therapy*; D054714:Echinocandins / Q000627:therapeutic use*; D005260:Female; D006760:Hospitalization; D006764:Hospitals, Community / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D008875:Middle Aged
chemical_list: D000935:Antifungal Agents; D054714:Echinocandins