title: Burden and treatment patterns of invasive fungal infections in hospitalized patients in the Middle East: real-world data from Saudi Arabia and Lebanon.
abstract: OBJECTIVE
  The objective of this study was to document the burden and treatment patterns associated with invasive fungal infections (IFIs) due toCandidaandAspergillusspecies in Saudi Arabia and Lebanon.
  
  
  METHODS
  A retrospective chart review study was conducted using data recorded from 2011 to 2012 from hospitals in Saudi Arabia and Lebanon. Patients were included if they had been discharged with a diagnosis of IFI due toCandidaorAspergillus, which was culture proven or suspected based on clinical criteria. Hospital data were abstracted for a random sample of patients to capture demographics, treatment patterns, hospital resource utilization, and clinical outcomes. Descriptive results were reported.
  
  
  RESULTS
  Five hospitals participated and provided data on 102 patients with IFI (51 from Lebanon and 51 from Saudi Arabia). The mean age of the patients was 55 years, and 55% were males. Comorbidities included diabetes (41%), coronary artery disease (24%), leukemia (19%), moderate-to-severe renal disease (16%), congestive heart failure (15%), and chronic obstructive pulmonary disease (15%). Twenty percent of patients received corticosteroids prior to admission and 26% had received chemotherapy in the past 90 days. Inpatient mortality was 42%, and the mean hospital length of stay was 32.4±28.6 days. Fifty-five percent of patients required intensive care unit admission (17.2±14.1 days), 37% required mechanical ventilation (13.7±13.2 days), and 11% required dialysis (14.6±14.2 days). The most commonly used first-line antifungal was fluconazole.
  
  
  CONCLUSIONS
  Patients with IFI in Saudi Arabia and Lebanon frequently have multiple medical comorbidities and may not have traditionally observed IFI risk factors. Efforts to increase use of rapid diagnostic tests and appropriate antifungal treatments may impact the substantial mortality and high length of stay observed in these patients.
authors.affiliation: College of Medicine, King Abdullah International Medical Research Center, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia.
authors.forename: Adel F
authors.initials: AF
authors.lastname: Alothman
authors.affiliation: Department of Infection Prevention and Control, King Abdullah International Medical Research Center, King Saud bin AbdulAziz University for Health Sciences, King AbdulAziz Medical City, Jeddah, Saudi Arabia.
authors.forename: Abdulhakeem O
authors.initials: AO
authors.lastname: Althaqafi
authors.affiliation: Department of Infectious Disease, Notre Dame de Secours University Hospital, Byblos, Lebanon.
authors.forename: Madonna J
authors.initials: MJ
authors.lastname: Matar
authors.affiliation: Department of Internal Medicine, Makassed General Hospital, Beirut, Lebanon.
authors.forename: Rima
authors.initials: R
authors.lastname: Moghnieh
authors.affiliation: College of Medicine, King Abdullah International Medical Research Center, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia.
authors.forename: Thamer H
authors.initials: TH
authors.lastname: Alenazi
authors.affiliation: Department of Infection Prevention and Control, King Abdullah International Medical Research Center, King Saud bin AbdulAziz University for Health Sciences, King AbdulAziz Medical City, Jeddah, Saudi Arabia.
authors.forename: Fayssal M
authors.initials: FM
authors.lastname: Farahat
authors.affiliation: Real-world Evidence/Data Analytics Center of Excellence, Pharmerit International, Bethesda, MD, USA.
authors.forename: Shelby
authors.initials: S
authors.lastname: Corman
authors.affiliation: Real-world Evidence/Data Analytics Center of Excellence, Pharmerit International, Bethesda, MD, USA.
authors.forename: Caitlyn T
authors.initials: CT
authors.lastname: Solem
authors.affiliation: Pfizer, New York, NY.
authors.forename: Nirvana
authors.initials: N
authors.lastname: Raghubir
authors.affiliation: Medical Data Analytics, Parsippany, NJ, USA.
authors.forename: Cynthia
authors.initials: C
authors.lastname: Macahilig
authors.affiliation: Pfizer International Operation, Paris, France.
authors.forename: Claudie
authors.initials: C
authors.lastname: Charbonneau
authors.affiliation: Real-world Evidence/Data Analytics Center of Excellence, Pharmerit International, Bethesda, MD, USA.
authors.forename: Jennifer M
authors.initials: JM
authors.lastname: Stephens
keywords: Aspergillus; Candida; antifungal; length of stay; mortality; resource use