Antifungal use in hospitalized adults in U.S. academic health centers

Use of antifungal agents and predictors of total antifungal use among adult inpatients at U.S. academic health centers was characterized.

Claims data obtained from a geographically representative sample of U.S. nonprofit academic health centers were analyzed to characterize use of systemic antifungals during the period 2004-08. Aggregate data were analyzed to identify trends in use of three antifungal classes (azoles, polyenes, echinocandins), as well as individual antifungal agents. Multivariate regression analysis was employed to investigate predictors of total antifungal use and interhospital variability in antifungal use.

Aggregate antifungal use at health centers included in the data analysis increased from (mean ± S.D.) 82 ± 36 days of therapy (DOT) per 1000 patient-days in 2004 to 88 ± 39 DOT per 1000 patient-days in 2007 and then declined to 77 ± 36 DOT per 1000 patient-days in 2008. Use of voriconazole increased significantly during the study period (p < 0.0001), while use of caspofungin decreased significantly (p < 0.0001). Higher use of third- or fourth- generation cephalosporins was a significant predictor of higher total antifungal use (p = 0.0005); performance of more stem cell or bone marrow transplants was also significantly associated with greater antifungal use.

Total antifungal use at a sample of U.S. academic health centers increased from 2004 to 2007 but decreased to below baseline in 2008. Azoles were the most commonly used agents. In 2008, total antifungal use at the centers ranged from 29 to 334 DOT per 1000 patient-days.