Antifungal Use in Immunocompromised Children in Europe: A 12-Week Multicenter Weekly Point Prevalence Survey...

Area of Science:

• Pediatric Hematology-Oncology
• Infectious Diseases
• Pharmacology

Background:

• Antifungal stewardship is critical in immunocompromised pediatric populations.
• Hematology-oncology (HO) and hematopoietic stem cell/solid organ transplant (HSCT/SOT) patients are at high risk for invasive fungal infections.
• Understanding current antifungal prescribing patterns is essential for optimizing patient care.

Purpose of the Study:

• To prospectively analyze antifungal drug utilization in immunocompromised children across European centers.
• To evaluate prophylaxis and treatment strategies, including indications and drug choices.
• To identify potential areas for improvement in antifungal prescribing and dosing.

Main Methods:

• A multicenter, 12-week, weekly point-prevalence survey was conducted in 31 HO and HSCT/SOT units across 18 European hospitals.
• Data collected included ward policies and weekly patient data for all hospitalized patients receiving systemic antifungals.
• Analysis focused on prophylaxis and treatment courses, indications, prescribed agents, and dosing.

Main Results:

• Prophylaxis accounted for the majority of the 572 recorded antifungal courses (77%), with fluconazole (31%) and liposomal amphotericin B (LAMB) (21%) being the most frequent agents.
• A significant proportion of prophylaxis (56%) was administered to non-high-risk patients.
• Underdosing was observed in 50% of micafungin treatment prescriptions and 70% of fluconazole prescriptions for both treatment and prophylaxis.

Conclusions:

• Antifungal prescribing in immunocompromised children is predominantly for prophylaxis, with fluconazole being the most commonly used agent.
• Inadequate dosing of antifungals and the administration of prophylaxis to non-high-risk patients represent significant opportunities for practice improvement.
• Optimizing antifungal strategies is crucial for enhancing outcomes in pediatric oncology and transplant patients.