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Antifungal Prescribing in European Pediatric Intensive Care Units: Results of a Multinational 3-Month Weekly
Elisavet Chorafa1, Elias Iosifidis1, Aisha Abdalla Alkhaaldi2
1Infectious Diseases Unit, 3rd Department of Pediatrics, Aristotle University School of Medicine, Hippokration Hospital, Thessaloniki, 54642, Greece.
Background:
Critically ill pediatric patients admitted to the pediatric intensive care unit (PICU) are highly vulnerable to infections, including invasive fungal diseases and antifungal agents are frequently prescribed. Little is known about antifungal usage in PICUs across Europe.
Methods:
A multinational 3-month weekly point-prevalence study for measuring antifungal drug use was organized. Eigtheen PICUs (16 hospitals) in 10 countries in the European region participated. All patients hospitalized in the participating PICUs and receiving systemic antifungals were included. Information about ward demographics was collected once; weekly ward and patient data were collected prospectively for the 12-week study period and entered in REDCap database.
Results:
Among 18 PICUs, 8 (44%) followed prophylactic practices for targeted group of patients, 7/18 (39%) had an antifungal stewardship program and the majority (16/18, 89%) had the capacity of biomarker utilization (16/16 galactomannan, 13/16 beta-D-glucan, and 9/16 pan-fungal PCR). One hundred one courses in equal number of patients were recorded; 14 for patients aged <3 month, 87 for patients ≥3 month. Malignancy was the most common underlying condition among patients aged ≥3 month (29%) followed by surgery/trauma (25%), whereas all patients <3 month had undergone a recent surgery. Indication for antifungal prescribing was prophylaxis in 38% and treatment in 62% [empirical (57%), preemptive (13%), and targeted (30%)]. Fluconazole was the most common agent both for prophylaxis and treatment, whereas liposomal amphotericin B was the most frequent agent for targeted treatment. The majority (63%) of patients on prophylaxis were oncology or transplant patients. Common reasons for empirical and targeted treatment were persistent fever/other signs of infections in high-risk patients (61%) and Candida infections (100%), respectively. For targeted treatment, the most frequent pathogens were Candida albicans (37%) and Candida parapsilosis (32%).
Conclusions:
Most antifungal prescriptions across European PICUs were for treatment. Fluconazole was the most frequently prescribed antifungal. These surveillance data can guide antifungal stewardship strategies in PICUs.
Insights
Antifungal drug use in European pediatric intensive care units (PICUs) primarily involves treatment, with fluconazole being the most common agent. These findings highlight the need for antifungal stewardship strategies in PICUs.
Area of Science:
- Pediatric Intensive Care
- Infectious Diseases
- Pharmacology
Background:
- Critically ill children in pediatric intensive care units (PICUs) are susceptible to invasive fungal infections.
- Antifungal agents are frequently used, but usage patterns in European PICUs are not well-documented.
Purpose of the Study:
- To investigate the patterns of systemic antifungal drug use in pediatric intensive care units (PICUs) across Europe.
- To provide data for developing antifungal stewardship programs in these vulnerable patient populations.
Main Methods:
- A multinational, 3-month, weekly point-prevalence study was conducted across 18 PICUs in 10 European countries.
- Data on patient demographics, underlying conditions, and antifungal prescriptions (prophylaxis and treatment) were collected prospectively.
- Information on antifungal stewardship programs and biomarker utilization was also gathered.
Main Results:
- Antifungal agents were prescribed for treatment in 62% of cases, with fluconazole being the most common agent for both prophylaxis and treatment.
- Liposomal amphotericin B was frequently used for targeted treatment, often for Candida infections.
- Malignancy and recent surgery were common reasons for antifungal use in older children, while all younger children had undergone recent surgery.
Conclusions:
- Treatment represents the majority of antifungal prescriptions in European PICUs.
- Fluconazole is the most frequently prescribed antifungal agent.
- Surveillance data on antifungal usage are crucial for guiding the development of effective antifungal stewardship strategies in PICUs.
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