Intensive care unit-related fluconazole use in Spain and Germany: patient characteristics and outcomes of a prospective multicenter longitudinal observational study

Abstract

Background

Candida spp. are a frequent cause of nosocomial bloodstream infections worldwide.

Objective

To evaluate the use patterns and outcomes associated with intravenous (IV) fluconazole therapy in intensive care units in Spain and Germany.

Patients and methods

The research reported here was a prospective multicenter longitudinal observational study in adult intensive care unit patients receiving IV fluconazole. Demographic, microbiologic, therapy success, length of hospital stay, adverse event, and all-cause mortality data were collected at 14 sites in Spain and five in Germany, from February 2004 to November 2005.

Results

Patients (n = 303) received prophylaxis (n = 29), empiric therapy (n = 140), preemptive therapy (n = 85), or definitive therapy (n = 49). A total of 298 patients (98.4%) were treated with IV fluconazole as first-line therapy. The treating physicians judged therapy successful in 66% of prophylactic, 55% of empiric, 45% of preemptive, and 43% of definitive group patients. In the subgroup of 152 patients with proven and specified Candida infection only, 32% suffered from Candida specified as potentially resistant to IV fluconazole. The overall mortality rate was 42%.

Conclusion

Our study informs treatment decision makers that approximately 32% of the patients with microbiological results available suffered from Candida specified as potentially resistant to IV fluconazole, highlighting the importance of appropriate therapy.

Keywords:

• antifungal agents
• Candida
• fungal infection
• therapy

Acknowledgments

This paper was presented in part at the Intensive Care And Emergency Medicine 27th International Symposium, Brussels, Belgium, March 27, 2007 (P113) and Sepsis Update 2009, Weimar, Germany, September 11, 2009 (O005).

We are grateful to Prof Dr Peter Rath, of the Institute of Medical Microbiology, University of Essen, Germany, for his valuable suggestions. We thank Syreon Corporation for managing the study and Wendy Horn for assisting in manuscript development. We are indebted to all participating study sites in Spain and Germany that contributed patients to the study.

Disclosure

Financing for this study came from Merck & Co, Whitehouse Station, New Jersey, USA.

Gonzalo Nocea, Karl J Krobot, Peter Kaskel, Ritesh N Kumar, and Panagiotis Mavros are employed by Merck and Co. Jose Ballus has received investigator payments from Merck, Sharp and Dohme, Madrid, Spain. The Department of Anesthesiology, Intensive Care and Pain Therapy, University Hospital of Frankfurt/Main, Germany (where this study’s primary investigator, Heimo Wissing, is employed) has received research funding and travel grants from MSD SHARP & DOHME GMBH, Haar, Germany.

Study group members

In addition to the authors of the present study, the following investigators in each country participated in the study.

Spain

M Palomar, A Socias, A Campos (Hospital Univeritario Vall d’Hebron, Barcelona); J Ballus, MR Cañizares Mediano, L-T Sánchez Salido, A Cabrejas Ayuso (Hospital Universitario de Bellvitge, Barcelona); A Bonet, N López de Albina (Hospital Universitario de Girona Doctor Josep Trueta, Gerona); A Martínez Pellus, M Bru Cartagena, D Martínez Bano, M Royo-Villanova, S Sánchez Cámara (Hospital Universitario Virgen de la Arrixaca, Murcia); J Blanquer Olivas, J Ferreres Franco, N Carbonell Monleón (Hospital Universitario Clínico de Valencia, Valencia); C Blanco, JM Raurich Puigdevall, JI Ayestarán (Hospital Universitario Son Dureta, Palma de Mallorca); P Marco Garde, A Murguialdai (Hospital Donostia, San Sebastián); L Alvarez Rocha, R Galeiras, P Rascado (Complejo Hospitalario Universitario Juan Canalejo, La Coruña); D Parra, V Español (Hospital Universitario Central de Asturias, Oviedo, Asturias); J Solé Violan, JM Ferrer, J Cabrera, O Pérez (Hospital Universitario de Gran Canaria Doctor Negrín, Las Palmas de Gran Canaria, Gran Canaria); V Caruezo Rodríguez, V Ginesta, J Álvarez, M Bouzada, MV Pombo, S del Río, J Oliveira, E San Luis (Complejo Hospitalario Universitario de Santiago, Santiago de Compostela, La Coruña); JL Teja Barbero, A Castellanos, JM Santidrián, T Obeso (Hospital Universitario Marqués de Valdecilla, Santander, Cantabria); G González Díaz, A Renedo Villarroya (Hospital General Universitario Morales Meseguer, Murcia); and MA Chiveli, P Herrera Melian (Hospital Universitario La Fe de Valencia, Valencia).

Germany

F Hinder (University Hospital of Munster); F Logemann (University Hospital of Hannover); M Thörner (University Hospital of Frankfurt/Main); and M Rist (Academic Hospital of Dachau).