The Evaluatıon of Antıfungal Consumption: Multi Central Point-Prevalence Survey of Western Turkey

Yıl 2022, , 136 - 142, 31.03.2022

Sebnem Senol , Oya Özlem Eren Kutsoylu Özge Turhan , Sema Alp Çavuş , Meltem Işıkgöz Taşbakan , Şerife Barçın Öztürk , Selda Sayın Kutlu , Çiğdem Banu Çetin , Onur Kaya , Betil Özhak , Hüsnü Pullukçu , Bülent Ertuğrul Murat Kutlu Gülşen Mermut Cagri Ergin , Dilek Yeşim Metin Nur Yapar Vildan Avkan-oguz

https://doi.org/10.34087/cbusbed.1064632

Öz

Objective: Antifungal consumption has increased in recent years due to new agents on the market. This increase leads to concern about drug resistance. Data about antifungal prescription in our country is limited. The aim of this study is to evaluate antifungal consumption in seven university hospital.
Materials and Methods: A form was designed to record patients’ data. The antifungal consumption at the west side of Turkey in seven University Hospital were evaluated by point prevalence. Hospitalized patients with antifungal treatment were determined and the designed forms were filled at the scheduled day. SPSS was used to determine significance of data.
Results: There were 4969 hospitalized patients totally and 112 (2.2%) of them were treated with antifungal agents at the day of point-prevalance. Out of 112 patients 56 (50%) were in hematology-oncology, 20 (17.8%) in ICU (intensive care unit), 23 (20.5%) in internal medicine and 13 (11.6%) in surgery clinics. Fluconazole [44 (39.3%)] was the most used antifungal agent, 34% of them had been using oral fluconazole for prophylaxis. All of the treatments, 38% were defined as targeted, 26.8% as empirical and 18.8% as pre-emptive. When the treatment indications were evaluated according to the clinic, the most pre-emptive antifungal usage was in the hemato-oncology clinic, 71.4% (15/21), while the empirical treatment was mostly used as 50% in the intensive care units.
Conclusion: In this study antifungal consumption rate was 2.2%. Antifungal agents were mostly used in hematology and internal medicine clinics. The reason of starting an antifungal treatment was ‘proven fungal infection’ mostly. Although the most frequent isolated pathogens were Candida species, the choice of antifungal agent depended on the clinic where the patient was hospitalized. There was no significantly difference between the university hospitals according to antifungal consumption. This may be explained by the antifungal prescription policy in our country. Depending on this results the hospitals should monitor their own fungal pathogens. And according to isolated fungal pathogens antifungal treatment policy should be improved

Anahtar Kelimeler

Antifungal consumption, point prevalence, invasive fungal infections

Antifungal Kullanımının Değerlendirilmesi: Türkiyenin Batısına Ait Çok Merkezli Nokta Prevelans Çalışması

Öz

Giriş ve Amaç: Son yıllarda yeni ajanların da kullanıma girmesiyle birlikte antifungal tüketimi giderek artmıştır. Bu durum, direnç gelişimi konusunda endişelere neden olmaktadır. Ülkemizde antifungal tüketimine ait veriler oldukça sınırlıdır. Bu çalışmada, Türkiye’nin batısındaki yedi üniversite hastanesinde yatan hastalarda antifungal kullanımının değerlendirilmesi amaçlanmıştır.
Gereç ve Yöntemler: Çalışma ekibi tarafından hazırlanan antifungal kullanım formu, tüm merkezler tarafından, aynı gün içinde, antifungal kullanan tüm hastalar için, nokta prevalans yöntemi ile dolduruldu, elde edilen veriler SPSS programı ile değerlendirildi.
Bulgular: Toplam hasta sayısı 4969 idi. Hastaların 112(%2.2) ’si antifungal tedavi almaktaydı. Bu 112 hastanın verileri değerlendirildiğinde; antifungal kullanan hastaların 56 (%50)’sı hematoloji-onkoloji, 20 (%17,8)’si yoğun bakım (YB), 23 (%20,5)’ü dahili bilimler ve 13 (%11,6)’ü cerrahi bilimlerde izlenmekteydi. En sık kullanılan antifungal flukonazol [44(%39,3)] olup %34.1’i profilaksi amacı ile kullanılmaktaydı. Tedavilerin %38’i hedefe yönelik, %26.8’i ampirik ve %18,8’i preemptif olarak tanımlanmıştı. Yattığı kliniğe göre tedavi endikasyonları değerlendirildiğinde en çok pre-emptif antifungal kullanımı hemato-onkoloji kliniğinde %71.4 (15/21) görülürken ampirik tedavi en çok yoğun bakımlarda %50 olmuştur.
Sonuç: Çalışmamızda antifungal tüketim oranı %2.2 olup, antifungal ajanlar daha çok hematoloji ve dahili birimlerde kullanılmıştır. Antifungal tedaviye başlama nedeni en fazla 'kanıtlanmış mantar infeksiyonu' olarak gözlenmiştir. En sık izole edilen patojenler Candida türleri olmasına rağmen, antifungal ajan seçimi hastanın yattığı kliniğe bağlıdır. Antifungal tüketim açısından yedi merkez arasında anlamlı fark gözlenmemiştir. Bu durum ülkemizdeki antifungal kullanımı politikası ile açıklanabilir. Bu sonuçlara bağlı olarak her hastane kendi verilerini izlemelidir ve izole edilen fungal patojenlere göre antifungal tedavi politikası geliştirilmelidir.

Anahtar Kelimeler

Antifungal kullanımı, nokta prevalans, invaziv fungal infeksiyonlar

Kaynakça

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