A multicentre pharmacoepidemiological study of therapeutic practices in invasive fungal infections in France during 1998-1999

Objective: To study the pharmacoepidemiology of the prescription of systemic antifungal agents in 48 French haematology, intensive care and infectious diseases units. Patients and methods: Cases of invasive fungal infections (IFI) were identified retrospectively over a 1 year period. Data on underlying condition, IFI diagnosis, antifungal treatment and outcome were collected on the last five cases in each centre. Factors associated with first line therapy and with death were identified by multivariate analysis. Results: Two hundred and nine cases were included (102 aspergillosis, 86 candidiasis, 15 cryptococcosis). Amphotericin B, in different formulations, was the first line therapy in 60%, azoles in 32%, combinations in 8%. Haematological malignancies and neutropenia were associated with less frequent initial prescription of azoles [OR=0.3 (0.1-0.8) and OR=0.3 (0.1-0.9), respectively]. In aspergillosis, younger age and neutropenia were associated with less frequent initial prescription of azoles [OR=0.03 (0.002-0.6) and OR=0.09 (0.03-0.3), respectively] and previous history of IFI was associated with a higher probability of azole prescription [OR=17.2 (2.4-124.3)]. In candidiasis, haematological malignancy and co-prescription of nephrotoxic agents were associated with a less frequent initial prescription of azoles [OR=0.1 (0.04-0.4) and OR=0.2 (0.06-0.9), respectively]. Three factors were associated with a lower risk of death: cryptococcosis [OR=0.16 (0.03-0.98)], hospitalization in infectious diseases units [OR=0.40 (0.16-0.97)] and recent surgery [OR=0.26 (0.08-0.80)]. Severe renal insufficiency was associated with a higher probability of death [OR=8.77 (1.97-38.97)]. Conclusions: Our results emphasize factors associated with the antifungal therapeutic decision and with the outcome of IFI.