Indications for antifungal treatment in intensive care unit patients

INTRODUCTION. This study investigates the indications for antifungal treatment in patients admitted to intensive care units (ICUs) in Spain and determines the frequency at which each individual drug is prescribed. METHODS. Observational, multicenter study including all patients admitted to 64 ICUs on 23 March, 22 June, and 16 November, 1999. The use of antifungal agents and the criteria for indicating antifungal therapy were assessed. Patients were classified as colonized or infected by fungi. RESULTS. In 180 (11.5%) of the 1562 patients included in the study, 219 courses of treatment with antifungal agents were prescribed (antifungal therapy rate of 14 per 100 patients). Fluconazole was the antifungal agent most frequently used, both in infected and colonized patients. The most common reasons for prescribing antifungal therapy were as follows: candiduria (21.9%), severe sepsis with no response to antibiotic therapy (19.6%), and evidence of fungi in two or more non-invasive sites (16.9%). Candidemia was the reason for antifungal treatment in 17 (7.9%) cases. Proven fungal infections accounted for 21.1% of indications. Variables significantly associated with the use of antifungal agents included underlying disease, severity of illness according to the APACHE II score, chronic liver disease, solid tumor, immunosuppression, and organ transplantation. Significant extrinsic risk factors for antifungal therapy included treatment with corticoids, chemotherapy, mechanical ventilation, urgent and/or elective surgery, and previous use of antibiotics. CONCLUSIONS. A total of 11.5% of patients included in the study were given one or more treatment courses with antifungal agents. Antifungal treatment was prescribed in proved fungal infections in only 21.1% of cases. Fluconazole was the antifungal agent most frequently used.