Adherence to recommendations for the evaluation and management of fungal infections in a referral teaching hospital in Iran: A retrospective cross-sectional study

Abstract

Introduction: Early diagnosis and appropriate management of fungal infections are critical for reducing complications and mortality in hospitalized patients. Due to the lack of appropriate local management protocols as well as the unavailability and cost of advanced tests for diagnosis of fungal infections, the irrational use of antifungals is a concern in developing countries. Objectives: This study was designed to evaluate diagnosis and management of fungal infections in hospitalized patients. Methods: In a retrospective cross-sectional study, the use of parenteral antifungal medications among hospitalized patients was evaluated according to the prepared protocols adapted from the international guidelines. Results: Among 151 patients, diagnostic approaches were appropriate and inappropriate in 90 and 61 patients respectively. Indications for antifungal drug administration were empiric therapy (80.1%) followed by targeted therapy (19.2%) and prophylaxis (0.7%). The indications were appropriate and inappropriate in 123 and 28 patients respectively. Selection of antifungals was appropriate in 117 patients, inappropriate in 16 patients, and was not assessable in other cases. The doses of antifungal medications were appropriate and inappropriate in 111 and 14 patients respectively. Among 151 patients, the duration of treatment was appropriate just in 33 cases. The techniques for antifungal administration were appropriate in 133 patients and inappropriate in 18 cases. Conclusions: Due to limited access to diagnostic tests, most parenteral antifungal medications were administered as empiric therapy. The diagnostic workups, treatment monitoring, and follow-up were inadequate in most patients. Development of local diagnostic and management protocols for invasive fungal infections and considering a stewardship program for antifungal medications are essential for each medical center.