Author:
Bienvenu Anne-Lise,Bestion Audrey,Pradat Pierre,Richard Jean-Christophe,Argaud Laurent,Guichon Céline,Roux Sandrine,Piriou Vincent,Paillet Carole,Leboucher Gilles,Ader Florence,Aubrun Frédéric,Besson Charlotte,Bréant Valentine,Doudet Charlotte,Ducastelle-Leprêtre Sophie,Dupont Damien,Guillemin Marie-Delphine,Leray Véronique,Miossec Charline,Paulus Sylvie,Rabain Anne-Marie,Rascle Pauline,Schulz Thomas,Tod Michel,Valour Florent,Wallet Florent,Wallon Martine,
Abstract
Abstract
Background
In the context of COVID-19 pandemic, antifungal overuse may have occurred in our hospitals as it has been previously reported for antibacterials.
Methods
To investigate the impact of COVID-19 on antifungal consumption, a multicenter retrospective study including four medical sites and 14 intensive care units (ICU) was performed. Antifungal consumption and incidences of invasive fungal diseases before and during COVID-19 pandemic, for non-COVID-19 patients and COVID-19 patients, were described.
Results
An increase in voriconazole consumption was observed in 2020 compared with 2019 for both the whole hospital and the ICU (+ 40.3% and + 63.7%, respectively), whereas the incidence of invasive aspergillosis significantly increased in slightly lower proportions in the ICU (+ 46%). Caspofungin consumption also increased in 2020 compared to 2019 for both the whole hospital and the ICU (+ 34.9% and + 17.0%, respectively) with an increased incidence of invasive candidiasis in the whole hospital and the ICU but in lower proportions (+ 20.0% and + 10.9%, respectively).
Conclusions
We observed an increased consumption of antifungals including voriconazole and caspofungin in our hospital during the COVID-19 pandemic and explained in part by an increased incidence of invasive fungal diseases in COVID-19 patients. These results are of utmost importance as it raises concern about the urgent need for appropriate antifungal stewardship activities to control antifungal consumption.
Publisher
Springer Science and Business Media LLC
Subject
Critical Care and Intensive Care Medicine
Reference10 articles.
1. Alhumaid S, Al Mutair A, Al Alawi Z, Alshawi AM, Alomran SA, Almuhanna MS, et al. Coinfections with bacteria, fungi, and respiratory viruses in patients with SARS-CoV-2: a systematic review and meta-analysis. Pathogens. 2021;10:809.
2. Koehler P, Bassetti M, Chakrabarti A, Chen SCA, Colombo AL, Hoenigl M, et al. Defining and managing COVID-19-associated pulmonary aspergillosis: the 2020 ECMM/ISHAM consensus criteria for research and clinical guidance. Lancet Infect Dis. 2021;21:e149–62.
3. Singh S, Verma N, Kanaujia R, Chakrabarti A, Rudramurthy SM. Mortality in critically ill patients with coronavirus disease 2019-associated pulmonary aspergillosis: a systematic review and meta-analysis. Mycoses. 2021;64:1015–27.
4. Bienvenu A-L, Bleyzac N, Richard J-C, Leboucher G. No time for pending confirmation of invasive fungal disease in critically ill COVID-19 patients-think empirical treatment. Crit Care. 2020;24:588.
5. Rawson TM, Moore LSP, Zhu N, Ranganathan N, Skolimowska K, Gilchrist M, et al. Bacterial and fungal coinfection in individuals with coronavirus: a rapid review to support COVID-19 antimicrobial prescribing. Clin Infect Dis. 2020;71:2459–68.