Echinocandins for invasive fungal infections†

Abstract

Background During recent years, an increase in the incidence of Invasive Fungal Infections (IFI) has been observed, in parallel to a progressive shift of invasive species from Candida albicans to fungi resistant to previously-effective treatments. The use of echinocandins in this context is spreading as an alternative to azoles. Purpose To determine the distribution of invasive fungal species in the population of patients treated with echinocandins in our hospital and the outcomes in this context over a year. Materials and methods All patients treated with echinocandins during 2010 were evaluated. Data such as sex, age and length of hospital stay were taken from the electronic chart. Information regarding treatment with caspofungin and anidulafungin was taken from electronic prescription programs. Results The authors identified 136 patients: 97 were men, the median of age was 65 years (17 months to 84 years) and median duration of hospital stay 37 days (2-137 days). There were 160 prescriptions: 127 for caspofungin, 33 for anidulafungin. The median duration of treatment was 7 days (1-37 days). In 52 prescriptions a positive isolate for fungi was detected. Of them, 26.9% (14) cultures were positive for C. albicans, 14 positive for species less susceptible to echinocandins (C. parapsilosis and A. fumigatus) and 29 positive for non-albicans susceptible species. In 5 cultures, two different species were found. 28.6% of patients exposed to species less susceptible to echinocandins died during the treatment (4 patients). Among the population whose positive cultures were sensitive to echinocandins, there were 6 deaths (15.8%). Conclusions The population studied confirms the tendency pointed out on the literature, a shift towards species different from C. albicans in IFI. Though the use of echinocandins seems to be effective and safe, attention should be paid to local sensitivities since less susceptible species such as C. parapsilosis and A. fumigatus are spreading