Trends in antifungal use in US hospitals, 2006–12
Open accessAbstract
Background: Although trends in antibiotic use have been characterized, less is known about antifungal use. Data on antifungal use are important for understanding practice patterns, assessing emergence of antifungal resistance and developing antifungal stewardship programmes. We estimated national trends in inpatient antifungal use in the USA. Methods: Using billing data for antifungals from the Truven Health MarketScan® Hospital Drug Database during 2006-12, we estimated the proportion of discharges at which antifungals were given and days of therapy (DOT)/1000 patient days (PDs) by antifungal drug type, year, patient and facility characteristics. We created national estimates using weights generated from Centers for Medicare and Medicaid Services data and assessed trends over time. Results: Overall, 2.7% of all inpatients and 7.7% of those in ICUs received antifungals. The estimated DOT/1000 PDs for any antifungal was 35.0 for all inpatients and 73.7 for ICU patients. Azoles accounted for 80% of all antifungal use (28.5/1000 PDs), followed by echinocandins (5.0/1000 PDs). By multivariable trend analysis, DOT/1000 PDs for azoles (-21%) and polyenes (-47%) decreased between 2006 and 2012, whereas echinocandins increased 11% during 2006-10 and declined after 2011. Unspecified septicaemia, HIV and antineoplastic therapy were among the top primary diagnosis codes for patients who received antifungals. Conclusions: Antifungals were most frequently used in ICU settings and fluconazole accounted for a large, but declining, proportion of antifungal use. Antifungal stewardship efforts may have the most impact if focused in ICUs, among certain patient groups (e.g. HIV and malignancy) and on stopping empirical antifungal therapy for unspecified sepsis when not indicated.
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The triazoles account for more than 80% of all antifungal prescribing in the United States.
“The triazoles are the most commonly relied upon class of antifungals worldwide, accounting for more than 80% of all antifungal prescribing in the United States (18).”
From Delineation of the Direct Contribution of Candida auris <i>ERG11</i> Mutations to Clinical Triazole Resistance (2021) · cites this paper as [18]
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- Authors
- Vallabhaneni, S., Baggs, J., Tsay, S., Srinivasan, A. R., Jernigan, J. A., & Jackson, B. R.
- Affiliations
- Centers for Disease Control and Prevention (US)
- Corresponding author
- Vallabhaneni, Snigdha
- ORCID
- Venue
- Journal of Antimicrobial Chemotherapy
- Publisher
- Oxford University Press (OUP)
- Published
- 2018-07-25
- Volume
- 73
- Issue
- 10
- Pages
- 2867-2875
- ISSN
- 0305-7453 (ISSN-L)
- 1460-2091
- OpenAlex
- W2883985253
- Semantic Scholar
- 1e344e313eda153d5e38164887399e7d577b0b06
- Cited by
- 45
- References
- 39
- Citations by year
- 2025: 4 · 2024: 3 · 2023: 6 · 2022: 8 · 2021: 13 · 2020: 7 · 2019: 3 · 2018: 1
- FWCI
- 4.56
- Type
- journal article
- Language
- en
- Open access
- hybrid
- doi.org
- Licence
- public-domain
- Locations
- Journal of Antimicrobial Chemotherapy (publishedVersion, public-domain)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Infectious Diseases › Antifungal resistance and susceptibility
- Life Sciences › Immunology and Microbiology › Applied Microbiology and Biotechnology › Antibiotic Use and Resistance
- Health Sciences › Medicine › Ophthalmology › Ocular Infections and Treatments
- Keywords
- antifungal stewardship, days of therapy, azoles, echinocandins, polyenes, fluconazole, intensive care unit, sepsis, HIV, antineoplastic therapy, antimicrobial resistance, prescribing trends
- MeSH terms
- Antifungal Agents, Azoles, Drug Utilization, Hospitals, Humans, Inpatients, Polyenes, United States, Echinocandins
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