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Hospital-wide antifungal prescription in Greek hospitals: a multicenter repeated point-prevalence study

  • Matthaios Papadimitriou-Olivgeris
  • Angeliki M. Andrianaki
  • Markos Marangos
  • Nikolaos Sipsas
  • Eirini A. Apostolidi
  • Efstratios Maltezos
  • Periklis Panagopoulos
  • Dimitris Karapiperis
  • Kostoula Arvaniti
  • Eleni-Isidora Perdikouri
  • George Samonis
  • Diamantis P. KofteridisEmail author
Original Article

Abstract

The aim of the study was to evaluate antifungal prescriptions among hospitalized adult patients in Greek hospitals. This multicenter two-times, 1-day, point-prevalence study was carried out in 2015 and 2017 in five and six hospitals, respectively. Among the 5812 patients screened in both periods, antifungals were prescribed in 129 patients (73 in 2015 and 56 in 2017); antifungals were used as prophylaxis in 31 patients (24%), pre-emptively in 32 (25%), empirically in 38 (30%), and as targeted therapy in 28 (22%). Triazoles were the class most commonly used (65 patients; 50%), followed by echinocandins (59; 46%) and liposomal amphotericin B (12; 9%). The use of echinocandins was higher (P 0.009) in the ICU (16 out of 22 patients), as compared with those in other departments (40%). Antifungal treatment was deemed inappropriate in 32/129 patients (25%) (16% in 2015 versus 36% in 2017; P 0.014). Inappropriate antifungal administration was more common if indicated by the primary physician, as compared with an infectious disease specialist (35% versus 5%; P < 0.001). Candidemia represented the majority of microbiologically documented infections (12 out of 28). Only two cases of proven pulmonary aspergillosis were diagnosed. Fluconazole and echinocandins were most frequently prescribed for identified or presumptive fungal infections, while fluconazole or posaconazole was given most frequently as prophylaxis. Antifungal treatment has been, ultimately, proven unnecessary in one-fourth of cases, underlining the need of a nationwide antifungal stewardship program.

Notes

Acknowledgments

We thank Parthena Kyriklidou (Nephrology Department), Maria Kasapi (Otorhinolaryngology Department), Konstantinos Rossios (Cardiology Department), Sotirios Karatzoglou (Neurosurgery Department), and Thomas Rallis (Cardiothoracic Surgery Department) of the Papageorgiou University Affiliated Hospital.

Funding information

This study was supported by internal funding.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of each participating hospital’s Ethics Committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  • Matthaios Papadimitriou-Olivgeris
    • 1
  • Angeliki M. Andrianaki
    • 2
  • Markos Marangos
    • 1
  • Nikolaos Sipsas
    • 3
  • Eirini A. Apostolidi
    • 3
  • Efstratios Maltezos
    • 4
  • Periklis Panagopoulos
    • 4
  • Dimitris Karapiperis
    • 5
  • Kostoula Arvaniti
    • 6
  • Eleni-Isidora Perdikouri
    • 7
  • George Samonis
    • 2
  • Diamantis P. Kofteridis
    • 2
    Email author
  1. 1.Division of Infectious DiseasesUniversity Hospital of PatrasPatrasGreece
  2. 2.Department of Internal MedicineUniversity Hospital of HeraklionCreteGreece
  3. 3.Department of Internal MedicineLaikon University HospitalAthensGreece
  4. 4.Department of Internal MedicineUniversity Hospital of AlexandroupolisAlexandroupoliGreece
  5. 5.Department of Internal Medicine424 Military Hospital of ThessalonikiThessalonikiGreece
  6. 6.Antimicrobial Stewardship UnitPapageorgiou University Affiliated  HospitalThessalonikiGreece
  7. 7.Oncology DepartmentPapageorgiou University Affiliated  HospitalThessalonikiGreece

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