Antifungal Prescribing in European Pediatric Intensive Care Units: Results of a Multinational 3-Month Weekly Point-Prevalence Survey
Year: 2025
Type: article
Study design: Observational Study
Abstract: BACKGROUND: Critically ill pediatric patients admitted to the pediatric intensive care unit (PICU) are highly vulnerable to infections, including invasive fungal diseases and antifungal agents are frequently prescribed. Little is known about antifungal usage in PICUs across Europe. METHODS: A multinational 3-month weekly point-prevalence study for measuring antifungal drug use was organized. Eigtheen PICUs (16 hospitals) in 10 countries in the European region participated. All patients hospitalized in the participating PICUs and receiving systemic antifungals were included. Information about ward demographics was collected once; weekly ward and patient data were collected prospectively for the 12-week study period and entered in REDCap database. RESULTS: Among 18 PICUs, 8 (44%) followed prophylactic practices for targeted group of patients, 7/18 (39%) had an antifungal stewardship program and the majority (16/18, 89%) had the capacity of biomarker utilization (16/16 galactomannan, 13/16 beta-D-glucan, and 9/16 pan-fungal PCR). One hundred one courses in equal number of patients were recorded; 14 for patients aged <3 month, 87 for patients ≥3 month. Malignancy was the most common underlying condition among patients aged ≥3 month (29%) followed by surgery/trauma (25%), whereas all patients <3 month had undergone a recent surgery. Indication for antifungal prescribing was prophylaxis in 38% and treatment in 62% [empirical (57%), preemptive (13%), and targeted (30%)]. Fluconazole was the most common agent both for prophylaxis and treatment, whereas liposomal amphotericin B was the most frequent agent for targeted treatment. The majority (63%) of patients on prophylaxis were oncology or transplant patients. Common reasons for empirical and targeted treatment were persistent fever/other signs of infections in high-risk patients (61%) and Candida infections (100%), respectively. For targeted treatment, the most frequent pathogens were Candida albicans (37%) and Candida parapsilosis (32%). CONCLUSIONS: Most antifungal prescriptions across European PICUs were for treatment. Fluconazole was the most frequently prescribed antifungal. These surveillance data can guide antifungal stewardship strategies in PICUs.
Authors: Elisavet Chorafa, Elias Iosifidis, Aisha Abdalla Alkhaaldi, Ana Arias, Benhur Sirvan Cetin, Maia De Luca, Marieke Emonts, Laura Ferreras-Antolin, Elisabetta Ghimenton-Walters, Carlos D Grasa, Andreas H Groll, Laura Herrera-Castillo, Thomas Lehrnbecher, Angela Manzanares, Katja Masjosthusmann, Susana Melendo, Natalia Mendoza-Palomar, Stéphane Paulus, Elena Rincón-López, Lorenza Romani, Maria Sdougka, Galina Solopova, Volker Strenger, Kara Tedford, Christina Tzika, Adilia Warris, Borbala Zsigmond, Emmanuel Roilides
Institutions: Aristotle University of Thessaloniki, Ippokrateio General Hospital of Thessaloniki, Hospital Universitario 12 De Octubre, Erciyes University, Bambino Gesù Children's Hospital, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne Hospital, Great North Children's Hospital, Newcastle University, St George’s University Hospitals NHS Foundation Trust, North Tees and Hartlepool NHS Foundation Trust, Hospital Universitario La Paz, Centro de Investigación Biomédica en Red Enfermedades Infecciosas, University of Münster, University Hospital Münster, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón, Goethe University Frankfurt, Vall d'Hebron Institut de Recerca, Vall d'Hebron Hospital Universitari, University of Oxford, Dmitry Rogachev National Research Center of Pediatric Hematology, Oncology and Immunology, Medical University of Graz, Children's Health Ireland at Crumlin, University of Exeter, MRC Centre for Medical Mycology, Heim Pál Országos Gyermekgyógyászati Intézet
Language: English
Subfield: Infectious Diseases
Field: Medicine
Domain: Health Sciences
Open Access status: green
OpenAlex ID: W4414083442