Surinfection fongique chez des patients traités par caspofungine en onco-hématologie

STRASBOURG ILLKIRCH-Pharmacie (672182101) / SudocSudocFranceF

Adherence to recommendations for the use of antifungal agents in a tertiary care hospital

OBJECTIVES: The aim of our study was to assess the adherence to labelling and international guidelines for antifungal prescribing. METHODS: A retrospective study was performed in intensive care units in addition to the oncology and haematology department, which covered 70% of antifungal consumption at Hautepierre Hospital, Strasbourg, France. On reviewing medical charts, the antifungal prescription was examined in relation to the recommendations of indication, dosage, risk of drug-drug interactions and, where appropriate, antifungal susceptibility testing. Treatments were considered appropriate, inappropriate or debatable. RESULTS: Between January and April 2007, 199 treatments were given for 179 different episodes in 133 adult patients. Treatments were prescribed for pre-emptive or targeted therapy (n = 90, with 60 for candidiasis, 26 for aspergillosis and 4 for other mould diseases), empirical therapy (n = 17) and primary (n = 81) or secondary (n = 11) prophylaxis. Fluconazole accounted for 67% of prescriptions, followed by voriconazole (19%), caspofungin (10%), posaconazole (2%), conventional or liposomal amphotericin B (2%), itraconazole (<1%) and terbinafine (<1%). Indication and dosage were found to be appropriate in 65% and 62% of cases, inappropriate in 22% and 21%, and debatable in 13% and 17%, respectively. The overall (by combining all assessment criteria) rate of inappropriate use was 40%. The overall survival rate at 12 weeks was highest in patients receiving appropriate therapy (81% versus 72% and 68% in the debatable and inappropriate therapy groups, respectively), with between-group differences not being significant (P = 0.49). CONCLUSIONS: Our evaluation revealed a high proportion of inappropriate or debatable use of antifungal agents, while highlighting significant issues, such as inadequate dosage or indications

Aspects cliniques et radiologiques des mucormycoses

Les mucormycoses sont des infections à champignons filamenteux de l’ordre des Mucorales. Elles surviennent en général chez des patients sévèrement immunodéprimés mais se voient également au cours des acidocétoses diabétiques et chez des patients immunocompétents après un traumatisme ou une brûlure. Les localisations primitives touchent principalement les voies aériennes supérieures (sinus avec une extension locorégionale jusqu’au niveau cérébral) et inférieures et, à un moindre degré, le tube digestif et la peau. Les Mucorales ont une forte aptitude à l’angioinvasion causant dissémination hématogène et thromboses vasculaires et, de ce fait, une nécrose des lésions. Les aspects radiocliniques sont proches de ceux des autres infections invasives à champignons filamenteux, dont les aspergilloses