Reviewed by Jen Cihlar, DO, Vanderbilt University Medical Center
This retrospective cohort study looking at multicenter Vizient Clinical Data Base across the United States, found a rising trend of antifungal use amongst hospitalized patients between 2018-2023 with 4.5% (1 in 20 hospitalizations) of nearly 40 million discharges receiving at least 1 dose of an antifungal, a doubling from 2006-2012. Azoles were the most prescribed anti-fungal class (3.8%), followed by echinocandins (0.9%). Days of therapy (DOT) per 1000 patient days found 114.5 among National Comprehensive Cancer Network (NCCN) designated facilities and 43.2 among non-NCCN with linear regression models noting statistically significant increase each year in all classes except polyenes. Only 30% of patients who received any antifungal also had correlating diagnosis falling within invasive fungal infection (IFI), with other top diagnoses being malignancy (35.4%) and sepsis (22.9%). Echinocandins were used more often for sepsis (45.6%) and in the ICU (49.1%) than other antifungal classes, which could be due to due to higher rates of fluconazole resistant candidal infections or overall higher use in critically ill patients. Limitations of this study are highlighted in the lack of IFI diagnosis for ~70% of patients could indicate mis- or under-coding of IFIs, or a much higher proportion of prophylactic use, as that was not well delineated in this study, nor was analysis for appropriate use. However, it is beneficial to highlight the trends and gaps to highlight the need for antifungal stewardship considering the increasing prevalence of antifungal resistance worldwide.
Reference:
Smith DJ, Murphy HR, Benedict K, et al. Trends in antifungal use among hospitalized patients in the USA, 2018-23. J Antimicrob Chemother. 2025;80(10):2659-2664. doi:10.1093/jac/dkaf269