Antifungal Use in Immunocompromised Children in Europe: A 12-Week Multicenter Weekly Point Prevalence Survey (CALYPSO)
Chorafa E., Iosifidis E., Oletto A., Warris A., Castagnola E., Bruggemann R., Groll AH., Lehrnbecher T., Antolin LF., Mesini A., Alkhaaldi AA., Baquero-Artigao F., Cetin BS., Ebrahimi-Fakhari D., Emonts M., Esposito S., Fainardi V., Ghimenton-Walters E., Gijón M., Guerrero AG., Grasa CD., Kairiene I., Kildonaviciute K., Kourti M., Manzanares A., Mendoza-Palomar N., Noni M., Papakonstantinou E., Paulus S., Perwein T., Rascon J., Rincón-López E., Soler-Palacin P., Solopova G., Spoulou V., Strenger V., Tedford K., Tzika C., Zsigmond B., Roilides E.
We prospectively analyzed antifungal use in immunocompromised children through a multicenter 12-week weekly point-prevalence survey in 31 hematology-oncology (HO) and hematopoietic stem cell/solid organ transplant (HSCT/SOT) units of 18 hospitals in 11 European countries. All patients hospitalized and receiving systemic antifungals were included. Ward policies, and weekly ward/patient data were collected. All 21 HO and 10 HSCT/SOT units had prophylaxis policies for high-risk patients (27/31 used azoles, 14/31 echinocandins and 15/31 liposomal amphotericin B [LAMB]). Among 572 courses recorded, prophylaxis was indicated in 439/572 (77%) and treatment in 133/572 (62/133 empirical, 43/133 pre-emptive, 28/133 targeted). Among patients receiving prophylaxis, 56% belonged to the non-high-risk group. Most common reasons for empirical, pre-emptive and targeted treatment were antibiotic-resistant febrile neutropenia (52%), abnormalities on chest-CT with/without positive galactomannan (77%) and candidiasis (82%), respectively. Fluconazole and LAMB were the most frequently prescribed agents both for prophylaxis (31%, 21%) and treatment (32%, 23%). Underdosing of micafungin for treatment in 50% of prescriptions and of fluconazole for treatment and prophylaxis in 70% of cases was noticed. In conclusion, most antifungal prescribing was for prophylaxis, with fluconazole being the main antifungal prescribed. Inadequate doses of antifungal prescribing and prophylaxis of non-high-risk patients could be targets for improvement.