Presentation (CTI)

OBJECTIVES: To evaluate antifungal consumption patterns, guideline adherence, and 30-day all-cause mortality in hospitalized patients receiving systemic antifungal therapy at a tertiary hospital during 2025, using an observational retrospective design
METHODS: Single-center retrospective observational study (198 prescriptions, 176 patients, January-December 2025). Variables: demographics, antifungal agent, infection focus, empirical vs targeted therapy, Charlson Comorbidity Index, SOFA score, 30-day all-cause mortality, microbiological isolation, antifungal resistance, guideline adherence (IDSA 2016/ESCMID 2012), and DDD/1000 patient-days (WHO methodology). Mortality analyses adjusted for palliative care patients (n=27). Statistical tests: Fisher exact, Mann-Whitney U, binary logistic regression.
RESULTS: Fluconazole dominated prescriptions (n=147, 74.2%), followed by caspofungin (n=26, 13.1%), voriconazole (n=18, 9.1%) and liposomal amphotericin B (n=7, 3.5%). Total consumption: 49.1 DDD/1000 patient-days. Mean Charlson Index: 4.9±2.8; 20.7% had SOFA>0. Global 30-day all-cause mortality: 33.3% (95%CI:26.8-39.9%); 28.7% excluding palliative patients. Empirical therapy (66.7%) showed higher mortality than targeted (36.4% vs 27.3%, p=0.263). Guideline adherence: 41.9% fully adherent; 74.1% of evaluable cases had treatment duration below guideline recommendations. Urinary focus was most frequent (20.2%); asymptomatic candiduria overtreatment identified in 9 cases (22.5%). Candida albicans predominated (50.8% of isolates); no antifungal resistance documented. SOFA discriminated mortality (deceased: 2.6±3.8 vs survivors: 0.7±2.2, p<0.001; AUC=0.681).
CONCLUSIONS: This study identified substantial guideline non-adherence, predominantly in treatment duration, and high all-cause mortality reflecting patient severity. Asymptomatic candiduria overtreatment and undetermined infection focus represent priority intervention areas for antifungal stewardship programmes.