Background Invasive fungal infections (IFIs) increase morbidity and mortality in immunocompromised patients (IPs).Controlling antifungal use is fundamental in avoiding drug resistance and containing costs.

Purpose To identify risk factors associated with IFIs in IPs, and monitor appropriateness and cost of antifungal treatment.

Materials and Methods A retrospective analysis was done at ISMETT, a 78-bed transplant centre in Palermo, Italy, from 1 January to 31 December 2010. One hundred and one IPs received intravenous antifungal treatment with fluconazole (F), liposomal amphotericin-B (A), caspofungin (C), itraconazole (I) for 4 or more days. Patient treatment was divided into three groups: prophylactic, empirical and target. Immunosuppressive treatment (IT), total parenteral nutrition (TPN), dialysis, central line, steroid treatment, stent use, neutropenia, and mechanical ventilation were evaluated. Variables were treatment duration, DDD (defined-daily-dose) consumption and DDD average cost.

Results Main risk factors were central line (65.3%), TPN (56.4%), dialysis (46.5%), IT (42.6%), mechanical ventilation (32.7%), neutropenia (24.8%), steroid treatment (23.8%), and stent use (14.9%). Average duration of prophylactic treatment was 7 days, F (61%), A (26%), C (13%) were used. Average duration of empirical treatment was 8 days, and F (52.9%), A (26.5%), C (8.8%), I (2.9%), and in association A+C, A+F, C+F (8.9%) were used. Average duration of target treatment was 9 days, and F (40.4%), A (23.1%), C (15.4%), I (7.7%), and in association A+C, A+F, C+F (13.4%) were used. DDD consumption and DDD average cost were, respectively, C 50 mg vial: 273 DDD, €381.1; C 70 mg vial: 33.6 DDD, €389.6; F 200 mg vial: 768 DDD, €11.8; F 100 mg vial: 89 DDD, €10.6; I 250 mg vial: 62.5 DDD, €68.8; and A 50 mg vial: 2200 DDD, €93.4.

Conclusions Data showed appropriate use of antifungals. The best treatment alternative (cheaper antifungal) was prescribed for most patients. The high cost of A and C was justified by resolution of the IFI.

No conflict of interest.