Background Antifungal drug resistance is an emerging problem during patient treatment, probably caused by incorrect use of antimicrobial agents.

Purpose To check the relationship between antifungal use and candidiasis, including related costs, between 2008 and 2012 in a Tertiary Hospital.

Materials and methods Retrospective study which included every blood culture that was positive for Candida spp. during 2008–2012. Pharmacy management software provided systemic antifungal use, expressed as Defined Daily Dose (DDD) per 100 patient-days. The number of stays was obtained from hospital records.

Results Candida albicans was the species most frequently isolated, but non-albicans species also underwent statistically significant growth. Total number of DDD/100 patient-days increased from 4.73 to 8.5. Excepting for amphotericin B which remained constant, the use of azole antifungals and echinocandins also experienced a significant rise (Table 1). In the azole group, posaconazole and voriconazole use suffered the most important change. In relation to echinocandins, anidulafungin use increased from 0.008 to 0.131 DDD/100 patient-days. This increased use may be related to the significant growth of Candida albicans isolations, considering they are the best antifungal treatment. The growth of azole use is related to the increasing incidence of Candida parapsilosis. There is a statically significant relationship between Candida glabrata and voriconazole use, which is a third-line treatment due to its limited efficacy. However, the use of echinocandins and amphotericin B, considered to be the best treatment available, also increased. Regarding the cost of antifungal treatment, 889,632 € was spent during 2008 and 2,080,133 € during 2012 (133.82 % more).

Conclusions There is an emergence of antifungal-resistant Candida species in the hospital similar to recent bibliography. In spite of study limitations, there is a statistically related increase both in antifungal use and costs. A correct antimicrobial policy focused on antifungal use is essential to avoid antifungal drug resistance.

No conflict of interest.