Background and importance With the arrival of SARS-CoV-2, it has been observed that the number of cases of fungal infection has increased in critically ill patients, especially invasive pulmonary aspergillosis (IPA).

Aim and objectives To analyse the use of antifungals, expressed in defined daily dose per 100 annual hospital stays (DDD/100S), and the difference in economic impact between 2019 and 2020 in the intensive care unit (ICU) of a tertiary hospital.

Material and methods Retrospective descriptive study of the use of antifungals in the ICU unit during the period 2019–2020. The data were obtained from the STOCK-Athos-APD drug management electronic program and PRISMA electronic prescription program. For each antifungal agent, the following information was collected: annual global DDD, annual DDD/100S and economic cost of antifungal agents in both years. To calculate this expense the mean annual cost/stay was used.

Results Eight antifungals were studied (liposomal amphotericin B, anidulafungin, caspofungin, micafungin, fluconazole, voriconazole, posaconazole and isavuconazole). The registered stays for admission to the ICU were 5768 in 2019 and 5782 in 2020. The global DDD/100S of antifungals in 2019 was 37.73 while in 2020 it increased to 38.43.

The antifungals with the highest increase were isavuconazole and posaconazole, with a difference of 4.2 and 5.1 DDD/100S, respectively, despite being antifungals of restricted use in our hospital. This increase is due to the rise in IPA cases and a period of shortage of voriconazole, the first-line antifungal in our hospital for IPA in patients without renal failure and without drugs with a possible interaction. However, there was a reduction in the DDD/100S of fluconazole. This is due to a greater number of patients with complicated candidaemia, long-term in the ICU who required a broad-spectrum antifungal such as caspofungin. DDD/100S of the rest of antifungals was not modified compared to the previous year. Therefore, the cost of antifungals in the ICU had an increase of €112 086.62 (43.8% more than in 2019).

Conclusion and relevance The global DDD/100S of many antifungals in ICU has shown a slight increase between both years. The consumption of these has changed, and this has been manifested with an increment in economic spending as they are drugs with a greater economic impact.

Conflict of interest No conflict of interest