Análise de custo-efetividade da introdução da terapia antifúngica empírica precoce em pacientes terapia intensiva com base em fatores de risco para infecções fúngicas invasivas

Abstract

Background: Invasive fungal infections (IFI) represent a serious and increasing complication in the treatment of critically ill patients in intensive care units (ICUs) and impose a significant economic burden on healthcare systems. One of the biggest challenges in the management of IFI is the difficulty in defining an early and accurate diagnosis. In this context identifying risk factors for IFI has been a widely recommended strategy to improve treatment outcomes. However, uncertainty about the ideal time to initiate treatment can expose patients to both the risk of therapeutic failure and the occasional overuse of antifungals. Aim: to identify the ideal time to introduce empirical antifungal therapy based on the number of risk factors for IFI in patients admitted to the ICU. Method: Pharmacoeconomic study of the Cost-effectiveness Analysis type based on retrospective data of patients admitted to the ICU of a general hospital, which included all patients over 18 years of age followed from admission to discharge from the ICU. Results: A total of 446 patients with a median age of 50 years participated in the study. Nine risk factors were identified, of which previous exposure to broad-spectrum antibiotics, human immunodeficiency virus (HIV) infection, abdominal surgery, and hemodialysis were the factors most associated with the use of antifungals. Furthermore, in the cost-effectiveness analysis, the initiation of empirical antifungal therapy in ICU patients based on the presence of up to two risk factors for IFI is a more cost-effective strategy when compared with the presence of a greater number of risk factors. Conclusion: The early initiation of antifungal therapy based on the presence of up to two risk factors for IFI is a cost-effective strategy that can improve the ideal time to initiate antifungal treatment.