Micafungin use in a UK tertiary referral hospital. (December 2018)

• Record Type: Journal Article
• Authors: Enoch, David A.; Murphy, Michael E.; Micallef, Christianne; Yang, Huina; Brown, Nicholas M.; Aliyu, Sani H.
• Is Part Of: Journal of global antimicrobial resistance. Volume 15(2018)
• Page Start: 82
• Page End: 87
• Publication Date: 2018-12
• Subjects: Micafungin -- Candidiasis -- Aspergillus; Drug resistance -- Periodicals; Drug resistance -- Periodicals; Drug resistance; Periodicals; 616.9041
• DOI: 10.1016/j.jgar.2018.06.009
• Languages: English
• ISSNs: 2213-7165

Abstract

Highlights: Micafungin use in a large teaching hospital was prospectively reviewed. Micafungin was used for candidiasis (132 courses) and aspergillosis (42 courses). Fungal infection was defined as 'proven' as per EORTC/MSG guidelines in 84 courses (48.3%). Micafungin was well tolerated; one patient discontinued therapy from 174 courses. One patient developed mucormycosis and four patients had candidaemia while on therapy. Abstract: Objectives: Here we sought to describe the real-life usage of micafungin in a UK tertiary referral hospital. Methods: A prospective, non-interventional, observational surveillance study was performed. Results: Micafungin was commenced in 174 courses involving 148 patients to treat invasive candidiasis and candidaemia (132 courses) and aspergillosis in situations where alternatives such as voriconazole or liposomal amphotericin B could not be used (42 courses). Fungal infection was defined as proven as per European Organization for Research and Treatment of Cancer/Mycoses Study Group (EORTC/MSG) guidelines in 84 courses (48.3%). Micafungin was well tolerated; 10 patients (6.8%) developed a rise in alanine aminotransferase (ALT) and only 1 patient stopped therapy due to this. Therapy was rationalised to fluconazole in 77 courses (44.3%). There were no differences in intensive care unit admission or deaths when comparing all 174 courses where patients received micafungin for Aspergillus and Candida infection, respectively [49% vs. 42% ( P = 0.82) and 24% vs. 15% ( P = 0.186)]. One patient developed disseminated mucormycosis and four patients had recurrent candidaemia (attributed to poor source control) while receiving micafungin. Conclusions: Micafungin was clinically effective for the treatment of invasive Candida and Aspergillus infections, and usage did not increase the risk of liver dysfunction even in patients with abnormal ALT at baseline.