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Avaliação do consumo de antifúngicos a nível hospitalar
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Abstract(s)
As infeções fúngicas invasivas constituem atualmente um dos maiores desafios em contexto hospitalar, associando-se a elevada morbilidade e mortalidade. Os géneros Candida e Aspergillus destacam-se como principais agentes etiológicos, embora outros fungos oportunistas, como Cryptococcus, Mucorales e Fusarium, assumam igualmente relevância clínica. Esta dissertação analisa o uso de antifúngicos no ambiente hospitalar, abordando a classificação das principais classes farmacológicas (azois, polienos e
equinocandinas), o respetivo espetro de ação, mecanismos de resistência e limitações terapêuticas.
São discutidos os padrões de consumo hospitalar em Portugal e na Europa, evidenciando o predomínio de terapêuticas profiláticas e empíricas, muitas vezes iniciadas sem confirmação microbiológica. Verificam-se ainda diferenças marcadas entre instituições e países, relacionadas com políticas de prescrição e disponibilidade de métodos diagnósticos. O aumento da resistência antifúngica, sobretudo em Candida spp. e Aspergillus spp., reforça a urgência de implementar programas de antifungal stewardship,
centrados no uso racional destes fármacos, na monitorização individualizada da terapêutica e no desenvolvimento de técnicas diagnósticas mais rápidas e sensíveis.
Neste contexto, a otimização da terapêutica antifúngica torna-se crucial para melhorar os resultados clínicos e garantir a preservação da eficácia dos agentes disponíveis.
Invasive fungal infections remain one of the greatest challenges in the hospital setting, being associated with substantial morbidity and mortality. Candida and Aspergillus are the leading etiological agents, although other opportunistic fungi, including Cryptococcus, Mucorales and Fusarium, also carry significant clinical relevance. This dissertation explores the use of antifungal agents in hospitals, addressing the classification of the main pharmacological classes (azoles, polyenes and echinocandins), their spectrum of activity, resistance mechanisms and therapeutic limitations. An analysis of antifungal consumption patterns in Portugal and across Europe reveals a predominance of prophylactic and empirical therapies, often initiated without microbiological confirmation. Marked differences are also observed between institutions and countries, reflecting variability in prescribing policies and access to diagnostic resources. The growing problem of antifungal resistance, particularly in Candida spp. and Aspergillus spp., highlights the urgent need to implement antifungal stewardship programs, focused on the rational use of these drugs, individualized therapeutic monitoring, and the development of faster and more sensitive diagnostic tools. Optimizing antifungal therapy is therefore essential to improve clinical outcomes and safeguard the long-term efficacy of the available agents.
Invasive fungal infections remain one of the greatest challenges in the hospital setting, being associated with substantial morbidity and mortality. Candida and Aspergillus are the leading etiological agents, although other opportunistic fungi, including Cryptococcus, Mucorales and Fusarium, also carry significant clinical relevance. This dissertation explores the use of antifungal agents in hospitals, addressing the classification of the main pharmacological classes (azoles, polyenes and echinocandins), their spectrum of activity, resistance mechanisms and therapeutic limitations. An analysis of antifungal consumption patterns in Portugal and across Europe reveals a predominance of prophylactic and empirical therapies, often initiated without microbiological confirmation. Marked differences are also observed between institutions and countries, reflecting variability in prescribing policies and access to diagnostic resources. The growing problem of antifungal resistance, particularly in Candida spp. and Aspergillus spp., highlights the urgent need to implement antifungal stewardship programs, focused on the rational use of these drugs, individualized therapeutic monitoring, and the development of faster and more sensitive diagnostic tools. Optimizing antifungal therapy is therefore essential to improve clinical outcomes and safeguard the long-term efficacy of the available agents.
Description
Dissertação para obtenção do grau de Mestre no Instituto Universitário Egas Moniz
Keywords
Antifúngicos Consumo Hospital Resistência Epidemiologia