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A evolução do consumo de antifúngicos em unidades de cuidados intensivos
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Abstract(s)
O número de casos de micoses invasivas aumentou globalmente nos últimos anos; ao mesmo tempo, mais casos de resistência estão a ser reportados, mesmo nas famílias mais recentes de agentes antifúngicos, como as equinocandinas. Estes fatos representam um sério desafio, principalmente em unidades de cuidados intensivos (UCI), onde os pacientes são imunocomprometidos e mais suscetíveis a infeções fúngicas invasivas, o que os torna uma das principais causas de morte em UCI. O desenvolvimento de novas moléculas de antifúngicos ainda é lento, sendo que nas últimas décadas, surgiram antifúngicos como as equinocandinas, fundamentais no tratamento de infeções fúngicas invasivas.
O objetivo desta monografia é verificar se a utilização de novos antifúngicos tem proporcionado uma diminuição tanto do tempo de internamento quanto da mortalidade. Das micoses invasivas, a candidíase, que atualmente constitui o 4º patogénico mais isolado em UCI, seguida da aspergilose, corresponde a cerca de 90% do total de micoses. No entanto, um aumento contínuo de casos de mucormicose em todo o mundo tem vindo a ser relatado, relacionado com o aumento da diabetes.
Graças a essa revisão bibliográfica, foi possível avaliar o uso e a evolução de diferentes antifúngicos em UCI em todo o mundo e verificar se as novas famílias de antifúngicos têm feito diferença no tratamento da micose invasiva. Os resultados mostram que apesar das mais novas adições ao mercado que ocorreram nos últimos anos, não houve evolução significativa, antifúngicos como a anfotericina B ou o fluconazol continuam a ser usados como primeira linha para muitas infeções fúngicas, embora se reflita um maior uso de equinocandinas e novos azóis como o isavuconazol. Apesar disso, ainda se observa uma mortalidade elevada associada a altos custos hospitalares, razão pela qual mais pesquisas sobre infeções fúngicas invasivas devem ser realizadas.
Invasive mycoses have increased globally in the recent years, at the same time, more cases of resistance are being reported even in the newest families of antifungal agents such as echinocandines. All this combined represents a serious challenge, especially in intensive care units (ICU) where patients are immunocompromised and more susceptible to invasive fungal infections, making them one of the main causes of death in ICU. Nevertheless, the development of new antifungals molecules is still slow. The objective of this work is to verify whether the use of new antifungal agents has led to an improvement in the decrease in both hospital stay duration and the mortality rate. Among the invasive mycoses, candidiasis, which currently constitutes the 4th most isolated pathogen in ICU, followed by aspergillosis, corresponds to about 90% of the total number of mycoses. However, a continuous increase in mucormycosis cases around the world are being reported, linked to the increase in diabetes. This bibliographic revision has evaluate the use and evolution of different antifungal agents in ICU worldwide. The results show that despite the newest additions to the market that have occurred in recent years, there has been no significant evolution. Antifungals such as amphotericin B or fluconazole continue to be used as the first line for many fungal infections, although greater use is reflected of echinocandins and new azoles such as isavuconazole. Despite this, a high mortality and high hospital cost are still observed, which is why more research on invasive fungal infections should be carried.
Invasive mycoses have increased globally in the recent years, at the same time, more cases of resistance are being reported even in the newest families of antifungal agents such as echinocandines. All this combined represents a serious challenge, especially in intensive care units (ICU) where patients are immunocompromised and more susceptible to invasive fungal infections, making them one of the main causes of death in ICU. Nevertheless, the development of new antifungals molecules is still slow. The objective of this work is to verify whether the use of new antifungal agents has led to an improvement in the decrease in both hospital stay duration and the mortality rate. Among the invasive mycoses, candidiasis, which currently constitutes the 4th most isolated pathogen in ICU, followed by aspergillosis, corresponds to about 90% of the total number of mycoses. However, a continuous increase in mucormycosis cases around the world are being reported, linked to the increase in diabetes. This bibliographic revision has evaluate the use and evolution of different antifungal agents in ICU worldwide. The results show that despite the newest additions to the market that have occurred in recent years, there has been no significant evolution. Antifungals such as amphotericin B or fluconazole continue to be used as the first line for many fungal infections, although greater use is reflected of echinocandins and new azoles such as isavuconazole. Despite this, a high mortality and high hospital cost are still observed, which is why more research on invasive fungal infections should be carried.
Description
Dissertação para obtenção do grau de Mestre no Instituto Universitário Egas Moniz
Keywords
Antifúngicos Micose invasiva UCI Terapêutica