MATERIALS AND METHODS
The research was a study of antifungal consumption trends using
retrospective data at a University Hospital in Salvador, Bahia, Brazil.
The study was carried out in the Intensive Care Unit for adult patients
at HUPES, linked to the Federal University of Bahia (UFBA). It is
certified as a Teaching Hospital. The HUPES ICU has 20 active beds and
receives patients with some type of comorbidity (hypertension, diabetes,
heart disease, kidney failure, cancer, autoimmune disease), who have
suffered hemodynamic instability and need 24-hour monitoring. The
consumption of antifungal agents for the period from January 1, 2009 to
December 31, 2020 was measured, totaling 12 years. Information on
antifungal consumption was obtained through annual consumption reports,
provided by the hospital’s Material Management System. These reports
were processed based on daily records of drug dispensing, carried out by
the Hospital Pharmacy Service and generated month by month,
corresponding to the study period, the database was consolidated in
Microsoft® Excel® version 2010.
Data regarding the number of patient-days were obtained through hospital
reports, prepared by the Hospital Center for Epidemiology (NHE) of
HUPES, the sector that prepares epidemiological indicators and
disseminates these reports to the entire internal (HUPES intranet) and
external community . This information was stored in file folders and
cataloged by year. This study included antifungals from the HUPES
standardized azole class, namely: fluconazole, itraconazole and
voriconazole defined as antiinfectives for systemic use, according to
the Anatomical Therapeutic and Chemical (ATC) classification system of
drugs, from the WHO Collaborating Center for Drug Statistics
Methodology. Topical antifungals, those dispensed outside the study
period or to other units (other than the adult general ICU) were
excluded, in addition to non-standardized hospital antifungals.
To calculate the presumed consumption of antifungal agents, the annual
consumption of each drug was considered, based on the amount dispensed
to the adult ICU by the Hospital Pharmacy Service of HUPES, expressed by
consumption density in DDD/100 patient-days (pd).
The next step took place through the process of converting the quantity
of dispensed units to the quantity in grams of the active ingredient.
The absolute consumption of each drug obtained per year was multiplied
by the amount of active ingredient, corresponding to each standardized
pharmaceutical presentation, the result being expressed in grams.
The DDD value of the fluconazole, voriconazole and itraconazole was
obtained from the ATC/DDD indexhttps://www.whocc.no/atc_ddd_index
and are respectively (J02AC01)
0.2g, (J02AC03)0.4g and (J02AC02)0.2g. Data were subjected to
statistical treatment of descriptive pattern and to obtain relevant
results. To calculate the trend, the Mann-Kendall statistical method was
used. In this study, a significance level (p<0.05) and a 95%
confidence interval (95%CI) were adopted.