Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2017 Feb 2:10:35-41.
doi: 10.2147/IDR.S97413. eCollection 2017.

Burden and treatment patterns of invasive fungal infections in hospitalized patients in the Middle East: real-world data from Saudi Arabia and Lebanon

Adel F Alothman  1 , Abdulhakeem O Althaqafi  2 , Madonna J Matar  3 , Rima Moghnieh  4 , Thamer H Alenazi  1 , Fayssal M Farahat  2 , Shelby Corman  5 , Caitlyn T Solem  5 , Nirvana Raghubir  6 , Cynthia Macahilig  7 , Claudie Charbonneau  8 , Jennifer M Stephens  5
Affiliations

Burden and treatment patterns of invasive fungal infections in hospitalized patients in the Middle East: real-world data from Saudi Arabia and Lebanon

Adel F Alothman et al. Infect Drug Resist. .

Abstract

Objectives: The objective of this study was to document the burden and treatment patterns associated with invasive fungal infections (IFIs) due to Candida and Aspergillus species in Saudi Arabia and Lebanon.

Methods: A retrospective chart review study was conducted using data recorded from 2011 to 2012 from hospitals in Saudi Arabia and Lebanon. Patients were included if they had been discharged with a diagnosis of IFI due to Candida or Aspergillus, which was culture proven or suspected based on clinical criteria. Hospital data were abstracted for a random sample of patients to capture demographics, treatment patterns, hospital resource utilization, and clinical outcomes. Descriptive results were reported.

Results: Five hospitals participated and provided data on 102 patients with IFI (51 from Lebanon and 51 from Saudi Arabia). The mean age of the patients was 55 years, and 55% were males. Comorbidities included diabetes (41%), coronary artery disease (24%), leukemia (19%), moderate-to-severe renal disease (16%), congestive heart failure (15%), and chronic obstructive pulmonary disease (15%). Twenty percent of patients received corticosteroids prior to admission and 26% had received chemotherapy in the past 90 days. Inpatient mortality was 42%, and the mean hospital length of stay was 32.4±28.6 days. Fifty-five percent of patients required intensive care unit admission (17.2±14.1 days), 37% required mechanical ventilation (13.7±13.2 days), and 11% required dialysis (14.6±14.2 days). The most commonly used first-line antifungal was fluconazole.

Conclusion: Patients with IFI in Saudi Arabia and Lebanon frequently have multiple medical comorbidities and may not have traditionally observed IFI risk factors. Efforts to increase use of rapid diagnostic tests and appropriate antifungal treatments may impact the substantial mortality and high length of stay observed in these patients.

Keywords: Aspergillus; Candida; antifungal; length of stay; mortality; resource use.

PubMed Disclaimer

Conflict of interest statement

Disclosure Shelby Corman, Jennifer M Stephens, and Caitlyn T Solem are employees of Pharmerit International, who were paid consultants to Pfizer in connection with the development of this manuscript and study design, management, and statistical analysis for this study. Cynthia Macahilig is an employee of Medical Data Analytics, a subcontractor to Pharmerit International, who was a paid consultant to Pfizer for the study design, management, and data collection for this study. Nirvana Raghubir and Claudie Charbonneau are employees and shareholders of Pfizer. Adel F Alothman received honoraria for several presentations from Pfizer, MSD, and Al-Hikmah University; travel support from Pfizer, MSD, Gilead Sciences, and Al-Hikmah University to attend symposia; and honoraria for patient data collection related to this study from Pfizer. Abdulhakeem O Althaqafi received a research grant (RR13/248/J) sponsored by Pfizer and received honoraria for patient data collection related to this study from Pfizer. Fayssal M Farahat received honoraria for patient data collection related to this study from Pfizer. Madonna J Matar has received travel support for attending meetings and received honoraria for patient data collection related to this study from Pfizer. Rima Moghnieh received honoraria for patient data collection related to this study from Pfizer and sponsorship for attending medical meetings from Pfizer and MSD. Thamer H Alenazi received travel support for attending medical meetings from MSD and Pfizer. The authors report no other conflicts of interest in this work.

Figures

Figure 1
Figure 1
Microbiologic profile of invasive fungal infections. Notes: (A) Candida (n=70 cultures). n=2 patients cultured both Candida albicans and Candida glabrata. Other Candida included C. parapsilosis (n=3), C. famata (n=2), C. krusei (n=1), C. lusitaniae (n=1), C. rugosa (n=1), and non-albicans (otherwise unspecified, n=1). (B) Aspergillus (n=10 cultures). Abbreviations: C. albicans, Candida albicans; C. glabrata, Candida glabrata; C. parapsilosis, Candida parapsilosis; C. famata, Candida famata; C. krusei, Candida krusei; C. lusitaniae, Candida lusitaniae; C. rugosa, Candida rugosa; C. tropicalis, Candida tropicalis; A. fumigatus, Aspergillus fumigatus; A. niger, Aspergillus niger; A. flavus, Aspergillus flavus.
Figure 2
Figure 2
Medications utilized for invasive fungal infection treatment.
See this image and copyright information in PMC

References

    1. Al-Abdely HM, Alothman AF, Salman JA, et al. Clinical practice guidelines for the treatment of invasive Aspergillus infections in adults in the Middle East region: expert panel recommendations. J Infect Public Health. 2014;7(1):20–31. - PubMed
    1. Alothman AF, Al-Musawi T, Al-Abdely HM, et al. Clinical practice guidelines for the management of invasive Candida infections in adults in the Middle East region: expert panel recommendations. J Infect Public Health. 2014;7(1):6–19. - PubMed
    1. Morrell M, Fraser VJ, Kollef MH. Delaying the empiric treatment of Candida bloodstream infection until positive blood culture results are obtained: a potential risk factor for hospital mortality. Antimicrob Agents Chemother. 2005;49(9):3640–3645. - PMC - PubMed
    1. Pfaller MA, Jones RN, Doern GV, Sader HS, Hollis RJ, Messer SA. International surveillance of bloodstream infections due to Candida species: frequency of occurrence and antifungal susceptibilities of isolates collected in 1997 in the United States, Canada, and South America for the SENTRY program. The SENTRY Participant Group. J Clin Microbiol. 1998;36(7):1886–1889. - PMC - PubMed
    1. Parkins MD, Sabuda DM, Elsayed S, Laupland KB. Adequacy of empirical antifungal therapy and effect on outcome among patients with invasive Candida species infections. J Antimicrob Chemother. 2007;60(3):613–618. - PubMed

LinkOut - more resources