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Current Status and Clinical Outcomes of Combination Antifungal Therapy in Intensive Care Units
J. Kor. Soc. Health-syst. Pharm. 2019;36:97-107
Published online February 28, 2019;
© 2019 Korean Society of Health-System Pharmacists

Hyo Joo Nam, Sun Mi Jung, Jae Song Kim, Soo Hyun Kim and Eun Sun Son

Department of Pharmacy, Severance Hospital, Yon-sei University Health System, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 03722, Republic of Korea
Correspondence to: 손은선 Tel:02-2228-6888
Received February 9, 2018; Revised June 13, 2018; Accepted December 14, 2018.
This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License ( which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
Background : Invasive fungal infections are major infections that increase morbidity and mortality in intensive care units (ICUs). Most infected patients are immunosuppressed or critically ill. In 2016, the Infectious Diseases Society of America (IDSA) guidelines recommended a combination of voriconazole and echinocandins for patients with invasive aspergillosis. The purpose of this study was to analyze the clinical efficacy of combination antifungal therapy in ICUs of tertiary-care hospitals and to provide reference information for future treatment of fungi.
Methods : We respectively reviewed the electronic medical records (EMRs) of patients who had been treated with combination antifungal therapy more than three days in ICUs from January 1 to December 31, 2016. To analyze the current status of combination antifungal therapy, we analyzed the type of concomitant medications, the dosage, and the periods of administration. The reasons the drugs were given were categorized into four groups, and efficacy was also assessed.
Results : A total of 21 patients were enrolled in this study. The combination of voriconazole and caspofungin was the most administered medication. The average duration of administration was 13.67±16.22 days. One patient (5%) received antifungal treatment for prophylactic purposes, seven patients (33%) were treated for empirical reasons, four patients (19%) for predictive purposes, and nine patients (43%) for therapeutic purposes. The drugs were effective in nine patients (43%), ineffective in four patients (19%), and eight patients (38%) died before assessment.
Conclusions : This study confirmed that a combination of antifungal agents was effective in ICU patients. Future research is necessary to further establish effectiveness.
Keywords : Intensive care units, Combination antifungal therapy, Invasive fungal infections