Utilization of Anidulafungin in Intensive Care Units at 108 Military Central Hospital

Abstract

Objective: To assess the utilization of anidulafungin in intensive care units (ICUs) at 108 Military Central Hospital. Subject and method: A retrospective cross-sectional descriptive study was conducted based on medical records of patients who received anidulafungin in intensive care units during the study period. Result: A total of 44 patients were included in the analysis, with a median age of 53 (42.8–67.3) years; males accounted for 70.5%. Patients commonly had multiple comorbidities, with liver disease being the most prevalent (47.7%), 25,0% had concomitant bacterial infections, mainly pneumonia and bloodstream infections. Major risk factors for invasive fungal infections included prolonged ICU stay (100.0%), use of broad-spectrum antibiotics (97.7%), abdominal surgery (75.0%), and solid organ transplantation (54.6%). Fungal investigations were performed in 40.9% of patients, of which 88.9% yielded positive results. Candida species were the predominant pathogens, with Candida albicans accounting for 33.3%. Anidulafungin was exclusively used as monotherapy (100%), with no cases of combination therapy with other antifungal agents., with a median treatment duration of 5.5 (4-7.3) days. Anidulafungin was predominantly prescribed for empirical (36.4%) and prophylactic (43.2%) indications, whereas targeted therapy was limited. A loading dose of 200 mg was administered in 81,8% of patients, while a maintenance dose of 100 mg/day was used in 97.7%. Most patients did not require modification of antifungal therapy. Adverse events included elevated liver enzymes (6.8%) and hypokalemia (11.4%), which were observed during the treatment period. The rate of unfavorable clinical outcomes was 45.5%. Conclusion: Anidulafungin was generally used with maintenance dosing consistent with current guidelines. However, suboptimal use of loading doses and limited utilization of fungal diagnostics indicate gaps in clinical practice. The high rate of unfavorable outcomes highlights the need for optimization of antifungal therapy and increased use of microbiological diagnostics to improve treatment effectiveness and mitigate antifungal resistance.