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.