The Early Detection of the Fungal Outbreak by Surveillance of Antifungal Agents Usage

Abstract

  The number of patients who were diagnosed with fungal infection and the amount of the antifungal agents used in the medical ward for blood diseases both increased in the National Hospital Organization Kagoshima Medical Center in 2008. At that time, we had surveyed the use of antimicrobial agents except for antifungal agents; so we could not detect the outbreak at the early stage. Therefore, we retrospectively investigated the amount of the antifungal agents used in the ward, and determined whether the outbreak could have been detected by the surveillance of the amount of the antifungal agents used. We calculated the monthly and weekly antimicrobial usage density (AUD) of the antifungal agents from January 2007 to December 2009. The monthly AUD showed an abrupt increase in August 2008, and the highest usage was three times the monthly average usage in November 2008. When we compared mean values of AUD every half year, we found the AUD predominantly increased. The weekly AUD gradually increased in the first week of August and then abruptly increased at the end of August 2008. Cleaning of the filter, fan coil, and exhaust vents of the air-conditioning machines was carried out in this ward on July 17, 2008; the cleaning was thought to be the reason for the fungal infection, especially the increase in the number of patients with Aspergillosis, although this could not be proven. The present study suggests that surveillance of the AUD can detect an outbreak of fungal infection at the early stage.