Document Detail


Cost-benefit analysis of extended antifungal prophylaxis in ventricular assist devices.
MedLine Citation:
PMID:  11016513     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
This report defines the cost and benefit of extended antifungal prophylaxis in ventricular assist device (VAD) patients (pts). Extended antifungal prophylaxis is defined as prophylaxis with fluconazole or nystatin that is given until pts are extubated and off antibiotics. These data are compared with that obtained from earlier VAD patients who only received anti-fungal drugs for documented fungal colonization or infection. Thirty-six patients had HeartMate (n = 15) or Thoratec (n = 21) VADs between 1989 and 1997. Cultures positive for fungus (n = 52 cultures) were obtained from 16 of 36 patients (44% of patients). Forty-three fungal cultures were in the preprophylaxis and nine in the postprophylaxis era. There was one death attributable to fungal sepsis in the preprophylaxis era and none in the postprophylaxis era. The total cost of antifungal drugs in the preprophylaxis era was $3,840 over 1,498 patient days (PD) (mean $2.56 per PD), versus $70,670 over 1,525 PD in the postprophylaxis era (mean $46.34 per PD). Extended antifungal prophylaxis was not cost effective in VAD patients at this institution. However, short-term perioperative antifungal prophylaxis was not addressed by this study. We are now using short-term antifungal prophylaxis with fluconazole and nystatin in VAD patients because of the potential for serious morbidity and mortality that is associated with fungal device infections. A future analysis will determine the usefulness of this change in strategy.
Authors:
J L Skinner; C Harris; M F Aaron; D C McGiffin; J K Kirklin; R C Bourge; W L Holman
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  ASAIO journal (American Society for Artificial Internal Organs : 1992)     Volume:  46     ISSN:  1058-2916     ISO Abbreviation:  ASAIO J.     Publication Date:    2000 Sep-Oct
Date Detail:
Created Date:  2001-01-11     Completed Date:  2001-01-11     Revised Date:  2006-05-23    
Medline Journal Info:
Nlm Unique ID:  9204109     Medline TA:  ASAIO J     Country:  UNITED STATES    
Other Details:
Languages:  eng     Pagination:  587-9     Citation Subset:  IM    
Affiliation:
Department of Medicine, University of Alabama at Birmingham, 35294-0007, USA.
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MeSH Terms
Descriptor/Qualifier:
Antifungal Agents / therapeutic use*
Cost-Benefit Analysis
Heart-Assist Devices / adverse effects*
Humans
Mycoses / prevention & control
Chemical
Reg. No./Substance:
0/Antifungal Agents

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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