Reduction of Invasive Fungal Infections Among Cancer Patients With Chemotherapy-Induced Neutropenia After Protective Environment Implementation May Save Costs in a Developing Country: A Quasi-Experimental Study

Invasive fungal infections (IFI) represent a serious threat for severely immunocompromised patients. Infection control interventions, including protective environment (PE) implementation, are essential to reduce IFI incidence, mortality and burden of hospitalization, among high-risk patients. Information about the impact of these strategies in cancer patients with chemotherapy-induced neutropenia (CIN), in developing countries, is insufficient. To assess the impact of PE implementation on IFI incidence, consumption and cost of antifungal treatment, in a general, tertiary teaching hospital, in Southern Brazil. We conducted a quasi-experimental study to evaluate an institutional intervention, in a hospital ward, for patients with CIN, which consisted in renovation of the ward and measures involving air-quality technologies installation, the main one being high efficiency particulate air (HEPA) filters. Simultaneously, infection control routines were implemented. Neutropenic patients, admitted to any other hospital ward, prior to the renovation, were included in the historical control group. The IFI incidence was defined, according to the criteria proposed by the European Organization for Research and Treatment of Cancer. Direct costs of antifungal drugs were recorded, for all neutropenic patients. A total of 190 and 181 hospital admissions were included in the intervention and control groups, respectively. Total IFI incidence was reduced in the PE group (7.4% vs. 18.2%; P = 0.002) and the same was observed when considering only proven and probable IFI (1.6% vs. 8.3%; P = 0.003). This benefit persisted even after adjusting for antifungal prophylaxis (OR = 0.17; 95% CI = 0.05 ? 0.60). We observed a decreasing trend in molds and yeasts IFI incidence, in the intervention group. Although the final cost of antifungal agents was lower, after intervention (78347.37 USD vs. 154176.60 USD), the median cost per admission did not differ between groups (1.00 USD = 1.9 Brazilian Real, in May 2007). Considering all admissions with IFI, the median cost was significantly higher than recorded in admissions without IFI. This study showed that preventive measures, including PE implementation, reduce IFI incidence in patients with CIN, admitted in a hospital in a developing country. This suggests that those strategies may overcome their costs on the long-term, by saving costs associated with fungal infections