A 6-year antifungal stewardship programme in a teaching hospital

Mondain, V.; Lieutier, F.; Hasseine, Lilia; Gari-Toussaint, M.; Poirée, Maryline; Lions, C.; Pulcini, Céline

doi:10.1007/s15010-013-0431-1

Cited by 80 publications

(67 citation statements)

References 24 publications

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“…Our study demonstrates that at the first bedside assessment, a diagnostic suggestion was necessary in 40% of the patients and that therapy had to be modified in 30%. Mondain et al demonstrated that an AFSP based on a complete bundle of measures improved the quality of care in candidemia and invasive aspergillosis and reduced overall mortality (7). Similar results were found by Antworth et al, who implemented a comprehensive care bundle for the management of candidemia in a US hospital.…”

Section: Adequacy Of Antifungal Therapy: Final Evaluationsupporting

confidence: 52%

“…Although significant success has been demonstrated with antibacterial stewardship interventions, experience with antifungal drugs is scarce. Some programs include formulary restriction and preauthorization requirements (3)(4)(5) or did not include all available antifungal agents (6)(7)(8). Nowadays, when competition for resources is huge and proof of return on investment a requisite, the cost-effectiveness and safety of antifungal stewardship programs (AFSPs) need to be demonstrated.…”

Section: Introductionmentioning

confidence: 99%

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Antifungal stewardship in a tertiary-care institution: a bedside intervention

Valerio

Muñóz

Rodríguez

et al. 2015

Clinical Microbiology and Infection

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Antifungal stewardship (AFS) programmes are needed in tertiary-care hospitals. Our aim is to describe a bedside non-restrictive AFS programme, and to evaluate its economic impact. During the first year of the AFS a bundle of non-interventional measures were implemented. During the second year an infectious diseases specialist visited 453 patients receiving candins, liposomal amphotericin B, voriconazole or posaconazole. Monthly costs were studied with an interrupted time series (ITS) analysis. The main prescribing departments were haematology (35%), medical departments (23%), and intensive care units (20%). Reasons to start antifungal therapy were: targeted therapy (36%), prophylaxis (32%), empirical therapy (20%) and pre-emptive therapy (12%). At the initial visit, diagnostic advice was provided in 40% of cases. The most common therapeutic recommendations were to de-escalate the antifungal drug (17%) or to suspend it (7%). Annual total antifungal expenditure was reduced from US$3.8 million to US$2.9 million over the first 2 years, generating net savings of US$407,663 and US$824,458 per year after considering the cost of additional staff required. The ITS analyses showed a significant economic impact after the first 12 months of the intervention (p 0.042 at month 13), which was enhanced in the following 24 months (p 0.006 at month 35). The number of defined daily doses decreased from 66.4 to 54.8 per 1000 patient-days. Incidence of candidaemia was reduced from 1.49 to 1.14 (p 0.08) and related mortality was reduced from 28% to 16% (p 0.1). A collaborative and non-compulsory AFS program based on bedside intervention is an efficacious and cost-effective approach that optimizes the use of AF drugs.

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Section: Adequacy Of Antifungal Therapy: Final Evaluationsupporting

confidence: 52%

Section: Introductionmentioning

confidence: 99%

Antifungal stewardship in a tertiary-care institution: a bedside intervention

Valerio

Muñóz

Rodríguez

et al. 2015

Clinical Microbiology and Infection

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“…conversion (1). Of the 36 included studies, 2 were full CEAs [13,14]; 27 studies reported changes to costs and health outcomes separately [3,5,[8][9][10][12][13][14][22][23][24][25][26][27][28][29][30][31][32][33][34][35][36][37][38][39][40] and 9 reported only changes to costs [4,6,[15][16][17][18][19][20][21]. Table 1 presents the methods and results for studies that measured only cost outcomes and Table 2 presents the methods and findings of those studies that measured both a clinical as well as a cost outcome.…”

Section: Resultsmentioning

confidence: 99%

“…Costing studies that did not measure clinical outcomes Table 1 groups 9 of the 36 included studies that measured only the cost impact of AMS strategies [4,6,[15][16][17][18][19][20][21]. PAIF was the most commonly evaluated strategy in this group (5/9; 56%) [4,6,[15][16][17]; 2 studies focused on i.v.-to-p.o.…”

Section: 1mentioning

confidence: 99%

The need for cost-effectiveness analyses of antimicrobial stewardship programmes: A structured review

Coulter

Merollini

Roberts

et al. 2015

International Journal of Antimicrobial Agents

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“…[108][109][110] One study reviewed 636 prescriptions, of which 72% were from the adult and pediatric hematology-oncology services, over 6 y. 108 The ASP provided feedback to the primary teams regarding diagnostic investigations, TDM, and antifungal prescribing and found a high compliance rate (88%) with ASP recommendations. Patient outcomes were favorable in 47 of 63 (75%) with IA and 52 of 60 (87%) with IC, and the total cost of antifungals was stable.…”

Section: Evidence For Antifungal Stewardshipmentioning

confidence: 99%

Antifungal stewardship considerations for adults and pediatrics

2016

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Antifungal stewardship refers to coordinated interventions to monitor and direct the appropriate use of antifungal agents in order to achieve the best clinical outcomes and minimize selective pressure and adverse events. Antifungal utilization has steadily risen over time in concert with the increase in number of immunocompromised adults and children at risk for invasive fungal infections (IFI). Challenges in diagnosing IFI often lead to delays in treatment and poorer outcomes. There are also emerging data linking prior antifungal exposure and suboptimal dosing to the emergence of antifungal resistance, particularly for Candida. Antimicrobial stewardship programs can take a multi-pronged bundle approach to ensure suitable prescribing of antifungals via postprescription review and feedback and/or prior authorization. Institutional guidelines can also be developed to guide diagnostic testing in at-risk populations; appropriate choice, dose, and duration of antifungal agent; therapeutic drug monitoring; and opportunities for de-escalation and intravenous-to-oral conversion.

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A 6-year antifungal stewardship programme in a teaching hospital

Abstract: The implementation of an antifungal stewardship programme was feasible, sustainable and well accepted. We observed an improved quality of care for some process of care measures, and antifungal use and cost were contained in our hospital.

Cited by 80 publications

References 24 publications

Antifungal stewardship in a tertiary-care institution: a bedside intervention

Antifungal stewardship in a tertiary-care institution: a bedside intervention

The need for cost-effectiveness analyses of antimicrobial stewardship programmes: A structured review

Antifungal stewardship considerations for adults and pediatrics

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