Improving quality of antifungal use through antifungal stewardship interventions

Lachenmayr, S.; Strobach, Dorothea; Berking, Sophie; Horns, Heidi; Berger, Karin; Ostermann, Helmut

doi:10.1007/s15010-019-01288-4

Cited by 22 publications

(49 citation statements)

References 22 publications

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“…Of the studies included, six were quasi-experimental before-after intervention studies [23][24][25][26][27][28] and one matched control analysis (Table 1). 29 All studies were from singlecentre academic hospitals, mostly (n = 5) from the USA.…”

Section: Study Characteristicsmentioning

confidence: 99%

“…Five studies were specifically dedicated to optimising candidaemia management at a hospital level, [23][24][25][26][27] one at optimising prescribing of caspofungin in an intensive care unit (ICU) 29 and the remaining study focusing on systemic antifungal prescribing in adult haematology and oncology units. 28 All studies included adult patients only. The median duration of intervention was 15 months (range, and included a median of 42 patients (range, 20-103).…”

Section: Study Characteristicsmentioning

confidence: 99%

“…Additional interventions in one study included guideline development and education for medical staff. 26 For the single study aimed at enhancing the quality of systemic antifungal prescribing in the haematology and oncology units, 28 a pharmacist evaluated every systemic antifungal prescription to provide feedback to physicians regarding drug choice, dosage, initiation, discontinuation and clinically relevant drug-drug interactions. Recommendations were voluntary.…”

Section: Interventionsmentioning

confidence: 99%

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The impact of pharmacist‐led antifungal stewardship interventions in the hospital setting: a systematic review

Khanina

Cairns

Kong

et al. 2021

Pharmacy Practice and Res

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Aim: To summarise the evidence on pharmacist-led antifungal stewardship (AFS) programs in the hospital setting and to evaluate their impact on the quality of antifungal prescribing and infection management, antifungal usage and clinical outcomes. Data sources: A systematic review of English-language studies identified in MEDLINE and EMBASE was performed on 27 November 2020 and conducted in accordance with PRISMA. Search terms included 'antifungal agent', 'invasive fungal infection', 'antimicrobial stewardship', 'patient care bundles' and 'pharmacist'. Study selection: Eligible studies describing pharmacist-led quality improvement intervention(s) implemented in the hospital setting targeted at optimising systemic antifungal prescribing. Results: Six hundred and forty-six studies were identified, and seven met inclusion criteria. Five were dedicated to optimising candidaemia management, one at optimising intensive care unit prescribing of caspofungin and one on antifungal prescribing in haematology and oncology units. All studies measured varied metrics relating to quality of prescribing and infection management, reporting improvement in proportion of effective antifungal therapy (n = 1/1), appropriate antifungal selection (n = 1/1), dosing (n = 2/3), management of drug-drug interactions (n = 1/1) and reduced time to antifungal initiation (n = 4/4). Studies that implemented a candidaemia bundle of care reported improvements in composite bundle adherence (n = 2/2), with greatest improvement in ophthalmological consultation (n = 4/4), echocardiography (n = 2/2) and infectious diseases consultation (n = 3/3). There was reduction in antifungal expenditure (n = 4/4) and consumption (n = 2/4). Pharmacist-led AFS programs did not influence clinical outcomes. Conclusion: Available evidence suggests that pharmacist-led AFS interventions can improve the quality and timeliness of antifungal prescribing and reduce antifungal usage. Further research is required to assess the impact on clinical and microbiological outcomes.

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Section: Study Characteristicsmentioning

confidence: 99%

Section: Study Characteristicsmentioning

confidence: 99%

Section: Interventionsmentioning

confidence: 99%

See 1 more Smart Citation

The impact of pharmacist‐led antifungal stewardship interventions in the hospital setting: a systematic review

Khanina

Cairns

Kong

et al. 2021

Pharmacy Practice and Res

View full text Add to dashboard Cite

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“…Additionally, adherence to guidelines in terms of dosing of antifungal drugs and duration of therapies significantly improved after our AFS intervention, while no differences were found by some other studies. Indeed, Lachenmayr et al, 4 in a German Department of Hematology and Oncology, found no significant improvement in duration of antifungal treatment (but an increase in dosage accuracy), and Valerio et al 21 carried out a follow‐up audit after 5 years of an AFSp, with no significant improvement regarding adequacy of dosing and the length of therapy. Minimising potential complications by optimising both dosing and duration is one of the goals of an AFS, and our implementation proved to be effective.…”

Section: Discussionmentioning

confidence: 99%

How can we optimise antifungal use in a solid organ transplant centre? Local epidemiology and antifungal stewardship implementation: A single‐centre study

Mularoni

Adamoli

Polidori

et al. 2020

Mycoses

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Purpose We aimed to implement and to assess the impact of the antifungal stewardship programme (AFSp) on prescription appropriateness of antifungals, management and outcomes of candidaemia patients, and antifungal consumption and costs at our solid organ transplant (SOT) institute. Methods Local epidemiology of invasive fungal infections (IFIs) from 2009 to 2017 was analysed in order to prepare an effective AFSp, implemented in January 2018. It included suspension of empirical antifungal prescriptions after 72 hours (antifungal time‐out), automated alert and infectious disease (ID) consult for empirical prescriptions and for every patient with IFI, and indication for step‐down to oral fluconazole when possible. We used process measures and results measures to assess the effects of the implemented programme. Results The ASFp led to significant improvements in selection of the appropriate antifungal (40.5% in pre‐AFS vs 78.6% in post‐AFS), correct dosing (51.2% vs 79.8%), correct length of treatment (55.9% vs 75%) and better management of patients with candidaemia. Analysis of prescribed empirical antifungal revealed that defined daily doses (DDDs) per 100 patient days decreased by 36.7% in 2018 compared to the average of pre‐AFSp period, with important savings in costs. Conclusion This AFSp led to a better use of antifungal drugs in terms of appropriateness and consumption, with stable clinical and microbiological outcomes in patients with IFI.

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“…Hinzu kommt in bestimmten Hochrisikogruppen das weite Feld der Prophylaxe und Therapie invasiver Pilzinfektionen bei Patienten mit hohem Risiko, für das sich unter Zuhilfenahme von nationalen und internationalen Leitlinien der Fachgesellschaften inzwischen erweiterte An tifungal Stewardship ( AFS)-Initiativen im Aufbau befinden [428][429][430][431][432][433][434][435][436][437][438][439][440][441][442][443][444].…”

Section: Surveillanceunclassified

Anforderungen an die Infektionsprävention bei der medizinischen Versorgung von immunsupprimierten Patienten

2021

Bundesgesundheitsbl

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Improving quality of antifungal use through antifungal stewardship interventions

Cited by 22 publications

References 22 publications

The impact of pharmacist‐led antifungal stewardship interventions in the hospital setting: a systematic review

The impact of pharmacist‐led antifungal stewardship interventions in the hospital setting: a systematic review

How can we optimise antifungal use in a solid organ transplant centre? Local epidemiology and antifungal stewardship implementation: A single‐centre study

Anforderungen an die Infektionsprävention bei der medizinischen Versorgung von immunsupprimierten Patienten

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