Post-Prescription Audit Plus Beta-D-Glucan Assessment Decrease Echinocandin Use in People with Suspected Invasive Candidiasis

Abstract

Background and Objectives: Overtreatment with antifungal drugs is often observed. Antifungal stewardship (AFS) focuses on optimizing the treatment for invasive fungal diseases. The objective of the present study was to evaluate the utility of a post-prescription audit plus beta-D-glucan (BDG) assessment on reducing echinocandin use in persons with suspected invasive candidiasis. Materials and Methods: This is a prospective, pre-post quasi-experimental study of people starting echinocandins for suspected invasive candidiasis. The intervention of the study included review of each echinocandin prescription and discontinuation of treatment if a very low probability of fungal disease or a negative BDG value were found. Pre-intervention data were compared with the intervention phase. The primary outcome of the study was the duration of echinocandin therapy. Secondary outcomes were length of hospital stay and mortality. Results: Ninety-two echinocandin prescriptions were reviewed, 49 (53.3%) in the pre-intervention phase and 43 (46.7%) in the intervention phase. Discontinuation of antifungal therapy was possible in 21 of the 43 patients in the intervention phase (48.8%). The duration of echinocandin therapy was 7.4 (SD 4.7) in the pre-intervention phase, 4.1 days (SD 2.9) in persons undergoing the intervention, and 8.6 (SD 7.3) in persons in whom the intervention was not feasible (p at ANOVA = 0.016). Length of stay and mortality did not differ between pre-intervention and intervention phases. Conclusions: An intervention based on pre-prescription restriction and post-prescription audit when combined with BDG measurement is effective in optimizing antifungal therapy by significantly reducing excessive treatment duration.

Improving management and antimicrobial stewardship for bacterial and fungal infections in hospitalized patients with COVID-19

“…Many AFS programmes designed in tertiary centres have succeeded in reducing mortality 32 – 34 improving the appropriateness of antifungal use and decreasing the economic burden of new antifungals 35 , 36 with the additional support of fungal biomarkers. 37 , 38 AMS has been shown to reduce the use of antifungals by increasing prescribers’ awareness and mitigating risk factors for fungal infections. 39 , 40 …”

“…Many AFS programmes designed in tertiary centres have succeeded in reducing mortality [32][33][34] improving the appropriateness of antifungal use and decreasing the economic burden of new antifungals 35,36 with the additional support of fungal biomarkers. 37,38 AMS has been shown to reduce the use of antifungals by increasing prescribers' awareness and mitigating risk factors for fungal infections. 39,40 Problems of AMS in daily practice in COVID-19 and possible solutions AMS is urgently needed to contain the high rates of antimicrobial prescription described, reversing the downward trend resulting from AMS practices.…”

Antifungal stewardship in solid‐organ transplantation: What is needed?

“…Incorporating diagnostics into the PAF process can further assist in this approach; a study evaluating combining PAF with β‐D‐glucan reduced echinocandin durations from 7.4 days (SD 4.7) in the pre‐intervention phase to 4.1 days (SD 2.9) in persons undergoing the intervention without affecting length of stay or mortality 68 …”

“…67 Incorporating diagnostics into the PAF process can further assist in this approach; a study evaluating combining PAF with β-D-glucan reduced echinocandin durations from 7.4 days (SD 4.7) in the preintervention phase to 4.1 days (SD 2.9) in persons undergoing the intervention without affecting length of stay or mortality. 68 The PAF approach involves identifying target patient populations when pathogens are detected or a target antifungal is prescribed 29 so can be facilitated by digital enablers where electronic health records are used.…”

Sepsis: New Challenges and Future Perspectives for an Evolving Disease—Precision Medicine Is the Way!

“…On this connection, again with a view to a personalized medicine that allows managing the infection in the context of the patient's singularity, the study by Murri et al acquires relevance [12]. It took into consideration the management of candidemia and the frequent overtreatment of this condition.…”