Repeated antifungal use audits are essential for selecting the targets for intervention in antifungal stewardship

Abstract

A previous audit to assess the quality of antifungal use was performed in our hospital in 2011. After 5 years of antifungal stewardship program (AFS), we performed a follow-up audit in order to describe the long-term effect of such program. Using a predefined score, we evaluated the antifungal use in 100 consecutive adult inpatients receiving systemic antifungals. Results of the present audit were compared with those of a previous one, performed in 2011, before the implementation of our AFS. After 5 years, AFS program has induced a change in the population who received antifungal drugs in our hospital with a reduction in medical patients and a relative higher prescription among hematological ones. As for indications, empirical use decreased very significantly (from 62 to 30%, p < 0.001), while tailored treatment (from 20 to 41%, p = 0.001) and prophylaxis (from 15 to 27%, p = 0.03) increased. Compared to 2011, we also observed an improvement in the optimal choice of antifungal drug, route of administration, and microbiological adjustment. However, no significant improvement was observed regarding adequacy of length of therapy or optimal dosage or administration route. Although we observed an increase in the number of optimal DOTs used, the potential estimated savings continued to be high (~ €44,199 for every 100 patients receiving antifungals). Our study is the first to show the impact on the use of antifungal drugs exerted by a prolonged non-coercive AFS program. We also demonstrate the utility of a periodic audit of antifungal use in order to point out new goals for future interventions.

A prospective, multi-center study of Candida bloodstream infections in Chile

“…glabrata to micafungin is similar to the alarming data of echinocandins resistance reported by other authors [26, 36]. Our results could represent a warning, suggesting the need of performing a prospective azole and echinocandins resistance surveillance in our country, reviewing the antifungal prophylaxis policies and implementing a national antifungal stewardship program before reaching a critical level of resistance [37, 38].…”

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

“…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.…”

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

“…Although gathering baseline data is of paramount importance for defining prescribing trends and identifying areas of improvement, 109 none of the aforementioned studies assessed the prescribing quality of antifungals in terms of indications, dosage or length of treatment. 36 Accordingly, it is not possible to evaluate what proportion of COVID-19 patients have been given antifungal treatment deemed unnecessary.…”

“…As for treatment, voriconazole currently represents the first-line treatment for IPA. 102 , 110 , 111 However, there are many drawbacks associated with voriconazole treatment including major drug–drug interactions, 109 the requirement for therapeutic drug monitoring 117 and the limited spectrum of activity. Although there are few data outside the haematological setting, isavuconazole goes beyond these limits, offering a wider spectrum of antifungal activity than voriconazole, fewer toxicities and fewer drug–drug interactions as well as a lack of cyclodextrin, which is a solubilizing agent used in some other azoles (e.g.…”