Highlights
- •The PRIOAM improved antifungal use in patients with hospital-acquired candidemia.
- •It resulted in a proportional reduction of antifungal consumption of 38.4%.
- •The most frequently prescribed antifungal agent was fluconazole.
- •The number of Candida spp. with antifungal resistance was remarkably low (4.7%).
- •The reduction in antifungal consumption was safe.
Summary
Objective
Few data exist regarding the impact of antimicrobial stewardship programs on antifungal
use. We evaluated the efficacy and safety of a comprehensive long-term antimicrobial
stewardship program (ASP) focused on antifungal use.
Methods
During a 9-year period, we quarterly assessed antifungal consumption, incidence density
of hospital-acquired candidemia, Candida spp. distribution, antifungal resistance, and crude death rate per 1000 occupied
bed days (OBDs) of hospital-acquired candidemia. We performed segmented regression
analysis of interrupted time series.
Results
A significant change in trend was observed for antifungal consumption, with a sustained
reduction of -0.87% per quarter (95% confidence interval [CI], −1.36 −0.38, p < 0.001), accounting for a final reduction of −38.4%. The main reduction was produced
in fluconazole, with a sustained reduction of −1.37% per quarter (95%CI, −1.96 −0.68,
p<0.001). The incidence density of hospital-acquired candidemia decreased, with a change
in slope of −5.06% cases per 1000 OBDs per year (95%CI, −8.23 −1.77, p = 0.009). The 14-day crude death rate per 1000 OBDs dropped from 0.044 to 0.017 (−6.36%
deaths per 1000 OBDs per year; 95%CI, −13.45 −1.31, p = 0.09).
Conclusions
This ASP has succeeded in optimizing the use of antifungal with a long-lasting reduction
without increasing the incidence, neither the mortality, of hospital-acquired candidemia.
Keywords
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Article info
Publication history
Published online: January 15, 2020
Accepted:
January 8,
2020
Identification
Copyright
© 2020 The British Infection Association. Published by Elsevier Ltd. All rights reserved.