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Efficacy and safety of a comprehensive educational antimicrobial stewardship program focused on antifungal use

Published:January 15, 2020DOI:https://doi.org/10.1016/j.jinf.2020.01.002

      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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