A L Bienvenu1,2, L Argaud3, F Aubrun4, J L Fellahi5,6, C Guerin7, E Javouhey8, V Piriou9, T Rimmele10, C Chidiac11, G Leboucher1. 1. Service Pharmacie, Groupement Hospitalier Nord, Hospices Civils de Lyon, Lyon, France. 2. UMR-CNRS 5246, Campus Lyon La Doua, University Lyon 1, Lyon, France. 3. Service de Réanimation Médicale, Hôpital Edouard Herriot, Hospices Civils de Lyon, Lyon, France. 4. Service de Réanimation Chirurgicale, Groupement Hospitalier Nord, Hospices Civils de Lyon, Lyon, France. 5. Service d'Anesthésie-Réanimation, Groupement Hospitalier Est, Hospices Civils de Lyon, Lyon, France. 6. Faculté de Médecine Lyon Est, University Lyon 1, Lyon, France. 7. Service de Réanimation Médicale, Groupement Hospitalier Nord, Hospices Civils de Lyon, Lyon, France. 8. Service de Réanimation Pédiatrique, Hôpital Femme Mère Enfant, Hospices Civils de Lyon, Lyon, France. 9. Service de Réanimation Médicale, Groupement Hospitalier Sud, Hospices Civils de Lyon, Lyon, France. 10. Service d'Anesthésie-Réanimation, Hôpital Edouard Herriot, Hospices Civils de Lyon, Lyon, France. 11. Service des Maladies Infectieuses, Groupement Hospitalier Nord, Hospices Civils de Lyon, Lyon, France.
Abstract
Objectives: Antifungal resistance is a significant and emerging threat. Stewardship programmes (SPs) have been proposed as an opportunity to optimize antifungal use. While examples of antifungal SP implementation have been recently described, there is yet to be an overview of interventions and their impacts on performance measures. Methods: We systematically reviewed published articles using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses check-list 2009. MEDLINE was searched using the term 'antifungal stewardship' on 15 February 2017. Eligible studies were those that described an antifungal SP and included an intervention and an evaluation of performance measures. Results: A total of 97 studies were identified and 14 were included. Only five studies reported an antifungal stewardship team composed of all the recommended members. The main intervention was the formulation of recommendations to change treatment (12 of 14). The main performance measure collected was antifungal consumption (10 of 14), followed by antifungal expenditure (7 of 14), adherence to therapeutic advice (4 of 14) and impact on mortality (4 of 14). Antifungal consumption was reduced by 11.8% to 71% and antifungal expenditure by as much as 50%. Adherence to therapeutic advice ranged from 40% to 88%, whereas antifungal SPs had no impact on mortality. Conclusions: All antifungal SPs had an impact, in particular on antifungal consumption and antifungal expenditure. Active intervention including a review of prescriptions seems to have more impact than implementation of treatment guidelines only. According to available published studies, antifungal consumption appears to be the most achievable performance measure to evaluate the impact of an antifungal SP.
Objectives: Antifungal resistance is a significant and emerging threat. Stewardship programmes (SPs) have been proposed as an opportunity to optimize antifungal use. While examples of antifungal SP implementation have been recently described, there is yet to be an overview of interventions and their impacts on performance measures. Methods: We systematically reviewed published articles using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses check-list 2009. MEDLINE was searched using the term 'antifungal stewardship' on 15 February 2017. Eligible studies were those that described an antifungal SP and included an intervention and an evaluation of performance measures. Results: A total of 97 studies were identified and 14 were included. Only five studies reported an antifungal stewardship team composed of all the recommended members. The main intervention was the formulation of recommendations to change treatment (12 of 14). The main performance measure collected was antifungal consumption (10 of 14), followed by antifungal expenditure (7 of 14), adherence to therapeutic advice (4 of 14) and impact on mortality (4 of 14). Antifungal consumption was reduced by 11.8% to 71% and antifungal expenditure by as much as 50%. Adherence to therapeutic advice ranged from 40% to 88%, whereas antifungal SPs had no impact on mortality. Conclusions: All antifungal SPs had an impact, in particular on antifungal consumption and antifungal expenditure. Active intervention including a review of prescriptions seems to have more impact than implementation of treatment guidelines only. According to available published studies, antifungal consumption appears to be the most achievable performance measure to evaluate the impact of an antifungal SP.
Authors: Melissa D Johnson; Russell E Lewis; Elizabeth S Dodds Ashley; Luis Ostrosky-Zeichner; Theoklis Zaoutis; George R Thompson; David R Andes; Thomas J Walsh; Peter G Pappas; Oliver A Cornely; John R Perfect; Dimitrios P Kontoyiannis Journal: J Infect Dis Date: 2020-08-05 Impact factor: 5.226
Authors: Michelle R Ananda-Rajah; Samuel Fitchett; Darshini Ayton; Anton Y Peleg; Shaun Fleming; Eliza Watson; Kelly Cairns; Trisha Peel Journal: Open Forum Infect Dis Date: 2020-05-21 Impact factor: 3.835
Authors: Marina Machado; Esther Chamorro de Vega; María Del Carmen Martínez-Jiménez; Carmen Guadalupe Rodríguez-González; Antonio Vena; Raquel Navarro; María Isabel Zamora-Cintas; Caroline Agnelli; María Olmedo; Alicia Galar; Jesús Guinea; Ana Fernández-Cruz; Roberto Alonso; Emilio Bouza; Patricia Muñoz; Maricela Valerio Journal: J Fungi (Basel) Date: 2021-01-17