Laura Whitney1, Hasan Al-Ghusein2, Stephen Glass2, Mickey Koh3, Matthias Klammer3, Jonathan Ball4, Jonathan Youngs2, Rachel Wake2, Angela Houston2, Tihana Bicanic2. 1. Pharmacy Department, St George's University Hospitals NHS Foundation Trust, Blackshaw Road, London, UK. 2. Department of Infection, St George's University Hospitals NHS Foundation Trust, Blackshaw Road, London, UK. 3. Department of Haematology, St George's University Hospitals NHS Foundation Trust, Blackshaw Road, London, UK. 4. Adult Critical Care, St George's University Hospitals NHS Foundation Trust, Blackshaw Road, London, UK.
Abstract
Background: The need for antifungal stewardship is gaining recognition with increasing incidence of invasive fungal infection (IFI) and antifungal resistance alongside the high cost of antifungal drugs. Following an audit showing suboptimal practice we initiated an antifungal stewardship programme and prospectively evaluated its impact on clinical and financial outcomes. Patients and methods: From October 2010 to September 2016, adult inpatients receiving amphotericin B, echinocandins, intravenous fluconazole, flucytosine or voriconazole were reviewed weekly by an infectious diseases consultant and antimicrobial pharmacist. Demographics, diagnosis by European Organization for Research and Treatment of Cancer (EORTC) criteria, drug, indication, advice, acceptance and in-hospital mortality were recorded. Antifungal consumption and expenditure, and candidaemia species and susceptibility data were extracted from pharmacy and microbiology databases. Results: A total of 432 patients were reviewed, most commonly receiving AmBisome® (35%) or intravenous fluconazole (29%). Empirical treatment was often unnecessary, with 82% having no evidence of IFI. Advice was given in 64% of reviews (most commonly de-escalating or stopping treatment) and was followed in 84%. Annual antifungal expenditure initially reduced by 30% (£0.98 million to £0.73 million), then increased to 20% above baseline over a 5 year period; this was a significantly lower rise compared with national figures, which showed a doubling of expenditure over the same period. Inpatient mortality, Candida species distribution and rates of resistance were not adversely affected by the intervention. Conclusions: Provision of specialist input to optimize antifungal prescribing resulted in significant cost savings without compromising on microbiological or clinical outcomes. Our model is readily implementable by hospitals with high numbers of at-risk patients and antifungal expenditure.
Background: The need for antifungal stewardship is gaining recognition with increasing incidence of invasive fungal infection (IFI) and antifungal resistance alongside the high cost of antifungal drugs. Following an audit showing suboptimal practice we initiated an antifungal stewardship programme and prospectively evaluated its impact on clinical and financial outcomes. Patients and methods: From October 2010 to September 2016, adult inpatients receiving amphotericin B, echinocandins, intravenous fluconazole, flucytosine or voriconazole were reviewed weekly by an infectious diseases consultant and antimicrobial pharmacist. Demographics, diagnosis by European Organization for Research and Treatment of Cancer (EORTC) criteria, drug, indication, advice, acceptance and in-hospital mortality were recorded. Antifungal consumption and expenditure, and candidaemia species and susceptibility data were extracted from pharmacy and microbiology databases. Results: A total of 432 patients were reviewed, most commonly receiving AmBisome® (35%) or intravenous fluconazole (29%). Empirical treatment was often unnecessary, with 82% having no evidence of IFI. Advice was given in 64% of reviews (most commonly de-escalating or stopping treatment) and was followed in 84%. Annual antifungal expenditure initially reduced by 30% (£0.98 million to £0.73 million), then increased to 20% above baseline over a 5 year period; this was a significantly lower rise compared with national figures, which showed a doubling of expenditure over the same period. Inpatient mortality, Candida species distribution and rates of resistance were not adversely affected by the intervention. Conclusions: Provision of specialist input to optimize antifungal prescribing resulted in significant cost savings without compromising on microbiological or clinical outcomes. Our model is readily implementable by hospitals with high numbers of at-risk patients and antifungal expenditure.
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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
Authors: Leenah Alaalm; Julia L Crunden; Mark Butcher; Ulrike Obst; Ryann Whealy; Carolyn E Williamson; Heath E O'Brien; Christiane Schaffitzel; Gordon Ramage; James Spencer; Stephanie Diezmann Journal: Front Cell Infect Microbiol Date: 2021-08-27 Impact factor: 5.293