Masaru Samura1, Naoki Hirose2, Takenori Kurata3, Junichi Ishii4, Fumio Nagumo5, Keisuke Takada6, Sakura Koshioka7, Masaki Uchida8, Syunya Yamamoto9, Junki Inoue10, Yuki Enoki11, Kazuaki Taguchi12, Akira Ishida13, Hisakazu Sekine14, Norifumi Kunika15, Hiroyuki Kunishima16, Kazuaki Matsumoto17. 1. Department of Pharmacy, Yokohama General Hospital, 2201-5 Kuroganecho, Aoba-ku, Yokohama-shi, Kanagawa, 225-0025, Japan; Division of Pharmacodynamics, Keio University Faculty of Pharmacy, 1-5-30 Shibakoen, Minato-ku, Tokyo, 105-8512, Japan. Electronic address: masaru.samura@gmail.com. 2. Department of Pharmacy, Yokohama General Hospital, 2201-5 Kuroganecho, Aoba-ku, Yokohama-shi, Kanagawa, 225-0025, Japan. Electronic address: h-naoki79@hotmail.co.jp. 3. Department of Pharmacy, Yokohama General Hospital, 2201-5 Kuroganecho, Aoba-ku, Yokohama-shi, Kanagawa, 225-0025, Japan. Electronic address: t-kurata1017@hotmail.co.jp. 4. Department of Pharmacy, Yokohama General Hospital, 2201-5 Kuroganecho, Aoba-ku, Yokohama-shi, Kanagawa, 225-0025, Japan. Electronic address: yokoso_j_ishii@yahoo.co.jp. 5. Department of Pharmacy, Yokohama General Hospital, 2201-5 Kuroganecho, Aoba-ku, Yokohama-shi, Kanagawa, 225-0025, Japan. Electronic address: pgqnf6888@yahoo.co.jp. 6. Department of Pharmacy, Yokohama General Hospital, 2201-5 Kuroganecho, Aoba-ku, Yokohama-shi, Kanagawa, 225-0025, Japan. Electronic address: ihanon555@hotmail.com. 7. Department of Pharmacy, Yokohama General Hospital, 2201-5 Kuroganecho, Aoba-ku, Yokohama-shi, Kanagawa, 225-0025, Japan. Electronic address: s.koshioka@gmail.com. 8. Department of Pharmacy, Yokohama General Hospital, 2201-5 Kuroganecho, Aoba-ku, Yokohama-shi, Kanagawa, 225-0025, Japan. Electronic address: uddy.dctrue41@gmail.com. 9. Department of Pharmacy, Yokohama General Hospital, 2201-5 Kuroganecho, Aoba-ku, Yokohama-shi, Kanagawa, 225-0025, Japan. Electronic address: s.yamamoto224@gmail.com. 10. Department of Pharmacy, Yokohama General Hospital, 2201-5 Kuroganecho, Aoba-ku, Yokohama-shi, Kanagawa, 225-0025, Japan. Electronic address: junki.inoue79@gmail.com. 11. Division of Pharmacodynamics, Keio University Faculty of Pharmacy, 1-5-30 Shibakoen, Minato-ku, Tokyo, 105-8512, Japan. Electronic address: enoki-yk@pha.keio.ac.jp. 12. Division of Pharmacodynamics, Keio University Faculty of Pharmacy, 1-5-30 Shibakoen, Minato-ku, Tokyo, 105-8512, Japan. Electronic address: taguchi-kz@pha.keio.ac.jp. 13. Internal Medicine, Yokohama General Hospital, 2201-5 Kuroganecho, Aoba-ku, Yokohama-shi, Kanagawa, 225-0025, Japan. Electronic address: qymhs228@yahoo.co.jp. 14. Department of Pharmacy, Yokohama General Hospital, 2201-5 Kuroganecho, Aoba-ku, Yokohama-shi, Kanagawa, 225-0025, Japan. Electronic address: sekine@yokoso.or.jp. 15. Internal Medicine, Yokohama General Hospital, 2201-5 Kuroganecho, Aoba-ku, Yokohama-shi, Kanagawa, 225-0025, Japan. Electronic address: nkunika0605@yahoo.co.jp. 16. Department of Infectious Disease, St. Marianna University School of Medicine, 2-16-1, Sugao, Miyamae-ku, Kawasaki-shi, Kanagawa, 216-8511, Japan. Electronic address: h2kuni@marianna-u.ac.jp. 17. Division of Pharmacodynamics, Keio University Faculty of Pharmacy, 1-5-30 Shibakoen, Minato-ku, Tokyo, 105-8512, Japan. Electronic address: matsumoto-kz@pha.keio.ac.jp.
Abstract
OBJECTIVE: At the Yokohama General Hospital, pharmacist-led antimicrobial stewardship programs (ASP) including antifungal stewardship programs (AFP) were started in 2012. To investigate the efficacy of the programs, we compared several parameters that are recommended for the measurement of ASP in Japan based on pre- and post-AFP activities. PATIENTS AND METHODS: The subjects were inpatients who developed candidemia between April 2008 and March 2016. They were divided into two groups: pre-AFP (April 2008 until March 2012) and post-AFP (April 2012 until March 2016). The results were compared between the two groups. RESULTS: The cumulative optimal antifungal drug usage rate, as a process parameter, significantly increased in the post-AFP group (p = 0.025). Furthermore, the days of therapy of antifungal drugs in the pre- and post-AFP groups was median 6.0 (interquartile range [IQR] 0.3-15.7) and median 3.4 (IQR 1.9-3.4) per 1,000 patient-days, respectively; there was a significant decrease in the post-AFP group (p < 0.001). Expenditure on antifungal drugs, as an outcome parameter, in the pre- and post-AFP groups was 9390.5 ± 5687.1 and 5930.8 ± 4687.0 US dollars, respectively; there was a significant decrease in the post-AFP group (p = 0.002). CONCLUSIONS: These results suggest that pharmacist-led antifungal stewardship activities improve both outcome and process parameters.
OBJECTIVE: At the Yokohama General Hospital, pharmacist-led antimicrobial stewardship programs (ASP) including antifungal stewardship programs (AFP) were started in 2012. To investigate the efficacy of the programs, we compared several parameters that are recommended for the measurement of ASP in Japan based on pre- and post-AFP activities. PATIENTS AND METHODS: The subjects were inpatients who developed candidemia between April 2008 and March 2016. They were divided into two groups: pre-AFP (April 2008 until March 2012) and post-AFP (April 2012 until March 2016). The results were compared between the two groups. RESULTS: The cumulative optimal antifungal drug usage rate, as a process parameter, significantly increased in the post-AFP group (p = 0.025). Furthermore, the days of therapy of antifungal drugs in the pre- and post-AFP groups was median 6.0 (interquartile range [IQR] 0.3-15.7) and median 3.4 (IQR 1.9-3.4) per 1,000 patient-days, respectively; there was a significant decrease in the post-AFP group (p < 0.001). Expenditure on antifungal drugs, as an outcome parameter, in the pre- and post-AFP groups was 9390.5 ± 5687.1 and 5930.8 ± 4687.0 US dollars, respectively; there was a significant decrease in the post-AFP group (p = 0.002). CONCLUSIONS: These results suggest that pharmacist-led antifungal stewardship activities improve both outcome and process parameters.