Antifungal Stewardship: A Bedside Intervention Approach

Ref ID: 18724

Author:

P. Muñoz, MD, PhD – ID Consultant, M. Valerio, MD – ID Consultant, B. Cáliz, PharmD – Pharmacist, C. Rodrí­guez, PharmD – Pharmacist, M. Sanjurjo, PharmD – Head of Pharmacy Dept, P. Escribano, PhD – Research, J. Guinea, PhD – Research, COMIC Study Gro

Author address:

H G.U. Gregorio Marañón. Univ. of Madrid, Madrid, Spain.

Full conference title:

52nd Annual ICAAC

Date: 9 September 2014

Abstract:

Background: Antifungal stewardship programs are sorely needed especially in large tertiary care hospitals in which many different physicians prescribe very costly drugs on empirical basis. Whilst some restrictive programs have demonstrated efficacy, we have implemented a collaborative stewardship model based on non-compulsory information and advice from expert ID physicians to prescribers. Objective: To evaluate the efficacy and cost-effectiveness of a bedside antifungal stewardship program. Methods: Ongoing study (Oct 2011-Feb 2012) in which an ID specialist visited all patients receiving candins, L-AMB, voriconazole or posaconazole, and interviewed the prescribing physician according to a purpose-made protocol. Patient’s records were reviewed after discharge. Staff attitudes to the recommendations, daily prescribed doses (DPDs) and the cost (€) of antifungals (AF) were monitored monthly. Results: 189 patients were evaluated an average of 3 days after the AF prescription, mostly in hematology and oncology departments (39.2%), ICUs (35.4%) and medical departments (20.6%). Reasons for prescribing AFs were: prophylaxis (32%), pre-emptive (15%), empirical (17%) and targeted therapy (36%). AFs prescribed were: candins (51.3%), L-AmB (25.9%), voriconazole (11.1%) and posaconazole (11.6%). Adjustments to the therapy were suggested regarding: indication (8%), drug selected (28.6%), dose or administration route (6%) and duration of treatment (29%). Of the 102 patients (54%) requiring adjustment, changes were made in 55 cases. During the study, 10,540 DPDs were consumed at a cost of 935,894€. The intervention saved a mean of 25,000€ per month – a potential saving of 300,000€ annually. Conclusions: A stewardship program delivered by experienced physicians is an efficacious and cost-effective approach to optimize the use of antifungal drugs in tertiary teaching institutions. In our case, the main focuses of intervention were to reduce the unnecessarily prolonged therapy and the deescalation of empirical drugs.

Abstract Number: M-1232

Conference Year: 2012

Link to conference website: NULL

New link: NULL

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