Utilization of Systemic Antifungal Therapy Among Community Hospitals in the Duke Antimicrobial Stewardship Network

Melissa Johnson, PharmD, MHS Deverick Anderson, MD, MPH, FIDSA, FSHEA Yuliya Lokhnygina, MS, PhD Elizabeth Dodds Ashley, PharmD, MHS Richard H. Drew, PharmD, MS, BCPS, FCCP Angelina Davis, PharmD, MS Daniel J. Sexton, MD, FIDSA, FSHEA Rebekah W. Moehring, MD, MPH


Background. Due to their relative high cost, toxicity, drug interactions and potential for resistance antifungal (AF) agents are excellent targets for antimicrobial stewardship programs. However benchmarking utilization of AF in acute care hospitals is needed as a first step in the development of targeted stewardship interventions.

Methods. This was a retrospective analysis of electronic medication administration records from inpatient units for 15 southeastern US community hospitals participating in the Duke Antimicrobial Stewardship Outreach Network. AF utilization for calendar year 2014 was calculated using days of therapy (DOT) per 1000 patient days, and then compared among hospitals using descriptive statistics. Poisson regression was used to evaluate hospital-level measures that may predict variation in overall AF use.

Results. 770,190 total patient days were captured. Overall utilization was 52 DOT/1000 patient-days (median 49.1, interquartile range [IQR] 31.4-62.8). Substantial variation in utilization was apparent between hospitals by AF class (figure). Azoles were most commonly used (median 30.3, IQR 24.3-35.9), followed by echinocandins (median 3.1, IQR 1.4-6.7) and polyenes (median 0.1, IQR 0-0.8). Fluconazole was the most used individual agent, (median 29.7) but use ranged from 6.2 to 78.8 DOT/1000 patient days among the hospitals. Hospital-level measurements of surgical volume, hospital size, ICU days, mean length of stay, mean patient age, and proportion of male or nonwhite patients were significantly associated with overall AF DOT/1000 patient days in single variable analysis.

Conclusion. We observed substantial variability in AF utilization among acute care community hospitals. This finding suggests that targeted interventions to improve AF stewardship may be possible. Additional investigation is needed to better understand and explain these variations in AF use.

Disclosures.M. Johnson, Astellas: Consultant and Research Contractor, Consulting fee and Research grant; R. H. Drew, UpToDate: Contributor, Publication royalty. American Society of Microbiology: Speaker's Bureau, Speaker honorarium. CustomID: Scientific Advisor, Licensing agreement or royalty. Independent Healthcare Education: Speaker's Bureau, Speaker honorarium



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