Evaluation of Appropriate Use of Antifungal Agents in a Tertiary Care Hospital in Greece

K. Korantanis1, A. Markogiannakis1, M. Gamaletsou2, M. Samarkos1, G. Daikos1, N. V. Sipsas

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1Natl. and Kapodistrian Univ. of Athens, Athens, Greece, 2Univ. of South Manchester, Athens, United Kingdom


Background: Studies have shown that misuse of antifungals (AF) is common in the hospital setting. Our aim was to the assess the quality of antifungal use in our institution as the first step for the implementation of a targeted antifungal stewardship programMethods: This study was conducted at a 550 bed tertiary teaching hospital inAthens, Greece. Starting in September 2014 and for 13 months all prescriptions of AF were prospectively assessed by using a pre-established protocol. All patients receiving AF were prospectively evaluated by the study team when the drug was first administered and at discharge. The adequacy of AF use was evaluated by using a predefined point score that considered indication, drug selection, dosage, adjustments after microbiology results, switching to an oral agent, length of treatment, serum levels monitoring, and interactions. The criteria used to define the appropriateness of AF prescription were adopted from the existing treatment guidelines. Each prescription was characterized as “appropriate”, “appropriate but not optimal,” and “inappropriate”, by consensus.Results: We assessed 208 consecutive prescriptions of antifungal agents for the treatment of 147 in-patients (male 89, mean age 58.7 y). AF were prescribed by the attending physicians in 69.3% of cases, and by infectious diseases specialists in 30.7%. The main underlying diseases were hematological malignancy (124, 59.6%), solid tumor (35, 16.8%), and HIV infection (9, 4.3%). Overall, 101 (48.5%) of prescriptions came from medical, 53 (25.5%) from hematology, and 36 (17.3%) from surgery departments and 18 (8.6%) from the intensive care unit. The main reasons for starting antifungals were prophylaxis 65 (31.25%); empirical 120(57.69%); pre-emptive 7 (3.36 %) and targeted treatment 19 (9.13%). Overall, 94 (45.1%) of the prescriptions have been characterized as appropriate, 25 (12%) appropriate but not optimal and 89 (42.7%) as inappropriate. The most common mistakes were no indication for AF (54.4%), selection of an inappropriate AF (27.2%), incorrect dosage (11.2%) or duration of treatment (12%).Conclusions: Inappropriate use of AF is unacceptably common in our institution, in accordance with similar findings from many hospitals around the world.

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ASM Microbe 2016
    • ASM microbe 1st (2016)