Objectives: A multifaceted antifungal stewardship program has been in place in our teaching tertiary-care hospital since 2005, with several actions implemented successively, including systematic evaluation of all costly antifungal prescriptions (echinocandins, lipid formulations of amphotericin B, posaconazole and voriconazole). We assessed the impact of this program on antifungal prescriptions and cost (between 2003 and 2010), and on standards of care regarding the management of invasive aspergillosis and candidemia . Methods: We conducted a prospective observational study over an 8- year period. Results: Six hundred and thirty-six antifungal prescriptions were discussed by the antifungal management team from 2005 to 2010, mainly from the haematology department (72%). In 344/636 (54%) cases, a piece of advice was fed back in real time to the physician in charge of the patient, with an 88% compliance rate. Optimal standard of care was achieved for performance of chest CT-scan, galactomannan antigen testing and voriconazole therapeutic drug monitoring for invasive aspergillosis, with no antifungal combination therapies used since 2008. Regarding candidemia, optimal standard of care was achieved for timing of antifungal therapy, recommended 1stline therapy, duration of therapy and removal of central venous catheters. Antifungal prescriptions and cost were stable between 2003 and 2010. Conclusion: Implementation of an antifungal stewardship program was feasible, sustainable and well-accepted, and we observed an improved quality of care and no increase in antifungal use or cost.
Full conference title:
22nd European Congress of Clinical Microbiology and Infectious Diseases
- ECCMID 22nd (2012)