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A 6-year antifungal stewardship programme in a teaching hospital

  • Clinical and Epidemiological Study
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Abstract

Purpose

To describe the antifungal stewardship programme in our hospital and to assess its impact on total antifungal prescriptions and their cost, and on the process of care measures regarding the diagnostic and therapeutic management of invasive aspergillosis and candidaemia.

Methods

We conducted a prospective observational study describing the multifaceted antifungal stewardship programme in place at our French teaching tertiary-care hospital since 2005. Several actions were implemented successively, including the systematic evaluation of all costly antifungal prescriptions (echinocandins, lipid formulations of amphotericin B, posaconazole and voriconazole).

Results

A total of 636 antifungal prescriptions were discussed by the antifungal management team from 2005 to 2010 inclusive, mainly from the haematology department (72 %). In 344/636 cases (54 %), a piece of advice was fed back to the physician in charge of the patient, with an 88 % compliance rate. Optimal standard of care was achieved for galactomannan antigen testing, performance of chest computed tomography (CT) scan and voriconazole therapeutic drug monitoring for invasive aspergillosis, with no combination therapies used since 2008. Regarding candidaemia, optimal standard of care was achieved for the timing of antifungal therapy, recommended first-line therapy, duration of therapy and the removal of central venous catheters. Total antifungal prescriptions (in defined daily doses, DDD) and their cost were contained between 2003 and 2010.

Conclusions

The implementation of an antifungal stewardship programme was feasible, sustainable and well accepted. We observed an improved quality of care for some process of care measures, and antifungal use and cost were contained in our hospital.

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Acknowledgments

We thank all the members of the antifungal management team and all physicians that have participated in the care of the patients included in this study. We also thank Aline Mousnier and Rémy Collomp for their support. V.M., F.L., L.H., M.G.-T. and M.P. are members of the antifungal management team, and reviewed the study protocol and the article. C.L. performed the statistical analysis and reviewed the article. C.P. designed the study, collected the data and wrote the article.

Conflict of interest

All authors declare no conflict of interest.

Author information

Authors and Affiliations

  1. Service d’Infectiologie, CHU de Nice, Nice, France

    V. Mondain & C. Pulcini

  2. Pharmacie, CHU de Nice, Nice, France

    F. Lieutier

  3. Laboratoire de Parasitologie-Mycologie, CHU de Nice, Nice, France

    L. Hasseine & M. Gari-Toussaint

  4. Service d’Onco-Hématologie Pédiatrique, CHU de Nice, Nice, France

    M. Poiree

  5. INSERM, UMR912 (SESSTIM), Marseille, France

    C. Lions & C. Pulcini

  6. Aix Marseille Université, UMR-S912, IRD, Marseille, France

    C. Lions

  7. Observatoire Régional de la Santé Provence-Alpes-Côte d’Azur (ORS PACA), Marseille, France

    C. Lions

  8. Faculté de Médecine de Nice, Université Nice-Sophia Antipolis, Nice, France

    C. Pulcini

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  1. V. Mondain
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  2. F. Lieutier
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  3. L. Hasseine
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  4. M. Gari-Toussaint
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  5. M. Poiree
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  6. C. Lions
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  7. C. Pulcini
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Corresponding author

Correspondence to C. Pulcini.

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Mondain, V., Lieutier, F., Hasseine, L. et al. A 6-year antifungal stewardship programme in a teaching hospital. Infection 41, 621–628 (2013). https://doi.org/10.1007/s15010-013-0431-1

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  • DOI: https://doi.org/10.1007/s15010-013-0431-1

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