International Journal of Clinical Pharmacy

, Volume 35, Issue 1, pp 145–148 | Cite as

A matched-control evaluation of an antifungal bundle in the intensive care unit at a university teaching hospital

  • Anthony J. GuarascioEmail author
  • Douglas Slain
  • Richard McKnight
  • Karen Petros
  • John Parker
  • Alison Wilson
  • Carrie M. Defazio
  • Arif R. Sarwari
Short Research Report


Background Antimicrobial use bundles are becoming a common means of implementing antimicrobial stewardship initiatives in the hospital setting. Although the utility of these bundles has been described for many disease states, their adoption for antifungal therapy management is largely unknown. Objective Our objective was to assess the utility of an antifungal bundle protocol in limiting excessive use of echinocandins in the intensive-care inpatient setting. Methods In this matched-control evaluation, pre-protocol control patients were matched with each prospective patient in a 2:1 ratio using five demographic and clinical characteristics. The impact of the antifungal bundle protocol on caspofungin days of therapy, drug costs, and adherence to bundle criteria was assessed. Results A significant reduction in median days of caspofungin therapy (4.00 vs. 2.00 days, p = 0.001) was found in the bundle group. Most of this reduction in use was realized in the medical ICU (p = 0.002) as opposed to the surgical ICU (p = 0.188). Conclusions Use of an antifungal bundle approach appears to facilitate a reduction in caspofungin use in the ICU without adversely affecting patient outcomes. Further trials are needed to assess the utility of such bundles in providing antimicrobial stewardship for antifungal drug use.


Fluconazole Caspofungin Invasive Candidiasis Clinical Pharmacist Antimicrobial Stewardship 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.



The authors wish to thank Maria Pompili, Pharm.D. and Melissa Rinehart, Pharm.D., clinical pharmacists, West Virginia University Healthcare, for their significant work in regard to bundle implementation and documentation. We would also like to thank Kim Evans, Lead Decision Support Analyst, West Virginia University Healthcare, for providing assistance with identifying matched control group patients.


No funding was received for this research.

Conflicts of interest

None of the authors have any conflicts of interest to disclose.


  1. 1.
    Edmond MB, Wallace SE, McClish DK, Pfaller MA, Jones RN, Wenzel RP. Nosocomial bloodstream infections in United States hospitals: a three-year analysis. Clin Infect Dis. 1999;29:239–44.PubMedCrossRefGoogle Scholar
  2. 2.
    Pappas PG, Kauffman CA, Andes D, Benjamin DK, Calandra TF, Edwards JE, et al. Clinical practice guidelines for the management of candidiasis: 2009 update by the infectious diseases society of America. Clin Infect Dis. 2009;48(5):503–35.PubMedCrossRefGoogle Scholar
  3. 3.
    Pfaller MA, Messer SA, Moet GJ, Jones RN, Castanheria M. Candida bloodstream infections: comparison of species distribution and resistance to echinocandin and azole antifungal agents in intensive care (ICU) and non-ICU settings in the SENTRY antimicrobial surveillance program (2008–2009). Int J Antimicrob Chemother. 2011;38:65–9.CrossRefGoogle Scholar
  4. 4.
    Lichtenstern C, Nguyen TH, Schemmer P, Hoppe-Tichy T, Weigand MA. Efficacy of caspofungin in invasive candidiasis and candidemia-de-escalation strategy. Mycoses. 2008;51(Suppl 1):35–46.PubMedCrossRefGoogle Scholar
  5. 5.
    Shah DN, Yau R, Weston J, Lasco TM, Salazar M, Palmer HR, et al. Evaluation of antifungal therapy in patients with candidaemia based on susceptibility testing results: implications for antimicrobial stewardship programmes. J Antimicrob Chemother. 2011;66:2146–51.PubMedCrossRefGoogle Scholar
  6. 6.
    Spellberg BJ, Scott GF, Edwards JE. Current treatment strategies for disseminated candidiasis. Clin Infect Dis. 2006;42(2):244–51.PubMedCrossRefGoogle Scholar
  7. 7.
    Dellit TH, Owens RC, McGowan JE, Gerding DN, Weinstein RA, Burke JP, et al. Infectious diseases society of America and the society for healthcare epidemiology of America guidelines for developing an institutional program to enhance antimicrobial stewardship. Clin Infect Dis. 2007;44:159–77.PubMedCrossRefGoogle Scholar
  8. 8.
    Cooke FJ, Holmes AH. The missing care bundle: antibiotic prescribing in hospitals. Int J Antimicrob Agents. 2007;30(1):25–9.PubMedCrossRefGoogle Scholar
  9. 9.
    Pulcini C, Defres S, Aggarwal I, Nathwani D, Davey P. Design of a ‘day 3 bundle’ to improve the reassessment of inpatient empirical antibiotic prescriptions. J Antimicrob Chemother. 2008;61(6):1384–8.PubMedCrossRefGoogle Scholar
  10. 10.
    Toth NR, Chambers RM, Davis SL. Implementation of a care bundle for antimicrobial stewardship. Am J Health-Syst Pharm. 2010;67:746–9.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media Dordrecht 2012

Authors and Affiliations

  • Anthony J. Guarascio
    • 1
    Email author
  • Douglas Slain
    • 2
  • Richard McKnight
    • 3
  • Karen Petros
    • 3
  • John Parker
    • 4
  • Alison Wilson
    • 4
  • Carrie M. Defazio
    • 3
  • Arif R. Sarwari
    • 4
  1. 1.College of PharmacyUniversity of Tennessee Health Science CenterKnoxvilleUSA
  2. 2.Clinical Pharmacy and Infectious DiseasesWest Virginia UniversityMorgantownUSA
  3. 3.Department of PharmacyWest Virginia University HealthcareMorgantownUSA
  4. 4.School of MedicineWest Virginia UniversityMorgantownUSA

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