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.
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All authors declare no conflict of interest.
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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