title: A matched-control evaluation of an antifungal bundle in the intensive care unit at a university teaching hospital.
abstract: 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.
authors.affiliation: College of Pharmacy, University of Tennessee Health Science Center, 1924 Alcoa Highway, Box 117, Knoxville, TN 37920, USA. aguarasc@uthsc.edu
authors.forename: Anthony J
authors.initials: AJ
authors.lastname: Guarascio
authors.forename: Douglas
authors.initials: D
authors.lastname: Slain
authors.forename: Richard
authors.initials: R
authors.lastname: McKnight
authors.forename: Karen
authors.initials: K
authors.lastname: Petros
authors.forename: John
authors.initials: J
authors.lastname: Parker
authors.forename: Alison
authors.initials: A
authors.lastname: Wilson
authors.forename: Carrie M
authors.initials: CM
authors.lastname: Defazio
authors.forename: Arif R
authors.initials: AR
authors.lastname: Sarwari
mesh_terms: D000328:Adult; D000935:Antifungal Agents / Q000627:therapeutic use*; D000077336:Caspofungin; D054714:Echinocandins / Q000627:therapeutic use; D005260:Female; D006784:Hospitals, Teaching; D006785:Hospitals, University; D006801:Humans; D007362:Intensive Care Units; D055666:Lipopeptides; D008297:Male; D008875:Middle Aged
chemical_list: D000935:Antifungal Agents; D054714:Echinocandins; D055666:Lipopeptides; D000077336:Caspofungin