title: Evaluation of antifungal use in a tertiary care institution: antifungal stewardship urgently needed.
abstract: OBJECTIVE
  To assess the quality of antifungal use, to propose a point score for this evaluation and to estimate the potential economic savings of an antifungal stewardship programme.
  
  
  METHODS
  From December 2010 to January 2011, we identified 100 adult inpatients receiving systemic antifungals. Antifungal use was evaluated by means of a predefined score that considered indication, drug selection, dosage, adjustments after microbiology results, switching to an oral agent and length of treatment. Total antifungal prescriptions [in defined daily doses (DDDs) and days of therapy (DOTs)] and potential cost savings were calculated.
  
  
  RESULTS
  Overall, 43% of prescriptions came from medical departments, 25% from haematology/oncology and 17% from intensive care units. The main reasons for starting antifungals were empirical (42%), pre-emptive (20%) and targeted treatment (20%). Antifungals were unnecessary in 16% of cases. Inadequacies in other aspects of antifungal prescription were: drug selection, 31%; dosing, 16%; no switch from intravenous to oral administration, 20%; no adjustment after microbiological results, 35%; and length of therapy, 27%. The number of antifungal DDDs per 1000 patient-days was 65.1. The total number of DOTs was 1556, which added a direct cost of €219 364. Only 51.3% of DOTs were considered optimal. The potential estimated savings would be €50 536.
  
  
  CONCLUSIONS
  Major efforts should be made to improve the selection and duration of antifungal therapy. Our study demonstrated the potential cost savings that could be achieved by optimizing antifungal therapy. A stewardship programme should include an instrument to objectively evaluate the adequacy of antifungal use.
authors.affiliation: Clinical Microbiology and Infectious Diseases Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain Instituto de Investigación Sanitaria del Hospital Gregorio Marañón, Madrid, Spain.
authors.forename: Maricela
authors.initials: M
authors.lastname: Valerio
authors.affiliation: Instituto de Investigación Sanitaria del Hospital Gregorio Marañón, Madrid, Spain Pharmacy Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain.
authors.forename: Carmen Guadalupe
authors.initials: CG
authors.lastname: Rodriguez-Gonzalez
authors.affiliation: Clinical Microbiology and Infectious Diseases Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain Instituto de Investigación Sanitaria del Hospital Gregorio Marañón, Madrid, Spain Medicine Department, School of Medicine, Universidad Complutense de Madrid, Madrid, Spain pmunoz@micro.hggm.es.
authors.forename: Patricia
authors.initials: P
authors.lastname: Muñoz
authors.affiliation: Instituto de Investigación Sanitaria del Hospital Gregorio Marañón, Madrid, Spain Pharmacy Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain.
authors.forename: Betsabe
authors.initials: B
authors.lastname: Caliz
authors.affiliation: Instituto de Investigación Sanitaria del Hospital Gregorio Marañón, Madrid, Spain Pharmacy Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain.
authors.forename: Maria
authors.initials: M
authors.lastname: Sanjurjo
authors.affiliation: Clinical Microbiology and Infectious Diseases Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain Instituto de Investigación Sanitaria del Hospital Gregorio Marañón, Madrid, Spain Medicine Department, School of Medicine, Universidad Complutense de Madrid, Madrid, Spain.
authors.forename: Emilio
authors.initials: E
authors.lastname: Bouza
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000935:Antifungal Agents / Q000627:therapeutic use*; D004363:Drug Utilization / Q000592:standards / Q000706:statistics & numerical data*; D005260:Female; D017048:Health Care Costs; D006291:Health Policy; D006302:Health Services Research; D006801:Humans; D008297:Male; D008875:Middle Aged; D062606:Tertiary Care Centers; D055815:Young Adult
chemical_list: D000935:Antifungal Agents
keywords: candidaemia; economic savings; invasive aspergillosis