Antifungal stewardship in a tertiary-care institution: a bedside intervention.
Antifungal stewardship (AFS) programmes are needed in tertiary-care hospitals. Our aim is to describe a bedside non-restrictive AFS programme, and to evaluate its economic impact. During the first year of the AFS a bundle of non-interventional measures were implemented. During the second year an infectious diseases specialist visited 453 patients receiving candins, liposomal amphotericin B, voriconazole or posaconazole. Monthly costs were studied with an interrupted time series (ITS) analysis. The main prescribing departments were haematology (35%), medical departments (23%), and intensive care units (20%). Reasons to start antifungal therapy were: targeted therapy (36%), prophylaxis (32%), empirical therapy (20%) and pre-emptive therapy (12%). At the initial visit, diagnostic advice was provided in 40% of cases. The most common therapeutic recommendations were to de-escalate the antifungal drug (17%) or to suspend it (7%). Annual total antifungal expenditure was reduced from US$3.8 million to US$2.9 million over the first 2 years, generating net savings of US$407,663 and US$824,458 per year after considering the cost of additional staff required. The ITS analyses showed a significant economic impact after the first 12 months of the intervention (p 0.042 at month 13), which was enhanced in the following 24 months (p 0.006 at month 35). The number of defined daily doses decreased from 66.4 to 54.8 per 1000 patient-days. Incidence of candidaemia was reduced from 1.49 to 1.14 (p 0.08) and related mortality was reduced from 28% to 16% (p 0.1). A collaborative and non-compulsory AFS program based on bedside intervention is an efficacious and cost-effective approach that optimizes the use of AF drugs.
Clinical Microbiology and Infectious Diseases Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain; Instituto de Investigación Sanitaria del Hospital Gregorio Marañón, Madrid, Spain. Electronic address: mavami_valerio@yahoo.com.mx.
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Valerio
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. Electronic address: pmunoz@micro.hggm.es.
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Muñoz
Instituto de Investigación Sanitaria del Hospital Gregorio Marañón, Madrid, Spain; Pharmacy Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain.
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Rodríguez
Pharmacy Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain.
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B
Caliz
Clinical Microbiology and Infectious Diseases Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain.
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B
Padilla
Clinical Microbiology and Infectious Diseases Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain.
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A
Fernández-Cruz
Clinical Microbiology and Infectious Diseases Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain.
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Sánchez-Somolinos
Clinical Microbiology and Infectious Diseases Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain.
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Gijón
Intensive Care Unit, Hospital General Universitario Gregorio Marañón, Madrid, Spain.
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Peral
Haematology Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain.
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Gayoso
Postsurgical Intensive Care Unit, Hospital General Universitario Gregorio Marañón, Madrid, Spain.
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Frias
Gastroenterology Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain.
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Salcedo
Instituto de Investigación Sanitaria del Hospital Gregorio Marañón, Madrid, Spain; Pharmacy Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain.
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Sanjurjo
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.
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Bouza
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000935:Antifungal Agents / Q000191:economics / Q000627:therapeutic use*; D002648:Child; D002675:Child, Preschool; D003365:Costs and Cost Analysis; D011307:Drug Prescriptions / Q000592:standards*; D004363:Drug Utilization / Q000592:standards*; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D008875:Middle Aged; D009181:Mycoses / Q000188:drug therapy*; D016134:Organizational Policy; D016019:Survival Analysis; D062606:Tertiary Care Centers; D016896:Treatment Outcome; D055815:Young Adult
D000935:Antifungal Agents
Antifungals; candidaemia; cost savings; invasive aspergillosis; stewardship