Table 1 Clinical and performance measures reported within antifungal stewardship interventions
From: A systematic review of the impact of antifungal stewardship interventions in the United States
References | Design | Setting and population | Intervention | Number of patients | Outcomes (non-intervention vs. intervention) | ||||
|---|---|---|---|---|---|---|---|---|---|
Non-intervention | Intervention | Mortality | Length of stay (LOS) | Appropriate choice | Time to therapy | ||||
Anthworth et al. [22] | Quasi-experimental | 930-bed academic hospital Adult and pediatric patients with positive Candida blood cultures | Care bundle for candidemia | 37 | 41 | Not reported | Overall LOS: 21 days vs. 20 days NS | Appropriate empiric therapy: 36 (97.3%) vs. 40 (97.5%) NS Appropriate therapy after sensitivity testing: 32 (86.5%) vs. 41 (100%) Increased, p = 0.0488 | Initiated antifungal therapy within 24 h of positive Gram stain: 33 (89.2%) vs. 38 (92.7%) NS |
Reed et al. [23] | Quasi-experimental | 1229-bed teaching hospital Patients aged 18–89 with positive Candida blood cultures | Pharmacist recommendations | 85 | 88 | In-hospital mortality: 16 (19%) vs. 26 (30%) NS | Overall LOS: 15 days vs. 19 days NS Infection-related LOS: 10 days vs. 11 days NS | Effective antifungal choice: 67 (88%) vs. 80 (99%) Increased, p = 0.008 | Median time from Gram stain to effective antifungal hang time: 13.5 h vs. 1.3 h Decreased, p = 0.04 Median time from Gram stain to effective order placement: 9.2 h vs. 0.1 h Decreased, p = 0.01 |
Heil et al. [24] | Before-and-after | Setting not reported Hospitalized patients with blood cultures positive for Candida | Diagnostic tool for Candida | 61 | 21 | In-hospital mortality: 19 (31%) vs. 5 (24%) NS | Median LOS: 25 days vs. 12 days NS | Not reported | Mean time to targeted therapy: 2.3 days vs. 0.6 days Decreased, p = 0.0016 Received targeted therapy after 1 week: 57 (93%) vs. 21 (100%) NS |
Huang et al. [25] | Pre-post quasi-experimental | University hospital Patients aged 18 and older with bloodstream infections | Diagnostic tool for candida and bacteremia | 22 | 20 | 30-day mortality (yeast infection): 6/18 (33.3%) vs. 3/17 (17.7%) NS | Overall LOS (yeast infection): 20.9Â days vs. 22.1Â days NS ICU LOS (yeast infection): 15.1 vs. 10.3 NS | Not reported | Time to effective therapy (yeast infection): 68.6Â h vs. 45.6Â h NS Time to optimal therapy (yeast infection): 57.1Â h vs. 50.9Â h NS |
Pardo et al. [26] | Pre-post quasi-experimental | 939 bed academic medical center Adult patients with Gram positive bacteremia or candidemia | Diagnostic tool for gram positive bacteria and candida | 27 | 9 | In-hospital mortality (Candida infection): 5 (19%) vs. 1 (11%) NS | Median LOS (Candida infection): 9.1Â days vs. 11Â days NS ICU LOS (Candida infection): 0Â days vs. 0Â days NS | Not reported | Median time to therapy from culture collection (Candida infection): 33.7Â h vs. 36.7Â h NS Median time to therapy from culture positivity (Candida infection): 4.4Â h vs. 3.9Â h NS |