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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): 20.9 days vs. 22.1 days NS ICU LOS (yeast infection): 15.1 vs. 10.3 NS Not reported Time to effective therapy (yeast infection): 68.6 h vs. 45.6 h NS Time to optimal therapy (yeast infection): 57.1 h vs. 50.9 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): 9.1 days vs. 11 days NS ICU LOS (Candida infection): 0 days vs. 0 days NS Not reported Median time to therapy from culture collection (Candida infection): 33.7 h vs. 36.7 h NS Median time to therapy from culture positivity (Candida infection): 4.4 h vs. 3.9 h NS
  1. ICU intensive care unit, LOS length of stay, NS not significant