Skip to main content

Advertisement

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