A systematic review of the impact of antifungal stewardship interventions in the United States

Hart, Emily; Nguyen, Melanie; Allen, Meghan; Clark, Collin M.; Jacobs, David M.

doi:10.1186/s12941-019-0323-z

Annals of Clinical Microbiology and Antimicrobials

Table 2 Antifungal consumption reported within general antimicrobial stewardship interventions

From: A systematic review of the impact of antifungal stewardship interventions in the United States

References	Design	Setting	Population	Intervention	Utilization
References	Design	Setting	Population	Intervention	Drug/class	Unit of Measurement	Non-intervention	Intervention	p
Storey et al. [27]	Quasi-experimental	100-bed community hospital	All inpatients on medical/surgical service who received more than 2 days of antimicrobial therapy	Audit and feedback twice weekly	Antifungals	DDD per 100 admissions	23.1	13.2	0.035
					Antifungals	DDD per 1000 PD	59.1	36.5	0.047
					Echinocandins	DDD per 100 admissions	4.7	3.2	0.975
					Echinocandins	DDD per 1000 PD	11.3	8.7	0.924
					Fluconazole	DDD per 100 admissions	17.6	9.8	0.105
					Fluconazole	DDD per 1000 PD	46.1	27.2	0.284
Cook et al. [28]	Quasi-experimental	904-bed tertiary care teaching hospital	Patients who received controlled or restricted antimicrobials	48-h review for controlled antimicrobials, restrictions and preauthorization	Antifungals	DDD per 1000 PD	151.9	44	< .0001
Jenkins et al. [29]	Quasi-experimental, interrupted time series	525-bed public safety-net hospital	Any patient receiving antimicrobial therapy	Preauthorization requirements, audit and feedback, local guideline development	Antifungals	DOT per 1000 PD	22	17.1	< .001
					Antifungals	DOT per 1000 PD per quarter (slope)	− 0.5	− 0.1	0.22
					Echinocandins	DOT per 1000 PD	2.8	2.4	0.38
					Echinocandins	DOT per 1000 PD per quarter (slope)	− 0.1	− 0.1	0.87
					Fluconazole	DOT per 1000 PD	19.2	14.8	< .001
					Fluconazole	DOT per 1000 PD per quarter (slope)	− 0.5	0	0.03
Hurst et al. [30]	Quasi-experimental	444-bed tertiary care academic pediatric hospital	All inpatients prescribed antimicrobials	In-person feedback, no restrictions or preauthorization	Antifungals	DOT per 1000 PD (hematology, oncology)	874	640	< 0.01
Hurst et al. [30]	Quasi-experimental	444-bed tertiary care academic pediatric hospital	All inpatients prescribed antimicrobials	In-person feedback, no restrictions or preauthorization	Antifungals	DOT per 1000 PD per month (slope)	5.4	0.7	> 0.05
Siegfried et al. [31]	Quasi-experimental	725-bed academic tertiary care center	Patients taking restricted antimicrobials	Stewardship pharmacist on weekends	Micafungin	DOT per 1000 PD	16.4	10.3	0.04
Nguyen-Ha et al. [32]	Quasi-experimental	315-bed pediatric hospital	Patients on day 3 of caspofungin therapy	72-h audits	Caspofungin	Mean start rate per 1000 patients	8	18.7	< 0.001
						Drug starts per 1000 patients per year (slope)	19.1	− 0.6	0.001
						Mean use rate per 1000 PD	14	29.3	0.003
						Drug use per 1000 PD per year (slope)	22.1	0.5	0.014
Guarascio et al. [33]	Matched control evaluation	450-bed university hospital	Adult ICU patients who received caspofungin	Care bundle for patients prescribed caspofungin	Caspofungin	Median days of caspofungin therapy	4.00	2.00	0.001
Di Pentima et al. [34]	Quasi-experimental	180-bed tertiary care academic pediatric hospital	Pediatric patients who received antibiotics in previous 24 h	Audit and feedback, preauthorization requirements	Azoles	Doses per 1000 PD	152 (24%)	137 (21.6%)	0.114
					Liposomal amphotericin	Doses per 1000 PD	14 (37.8%)	3 (8.1%)	0.0003
					Targeted antifungals^a	Doses per 1000 PD	166 (24.8%)	141 (21%)	0.02
					Non-targeted antifungals^b	Doses per 1000 PD	50	4	< .0001

DDD defined daily doses, DOT days of therapy, PD patient days
^aTargeted antifungals = amphotericin B lipid formulations, fluconazole, voriconazole
^bNon-targeted antifungals = amphotericin B deoxycholate, itraconazole

Back to article page

ISSN: 1476-0711

Contact us

Submission enquiries: journalsubmissions@springernature.com