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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
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
DDD per 1000 PD 59.1 36.5 0.047
Echinocandins DDD per 100 admissions 4.7 3.2 0.975
DDD per 1000 PD 11.3 8.7 0.924
Fluconazole DDD per 100 admissions 17.6 9.8 0.105
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
DOT per 1000 PD per quarter (slope) − 0.5 − 0.1 0.22
Echinocandins DOT per 1000 PD 2.8 2.4 0.38
DOT per 1000 PD per quarter (slope) − 0.1 − 0.1 0.87
Fluconazole DOT per 1000 PD 19.2 14.8 < .001
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
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 antifungalsa Doses per 1000 PD 166 (24.8%) 141 (21%) 0.02
Non-targeted antifungalsb Doses per 1000 PD 50 4 < .0001
  1. DDD defined daily doses, DOT days of therapy, PD patient days
  2. aTargeted antifungals = amphotericin B lipid formulations, fluconazole, voriconazole
  3. bNon-targeted antifungals = amphotericin B deoxycholate, itraconazole