TY - JOUR
TI - Impact of a non-compulsory antifungal stewardship program on overuse and misuse of antifungal agents in a tertiary care hospital
AU - Markogiannakis, A.
AU - Korantanis, K.
AU - Gamaletsou, M.N.
AU - Samarkos, M.
AU - Psichogiou, M.
AU - Daikos, G.
AU - Sipsas, N.V.
JO - International Journal of Antimicrobial Agents
PY - 2021
VL - 57
TODO - 1
SP - null
PB - Elsevier B.V.
SN - 0924-8579
TODO - 10.1016/j.ijantimicag.2020.106255
TODO - antifungal agent;  echinocandin;  polyene antibiotic agent;  pyrrole derivative;  antifungal agent;  mycosis, adult;  all cause mortality;  antifungal therapy;  antimicrobial stewardship;  Article;  controlled study;  cost control;  drug cost;  drug misuse;  female;  hospital mortality;  human;  inappropriate prescribing;  length of stay;  major clinical study;  male;  medication overuse;  middle aged;  mycosis;  prescription;  priority journal;  prospective study;  tertiary care center;  treatment duration;  aged;  antimicrobial stewardship;  cost;  drug misuse;  drug therapy;  drug utilization;  epidemiology;  Greece;  prevention and control;  procedures;  tertiary care center;  treatment outcome, Aged;  Antifungal Agents;  Antimicrobial Stewardship;  Costs and Cost Analysis;  Drug Misuse;  Drug Utilization;  Female;  Greece;  Hospital Mortality;  Humans;  Inappropriate Prescribing;  Interrupted Time Series Analysis;  Length of Stay;  Male;  Middle Aged;  Mycoses;  Tertiary Care Centers;  Treatment Outcome
TODO - Objectives: To assess the impact of an antifungal stewardship (AFS) program on appropriate use, consumption and acquisition costs of antifungals, and on clinical outcomes (in-hospital-mortality, in-hospital-length-of-stay). Methods: The study was conducted at a 535-bed tertiary-care hospital and had three consecutive periods. A) Observational period (10 months): all antifungal prescriptions were prospectively evaluated. B) Educational intervention to increase the awareness on proper antifungals use. C) Implementation of a non-compulsory AFS program (10 months) based on prospective audit and feedback. Interrupted time series analysis has been used to assess the impact of the intervention. Results: During the pre-interventional period 198 AF prescriptions for 147 patients, have been evaluated compared to 181 prescriptions in 138 patients during the AFS period. Statistical analysis showed a significant immediate drop of inappropriate prescriptions after intervention with a significantly declining trend thereafter, and a significant drop of the total consumption of antifungals immediately after the intervention with a significant declining trend thereafter. All-cause, in-hospital- mortality was stable during the pre-intervention period with a significant declining trend after the AFS program implementation, although no immediate intervention effect could be established. Comparison of pre-and post-interventional periods showed significant reduction in acquisition costs (-26.8%, p<0.001) but no difference regarding the total number of bed-days (107,654 vs. 102,382), and mean length of hospital-stay (5.19 vs. 4.96 days, p=NS). Conclusions: The implementation of a non-compulsory AFS program resulted in significant improvement in the quality of prescriptions and reduction in antifungals consumption and acquisitions costs, without affecting the overall in-hospital-mortality and mean in-hospital-length-of-stay. © 2020
ER -