Τίτλος:
Impact of a non-compulsory antifungal stewardship program on overuse and misuse of antifungal agents in a tertiary care hospital
Γλώσσες Τεκμηρίου:
Αγγλικά
Περίληψη:
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
Συγγραφείς:
Markogiannakis, A.
Korantanis, K.
Gamaletsou, M.N.
Samarkos, M.
Psichogiou, M.
Daikos, G.
Sipsas, N.V.
Περιοδικό:
International Journal of Antimicrobial Agents
Λέξεις-κλειδιά:
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
DOI:
10.1016/j.ijantimicag.2020.106255
