Evaluation of antifungal use in a tertiary care institution: antifungal stewardship urgently needed

被引:111
作者
Valerio, Maricela [1 ,2 ]
Guadalupe Rodriguez-Gonzalez, Carmen [2 ,3 ]
Munoz, Patricia [1 ,2 ,4 ]
Caliz, Betsabe [2 ,3 ]
Sanjurjo, Maria [2 ,3 ]
Bouza, Emilio [1 ,2 ,4 ]
机构
[1] Hosp Gen Univ Gregorio Maranon, Clin Microbiol & Infect Dis Dept, Madrid 28007, Spain
[2] Hosp Gen Gregorio Maranon, Inst Invest Sanitaria, Madrid, Spain
[3] Hosp Gen Univ Gregorio Maranon, Dept Pharm, Madrid 28007, Spain
[4] Univ Complutense Madrid, Sch Med, Dept Med, Madrid, Spain
关键词
economic savings; invasive aspergillosis; candidaemia; HOSPITAL RESOURCE UTILIZATION; INFECTIOUS-DISEASES SOCIETY; ANTIMICROBIAL STEWARDSHIP; THERAPEUTIC RESPONSE; DOSE/MIC RATIO; CANDIDEMIA; FLUCONAZOLE; GUIDELINES; PROGRAM; MANAGEMENT;
D O I
10.1093/jac/dku053
中图分类号
R51 [传染病];
学科分类号
100401 ;
摘要
To assess the quality of antifungal use, to propose a point score for this evaluation and to estimate the potential economic savings of an antifungal stewardship programme. From December 2010 to January 2011, we identified 100 adult inpatients receiving systemic antifungals. Antifungal use was evaluated by means of a predefined score that considered indication, drug selection, dosage, adjustments after microbiology results, switching to an oral agent and length of treatment. Total antifungal prescriptions [in defined daily doses (DDDs) and days of therapy (DOTs)] and potential cost savings were calculated. Overall, 43% of prescriptions came from medical departments, 25% from haematology/oncology and 17% from intensive care units. The main reasons for starting antifungals were empirical (42%), pre-emptive (20%) and targeted treatment (20%). Antifungals were unnecessary in 16% of cases. Inadequacies in other aspects of antifungal prescription were: drug selection, 31%; dosing, 16%; no switch from intravenous to oral administration, 20%; no adjustment after microbiological results, 35%; and length of therapy, 27%. The number of antifungal DDDs per 1000 patient-days was 65.1. The total number of DOTs was 1556, which added a direct cost of a,not sign219aEuroS364. Only 51.3% of DOTs were considered optimal. The potential estimated savings would be a,not sign50aEuroS536. Major efforts should be made to improve the selection and duration of antifungal therapy. Our study demonstrated the potential cost savings that could be achieved by optimizing antifungal therapy. A stewardship programme should include an instrument to objectively evaluate the adequacy of antifungal use.
引用
收藏
页码:1993 / 1999
页数:7
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