Impact of a non-compulsory antifungal stewardship program on overuse and misuse of antifungal agents in a tertiary care hospital

• Published in: International journal of antimicrobial agents 2021-01, Vol.57 (1), p.106255-106255, Article 106255
• Main Authors: Markogiannakis, Antonios, Korantanis, Konstantinos, Gamaletsou, Maria N., Samarkos, Michael, Psichogiou, Mina, Daikos, George, Sipsas, Nikolaos V.
• Format: Article
• Language: English
• Subjects: Antifungal therapy; Antifungals; Greece; Pharmacist; Stewardship
• ISSN: 0924-8579; 1872-7913
• DOI: 10.1016/j.ijantimicag.2020.106255

•Educational intervention combined with a non-compulsory antifungal stewardship (AFS) program had a significant impact on overuse and misuse of antifungal agents•The major errors in prescribing antifungals were suboptimal selection of antifungal agent, inappropriate dosage and duration of treatment•The AFS program resulted in a significant decrease in the consumption of AFs, mainly polyenes and echinocandins and in a significant reduction of the acquisition costs•Audits of the antifungals use are essential for selecting the targets for intervention 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