Implementation of Pharmacist-Driven Antifungal Stewardship Program in a Tertiary Care Hospital

• Published in: Antimicrobial agents and chemotherapy 2021-08, Vol.65 (9), p.e0062921-e0062921
• Main Authors: Kara, Emre, Metan, Gokhan, Bayraktar-Ekincioglu, Aygin, Gulmez, Dolunay, Arikan-Akdagli, Sevtap, Demirkazik, Figen, Akova, Murat, Unal, Serhat, Uzun, Omrum
• Format: Article
• Language: English
• Subjects: Antifungal Agents - therapeutic use; Clinical Therapeutics; Humans; Mycoses - drug therapy; Pharmacists; Tertiary Care Centers
• ISSN: 0066-4804; 1098-6596
• DOI: 10.1128/AAC.00629-21

Antifungal stewardship (AFS) is recommended to reduce the inappropriate use of antifungal drugs. In this study, the role of AFS in providing appropriate antifungal therapy was evaluated. This study included three periods, consisting of observation, feedback/education, and daily AFS activities. In the observation period, the use of systemic antifungals was evaluated for a baseline measurement of appropriateness. In the second period, monthly meetings were organized to provide feedback and education to physicians regarding antifungal therapy and the rate of adherence to the clinical guidelines. In the final period, a clinical pharmacist participated in daily ward rounds to evaluate the appropriateness of the antifungal therapy. A scoring system for appropriateness was used for comparison between the three periods. Four hundred eighteen episodes of antifungal therapy were evaluated. Baseline demographics of patients were similar in all three periods for age, gender, and the number of comorbidities. The indications for antifungal use were for prophylaxis in 22.7%, infections in 58.6%, and invasive mold infections in 18.7%. During the third period, 157 (78.9%) recommendations were made and 151 (96.2%) were accepted. The overall appropriateness of antifungal use increased significantly for prophylaxis (30.8%, 17.9%, and 46.3%;  = 0.046) and treatment of fungal diseases (27.8%, 32.4%, and 71.9%;