Impact of an antifungal stewardship programme in a tertiary respiratory medicine setting: a prospective real-world study
File(s)
Accepted version
Author(s)
Type
Journal Article
Abstract
There has been an increase in fungal infections in patients with chronic lung disease over the past decades, which is associated with rapidly increasing costs to healthcare systems.An antifungal stewardship team was introduced to a tertiary cardiopulmonary hospital, consisting of a medical mycologist and pharmacy support providing weekly stewardship ward rounds, twice monthly multidisciplinary team meetings and a dedicated weekly outpatient clinic. A database was set up to record the activity of the stewardship team.During the first eighteen months of implementation the antifungal stewardship team had reviewed 178 patients, with 285 recommendations made to inpatients, and 287 outpatient visits. The commonest diagnoses treated were allergic bronchopulmonary aspergillosis and chronic pulmonary aspergillosis. Cystic fibrosis was the largest patient group treated followed by asthma and interstitial lung disease. There was a significant, sustained reduction in monthly antifungal expenditure (p=0.005) by £130,000 per month. There was also a significant reduction in antifungal use measured as Defined Daily Dose/100 bed days (p=0.017). There were no significant changes in expenditure on diagnostic tests. There has been a trend toward more patients having therapeutic levels of voriconazole (p=0.086) and a significant increase in therapeutic levels of posaconazole (p<0.0001).This study shows that an effective antifungal stewardship programme can significantly reduce expenditure in a specialist respiratory service.
Date Issued
2018-10-01
Date Acceptance
2018-07-01
Citation
Antimicrobial Agents and Chemotherapy, 2018, 62 (10)
ISSN
0066-4804
Publisher
American Society for Microbiology
Journal / Book Title
Antimicrobial Agents and Chemotherapy
Volume
62
Issue
10
Copyright Statement
© 2018 American Society for Microbiology. All Rights Reserved.
Identifier
https://www.ncbi.nlm.nih.gov/pubmed/30012769
PII: AAC.00402-18
Subjects
antifungal agents
antifungal therapy
0605 Microbiology
1108 Medical Microbiology
1115 Pharmacology And Pharmaceutical Sciences
Microbiology
Publication Status
Published
Coverage Spatial
United States
Date Publish Online
2018-07-16