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

2021 ◽  
Vol 57 (1) ◽  
pp. 106255
Author(s):  
Antonios Markogiannakis ◽  
Konstantinos Korantanis ◽  
Maria N. Gamaletsou ◽  
Michael Samarkos ◽  
Mina Psichogiou ◽  
...  
Keyword(s):  
Antifungal Agents ◽  
Tertiary Care Hospital ◽  
Tertiary Care ◽  
Care Hospital ◽  
Antifungal Stewardship ◽  
Stewardship Program

scholarly journals Implementation of Pharmacist-driven Antifungal Stewardship Program in A Tertiary Care Hospital

2021 ◽  
Author(s):  
Emre Kara ◽  
Gokhan Metan ◽  
Aygin Bayraktar-Ekincioglu ◽  
Dolunay Gulmez ◽  
Sevtap Arikan-Akdagli ◽  
...  
Keyword(s):  
Antifungal Therapy ◽  
Clinical Pharmacist ◽  
Fungal Infections ◽  
Tertiary Care ◽  
Antifungal Drugs ◽  
Care Hospital ◽  
Antifungal Stewardship ◽  
Inappropriate Use ◽  
Stewardship Program ◽  
Antifungal Use

Objectives: 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. Methods: This study included three periods as observation, feedback/education, and daily AFS activities. In observation period, the use of systemic antifungals was evaluated for a baseline measurement of appropriateness. In 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 final period, a clinical pharmacist participated in daily ward rounds to evaluate appropriateness of the antifungal therapy. A scoring system for appropriateness was used for comparison between the three periods. Results: Four hundred and 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%, Candida infections in 58.6%, and invasive mould 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%, 46.3%, p=0.046) and treatment of fungal diseases (27.8%, 32.4%, 71.9%, p<0.001) between the first, second and third periods, respectively. A 30-day mortality was not significantly changed between the three periods (19%, 15.6% and 27.5%; p=0.050). Conclusions: Appropriateness in antifungal therapy can be augmented by the integration of an AFS program. A team-based evaluation of fungal infections and assessment of patients by a clinical pharmacist with a therapeutic perspective may help to increase the quality of antifungal therapy.

Impact of Education and an Antifungal Stewardship Program for Candidiasis at a Thai Tertiary Care Center

2010 ◽  
Vol 31 (7) ◽  
pp. 722-727 ◽  
Author(s):  
Anucha Apisarnthanarak ◽  
Apiwat Yatrasert ◽  
Linda M. Mundy ◽  
Keyword(s):  
Care Center ◽  
Tertiary Care ◽  
Cost Savings ◽  
Care Hospital ◽  
Prescribing Practices ◽  
Antifungal Stewardship ◽  
Defined Daily Doses ◽  
Stewardship Program ◽  
Antifungal Use ◽  
The Impact

Background.We evaluated the impact of education and an antifungal stewardship program for candidiasis on prescribing practices, antifungal consumption, Candida species infections, and estimated costs at a Thai tertiary care hospital.Methods.A hospital-wide, quasi-experimental study was conducted for 1.5 years before the intervention and 1.5 years after the implementation of an antifungal stewardship program. Inpatient antifungal prescriptions were prospectively observed, and patients' demographic, clinical, and administrative-cost data were collected. Interventions included education, introduction of an antifungal hepatic and/or renal dose adjustment tool, antifungal prescription forms, and prescription-control strategies.Results.After the intervention, there was a 59% reduction in antifungal prescriptions (from 194 to 80 prescriptions per 1,000 hospitalizations; P < .001). Inappropriate antifungal use decreased (from 71% to 24%; P < .001), a sustained reduction in antifungal use was observed (r = 0.83; P < .001), and fluconazole use decreased (from 242 to 117 defined daily doses per 1,000 patient-days; P < .001). Reductions in the incidence of infection with Candida glabrata (r = 0.69; P < .001) and Candida krusei (r = 0.71; P < .001) were observed, whereas the incidence of infection with Candida albicans (r = —0.81; P < .001) increased. Total cost savings were US$31,615 during the 18-month postintervention period.Conclusions.Implementation of an antifungal stewardship program was associated with appropriate antifungal drug use, improved resource utilization, and cost savings.

scholarly journals Appropriateness of Gram-Negative Agent Use at a Tertiary Care Hospital in the Setting of Significant Antimicrobial Resistance

2015 ◽  
Vol 2 (1) ◽  
Author(s):  
Neil M. Vora ◽  
Christine J. Kubin ◽  
E. Yoko Furuya
Keyword(s):  
New York ◽  
Antimicrobial Resistance ◽  
Antimicrobial Stewardship ◽  
Tertiary Care Hospital ◽  
Tertiary Care ◽  
Categorical Variables ◽  
Care Hospital ◽  
Antimicrobial Stewardship Program ◽  
Gram Negative ◽  
Stewardship Program

Abstract Background.  Practicing antimicrobial stewardship in the setting of widespread antimicrobial resistance among gram-negative bacilli, particularly in urban areas, is challenging. Methods.  We conducted a retrospective cross-sectional study at a tertiary care hospital with an established antimicrobial stewardship program in New York, New York to determine appropriateness of use of gram-negative antimicrobials and to identify factors associated with suboptimal antimicrobial use. Adult inpatients who received gram-negative agents on 2 dates, 1 June 2010 or 1 December 2010, were identified through pharmacy records. Clinical data were collected for each patient. Use of gram-negative agents was deemed optimal or suboptimal through chart review and according to hospital guidelines. Data were compared using χ2 or Fischer's exact test for categorical variables and Student t test or Mann–Whitney U test for continuous variables. Results.  A total of 356 patients were included who received 422 gram-negative agents. Administration was deemed suboptimal in 26% of instances, with the most common reason being spectrum of activity too broad. In multivariable analysis, being in an intensive care unit (adjusted odds ratio [aOR], .49; 95% confidence interval [CI], .29–.84), having an infectious diseases consultation within the previous 7 days (aOR, .52; 95% CI, .28–.98), and having a history of multidrug-resistant gram-negative bacilli within the past year (aOR, .24; 95% CI, .09–.65) were associated with optimal gram-negative agent use. Beta-lactam/beta-lactamase inhibitor combination drug use (aOR, 2.6; 95% CI, 1.35–5.16) was associated with suboptimal use. Conclusions.  Gram-negative agents were used too broadly despite numerous antimicrobial stewardship program activities.

scholarly journals Point-Prevalence Survey for the Hospital-Acquired Infections in Intensive Care Units of Trauma Center in a Tertiary Care Hospital of Northern India

2021 ◽  
Author(s):  
Sandeep Boora ◽  
Parul Singh ◽  
Arun Verma ◽  
Ashok Chauhan ◽  
Amit Lathwal ◽  
...  
Keyword(s):  
Trauma Center ◽  
Tertiary Care Hospital ◽  
Tertiary Care ◽  
Point Prevalence ◽  
Care Hospital ◽  
Prevalence Survey ◽  
Hospital Acquired Infections ◽  
Point Prevalence Survey ◽  
Stewardship Program ◽  
Hospital Acquired

Abstract Background The burden of hospital-acquired infections (HAIs) is all assumption based, and the true burden remains unknown in most countries, particularly in the developing countries where healthcare facilities are suboptimal and knowledge is limited. Methodology This cross-sectional study was conducted at the trauma center of a tertiary care institute from August to September 2019, to assess the burden of HAI and antibiotic resistance pattern of HAI. The total sample size in our study was 105. Our objective was to estimate the point prevalence of HAI and study the associated factors in a tertiary care hospital. Result In this study, the point prevalence of HAI was five to six times higher when compared with that of developed countries. Gram-negative organisms were the predominant bacteria; with Acinetobacter baumannii the most common among them. Conclusion Point-prevalence survey is an important objective of the antimicrobial stewardship program; it will be helpful in controlling antimicrobial resistance and this tool plays a significant role in hospital settings. Our study is quite pertinent to assess the point prevalence of HAI. It will help in knowing the current prevalence and pattern of the HAI. Therefore, as healthcare administrators, we can further decrease the HAI for better patient outcomes in the future.

scholarly journals Impact of antibiotic stewardship program on usage of higher range of antibiotics in patients of intensive care units in a tertiary care hospital, India

2020 ◽  
Vol 7 (2) ◽  
pp. 287
Author(s):  
Mounamukhar Bhattacharjee ◽  
Vijaya Lakshmi Nag ◽  
Jagdish Prasad Goyal ◽  
Vibhor Tak
Keyword(s):  
Intensive Care ◽  
Intensive Care Units ◽  
Antibiotic Stewardship ◽  
Tertiary Care Hospital ◽  
Positive Impact ◽  
Tertiary Care ◽  
P Value ◽  
Care Hospital ◽  
Stewardship Program ◽  
Definitive Therapy

Background: The aim of the study was to monitor the changes in antimicrobial use after implementation of Antibiotic Stewardship Programmed (ASP) and pattern of use of antimicrobials in the respective ICU’s.Methods: The study was conducted in three ICU’s Adult ICU(AICU), Paediatric ICU (PICU), Neonatal ICU (NICU) -Six bedded each) over a period of six months from September 2018 to February 2019 in a tertiary care hospital. Antibiotics monitored over total 155 patients and antibiotics selected for the study are β-lactam inhibitors, Carbapenem derivatives and ColistinResults: Out of total 155 patients 51% were males and the definitive therapy (Implementation of antibiotics according to the antibiotic policy of the hospital) in the respective ICU’s showed increase from 66.7% to 83.3% after implementation of ASP activity in that particular duration. Antibiotic consumption showed fluctuation in the whole duration of the study (p value <0.05).Conclusions: Analysis of the study shows a positive impact on implementation of ASP programme in intensive care units, brought an effective increase in appropriate use of antimicrobials.

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