Impact of a diagnostics-driven antifungal stewardship programme in a UK tertiary referral teaching hospital

Rautemaa‐Richardson, Riina; Ragy, Omar; Al-Wathiqi, F; Moore, CB; Craig, Linda; Felton, Timothy; Muldoon, Eavan G.

doi:10.1093/jac/dky360

Cited by 38 publications

(59 citation statements)

References 27 publications

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“…8,23 However, no report has yet shown that antifungal stewardship improves clinical outcomes, including mortality. 24 Further, few studies have evaluated the clinical effects of an antifungal stewardship intervention using βDG testing, 12 which is useful for ruling out invasive candidemia. 11 Here, we was significantly reduced after intervention, although oral antifungal consumption, which was not a target of our daily review, was slightly but significantly increased after the intervention, resulting in an annual saving in the total cost of antifungal agents.…”

Section: Discussionmentioning

confidence: 99%

“…Compared to the situation with antimicrobial stewardship programmes, however, data on antifungal stewardship programmes are limited. 11 However, few studies have evaluated the clinical effects of an antifungal stewardship intervention using βDG testing, 12 indicating that further study is needed. [6][7][8][9] Taur et al reported that delays in treatment are associated with increased mortality in patients with Candida bloodstream infection.…”

Section: What Is K Nown and Objec Tivementioning

confidence: 99%

“…The test for 1-3, β-D-glucan (βDG), a surrogate marker for fungal infection, shows high negative predictive values and is useful for ruling out invasive candidemia. 11 However, few studies have evaluated the clinical effects of an antifungal stewardship intervention using βDG testing, 12 indicating that further study is needed.…”

Section: What Is K Nown and Objec Tivementioning

confidence: 99%

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The impact of implementing an antifungal stewardship with monitoring of 1‐3, β‐D‐glucan values on antifungal consumption and clinical outcomes

et al. 2019

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What is known and objective Implementation of an antifungal stewardship programme is a recognized need. However, there is insufficient information to confirm the impact of antifungal stewardship interventions. Further, few studies have evaluated the clinical effects of an antifungal stewardship intervention using 1‐3, β‐D‐glucan (βDG) testing. The aim of the present study was to evaluate the impact of implementing an antifungal stewardship with monitoring of βDG values on antifungal use and clinical outcomes. Methods A single institutional prospective cohort study was conducted to evaluate the impact of implementing daily reviews of antifungal agents and monitoring patients who measured βDG values since August 2013. Antifungal consumption and clinical outcomes in patients with Candida bloodstream infection were compared before and after the intervention. Results After implementation of the programme, parental antifungal use was significantly reduced compared to that before intervention (P = 0.006). In the after‐intervention group, the rate of 60‐day clinical failure in patients with Candida bloodstream infection was significantly reduced, from 80.0% (28/35) to 36.4% (8/22) (P < 0.001), and the rate of 60‐day mortality associated with Candida bloodstream infection tended to be reduced, from 42.9% (15/35) to 18.2% (4/22) (P = 0.081) compared to the before‐intervention group. The incidence of adverse events associated with antifungal agents was significantly lower in the after‐intervention group than in the before‐intervention group (51.4% [18/35] vs 13.6% [3/22], P = 0.004). What is new and conclusion Our findings suggest that daily review of the use of antifungal agents and monitoring of measured βDG values was highly effective in reducing antifungal consumption and improving the clinical outcomes of patients with Candida bloodstream infection.

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Section: Discussionmentioning

confidence: 99%

Section: What Is K Nown and Objec Tivementioning

confidence: 99%

Section: What Is K Nown and Objec Tivementioning

confidence: 99%

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The impact of implementing an antifungal stewardship with monitoring of 1‐3, β‐D‐glucan values on antifungal consumption and clinical outcomes

et al. 2019

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“…[81][82][83][84][85][86][87] Similar findings have been observed with RDTs and ASPs for fungal infections. [88][89][90] Currently, the greatest challenge to ICU clinicians is effective management of multidrug-resistant GNB infections. 79 IIAT of serious GNB infections is associated with increased mortality and has been the rationale for using broad-spectrum antibiotics upfront in critically ill patients.…”

Section: Evidence In Support Of the Use Of Rdts To Optimize Antibiotimentioning

confidence: 99%

Novel Approaches to Hasten Detection of Pathogens and Antimicrobial Resistance in the Intensive Care Unit

Guillamet

Burnham

Kollef

2019

Semin Respir Crit Care Med

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Antibiotic resistance is recognized as a key determinant of outcome in patients with serious infections influencing empiric antibiotic practices especially for critically ill patients. Within the intensive care unit (ICU), nosocomial infections and increasingly community-onset infections are caused by multidrug-resistant bacteria. Escalating rates of antibiotic resistance adds substantially to the morbidity, mortality, and cost related to infections treated in the ICU. Both gram-positive organisms, such as methicillin-resistant Staphylococcus aureus and vancomycin-resistant enterococci, and gram-negative bacteria, including Pseudomonas aeruginosa, Acinetobacter species, carbapenem-resistant Enterobacteriaceae, and extended spectrum β-lactamase producing organisms, are urgent threats. The rising rates of antimicrobial resistance have resulted in routine empiric administration of broad-spectrum antibiotics by clinicians to critically ill patients even when bacterial infection is microbiologically absent. Moreover, new broad-spectrum antibiotics are a challenge to use effectively while avoiding emergence of further resistance. Use of rapid diagnostic technologies (RDTs) will likely provide an important methodology for achieving this important balance. There is an urgent need for integrating the administration of new and existing antibiotics with RDTs in a way that is safe, cost-effective, applicable in all countries, and sustainable.

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“…Even in colonized patients, susceptibility patterns might change over time, especially in immunocompromised hosts [8]. Although the AFS has known short-term effects (e.g., reduction in antifungal consumption, costs and outcomes) on the management of IFDs and patient safety [38][39][40][41], its long-term effects has been described on resistance patterns [42]. Based on stewardship program metrics, change in resistance patterns, and pathogen-speci c resistance is the most di cult target to reach [34].…”

Section: Comparison Of the Mean Minimum Inhibitory Concentration (Micmentioning

confidence: 99%

Impact of antifungal stewardship interventions on the susceptibility of Candida species in pediatric patients with malignancy

Amanati

Badiee

Jafarian

et al. 2020

Preprint

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Background There is a worldwide concern with respect to the antimicrobial resistance and the inappropriate use of antifungal agents, which had led to an ever-increasing antifungal resistance. This study aimed to identify the antifungal susceptibility of Candida species isolated from the pediatric patients with cancer and also to evaluate the clinical impact of antifungal stewardship (AFS) ‎interventions on antifungal susceptibility of Candida species. Methods In this study, Candida species colonization were evaluated among hospitalized children with cancer in a tertiary teaching hospital, Shiraz 2017-18. The broth microdilution method was used to determine the minimum inhibitory concentrations (MICs) for polyenes (amphotericin B), echinocandins (caspofungin), and azoles (voriconazole, fluconazole, posaconazole, and itraconazole). Antifungal susceptibility of Candida species was compared with our previous study results to determine the clinical impact of AFS interventions on the antifungal susceptibility. Results The prevalence of Candida albicans in the present study was significantly higher than other Candida species. Candida albicans species were completely susceptible to the azoles. The sensitivity rate of C. albicans to amphotericin B and caspofungin was 93.1% and 97.1%, respectively. The results confirm the positive effect of optimized antifungal usage and bedside intervention on the susceptibility of Candida species after the implementation of the AFS program. C. albicans and C. glabrata exhibited significant increase in sensitivity after the execution of AFS program. Conclusions Improving the antifungal agent usage can improve antifungal ‎susceptibility and reduce resistance. The AFS is recommended to be addressed, applied, and regularly assessed in centers.

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Impact of a diagnostics-driven antifungal stewardship programme in a UK tertiary referral teaching hospital

Abstract: The AFS programme was successful in reducing the number of inappropriate initiations of antifungals by 90%. Concurrently, mortality due to invasive candidosis was reduced by 58%. BDG testing can guide safe cessation of antifungals in ICU patients at risk of invasive candidosis.

Cited by 38 publications

References 27 publications

The impact of implementing an antifungal stewardship with monitoring of 1‐3, β‐D‐glucan values on antifungal consumption and clinical outcomes

The impact of implementing an antifungal stewardship with monitoring of 1‐3, β‐D‐glucan values on antifungal consumption and clinical outcomes

Novel Approaches to Hasten Detection of Pathogens and Antimicrobial Resistance in the Intensive Care Unit

Impact of antifungal stewardship interventions on the susceptibility of Candida species in pediatric patients with malignancy

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