Improving the management of candidemia through antimicrobial stewardship interventions

Reed, Erica E; West, Jessica E.; Keating, Ellen A.; Pancholi, Preeti; Balada-Llasat, Joan-Miquel; Mangino, Julie E.; Bauer, Karri A.; Goff, Debra A.

doi:10.1016/j.diagmicrobio.2013.11.012

Cited by 56 publications

(69 citation statements)

References 32 publications

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“…Recently, several articles have reported on the usefulness of AFS in improving care quality and reducing medical costs [110][111][112][113]. Furthermore, a report by Reed et al [114] stated that AFS introduced by pharmacists shortened the time until the appropriate antifungal agent was administered and led to more patients receiving antifungals. However, they did not observe significant effects on in-hospital mortality rate, infection-related length of stay and medical costs.…”

Section: Principles Of Ams and Afsmentioning

confidence: 97%

“…According to a quasi-experimental study conducted in a 1229-bed teaching hospital in the USA [114], an antimicrobial stewardship program (ASP) pharmacist's interventions significantly decreased the time to effective therapy (median 13.5 vs 1.3 h, p = 0.04) and increased the number of candidemia patients receiving effective antifungal therapy (67 [ from the time of blood culture draw, rapid communication of culture results from the microbiology laboratory to the ASP PharmD does not appear to be enough to decrease mortality of candidemia patients. These findings suggest that development of non-culturebased early diagnosis tools is important to shorten the time to positive identification of infecting Candida species.…”

Section: From Economical Perspectivesmentioning

confidence: 99%

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Current recommendations and importance of antifungal stewardship for the management of invasive candidiasis

Miyazaki

Kohno

2015

Expert Review of Anti-infective Therapy

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Invasive candidiasis can have a major effect on patient prognosis and medical economics. Quickly eliminating the focus of the infection and administering appropriate antifungal therapy are important. Clinical guidelines for invasive candidiasis have been issued in the USA, Europe and recently in Japan. The purpose of this review is to summarize the current recommendations on how to diagnose and treat invasive candidiasis based on the evidence gathered to date and by referencing guidelines from various countries. Echinocandin antifungals play a central role in the prevention and treatment of invasive candidiasis although a recent increase in echinocandin-resistant Candida glabrata is seen as problematic. In the future, promoting the appropriate use of antifungal agents by antifungal stewardship teams will be necessary to suppress adverse effects, appearance of resistant strains and unnecessary medical expenses, as well as improve positive clinical outcomes and prognoses.

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Section: Principles Of Ams and Afsmentioning

confidence: 97%

Section: From Economical Perspectivesmentioning

confidence: 99%

Current recommendations and importance of antifungal stewardship for the management of invasive candidiasis

Miyazaki

Kohno

2015

Expert Review of Anti-infective Therapy

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“…Benefits from ID consultation have been well‐described in candidemia : An ID pharmacist‐led stewardship program resulted in more frequent and faster administration of appropriate antifungal treatment, although it did not have a significant effect on mortality rates, length of stay and hospital costs . However, Patel et al showed that ID consultation was associated with decreased mortality among 119 patients with candidemia, independent of APACHE II scores (p < 0.01).…”

Section: New Antifungal Agents and Toxicitiesmentioning

confidence: 99%

Emerging Issues With Diagnosis and Management of Fungal Infections in Solid Organ Transplant Recipients

Farmakiotis

Kontoyiannis

2015

American Journal of Transplantation

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Invasive fungal infections (IFIs) are being increasingly recognized in solid organ transplant (SOT) recipients, and delayed diagnosis can lead to graft loss and death. Therefore, there is a low threshold for prophylaxis and early initiation of empiric antifungal treatment, in this patient population. Meanwhile, the increasing consumption of antifungals is associated with high cost, medication toxicities and the emergence of resistance in Candida species, all of which call for rational use of antifungal agents. The implementation of fungal biomarkers, molecular diagnostic methods and direct detection of volatile fungal metabolites in breath samples could lead to faster diagnosis, early appropriate treatment and improved clinical outcomes, but also aid in the de‐escalation of antifungal treatment. Those novel diagnostic modalities need to be validated specifically in SOT recipients. Infectious diseases consultation can contribute to optimization of care through prompt initiation and appropriate modification of antifungal treatment, management of medication toxicities and drug‐drug interactions, as well as source control. In this review, we conceptually summarize recent advances in the diagnosis and management of IFI in SOT recipients, and highlight the importance of early diagnostic tools and good stewardship of antifungal drugs.

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“…7 Only a handful of reports on the effectiveness of AFS programs in the USA and Europe have been published to date. [14][15][16][17][18][19] A single report from a tertiary UK centre demonstrated a crude saving of £188,000 in drug costs over a 1-year intervention period in 173 patients. We present an evaluation of the effectiveness of our AFS programme (2010-16) based on comprehensive, prospectively collected clinical, microbiologic and financial outcome data.…”

Section: Resultsmentioning

confidence: 99%

Effectiveness of an antifungal stewardship programme at a London teaching hospital 2010–16

Whitney

Al-Ghusein

Koh

et al. 2018

Journal of Antimicrobial Chemotherapy

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Improving the management of candidemia through antimicrobial stewardship interventions

Cited by 56 publications

References 32 publications

Current recommendations and importance of antifungal stewardship for the management of invasive candidiasis

Current recommendations and importance of antifungal stewardship for the management of invasive candidiasis

Emerging Issues With Diagnosis and Management of Fungal Infections in Solid Organ Transplant Recipients

Effectiveness of an antifungal stewardship programme at a London teaching hospital 2010–16

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