Support for fungal infection treatment mediated by pharmacist-led antifungal stewardship activities

Samura, Masaru; Hirose, Naoki; Kurata, Takenori; Ishii, Junichi; Nagumo, Fumio; Takada, Keisuke; Koshioka, Sakura; Uchida, Masaki; Yamamoto, S.; Inoue, Junki; Enoki, Yuki; Taguchi, Kazuaki; Ishida, Akira; Sekine, Hisakazu; Kunika, Norifumi; Kunishima, Hiroyuki; Matsumoto, Kazuaki

doi:10.1016/j.jiac.2019.09.016

Cited by 20 publications

(27 citation statements)

References 13 publications

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“…Of the studies included, six were quasi-experimental before-after intervention studies [23][24][25][26][27][28] and one matched control analysis (Table 1). 29 All studies were from singlecentre academic hospitals, mostly (n = 5) from the USA.…”

Section: Study Characteristicsmentioning

confidence: 99%

“…29 All studies were from singlecentre academic hospitals, mostly (n = 5) from the USA. Five studies were specifically dedicated to optimising candidaemia management at a hospital level, [23][24][25][26][27] one at optimising prescribing of caspofungin in an intensive care unit (ICU) 29 and the remaining study focusing on systemic antifungal prescribing in adult haematology and oncology units. 28 All studies included adult patients only.…”

Section: Study Characteristicsmentioning

confidence: 99%

“…During the intervention period for five studies, the pharmacist received real-time notification of all patients with a positive blood culture for a yeast organism resembling Candida via an electronic alert or directly by the microbiology laboratory. [23][24][25][26][27] One further study, targeting optimising caspofungin prescribing for candidaemia in the ICU, identified patients initiated on caspofungin via the electronic medical record and electronic alerts. 29 The role of the pharmacist in these studies was to perform a comprehensive review of the patient's medical record and to make recommendations to the primary treating team.…”

Section: Interventionsmentioning

confidence: 99%

“…Where measured, most studies (3/4) found no change in the overall appropriateness of antifungal prescribing following the intervention, while Reed et al demonstrated an improvement in rate of effective antifungal therapy following implementation of pharmacist-led recommendations for patients with candidaemia. 26 Appropriate duration of antifungal prescribing was reported in five studies, showing no change in the proportion of patients receiving greater than 14 days of antifungal therapy following candidaemia clearance (Table 3) 23,25,27 or duration of effective antifungal therapy. 26 Lachenmayr et al, reported improvement in compliance with guideline duration of antifungal therapy.…”

Section: Quality Of Antifungal Prescribingmentioning

confidence: 99%

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The impact of pharmacist‐led antifungal stewardship interventions in the hospital setting: a systematic review

Khanina

Cairns

Kong

et al. 2021

Pharmacy Practice and Res

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Aim: To summarise the evidence on pharmacist-led antifungal stewardship (AFS) programs in the hospital setting and to evaluate their impact on the quality of antifungal prescribing and infection management, antifungal usage and clinical outcomes. Data sources: A systematic review of English-language studies identified in MEDLINE and EMBASE was performed on 27 November 2020 and conducted in accordance with PRISMA. Search terms included 'antifungal agent', 'invasive fungal infection', 'antimicrobial stewardship', 'patient care bundles' and 'pharmacist'. Study selection: Eligible studies describing pharmacist-led quality improvement intervention(s) implemented in the hospital setting targeted at optimising systemic antifungal prescribing. Results: Six hundred and forty-six studies were identified, and seven met inclusion criteria. Five were dedicated to optimising candidaemia management, one at optimising intensive care unit prescribing of caspofungin and one on antifungal prescribing in haematology and oncology units. All studies measured varied metrics relating to quality of prescribing and infection management, reporting improvement in proportion of effective antifungal therapy (n = 1/1), appropriate antifungal selection (n = 1/1), dosing (n = 2/3), management of drug-drug interactions (n = 1/1) and reduced time to antifungal initiation (n = 4/4). Studies that implemented a candidaemia bundle of care reported improvements in composite bundle adherence (n = 2/2), with greatest improvement in ophthalmological consultation (n = 4/4), echocardiography (n = 2/2) and infectious diseases consultation (n = 3/3). There was reduction in antifungal expenditure (n = 4/4) and consumption (n = 2/4). Pharmacist-led AFS programs did not influence clinical outcomes. Conclusion: Available evidence suggests that pharmacist-led AFS interventions can improve the quality and timeliness of antifungal prescribing and reduce antifungal usage. Further research is required to assess the impact on clinical and microbiological outcomes.

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Section: Study Characteristicsmentioning

confidence: 99%

Section: Study Characteristicsmentioning

confidence: 99%

Section: Interventionsmentioning

confidence: 99%

Section: Quality Of Antifungal Prescribingmentioning

confidence: 99%

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The impact of pharmacist‐led antifungal stewardship interventions in the hospital setting: a systematic review

Khanina

Cairns

Kong

et al. 2021

Pharmacy Practice and Res

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“…24 A previous observational study in Japan pointed out that AFS was important to reduce the cost of antifungal use. 25 In terms of not only patient bene t, but also the cost savings, we think that the importance of appropriate use of antifungal agents is paramount.…”

Section: Discussionmentioning

confidence: 99%

Nationwide Cross-Sectional Study of Antimicrobial Stewardship and Antifungal Stewardship Programs in Inpatient Settings in Japan

Moriyama

Ishikane

Kusama

et al. 2021

Preprint

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Background To prevent antimicrobial resistance, both antimicrobial stewardship (AMS) and antifungal stewardship (AFS) in inpatient settings are needed in small/middle-sized hospitals as well as large hospitals. Methods We conducted the web-based, self-administered, nationwide cross-sectional study regarding AMS and AFS in inpatient settings in Japan, targeting hospitals that participated in a hospital epidemiology workshop conducted in July 2018. The questionnaire was composed of intervention protocols for use of broad-spectrum antimicrobials and antifungals within 7 or 28 d of beginning usage. These broad-spectrum antimicrobial and antifungal protocols were compared between large (≥ 501beds) and small/middle-sized (≤ 500 beds) hospitals. Results Of 240 hospitals surveyed, 39 (16%; 18 large and 21 small/middle-sized) responded. The number of hospitals that intervened in the use of broad-spectrum antimicrobials within 7 and 28 d were 17 (44%) and 34 (87%), respectively; those that intervened for antifungals were 3 (8%) and 10 (26%), respectively. Interventions for use of broad-spectrum antimicrobials within 7 d were significantly more frequent in small/middle-sized hospitals compared to large hospitals [13 (61. 9%) vs. 4 (22. 2%), odds ratio = 5.7, 95% confidence interval = 1.4–23.3, p = 0.023]. Conclusions Small/middle-sized hospitals had more frequent interventions within 7 d of broad-spectrum antimicrobial use than large hospitals. More effort to improve AFS is needed among all hospitals.

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Antifungal Stewardship in Invasive Fungal Infections, a Systematic Review

Procacci,

Marras,

Maurmo

et al. 2024

Advances in Experimental Medicine and Biology

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Support for fungal infection treatment mediated by pharmacist-led antifungal stewardship activities

Cited by 20 publications

References 13 publications

The impact of pharmacist‐led antifungal stewardship interventions in the hospital setting: a systematic review

The impact of pharmacist‐led antifungal stewardship interventions in the hospital setting: a systematic review

Nationwide Cross-Sectional Study of Antimicrobial Stewardship and Antifungal Stewardship Programs in Inpatient Settings in Japan

Antifungal Stewardship in Invasive Fungal Infections, a Systematic Review

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