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Efficacy and safety of a comprehensive educational antimicrobial stewardship program focused on antifungal use

2020; Elsevier BV; Volume: 80; Issue: 3 Linguagem: Inglês

10.1016/j.jinf.2020.01.002

1532-2742

Guillermo Martín-Gutiérrez, Germán Peñalva, Maite Ruíz-Pérez de Pipaón, Manuela Aguilar, María Victoria Gil-Navarro, José Luis Pérez-Blanco, María Antonia Pérez-Moreno, Rosario Amaya-Villar, Carmen Ferrándiz‐Millón, María Lucía Bermá Gascón, Walter Alfredo Goycochea-Valdivia, Jiménez-Mejías Me, M.D. Navarro, José Antonio Lepe, Rocío Álvarez‐Marín, Olaf Neth, Ana Belén Guisado-Gil, Carmen Infante-Domínguez, José Molina, José Miguel Cisneros,

Antibiotic Use and Resistance

Few data exist regarding the impact of antimicrobial stewardship programs on antifungal use. We evaluated the efficacy and safety of a comprehensive long-term antimicrobial stewardship program (ASP) focused on antifungal use.During a 9-year period, we quarterly assessed antifungal consumption, incidence density of hospital-acquired candidemia, Candida spp. distribution, antifungal resistance, and crude death rate per 1000 occupied bed days (OBDs) of hospital-acquired candidemia. We performed segmented regression analysis of interrupted time series.A significant change in trend was observed for antifungal consumption, with a sustained reduction of -0.87% per quarter (95% confidence interval [CI], -1.36 -0.38, p < 0.001), accounting for a final reduction of -38.4%. The main reduction was produced in fluconazole, with a sustained reduction of -1.37% per quarter (95%CI, -1.96 -0.68, p<0.001). The incidence density of hospital-acquired candidemia decreased, with a change in slope of -5.06% cases per 1000 OBDs per year (95%CI, -8.23 -1.77, p = 0.009). The 14-day crude death rate per 1000 OBDs dropped from 0.044 to 0.017 (-6.36% deaths per 1000 OBDs per year; 95%CI, -13.45 -1.31, p = 0.09).This ASP has succeeded in optimizing the use of antifungal with a long-lasting reduction without increasing the incidence, neither the mortality, of hospital-acquired candidemia.