MARTÍN GUTIÉRREZ, GUILLERMO, Penalva, German , Ruiz-Perez de Pipaon, Maite , Aguilar, Manuela , Gil-Navarro, Maria Victoria , Luis Perez-Blanco, Jose , Antonia Perez-Moreno, Maria , Amaya-Villar, Rosario , Ferrandiz-Millon, Carmen , Gascon, Maria L. , Goycochea-Valdivia, Walter A. , Jimenez-Mejias, Manuel E. , Dolores Navarro, Maria , Lepe, Jose A. , Alvarez-Marin, Rocio , Neth, Olaf , Guisado-Gil, Ana B. , Infante-Dominguez, Carmen , Molina, Jose , Cisneros, Jose M. , PRIOAM Team
No
J Infect
Article
Científica
6.072
1.946
01/03/2020
000516606700013
Objective: 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. Methods: 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. Results: 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). Conclusions: 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. (C) 2020 The British Infection Association. Published by Elsevier Ltd. All rights reserved.
Antimicrobial stewardship programs; Educational interviews; Hospital-acquired candidemia; Antifungal consumption