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

Abstract

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 10 0 0 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 re- duction 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 can- didemia decreased, with a change in slope of −5.06% cases per 10 0 0 OBDs per year (95%CI, −8.23 −1.77, p = 0.009). The 14-day crude death rate per 10 0 0 OBDs dropped from 0.044 to 0.017 ( −6.36% deaths per 10 0 0 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.