Efficacy and safety of a comprehensive educational antimicrobial stewardship program focused on antifungal use
| Autor: | Carmen Infante-Domínguez, Guillermo Martín-Gutiérrez, Ana Belén Guisado-Gil, María Antonia Pérez-Moreno, José Miguel Cisneros, José Molina, Rocío Álvarez-Marín, Maite Ruiz Pérez de Pipaón, María L. Gascón, María Dolores Navarro, Manuela Aguilar, María Victoria Gil-Navarro, Olaf Neth, José Luis Pérez-Blanco, Rosario Amaya-Villar, Manuel E. Jiménez-Mejías, José Antonio Lepe, Walter Alfredo Goycochea-Valdivia, Germán Peñalva, Carmen Ferrándiz-Millón |
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| Přispěvatelé: | Junta de Andalucía |
| Rok vydání: | 2020 |
| Předmět: |
0301 basic medicine
Microbiology (medical) Antifungal medicine.medical_specialty Antifungal Agents medicine.drug_class 030106 microbiology Bed days Antimicrobial Stewardship 03 medical and health sciences 0302 clinical medicine Internal medicine medicine Humans Antimicrobial stewardship 030212 general & internal medicine Fluconazole Candida business.industry Incidence Mortality rate Incidence (epidemiology) Candidemia Interrupted time series Confidence interval Infectious Diseases Candida spp business |
| Zdroj: | Digital.CSIC. Repositorio Institucional del CSIC instname |
| ISSN: | 0163-4453 |
| DOI: | 10.1016/j.jinf.2020.01.002 |
| Popis: | [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 [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. The program received public funding from the Regional Health Ministry of Andalucía (Grant PI-0361-2010), which did not participate in the development of the program or the analysis of its results. |
| Databáze: | OpenAIRE |
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