Efficacy and safety of a comprehensive educational antimicrobial stewardship program focused on antifungal use.
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.
['Martín-Gutiérrez|Guillermo|G|', 'Peñalva|Germán|G|', 'Ruiz-Pérez de Pipaón|Maite|M|', 'Aguilar|Manuela|M|', 'Gil-Navarro|María Victoria|MV|', 'Pérez-Blanco|José Luis|JL|', 'Pérez-Moreno|María Antonia|MA|', 'Amaya-Villar|Rosario|R|', 'Ferrándiz-Millón|Carmen|C|', 'Gascón|María L|ML|', 'Goycochea-Valdivia|Walter A|WA|', 'Jiménez-Mejías|Manuel E|ME|', 'Navarro|María Dolores|MD|', 'Lepe|José A|JA|', 'Alvarez-Marín|Rocío|R|', 'Neth|Olaf|O|', 'Guisado-Gil|Ana B|AB|', 'Infante-Domínguez|Carmen|C|', 'Molina|José|J|', 'Cisneros|José M|JM|', '|||']
D000935:Antifungal Agents D000073602:Antimicrobial Stewardship D002175:Candida D058387:Candidemia D015725:Fluconazole D006801:Humans D015994:Incidence
Antimicrobial stewardship programs Antifungal consumption Hospital-acquired candidemia Educational interviews