A Prospective Real-World Study of the Impact of an Antifungal Stewardship Program in a Tertiary Respiratory-Medicine Setting.
| Title: | A Prospective Real-World Study of the Impact of an Antifungal Stewardship Program in a Tertiary Respiratory-Medicine Setting. |
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| Authors: | Nwankwo L; Department of Pharmacy, Royal Brompton & Harefield NHS Foundation Trust, London, United Kingdom.; Periselneris J; Department of Respiratory Medicine, Royal Brompton & Harefield NHS Foundation Trust, London, United Kingdom jperiselneris@nhs.net.; Cheong J; Department of Pharmacy, Royal Brompton & Harefield NHS Foundation Trust, London, United Kingdom.; Thompson K; Department of Pharmacy, Royal Brompton & Harefield NHS Foundation Trust, London, United Kingdom.; Darby P; Department of Microbiology, Royal Brompton & Harefield NHS Foundation Trust, London, United Kingdom.; Leaver N; Immunosuppression Monitoring Service, Royal Brompton & Harefield NHS Foundation Trust, London, United Kingdom.; Schelenz S; Department of Microbiology, Royal Brompton & Harefield NHS Foundation Trust, London, United Kingdom.; Armstrong-James D; Faculty of Medicine, National Heart & Lung Institute, Imperial College London, London, United Kingdom. |
| Source: | Antimicrobial agents and chemotherapy [Antimicrob Agents Chemother] 2018 Sep 24; Vol. 62 (10). Date of Electronic Publication: 2018 Sep 24 (Print Publication: 2018). |
| Publication Type: | Journal Article; Research Support, Non-U.S. Gov't |
| Language: | English |
| Journal Info: | Publisher: American Society for Microbiology Country of Publication: United States NLM ID: 0315061 Publication Model: Electronic-Print Cited Medium: Internet ISSN: 1098-6596 (Electronic) Linking ISSN: 00664804 NLM ISO Abbreviation: Antimicrob Agents Chemother Subsets: MEDLINE |
| Imprint Name(s): | Original Publication: Washington, American Society for Microbiology |
| MeSH Terms: | Antifungal Agents/*therapeutic use ; Pulmonary Aspergillosis/*drug therapy; Tertiary Care Centers/statistics & numerical data ; Triazoles/therapeutic use ; Voriconazole/therapeutic use ; Aged ; Female ; Humans ; Male ; Middle Aged ; Prospective Studies |
| Abstract: | There has been an increase in fungal infections in patients with chronic lung disease over the past decades, which is associated with rapidly increasing costs to health care systems. An antifungal stewardship team was introduced to a tertiary cardiopulmonary hospital, consisting of a medical mycologist and pharmacy support providing weekly stewardship ward rounds, twice-monthly multidisciplinary team meetings, and a dedicated weekly outpatient clinic. A database was set up to record the activity of the stewardship team. During the first 18 months of implementation, the antifungal stewardship team had reviewed 178 patients, with 285 recommendations made to inpatients, and 287 outpatient visits. The commonest diagnoses treated were allergic bronchopulmonary aspergillosis and chronic pulmonary aspergillosis. Cystic fibrosis was the largest patient group treated, followed by asthma and interstitial lung disease. There was a significant sustained reduction in monthly antifungal expenditure (P = 0.005) by £130,000 per month. There was also a significant reduction in antifungal use, measured as the defined daily dose/100 bed days (P = 0.017). There were no significant changes in expenditure on diagnostic tests. There has been a trend toward more patients having therapeutic levels of voriconazole (P = 0.086) and a significant increase in therapeutic levels of posaconazole (P < 0.0001). This study shows that an effective antifungal stewardship program can significantly reduce expenditure in a specialist respiratory service.; (Copyright © 2018 American Society for Microbiology.) |
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| Contributed Indexing: | Keywords: antifungal agents; antifungal therapy |
| Substance Nomenclature: | 0 (Antifungal Agents); 0 (Triazoles); 6TK1G07BHZ (posaconazole); JFU09I87TR (Voriconazole) |
| Entry Date(s): | Date Created: 20180718 Date Completed: 20190930 Latest Revision: 20190930 |
| Update Code: | 20260130 |
| PubMed Central ID: | PMC6153826 |
| DOI: | 10.1128/AAC.00402-18 |
| PMID: | 30012769 |
| Database: | MEDLINE |
Journal Article; Research Support, Non-U.S. Gov't