240. A Matched-Controlled Evaluation of an Antifungal Bundle in the Intensive Care Unit (ICU) at a University Teaching Hospital
Session: Poster Abstract Session: Antimicrobial Stewardship in Clinical Practice
Friday, October 21, 2011
Room: Poster Hall B1

Care bundles have recently become important in antimicrobial stewardship efforts.  Echinocandins are expensive antifungals that are often overutilized in the ICU setting. We implemented an antifungal bundle to encourage appropriate use of antifungals in the ICU.  The primary objective of this study is to assess the utility of an antifungal bundle that specifically targets caspofungin use in the ICU.


This is a matched-controlled study of 75 adult patients prescribed caspofungin therapy in the ICU setting at an academic medical center.  The antifungal bundle was implemented over a five-month time period in 2011.  Bundle patients were compared to control group patients who received treatment within a two year time period prior to initiation of the bundle protocol. Patients were matched based on age, gender, ICU service, indication, and modified APACHE II score in a 1:2 ratio.  Key components of the bundle include assessment of drug indication, dose, interval, and planned duration of therapy.


We found a significant difference in median days of therapy (4.5 vs. 2.0 days, p=0.005) for caspofungin use before and after bundle implementation.  Most of this reduction in use was realized in the medical ICU (p=0.02) as opposed to the surgical ICU (p=0.54).  Based on average wholesale price (AWP), these findings reflect a median cost savings of approximately $1,013 per patient.  Although adherence to bundle criteria was higher in the medical ICU compared to the surgical ICU, these differences were not found to be statistically significant (76% vs. 50%, respectively; p=0.36).  Of 25 patients receiving caspofungin during the bundle period, three were de-escalated to fluconazole and 13 had antifungal therapy discontinued within three days.  Eleven of these patients had yeast culture growth from either BAL or urine specimens.  None of the patients in the bundle implementation group experienced recurrence or death from a fungal infection.


Use of an antifungal bundle approach appears to facilitate a reduction in echinocandin use in the ICU without adversely affecting patient outcomes.

Subject Category: J. Clinical practice issues

Anthony Guarascio, Pharm.D.1, Douglas Slain, Pharm.D., FCCP2, Arif Sarwari, MD, MSc1, Richard McKnight, Pharm.D.3, Karen Petros, Pharm.D.3, John Parker, MD, FACP, FCCP3, Alison Wilson, MD, FACS3, Maria Pompili, Pharm.D.3, Melissa Rinehart, Pharm.D.3 and Carrie Defazio, Pharm.D.3, (1)West Virginia University, Morgantown, WV, (2)West Virginia University , Morgantown, WV, (3)West Virginia University Hospitals, Morgantown, WV


A. Guarascio, None

D. Slain, None

A. Sarwari, None

R. McKnight, None

K. Petros, None

J. Parker, None

A. Wilson, None

M. Pompili, None

M. Rinehart, None

C. Defazio, None

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