A collaborative and non-compulsory antifungal stewardship program (AFS) based on education, improved microbiological diagnosis and bedside intervention on restricted antifungals, was implemented in our center in 2010. We performed our second quality survey in order to assess the impact of these years of AFS on the use of antifungals and to identify potential targets for improving the prescription quality.
From April 2015 to May 2015, we identified 94 consecutive adult inpatients receiving a systemic antifungal. No intervention was performed during the study period. Antifungal use was evaluated by means of a predefined 10- point score described by our group in the first survey that evaluated indication, drug selection, dose, adjustment, administration route and length of therapy (Valerio et al, JAC 2014). Results of both studies were compared.
Antifungal drugs were prescribed in the following departments: oncology/hematology 39.4%, medical 36.2%, surgical 19.1% and ICUs 5.3%. Indications were: targeted treatment (40% vs 20% in the previous report) followed by empirical or prophylactic therapy (28.7% each). An IFI was finally demonstrated in 43.1%.
Present results compared with our previous study showed a slight deterioration of the mean point score for antifungal use (7.38±2.54. vs 7.7±2.6; p=0.5), mainly due to a higher rate of mistakes in antifungal indication (27% vs 16%; p=0.06). Indication of candins was less frequently incorrect than fluconazole’s (20%vs 34.1%, p=0.15). There were less errors in drug selection (19% vs 31%; p= 0.07) and less lack of adjustment to microbiological results (29% vs 35%; p=0.44). Problems related to incorrect dosing (16% vs 18%, p=1), lack of switch to oral route (20% vs 19%, p=1) and length of antifungal therapy (27% vs 26%, p=1) remained stable.
Presence of yeasts in the urinary sediment (with negative culture) and isolation of Candida spp. from wound specimens were the most frequent reasons for an incorrect indication of antifungal drugs and will be the targets for our next intervention.
Our study demonstrates that, even after years of AFS programs, avoidable mistakes are still present and that almost one third of the prescribed antifungals are not necessary..(This study was partially financed by PROMULGA Project. Instituto de Salud Carlos III. PI1002868).
M. Mateos, None
M. Valerio, None
C. Rodriguez, None
E. Bouza, None
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