抗真菌
医学
管理(神学)
心理干预
抗真菌药
重症监护医学
不利影响
干预(咨询)
抗菌管理
内科学
生物
微生物学
护理部
抗生素
法学
皮肤病科
抗生素耐药性
政治
政治学
作者
Syuri Ito‐Takeichi,Takashi Niwa,Ayasa Fujibayashi,Keiko Suzuki,Hiroyuki Ohta,Ayumi Niwa,Mayumi Tsuchiya,Masayo Yamamoto,Daijiro Hatakeyama,Akio Suzuki,Hisashi Baba,Nobuo Murakami,Yoshinori Itoh
摘要
What is known and objective Implementation of an antifungal stewardship programme is a recognized need. However, there is insufficient information to confirm the impact of antifungal stewardship interventions. Further, few studies have evaluated the clinical effects of an antifungal stewardship intervention using 1-3, β-D-glucan (βDG) testing. The aim of the present study was to evaluate the impact of implementing an antifungal stewardship with monitoring of βDG values on antifungal use and clinical outcomes. Methods A single institutional prospective cohort study was conducted to evaluate the impact of implementing daily reviews of antifungal agents and monitoring patients who measured βDG values since August 2013. Antifungal consumption and clinical outcomes in patients with Candida bloodstream infection were compared before and after the intervention. Results After implementation of the programme, parental antifungal use was significantly reduced compared to that before intervention (P = 0.006). In the after-intervention group, the rate of 60-day clinical failure in patients with Candida bloodstream infection was significantly reduced, from 80.0% (28/35) to 36.4% (8/22) (P < 0.001), and the rate of 60-day mortality associated with Candida bloodstream infection tended to be reduced, from 42.9% (15/35) to 18.2% (4/22) (P = 0.081) compared to the before-intervention group. The incidence of adverse events associated with antifungal agents was significantly lower in the after-intervention group than in the before-intervention group (51.4% [18/35] vs 13.6% [3/22], P = 0.004). What is new and conclusion Our findings suggest that daily review of the use of antifungal agents and monitoring of measured βDG values was highly effective in reducing antifungal consumption and improving the clinical outcomes of patients with Candida bloodstream infection.
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