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Published on: April 19, 2017
A matched-control evaluation of an antifungal bundle in the intensive care unit at a university teaching hospital
Anthony J Guarascio1, Douglas Slain, Richard McKnight
1College of Pharmacy, University of Tennessee Health Science Center, 1924 Alcoa Highway, Box 117, Knoxville, TN 37920, USA. aguarasc@uthsc.edu
Background:
Antimicrobial use bundles are becoming a common means of implementing antimicrobial stewardship initiatives in the hospital setting. Although the utility of these bundles has been described for many disease states, their adoption for antifungal therapy management is largely unknown.
Objective:
Our objective was to assess the utility of an antifungal bundle protocol in limiting excessive use of echinocandins in the intensive-care inpatient setting.
Methods:
In this matched-control evaluation, pre-protocol control patients were matched with each prospective patient in a 2:1 ratio using five demographic and clinical characteristics. The impact of the antifungal bundle protocol on caspofungin days of therapy, drug costs, and adherence to bundle criteria was assessed.
Results:
A significant reduction in median days of caspofungin therapy (4.00 vs. 2.00 days, p = 0.001) was found in the bundle group. Most of this reduction in use was realized in the medical ICU (p = 0.002) as opposed to the surgical ICU (p = 0.188).
Conclusions:
Use of an antifungal bundle approach appears to facilitate a reduction in caspofungin use in the ICU without adversely affecting patient outcomes. Further trials are needed to assess the utility of such bundles in providing antimicrobial stewardship for antifungal drug use.
Insights
An antifungal bundle protocol effectively reduced echinocandin use in intensive care units. This antimicrobial stewardship strategy limited caspofungin therapy days without negatively impacting patient outcomes.
Area of Science:
- Infectious Diseases
- Critical Care Medicine
- Pharmacology
Background:
- Antimicrobial stewardship programs are crucial for optimizing drug use in hospitals.
- Antifungal therapy management, particularly with echinocandins, requires effective stewardship strategies.
- The adoption of antifungal bundles for stewardship is not well-established.
Purpose of the Study:
- To evaluate the effectiveness of an antifungal bundle protocol in reducing echinocandin use.
- To assess the impact of the protocol on caspofungin therapy duration and costs in intensive care units.
- To determine adherence to antifungal bundle criteria.
Main Methods:
- A matched-control evaluation comparing pre-protocol and prospective patient groups.
- Patients were matched in a 2:1 ratio based on demographic and clinical characteristics.
- Assessed outcomes included caspofungin days of therapy, drug costs, and adherence to bundle criteria.
Main Results:
- A significant reduction in median caspofungin days of therapy was observed in the bundle group (4.00 vs. 2.00 days, p = 0.001).
- The reduction in caspofungin use was more pronounced in the medical ICU compared to the surgical ICU.
- Adherence to bundle criteria and impact on drug costs were also assessed.
Conclusions:
- The antifungal bundle approach successfully reduced caspofungin use in the ICU setting.
- The implemented strategy did not adversely affect patient outcomes.
- Further research is warranted to explore the broader utility of antifungal stewardship bundles.
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