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The effects of antifungal stewardship programs at a tertiary-care teaching hospital in Japan
Hiroshi Kawaguchi1, Koichi Yamada2, Waki Imoto3
1Department of Pharmacy, Osaka City University Hospital, 1-5-7, Asahi-machi, Abeno-ku, Osaka-shi, Osaka, 545-8586 Japan; Department of Infection Control Science, Graduate School of Medicine, Osaka City University, 1-4-3, Asahi-machi, Abeno-ku, Osaka-shi, Osaka, 545-8585 Japan.
Abstract:
Patients with invasive fungal diseases (IFDs) generally have a high mortality rate, and resistance to antifungal drugs and the high costs associated with it have led to recent problems, necessitating the appropriate use of antifungals. To this end, we launched Antifungal Stewardship Programs (AFSPs) in our hospital. Patients who were systemically administered antifungals from January 2011 to December 2016 were enrolled this study and divided into pre-intervention and intervention groups. No significant difference was observed in defined daily doses per 1000 patient-days (23.3 ± 8.0 vs 20.4 ± 10.8, p = 0.251) between the groups. The monthly average for the days of therapy per 1000 patient-days was significantly lower in the intervention group (15.1 ± 3.1 vs 12.7 ± 4.3, p = 0.009). The cost of the antifungals reduced over the 3-year period by $260,520 (13.5%). Furthermore, a decreasing trend was observed in both the 30-day mortality (40.9% vs 30.0%, p = 0.414) and in-hospital mortality (63.6% vs 36.7%, p = 0.054) in patients with candidemia. Our results indicate that AFSPs are efficacious and cost-effective approaches.
Insights
Antifungal Stewardship Programs (AFSPs) significantly reduced antifungal therapy duration and costs. These programs show promise in improving patient outcomes for invasive fungal diseases, demonstrating cost-effectiveness.
Area of Science:
- Infectious Diseases
- Pharmacoeconomics
- Antimicrobial Stewardship
Background:
- Invasive fungal diseases (IFDs) are associated with high mortality rates.
- Antifungal drug resistance and high treatment costs pose significant challenges.
- Appropriate antifungal use is crucial for patient management.
Purpose of the Study:
- To evaluate the efficacy and cost-effectiveness of Antifungal Stewardship Programs (AFSPs).
- To assess the impact of AFSPs on antifungal utilization and patient outcomes.
Main Methods:
- A study was conducted enrolling patients receiving systemic antifungals from January 2011 to December 2016.
- Patients were divided into pre-intervention and intervention groups.
- Key metrics included defined daily doses, days of therapy, mortality rates, and antifungal costs.
Main Results:
- No significant difference in defined daily doses per 1000 patient-days was observed.
- The monthly average days of therapy per 1000 patient-days were significantly lower in the intervention group (p=0.009).
- Antifungal costs decreased by $260,520 (13.5%) over three years, with a trend towards reduced 30-day and in-hospital mortality in candidemia patients.
Conclusions:
- Antifungal Stewardship Programs are effective in optimizing antifungal use.
- AFSPs demonstrate significant cost savings and a positive trend in patient mortality.
- Implementation of AFSPs is recommended for managing invasive fungal diseases.
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