Antifungal stewardship in practice: Insights from a prospective audit and feedback program

Area of Science:

• Infectious Diseases
• Antimicrobial Stewardship
• Pharmacology

Background:

• Antimicrobial stewardship programs (ASPs) are crucial for optimizing antibiotic and antifungal use.
• Prospective audit and feedback (PAF) is a key strategy within ASPs.
• Limited data exists on the characteristics and effectiveness of antifungal PAF compared to antibiotic PAF.

Purpose of the Study:

• To characterize antifungal prospective audit and feedback (PAF).
• To compare the rates of PAF recommendation and acceptance between antifungal and antibiotic agents.
• To identify factors influencing antifungal and antibiotic PAF recommendation and acceptance rates.

Main Methods:

• Retrospective cohort study of audits from a children's hospital ASP (Nov 2020 - Oct 2022).
• Data included 10,402 antimicrobial audits (17% antifungal, 83% antibiotic).
• Descriptive statistics and comparative analyses were used to assess recommendation and acceptance rates.

Main Results:

• Antifungal audits comprised 17% of total antimicrobial audits.
• Antibiotics had higher recommendation rates (29%) than antifungals (21%; P < .001).
• Recommendation acceptance rates were similar for antifungals and antibiotics; discontinuation/monitoring recommendations were more common for antifungals.

Conclusions:

• Antifungal PAF highlights opportunities for optimizing specific agent use and targeting medical services.
• Antifungal PAF, though yielding fewer recommendations than antibiotic PAF, demonstrated comparable acceptance rates.
• Antifungal stewardship through PAF presents a promising avenue for improving antifungal utilization.