Related Experiment Video
Updated: Jul 5, 2025
Whole Genome Sequencing of Candida glabrata for Detection of Markers of Antifungal Drug Resistance
Published on: December 28, 2017
The Impact of Antifungal Stewardship on Clinical and Performance Measures: A Global Systematic Review
Fares Albahar1, Hamza Alhamad1, Mohammad Abu Assab1
1Department of Clinical Pharmacy, Faculty of Pharmacy, Zarqa University, P.O. Box 2000, Zarqa 13110, Jordan.
Background:
Antimicrobial stewardship programs (ASP) have been proposed as an opportunity to optimize antifungal use. The antifungal resistance is a significant and emerging threat. The literature on antifungal stewardship (AFS) and its influence on performance and clinical outcome measures is scarce. This study aimed to examine global evidence of the impact of AFS on patients and performance measures.
Methods:
The "Preferred Reporting Items for Systematic Reviews and Meta-Analyses" (PRISMA) was used for the flow of identification, screening, eligibility, and inclusion. PubMed and MEDLINE were searched using the term ''antifungal stewardship'' on 15 February 2023. Search terms included antifungal stewardship, antimicrobial stewardship, candida, candidemia, candiduria, and invasive fungal disease. Of the 1366 records, 1304 were removed since they did not describe an antifungal stewardship intervention. Among the 62 full texts assessed, 21 articles were excluded since they were non-interventional studies and did not include the outcome of interest. Thus, 41 articles were eligible for systematic review. Eligible studies were those that described an AFS program and evaluated clinical or performance measures.
Results:
Of the 41 included studies, the primary performance measure collected was antifungal consumption (22 of 41), and mortality (22 of 41), followed by length of stay (11 of 41) and cost (9 of 41). Most studies were single-center, quasi-experimental, with varying interventions across studies. The principal finding from most of the studies in this systematic review is a reduction in mortality expressed in different units and the use of antifungal agents (13 studies out of 22 reporting mortality). Antifungal consumption was significantly blunted or reduced following stewardship initiation (10 of 22). Comparing studies was impossible due to a lack of standard units, making conducting a meta-analysis unfeasible, which would be a limitation of our study.
Conclusion:
It has been shown that AFS interventions may improve antifungal consumption and other performance measures. According to available published studies, antifungal consumption and mortality appear to be the possible performance measures to evaluate the impact of AFS.
Insights
Antifungal stewardship (AFS) programs can reduce antifungal use and mortality. This systematic review highlights AFS as a key strategy to improve patient outcomes and optimize antifungal consumption.
Area of Science:
- Infectious Diseases
- Clinical Pharmacy
- Public Health
Background:
- Antimicrobial stewardship programs (ASP) are crucial for optimizing antimicrobial use.
- Antifungal resistance is a growing global health concern.
- Limited data exists on the impact of antifungal stewardship (AFS) on clinical and performance outcomes.
Purpose of the Study:
- To systematically review global evidence on the impact of antifungal stewardship interventions.
- To assess the influence of AFS on patient outcomes and performance measures.
- To identify key performance indicators for evaluating AFS effectiveness.
Main Methods:
- Systematic review following PRISMA guidelines.
- Searched PubMed and MEDLINE for studies on antifungal stewardship interventions.
- Included 41 studies evaluating clinical or performance measures related to AFS.
Main Results:
- Most studies reported reductions in mortality and antifungal consumption.
- Antifungal consumption decreased significantly post-AFS implementation in 10 of 22 studies.
- Mortality rates improved in 13 of 22 studies reporting this outcome.
Conclusions:
- Antifungal stewardship interventions demonstrate potential to improve antifungal consumption.
- AFS programs may lead to better patient outcomes, particularly reduced mortality.
- Antifungal consumption and mortality are key performance measures for evaluating AFS impact.
