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Antifungal Stewardship in Invasive Fungal Infections, a Systematic Review
Cataldo Procacci1, Luisa Marras2, Leonarda Maurmo3
1Pharmaceutical Department, ASL BAT, Barletta - Adria - Trani, Italy.
Introduction:
Invasive fungal infections (IFI) are a group of life-threatening diseases associated with significant morbidity, mortality and high healthcare costs. Some modern management programs known as AFS (antifungal stewardship programs) have now been developed. The purpose of this systematic review is to evaluate the different declinations of antifungal stewardship programs (AFPs).
Methods:
Articles were systematically reviewed using the PRISMA checklist 2020. EMBASE and MEDLINE/PubMED were searched using the term "antifungal stewardship" (2012-2022 data) on 2 January 2023. Eligible studies were those that described an AFS and included an intervention, performance evaluation and outcome measures.
Results:
A total of 22/796 studies were included. Approximately two-thirds (16) were published between 2018 and 2022. 16 (72.7%) stated a minimal complete AFS team. 12 (54.5%) adopted a non-compulsory AFS approach, 6(27.3%) had an Educational AFS and 4(18.2%) a compulsory AFS. Cost analyses of 12 studies showed a decrease for 7 (31.8%) compared to an increase for 5 (22.7%). In terms of outcomes, 18 studies showed a lower (10;45.5%) or the same (8;36.4%) pre-post intervention mortality rate.
Conclusion:
AFS programs seem to be related to lower costs and better outcomes and should thus be implemented in tandem with antimicrobial stewardship programs.
Insights
Antifungal stewardship programs (AFPs) are associated with reduced healthcare costs and improved patient outcomes. Implementing these programs alongside antimicrobial stewardship can enhance patient care and reduce mortality rates.
Area of Science:
- Infectious Diseases
- Healthcare Management
- Clinical Pharmacy
Background:
- Invasive fungal infections (IFIs) pose significant threats, causing high morbidity, mortality, and healthcare expenses.
- Antifungal stewardship programs (AFPs) have emerged as a modern strategy to manage IFIs.
- This systematic review evaluates the various implementations of AFPs.
Purpose of the Study:
- To systematically review and evaluate different declinations of antifungal stewardship programs (AFPs).
- To assess the impact of AFPs on healthcare costs and patient outcomes.
Main Methods:
- Systematic review adhering to the PRISMA 2020 checklist.
- Searched EMBASE and MEDLINE/PubMED for studies on "antifungal stewardship" from 2012-2022.
- Included studies describing AFPs with interventions, performance evaluation, and outcome measures.
Main Results:
- 16 of 22 included studies were published between 2018-2022, with most reporting complete AFP teams.
- A majority of AFPs were non-compulsory (54.5%) or educational (27.3%).
- Cost analyses indicated cost decreases in 31.8% of studies, while 45.5% showed reduced mortality rates.
Conclusions:
- Antifungal stewardship programs demonstrate a positive association with reduced costs and improved patient outcomes.
- AFPs should be implemented in conjunction with antimicrobial stewardship programs.
- The findings support the broader adoption of structured AFP interventions.
