Related Experiment Video
Updated: Jun 25, 2025
Author Spotlight: Advancing Pathogen Detection and Disease Assessment in Real-Time Using M-ROSE
Published on: March 1, 2024
The practice and evaluation of antifungal stewardship programs at a tertiary first-class hospital in China
Huiyuan Zhang1, Yinglin Wang1, Ruigang Diao1
1Department of Pharmacy, Yantai Yuhuangding Hospital, Yantai, Shandong Province, China.
Background:
The sharp increase in fungal infections, insufficient diagnostic and treatment capabilities for fungal infections, poor prognosis of patients with fungal infections as well as the increasing drug resistance of fungi are serious clinical problems. It is necessary to explore the implementation and evaluation methods of antifungal stewardship (AFS) to promote the standardized use of antifungal drugs.
Methods:
The AFS programme was implemented at a tertiary first-class hospital in China using a plan-do-check-act (PDCA) quality management tool. A baseline investigation was carried out to determine the utilization of antifungal drugs in pilot hospitals, analyse the existing problems and causes, and propose corresponding solutions. The AFS programme was proposed and implemented beginning in 2021, and included various aspects, such as team building, establishment of regulations, information construction, prescription review and professional training. The management effectiveness was recorded from multiple perspectives, such as the consumption of antifungal drugs, the microbial inspection rate of clinical specimens, and the proportion of rational prescriptions. The PDCA management concept was used for continuous improvement to achieve closed-loop management.
Results:
In the first year after the implementation of the AFS programme, the consumption cost, use intensity and utilization rate of antifungal drugs decreased significantly (P < 0.01). The proportion of rational antifungal drug prescriptions markedly increased, with the proportion of prescriptions with indications increasing from 86.4% in 2019 to 97.0% in 2022, and the proportion of prescriptions with appropriate usage and dosage increased from 51.9 to 87.1%. In addition, after the implementation of the AFS programme, physicians' awareness of the need to complete microbial examinations improved, and the number of fungal cultures and serological examinations increased substantially. Statistics from drug susceptibility tests revealed a decrease in the resistance rate of Candida to fluconazole.
Conclusion:
This study indicated that the combination of AFS and the PDCA cycle could effectively reduce antifungal consumption and promote the rational use of antifungal drugs, providing a reference for other health care systems to reduce the overuse of antifungal drugs and delay the progression of fungal resistance.
Insights
Implementing antifungal stewardship (AFS) with PDCA management significantly reduced antifungal drug use and improved prescription rationality. This approach helps combat rising fungal infections and antimicrobial resistance.
Area of Science:
- Infectious Diseases
- Pharmacology
- Healthcare Management
Background:
- Rising rates of fungal infections pose significant clinical challenges.
- Insufficient diagnostics, treatments, and increasing antifungal drug resistance necessitate improved strategies.
- Antifungal stewardship (AFS) is crucial for standardizing antifungal drug use.
Purpose of the Study:
- To implement and evaluate an Antifungal Stewardship (AFS) program.
- To promote the standardized and rational use of antifungal drugs.
- To reduce antifungal consumption and combat antifungal resistance.
Main Methods:
- Implemented an AFS program in a Chinese tertiary hospital using the Plan-Do-Check-Act (PDCA) cycle.
- Conducted baseline investigations on antifungal drug utilization and identified problem areas.
- Focused on team building, regulations, information systems, prescription review, and training.
Main Results:
- Significant reduction in antifungal drug consumption cost, use intensity, and utilization rate (P < 0.01).
- Marked increase in rational antifungal prescriptions: indications rose from 86.4% to 97.0%, appropriate usage from 51.9% to 87.1%.
- Increased microbial examinations and a decrease in Candida fluconazole resistance rates.
Conclusions:
- Combining AFS with the PDCA cycle effectively reduces antifungal drug consumption.
- Promotes rational use of antifungal drugs and provides a model for other healthcare systems.
- Helps mitigate overuse of antifungals and delays the progression of fungal resistance.
