1
|
Bienvenu AL, Argaud L, Aubrun F, Fellahi JL, Guerin C, Javouhey E, Piriou V, Rimmele T, Chidiac C, Leboucher G. A systematic review of interventions and performance measures for antifungal stewardship programmes. J Antimicrob Chemother 2019; 73:297-305. [PMID: 29155990 DOI: 10.1093/jac/dkx388] [Citation(s) in RCA: 37] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2017] [Accepted: 09/26/2017] [Indexed: 01/31/2023] Open
Abstract
Objectives Antifungal resistance is a significant and emerging threat. Stewardship programmes (SPs) have been proposed as an opportunity to optimize antifungal use. While examples of antifungal SP implementation have been recently described, there is yet to be an overview of interventions and their impacts on performance measures. Methods We systematically reviewed published articles using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses check-list 2009. MEDLINE was searched using the term 'antifungal stewardship' on 15 February 2017. Eligible studies were those that described an antifungal SP and included an intervention and an evaluation of performance measures. Results A total of 97 studies were identified and 14 were included. Only five studies reported an antifungal stewardship team composed of all the recommended members. The main intervention was the formulation of recommendations to change treatment (12 of 14). The main performance measure collected was antifungal consumption (10 of 14), followed by antifungal expenditure (7 of 14), adherence to therapeutic advice (4 of 14) and impact on mortality (4 of 14). Antifungal consumption was reduced by 11.8% to 71% and antifungal expenditure by as much as 50%. Adherence to therapeutic advice ranged from 40% to 88%, whereas antifungal SPs had no impact on mortality. Conclusions All antifungal SPs had an impact, in particular on antifungal consumption and antifungal expenditure. Active intervention including a review of prescriptions seems to have more impact than implementation of treatment guidelines only. According to available published studies, antifungal consumption appears to be the most achievable performance measure to evaluate the impact of an antifungal SP.
Collapse
Affiliation(s)
- A L Bienvenu
- Service Pharmacie, Groupement Hospitalier Nord, Hospices Civils de Lyon, Lyon, France.,UMR-CNRS 5246, Campus Lyon La Doua, University Lyon 1, Lyon, France
| | - L Argaud
- Service de Réanimation Médicale, Hôpital Edouard Herriot, Hospices Civils de Lyon, Lyon, France
| | - F Aubrun
- Service de Réanimation Chirurgicale, Groupement Hospitalier Nord, Hospices Civils de Lyon, Lyon, France
| | - J L Fellahi
- Service d'Anesthésie-Réanimation, Groupement Hospitalier Est, Hospices Civils de Lyon, Lyon, France.,Faculté de Médecine Lyon Est, University Lyon 1, Lyon, France
| | - C Guerin
- Service de Réanimation Médicale, Groupement Hospitalier Nord, Hospices Civils de Lyon, Lyon, France
| | - E Javouhey
- Service de Réanimation Pédiatrique, Hôpital Femme Mère Enfant, Hospices Civils de Lyon, Lyon, France
| | - V Piriou
- Service de Réanimation Médicale, Groupement Hospitalier Sud, Hospices Civils de Lyon, Lyon, France
| | - T Rimmele
- Service d'Anesthésie-Réanimation, Hôpital Edouard Herriot, Hospices Civils de Lyon, Lyon, France
| | - C Chidiac
- Service des Maladies Infectieuses, Groupement Hospitalier Nord, Hospices Civils de Lyon, Lyon, France
| | - G Leboucher
- Service Pharmacie, Groupement Hospitalier Nord, Hospices Civils de Lyon, Lyon, France
| |
Collapse
|