Impact of Education and an Antifungal Stewardship Program for Candidiasis at a Thai Tertiary Care Center

Abstract

We evaluated the impact of education and an antifungal stewardship program for candidiasis on prescribing practices, antifungal consumption, Candida species infections, and estimated costs at a Thai tertiary care hospital. A hospital-wide, quasi-experimental study was conducted for 1.5 years before the intervention and 1.5 years after the implementation of an antifungal stewardship program. Inpatient antifungal prescriptions were prospectively observed, and patients' demographic, clinical, and administrative-cost data were collected. Interventions included education, introduction of an antifungal hepatic and/or renal dose adjustment tool, antifungal prescription forms, and prescription-control strategies. After the intervention, there was a 59% reduction in antifungal prescriptions (from 194 to 80 prescriptions per 1,000 hospitalizations; P<.001). Inappropriate antifungal use decreased (from 71% to 24%; P<.001), a sustained reduction in antifungal use was observed (r=0.83; P<.001), and fluconazole use decreased (from 242 to 117 defined daily doses per 1,000 patient-days; P<.001). Reductions in the incidence of infection with Candida glabrata (r=0.69; P<.001) and Candida krusei (r=0.71; P<.001) were observed, whereas the incidence of infection with Candida albicans (r=-0.81; P<.001) increased. Total cost savings were US$31,615 during the 18-month postintervention period. Implementation of an antifungal stewardship program was associated with appropriate antifungal drug use, improved resource utilization, and cost savings.