The impact of implementing an antifungal stewardship with monitoring of 1-3, β-D-glucan values on antifungal consumption and clinical outcomes.

Abstract

Implementation of an antifungal stewardship programme is a recognized need. However, there is insufficient information to confirm the impact of antifungal stewardship interventions. Further, few studies have evaluated the clinical effects of an antifungal stewardship intervention using 1-3, β-D-glucan (βDG) testing. The aim of the present study was to evaluate the impact of implementing an antifungal stewardship with monitoring of βDG values on antifungal use and clinical outcomes. A single institutional prospective cohort study was conducted to evaluate the impact of implementing daily reviews of antifungal agents and monitoring patients who measured βDG values since August 2013. Antifungal consumption and clinical outcomes in patients with Candida bloodstream infection were compared before and after the intervention. After implementation of the programme, parental antifungal use was significantly reduced compared to that before intervention (P=0.006). In the after-intervention group, the rate of 60-day clinical failure in patients with Candida bloodstream infection was significantly reduced, from 80.0% (28/35) to 36.4% (8/22) (P<0.001), and the rate of 60-day mortality associated with Candida bloodstream infection tended to be reduced, from 42.9% (15/35) to 18.2% (4/22) (P=0.081) compared to the before-intervention group. The incidence of adverse events associated with antifungal agents was significantly lower in the after-intervention group than in the before-intervention group (51.4% [18/35] vs 13.6% [3/22], P=0.004). Our findings suggest that daily review of the use of antifungal agents and monitoring of measured βDG values was highly effective in reducing antifungal consumption and improving the clinical outcomes of patients with Candida bloodstream infection.