Effects of Antifungal Stewardship on Outcomes of Patients with Candidemia in a Small and Medium-Sized Hospital

• Published in: Japanese Journal of Infection Prevention and Control Vol. 37; no. 5; pp. 210 - 215
• Main Authors: HOSHI, Takanobu, WADA, Naoki, IBATA, Risa, SUGANUMA, Misato, MATSUDA, Manabu, YAMADA, Kazunori, SATO, Hideki
• Format: Journal Article
• Language: Japanese
• Published: Japanese Society for Infection Prevention and Control 25.09.2022
• Subjects: candidemia; support for appropriate use of antifungal drugs
• ISSN: 1882-532X; 1883-2407
• DOI: 10.4058/jsei.37.210

This study aimed to investigate the effectiveness of antifungal stewardship (AFS) and the intervention points of AFS among patients with candidemia in small and medium-sized hospitals. To this end, hospitalized patients from whose blood cultures Candida spp. were isolated from April 2016 to March 2020 were included. The patients were assigned to the pre-intervention group (2016-2017) and post-intervention group (2018-2019), and the changes in patient outcomes before and after aggressive AFS were compared. Overall, 51 patients (28 and 23 in the pre-intervention and post-intervention groups, respectively) were included in the study, and four were excluded. The 30-day mortality rates were 39.3% and 39.1% in the pre-intervention and post-intervention groups, respectively, with the intergroup difference not being significant. The rate of change in the type of antifungal medication significantly increased from 7.1% in the pre-intervention group to 44.0% in the post-intervention group (p<0.05). Multivariate logistic regression analysis for 30-day mortality showed that the administration of appropriate antifungal medication within 72 hours on a positive blood culture and Candida glabrata isolates were factors associated with a reduction in the risk of mortality (p<0.05). These results indicate that early identification of Candida spp. and early initiation of appropriate antifungal therapy are the intervention points that should be focused on in the AFS approach. In many small and medium-sized hospitals without infectious disease specialists, many of the roles of these specialists are played by pharmacists. Our findings indicate that it is important for pharmacists to play a leading role in candidemia management.