Hostname: page-component-586b7cd67f-t7czq Total loading time: 0 Render date: 2024-11-22T06:48:06.975Z Has data issue: false hasContentIssue false
  • English
  • Français

Variability in antifungal stewardship strategies among Society for Healthcare Epidemiology of America (SHEA) Research Network facilities

Part of: SHEA Research Network Collection

Published online by Cambridge University Press:  07 April 2020

Margaret A. Fitzpatrick Open the ORCID record for Margaret A. Fitzpatrick [Opens in a new window] ,
Fritzie Albarillo ,
Maressa Santarossa ,
Charlesnika T. Evans  and
Katie J. Suda
Margaret A. Fitzpatrick*
Affiliation:
Department of Veterans’ Affairs, Center of Innovation for Complex Chronic Healthcare, Edward Hines Jr VA Hospital, Hines, Illinois Division of Infectious Diseases, Department of Medicine, Loyola University Chicago Stritch School of Medicine, Maywood, Illinois
Fritzie Albarillo
Affiliation:
Division of Infectious Diseases, Department of Medicine, Loyola University Chicago Stritch School of Medicine, Maywood, Illinois
Maressa Santarossa
Affiliation:
Division of Infectious Diseases, Department of Medicine, Loyola University Chicago Stritch School of Medicine, Maywood, Illinois
Charlesnika T. Evans
Affiliation:
Department of Veterans’ Affairs, Center of Innovation for Complex Chronic Healthcare, Edward Hines Jr VA Hospital, Hines, Illinois Center for Health Services and Outcomes Research, Department of Preventive Medicine Institute for Public Health and Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
Katie J. Suda
Affiliation:
Department of Veterans’ Affairs, Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, Pittsburgh, Pennsylvania Division of General Internal Medicine, Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
*
Author for correspondence: Margaret A. Fitzpatrick, E-mail: [email protected]
Get access Rights & Permissions [Opens in a new window]

Abstract

Objective:

To characterize antifungal stewardship among antimicrobial stewardship programs (ASPs) at a diverse range of hospitals and to correlate antifungal stewardship with hospital characteristics.

Design:

Cross-sectional survey.

Participants:

ASP physician and/or pharmacist members at Society for Healthcare Epidemiology of America (SHEA) Research Network (SRN) hospitals.

Methods:

An electronic survey administered August–September 2018 via the SRN to 111 hospitals. The χ2 test was used to test associations between ASP and hospital characteristics and use of antifungal stewardship strategies.

Results:

Of 111 hospitals, 45 (41%) responded; most were academic medical centers (65%) caring for stem-cell patients (73.3%) and solid-organ transplant patients (80.0%). Most hospitals have large, well-established ASPs: 60% had >5 team members and 68.9% had a duration ≥6 years. In 43 hospitals (95.6%), ASPs used antifungal stewardship strategies, most commonly prospective audit and feedback (73.3%) by a pharmacist (71.4%). Half of ASPs (51.1%) created guidelines for invasive fungal infection (IFI) management. Most hospitals (71.1%) offered rapid laboratory tests to diagnose IFI, but polymerase chain reaction (PCR) testing and antifungal susceptibility testing varied. Also, 29 ASPs (64.4%) perform surveillance of antifungal utilization, but only 9 (31%) reported to the CDC National Healthcare Safety Network. ASP size, duration, and presence of transplant populations were not associated with a higher likelihood of using antifungal stewardship strategies (P > .05 for all).

Conclusions:

The use of antifungal stewardship strategies was high at SRN hospitals, but they mainly involved audit and feedback. ASPs should be encouraged (1) to disseminate guidelines for IFI management, (2) to promote access to laboratory tests for rapid and accurate IFI diagnosis, and (3) to perform surveillance for antifungal utilization with reporting to the CDC.

Type
Original Article
Information
Infection Control & Hospital Epidemiology , Volume 41 , Issue 5 , May 2020 , pp. 585 - 589
Copyright
© 2020 by The Society for Healthcare Epidemiology of America. All rights reserved

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Pollack, LA, Srinivasan, A. Core elements of hospital antibiotic stewardship programs from the Centers for Disease Control and Prevention. Clin Infect Dis 2014;59 suppl 3:S97–S100.CrossRefGoogle Scholar
Barlam, TF, Cosgrove, SE, Abbo, LM, et al. Implementing an antibiotic stewardship program: guidelines by the Infectious Diseases Society of America and the Society for Healthcare Epidemiology of America. Clin Infect Dis 2016;62:e51–e77.CrossRefGoogle Scholar
Fridkin, S, Baggs, J, Fagan, R, et al. Vital signs: improving antibiotic use among hospitalized patients. Morb Mortal Wkly Rep 2014;63:194–200.Google ScholarPubMed
Chou, AF, Graber, CJ, Jones, M, et al. Characteristics of antimicrobial stewardship programs at Veterans’ Affairs hospitals: results of a nationwide survey. Infect Control Hosp Epidemiol 2016;37:647–654.CrossRefGoogle Scholar
Richardson, M. D. Changing patterns and trends in systemic fungal infections. J Antimicrob Chemother 2005;56 (suppl 1):i5–i11.CrossRefGoogle ScholarPubMed
Antibiotic resistance threats in the United States, 2019. Centers for Disease Control and Prevention website. www.cdc.gov/DrugResistance/Biggest-Threats.html. Published 2019. Accessed December 6, 2019.Google Scholar
Desai, VC, Cavanaugh, TM, Kelton, CM, Guo, JJ, Heaton, PC. Trends in the utilization of, spending on, and prices for outpatient antifungal agents in US Medicaid programs: 1991–2009. Clin Ther 2012;34:2118–2131.CrossRefGoogle ScholarPubMed
Garey, KW, Aitken, SL, Dima-Ala, A, et al. Echinocandin use in hospitalized patients: a multi-institutional study. Am J Med Sci 2015;349:316–320.CrossRefGoogle ScholarPubMed
Munoz, P, Valerio, M, Vena, A, Bouza, E. Antifungal stewardship in daily practice and health economic implications. Mycoses 2015;58 suppl 2:14–25.CrossRefGoogle Scholar
Nivoix, Y, Launoy, A, Lutun, P, et al. Adherence to recommendations for the use of antifungal agents in a tertiary-care hospital. J Antimicrob Chemother 2012;67:2506–2513.CrossRefGoogle ScholarPubMed
Sutepvarnon, A, Apisarnthanarak, A, Camins, B, Mondy, K, Fraser, V. J. Inappropriate use of antifungal medications in a tertiary-care center in Thailand: a prospective study. Infect Control Hosp Epidemiol 2008;29:370–373.CrossRefGoogle Scholar
Ananda-Rajah, MR, Slavin, MA, Thursky, KT. The case for antifungal stewardship. Curr Opin Infect Dis 2012;25:107–115.CrossRefGoogle ScholarPubMed
Livorsi, DJ, Heintz, B, Jacob, JT, Krein, SL, Morgan, DJ, Perencevich, EN. Audit and feedback processes among antimicrobial stewardship programs: a survey of the Society for Healthcare Epidemiology of America Research Network. Infect Control Hosp Epidemiol 2016;37:704–706.CrossRefGoogle Scholar
Pogorzelska-Maziarz, M, Herzig, CT, Larson, EL, Furuya, EY, Perencevich, EN, Stone, PW. Implementation of antimicrobial stewardship policies in US hospitals: findings from a national survey. Infect Control Hosp Epidemiol 2015;36:261–264.CrossRefGoogle Scholar
Wagner, B, Filice, GA, Drekonja, D, et al. Antimicrobial stewardship programs in inpatient hospital settings: a systematic review. Infect Control Hosp Epidemiol 2014;35:1209–1228.CrossRefGoogle ScholarPubMed
Davey, P, Brown, E, Charani, E, et al. Interventions to improve antibiotic prescribing practices for hospital patients. Cochrane Database Syst Rev 2013;4:CD003543.Google Scholar
MacVane, SH, Nolte, FS. Benefits of adding a rapid PCR-based blood culture identification panel to an established antimicrobial stewardship program. J Clin Microbiol 2016;54:2455–2463.CrossRefGoogle Scholar
Timbrook, TT, Morton, JB, McConeghy, KW, Caffrey, AR, Mylonakis, E, LaPlante KL. The effect of molecular rapid diagnostic testing on clinical outcomes in bloodstream infections: a systematic review and meta-analysis. Clin Infect Dis 2017;64:15–23.CrossRefGoogle ScholarPubMed
Mehrotra, P, Gupta, K, Strymish, J, et al. Implementation of infection prevention and antimicrobial stewardship in cardiac electrophysiology laboratories: results from the SHEA Research Network. Infect Control Hosp Epidemiol 2017;38:492–498.CrossRefGoogle ScholarPubMed
Sullivan, KV, Morgan, DJ, Leehka, S. Use of diagnostic stewardship practices to improve urine culturing among SHEA Research Network hospitals. Infect Control Hosp Epidemiol 2019;40:228–231.CrossRefGoogle ScholarPubMed