Sistemik Antifungal İlaç Kullanımının Değerlendirilmesi ve Antifungal Yönetim Ekibi Uygulamaları

Abstract

Implementation of antifungal stewardship (AFS) program aims to reduce inappropriate use of antifungal drugs. The role of AFS program in the appropriate use of antifungal therapy was evaluated in this study. This study was conducted at the Hacettepe University Hospitals between January 2019 and December 2020 and consisted of three periods as observation, feedback/education, and daily AFS activities. In the observation period, the use of systemic antifungals in services was evaluated. In the second period, monthly meetings have been performed in order to provide feedback and education to physicians about antifungal therapy and the rate of adherence to the clinical guidelines. In the final period, AFS team was established with the involvement of a clinical pharmacist in daily ward rounds to assess the appropriateness of the antifungal therapy. Appropriateness of antifungal therapy was evaluated at each study period individually. In addition, ‘EQUAL (ECMM Quality) Candida’, ‘EQUAL Aspergillus’ and ‘EQUAL Mucormycosis’ scores were used. During three study periods, a total of 418 antifungal therapy periods have been evaluated in this study. The baseline demographics and comorbidities of patients were similar in all three periods. Indications for antifungal therapies were prophylaxis in 22.7%, Candida infections in 58.6%, and invasive mould infections in 18.7%. During the third period, 157 recommendations have been made by AFS team, and 151 (96.2%) have been accepted. The overall appropriateness of antifungal therapy has increased significantly for prophylaxis (p=0.046) and targeted antifungal therapy (p<0.001) at third period compared with the others. The rate for compliance on recommendations about initial two sets (40 ml) of blood cultures, echocardiography, ophthalmoscopy, 14-day antifungal treatment after the first negative follow-up blood culture have increased during the feedback/education and the AFS periods. The rate in appropriateness of antifungal therapy may be increased by integration of an AFS program. Quality of antifungal therapy can be enhanced by assessment of patients infected by fungal agents through a team-based approach including therapeutic assessment by a clinical pharmacist.