The Impact of Antifungal Stewardship on Clinical and Performance Measures: A Global Systematic Review
Background: Antimicrobial stewardship programs (ASP) have been proposed as an opportunity to optimize antifungal use. The antifungal resistance is a significant and emerging threat. The literature on antifungal stewardship (AFS) and its influence on performance and clinical outcome measures is scarc...
| Main Authors: | , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
MDPI AG
2023-12-01
|
| Series: | Tropical Medicine and Infectious Disease |
| Subjects: | |
| Online Access: | https://www.mdpi.com/2414-6366/9/1/8 |
| _version_ | 1797342425979551744 |
|---|---|
| author | Fares Albahar Hamza Alhamad Mohammad Abu Assab Rana Abu-Farha Lina Alawi Sara Khaleel |
| author_facet | Fares Albahar Hamza Alhamad Mohammad Abu Assab Rana Abu-Farha Lina Alawi Sara Khaleel |
| author_sort | Fares Albahar |
| collection | DOAJ |
| description | Background: Antimicrobial stewardship programs (ASP) have been proposed as an opportunity to optimize antifungal use. The antifungal resistance is a significant and emerging threat. The literature on antifungal stewardship (AFS) and its influence on performance and clinical outcome measures is scarce. This study aimed to examine global evidence of the impact of AFS on patients and performance measures. Methods: The “Preferred Reporting Items for Systematic Reviews and Meta-Analyses” (PRISMA) was used for the flow of identification, screening, eligibility, and inclusion. PubMed and MEDLINE were searched using the term ‘‘antifungal stewardship’’ on 15 February 2023. Search terms included antifungal stewardship, antimicrobial stewardship, candida, candidemia, candiduria, and invasive fungal disease. Of the 1366 records, 1304 were removed since they did not describe an antifungal stewardship intervention. Among the 62 full texts assessed, 21 articles were excluded since they were non-interventional studies and did not include the outcome of interest. Thus, 41 articles were eligible for systematic review. Eligible studies were those that described an AFS program and evaluated clinical or performance measures. Results: Of the 41 included studies, the primary performance measure collected was antifungal consumption (22 of 41), and mortality (22 of 41), followed by length of stay (11 of 41) and cost (9 of 41). Most studies were single-center, quasi-experimental, with varying interventions across studies. The principal finding from most of the studies in this systematic review is a reduction in mortality expressed in different units and the use of antifungal agents (13 studies out of 22 reporting mortality). Antifungal consumption was significantly blunted or reduced following stewardship initiation (10 of 22). Comparing studies was impossible due to a lack of standard units, making conducting a meta-analysis unfeasible, which would be a limitation of our study. Conclusion: It has been shown that AFS interventions may improve antifungal consumption and other performance measures. According to available published studies, antifungal consumption and mortality appear to be the possible performance measures to evaluate the impact of AFS. |
| first_indexed | 2024-03-08T10:33:06Z |
| format | Article |
| id | doaj.art-11b70a761f7b4d038087124bd893065f |
| institution | Directory Open Access Journal |
| issn | 2414-6366 |
| language | English |
| last_indexed | 2024-03-08T10:33:06Z |
| publishDate | 2023-12-01 |
| publisher | MDPI AG |
| record_format | Article |
| series | Tropical Medicine and Infectious Disease |
| spelling | doaj.art-11b70a761f7b4d038087124bd893065f2024-01-26T18:42:43ZengMDPI AGTropical Medicine and Infectious Disease2414-63662023-12-0191810.3390/tropicalmed9010008The Impact of Antifungal Stewardship on Clinical and Performance Measures: A Global Systematic ReviewFares Albahar0Hamza Alhamad1Mohammad Abu Assab2Rana Abu-Farha3Lina Alawi4Sara Khaleel5Department of Clinical Pharmacy, Faculty of Pharmacy, Zarqa University, P.O. Box 2000, Zarqa 13110, JordanDepartment of Clinical Pharmacy, Faculty of Pharmacy, Zarqa University, P.O. Box 2000, Zarqa 13110, JordanDepartment of Clinical Pharmacy, Faculty of Pharmacy, Zarqa University, P.O. Box 2000, Zarqa 13110, JordanDepartment of Clinical Pharmacy and Therapeutics, Faculty of Pharmacy, Applied Science Private University, P.O. Box 541350, Amman 11937, JordanDepartment of Physiology and Pharmacology, Faculty of Medicine and Health Sciences, An Najah National University, Nablus P.O. Box 7, PalestineDepartment of Pharmaceutical Sciences, Faculty of Pharmacy, Al Zaytoonah University, P.O. Box 130, Amman 11733, JordanBackground: Antimicrobial stewardship programs (ASP) have been proposed as an opportunity to optimize antifungal use. The antifungal resistance is a significant and emerging threat. The literature on antifungal stewardship (AFS) and its influence on performance and clinical outcome measures is scarce. This study aimed to examine global evidence of the impact of AFS on patients and performance measures. Methods: The “Preferred Reporting Items for Systematic Reviews and Meta-Analyses” (PRISMA) was used for the flow of identification, screening, eligibility, and inclusion. PubMed and MEDLINE were searched using the term ‘‘antifungal stewardship’’ on 15 February 2023. Search terms included antifungal stewardship, antimicrobial stewardship, candida, candidemia, candiduria, and invasive fungal disease. Of the 1366 records, 1304 were removed since they did not describe an antifungal stewardship intervention. Among the 62 full texts assessed, 21 articles were excluded since they were non-interventional studies and did not include the outcome of interest. Thus, 41 articles were eligible for systematic review. Eligible studies were those that described an AFS program and evaluated clinical or performance measures. Results: Of the 41 included studies, the primary performance measure collected was antifungal consumption (22 of 41), and mortality (22 of 41), followed by length of stay (11 of 41) and cost (9 of 41). Most studies were single-center, quasi-experimental, with varying interventions across studies. The principal finding from most of the studies in this systematic review is a reduction in mortality expressed in different units and the use of antifungal agents (13 studies out of 22 reporting mortality). Antifungal consumption was significantly blunted or reduced following stewardship initiation (10 of 22). Comparing studies was impossible due to a lack of standard units, making conducting a meta-analysis unfeasible, which would be a limitation of our study. Conclusion: It has been shown that AFS interventions may improve antifungal consumption and other performance measures. According to available published studies, antifungal consumption and mortality appear to be the possible performance measures to evaluate the impact of AFS.https://www.mdpi.com/2414-6366/9/1/8antimicrobial stewardshipantifungal stewardshipsystematic reviewantimicrobial consumptionmortalityhospital length of stay |
| spellingShingle | Fares Albahar Hamza Alhamad Mohammad Abu Assab Rana Abu-Farha Lina Alawi Sara Khaleel The Impact of Antifungal Stewardship on Clinical and Performance Measures: A Global Systematic Review Tropical Medicine and Infectious Disease antimicrobial stewardship antifungal stewardship systematic review antimicrobial consumption mortality hospital length of stay |
| title | The Impact of Antifungal Stewardship on Clinical and Performance Measures: A Global Systematic Review |
| title_full | The Impact of Antifungal Stewardship on Clinical and Performance Measures: A Global Systematic Review |
| title_fullStr | The Impact of Antifungal Stewardship on Clinical and Performance Measures: A Global Systematic Review |
| title_full_unstemmed | The Impact of Antifungal Stewardship on Clinical and Performance Measures: A Global Systematic Review |
| title_short | The Impact of Antifungal Stewardship on Clinical and Performance Measures: A Global Systematic Review |
| title_sort | impact of antifungal stewardship on clinical and performance measures a global systematic review |
| topic | antimicrobial stewardship antifungal stewardship systematic review antimicrobial consumption mortality hospital length of stay |
| url | https://www.mdpi.com/2414-6366/9/1/8 |
| work_keys_str_mv | AT faresalbahar theimpactofantifungalstewardshiponclinicalandperformancemeasuresaglobalsystematicreview AT hamzaalhamad theimpactofantifungalstewardshiponclinicalandperformancemeasuresaglobalsystematicreview AT mohammadabuassab theimpactofantifungalstewardshiponclinicalandperformancemeasuresaglobalsystematicreview AT ranaabufarha theimpactofantifungalstewardshiponclinicalandperformancemeasuresaglobalsystematicreview AT linaalawi theimpactofantifungalstewardshiponclinicalandperformancemeasuresaglobalsystematicreview AT sarakhaleel theimpactofantifungalstewardshiponclinicalandperformancemeasuresaglobalsystematicreview AT faresalbahar impactofantifungalstewardshiponclinicalandperformancemeasuresaglobalsystematicreview AT hamzaalhamad impactofantifungalstewardshiponclinicalandperformancemeasuresaglobalsystematicreview AT mohammadabuassab impactofantifungalstewardshiponclinicalandperformancemeasuresaglobalsystematicreview AT ranaabufarha impactofantifungalstewardshiponclinicalandperformancemeasuresaglobalsystematicreview AT linaalawi impactofantifungalstewardshiponclinicalandperformancemeasuresaglobalsystematicreview AT sarakhaleel impactofantifungalstewardshiponclinicalandperformancemeasuresaglobalsystematicreview |