A matched-control evaluation of an antifungal bundle in the intensive care unit at a university teaching hospital
A matched-control evaluation of an antifungal bundle in the intensive care unit at a university teaching hospital
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DOI：
10.1007/s11096-012-9712-5
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发表时间：
2013-02-01
影响因子：
2.4
通讯作者：
Sarwari, Arif R.
中科院分区：
文献类型：
--
作者：
Guarascio, Anthony J.;Slain, Douglas;Sarwari, Arif R.
背景：抗菌药物使用包正在成为医院环境中实施抗菌药物管理举措的常用手段。虽然这些束的效用已被描述为许多疾病状态，它们在抗真菌治疗管理中的应用在很大程度上是未知的。目的：我们的目的是评估抗真菌捆绑方案在限制在重症监护住院患者环境中过度使用棘白菌素方面的效用。方法在匹配对照评估中，根据5个人口学和临床特征，将方案前对照患者与每个预期患者按2:1的比例进行匹配。评估抗真菌捆绑治疗方案对caspofungin治疗天数、药物成本和对捆绑标准的依从性的影响。结果捆绑治疗组caspofungin治疗的中位天数显著减少（4.00天vs. 2.00天，p = 0.001）。使用减少的大部分是在内科ICU (p = 0.002)，而不是外科ICU （p = 0.188）。结论：使用抗真菌束方法似乎有助于减少卡泊真菌素在ICU的使用，而不会对患者的预后产生不利影响。需要进一步的试验来评估这种捆绑在提供抗真菌药物使用的抗菌管理方面的效用。
Background Antimicrobial use bundles are becoming a common means of implementing antimicrobial stewardship initiatives in the hospital setting. Although the utility of these bundles has been described for many disease states, their adoption for antifungal therapy management is largely unknown. Objective Our objective was to assess the utility of an antifungal bundle protocol in limiting excessive use of echinocandins in the intensive-care inpatient setting. Methods In this matched-control evaluation, pre-protocol control patients were matched with each prospective patient in a 2:1 ratio using five demographic and clinical characteristics. The impact of the antifungal bundle protocol on caspofungin days of therapy, drug costs, and adherence to bundle criteria was assessed. Results A significant reduction in median days of caspofungin therapy (4.00 vs. 2.00 days, p = 0.001) was found in the bundle group. Most of this reduction in use was realized in the medical ICU (p = 0.002) as opposed to the surgical ICU (p = 0.188). Conclusions Use of an antifungal bundle approach appears to facilitate a reduction in caspofungin use in the ICU without adversely affecting patient outcomes. Further trials are needed to assess the utility of such bundles in providing antimicrobial stewardship for antifungal drug use.