Survey highlights antifungal stewardship in pediatric hospitals
The results of a survey sent to pediatric antimicrobial stewardship program (ASP) physicians and pharmacists indicate that most pediatric ASPs conduct antifungal stewardship but many don’t feel confident about making antifungal recommendations, US researchers reported today in Infection Control & Hospital Epidemiology.
The electronic survey, which included 17 close-ended questions about institutional antifungal stewardship practices, was sent to 74 hospitals participating in the Sharing Antimicrobial Reports for Pediatric Stewardship collaborative, 68 of which responded.
Overall, 63 of the 68 hospitals (93%) responded that they conduct one or more antifungal stewardship activities, with 43 (63%) performing prospective audit and feedback and 52 (76%) requiring preauthorization for one or more antifungal agents. The most commonly restricted antifungals were isavuconazole (42 of 52 hospitals [80%]) and posaconazole (39 of 52 hospitals [75%]).
Although 33 ASPs (48%) agreed or strongly agreed that antifungals are used inappropriately at their institution, only 25 (37%) felt very confident making recommendations about antifungals. Respondents reported that having clinical guidelines specific to antifungal use in children (31 of 68 [46%]) and better diagnostics (25 of 68 [37%]) would improve their level of confidence in making antifungal recommendations.
“Although implementing antifungal stewardship has challenges, it has the potential to decrease unnecessary and suboptimal antifungal use, to reduce toxicities associated with inappropriate antifungal use, and to prevent the emergence of antifungal resistance,” the authors of the study wrote. “Currently, [prospective and adult feedback] and preauthorization are the main strategies used by pediatric ASPs to perform antifungal stewardship. Future studies should evaluate the effectiveness and clinical impact of such interventions.”
Jul 14 Infect Control Hosp Epidemiol abstract
Stewardship program tied to less carbapenem resistance in Australian hospitals
Implementation of a computer-assisted stewardship program at healthcare facilities in an Australian local health district and a reduction in carbapenem use were associated with a decline in carbapenem-producing Enterobacteriaceae (CPE) isolates, according to a new study in JAC-Antimicrobial Resistance.
For the study, researchers analyzed CPE isolates collected from hospitals in the Illawarra Shoalhaven Local Health District from 2008 through 2018. In particular, they were looking to see whether the 2012 introduction of a district-wide stewardship program supported by a computerized clinical decision support system had any impact on carbapenem use and detection of CPE isolates.
They also looked at microbiological and demographic data, CPE risk factors and outcomes, and hand hygiene compliance rates among healthcare workers. Bivariate relationships were examined using Pearson’s r, and predictors of CPE isolates were assessed using time series linear regression.
In total, 120 CPE isolates from 110 patients were identified. Most isolates (61%) were urinary and primarily categorized as hospital acquired. The numbers of CPE isolates and carbapenem use both showed a strong downward trend during the study period, and the decreases were strongly correlated (r = 0.80; P = 0.006).
Hand hygiene compliance remained at high levels throughout the study period and was negatively correlated with the numbers of CPE isolates (r = –0.70; P < 0.038). The time series regression analysis showed that the positive relationship between CPE isolation and carbapenem use was maintained while adjusting for time (b = 0.05; P < 0.001).
The average yearly consumption of carbapenems fell from 18.4 defined daily doses (DDDs) per 1,000 occupied bed days (OBDs) in the years before implementation of the ASP to 14.7 DDDs/1,000 OBDs in the years after implementation.
“In conclusion, we demonstrated a reduction in CPE isolates in conjunction with reduced carbapenem use in an Australian setting, longitudinally consolidated by a comprehensive district-wide AMS [antimicrobial stewardship] programme,” the authors wrote. “Prospective studies are needed to confirm the influence of the AMS-driven carbapenem use reduction on carbapenemase prevalence, as well as the effect in high-prevalence settings.”
Jul 13 JAC-Antimicrob Resist study
