Department of Clinical Pharmacy, Diagnostiko kai Therapeftiko Kedro Athinas - Hygeia, Athens, Greece.
National and Kapodistrian University of Athens Faculty of Pharmacy, Athens, Greece.
Eur J Hosp Pharm. 2020 Jan;27(1):14-18. doi: 10.1136/ejhpharm-2017-001467. Epub 2018 Jun 28.
Although antimicrobial stewardship programmes are one of the highest priorities in healthcare systems and many articles have been published, few refer to the implementation of antifungal stewardship and highlight specific points on which efforts should be focused.
To assess the percentage of patients with confirmed candidaemia in whom de-escalation was conducted, and the economic impact of step-down or step-up antifungal therapy. Additionally, we attempted to estimate the potential increase in drug minimum inhibitory concentrations or to detect resistant strains of species.
We selected, retrospectively, patients who had received systemic antifungal therapy between 2011 and 2016 for documented candidaemia. Statistical analysis and diagrams were used to assess the results.
Of 157 patients with confirmed candidaemia, 58 received azoles, 74 echinocandinsand 18 liposomal amphotericin B for empirical therapy. 51 patients were eligible to step-down to fluconazole but only 23 patients did so. Furthermore, in nine patients unjustified step-up from fluconazole to echinocandins or liposomal amphotericin B was carried out. The additional cost incurred bythe healthcare system due to high prices of echinocandins and liposomal amphotericin B in comparison with fluconazole was€211 837. Interestingly, it was found that one strain of and two strains of were resistant to echinocandins.
The presence of a multidisciplinary team, including an infection control specialist and a clinical pharmacist, would limit the prescription of advanced antifungal agents as empirical therapy. Moreover, this team would control the de-escalation process-where applicable-leading to a reduction in costs and, probably, a decrease in the emergence of resistant species. These facts contribute to the broader discussion on the adoption of antifungal stewardship programmes.
尽管抗菌药物管理计划是医疗系统的重中之重之一，并且已经发表了许多相关文章，但很少有文章涉及抗真菌药物管理计划，并强调应关注的具体要点。
评估行降阶梯治疗的确诊念珠菌血症患者的比例，以及降阶梯或升阶梯抗真菌治疗的经济影响。此外，我们还试图估计药物最低抑菌浓度增加的可能性，或检测特定种属的耐药菌株。
我们回顾性选择了 2011 年至 2016 年期间接受系统性抗真菌治疗的确诊念珠菌血症患者。使用统计分析和图表来评估结果。
在 157 例确诊念珠菌血症患者中，58 例接受唑类药物、74 例接受棘白菌素类药物和 18 例接受脂质体两性霉素 B 进行经验性治疗。51 例患者符合降阶梯治疗氟康唑的条件，但仅有 23 例患者进行了降阶梯治疗。此外，有 9 例患者在氟康唑治疗的基础上不合理地升阶梯至棘白菌素类药物或脂质体两性霉素 B。由于棘白菌素类药物和脂质体两性霉素 B 价格较高，与氟康唑相比，医疗系统增加了 211 837 欧元的额外费用。有趣的是，发现一株 对棘白菌素类药物耐药，两株 对棘白菌素类药物耐药。
多学科团队的存在，包括感染控制专家和临床药师，将限制将高级抗真菌药物作为经验性治疗药物的使用。此外，该团队将控制降阶梯治疗过程（如有必要），从而降低成本，并可能减少耐药 种属的出现。这些事实有助于更广泛地讨论抗真菌药物管理计划的采用。
