Department of Veterans' Affairs, Center of Innovation for Complex Chronic Healthcare, Edward Hines Jr VA Hospital, Hines, Illinois.
Division of Infectious Diseases, Department of Medicine, Loyola University Chicago Stritch School of Medicine, Maywood, Illinois.
Infect Control Hosp Epidemiol. 2020 May;41(5):585-589. doi: 10.1017/ice.2020.76. Epub 2020 Apr 7.
To characterize antifungal stewardship among antimicrobial stewardship programs (ASPs) at a diverse range of hospitals and to correlate antifungal stewardship with hospital characteristics.
Cross-sectional survey.
ASP physician and/or pharmacist members at Society for Healthcare Epidemiology of America (SHEA) Research Network (SRN) hospitals.
An electronic survey administered August-September 2018 via the SRN to 111 hospitals. The χ2 test was used to test associations between ASP and hospital characteristics and use of antifungal stewardship strategies.
Of 111 hospitals, 45 (41%) responded; most were academic medical centers (65%) caring for stem-cell patients (73.3%) and solid-organ transplant patients (80.0%). Most hospitals have large, well-established ASPs: 60% had >5 team members and 68.9% had a duration ≥6 years. In 43 hospitals (95.6%), ASPs used antifungal stewardship strategies, most commonly prospective audit and feedback (73.3%) by a pharmacist (71.4%). Half of ASPs (51.1%) created guidelines for invasive fungal infection (IFI) management. Most hospitals (71.1%) offered rapid laboratory tests to diagnose IFI, but polymerase chain reaction (PCR) testing and antifungal susceptibility testing varied. Also, 29 ASPs (64.4%) perform surveillance of antifungal utilization, but only 9 (31%) reported to the CDC National Healthcare Safety Network. ASP size, duration, and presence of transplant populations were not associated with a higher likelihood of using antifungal stewardship strategies (P > .05 for all).
The use of antifungal stewardship strategies was high at SRN hospitals, but they mainly involved audit and feedback. ASPs should be encouraged (1) to disseminate guidelines for IFI management, (2) to promote access to laboratory tests for rapid and accurate IFI diagnosis, and (3) to perform surveillance for antifungal utilization with reporting to the CDC.
描述不同类型医院抗菌药物管理项目（ASPs）中的抗真菌药物管理特点，并将抗真菌药物管理与医院特征进行关联。
横断面调查。
美国医疗机构流行病学协会（SHEA）研究网络（SRN）医院的 ASP 医生和/或药剂师成员。
2018 年 8 月至 9 月，通过 SRN 向 111 家医院发放电子调查问卷。采用 χ2 检验来检验 ASP 与医院特征以及抗真菌药物管理策略的使用之间的关联。
在 111 家医院中，有 45 家（41%）做出了回应；大多数为学术医疗中心（65%），收治造血干细胞患者（73.3%）和实体器官移植患者（80.0%）。大多数医院都有规模较大、成熟的 ASP：60%的团队成员超过 5 人，68.9%的团队成立时间超过 6 年。在 43 家（95.6%）医院中，ASP 采用了抗真菌药物管理策略，最常见的是由药剂师进行前瞻性审核和反馈（73.3%）。有一半的 ASP（51.1%）制定了侵袭性真菌感染（IFI）管理指南。大多数医院（71.1%）提供了快速诊断 IFI 的实验室检测，但聚合酶链反应（PCR）检测和抗真菌药敏试验存在差异。此外，29 个 ASP（64.4%）对抗真菌药物使用情况进行了监测，但仅有 9 个（31%）向 CDC 国家医疗保健安全网络报告。ASP 的规模、持续时间和移植人群的存在与更有可能采用抗真菌药物管理策略之间没有相关性（所有 P 值均＞0.05）。
SRN 医院中抗真菌药物管理策略的使用较为普遍，但主要涉及审核和反馈。应鼓励 ASP （1）传播 IFI 管理指南，（2）促进获得用于快速准确诊断 IFI 的实验室检测，（3）开展抗真菌药物使用监测并向 CDC 报告。
