Keck J Myles, Cretella David A, Stover Kayla R, Wagner Jamie L, Barber Katie E, Jhaveri Tulip A, Vijayvargiya Prakhar, Garrigos Zerelda Esquer, Wingler Mary Joyce B
Department of Pharmacy, University of Arkansas for Medical Sciences, Little Rock, AR 72205, USA.
Division of Infectious Diseases, University of Mississippi Medical Center, Jackson, MS 39216, USA.
Antibiotics (Basel). 2023 Jan 17;12(2):193. doi: 10.3390/antibiotics12020193.
Delays in the treatment of proven invasive fungal disease have been shown to be harmful. However, empiric treatment for all patients at risk of infection has not demonstrated benefit. This study evaluates the effects of a micafungin stewardship initiative on the duration of therapy and clinical outcomes at the University of Mississippi Medical Center in Jackson, Mississippi. This single-center quasi-experiment evaluated patients who received micafungin. Adult inpatients who received at least one treatment dose of micafungin in the pre-intervention (1 October 2020 to 30 September 2021) or post-intervention (1 October 2021 to 30 April 2022) groups were included. Patients were placed on micafungin for prophylaxis and those who required definitive micafungin therapy were excluded. An algorithm was used to provide real-time recommendations in order to assess change in the treatment days of micafungin therapy. A total of 282 patients were included (141 pre-group versus 141 post-group). Over 80% of the patients included in the study were in an intensive care unit, and other baseline characteristics were similar. The median number of treatment days with micafungin was 4 [IQR 3-6] in the pre-group and 3 [IQR 2-6] in the post-group ( = 0.005). Other endpoints, such as time to discontinuation or de-escalation, hospital mortality, and hospital length of stay, were not significantly different between the groups. An antifungal stewardship initiative can be an effective way to decrease unnecessary empiric antifungal therapy for patients who are at risk of invasive fugal disease.
已证实侵袭性真菌病治疗延迟是有害的。然而，对所有有感染风险的患者进行经验性治疗并未显示出益处。本研究评估了米卡芬净管理倡议对密西西比州杰克逊市密西西比大学医学中心治疗持续时间和临床结局的影响。这项单中心准实验评估了接受米卡芬净治疗的患者。纳入了在干预前（2020年10月1日至2021年9月30日）或干预后（2021年10月1日至2022年4月30日）接受至少一剂米卡芬净治疗的成年住院患者。接受米卡芬净预防治疗的患者以及需要确定性米卡芬净治疗的患者被排除在外。使用一种算法提供实时建议，以评估米卡芬净治疗天数的变化。总共纳入了282例患者（干预前组141例，干预后组141例）。纳入研究的患者中超过80%在重症监护病房，其他基线特征相似。干预前组米卡芬净治疗天数的中位数为4天[四分位间距3 - 6天]，干预后组为3天[四分位间距2 - 6天]（P = 0.005）。其他终点指标，如停药或降阶梯时间、医院死亡率和住院时间，两组之间无显著差异。抗真菌管理倡议可能是减少侵袭性真菌病风险患者不必要经验性抗真菌治疗的有效方法。
