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Antimicrob Agents Chemother. 2018 Sep 24;62(10). pii: e00402-18. doi: 10.1128/AAC.00402-18. Print 2018 Oct.

A Prospective Real-World Study of the Impact of an Antifungal Stewardship Program in a Tertiary Respiratory-Medicine Setting.

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Department of Pharmacy, Royal Brompton & Harefield NHS Foundation Trust, London, United Kingdom.
Department of Respiratory Medicine, Royal Brompton & Harefield NHS Foundation Trust, London, United Kingdom
Department of Microbiology, Royal Brompton & Harefield NHS Foundation Trust, London, United Kingdom.
Immunosuppression Monitoring Service, Royal Brompton & Harefield NHS Foundation Trust, London, United Kingdom.
Faculty of Medicine, National Heart & Lung Institute, Imperial College London, London, United Kingdom.
Contributed equally


There has been an increase in fungal infections in patients with chronic lung disease over the past decades, which is associated with rapidly increasing costs to health care systems. An antifungal stewardship team was introduced to a tertiary cardiopulmonary hospital, consisting of a medical mycologist and pharmacy support providing weekly stewardship ward rounds, twice-monthly multidisciplinary team meetings, and a dedicated weekly outpatient clinic. A database was set up to record the activity of the stewardship team. During the first 18 months of implementation, the antifungal stewardship team had reviewed 178 patients, with 285 recommendations made to inpatients, and 287 outpatient visits. The commonest diagnoses treated were allergic bronchopulmonary aspergillosis and chronic pulmonary aspergillosis. Cystic fibrosis was the largest patient group treated, followed by asthma and interstitial lung disease. There was a significant sustained reduction in monthly antifungal expenditure (P = 0.005) by £130,000 per month. There was also a significant reduction in antifungal use, measured as the defined daily dose/100 bed days (P = 0.017). There were no significant changes in expenditure on diagnostic tests. There has been a trend toward more patients having therapeutic levels of voriconazole (P = 0.086) and a significant increase in therapeutic levels of posaconazole (P < 0.0001). This study shows that an effective antifungal stewardship program can significantly reduce expenditure in a specialist respiratory service.


antifungal agents; antifungal therapy

[Available on 2019-03-24]
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