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1763. A study on the effectiveness of a pharmacist led Antifungal stewardship program, in immunocompromised patients of a tertiary care teaching hospital in South-India.

BACKGROUND: Anti-fungal stewardship (AFS) is a less explored area of an anti-microbial stewardship (AMS) program as the patients prone to fungal infections are mostly immunocompromised, post-chemotherapy or post-transplant. In a Low-and- Middle income country (LMIC) like India, there is a dearth of...

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Autores principales: Rupali, Priscilla, John, Jisha Sara, Jacob, Amita, Karthik, Rajiv, Alexander, Hanna, Selvarajan, Sushil, George, Biju
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Oxford University Press 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9752707/
http://dx.doi.org/10.1093/ofid/ofac492.1393
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author Rupali, Priscilla
John, Jisha Sara
Jacob, Amita
Karthik, Rajiv
Alexander, Hanna
Selvarajan, Sushil
George, Biju
author_facet Rupali, Priscilla
John, Jisha Sara
Jacob, Amita
Karthik, Rajiv
Alexander, Hanna
Selvarajan, Sushil
George, Biju
author_sort Rupali, Priscilla
collection PubMed
description BACKGROUND: Anti-fungal stewardship (AFS) is a less explored area of an anti-microbial stewardship (AMS) program as the patients prone to fungal infections are mostly immunocompromised, post-chemotherapy or post-transplant. In a Low-and- Middle income country (LMIC) like India, there is a dearth of Infectious Disease (ID) trained physicians and pharmacists. We aimed to study the effectiveness of a pharmacist led AFS program to ensure rational prescribing of antifungals via a post-prescription review and feedback method. METHODS: In this prospective interrupted time series analysis from June 2021 to November 2021, AFS was done on adult in-patients in the department of Hematology in a tertiary care teaching hospital in South India. The study had a pre-intervention phase and intervention phase of 3 months each. In the pre-intervention phase, patients on anti-fungal therapy > 48 hours were identified and base line data were collected and no recommendations were given. In the intervention phase, in those on antifungals >48 hours, appropriate recommendations were made with regard to modification and discontinuation of the anti-fungals based on patients’ clinical condition under the supervision of an ID physician. Acceptance and impact of the intervention were monitored and recorded. METHOD OF THE STUDY [Figure: see text] The study was a prospective study with 2 phases : pre-intervention and intervention. In the intervention phase, the appropriateness of the Anti-fungal therapy was analyzed and recommendations were given. RESULTS: A total of 193 patients were analyzed over 6 months, of which 107 patients with a mean age of 42.1 ± 14.2 belonged to the pre-intervention phase and 86 patients aged 40.2 ±12.6 years were in the intervention phase. There was no statistically significant difference in the in-hospital mortality [26.16% vs 23. 25% (p = 0.64)] between the two groups. In the intervention phase, 15 (17.44%) prescriptions were found to be inappropriate. Among these 66% of the recommendations were accepted by the treating physician. The days of therapy per 100 patient days were calculated for each individual anti-fungal drug and there was a significant reduction in consumption of Anidulafungin [29.648 Vs 14.28 (p < 0.0007)], Amphotericin B [42.05 Vs 22.18 (p< 0.0001)] and Voriconazole [56.41 Vs 35.77 (p< 0.00001)] in the intervention phase. [Figure: see text] Outcome measurements [Figure: see text] [Figure: see text] CONCLUSION: A pharmacist led AFS program resulted in statistically significant reduction in the consumption of antifungals, without a significant difference in the in-hospital mortality. DISCLOSURES: Priscilla Rupali, MD, DTM&H, PFIZER: Grant/Research Support|PFIZER: Grant/Research Support.
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spelling pubmed-97527072022-12-16 1763. A study on the effectiveness of a pharmacist led Antifungal stewardship program, in immunocompromised patients of a tertiary care teaching hospital in South-India. Rupali, Priscilla John, Jisha Sara Jacob, Amita Karthik, Rajiv Alexander, Hanna Selvarajan, Sushil George, Biju Open Forum Infect Dis Abstracts BACKGROUND: Anti-fungal stewardship (AFS) is a less explored area of an anti-microbial stewardship (AMS) program as the patients prone to fungal infections are mostly immunocompromised, post-chemotherapy or post-transplant. In a Low-and- Middle income country (LMIC) like India, there is a dearth of Infectious Disease (ID) trained physicians and pharmacists. We aimed to study the effectiveness of a pharmacist led AFS program to ensure rational prescribing of antifungals via a post-prescription review and feedback method. METHODS: In this prospective interrupted time series analysis from June 2021 to November 2021, AFS was done on adult in-patients in the department of Hematology in a tertiary care teaching hospital in South India. The study had a pre-intervention phase and intervention phase of 3 months each. In the pre-intervention phase, patients on anti-fungal therapy > 48 hours were identified and base line data were collected and no recommendations were given. In the intervention phase, in those on antifungals >48 hours, appropriate recommendations were made with regard to modification and discontinuation of the anti-fungals based on patients’ clinical condition under the supervision of an ID physician. Acceptance and impact of the intervention were monitored and recorded. METHOD OF THE STUDY [Figure: see text] The study was a prospective study with 2 phases : pre-intervention and intervention. In the intervention phase, the appropriateness of the Anti-fungal therapy was analyzed and recommendations were given. RESULTS: A total of 193 patients were analyzed over 6 months, of which 107 patients with a mean age of 42.1 ± 14.2 belonged to the pre-intervention phase and 86 patients aged 40.2 ±12.6 years were in the intervention phase. There was no statistically significant difference in the in-hospital mortality [26.16% vs 23. 25% (p = 0.64)] between the two groups. In the intervention phase, 15 (17.44%) prescriptions were found to be inappropriate. Among these 66% of the recommendations were accepted by the treating physician. The days of therapy per 100 patient days were calculated for each individual anti-fungal drug and there was a significant reduction in consumption of Anidulafungin [29.648 Vs 14.28 (p < 0.0007)], Amphotericin B [42.05 Vs 22.18 (p< 0.0001)] and Voriconazole [56.41 Vs 35.77 (p< 0.00001)] in the intervention phase. [Figure: see text] Outcome measurements [Figure: see text] [Figure: see text] CONCLUSION: A pharmacist led AFS program resulted in statistically significant reduction in the consumption of antifungals, without a significant difference in the in-hospital mortality. DISCLOSURES: Priscilla Rupali, MD, DTM&H, PFIZER: Grant/Research Support|PFIZER: Grant/Research Support. Oxford University Press 2022-12-15 /pmc/articles/PMC9752707/ http://dx.doi.org/10.1093/ofid/ofac492.1393 Text en © The Author(s) 2022. Published by Oxford University Press on behalf of Infectious Diseases Society of America. https://creativecommons.org/licenses/by/4.0/This is an Open Access article distributed under the terms of the Creative Commons Attribution License (https://creativecommons.org/licenses/by/4.0/), which permits unrestricted reuse, distribution, and reproduction in any medium, provided the original work is properly cited.
spellingShingle Abstracts
Rupali, Priscilla
John, Jisha Sara
Jacob, Amita
Karthik, Rajiv
Alexander, Hanna
Selvarajan, Sushil
George, Biju
1763. A study on the effectiveness of a pharmacist led Antifungal stewardship program, in immunocompromised patients of a tertiary care teaching hospital in South-India.
title 1763. A study on the effectiveness of a pharmacist led Antifungal stewardship program, in immunocompromised patients of a tertiary care teaching hospital in South-India.
title_full 1763. A study on the effectiveness of a pharmacist led Antifungal stewardship program, in immunocompromised patients of a tertiary care teaching hospital in South-India.
title_fullStr 1763. A study on the effectiveness of a pharmacist led Antifungal stewardship program, in immunocompromised patients of a tertiary care teaching hospital in South-India.
title_full_unstemmed 1763. A study on the effectiveness of a pharmacist led Antifungal stewardship program, in immunocompromised patients of a tertiary care teaching hospital in South-India.
title_short 1763. A study on the effectiveness of a pharmacist led Antifungal stewardship program, in immunocompromised patients of a tertiary care teaching hospital in South-India.
title_sort 1763. a study on the effectiveness of a pharmacist led antifungal stewardship program, in immunocompromised patients of a tertiary care teaching hospital in south-india.
topic Abstracts
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9752707/
http://dx.doi.org/10.1093/ofid/ofac492.1393
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