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Variability in antifungal stewardship strategies among Society for Healthcare Epidemiology of America (SHEA) Research Network facilities

Part of: SHEA Research Network Collection

Published online by Cambridge University Press:  07 April 2020

Margaret A. Fitzpatrick Open the ORCID record for Margaret A. Fitzpatrick [Opens in a new window] ,
Fritzie Albarillo ,
Maressa Santarossa ,
Charlesnika T. Evans  and
Katie J. Suda
Margaret A. Fitzpatrick*
Affiliation:
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
Fritzie Albarillo
Affiliation:
Division of Infectious Diseases, Department of Medicine, Loyola University Chicago Stritch School of Medicine, Maywood, Illinois
Maressa Santarossa
Affiliation:
Division of Infectious Diseases, Department of Medicine, Loyola University Chicago Stritch School of Medicine, Maywood, Illinois
Charlesnika T. Evans
Affiliation:
Department of Veterans’ Affairs, Center of Innovation for Complex Chronic Healthcare, Edward Hines Jr VA Hospital, Hines, Illinois Center for Health Services and Outcomes Research, Department of Preventive Medicine Institute for Public Health and Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
Katie J. Suda
Affiliation:
Department of Veterans’ Affairs, Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, Pittsburgh, Pennsylvania Division of General Internal Medicine, Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
*
Author for correspondence: Margaret A. Fitzpatrick, E-mail: Margaret.fitzpatrick@lumc.edu
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Abstract

Objective:

To characterize antifungal stewardship among antimicrobial stewardship programs (ASPs) at a diverse range of hospitals and to correlate antifungal stewardship with hospital characteristics.

Design:

Cross-sectional survey.

Participants:

ASP physician and/or pharmacist members at Society for Healthcare Epidemiology of America (SHEA) Research Network (SRN) hospitals.

Methods:

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.

Results:

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).

Conclusions:

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.

Type
Original Article
Information
Infection Control & Hospital Epidemiology , Volume 41 , Issue 5 , May 2020 , pp. 585 - 589
Copyright
© 2020 by The Society for Healthcare Epidemiology of America. All rights reserved

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