OBJECTIVE Few data exist regarding the impact of antimicrobial stewardship programs on antifungal use. We evaluated the efficacy and safety of a comprehensive long-term antimicrobial stewardship program (ASP) focused on antifungal use. METHODS During a 9-year period, we quarterly assessed antifungal consumption, incidence density of hospital-acquired candidemia, Candida spp. distribution, antifungal resistance, and crude death rate per 1000 occupied bed days (OBDs) of hospital-acquired candidemia. We performed segmented regression analysis of interrupted time series. RESULTS A significant change in trend was observed for antifungal consumption, with a sustained reduction of -0.87% per quarter (95% confidence interval [CI], -1.36 -0.38, p < 0.001), accounting for a final reduction of -38.4%. The main reduction was produced in fluconazole, with a sustained reduction of -1.37% per quarter (95%CI, -1.96 -0.68, p<0.001). The incidence density of hospital-acquired candidemia decreased, with a change in slope of -5.06% cases per 1000 OBDs per year (95%CI, -8.23 -1.77, p = 0.009). The 14-day crude death rate per 1000 OBDs dropped from 0.044 to 0.017 (-6.36% deaths per 1000 OBDs per year; 95%CI, -13.45 -1.31, p = 0.09). CONCLUSIONS This ASP has succeeded in optimizing the use of antifungal with a long-lasting reduction without increasing the incidence, neither the mortality, of hospital-acquired candidemia.

中文翻译：

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以抗真菌药物为重点的综合性抗菌药物管理教育计划的有效性和安全性。

目的很少有关于抗菌素管理计划对抗菌药使用的影响的数据。我们评估了以抗真菌药物为重点的综合性长期抗菌药物管理计划（ASP）的有效性和安全性。方法在9年的时间里，我们每季度评估抗真菌药物的消耗量，医院获得的念珠菌血症念珠菌的密度。医院获得性念珠菌血症的分布，抗真菌药耐药性和每1000占用床日（OBD）的粗死亡率。我们对中断的时间序列进行了分段回归分析。结果观察到抗真菌药物消费趋势出现显着变化，每季度持续下降-0.87％（95％置信区间[CI]，-1.36 -0.38，p <0.001），最终下降了-38.4％ 。主要减少的是氟康唑，每季度持续减少-1.37％（95％CI，-1.96 -0.68，p <0.001）。医院获得性念珠菌血症的发病率降低，每年每1000 OBD的斜率变化-5.06％（95％CI，-8.23 -1.77，p = 0.009）。每1000个OBD的14天原油死亡率从0.044降至0.017（每年每1000个OBD的死亡率为-6.36％； 95％CI，-13.45 -1.31，p = 0.09）。结论该ASP已经成功地优化了抗真菌剂的使用，并长期减少了使用率，而没有增加医院获得性念珠菌血症的发生率和死亡率。每1000个OBD的14天原油死亡率从0.044降至0.017（每年每1000个OBD的死亡率为-6.36％； 95％CI，-13.45 -1.31，p = 0.09）。结论该ASP已经成功地优化了抗真菌剂的使用，并长期减少了使用率，而没有增加医院获得性念珠菌血症的发生率和死亡率。每1000个OBD的14天原油死亡率从0.044降至0.017（每年每1000个OBD的死亡率为-6.36％； 95％CI，-13.45 -1.31，p = 0.09）。结论该ASP已经成功地优化了抗真菌剂的使用，并长期减少了使用率，而没有增加医院获得性念珠菌血症的发生率和死亡率。