Efficacy and safety of a comprehensive educational antimicrobial stewardship program focused on antifungal use

[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
[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.
The program received public funding from the Regional Health Ministry of Andalucía (Grant PI-0361-2010), which did not participate in the development of the program or the analysis of its results.