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The current state of antifungal stewardship among pediatric antimicrobial stewardship programs

Published online by Cambridge University Press:  14 July 2020

Lourdes Eguiguren Open the ORCID record for Lourdes Eguiguren [Opens in a new window] ,
Jason G. Newland ,
Matthew P. Kronman ,
Adam L. Hersh ,
Jeffrey S. Gerber ,
Grace M. Lee  and
Hayden T. Schwenk Open the ORCID record for Hayden T. Schwenk [Opens in a new window]
Lourdes Eguiguren
Affiliation:
Division of Pediatric Infectious Diseases, Department of Pediatrics, Stanford University, Stanford, California
Jason G. Newland
Affiliation:
Division of Infectious Diseases, Department of Pediatrics, Washington University in St Louis, St Louis, Missouri
Matthew P. Kronman
Affiliation:
Division of Pediatric Infectious Diseases, Department of Pediatrics, University of Washington, Seattle, Washington
Adam L. Hersh
Affiliation:
Division of Pediatric Infectious Diseases, Department of Pediatrics, University of Utah, Salt Lake City, Utah
Jeffrey S. Gerber
Affiliation:
Division of Pediatric Infectious Diseases, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
Grace M. Lee
Affiliation:
Division of Pediatric Infectious Diseases, Department of Pediatrics, Stanford University, Stanford, California
Hayden T. Schwenk*
Affiliation:
Division of Pediatric Infectious Diseases, Department of Pediatrics, Stanford University, Stanford, California
*
Author for correspondence: Hayden T. Schwenk, E-mail: hschwenk@stanford.edu
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Abstract

Objective:

To characterize the current state of antifungal stewardship practices and perceptions of antifungal use among pediatric antimicrobial stewardship programs (ASPs).

Design:

We developed and distributed an electronic survey, which included 17 closed-ended questions about institutional antifungal stewardship practices and perceptions, among pediatric ASPs.

Participants:

ASP physicians and pharmacists of 74 hospitals participating in the multicenter Sharing Antimicrobial Reports for Pediatric Stewardship (SHARPS) Collaborative.

Results:

We sent surveys to 74 hospitals and received 68 unique responses, for a response rate of 92%. Overall, 63 of 68 the respondent ASPs (93%) reported that they conduct 1 or more antifungal stewardship activities. Of these 68 hospital ASPs, 43 (63%) perform prospective audit and feedback (PAF) of antifungals. The most common reasons reported for not performing PAF of antifungals were not enough time or resources (19 of 25, 76%) and minimal institutional antifungal use (6 of 25, 24%). Also, 52 hospitals (76%) require preauthorization for 1 or more antifungal agents. The most commonly restricted antifungals were isavuconazole (42 of 52 hospitals, 80%) and posaconazole (39 of 52 hospitals, 75%). Furthermore, 33 ASPs (48%) agreed or strongly agreed that antifungals are inappropriately used at their institution, and only 25 of 68 (37%) of ASPs felt very confident making recommendations about antifungals.

Conclusions:

Most pediatric ASPs steward antifungals, but the strategies employed are highly variable across surveyed institutions. Although nearly half of respondents identified inappropriate antifungal use as a problem at their institution, most ASPs do not feel confident making recommendations about antifungals. Future studies are needed to determine the rate of inappropriate antifungal use and the best antifungal stewardship strategies.

Type
Original Article
Information
Infection Control & Hospital Epidemiology , Volume 41 , Issue 11 , November 2020 , pp. 1279 - 1284
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Copyright
© 2020 by The Society for Healthcare Epidemiology of America. All rights reserved.

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