背景:已提出将抗菌药物管理计划(ASP)作为优化抗真菌药物使用的机会。抗真菌耐药性是一个重要的和新出现的威胁。关于抗真菌管理(AFS)及其对性能和临床结果指标的影响的文献很少。本研究旨在研究AFS对患者和绩效指标影响的全球证据。
方法:“系统评价和荟萃分析的首选报告项目”(PRISMA)用于鉴定流程,筛选,资格,和包容。于2023年2月15日使用术语\'\'抗真菌管理\'\'搜索PubMed和MEDLINE。搜索词包括抗真菌管理,抗菌药物管理,念珠菌,念珠菌病,念珠菌,和侵袭性真菌病。在1366条记录中,由于他们没有描述抗真菌管理干预措施,因此删除了1304。在评估的62个全文中,21篇文章被排除在外,因为它们是非干预性研究,不包括感兴趣的结果。因此,41篇有资格进行系统评价。符合条件的研究是描述AFS计划并评估临床或性能测量的研究。
结果:在纳入的41项研究中,收集的主要性能测量是抗真菌药物的消耗(41个中的22个),和死亡率(41个中的22个),其次是住院时间(41人中的11人)和费用(41人中的9人)。大多数研究是单中心的,准实验,不同的干预措施。本系统评价中大多数研究的主要发现是以不同单位表示的死亡率降低和抗真菌药物的使用(22项报告死亡率中的13项研究)。开始管理后,抗真菌药物的消耗显着减弱或减少(22个中的10个)。由于缺乏标准单位,比较研究是不可能的,使得进行荟萃分析不可行,这将限制我们的研究。
结论:已经表明,AFS干预措施可以改善抗真菌药物的消耗和其他性能指标。根据现有的已发表的研究,抗真菌药物消耗和死亡率似乎是评估AFS影响的可能性能指标。
BACKGROUND: Antimicrobial stewardship programs (ASP) have been proposed as an opportunity to optimize antifungal use. The antifungal resistance is a significant and emerging threat. The literature on antifungal stewardship (AFS) and its influence on performance and clinical outcome measures is scarce. This study aimed to examine global evidence of the impact of AFS on patients and performance measures.
METHODS: The \"Preferred Reporting Items for Systematic Reviews and Meta-Analyses\" (PRISMA) was used for the flow of identification, screening, eligibility, and inclusion. PubMed and MEDLINE were searched using the term \'\'antifungal stewardship\'\' on 15 February 2023. Search terms included antifungal stewardship, antimicrobial stewardship, candida, candidemia, candiduria, and invasive fungal disease. Of the 1366 records, 1304 were removed since they did not describe an antifungal stewardship intervention. Among the 62 full texts assessed, 21 articles were excluded since they were non-interventional studies and did not include the outcome of interest. Thus, 41 articles were eligible for systematic
review. Eligible studies were those that described an AFS program and evaluated clinical or performance measures.
RESULTS: Of the 41 included studies, the primary performance measure collected was antifungal consumption (22 of 41), and mortality (22 of 41), followed by length of stay (11 of 41) and cost (9 of 41). Most studies were single-center, quasi-experimental, with varying interventions across studies. The principal finding from most of the studies in this systematic
review is a reduction in mortality expressed in different units and the use of antifungal agents (13 studies out of 22 reporting mortality). Antifungal consumption was significantly blunted or reduced following stewardship initiation (10 of 22). Comparing studies was impossible due to a lack of standard units, making conducting a meta-analysis unfeasible, which would be a limitation of our study.
CONCLUSIONS: It has been shown that AFS interventions may improve antifungal consumption and other performance measures. According to available published studies, antifungal consumption and mortality appear to be the possible performance measures to evaluate the impact of AFS.