A matched-control evaluation of an antifungal bundle in the intensive care unit at a university teaching hospital

Abstract

Background Antimicrobial use bundles are becoming a common means of implementing antimicrobial stewardship initiatives in the hospital setting. Although the utility of these bundles has been described for many disease states, their adoption for antifungal therapy management is largely unknown. Objective Our objective was to assess the utility of an antifungal bundle protocol in limiting excessive use of echinocandins in the intensive-care inpatient setting. Methods In this matched-control evaluation, pre-protocol control patients were matched with each prospective patient in a 2:1 ratio using five demographic and clinical characteristics. The impact of the antifungal bundle protocol on caspofungin days of therapy, drug costs, and adherence to bundle criteria was assessed. Results A significant reduction in median days of caspofungin therapy (4.00 vs. 2.00 days, p = 0.001) was found in the bundle group. Most of this reduction in use was realized in the medical ICU (p = 0.002) as opposed to the surgical ICU (p = 0.188). Conclusions Use of an antifungal bundle approach appears to facilitate a reduction in caspofungin use in the ICU without adversely affecting patient outcomes. Further trials are needed to assess the utility of such bundles in providing antimicrobial stewardship for antifungal drug use.