You have already added 0 works in your ORCID record related to the merged Research product.
You have already added 0 works in your ORCID record related to the merged Research product.
Antifungal stewardship in a tertiary care paediatric hospital: the PROAFUNGI study
Copyright policy )Antifungal stewardship in a tertiary care paediatric hospital: the PROAFUNGI study
Abstract Background The increasing use of antifungal drugs (AF) in children and the concern for related adverse events and costs has led to the development of specific AF stewardship programmes (AFS). Studies in adult patients have shown improvements in AF prescription and usage after implementation, but paediatric data are scant. The aim of this PROAFUNGI study was to describe the use and appropriateness of AF in a high complexity paediatric centre. Methods Observational, prospective, single-centre, modified point-prevalence study (11 surveys, July–October 2018), including paediatric (< 18 years) patients receiving at least one systemic AF. Prescriptions were evaluated by the AFS team. Results The study included 119 prescriptions in 55 patients (53% males, median age 8.7 years [IQR 2.4–13.8]). The main underlying condition was cancer (45.5% of patients; HSCT in 60% of them); and the first indication for AF was prophylaxis (75 prescriptions, 63.2%). Liposomal amphotericin B was used most commonly (46% prescriptions), mainly as prophylaxis (75%). Among the 219 evaluations, 195 (89%) were considered optimal. The reason for non-optimal prescriptions was mostly lack of indication (14/24), especially in critical patients with ventricular assist devices. The use of AF without paediatric approval accounted for 8/24 inappropriate prescriptions. Conclusions A high rate of AF appropriateness was found for the children’s hospital as a whole, in relation with a well-established AFS. Nonetheless, the identification of specific areas of improvement should guide future actions of the AFS team, which will focus mainly on prophylaxis in critically ill patients receiving circulatory assistance and the use of non-approved drugs in children.
Microsoft Academic Graph classification: Tertiary care Inappropriate Prescriptions Liposomal amphotericin Antifungal medicine.medical_specialty medicine.drug_class medicine Medical prescription Adverse effect Critically ill business.industry Emergency medicine Observational study business
Library of Congress Subject Headings: lcsh:Infectious and parasitic diseases lcsh:RC109-216
Male, Antifungal Agents, :Therapeutics::Drug Therapy::Drug Prescriptions [ANALYTICAL, DIAGNOSTIC AND THERAPEUTIC TECHNIQUES, AND EQUIPMENT], Inappropriate Prescribing, Medicaments antifúngics - Ús terapèutic, Tertiary Care Centers, Antimicrobial Stewardship, :terapéutica::farmacoterapia::prescripciones de medicamentos [TÉCNICAS Y EQUIPOS ANALÍTICOS, DIAGNÓSTICOS Y TERAPÉUTICOS], Surveys and Questionnaires, Prevalence, :Other subheadings::/therapeutic use [Other subheadings], Prospective Studies, Child, Antifungal therapy, :acciones y usos químicos::acciones farmacológicas::usos terapéuticos::antiinfecciosos::antifúngicos [COMPUESTOS QUÍMICOS Y DROGAS], Hospitals, Pediatric, Infectious Diseases, Medicaments - Prescripció, Child, Preschool, :Chemical Actions and Uses::Pharmacologic Actions::Therapeutic Uses::Anti-Infective Agents::Antifungal Agents [CHEMICALS AND DRUGS], Female, Antimicrobial management, Infants, Research Article, Adolescent, :personas::Grupos de Edad::niño [DENOMINACIONES DE GRUPOS], Drug Prescriptions, Humans, :Otros calificadores::/uso terapéutico [Otros calificadores], Paediatrics, :Persons::Age Groups::Child [NAMED GROUPS]
Male, Antifungal Agents, :Therapeutics::Drug Therapy::Drug Prescriptions [ANALYTICAL, DIAGNOSTIC AND THERAPEUTIC TECHNIQUES, AND EQUIPMENT], Inappropriate Prescribing, Medicaments antifúngics - Ús terapèutic, Tertiary Care Centers, Antimicrobial Stewardship, :terapéutica::farmacoterapia::prescripciones de medicamentos [TÉCNICAS Y EQUIPOS ANALÍTICOS, DIAGNÓSTICOS Y TERAPÉUTICOS], Surveys and Questionnaires, Prevalence, :Other subheadings::/therapeutic use [Other subheadings], Prospective Studies, Child, Antifungal therapy, :acciones y usos químicos::acciones farmacológicas::usos terapéuticos::antiinfecciosos::antifúngicos [COMPUESTOS QUÍMICOS Y DROGAS], Hospitals, Pediatric, Infectious Diseases, Medicaments - Prescripció, Child, Preschool, :Chemical Actions and Uses::Pharmacologic Actions::Therapeutic Uses::Anti-Infective Agents::Antifungal Agents [CHEMICALS AND DRUGS], Female, Antimicrobial management, Infants, Research Article, Adolescent, :personas::Grupos de Edad::niño [DENOMINACIONES DE GRUPOS], Drug Prescriptions, Humans, :Otros calificadores::/uso terapéutico [Otros calificadores], Paediatrics, :Persons::Age Groups::Child [NAMED GROUPS]
Microsoft Academic Graph classification: Tertiary care Inappropriate Prescriptions Liposomal amphotericin Antifungal medicine.medical_specialty medicine.drug_class medicine Medical prescription Adverse effect Critically ill business.industry Emergency medicine Observational study business
Library of Congress Subject Headings: lcsh:Infectious and parasitic diseases lcsh:RC109-216
2012
1. Hamdy RF, Zaoutis TE, Seo SK. Antifungal stewardship considerations for adults and pediatrics. Virulence. 2017;8:658-72. https://doi.org/10.1080/ 21505594.2016.1226721.
2. Ramos JT, Francisco L, Daoud Z. Infección fúngica invasora en niños: diferencias y homologías con el adulto [Invasive fungal infections in children: similarities and differences with adults]. Rev Esp Quimioter. 2016;29 Suppl 1:59-65 Spanish. PMID: 27608317.
3. Science M, Timberlake K. Antifungal stewardship: a budding branch of antimicrobial stewardship. Pediatr Blood Cancer. 2020;67(4):e28145. https:// doi.org/10.1002/pbc.28145.
4. Barlam TF, Cosgrove SE, Abbo LM, et al. Implementing an antibiotic stewardship program: guidelines by the Infectious Diseases Society of America and the Society for Healthcare Epidemiology of America. Clin Infect Dis. 2016;62(10):e51-77. https://doi.org/10.1093/cid/ciw118.
5. Rodríguez-Baño J, Paño-Pardo JR, Alvarez-Rocha L, et al. Programs for optimizing the use of antibiotics (PROA) in Spanish hospitals: GEIH-SEIMC, SEFH and SEMPSPH consensus document. Enferm Infecc Microbiol Clin. 2012;30(1):22.e1-22.e23. https://doi.org/10.1016/j.eimc.2011.09.018.
6. Bienvenu AL, Argaud L, Aubrun F, et al. A systematic review of interventions and performance measures for antifungal stewardship programmes. J Antimicrob Chemother. 2018;73(2):297-305. https://doi.org/10.1093/jac/dkx388.
7. Ferreras-Antolín L, Irwin A, Atra A, et al. Neonatal antifungal consumption is dominated by prophylactic use; outcomes from the pediatric antifungal stewardship: optimizing antifungal prescription study. Pediatr Infect Dis J. 2019;38(12):1219-23. https://doi.org/10.1097/INF.0000000000002463.
8. Santiago-García B, Rincón-López EM, Ponce Salas B, et al. Effect of an intervention to improve the prescription of antifungals in pediatric hematology-oncology. Pediatr Blood Cancer. 2020;67(4):e27963. https://doi. org/10.1002/pbc.27963.
9. De Pauw B, Walsh TJ, Donnelly JP, et al. Revised definitions of invasive fungal disease from the European Organization for Research and Treatment of Cancer/invasive infections cooperative group. Clin Infect Dis. 2008;46(12): 1813-21. https://doi.org/10.1086/588660 Revised.
10. Rodríguez-Baño J, Paño-Pardo JR, Alvarez-Rocha L, et al. Programs for optimizing the use of antibiotics (PROA) in Spanish hospitals: GEIH-SEIMC, SEFH and SEMPSPH consensus document. Farm Hosp. 2012;36(1):33.e1-30. https://doi.org/10.1016/j.farma.2011.10.001.
- 1
- 2
citations This is an alternative to the "Influence" indicator, which also reflects the overall/total impact of an article in the research community at large, based on the underlying citation network (diachronically).3 popularity This indicator reflects the "current" impact/attention (the "hype") of an article in the research community at large, based on the underlying citation network.Top 10% influence This indicator reflects the overall/total impact of an article in the research community at large, based on the underlying citation network (diachronically).Average impulse This indicator reflects the initial momentum of an article directly after its publication, based on the underlying citation network.Average citations This is an alternative to the "Influence" indicator, which also reflects the overall/total impact of an article in the research community at large, based on the underlying citation network (diachronically).3 popularity This indicator reflects the "current" impact/attention (the "hype") of an article in the research community at large, based on the underlying citation network.Top 10% influence This indicator reflects the overall/total impact of an article in the research community at large, based on the underlying citation network (diachronically).Average impulse This indicator reflects the initial momentum of an article directly after its publication, based on the underlying citation network.Average
Citations provided by BIP!Popularity provided by BIP!Abstract Background The increasing use of antifungal drugs (AF) in children and the concern for related adverse events and costs has led to the development of specific AF stewardship programmes (AFS). Studies in adult patients have shown improvements in AF prescription and usage after implementation, but paediatric data are scant. The aim of this PROAFUNGI study was to describe the use and appropriateness of AF in a high complexity paediatric centre. Methods Observational, prospective, single-centre, modified point-prevalence study (11 surveys, July–October 2018), including paediatric (< 18 years) patients receiving at least one systemic AF. Prescriptions were evaluated by the AFS team. Results The study included 119 prescriptions in 55 patients (53% males, median age 8.7 years [IQR 2.4–13.8]). The main underlying condition was cancer (45.5% of patients; HSCT in 60% of them); and the first indication for AF was prophylaxis (75 prescriptions, 63.2%). Liposomal amphotericin B was used most commonly (46% prescriptions), mainly as prophylaxis (75%). Among the 219 evaluations, 195 (89%) were considered optimal. The reason for non-optimal prescriptions was mostly lack of indication (14/24), especially in critical patients with ventricular assist devices. The use of AF without paediatric approval accounted for 8/24 inappropriate prescriptions. Conclusions A high rate of AF appropriateness was found for the children’s hospital as a whole, in relation with a well-established AFS. Nonetheless, the identification of specific areas of improvement should guide future actions of the AFS team, which will focus mainly on prophylaxis in critically ill patients receiving circulatory assistance and the use of non-approved drugs in children.