Objectives: A concise invasive candidosis (IC) guideline (based on the ESCMID candidaemia guideline) utilising an informative biomarker (serumβ-1-3-D-glucan) was developed in 2013 by the antifungal stewardship (AFS) team and implemented with the help of an AFS Champion in 2014. The main aims of the AFS programme were to reduce inappropriate use of antifungals and improve patient outcomes. The aim of this project was to evaluate the compliance of the ICU teams with the IC guideline and the impact of the AFS programme on mortality and antifungal consumption on the ICUs (total of 71 beds).
Methods: All patients who were prescribed micafungin for suspected or proven IC during 4-month audit periods in 2014 and 2016 were included. Prescriptions and patient records were reviewed against the guideline. Antifungal consumption and mortality data was analysed.
Results: The number of patients treated for IC decreased from 39 in 2014 to 29 in 2016. This was mainly due to the reduction in patients initiated on antifungal therapy inappropriately: 18 in 2014 and 2 in 2016. Antifungal therapy was stopped following negative biomarker results in 12 patients in 2014 and 10 patients in 2016. Crude mortality to proven or probable IC decreased to 19% from 45% in 2003-2007. Antifungal consumption reduced by 49% from 2014 to 2016.
Conclusions: The AFS program was successful in reducing the number of inappropriate initiations of antifungals by 90%. Concurrently, mortality from IC was reduced by 58%. BDG testing can guide safe cessation of antifungals in ICU patients at risk of IC.