Impact of Education and an Antifungal-Management Program For Candidiasis at a Thai Tertiary Care Center

Background: Increased antifungal drug resistance, especially for Candida species, has been associated with inappropriate antifungal drug use, persistent infections, high mortality, and excess healthcare costs.

Objective: We conducted a study to evaluate the impact of education and an antifungal-management program on antifungal prescribing practices for candidiasis, antifungal consumptions, Candida spp., and estimated costs at a Thai tertiary-care hospital.

Methods: A hospital-wide, quasi-experimental study was conducted for 1.5 years before the intervention and 1.5 years after the implementation of an antifungal-management program. Inpatient antifungal prescriptions were prospectively observed.  Demographics, clinical, and administrative cost data were collected.  Interventions included education, introduction of an antifungal renal/hepatic dose adjustment poster, use of antifungal prescription forms, and prescribing control strategies.

Results: Post-intervention, there was a 59% reduction in antifungal prescriptions (194 vs. 80 prescriptions/1000 admission; P<0.001) and the incidence of inappropriate antifungal use (71% vs. 24%; P<0.001).  A sustained reduction in antifungal use was observed (r = 0.83; P<0.001) and fluconazole consumption significantly declined (242 vs. 117 DDD/1000 patient-days; P<0.001).  Significant reduction in the incidence of C. glabrata (r= 0.69; P <0.001) and C. krusei (r= 0.71; P<0.001) were observed, while the incidence of C. albicans (r= -0.81; P<0.001) increased.  There was no interval difference in crude mortality among patients who received antifungal therapy (24% vs. 21%; P = 0.81).  Total cost savings were US$31,615 during the 18-month, post-intervention period.

Conclusions: Implementation of an antifungal-management program was associated with appropriate antifungal drug use, improved resource utilization, and cost savings to a large Thai tertiary care center.