A study on the effectiveness of an antifungal stewardship program in immunocompromised patients in a tertiary-care teaching hospital: The antifungal stewardship (TAFS) study
Bibliographic record
Abstract
INTRODUCTION: Anti-fungal stewardship (AFS) is a neglected aspect of antimicrobial stewardship programs. This study aimed to examine the effectiveness of an AFS program to ensure rational prescribing of antifungals via a post-prescription review and feedback method. METHODS: In this prospective, interrupted time series analysis, AFS was done on adult patients admitted to the department of hematology in a tertiary care hospital in South India. In the pre-intervention phase, patients on anti-fungal therapy for more than 48 h were identified and baseline data was collected. In the intervention phase, patients on antifungals for >48 h were assessed by an AFS team including an infectious diseases specialist and appropriate recommendations were made regarding modification or discontinuation of the antifungals where required. Acceptance of the intervention by the treating team and clinical outcomes were recorded. RESULTS: A total of 193 courses of antifungal therapy in 152 patients were analyzed over 6 months, of which 107 courses belonged to the pre-intervention phase and 86 were in the intervention phase. In the intervention phase, the AFS teams recommended that 15 (17.44 %) of antifungal prescriptions be modified. Among these, 66 % of the recommendations were accepted by the treating physician. Days of therapy per 1000 patient days were calculated for each individual anti-fungal drug and there was a significant reduction in consumption of antifungals, particularly voriconazole, posaconazole and echinocandins in the intervention phase. There was no statistically significant difference in the in-hospital mortality [26.16 % vs 23. 25 % (p = 0.64)] between the two groups. CONCLUSION: In this study, a focused post prescription review and feedback in an antifungal stewardship program appeared to significantly decrease the prescription of antifungal medication without adversely affecting patient outcomes.
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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.010 | 0.003 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.000 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.001 | 0.000 |
| Research integrity | 0.000 | 0.003 |
| Insufficient payload (model declined to judge) | 0.000 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one teacher head, not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".