{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,25]],"date-time":"2026-07-25T05:51:25Z","timestamp":1784958685526,"version":"3.55.0"},"reference-count":32,"publisher":"MDPI AG","issue":"7","license":[{"start":{"date-parts":[[2021,6,26]],"date-time":"2021-06-26T00:00:00Z","timestamp":1624665600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Medicina"],"abstract":"<jats:p>Background and Objectives: Overtreatment with antifungal drugs is often observed. Antifungal stewardship (AFS) focuses on optimizing the treatment for invasive fungal diseases. The objective of the present study was to evaluate the utility of a post-prescription audit plus beta-D-glucan (BDG) assessment on reducing echinocandin use in persons with suspected invasive candidiasis. Materials and Methods: This is a prospective, pre-post quasi-experimental study of people starting echinocandins for suspected invasive candidiasis. The intervention of the study included review of each echinocandin prescription and discontinuation of treatment if a very low probability of fungal disease or a negative BDG value were found. Pre-intervention data were compared with the intervention phase. The primary outcome of the study was the duration of echinocandin therapy. Secondary outcomes were length of hospital stay and mortality. Results: Ninety-two echinocandin prescriptions were reviewed, 49 (53.3%) in the pre-intervention phase and 43 (46.7%) in the intervention phase. Discontinuation of antifungal therapy was possible in 21 of the 43 patients in the intervention phase (48.8%). The duration of echinocandin therapy was 7.4 (SD 4.7) in the pre-intervention phase, 4.1 days (SD 2.9) in persons undergoing the intervention, and 8.6 (SD 7.3) in persons in whom the intervention was not feasible (p at ANOVA = 0.016). Length of stay and mortality did not differ between pre-intervention and intervention phases. Conclusions: An intervention based on pre-prescription restriction and post-prescription audit when combined with BDG measurement is effective in optimizing antifungal therapy by significantly reducing excessive treatment duration.<\/jats:p>","DOI":"10.3390\/medicina57070656","type":"journal-article","created":{"date-parts":[[2021,6,27]],"date-time":"2021-06-27T22:24:57Z","timestamp":1624832697000},"page":"656","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":7,"title":["Post-Prescription Audit Plus Beta-D-Glucan Assessment Decrease Echinocandin Use in People with Suspected Invasive Candidiasis"],"prefix":"10.3390","volume":"57","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-9468-5458","authenticated-orcid":false,"given":"Rita","family":"Murri","sequence":"first","affiliation":[{"name":"Department of Laboratory and Infectious Diseases Sciences, A. Gemelli University Hospital Foundation IRCCS, 00168 Rome, Italy"},{"name":"Infectious Diseases Section, Department of Safety and Bioethics, Catholic University of the Sacred Heart, 00168 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sara","family":"Lardo","sequence":"additional","affiliation":[{"name":"A. Gemelli University Hospital Foundation IRCCS, 00168 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alessio","family":"De Luca","sequence":"additional","affiliation":[{"name":"Pharmacy Complex Operative Unit, A. Gemelli University Hospital Foundation IRCCS, 00168 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Brunella","family":"Posteraro","sequence":"additional","affiliation":[{"name":"Department of Laboratory and Infectious Diseases Sciences, A. Gemelli University Hospital Foundation IRCCS, 00168 Rome, Italy"},{"name":"Department of Basic Biotechnology, Clinical Intensive Care and Perioperative Sciences, Catholic University of the Sacred Heart, 00168 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Riccardo","family":"Torelli","sequence":"additional","affiliation":[{"name":"Department of Laboratory and Infectious Diseases Sciences, A. Gemelli University Hospital Foundation IRCCS, 00168 Rome, Italy"},{"name":"Department of Basic Biotechnology, Clinical Intensive Care and Perioperative Sciences, Catholic University of the Sacred Heart, 00168 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Giulia","family":"De Angelis","sequence":"additional","affiliation":[{"name":"Department of Laboratory and Infectious Diseases Sciences, A. Gemelli University Hospital Foundation IRCCS, 00168 Rome, Italy"},{"name":"Department of Basic Biotechnology, Clinical Intensive Care and Perioperative Sciences, Catholic University of the Sacred Heart, 00168 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6972-6470","authenticated-orcid":false,"given":"Francesca","family":"Giovannenze","sequence":"additional","affiliation":[{"name":"Department of Laboratory and Infectious Diseases Sciences, A. Gemelli University Hospital Foundation IRCCS, 00168 Rome, Italy"},{"name":"Infectious Diseases Section, Department of Safety and Bioethics, Catholic University of the Sacred Heart, 00168 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Francesco","family":"Taccari","sequence":"additional","affiliation":[{"name":"Department of Laboratory and Infectious Diseases Sciences, A. Gemelli University Hospital Foundation IRCCS, 00168 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lucia","family":"Pavan","sequence":"additional","affiliation":[{"name":"Pharmacy Complex Operative Unit, A. Gemelli University Hospital Foundation IRCCS, 00168 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lucia","family":"Parroni","sequence":"additional","affiliation":[{"name":"Pharmacy Complex Operative Unit, A. Gemelli University Hospital Foundation IRCCS, 00168 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9780-7059","authenticated-orcid":false,"given":"Maurizio","family":"Sanguinetti","sequence":"additional","affiliation":[{"name":"Department of Laboratory and Infectious Diseases Sciences, A. Gemelli University Hospital Foundation IRCCS, 00168 Rome, Italy"},{"name":"Department of Basic Biotechnology, Clinical Intensive Care and Perioperative Sciences, Catholic University of the Sacred Heart, 00168 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6913-8460","authenticated-orcid":false,"given":"Massimo","family":"Fantoni","sequence":"additional","affiliation":[{"name":"Department of Laboratory and Infectious Diseases Sciences, A. Gemelli University Hospital Foundation IRCCS, 00168 Rome, Italy"},{"name":"Infectious Diseases Section, Department of Safety and Bioethics, Catholic University of the Sacred Heart, 00168 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2021,6,26]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"18026","DOI":"10.1038\/nrdp.2018.26","article-title":"Invasive candidiasis","volume":"4","author":"Pappas","year":"2018","journal-title":"Nat. Rev. Dis. Primers"},{"key":"ref_2","first-page":"1","article-title":"Nosocomial Candidiasis: Antifungal Stewardship and the Importance of Rapid Diagnosis","volume":"54","author":"Pfaller","year":"2016","journal-title":"Med. Mycol."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"4167","DOI":"10.1128\/JCM.01998-13","article-title":"Epidemiology, species distribution, antifungal susceptibility, and outcome of candidemia across five sites in Italy and Spain","volume":"51","author":"Bassetti","year":"2013","journal-title":"J. Clin. Microbiol."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"3107","DOI":"10.1093\/jac\/dkv241","article-title":"Combination of Candida biomarkers in patients receiving empirical antifungal therapy in a Spanish tertiary hospital: A potential role in reducing the duration of treatment","volume":"70","author":"Valerio","year":"2015","journal-title":"J. Antimicrob. Chemother."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"808","DOI":"10.1007\/s00134-014-3281-0","article-title":"What it\u2019s new in the clinical and diagnostic management of invasive candidiasis in critically ill patients","volume":"40","author":"Leon","year":"2014","journal-title":"Intensive Care Med."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"1993","DOI":"10.1093\/jac\/dku053","article-title":"Evaluation of antifungal use in a tertiary care institution: Antifungal stewardship urgently needed","volume":"69","author":"Valerio","year":"2014","journal-title":"J. Antimicrob. Chemother."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"11","DOI":"10.1111\/1469-0691.12622","article-title":"Antifungal stewardship in invasive Candida infections","volume":"20","author":"Ruhnke","year":"2014","journal-title":"Clin. Microbiol. Infect."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"107","DOI":"10.1097\/QCO.0b013e32834e0680","article-title":"The case for an-tifungal stewardship","volume":"25","author":"Slavin","year":"2012","journal-title":"Curr. Opin. Infect. Dis."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"658","DOI":"10.1080\/21505594.2016.1226721","article-title":"Antifungal stewardship considerations for adults and pediatrics","volume":"8","author":"Hamdy","year":"2017","journal-title":"Virulence"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"e383","DOI":"10.1016\/S1473-3099(17)30316-X","article-title":"The global problem of antifungal resistance: Prevalence, mechanisms, and management","volume":"17","author":"Perlin","year":"2017","journal-title":"Lancet Infect. Dis."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"19","DOI":"10.1111\/1469-0691.12039","article-title":"ESCMID* guideline for the diagnosis and management of Candida diseases 2012: Non-neutropenic adult patients","volume":"18","author":"Cornely","year":"2012","journal-title":"Clin. Microbiol. Infect."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"e1","DOI":"10.1093\/cid\/civ933","article-title":"Clinical Practice Guideline for the Management of Candidiasis: 2016 Update by the Infectious Diseases Society of America","volume":"62","author":"Pappas","year":"2016","journal-title":"Clin. Infect. Dis."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"19","DOI":"10.2147\/IDR.S181489","article-title":"Performance evaluation of the (1,3)-\u03b2-D-glucan detection assay in non-intensive care unit adult patients","volume":"12","author":"Murri","year":"2018","journal-title":"Infect. Drug Resist."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"R249","DOI":"10.1186\/cc10507","article-title":"Early diagnosis of candidemia in intensive care unit patients with sepsis: A prospective comparison of (1\u21923)-\u03b2-D-glucan assay, Candida score, and colonization index","volume":"15","author":"Posteraro","year":"2011","journal-title":"Crit. Care"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"2262","DOI":"10.1093\/jac\/dkw112","article-title":"(1,3)-\u03b2-d-Glucan-based antifungal treatment in critically ill adults at high risk of candidaemia: An observational study","volume":"71","author":"Posteraro","year":"2016","journal-title":"J. Antimicrob. Chemother."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"263","DOI":"10.1007\/s15010-013-0558-0","article-title":"An Italian consensus for invasive candidiasis management (ITALIC)","volume":"42","author":"Scudeller","year":"2014","journal-title":"Infection"},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"730","DOI":"10.1097\/01.CCM.0000202208.37364.7D","article-title":"A bedside scoring system (\u201cCandida score\u201d) for early antifungal treatment in nonneutropenic critically ill patients with Candida colonization","volume":"34","author":"Saavedra","year":"2006","journal-title":"Crit. Care Med."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"271","DOI":"10.1007\/s10096-007-0270-z","article-title":"Multicenter retrospective development and validation of a clinical prediction rule for nosocomial invasive candidiasis in the intensive care setting","volume":"26","author":"Sable","year":"2007","journal-title":"Eur. J. Clin. Microbiol. Infect. Dis."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"625","DOI":"10.1007\/s15010-018-1162-0","article-title":"A prediction rule for early recognition of patients with candidemia in Internal Medicine: Results from an Italian, multicentric, case-control study","volume":"46","author":"Sozio","year":"2018","journal-title":"Infection"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"819","DOI":"10.1093\/cid\/ciu407","article-title":"FKS mutant Candida glabrata: Risk factors and outcomes in patients with candidemia","volume":"59","author":"Beyda","year":"2014","journal-title":"Clin. Infect. Dis."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"1042","DOI":"10.1093\/jac\/dkq053","article-title":"Candidaemia in adult cancer patients: Risks for fluconazole-resistant isolates and death","volume":"65","author":"Slavin","year":"2010","journal-title":"J. Antimicrob. Chemother."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"532","DOI":"10.1128\/AAC.01128-10","article-title":"Recent exposure to caspofungin or fluconazole influences the epidemiology of candidemia: A prospective multicenter study involving 2441 patients","volume":"55","author":"Lortholary","year":"2011","journal-title":"Antimicrob. Agents Chemother."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"3398","DOI":"10.1128\/AAC.00054-16","article-title":"Drug-Drug Interaction Associated with Mold-Active Triazoles among Hospitalized Patients","volume":"60","author":"Andes","year":"2016","journal-title":"Antimicrob. Agents Chemother."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"i26","DOI":"10.1093\/jac\/dkx446","article-title":"Tolerability profile of the current antifungal armoury","volume":"73","author":"Mourad","year":"2018","journal-title":"J. Antimicrob. Chemother."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"297","DOI":"10.1093\/jac\/dkx388","article-title":"A systematic review of interventions and performance measures for antifungal stewardship programmes","volume":"73","author":"Bienvenu","year":"2018","journal-title":"J. Antimicrob. Chemother."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"1581","DOI":"10.1099\/jmm.0.000612","article-title":"An investigation of antifungal stewardship programmes in England","volume":"66","author":"Micallef","year":"2017","journal-title":"J. Med. Microbiol."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"464","DOI":"10.1111\/myc.12768","article-title":"Antifungal treatment in haematological and oncological patients: Need for quality assessment in routine care","volume":"61","author":"Lachenmayr","year":"2018","journal-title":"Mycoses"},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"338","DOI":"10.1086\/664909","article-title":"Antimicrobial stewardship at a large tertiary care academic medical center: Cost analysis before, during, and after a 7-year program","volume":"33","author":"Standiford","year":"2012","journal-title":"Infect. Control Hosp. Epidemiol."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"234","DOI":"10.1093\/jac\/dky389","article-title":"Effectiveness of an antifungal stewardship programme at a London teaching hospital 2010-16","volume":"74","author":"Whitney","year":"2019","journal-title":"J. Antimicrob. Chemother."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"435","DOI":"10.1007\/s15010-018-01264-4","article-title":"Appropriate use of antifungals: Impact of an antifungal stewardship program on the clinical outcome of candidaemia in a French University Hospital","volume":"47","author":"Benoist","year":"2019","journal-title":"Infection"},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"e1","DOI":"10.1016\/j.cmi.2015.01.013","article-title":"Antifungal stewardship in a tertiary-care institution: A bedside intervention","volume":"21","author":"Valerio","year":"2015","journal-title":"Clin. Microbiol. Infect."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"454","DOI":"10.1111\/jcpt.12809","article-title":"The impact of implementing an antifungal stewardship with monitoring of 1-3, \u03b2-D-glucan values on antifungal consumption and clinical outcomes","volume":"44","author":"Niwa","year":"2019","journal-title":"J. Clin. Pharm. Ther."}],"container-title":["Medicina"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1648-9144\/57\/7\/656\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T06:24:54Z","timestamp":1760163894000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1648-9144\/57\/7\/656"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,6,26]]},"references-count":32,"journal-issue":{"issue":"7","published-online":{"date-parts":[[2021,7]]}},"alternative-id":["medicina57070656"],"URL":"https:\/\/doi.org\/10.3390\/medicina57070656","relation":{},"ISSN":["1648-9144"],"issn-type":[{"value":"1648-9144","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,6,26]]}}}