4CPS-139 Evaluation of antifungal prescription practices in a hospital with an antimicrobial stewardship programme

<h3>Background and Importance</h3> Nowadays, there are various antifungal treatments on the market, highlighting the need for restrictions on their use. <h3>Aim and Objectives</h3> Our aim is to evaluate the quality of prescription and clinical evolution of the patient with antifungal treatment in a hospital with an educational antimicrobial stewardship programme (ASP). <h3>Material and Methods</h3> Retrospective and observational study. Patients who required treatment with controlled antifungals in 2023 were included. The variables collected were: sex, age, hospital admission and discharge date, prescriber service and antifungal treatment. The prescription quality was measured based on empirical vs directed antimicrobial therapy, indication adequacy according to the ASP criteria and the doctor’s approval of the recommendation made by the ASP. The clinical progress was analysed by the 30-day hospital readmission and mortality. Data were obtained through Orion Clinic and Farmis-Oncofarm. <h3>Results</h3> 138 patients were included, being 87(63%) men, with an average age of 66 years. The median of days with antifungal treatment and the hospital stay was 4 (RIC:8) and 20 (RIC: 24), respectively. 64% of the antifungal prescription was made by critical intensive care. The antifungals prescribed were: 41(29.7%) patients with azoles (20 with isavuconazole, 19 with voriconazole and 2 with posaconazole), 7(5%) with liposomal amphotericin B and 90(65.3%) with echinocandin (70 with anidulafungin and 20 with caspofungin). 110 treatments were empirical and 28 directed at a microorganism. 69(50%) prescriptions were considered appropriate by ASP, being 52 empirical therapies and 17 directed therapies. A treatment modification recommendation was suggested in 69(50%) patients, being accepted in 41(60%) patients by the doctor. As for clinical progress, 70 (49.2%) patients were discharged without new readmissions or infection complications, 19 (13.7%) were readmitted 30 days after de discharge, and 49(35.5%) died (39/49 critical patients). <h3>Conclusion and Relevance</h3> Quality of prescription The majority of antifungal treatments were prescribed empirically, with echinocandins being the most commonly used group. ASP deemed half of the prescriptions to be appropriate. Over half of the cases implemented the recommendations suggested by ASP. Clinical evolution Fifty percent of the patients had no complications following discharge. The intervention of these programmes is important to ensure a favourable clinical evolution in more complex patients. <h3>References and/or Acknowledgements</h3> <h3>Conflict of Interest</h3> No conflict of interest