Lessons from an Educational Invasive Fungal Disease Conference on Hospital Antifungal Stewardship Practices across the UK and Ireland.

Alida Fe Talento,Malcolm Qualie,Laura Cottom,P Lewis White,Matthijs Backx

doi:10.3390/jof7100801

Abstract

Invasive fungal disease (IFD) is a growing health burden. High mortality rates, increasing numbers of at-risk hosts, and a limited availability of rapid diagnostics and therapeutic options mean that patients are increasingly exposed to unnecessary antifungals. High rates of prescriptions promote patient exposure to undue toxicity and drive the emergence of resistance. Antifungal stewardship (AFS) aims to guide antifungal usage and reduce unnecessary exposure and antifungal consumption whilst maintaining or improving outcomes. Here, we examine several AFS approaches from hospitals across the UK and Ireland to demonstrate the benefits of AFS practices and support the broader implementation of AFS as both a necessary and achievable strategy. Since the accuracy and turnaround times (TATs) of diagnostic tools can impact treatment decisions, several AFS strategies have included the development and implementation of diagnostic-driven care pathways. AFS informed treatment strategies can help stratify patients on a risk basis ensuring the right patients receive antifungals at the optimal time. Using a multidisciplinary approach is also key due to the complexity of managing and treating patients at risk of IFD. Through knowledge sharing, such as The Gilead Antifungal Information Network (GAIN), we hope to drive practices that improve patient management and support the preservation of antifungals for future use.

Highlights

The World Health Organization has recognised that invasive fungal diseases (IFDs) are a significant health burden [1], with mortality rates as high as 45–63% for aspergillosis and 50% for candidiasis [2]
In the absence of an apparent fungal infection, treatment is often given prophylactically and/or empirically to patients in high-risk groups; something that could be avoided with the implementation of timely and accurate diagnostic screening strategies [7]
Findings from an electronic survey into Antifungal stewardship (AFS) programmes in England identified that 57%

Summary

Introduction

The World Health Organization has recognised that invasive fungal diseases (IFDs) are a significant health burden [1], with mortality rates as high as 45–63% for aspergillosis and 50% for candidiasis [2]. The majority of hosts are immune-compromised or receiving multiple treatments or interventions [2,3,4], and there is a growing number of patients at high risk of IFDs in haematology, transplantation, and critical care [5,6]. Management of these patients is complex, since antifungals interact with many other drugs and are contraindicated in combination treatments [3,4,6], risking patient exposure to undue toxicity and potential drug–drug interactions (DDIs). In the absence of an apparent fungal infection, treatment is often given prophylactically and/or empirically to patients in high-risk groups; something that could be avoided with the implementation of timely and accurate diagnostic screening strategies [7]

Results

Discussion

Conclusion