Standards of CARE: what is considered ‘best practice’ for the management of invasive fungal infections? A haematologist’s and a mycologist’s perspective

Abstract

Patients at risk of, or diagnosed with, an invasive fungal infection benefit from an early antifungal intervention. Different strategies have been explored, each with particular strengths and weaknesses. The use of broad-spectrum antifungal prophylaxis seems logical, but selective use is important given its potential for major collateral damage, including interference with diagnostic assays, selection of resistance, toxicity and drug interactions. Hence, anti-mould prophylaxis should be restricted to well-defined high-risk groups. An empirical approach is still widely applied but incurs the clinical and cost penalties associated with overtreatment. Nowadays there is a growing interest in delaying antifungal treatment until an invasive fungal infection is highly suspected ('pre-emptive' management) or confirmed, prompted by the development of more-sensitive diagnostic techniques. While pre-emptive treatment looks appealing, the necessary monitoring and detailed treatment algorithms can be rather complex and often require a multidisciplinary effort. This article aims to bring together different perspectives on 'best practice' for the management of invasive fungal infections, using haematology patients as a model.