Auditing fungal disease in leukemia patients in a tertiary care center: opportunities and challenges for an antifungal stewardship program

Implementation of Effective Antifungal Stewardship in Cancer Patients—A Review of Current Evidence

“…Traditional approaches to surveillance involve the examination of radiology reports, medical records, antifungal drug dispensing data, and microbiology results [40,41]. This manual approach is resource intensive, time consuming, error prone, and subject to either underreporting and/or variability in case ascertainment [42,43]. Similarly, auditing of antifungal prescribing is not feasible in routine work due to the requirement for detailed chart review and the subjective nature of many assessments of quality and outcomes, which may be confounded by the patient complexity [39••, 42].…”

“…In the cancer setting, the heterogeneity of patients' clinical conditions, widely varying comorbidities and medications (often leading to drug-drug interactions) means that clinical guideline recommendations may not provide advice for all possible clinical scenarios in routine care [27••, 44]. Additionally, there is an absence of comprehensive consensus or local guidelines regarding antifungal prophylaxis in selected patient cohorts [43]. These factors often lead to uncertainties when initiating antifungal treatment and prophylaxis in special patient groups and frequently complicates efforts to determine appropriateness of prescribing [43].…”

“…Additionally, there is an absence of comprehensive consensus or local guidelines regarding antifungal prophylaxis in selected patient cohorts [43]. These factors often lead to uncertainties when initiating antifungal treatment and prophylaxis in special patient groups and frequently complicates efforts to determine appropriateness of prescribing [43]. As populations grow older and have more complex disease states and comorbidities, the difficulties in applying general guidelines for specific clinical situations will likely increase in the future [42].…”

“…A review of the literature revealed six studies evaluating the appropriateness of antifungal prescribing solely or predominantly in the cancer setting [42,43,[45][46][47][48] (Table 2). The overall rate of appropriate antifungal prescribing was found to be suboptimal, ranging between 29.4 and 56.5%, with one outlier study of Australian acute leukemia patients where overall appropriateness was 95.7% [43].…”

“…A review of the literature revealed six studies evaluating the appropriateness of antifungal prescribing solely or predominantly in the cancer setting [42,43,[45][46][47][48] (Table 2). The overall rate of appropriate antifungal prescribing was found to be suboptimal, ranging between 29.4 and 56.5%, with one outlier study of Australian acute leukemia patients where overall appropriateness was 95.7% [43]. The variability in appropriateness is in part due to varied stringency in assessment methodology and the exclusion of patient groups where no gold standard guidelines for prophylaxis were available.…”