Core Recommendations for Antifungal Stewardship: A Statement of the Mycoses Study Group Education and Research Consortium

Johnson, Melissa D.; Lewis, Russell E.; Ashley, Elizabeth S. Dodds; Ostrosky-Zeichner, Luis; Zaoutis, Theoklis; Thompson, George R.; Andes, David R.; Walsh, Thomas J.; Pappas, Peter G.; Cornely, Oliver A.; Perfect, John R.; Kontoyiannis, Dimitrios P.

doi:10.1093/infdis/jiaa394

Cited by 109 publications

(154 citation statements)

References 208 publications

(267 reference statements)

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“…The majority of treatment courses were for oral candidiasis, and only 1% (7/580) of infants were treated for systemic disease with either amphotericin B deoxycholate ( n = 3) or fluconazole ( n = 4). A more targeted assessment of antifungal prophylaxis and treatment is needed to address needed stewardship in this area [66] .…”

Section: Discussionmentioning

confidence: 99%

A global point prevalence survey of antimicrobial use in neonatal intensive care units: The no-more-antibiotics and resistance (NO-MAS-R) study

et al. 2021

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Background Global assessment of antimicrobial agents prescribed to infants in the neonatal intensive care unit (NICU) may inform antimicrobial stewardship efforts. Methods We conducted a one-day global point prevalence study of all antimicrobials provided to NICU infants. Demographic, clinical, and microbiologic data were obtained including NICU level, census, birth weight, gestational/chronologic age, diagnoses, antimicrobial therapy (reason for use; length of therapy), antimicrobial stewardship program (ASP), and 30-day in-hospital mortality. Findings On July 1, 2019, 26% of infants (580/2,265; range, 0–100%; median gestational age, 33 weeks; median birth weight, 1800 g) in 84 NICUs (51, high-income; 33, low-to-middle income) from 29 countries (14, high-income; 15, low-to-middle income) in five continents received ≥1 antimicrobial agent (92%, antibacterial; 19%, antifungal; 4%, antiviral). The most common reasons for antibiotic therapy were “rule-out” sepsis (32%) and “culture-negative” sepsis (16%) with ampicillin (40%), gentamicin (35%), amikacin (19%), vancomycin (15%), and meropenem (9%) used most frequently. For definitive treatment of presumed/confirmed infection, vancomycin (26%), amikacin (20%), and meropenem (16%) were the most prescribed agents. Length of therapy for culture-positive and “culture-negative” infections was 12 days (median; IQR, 8–14) and 7 days (median; IQR, 5–10), respectively. Mortality was 6% (42%, infection-related). An NICU ASP was associated with lower rate of antibiotic utilization ( p = 0·02). Interpretation Global NICU antibiotic use was frequent and prolonged regardless of culture results. NICU-specific ASPs were associated with lower antibiotic utilization rates, suggesting the need for their implementation worldwide. Funding Merck & Co.; The Ohio State University College of Medicine Barnes Medical Student Research Scholarship

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Section: Discussionmentioning

confidence: 99%

A global point prevalence survey of antimicrobial use in neonatal intensive care units: The no-more-antibiotics and resistance (NO-MAS-R) study

et al. 2021

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“…20 Pharmacists are key members of antimicrobial stewardship (AMS) teams globally and have shown that they can lead AMS programs. 21 Despite a recent focus on AFS, 22 the role of the pharmacist in AFS has not been extensively explored. The aim of this systematic review is to summarise the available evidence on pharmacistled AFS programs in the hospital setting and to evaluate the impact of pharmacist-led AFS programs on the quality of systemic antifungal prescribing and infection management, antifungal usage and clinical outcomes.…”

Section: Introductionmentioning

confidence: 99%

The impact of pharmacist‐led antifungal stewardship interventions in the hospital setting: a systematic review

Khanina

Cairns

Kong

et al. 2021

Pharmacy Practice and Res

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Aim: To summarise the evidence on pharmacist-led antifungal stewardship (AFS) programs in the hospital setting and to evaluate their impact on the quality of antifungal prescribing and infection management, antifungal usage and clinical outcomes. Data sources: A systematic review of English-language studies identified in MEDLINE and EMBASE was performed on 27 November 2020 and conducted in accordance with PRISMA. Search terms included 'antifungal agent', 'invasive fungal infection', 'antimicrobial stewardship', 'patient care bundles' and 'pharmacist'. Study selection: Eligible studies describing pharmacist-led quality improvement intervention(s) implemented in the hospital setting targeted at optimising systemic antifungal prescribing. Results: Six hundred and forty-six studies were identified, and seven met inclusion criteria. Five were dedicated to optimising candidaemia management, one at optimising intensive care unit prescribing of caspofungin and one on antifungal prescribing in haematology and oncology units. All studies measured varied metrics relating to quality of prescribing and infection management, reporting improvement in proportion of effective antifungal therapy (n = 1/1), appropriate antifungal selection (n = 1/1), dosing (n = 2/3), management of drug-drug interactions (n = 1/1) and reduced time to antifungal initiation (n = 4/4). Studies that implemented a candidaemia bundle of care reported improvements in composite bundle adherence (n = 2/2), with greatest improvement in ophthalmological consultation (n = 4/4), echocardiography (n = 2/2) and infectious diseases consultation (n = 3/3). There was reduction in antifungal expenditure (n = 4/4) and consumption (n = 2/4). Pharmacist-led AFS programs did not influence clinical outcomes. Conclusion: Available evidence suggests that pharmacist-led AFS interventions can improve the quality and timeliness of antifungal prescribing and reduce antifungal usage. Further research is required to assess the impact on clinical and microbiological outcomes.

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“…Antifungals, like antimicrobials, require active stewardship initiatives to ensure responsible use and minimize development of resistance. The recent guidance from the Mycoses Study Group for antifungal stewardship recommend that all centers frequently managing patients with invasive fungal infection have access to timely conventional and non-culture based diagnostic methods for Candida species [ 29 ]. However, diagnostic stewardship (responsible use of the diagnostic test itself), is an important consideration especially for newer more costly non-culture-based methods such as T2Candida.…”

Section: T2candida Cost-effectiveness and Potential Role In Antifumentioning

confidence: 99%

“…In care settings with low pre-test likelihoods of candidemia, PPVs are too low to justify initiating antifungals based purely on a positive result [ 11 , 17 ]. The strong NPVs of T2Candida across a broad range of prevalence’s, one of its strengths is as a stewardship tool to aid in decisions regarding discontinuation of empiric antifungal treatment [ 17 , 29 ]. The standard T2Candida panel currently identifies the five commonly isolated Candida sp.…”

Section: T2candida: Strengths and Limitationsmentioning

confidence: 99%

T2Candida for the Diagnosis and Management of Invasive Candida Infections

Monday

Acosta

Alangaden

2021

JoF

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Invasive candidiasis is a common healthcare-associated infection with high mortality and is difficult to diagnose due to nonspecific symptoms and limitations of culture based diagnostic methods. T2Candida, based on T2 magnetic resonance technology, is FDA approved for the diagnosis of candidemia and can rapidly detect the five most commonly isolated Candida sp. in approximately 5 h directly from whole blood. We discuss the preclinical and clinical studies of T2Candida for the diagnosis of candidemia and review the current literature on its use in deep-seated candidiasis, its role in patient management and prognosis, clinical utility in unique populations and non-blood specimens, and as an antifungal stewardship tool. Lastly, we summarize the strengths and limitations of this promising nonculture-based diagnostic test.

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Core Recommendations for Antifungal Stewardship: A Statement of the Mycoses Study Group Education and Research Consortium

Cited by 109 publications

References 208 publications

A global point prevalence survey of antimicrobial use in neonatal intensive care units: The no-more-antibiotics and resistance (NO-MAS-R) study

A global point prevalence survey of antimicrobial use in neonatal intensive care units: The no-more-antibiotics and resistance (NO-MAS-R) study

The impact of pharmacist‐led antifungal stewardship interventions in the hospital setting: a systematic review

T2Candida for the Diagnosis and Management of Invasive Candida Infections

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