Evaluation of Systemic Antifungal Prescribing Knowledge and Practice in the Critical Care Setting among ICU Physicians and Clinical Pharmacists: A Cross-Sectional Study

Abstract

Management of invasive fungal infections (IFI) and subsequent treatment choices remain challenging for physicians in the ICU. Documented evidence shows increased practice of the inappropriate use of antifungal agents in the ICU. Continuous education of healthcare providers (HCPs) represents the cornerstone requirement for starting an antifungal stewardship program (AFS). This study aimed at evaluating knowledge gaps in systemic antifungal prescribing among physicians and clinical pharmacists in a critical care setting. A cross-sectional, multi-center, survey-based study was conducted in five tertiary hospitals located in Al-Ahsaa, Saudi Arabia between January and May 2021. A self-administered questionnaire was distributed among the targeted clinicians. A total of 63 clinicians were involved (65.5% ICU physicians and 34.5% clinical pharmacists). It was noted that a minority of the participating HCPs (3.2%) had overall good knowledge about antifungal prescribing, but the majority had either moderate (46%) or poor (50.8%) knowledge. The difference in overall knowledge scores between the ICU physicians and the clinical pharmacists (p = 0.925) was not significant. However, pharmacists showed better scores for the pharmacokinetics of antifungal therapy (p = 0.05). This study has revealed a significant gap in the knowledge and practice of clinicians as regards prescribing antifungal therapy in our area. Although the results cannot be generalized, the outcome of this study has exposed the need for a tailored training program essential for carrying out an AFS program.

Middle Eastern Expert Opinion: Strategies for Successful Antifungal Stewardship Program Implementation in Invasive Fungal Infections

“…A similar study conducted in Saudi Arabia by Ibrahim et al highlighted comparable deficiencies in the knowledge and practice of clinicians prescribing antifungal therapy in the region. Specifically, challenges were observed in areas related to treatment deescalation, accurate identification of the appropriate antifungal treatment, and differentiation between Candida urinary infection and colonization [21]. Healthcare professionals face significant difficulties when managing patients with IFI due to their limited knowledge of symptoms, diagnostic techniques, and the proper usage and dosing of antifungal drugs [22].…”

“…Additionally, the involvement of hematologists and intensive care specialists is vital for addressing the specific needs of immunocompromised patient populations [ 26 ]. Given the intricate nature of diagnosing and treating IFI, especially in critically ill patients or in patients undergoing chemotherapy, it is crucial to establish a collaborative multidisciplinary team to ensure a diverse approach to enhance patient care, minimize risks, and avoid drug-drug interactions, especially in patients who are often on polypharmacy [ 21 , 27 ].…”