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

Abstract

Purpose of Review This review summarizes the literature around antifungal stewardship (AFS) with a focus on the cancer setting. We include a review of identified challenges to the implementation of AFS, summarize studies evaluating quality of prescribing and interventions to optimize invasive fungal disease management. We also provide a review of metrics for AFS programs and advances in fungal diagnostics which can be harnessed by the AFS team. Recent Findings In recent times, there has been an increase in targeted research assessing the quality of antifungal prescribing and the impact of AFS interventions, largely within single centers and observational in nature. Summary Several challenges exist to the implementation of AFS programs. Studies have found high rates of suboptimal antifungal prescribing, and multifaceted interventions have been successful in optimizing the quality and reducing the volume of prescribing. Standardized metrics may assist hospitals to interpret data effectively and structure suitable quality improvement programs.

Quality of inpatient antimicrobial use in hematology and oncology patients

“…13,22 Antifungal stewardship and review of antifungal prescription quality is recognized as a complex and challenging area requiring specific data, methods, and expertise that were beyond the scope of the Hospital NAPS survey. 23 Consensus definitions of feasible core antifungal auditing metrics have recently been established by an international Delphi method 24 and will inform development of a targeted antifungal NAPS tool.…”