Issues in antifungal stewardship: an opportunity that should not be lost: Table 1

Abstract

Many countries have observed an increase in the incidence of invasive fungal infections (IFIs) over the past two decades with emergence of new risk factors and isolation of new fungal pathogens. Early diagnosis and appropriate antifungal treatment remain the cornerstones of successful outcomes. However, due to non-specific clinical presentations and limited availability of rapid diagnostic tests, in more than half of cases antifungal treatment is inappropriate. As a result, the emergence of antifungal resistance both in yeasts and mycelial fungi is becoming increasingly common. The Delhi Chapter of the Indian Association of Medical Microbiologists (IAMM-DC) organized a 1 day workshop in collaboration with BSAC on 10 December 2015 in New Delhi to design a road map towards the development of a robust antifungal stewardship programme in the context of conditions in India. The workshop aimed at developing a road map for optimizing better outcomes in patients with IFIs while minimizing unintended consequences of antifungal use, ultimately leading to reduced healthcare costs and prevention development of resistance to antifungals. The workshop was a conclave of all stakeholders, eminent experts from India and the UK, including clinical microbiologists, critical care specialists and infectious disease physicians. Various issues in managing IFIs were discussed, including epidemiology, diagnostic and therapeutic algorithms in different healthcare settings. At the end of the deliberations, a consensus opinion and key messages were formulated, outlining a step-by-step approach to tackling the growing incidence of IFIs and antifungal resistance, particularly in the Indian scenario.

Closing the Gap in Surveillance and Audit of Invasive Mold Diseases for Antifungal Stewardship Using Machine Learning

“…Antifungal stewardship (AFS) is a growing area of clinical importance in hospitals worldwide that manage patients vulnerable to invasive fungal diseases (IFD) [1,2]. Like antibiotics, overuse of antifungal drugs is common but largely driven by the high morbidity and mortality of IFD [3] combined with insensitive diagnostic tools [4,5].…”

“…Recent British guidelines cite surveillance and audit as the first step in AFS in order to identify gaps in practice [1]. Similar views from low income settings like India recognize that regular audit and feedback of local (i.e., institutional) epidemiology acquired through continuous surveillance best drive “corrective and preventive actions” in AFS practice [2].…”

Anforderungen an die Infektionsprävention bei der medizinischen Versorgung von immunsupprimierten Patienten

“…Hinzu kommt in bestimmten Hochrisikogruppen das weite Feld der Prophylaxe und Therapie invasiver Pilzinfektionen bei Patienten mit hohem Risiko, für das sich unter Zuhilfenahme von nationalen und internationalen Leitlinien der Fachgesellschaften inzwischen erweiterte An tifungal Stewardship ( AFS)-Initiativen im Aufbau befinden [428][429][430][431][432][433][434][435][436][437][438][439][440][441][442][443][444].…”

Therapeutic Drug Monitoring of Antifungal Drugs: Another Tool to Improve Patient Outcome?

“…Invasive fungal infections (IFIs) remain a major clinical concern because of their increasing incidence, high morbidity and mortality rates [1,2]. Adequate treatment requires proper drug selection and proper dosing of antifungal drugs [3][4][5].…”