Antifungal stewardship: developments in the field

Urbancic, Karen; Thursky, Karin; Kong, David C M; Johnson, Paul D R; Slavin, Monica

doi:10.1097/qco.0000000000000497

Cited by 29 publications

(8 citation statements)

References 77 publications

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“…Antifungal agents are also among the costliest anti-infective agents on hospital formularies, and "at risk" populations continue to grow and to present with more IFDs. As such, antifungal prescribing has come under greater scrutiny, in keeping with the expansion of antimicrobial stewardship (AMS) programs to include antifungal agents and IFD management [12]. This document builds upon prior reports of building capacity and improving antifungal stewardship (AFS) programs [12,13].…”

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confidence: 99%

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

Johnson

Lewis

Ashley

et al. 2020

The Journal of Infectious Diseases

102

135

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In recent years, the global public health community has increasingly recognized the importance of antimicrobial stewardship (AMS) in the fight to improve outcomes, decrease costs, and curb increases in antimicrobial resistance around the world. However, the subject of antifungal stewardship (AFS) has received less attention. While the principles of AMS guidelines likely apply to stewarding of antifungal agents, there are additional considerations unique to AFS and the complex field of fungal infections that require specific recommendations. In this article, we review the literature on AMS best practices and discuss AFS through the lens of the global core elements of AMS. We offer recommendations for best practices in AFS based on a synthesis of this evidence by an interdisciplinary expert panel of members of the Mycoses Study Group Education and Research Consortium. We also discuss research directions in this rapidly evolving field. AFS is an emerging and important component of AMS, yet requires special considerations in certain areas such as expertise, education, interventions to optimize utilization, therapeutic drug monitoring, and data analysis and reporting.

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mentioning

confidence: 99%

“…As such, antifungal prescribing has come under greater scrutiny, in keeping with the expansion of antimicrobial stewardship (AMS) programs to include antifungal agents and IFD management [12]. This document builds upon prior reports of building capacity and improving antifungal stewardship (AFS) programs [12,13].…”

mentioning

confidence: 99%

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

Johnson

Lewis

Ashley

et al. 2020

The Journal of Infectious Diseases

102

135

View full text Add to dashboard Cite

show abstract

“…Antifungal stewardship refers to the method in which the diagnostics method and the usage and dosage of antifungal drugs are combined to obtain a gained better clinical outcome, which can reduce the emergence of resistance in fungi [ 139 , 140 ]. As antifungal management is mainly based on the guidelines used for the treatment and diagnostic tests that are safe for the patient, the combination of health professionals and public health centres following the guidelines for proper care of patients formed a stewardship team to execute the program [ 141 , 142 ]. However, several health centres lack antifungal stewardship due to unavailability or lack of access to long-term diagnostic tools, and, hence, failed to manage and execute the program.…”

Section: Resultsmentioning

confidence: 99%

Potential Strategies to Control the Risk of Antifungal Resistance in Humans: A Comprehensive Review

et al. 2023

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Fungal infections are becoming one of the main causes of morbidity and mortality in people with weakened immune systems. Mycoses are becoming more common, despite greater knowledge and better treatment methods, due to the regular emergence of resistance to the antifungal medications used in clinical settings. Antifungal therapy is the mainstay of patient management for acute and chronic mycoses. However, the limited availability of antifungal drug classes limits the range of available treatments. Additionally, several drawbacks to treating mycoses include unfavourable side effects, a limited activity spectrum, a paucity of targets, and fungal resistance, all of which continue to be significant issues in developing antifungal drugs. The emergence of antifungal drug resistance has eliminated accessible drug classes as treatment choices, which significantly compromises the clinical management of fungal illnesses. In some situations, the emergence of strains resistant to many antifungal medications is a major concern. Although new medications have been developed to address this issue, antifungal drug resistance has grown more pronounced, particularly in patients who need long-term care or are undergoing antifungal prophylaxis. Moreover, the mechanisms that cause resistance must be well understood, including modifications in drug target affinities and abundances, along with biofilms and efflux pumps that diminish intracellular drug levels, to find novel antifungal drugs and drug targets. In this review, different classes of antifungal agents, and their resistance mechanisms, have been discussed. The latter part of the review focuses on the strategies by which we can overcome this serious issue of antifungal resistance in humans.

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“…Therefore, there is a need to promote a One Health approach in addressing fungal infections and AFR [57] [159]. [160]. The rational use of antifungal agents is paramount in addressing AFR [79].…”

Section: Strategies To Address Antifungal Resistancementioning

confidence: 99%

Global Burden of Fungal Infections and Antifungal Resistance from 1961 to 2024: Findings and Future Implications

Mudenda

2024

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Background: Antifungal resistance (AFR) is a global public health problem with devastating effects, especially among immunocompromised individuals. Addressing AFR requires a One Health approach including Antifungal Stewardship (AFS). This study aimed to comprehensively review global studies published on fungal infections and AFR and to recommend solutions to address this growing problem. Materials and Methods: This was a narrative review that was conducted using published papers on fungal infections, AFR, and AFS between January 1961 and March 2024. The literature was searched using PubMed, Google Scholar, Web of Science, and EMBASE. Results: This found that there has been an increase in fungal infections globally, especially among immunocompromised patients. Due to this increase in fungal infections, there has been a proportionate increase in the use of antifungal agents to prevent and treat fungal infections. This increased use of antifungal agents has worsened the problem of AFR contributing to increased morbidity and mortality. Globally, fungal infections have contributed to 150 million infections annually and 1.7 million deaths per year. By the year 2023, over 3.8 million people died from fungal infections. Addressing AFR remains a challenge because the treatment of antifungal-resistant infections is difficult. Finally, the treatment of fungal infections is a global challenge exacerbated by the limited number of antifungal agents to treat invasive fungal infections. Conclusion: The results of this study indicated that fungal infections and AFR are prevalent across humans, animals, agriculture, and the environment. Addressing this problem requires the provision of solutions such as improving the awareness of AFR, conducting further research on the discovery of new antifungal agents, and implementing AFS programs. If this global problem is not addressed, the morbidity and mortality associated with AFR will continue to rise in the future.How to cite this paper: Mudenda, S.

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Antifungal stewardship: developments in the field

Cited by 29 publications

References 77 publications

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

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

Potential Strategies to Control the Risk of Antifungal Resistance in Humans: A Comprehensive Review

Global Burden of Fungal Infections and Antifungal Resistance from 1961 to 2024: Findings and Future Implications

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