Consensus guidelines for antifungal stewardship, surveillance and infection prevention, 2021

Abstract

Invasive fungal diseases (IFD) are serious infections associated with high mortality, particularly in immunocompromised patients. The prescribing of antifungal agents to prevent and treat IFD is associated with substantial economic burden on the health system, high rates of adverse drug reactions, significant drug-drug interactions and the emergence of antifungal resistance. As the population at risk of IFD continues to grow due to the increased burden of cancer and related factors, the need for hospitals to employ antifungal stewardship (AFS) programmes and measures to monitor and prevent infection has become increasingly important. These guidelines outline the essential components, key interventions and metrics, which can help guide implementation of an AFS programme in order to optimise antifungal prescribing and IFD management. Specific recommendations are provided for quality processes for the prevention of IFD in the setting of outbreaks, during hospital building works, and in the context of Candida auris infection. Recommendations are detailed for the implementation of IFD surveillance to enhance detection of outbreaks, evaluate infection prevention and prophylaxis interventions and to allow benchmarking between hospitals. Areas in which information is still lacking and further research is required are also highlighted.

Evaluation of a stewardship program of antifungal use at a Brazilian tertiary care hospital

“… 3 Most of the stewardship programs have focused on antibiotics, with less initiatives in IFD and use of antifungal agents. 4 , 5 , 6 , 7 , 8 In this study we evaluated the quality of antifungal prescriptions in a tertiary care hospital and tested if a simple educational activity could improve the quality of prescriptions.…”

Antifungal stewardship in solid‐organ transplantation: What is needed?

“…The Australasian Antifungal Guidelines Steering Group produced consensus guidelines for AFS and infection prevention in 2021 7 . These recommend antifungal guidelines and care bundles, education, prescribing restrictions, post‐prescription review/audit and feedback, selective reporting of susceptibilities, and TDM as key components of AFS.…”

“…Suggested metrics that should be used to monitor AFS programs include antifungal prescribing and IFI management quality data, AFS activity and intervention data, antifungal consumption data, and clinical and microbiological outcomes 7,84 …”

“…Notably, it is propensity to affect immunocompromised patients, the poor sensitivity of culture-based tests, and the pressure to start treatment early due to the high morbidity and mortality associated with IFI. 6,7…”

Penggunaan Skor Kandida Untuk Pemberian Antijamur Rasional Pasa Pasien Icu Dengan Risiko Candidiasis Invasif

“…Terapi pre-emptif antijamur adalah terapi antijamur yang diberikan pada pasien sakit kritis dengan faktor risiko kandidiasis invasif, mengalami demam persisten dan terdapat bukti mikrobiologis adanya kolonisasi candida pada cairan non steril tubuh. 17 Terapi pre-emptif diterapkan di ICU dengan tujuan mempersempit penggunaan antijamur, tanpa menimbulkan risiko keterlambatan diagnosis dan terapi definitif kandidiasis invasif.…”