How much European prescribing physicians know about invasive fungal infections management?

Abstract

BackgroundThe use of systemic antifungal agents has increased in most tertiary care centers. However, antifungal stewardship has deserved very little attention. Our objective was to assess the knowledge of European prescribing physicians as a first step of an international program of antifungal stewardship.MethodsStaff physicians and residents of 4 European countries were invited to complete a 20-point questionnaire that was based on current guidelines of invasive candidiasis and invasive aspergillosis.Results121 physicians (44.6% staff, 55.4% residents) from Spain 53.7%, Italy 17.4%, Denmark 16.5% and Germany 12.4% completed the survey. Hospital departments involved were: medical 51.2%, ICUs 43%, surgical 3.3% and pharmaceutical 2.5%. The mean score of adequate responses (± SD) was 5.8 ± 1.7 points, with statistically significant differences between study site and type of physicians. Regarding candidiasis, 69% of the physicians clearly distinguished colonization from infection and the local rate of fluconazole resistance was known by 24%. The accepted indications of antifungal prophylaxis were known by 38%. Regarding aspergillosis, 52% of responders could differentiate colonization from infection and 42% knew the diagnostic value of galactomannan. Radiological features of invasive aspergillosis were well recognized by 58% of physicians and 57% of them were aware of the antifungal considered as first line treatment. However, only 37% knew the recommended length of therapy.ConclusionsThis simple, easily completed questionnaire enabled us to identify some weakness in the knowledge of invasive fungal infection management among European physicians. This survey could serve as a guide to design a future tailored European training program.Electronic supplementary materialThe online version of this article (doi:10.1186/s12879-015-0809-z) contains supplementary material, which is available to authorized users.

The impact of implementing an antifungal stewardship with monitoring of 1‐3, β‐D‐glucan values on antifungal consumption and clinical outcomes

“…[1][2][3][4] However, Valerio et al reported that there is a serious lack of knowledge among physicians regarding invasive fungal infection management. 5 Indeed, Apisarnthanarak et al 6 reported that inappropriate antifungal use was detected in 44%, 31% and 15% of medical departments, intensive care units (ICUs) and surgical departments, respectively. These findings suggest the importance of antifungal stewardship interventions.…”

Antifungal stewardship in daily practice and health economic implications

“…Traditionally, invasive fungal diseases were thought to occur primarily in patients with haematologic cancers, transplant recipients or ICU patients, and it was believed that the physicians of these departments had enough expertise, so they did not need the help of stewardship programmes. It is now clear that, independent of the level of expertise of the group of physicians, the adherence to recommendations on antifungal drug use is extremely poor …”

Interventions to improve antimicrobial prescribing of doctors in training (IMPACT): a realist review

“…In other words, as guided by our data, we recognise that these factors will always limit prescribing decisions and place more emphasis on solutions that can work in the face of uncertainty, inexperience and lack of knowledge. For the same reasons, our analysis draws less attention to uncertainty about technical aspects of the process of prescribing, [56][57][58][59] poor dissemination of information or conflicting guidelines and lack of awareness, 43,[60][61][62][63][64][65] and operational inefficiencies and pressures. 43,62,[66][67][68][69][70] Instead, we are looking to understand what drives the behaviour of doctors in training in the presence of these limitations -namely uncertainty, inexperience and lack of knowledge.…”