Impact of antifungal stewardship interventions on the susceptibility of Candida species in pediatric patients with malignancy

Abstract

Background There is a worldwide concern with respect to the antimicrobial resistance and the inappropriate use of antifungal agents, which had led to an ever-increasing antifungal resistance. This study aimed to identify the antifungal susceptibility of Candida species isolated from the pediatric patients with cancer and also to evaluate the clinical impact of antifungal stewardship (AFS) ‎interventions on antifungal susceptibility of Candida species. Methods In this study, Candida species colonization were evaluated among hospitalized children with cancer in a tertiary teaching hospital, Shiraz 2017-18. The broth microdilution method was used to determine the minimum inhibitory concentrations (MICs) for polyenes (amphotericin B), echinocandins (caspofungin), and azoles (voriconazole, fluconazole, posaconazole, and itraconazole). Antifungal susceptibility of Candida species was compared with our previous study results to determine the clinical impact of AFS interventions on the antifungal susceptibility. Results The prevalence of Candida albicans in the present study was significantly higher than other Candida species. Candida albicans species were completely susceptible to the azoles. The sensitivity rate of C. albicans to amphotericin B and caspofungin was 93.1% and 97.1%, respectively. The results confirm the positive effect of optimized antifungal usage and bedside intervention on the susceptibility of Candida species after the implementation of the AFS program. C. albicans and C. glabrata exhibited significant increase in sensitivity after the execution of AFS program. Conclusions Improving the antifungal agent usage can improve antifungal ‎susceptibility and reduce resistance. The AFS is recommended to be addressed, applied, and regularly assessed in centers.