Latest Trends in Fungal Epidemiology Inform Treatment Choices and Stewardship Initiatives

Invasive candidiasis can have a major effect on patient prognosis and medical economics. Quickly eliminating the focus of the infection and administering appropriate antifungal therapy are important. Clinical guidelines for invasive candidiasis have been issued in the USA, Europe and recently in Japan. The purpose of this review is to summarize the current recommendations on how to diagnose and treat invasive candidiasis based on the evidence gathered to date and by referencing guidelines from various countries. Echinocandin antifungals play a central role in the prevention and treatment of invasive candidiasis although a recent increase in echinocandin-resistant Candida glabrata is seen as problematic. In the future, promoting the appropriate use of antifungal agents by antifungal stewardship teams will be necessary to suppress adverse effects, appearance of resistant strains and unnecessary medical expenses, as well as improve positive clinical outcomes and prognoses.

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Mitigation of Human-Pathogenic Fungi that Exhibit Resistance to Medical Agents: Can Clinical Antifungal Stewardship Help?

Hull

Purdy

Moody

2014

Future Microbiol.

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Reducing indiscriminate antimicrobial usage to combat the expansion of multidrug-resistant human-pathogenic bacteria is fundamental to clinical antibiotic stewardship. In contrast to bacteria, fungal resistance traits are not understood to be propagated via mobile genetic elements, and it has been proposed that a global explosion of resistance to medical antifungals is therefore unlikely. Clinical antifungal stewardship has focused instead on reducing the drug toxicity and high costs associated with medical agents. Mitigating the problem of human-pathogenic fungi that exhibit resistance to antimicrobials is an emergent issue. This article addresses the extent to which clinical antifungal stewardship could influence the scale and epidemiology of resistance to medical antifungals both now and in the future. The importance of uncharted selection pressure exerted by agents outside the clinical setting (agricultural pesticides, industrial xenobiotics, biocides, pharmaceutical waste and others) on environmentally ubiquitous spore-forming molds that are lesserstudied but increasingly responsible for drug-refractory infections is considered.

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Latest Trends in Fungal Epidemiology Inform Treatment Choices and Stewardship Initiatives

Cited by 3 publications

References 17 publications

Fungal Infection Mimicking Pulmonary Malignancy: Clinical and Radiological Characteristics

Fungal Infection Mimicking Pulmonary Malignancy: Clinical and Radiological Characteristics

Current recommendations and importance of antifungal stewardship for the management of invasive candidiasis

Mitigation of Human-Pathogenic Fungi that Exhibit Resistance to Medical Agents: Can Clinical Antifungal Stewardship Help?

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