The Current State of Antifungal Stewardship in Immunocompromised Populations

Alegria, William; Patel, Payal

doi:10.3390/jof7050352

Cited by 9 publications

(14 citation statements)

References 66 publications

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“… 28 , 52 Therefore, after standardized work up of a suspected fungal infection, the AFS members need to evaluate the initial testing, interpret results, and may adapt therapy according to the specific requirements of the individual situation. 46 , 51 , 62 It should be noted that AFS members as supervisors provide their expertise as recommendations to improve the acceptance of the program, leading to better cooperation between the specialized departments and the AFS experts. In SOT‐recipients, important considerations lie in the drug–drug interactions of antifungal agents, especially azoles and the required immunosuppressive therapy needed in this population as well as the safety in the presence of organ dysfunction.…”

Section: Antifungal Stewardship In the Solid Organ Transplant Settingmentioning

confidence: 99%

“…In SOT‐recipients, important considerations lie in the drug–drug interactions of antifungal agents, especially azoles and the required immunosuppressive therapy needed in this population as well as the safety in the presence of organ dysfunction. 52 , 62 Furthermore, patients often have a history of multiple antifungal therapies, particularly after lung transplantation, which increases the risk of different, more resistant fungi species.…”

Section: Antifungal Stewardship In the Solid Organ Transplant Settingmentioning

confidence: 99%

“…It is crucial to evaluate obtained data to reveal shortcomings, design strategies going forward, and enable a successful feedbackloop including antifungal specialists as well as physicians at the main describing departments. Set measures need to be revised periodically to assure continuous improvement of the AFS (59,61,62).…”

Section: Candidamentioning

confidence: 99%

“…As mentioned above IFIs are complex infections, which require a lot of expertise on different aspects such as interpretation of diagnostic tests and selection of appropriate antifungal agents 28,52 . Therefore, after standardized work up of a suspected fungal infection, the AFS members need to evaluate the initial testing, interpret results, and may adapt therapy according to the specific requirements of the individual situation 46,51,62 . It should be noted that AFS members as supervisors provide their expertise as recommendations to improve the acceptance of the program, leading to better cooperation between the specialized departments and the AFS experts.…”

Section: Antifungal Stewardship In the Solid Organ Transplant Settingmentioning

confidence: 99%

“…It should be noted that AFS members as supervisors provide their expertise as recommendations to improve the acceptance of the program, leading to better cooperation between the specialized departments and the AFS experts. In SOT‐recipients, important considerations lie in the drug–drug interactions of antifungal agents, especially azoles and the required immunosuppressive therapy needed in this population as well as the safety in the presence of organ dysfunction 52,62 . Furthermore, patients often have a history of multiple antifungal therapies, particularly after lung transplantation, which increases the risk of different, more resistant fungi species.…”

Section: Antifungal Stewardship In the Solid Organ Transplant Settingmentioning

confidence: 99%

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Antifungal stewardship in solid organ transplantation

Kriegl

Boyer

Egger

et al. 2022

Transplant Infectious Dis

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Background: Antifungal stewardship (AFS) has emerged as an important component of quality in managing invasive fungal infections (IFIs), and cost-benefit calculations suggest regular training in AFS is well worth the effort. Methods: This review will discuss the most common IFIs in solid organ transplantation (SOT)-recipients, how to diagnose them, and current recommendations for antifungal treatment and prophylaxis before demonstrating key takeaway points of AFS in this high-risk population. Results: Effective AFS starts before a patient is admitted for SOT, through education and regular interactions of the interdisciplinary clinical team involved in patient management, considering local factors such as epidemiological data and knowledge of diagnostic options including local turnaround times. Understanding the spectrum of antifungal agents, their efficacy and safety profiles, and pharmacokinetics, as well as duration of therapy is hereby essential. The most frequent IFIs in SOT recipients are caused by Candida species, followed by Aspergillus species, both with increasing resistance rates. Diagnosis of IFI can be challenging due to unspecific clinical presentation and difficult interpretation of microbiological findings and biomarkers. Prophylactic strategies, such as those for invasive aspergillosis in lung transplantation or invasive candidiasis (IC) in certain liver transplant settings, as well as the selection of the appropriate therapeutic agents require detailed knowledge on the pharmacokinetics and drug-drug interactions of antifungals.

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