Promoting antifungal stewardship through an antifungal multidisciplinary team in a paediatric and adult tertiary centre in the UK.

IF 3.7 Q2 INFECTIOUS DISEASES JAC-Antimicrobial Resistance Pub Date : 2024-08-05 eCollection Date: 2024-08-01 DOI:10.1093/jacamr/dlae119
Shuchita Soni, David Hettle, Stephanie Hutchings, Susan Wade, Kate Forrest-Jones, Iara Sequeiros, Andrew Borman, Elizabeth M Johnson, Irasha Harding
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Abstract

Background: Invasive fungal infections (IFIs) present significant challenges, especially among immunocompromised patients, with associated high morbidity, mortality and significant economic impact. Diagnostic difficulties and the emergence of antifungal resistance necessitates enhanced antifungal stewardship (AFS) efforts.

Methods: We report outcomes from a review of our multidisciplinary approach to AFS, based in a 1300-bed teaching hospital in the South-West of England. Retrospectively reviewing all adult and paediatric cases over 12 months in 2022, we investigated demographics, diagnosis, antifungal therapy and adherence to AFS advice, including clinical, mycological, financial and teamwork metrics. Data were extracted from our AFS database, supported by pharmacy records.

Results: The AFS multidisciplinary team (MDT) reviewed 111 patients, with 30 day and 1 year mortality of 22.7% and 35.4%, respectively. IFIs classified as proven accounted for 26%, with fungal pathogens identified in 36.3% of cases. Antifungal consumption (by 25.1%) and expenditure (by 59.9%) decreased from 2018 to 2022. The AFS MDT issued 324 recommendations, with a 93% acceptance rate.

Conclusions: Our approach to AFS, centred around a weekly MDT, demonstrated improvements in IFI management, antifungal consumption and cost-efficiency. This single-centre study highlights the value of a comprehensive, collaborative approach to AFS involving experts in mycology, infection, radiology, antifungal therapies and clinical teams. The programme's success in paediatric and adult populations and the near-universal acceptance of its recommendations show its potential as a model for replication. It represents a model for enhancing patient care and AFS practices, with future directions aimed at expanding service reach and the integration of further rapid diagnostic modalities.

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在英国的一家儿科和成人三级医疗中心,通过抗真菌多学科团队促进抗真菌管理。
背景:侵袭性真菌感染(IFIs)是一项重大挑战,尤其是在免疫力低下的患者中,相关的发病率、死亡率和经济影响都很高。诊断困难和抗真菌耐药性的出现要求加强抗真菌管理(AFS)工作:我们报告了对英格兰西南部一家拥有 1300 张病床的教学医院的多学科抗真菌治疗方法的审查结果。我们回顾了 2022 年 12 个月内的所有成人和儿科病例,调查了人口统计学、诊断、抗真菌治疗和对 AFS 建议的遵守情况,包括临床、真菌学、财务和团队合作指标。数据提取自我们的 AFS 数据库,并辅以药房记录:美国战地服务团多学科小组(MDT)对111名患者进行了复查,30天和1年的死亡率分别为22.7%和35.4%。经证实的 IFI 占 26%,其中 36.3% 的病例确定了真菌病原体。从 2018 年到 2022 年,抗真菌药物消耗量(减少 25.1%)和支出(减少 59.9%)均有所下降。AFS MDT 发布了 324 项建议,接受率为 93%:我们的 AFS 方法以每周一次的 MDT 为中心,在 IFI 管理、抗真菌药物消耗和成本效益方面均有所改善。这项单中心研究凸显了由真菌学、感染学、放射学、抗真菌疗法和临床团队专家参与的全面合作式 AFS 方法的价值。该计划在儿科和成人人群中取得了成功,其建议几乎得到了普遍接受,这表明它有可能成为一种可推广的模式。它是加强病人护理和 AFS 实践的典范,未来的发展方向是扩大服务范围,并整合更多的快速诊断模式。
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16 weeks
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