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

Autor:	Soni S; Department of Microbiology, University Hospitals Bristol and Weston NHS Trust, Marlborough Street, Bristol BS1 3NU, UK., Hettle D; Department of Microbiology, University Hospitals Bristol and Weston NHS Trust, Marlborough Street, Bristol BS1 3NU, UK., Hutchings S; United Kingdom Health Security Agency (UKHSA) South-West Regional Laboratory, Southmead Hospital, Westbury-on-Trym, Bristol BS10 5NB, UK., Wade S; Pharmacy Department, University Hospitals Bristol and Weston NHS Trust, Marlborough Street, Bristol BS1 3NU, UK., Forrest-Jones K; Pharmacy Department, University Hospitals Bristol and Weston NHS Trust, Marlborough Street, Bristol BS1 3NU, UK., Sequeiros I; Department of Radiology, University Hospitals Bristol and Weston NHS Trust, Marlborough Street, Bristol BS1 3NU, UK., Borman A; UK National Mycology Reference Laboratory, National Infection Service, United Kingdom Health Security Agency South-West, Bristol BS10 5NB, UK.; MRC Centre for Medical Mycology, University of Exeter, Exeter, EX4 4QD, UK., Johnson EM; UK National Mycology Reference Laboratory, National Infection Service, United Kingdom Health Security Agency South-West, Bristol BS10 5NB, UK.; MRC Centre for Medical Mycology, University of Exeter, Exeter, EX4 4QD, UK., Harding I; Department of Microbiology, University Hospitals Bristol and Weston NHS Trust, Marlborough Street, Bristol BS1 3NU, UK.; United Kingdom Health Security Agency, Bristol Royal Infirmary, Marlborough Street, Bristol BS1 3NU, UK.
Jazyk:	angličtina
Zdroj:	JAC-antimicrobial resistance [JAC Antimicrob Resist] 2024 Aug 05; Vol. 6 (4), pp. dlae119. Date of Electronic Publication: 2024 Aug 05 (Print Publication: 2024).
DOI:	10.1093/jacamr/dlae119
Abstrakt:	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. (© The Author(s) 2024. Published by Oxford University Press on behalf of British Society for Antimicrobial Chemotherapy.)
Databáze:	MEDLINE
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