"Antifungal stewardship in invasive Candida infections"
Clin Microbiol Infect. 2014 Mar 24;
Authors: Ruhnke M
Bloodstream and other invasive infections due to Candida species (invasive fungal diseases = IFD) are a major cause of morbidity and mortality in hospitalized adults and children in many countries worldwide. The high infection-related morbidity and mortality associated with invasive Candida infection / candidaemia (IC/C), combined with suboptimal diagnostic tools, have driven the overuse of antifungal drugs. Antifungal stewardship (AFS) may be regarded as sub-entity of the more general term Antiinfective or Antimicrobial Stewardship Program (AIS/AMS). The high costs and high contribution of antifungal agents to the management of IFDs along with their recognized toxicities has been addressed as the principal justification for antifungal stewardship. AFS programs should be organized by an interdisciplinary team of clinicians, pharmacists, microbiologists and infection control experts with the lead of an infectious disease specialist preferably in each large hospital /institution dealing with high-risk patients for invasive fungal infections. These programs should consider various aspects of IC/C including: 1) the local fungal epidemiology, 2) information on antifungal resistance rates, 3) establishing and application of therapeutic guidelines, 4) implementation of treatment strategies for empirical, pre-emptive therapy including PK/PD data for antifungal drugs, de-escalation and "switch and step-down strategies" (from intravenous to oral medication) in defined patient populations, 5) catheter management together with the application of routine diagnostic procedures such as ophthalmological and cardiac evaluations, and 6) the best available diagnostic tests for diagnosing IC and candidaemia. This article is protected by copyright. All rights reserved.
PMID: 24661820 [PubMed - as supplied by publisher]