Antifungal stewardship considerations for adults and pediatrics

被引:87
作者
Hamdy, Rana F. [1 ]
Zaoutis, Theoklis E. [2 ]
Seo, Susan K. [3 ]
机构
[1] Childrens Natl Hlth Syst, Div Infect Dis, Washington, DC USA
[2] Childrens Hosp Philadelphia, Dept Pediat, Div Infect Dis, Philadelphia, PA 19104 USA
[3] Mem Sloan Kettering Canc Ctr, Dept Med, Infect Dis Serv, New York, NY 10021 USA
关键词
antifungal resistance; antifungal stewardship; antimicrobial stewardship program; hematologic malignancy; invasive aspergillosis; invasive candidiasis; invasive fungal infection; pediatrics; rapid diagnostics; transplantation; INVASIVE FUNGAL-INFECTIONS; PNEUMOCYSTIS-JIROVECI PNEUMONIA; HEALTH-CARE EPIDEMIOLOGY; ANTIMICROBIAL STEWARDSHIP; PULMONARY ASPERGILLOSIS; TRANSPLANT RECIPIENTS; AZOLE RESISTANCE; DISEASES SOCIETY; HIGH-RISK; IMMUNOCOMPROMISED PATIENTS;
D O I
10.1080/21505594.2016.1226721
中图分类号
R392 [医学免疫学]; Q939.91 [免疫学];
学科分类号
100102 ;
摘要
Antifungal stewardship refers to coordinated interventions to monitor and direct the appropriate use of antifungal agents in order to achieve the best clinical outcomes and minimize selective pressure and adverse events. Antifungal utilization has steadily risen over time in concert with the increase in number of immunocompromised adults and children at risk for invasive fungal infections (IFI). Challenges in diagnosing IFI often lead to delays in treatment and poorer outcomes. There are also emerging data linking prior antifungal exposure and suboptimal dosing to the emergence of antifungal resistance, particularly for Candida. Antimicrobial stewardship programs can take a multi-pronged bundle approach to ensure suitable prescribing of antifungals via postprescription review and feedback and/or prior authorization. Institutional guidelines can also be developed to guide diagnostic testing in at-risk populations; appropriate choice, dose, and duration of antifungal agent; therapeutic drug monitoring; and opportunities for de-escalation and intravenous-to-oral conversion.
引用
收藏
页码:658 / 672
页数:15
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