Antifungal stewardship in Australian hospitals: defining the scope and future targets

IF 1.8 4区医学 Q2 MEDICINE, GENERAL & INTERNAL

Internal Medicine Journal Pub Date : 2024-12-01 DOI:10.1111/imj.16571

Karen F. Urbancic, David C. M. Kong, Paul D. R. Johnson, Michelle K. Yong, Monica A. Slavin, Karin Thursky

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引用次数: 0

Abstract

Background

Antimicrobial stewardship (AMS) guidelines now recommend antifungal stewardship (AFS) interventions to improve the management of invasive fungal diseases (IFDs). AFS programmes have not been reported in Australia.

Aims

To determine the monitoring of antifungal use, AFS strategies and targets, and barriers to AFS implementation in Australian hospitals.

Methods

An electronic quantitative cross-sectional survey was developed and distributed to public and private hospitals in Australia in February 2018. Descriptive statistics were used to summarise the findings.

Results

Eighty-three Australian hospitals completed the survey with an overall response rate of 58% (83/143). Most hospitals monitored antifungal use (62/83, 75%). Frequently used AFS metrics included costs (48/60, 80%) and yearly point prevalence surveys (45/60, 75%). Core AFS strategies were commonly in place, including preauthorisation requirements (71/80, 89%) and expert antifungal post-prescription review and feedback (PPRF) (63/80, 79%). Both these strategies were more strictly applied to high-cost, intravenous agents. Formal education (44/79, 56%) and hospital-endorsed guidelines (35/79, 44%) were modestly used. Fungal diagnostics and antifungal therapeutic drug monitoring (TDM) were utilised, largely off site. IFD surveillance was infrequently performed (9/77, 12%). Barriers to AFS identified included lack of staff time, prioritisation of AFS, and access to rapid diagnostics and TDM.

Conclusions

AFS strategies utilised in Australian hospitals have focused on high-cost, intravenous agents. Although expert oversight of antifungals is evident, many sites omit potentially important targets for AFS, including fluconazole and oral posaconazole. Identifying these gaps and barriers to AFS will guide the development of an AFS model for hospitals.

查看原文本刊更多论文

澳大利亚医院的抗真菌管理：确定范围和未来目标。

背景：抗菌药物管理（AMS）指南现在推荐抗真菌管理（AFS）干预措施来改善侵袭性真菌疾病（IFDs）的管理。澳大利亚尚未有AFS项目的报道。目的：确定澳大利亚医院抗真菌药物使用监测情况、AFS策略和目标，以及AFS实施的障碍。方法：于2018年2月对澳大利亚公立和私立医院进行电子定量横断面调查。描述性统计用于总结研究结果。结果：83家澳大利亚医院完成了调查，总有效率为58%（83/143）。大多数医院监测抗真菌药的使用情况（62/ 83,75%）。常用的AFS指标包括成本（48/ 60,80 %）和年度点患病率调查（45/ 60,75 %）。核心AFS策略通常到位，包括预授权要求（71/ 80,89%）和专家抗真菌处方后审查和反馈（PPRF）（63/ 80,79%）。这两种策略更严格地适用于高成本的静脉注射药物。正规教育（44/ 79,56%）和医院认可的指南（35/ 79,44%）被适度使用。真菌诊断和抗真菌治疗药物监测（TDM）主要用于非现场。IFD监测很少进行（9/ 77,12 %）。确定的AFS障碍包括缺乏工作人员时间，AFS的优先级，以及获得快速诊断和TDM。结论：澳大利亚医院采用的AFS策略侧重于高成本的静脉注射药物。尽管专家对抗真菌药物的监督是显而易见的，但许多位点忽略了AFS的潜在重要靶点，包括氟康唑和口服泊沙康唑。确定AFS的这些差距和障碍将指导医院AFS模式的发展。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Internal Medicine Journal 医学-医学：内科

CiteScore

3.50

自引率

4.80%

发文量

600

审稿时长

3-6 weeks

期刊介绍： The Internal Medicine Journal is the official journal of the Adult Medicine Division of The Royal Australasian College of Physicians (RACP). Its purpose is to publish high-quality internationally competitive peer-reviewed original medical research, both laboratory and clinical, relating to the study and research of human disease. Papers will be considered from all areas of medical practice and science. The Journal also has a major role in continuing medical education and publishes review articles relevant to physician education.