Antifungal stewardship in critical care: Implementing a diagnostics-driven care pathway in the management of invasive candidiasis.
(1–3)-β-d-glucan
Antifungal stewardship
Critical care
Fungal biomarkers
Invasive fungal disease
Journal
Infection prevention in practice
ISSN: 2590-0889
Titre abrégé: Infect Prev Pract
Pays: England
ID NLM: 101777928
Informations de publication
Date de publication:
Jun 2020
Jun 2020
Historique:
received:
13
11
2019
accepted:
08
02
2020
entrez:
9
8
2021
pubmed:
19
2
2020
medline:
19
2
2020
Statut:
epublish
Résumé
Invasive candidiasis (IC) is the most common invasive fungal disease in patients admitted to critical care and is associated with high mortality rates. Diagnosis can be delayed by the poor sensitivity of culture-based methods, leading to unnecessary use of empirical antifungal therapy (EAFT). The fungal biomarker (1-3)-β-d-glucan (BDG) has been shown to aid in the diagnosis of IC in critical care and has been incorporated into antifungal stewardship (AFS) programmes. To describe our experience using a diagnostics-driven AFS programme incorporating the fungal biomarker BDG, analyse its impact on antifungal therapy (AFT), and gain an improved understanding of the epidemiology of IC in our critical care unit (CrCU). An AFS care pathway incorporating BDG was introduced in the CrCU in St James's Hospital, Dublin. Following an educational programme, compliance with the pathway was prospectively audited between December 1st, 2017 and July 31 One hundred and nine AFT episodes were included, of which 95 (87%) had a BDG sent. Of those with BDG results available at the time of decision-making, 38 (63%) were managed in accordance with the care pathway. In compliant episodes without IC, median EAFT duration was 5.5 days [IQR 4-7] and no increase in mortality or subsequent IC was observed. Although adopting a diagnostics-driven approach was found to be useful in the cohort of patients with BDG results available, the use of once-weekly BDG testing did not result in an observed reduction in the consumption of anidulafungin, highlighting an important limitation of this approach.
Sections du résumé
BACKGROUND
BACKGROUND
Invasive candidiasis (IC) is the most common invasive fungal disease in patients admitted to critical care and is associated with high mortality rates. Diagnosis can be delayed by the poor sensitivity of culture-based methods, leading to unnecessary use of empirical antifungal therapy (EAFT). The fungal biomarker (1-3)-β-d-glucan (BDG) has been shown to aid in the diagnosis of IC in critical care and has been incorporated into antifungal stewardship (AFS) programmes.
AIM
OBJECTIVE
To describe our experience using a diagnostics-driven AFS programme incorporating the fungal biomarker BDG, analyse its impact on antifungal therapy (AFT), and gain an improved understanding of the epidemiology of IC in our critical care unit (CrCU).
METHODS
METHODS
An AFS care pathway incorporating BDG was introduced in the CrCU in St James's Hospital, Dublin. Following an educational programme, compliance with the pathway was prospectively audited between December 1st, 2017 and July 31
RESULTS AND CONCLUSION
CONCLUSIONS
One hundred and nine AFT episodes were included, of which 95 (87%) had a BDG sent. Of those with BDG results available at the time of decision-making, 38 (63%) were managed in accordance with the care pathway. In compliant episodes without IC, median EAFT duration was 5.5 days [IQR 4-7] and no increase in mortality or subsequent IC was observed. Although adopting a diagnostics-driven approach was found to be useful in the cohort of patients with BDG results available, the use of once-weekly BDG testing did not result in an observed reduction in the consumption of anidulafungin, highlighting an important limitation of this approach.
Identifiants
pubmed: 34368697
doi: 10.1016/j.infpip.2020.100047
pii: S2590-0889(20)30011-1
pmc: PMC8336030
doi:
Types de publication
Journal Article
Langues
eng
Pagination
100047Informations de copyright
© 2020 The Authors.
Déclaration de conflit d'intérêts
None declared.
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