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An Ex vivo Assay to Study Candida albicans Hyphal Morphogenesis in the Gastrointestinal Tract
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Antifungal stewardship in invasive Candida infections

M Ruhnke1

  • 1Department of Internal Medicine, Charité University Medicine, Berlin, Germany.

Clinical Microbiology and Infection : the Official Publication of the European Society of Clinical Microbiology and Infectious Diseases
|March 26, 2014
PubMed

Insights

Antifungal stewardship programs are crucial for managing invasive Candida infections, reducing morbidity and mortality. These programs optimize antifungal drug use, considering local resistance and patient-specific strategies.

Area of Science:

  • Infectious Diseases
  • Clinical Pharmacy
  • Medical Microbiology

Background:

  • Invasive fungal diseases (IFD), particularly bloodstream infections caused by Candida species (invasive candidiasis/candidaemia, IC/C), significantly contribute to morbidity and mortality in hospitalized patients.
  • Suboptimal diagnostic tools and high associated risks have led to the overuse of antifungal drugs, necessitating structured management approaches.
  • Antifungal stewardship (AFS) is a critical component of antimicrobial stewardship programs (ASP), addressing the high costs, toxicities, and contributions of antifungals to IFD management.

Purpose of the Study:

  • To highlight the importance and components of antifungal stewardship (AFS) programs in combating invasive Candida infections (IC/C).
  • To emphasize the need for interdisciplinary collaboration and strategic planning in AFS programs.
  • To guide the optimization of antifungal drug utilization in high-risk patient populations.

Main Methods:

  • AFS programs should be led by infectious disease specialists and involve interdisciplinary teams (clinicians, pharmacists, microbiologists, infection control experts).
  • Programs require consideration of local fungal epidemiology and antifungal resistance rates.
  • Implementation involves establishing therapeutic guidelines, optimizing treatment strategies (empirical, pre-emptive, de-escalation, switch/step-down), and integrating diagnostic procedures.

Main Results:

  • AFS programs aim to reduce the overuse of antifungal drugs by implementing evidence-based strategies.
  • Optimized treatment strategies, including PK/PD data and de-escalation, improve patient outcomes and reduce toxicity.
  • Comprehensive management includes catheter care and appropriate diagnostic evaluations (e.g., ophthalmological, cardiac).

Conclusions:

  • Effective antifungal stewardship programs are essential for managing invasive candidiasis and improving patient outcomes.
  • Interdisciplinary collaboration and tailored treatment strategies are key to successful AFS implementation.
  • AFS programs play a vital role in optimizing antifungal use, mitigating resistance, and reducing healthcare costs.
Keywords:
Antifungal stewardshipCandidaantifungal therapycandidosisinvasive fungal infectionresistance

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