Training should be the first step toward an antifungal stewardship program

Area of Science:

• Medical Mycology
• Infectious Diseases
• Antimicrobial Stewardship

Background:

• Systemic antifungal agent use is rising in tertiary care centers.
• Antifungal stewardship programs are underdeveloped, despite increased usage.
• Physician knowledge is crucial for developing effective antifungal stewardship.

Purpose of the Study:

• To assess the knowledge of prescribing physicians regarding invasive candidiasis and invasive aspergillosis.
• To identify areas for improvement in physician education for antifungal stewardship.
• To lay the groundwork for establishing an institutional antifungal stewardship program.

Main Methods:

• A questionnaire survey was distributed to physicians in departments with high antifungal prescribing rates.
• The survey assessed knowledge based on current guidelines for invasive candidiasis and invasive aspergillosis.
• Data were collected from 200 physicians, representing a 60.8% response rate.

Main Results:

• Physicians demonstrated significant knowledge deficits in differentiating colonization from infection (55% for candidiasis) and understanding local resistance patterns (17.5% for fluconazole).
• Awareness of accepted indications for antifungal prophylaxis (33%) and empirical therapy (23%) was low, though most knew which agents to select for empirical treatment (73.5%).
• Knowledge regarding invasive aspergillosis diagnosis (galactomannan value 34.5%, radiological features 64%) and treatment (first-line therapy 31.5%, duration 36%) was also limited, despite moderate recognition of antifungal level utility (67%).

Conclusions:

• Significant gaps exist in physician knowledge concerning the diagnosis and management of invasive fungal infections.
• These findings highlight the need for targeted educational interventions to enhance antifungal stewardship.
• Improving physician knowledge is a critical first step toward optimizing antifungal use and patient outcomes.