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Measuring Volatile and Non-volatile Antifungal Activity of Biocontrol Products
Published on: December 5, 2020
Training should be the first step toward an antifungal stewardship program
Maricela Valerio1, Patricia Muñoz2, Carmen Rodríguez-González3
1Clinical Microbiology and Infectious Diseases Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain; Instituto de Investigación Sanitaria del Hospital Gregorio Marañón, Madrid, Spain.
Abstract:
The frequency of use of systemic antifungal agents has increased significantly in most tertiary centers. However, antifungal stewardship has received very little attention. The objective of this article was to assess the knowledge of prescribing physicians in our institution as a first step in the development of an antifungal stewardship program. Attending physicians from the departments that prescribe most antifungals were invited to complete a questionnaire based on current guidelines on diagnosis and therapy of invasive candidiasis and invasive aspergillosis (IA). The survey was completed by 60.8% (200/329) of the physicians who were invited to participate. The physicians belonged to the following departments: medical (60%), pediatric (19%), intensive care (15.5%), and surgical (5.5%). The mean (±SD) score of correct responses was 5.16±1.73. In the case of candidiasis, only 55% of the physicians clearly distinguished between colonization and infection, and 17.5% knew the local rate of fluconazole resistance. Thirty-three percent knew the accepted indications for antifungal prophylaxis, and 23% the indications for empirical therapy. However, most physicians knew which antifungals to choose when starting empirical therapy (73.5%). As for aspergillosis, most physicians (67%) could differentiate between colonization and infection, and 34.5% knew the diagnostic value of galactomannan. The radiological features of IA were well recognized by 64%, but only 31.5% were aware of the first line of treatment for IA, and 36% of the recommended duration of therapy. The usefulness of antifungal levels was known by 67%. This simple, easily completed questionnaire enabled us to identify which areas of our training strategy could be improved.
Insights
Physician knowledge gaps in antifungal use, particularly for invasive candidiasis and aspergillosis, hinder effective antifungal stewardship. Targeted education is needed to improve diagnosis, prophylaxis, and treatment strategies.
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.
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