Antifungal stewardship in solid organ transplantation

Area of Science:

• Infectious Diseases
• Transplantation Medicine
• Clinical Pharmacy

Background:

• Antifungal stewardship (AFS) is crucial for quality care in invasive fungal infections (IFIs).
• Cost-benefit analyses support regular AFS training for healthcare professionals.
• IFIs pose significant risks, particularly in immunocompromised patient populations.

Purpose of the Study:

• To review common IFIs in solid organ transplantation (SOT) recipients.
• To outline diagnostic strategies and current antifungal treatment/prophylaxis recommendations.
• To highlight key principles of AFS tailored for SOT recipients.

Main Methods:

• Literature review focusing on IFIs in SOT.
• Synthesis of diagnostic approaches and treatment guidelines.
• Identification of critical AFS components for this population.

Main Results:

• Effective AFS involves pre-transplant education and interdisciplinary collaboration.
• Understanding antifungal agents, pharmacokinetics, efficacy, and safety is essential.
• Candida and Aspergillus species are common IFIs with rising resistance; diagnosis is challenging.
• Prophylaxis and treatment selection require knowledge of pharmacokinetics and drug interactions.

Conclusions:

• Good AFS in SOT recipients necessitates a comprehensive, individualized approach.
• AFS implementation requires consideration of local epidemiological data and diagnostic capabilities.
• Optimizing antifungal use is critical for improving outcomes in SOT patients.