Consensus for antifungal stewardship in China (2024 edition)

Area of Science:

• Medical Science
• Infectious Diseases
• Pharmacology

Background:

• Invasive fungal disease (IFD) poses a significant global health threat with high mortality and morbidity.
• Challenges in China include high misdiagnosis rates, suboptimal antifungal quality, and adverse events, leading to increased healthcare burden.
• Antifungal stewardship (AFS) is crucial for improving IFD diagnosis, optimizing antifungal drug use, and enhancing patient prognosis and safety.

Purpose of the Study:

• To identify and establish a set of key antifungal stewardship (AFS) metrics tailored to the specific context of China.
• To address the urgent need for standardized AFS practices to combat the challenges posed by invasive fungal diseases (IFDs) in the region.

Main Methods:

• A Delphi method was employed, involving 46 authoritative experts across various medical fields.
• Metrics were selected based on international recommendations and adapted to China's healthcare landscape.
• Consensus was defined as an agreement level of 80% or higher among the participating experts.

Main Results:

• Consensus was reached on 24 initial metrics, encompassing right patient (4), right time (3), and right use (17) categories.
• The 'right use' metrics were further detailed into drug choice, dosage, de-escalation, duration, and consumption.
• Ultimately, 22 metrics achieved the ≥80% agreement threshold after expert review and assessment.

Conclusions:

• This consensus establishes the first set of AFS metrics specifically designed for China, serving as a foundational standard for the region.
• It represents the first AFS consensus in Asia, potentially improving IFD diagnosis and treatment standards.
• Implementation of these metrics is expected to guide hospitals in adopting AFS, promoting rational antifungal drug use, and improving patient outcomes.