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Consensus for antifungal stewardship in China (2024 edition)
Feng Ye1, Shaoxi Cai2, Bin Cao3
1The First Affiliated Hospital of Guangzhou Medical University, National Center for Respiratory Medicine, National Clinical Research Center for Respiratory Disease, State Key Laboratory of Respiratory Disease, Department of Pulmonary and Critical Care Medicine, Guangzhou Institute of Respiratory Health, Guangzhou National Laboratory, Guangzhou Medical University, Guangzhou, China.
Background:
Invasive fungal disease (IFD) has become a serious threat to human health in China and around the world, with high mortality and morbidity. Currently, the misdiagnosis rate of IFD is extremely high, compounded with the low quality of prescription antifungals and the high incidence of adverse events associated with IFD treatment, resulting in lengthy hospitalization, low clinical response, and high disease burden, which have become serious challenges in clinical practice. Antifungal stewardship (AFS) can not only significantly increase the early diagnosis rate of IFD, reduce inappropriate utilization of antifungal drugs, improve patient prognosis, but can also improve therapeutic safety and reduce healthcare expenses. Thus, it is urgent to identify key AFS metrics suitable for China's current situation.
Methods:
Based on metrics recommended by international AFS consensuses, combined with the current situation of China and the clinical experience of authoritative experts in various fields, several metrics were selected, and experts in the fields of respiratory diseases, hematology, intensive care units (ICUs), dermatology, infectious diseases, microbiology laboratory and pharmacy were invited to assess AFS metrics by the Delphi method. Consensus was considered to be reached with an agreement level of ≥80% for the metric.
Results:
Consensus was reached for 24 metrics, including right patient metrics (n=4), right time metrics (n=3), and right use metrics (n=17). Right use metrics were further subdivided into drug choice (n=8), drug dosage (n=4), drug de-escalation (n=1), drug duration (n=2), and drug consumption (n=2) metrics. Forty-six authoritative experts assessed and reviewed the above metrics, and a consensus was reached with a final agreement level of ≥80% for 22 metrics.
Conclusions:
This consensus is the first to propose a set of AFS metrics suitable for China, which helps to establish AFS standards in China and is also the first AFS consensus in Asia, and may improve the standard of clinical diagnosis and treatment of IFD, and guide hospitals to implement AFS, ultimately promoting the rational use of antifungal drugs and improving patient prognosis.
Insights
This study identified 22 key antifungal stewardship (AFS) metrics for China to improve invasive fungal disease (IFD) diagnosis and treatment, aiming to reduce drug misuse and enhance patient outcomes.
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.
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