Related Experiment Video
Updated: Jun 6, 2025
An Ex vivo Assay to Study Candida albicans Hyphal Morphogenesis in the Gastrointestinal Tract
Published on: July 1, 2020
Antifungal stewardship in Australian hospitals: defining the scope and future targets
Karen F Urbancic1,2,3,4,5, David C M Kong2,6, Paul D R Johnson3,5
1National Centre for Infections in Cancer, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia.
Background:
Antimicrobial stewardship (AMS) guidelines now recommend antifungal stewardship (AFS) interventions to improve the management of invasive fungal diseases (IFDs). AFS programmes have not been reported in Australia.
Aims:
To determine the monitoring of antifungal use, AFS strategies and targets, and barriers to AFS implementation in Australian hospitals.
Methods:
An electronic quantitative cross-sectional survey was developed and distributed to public and private hospitals in Australia in February 2018. Descriptive statistics were used to summarise the findings.
Results:
Eighty-three Australian hospitals completed the survey with an overall response rate of 58% (83/143). Most hospitals monitored antifungal use (62/83, 75%). Frequently used AFS metrics included costs (48/60, 80%) and yearly point prevalence surveys (45/60, 75%). Core AFS strategies were commonly in place, including preauthorisation requirements (71/80, 89%) and expert antifungal post-prescription review and feedback (PPRF) (63/80, 79%). Both these strategies were more strictly applied to high-cost, intravenous agents. Formal education (44/79, 56%) and hospital-endorsed guidelines (35/79, 44%) were modestly used. Fungal diagnostics and antifungal therapeutic drug monitoring (TDM) were utilised, largely off site. IFD surveillance was infrequently performed (9/77, 12%). Barriers to AFS identified included lack of staff time, prioritisation of AFS, and access to rapid diagnostics and TDM.
Conclusions:
AFS strategies utilised in Australian hospitals have focused on high-cost, intravenous agents. Although expert oversight of antifungals is evident, many sites omit potentially important targets for AFS, including fluconazole and oral posaconazole. Identifying these gaps and barriers to AFS will guide the development of an AFS model for hospitals.
Insights
Australian hospitals are implementing antifungal stewardship (AFS) programs, focusing on high-cost intravenous medications. Key barriers include staff time and diagnostic access, highlighting areas for improvement in AFS models.
Area of Science:
- Infectious Diseases
- Hospital Pharmacy
- Public Health
Background:
- Antimicrobial stewardship (AMS) guidelines increasingly recommend antifungal stewardship (AFS) for managing invasive fungal diseases (IFDs).
- No prior reports on AFS programs in Australian hospitals existed.
- This study addresses the gap in understanding current AFS practices in Australia.
Purpose of the Study:
- To assess the current state of antifungal use monitoring in Australian hospitals.
- To identify implemented AFS strategies and their targets.
- To determine the barriers encountered during AFS implementation.
Main Methods:
- A quantitative, cross-sectional electronic survey was distributed to Australian public and private hospitals in February 2018.
- Descriptive statistics were employed to analyze the survey data.
- The survey achieved a 58% response rate from 143 hospitals, with 83 participants.
Main Results:
- Most hospitals (75%) monitored antifungal use, primarily tracking costs and conducting annual point prevalence surveys.
- Core AFS strategies like pre-authorization (89%) and expert post-prescription review (79%) were common, especially for high-cost intravenous agents.
- Barriers included limited staff time, AFS prioritization challenges, and inadequate access to rapid diagnostics and therapeutic drug monitoring (TDM).
Conclusions:
- Australian AFS programs predominantly target expensive intravenous antifungals.
- While expert oversight exists, crucial agents like fluconazole and oral posaconazole are often not targeted.
- Addressing identified gaps and barriers is essential for developing effective AFS models in Australian hospitals.
Related Concept Videos
01:22Healthcare Associated Infections II: Preventive Measures
The best practices for preventing healthcare-associated infections include hand hygiene, patient risk...
01:29Endocarditis IV: Nursing Management
01:28Pulmonary Tuberculosis V
Latent tuberculosis infection occurs when TB bacteria are present in a person's body, but are not causing illness or symptoms. It is not contagious, and preventive treatment is crucial to avoid the...
01:18Endocarditis III: Medical Management
01:26Standard Precaution
Hand hygiene is the most crucial means to prevent the transmission of disease. Employers are legally required to provide their workers with personal protective equipment (PPE) to minimize exposure or contact with...
01:28Antimicrobial Effectiveness