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Ye F, Cai S, Cao B, Cheng L, Fan H, Huang Y, Jiang S, Lai G, Li Y, Shi Y, She D, Su X, Tang K, Wang H, Wang L, Xu B, Xu J, Zhang J, Zhang J, Zhang T, Zhang W, Zhang Y, Zhou H, Hu J, Huang X, Jiang E, Liu Q, Wang J, Wu D, Zhang X, Kang Y, Qiu H, Gu B, Sun B, Xu Y, Cao C, Li R, Pan W, Zhuo C, Zhu L, Huang H, Tong R, Zhang J, Jiang M, Qu J. Consensus for antifungal stewardship in China (2024 edition). J Thorac Dis 2024; 16:4016-4029. [PMID: 38983176 PMCID: PMC11228704 DOI: 10.21037/jtd-24-13] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2024] [Accepted: 05/17/2024] [Indexed: 07/11/2024]
Abstract
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.
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Affiliation(s)
- Feng Ye
- The 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
| | - Shaoxi Cai
- Department of Pulmonary Medicine, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Bin Cao
- Department of Pulmonary and Critical Care Medicine, China-Japan Friendship Hospital, Beijing, China
| | - Linling Cheng
- The 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
| | - Hong Fan
- Department of Pulmonary and Critical Care Medicine, West China Hospital, Sichuan University, Chengdu, China
| | - Yi Huang
- Department of Pulmonary and Critical Care Medicine, Shanghai Changhai Hospital, Navy Medical University, Shanghai, China
| | - Shanping Jiang
- Department of Pulmonary and Critical Care Medicine, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Guoxiang Lai
- Department of Pulmonary and Critical Care Medicine, The Second Affiliated Hospital of Fujian University of Traditional Chinese Medicine, Fuzhou, China
| | - Yuping Li
- Department of Pulmonary and Critical Care Medicine, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Yi Shi
- Department of Pulmonary and Critical Care Medicine, Jinling Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, China
| | - Danyang She
- Department of Pulmonary and Critical Care Medicine, the First Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Xin Su
- Department of Pulmonary and Critical Care Medicine, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, China
| | - Kejing Tang
- Department of Pulmonary and Critical Care Medicine, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Hongmin Wang
- Department of Respiratory Medicine, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Lingwei Wang
- Department of Pulmonary and Critical Care Medicine, Shenzhen People’s Hospital, Shenzhen, China
| | - Bin Xu
- Jiangxi Health Committee Key (JHCK) Laboratory of Tumor Metastasis, Jiangxi Cancer Hospital, Nanchang, China
| | - Jinfu Xu
- Department of Pulmonary and Critical Care Medicine, Tongji University Affiliated Shanghai Pulmonary Hospital, Shanghai, China
| | - Jing Zhang
- Department of Pulmonary Medicine, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Jianquan Zhang
- Department of Pulmonary and Critical Care Medicine, The Eighth Affiliated Hospital, Sun Yat-sen University, Shenzhen, China
| | - Tiantuo Zhang
- Department of Pulmonary and Critical Care Medicine, The Third Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Wei Zhang
- Department of Pulmonary and Critical Care Medicine, The First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Yunhui Zhang
- Department of Pulmonary and Critical Care Medicine, The First People’s Hospital of Yunnan Province, Kunming, China
| | - Hua Zhou
- Department of Pulmonary and Critical Care Medicine, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Jianda Hu
- Department of Hematology, The Second Affiliated Hospital of Fujian Medical University, Fuzhou, China
| | - Xiaojun Huang
- Department of Hematology, Peking University People’s Hospital, Beijing, China
| | - Erlie Jiang
- Department of Hematology, Institute of Hematology and Blood Disease Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Tianjin, China
| | - Qifa Liu
- Department of Hematology, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Jingbo Wang
- Department of Hematology, Aerospace Center Hospital, Beijing, China
| | - Depei Wu
- Department of Hematology, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Xi Zhang
- Department of Hematology, Xinqiao Hospital, Army Medical University, Chongqing, China
| | - Yan Kang
- Department of Critical Care Medicine, West China Hospital of Sichuan University, West China Tianfu Hospital, Chengdu, China
| | - Haibo Qiu
- Department of Critical Care Medicine, Zhongda Hospital Southeast University, Nanjing, China
| | - Bing Gu
- Department of Laboratory Medicine, Guangdong Provincial People’s Hospital, Guangzhou, China
| | - Baoqing Sun
- Department of Clinical Laboratory, National Center for Respiratory Medicine, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Yingchun Xu
- Department of Laboratory Medicine, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China
| | - Cunwei Cao
- Department of Dermatology and Venerology, The First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Ruoyu Li
- Department of Dermatology and Venereology, Peking University First Hospital, National Clinical Research Centre for Skin and Immune Diseases, Beijing, China
| | - Weihua Pan
- Department of Dermatology, Shanghai Changzheng Hospital, Shanghai, China
| | - Chao Zhuo
- Department of Infectious Disease, State Key Laboratory of Respiratory Disease, National Center for Respiratory Medicine, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Liping Zhu
- Department of Infectious Disease, Huashan Hospital, Fudan University, Shanghai, China
| | - Haihui Huang
- Department of Infectious Disease, Institute of Antibiotics, Huashan Hospital, Fudan University, Shanghai, China
| | - Rongsheng Tong
- Department of Pharmacy, Sichuan Academy of Medical Sciences & Sichuan Provincial People’s Hospital, Chengdu, China
| | - Jing Zhang
- Department of Pharmacy, Institute of Antibiotics, Huashan Hospital, Fudan University, Shanghai, China
| | - Mei Jiang
- Department of Biostatistics, National Clinical Research Center for Respiratory Disease, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Jieming Qu
- Department of Pulmonary and Critical Care Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
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Riera F, Cortes Luna J, Rabagliatti R, Scapellato P, Caeiro JP, Chaves Magri MM, Sotomayor CE, Rodrigues Falci D. Antifungal stewardship: the Latin American experience. ANTIMICROBIAL STEWARDSHIP & HEALTHCARE EPIDEMIOLOGY : ASHE 2023; 3:e217. [PMID: 38156226 PMCID: PMC10753509 DOI: 10.1017/ash.2023.471] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Revised: 09/20/2023] [Accepted: 09/21/2023] [Indexed: 12/30/2023]
Abstract
Antifungal stewardship is a critical component of healthcare management that focuses on optimizing the use of antifungal medications to improve patient outcomes, minimize resistance, and reduce healthcare costs. In resource-limited settings, the prevalence of fungal infections remains a significant health concern, often exacerbated by factors such as compromised immune systems, inadequate diagnostic capabilities, and limited access to antifungal agents. This paper reviews the current state of antifungal stewardship practices in developing countries, addressing the unique socioeconomic and healthcare landscape.
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Affiliation(s)
- Fernando Riera
- Division of Infectious Diseases, Sanatorio Allende Córdoba, Córdoba, Argentina
- Infectious Diseases, Universidad Nacional de Córdoba, Córdoba, Argentina
| | - Jorge Cortes Luna
- Medicine Department of Internal Medicine School of Medicine, Universidad Nacional de Colombia, Colombia
| | - Ricardo Rabagliatti
- Departamento de Enfermedades Infecciosas del Adulto, Escuela de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Pablo Scapellato
- Chief Infectious Diseases Unit, Hospital D.F. Santojanni, Medicina Universidad Favaloro, Argentina
| | - Juan Pablo Caeiro
- HIV/Infectious Diseases Services at AltaMed, Infectious Diseases, Universidad Nacional de Córdoba, Córdoba, Argentina
| | - Marcello Mihalenko Chaves Magri
- Infectious Diseases Services, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Claudia Elena Sotomayor
- CIBICI-CONICET, Facultad de Ciencias Químicas, Universidad Nacional de Córdoba, Laboratory of Innate Immunity to Fungal Pathogens, Córdoba, Argentina
- Departamento de Bioquímica Clínica, Facultad de Ciencias Químicas, Universidad Nacional de Córdoba, Córdoba, Argentina
| | - Diego Rodrigues Falci
- Infectious Diseases Service, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
- Infectious Diseases at the School of Medicine, Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre, Brazil
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