Micallef Christianne, Ashiru-Oredope Diane, Hansraj Sejal, Denning David W, Agrawal Samir G, Manuel Rohini J, Schelenz Silke, Guy Rebecca, Muller-Pebody Berit, Patel Rakhee, Howard Philip, Hopkins Susan, Johnson Elizabeth, Enoch David A
Pharmacy Department, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Addenbrooke's Hospital Biomedical Campus, Hills Road, Cambridge CB2 0QQ, UK.
Antimicrobial Resistance Programme, Public Health England, 61 Colindale Avenue, London NW9 5EQ, UK.
J Med Microbiol. 2017 Nov;66(11):1581-1589. doi: 10.1099/jmm.0.000612. Epub 2017 Oct 25.
We sought to explore the current status of antifungal stewardship (AFS) initiatives across National Health Service (NHS) Trusts within England, the challenges and barriers, as well as ways to improve current AFS programmes.
An electronic survey was sent to all 155 acute NHS Trusts in England. A total of 47 Trusts, corresponding to 30 % of English acute Trusts, responded to the the survey; 46 Trusts (98 %) had an antimicrobial stewardship (AMS) programme but only 5 (11 %) had a dedicated AFS programme. Overall, 20 (43 %) Trusts said they included AFS as part of their AMS programmes. From those conducting AFS programmes, 7 (28 %) have an AFS/management team, 16 (64 %) monitor and report on antifungal usage, 5 (20 %) have dedicated AFS ward rounds and 12 (48 %) are directly involved in the management of invasive fungal infections.Results/Key findings. Altogether, 13 acute Trusts (52 %) started their AFS programme to manage costs, whilst 12 (48 %) commenced the programme due to clinical need; 27 (73 %) declared that they would increase their AFS initiatives if they could. Of those without an AFS programme, 14 (67 %) responded that this was due to lack of resources/staff time. Overall, 12 Trusts (57 %) responded that the availability of rapid diagnostics and clinical support would enable them to conduct AFS activities.
Although a minority of Trusts conduct dedicated AFS programmes, nearly half include AFS as part of routine AMS activities. Cost issues are the main driver for AFS, followed by clinical need. The availability of rapid diagnostics and clinical support could help increase AFS initiatives.
我们试图探究英格兰国民医疗服务体系（NHS）各信托机构内抗真菌管理（AFS）举措的现状、挑战和障碍，以及改进当前AFS项目的方法。
向英格兰所有155家急性病NHS信托机构发送了电子调查问卷。共有47家信托机构回复了调查，占英格兰急性病信托机构的30%；46家信托机构（98%）有抗菌药物管理（AMS）项目，但只有5家（11%）有专门的AFS项目。总体而言，20家（43%）信托机构表示他们将AFS纳入了AMS项目。在开展AFS项目的机构中，7家（28%）有AFS/管理团队，16家（64%）监测并报告抗真菌药物的使用情况，5家（20%）有专门的AFS病房巡查，12家（48%）直接参与侵袭性真菌感染的管理。结果/主要发现。总共有13家急性病信托机构（52%）启动AFS项目以控制成本，而12家（48%）因临床需要启动该项目；27家（73%）表示如果可以，他们会增加AFS举措。在没有AFS项目的机构中，14家（67%）回复称这是由于缺乏资源/工作人员时间。总体而言，12家信托机构（57%）回复称快速诊断和临床支持的可获得性将使他们能够开展AFS活动。
虽然少数信托机构开展专门的AFS项目，但近一半将AFS作为常规AMS活动的一部分。成本问题是AFS的主要驱动因素，其次是临床需要。快速诊断和临床支持的可获得性有助于增加AFS举措。
