National Centre for Infections in Cancer, Peter MacCallum Cancer Centre.
National Centre for Antimicrobial Stewardship.
Curr Opin Infect Dis. 2018 Dec;31(6):490-498. doi: 10.1097/QCO.0000000000000497.
To outline key drivers and components of antifungal stewardship (AFS) programmes, the evidence for specific interventions, and methods to assess performance of programmes.
Recent developments in antifungal resistance and breakthrough invasive fungal diseases have increased the urgency for effective AFS. In practice, however, few hospitals have dedicated AFS programmes. To date, AFS programmes have centred around the provision of expert bedside reviews and have reduced costs and consumption of antifungal agents. Incorporating tools such as fungal diagnostics and therapeutic drug monitoring into AFS programme models is recommended. However, the application and impact of these tools in this context have not been adequately assessed. The effectiveness of AFS programmes has been measured in multiple ways but a standardized method of evaluation remains elusive. Few studies have explored the impact of AFS interventions on patient outcomes.
The uptake of formal AFS programmes has been slow. New initiatives integrating AFS tools in programmes, and measuring the impacts on patient outcomes are required given such data are not readily available. A comprehensive approach to evaluate AFS programmes by correlating the quantity and quality of antifungal prescribing with impacts on patient outcomes is needed. Consensus definitions for core AFS metrics are required to benchmark performance and are essential to the resourcing and sustainability of these programmes.
概述抗真菌药物管理（AFS）计划的关键驱动因素和组成部分、具体干预措施的证据，以及评估计划绩效的方法。
抗真菌药物耐药性和突破性侵袭性真菌感染的新进展增加了有效 AFS 的紧迫性。然而，实际上，很少有医院有专门的 AFS 计划。迄今为止，AFS 计划主要集中在提供专家床边审查上，并降低了抗真菌药物的成本和消耗。建议将真菌诊断和治疗药物监测等工具纳入 AFS 计划模型中。然而，这些工具在这方面的应用和影响尚未得到充分评估。AFS 计划的有效性已经通过多种方式进行了衡量，但标准化的评估方法仍然难以实现。很少有研究探讨 AFS 干预对患者结局的影响。
正式的 AFS 计划的采用进展缓慢。鉴于此类数据尚不可用，需要新的举措将 AFS 工具整合到计划中，并衡量对患者结局的影响。需要通过将抗真菌药物处方的数量和质量与对患者结局的影响相关联来全面评估 AFS 计划。需要为核心 AFS 指标制定共识定义，以进行基准测试，这对于这些计划的资源和可持续性至关重要。
