Reslan Zainab, Lindsay Julian, Kerridge Ian, Gellatly Rochelle
Royal North Shore Hospital, Sydney, New South Wales, Australia.
Monash University, Melbourne, Victoria, Australia.
J Pharm Technol. 2019 Dec;35(6):270-280. doi: 10.1177/8755122519859976. Epub 2019 Jul 7.
To review the published literature assessing adherence rates to antifungal guidelines and reasons for nonadherence in the adult malignant hematology inpatient setting. The databases Embase, MEDLINE, and PubMed (from data inception to May 2019) were searched using the terms hematology, oncology, antifungal, guidelines, adherence, and stewardship with the search limited to adult human subjects and published in English. This yielded 123 articles. From this list, studies that were published in peer-reviewed journals were extracted, leaving 10 citations that met the final inclusion criteria. Ten studies were selected assessing adherence to consensus antifungal guidelines in the malignant hematology setting. These included studies investigating the introduction of antifungal stewardship programs in tertiary hospitals. Although the studies were heterogeneous, all focused on appropriateness of antifungal therapy in the inpatient setting. Adherence to antifungal guidelines for optimal antifungal prophylaxis and treatment was low in most studies, with rates of inappropriate antifungal therapy ranging from 25% to 70% of fungal prescriptions. Adherence rates with guidelines for antifungal therapy are low in the hematology inpatient setting. This may affect infection rates influencing morbidity and mortality in this high-risk population. Given the prevalence of invasive fungal infections in malignant hematology inpatients, suboptimal adherence with antifungal guidelines is concerning. This demands a focus on education, antifungal stewardship, and updating guidelines to meet real-world scenarios. Adherence with antifungal guidelines in the outpatient hematology setting is unknown and requires further research.
回顾已发表的文献，评估成人恶性血液病住院患者中抗真菌指南的依从率及不依从的原因。使用血液学、肿瘤学、抗真菌、指南、依从性和管理等术语检索Embase、MEDLINE和PubMed数据库（从数据起始至2019年5月），检索范围限于成年人类受试者且文献为英文发表。这产生了123篇文章。从该列表中，提取发表于同行评审期刊的研究，最终有10篇引文符合纳入标准。选择了10项评估恶性血液病环境中抗真菌共识指南依从性的研究。这些研究包括在三级医院引入抗真菌管理计划的调查。尽管研究具有异质性，但均聚焦于住院环境中抗真菌治疗的适宜性。在大多数研究中，针对最佳抗真菌预防和治疗的抗真菌指南依从性较低，不适当抗真菌治疗的比例在真菌处方的25%至70%之间。血液科住院患者中抗真菌治疗指南的依从率较低。这可能会影响感染率，进而影响这一高危人群的发病率和死亡率。鉴于侵袭性真菌感染在恶性血液病住院患者中的普遍存在，抗真菌指南依从性欠佳令人担忧。这需要关注教育、抗真菌管理以及更新指南以适应实际情况。门诊血液科环境中抗真菌指南的依从性尚不清楚，需要进一步研究。
