Pates Katharine, Shang Zhendan, Jabbar Rebeka, Armstrong-James Darius, Schelenz Silke, Periselneris Jimstan, Arcucci Rossella, Shah Anand
Department of Respiratory Medicine, King's College Hospital NHS Foundation Trust, London SE5 9RS, UK.
Department of Earth Science and Engineering, Imperial College London, London SW7 2AZ, UK.
J Fungi (Basel). 2024 Nov 13;10(11):787. doi: 10.3390/jof10110787.
Fungal infections are increasingly prevalent; however, antifungal stewardship attracts little funding or attention. Previous studies have shown that knowledge of guidelines and scientific evidence regarding antifungals is poor, leading to prescribing based on personal experiences and the inherent biases this entails. We carried out a retrospective study of inpatient antifungal usage at two major hospitals. We assessed the longitudinal trends in antifungal usage and the effect of COVID-19 on antifungal prescription, alongside levels of empirical and diagnostically targeted antifungal usage. Our results showed that the longitudinal patterns of total systemic antifungal usage within the trusts were similar to national prescribing trends; however, the composition of antifungals varied considerably, even when looking exclusively at the more homogenous group of COVID-19 patients. We showed a high level of empirical antifungal use in COVID-19 patients, with neither trust adhering to international recommendations and instead appearing to follow prior prescribing habits. This study highlights the significant challenges to optimise antifungal use with prescribing behaviour largely dictated by habit, a lack of adherence to guidelines, and high rates of empirical non-diagnostic-based prescribing. Further research and resources are required to understand the impact of antifungal stewardship on improving antifungal prescribing behaviours in this setting and the effects on outcome.
真菌感染日益普遍；然而，抗真菌药物管理几乎没有获得资金或受到关注。先前的研究表明，关于抗真菌药物的指南和科学证据的知晓情况很差，导致基于个人经验及由此产生的固有偏见进行处方开具。我们对两家大型医院的住院患者抗真菌药物使用情况进行了一项回顾性研究。我们评估了抗真菌药物使用的纵向趋势以及新冠疫情对抗真菌药物处方的影响，同时还评估了经验性和诊断针对性抗真菌药物的使用水平。我们的结果表明，信托机构内全身抗真菌药物使用的纵向模式与全国处方趋势相似；然而，即使仅观察新冠患者这一更为同质的群体，抗真菌药物的构成也有很大差异。我们发现新冠患者中经验性使用抗真菌药物的比例很高，两家信托机构均未遵循国际建议，而是似乎遵循先前的处方习惯。本研究凸显了优化抗真菌药物使用所面临的重大挑战，处方行为很大程度上由习惯决定，缺乏对指南的遵循，以及基于非诊断的经验性处方开具率很高。需要进一步的研究和资源来了解抗真菌药物管理对改善这种情况下抗真菌药物处方行为的影响以及对治疗结果的影响。
