Schelenz Silke, Agrawal Samir, Brady Aaron, Kiely Gillian, Riaz Zeshan, Howes Emilie, Felton Tim, Micallef Christianne, Tyler Netta, Bicanic Tihana, White P Lewis
School of Immunology & Microbial Sciences, Kings College London, London, UK.
Haemato-Oncology, Barts Health NHS Trust, London, UK.
JAC Antimicrob Resist. 2024 Dec 31;7(1):dlae209. doi: 10.1093/jacamr/dlae209. eCollection 2025 Feb.
Antifungal stewardship (AFS) is the judicious use of today's antifungal agents with the aim of improving patient outcomes and preserving their future effectiveness. Antifungal resistance (AFR) is increasing globally, with more patients at risk of Invasive Fungal Disease (IFD), highlighting the urgent need to standardize AFS practices in the UK. The aim of this position paper is to understand the current AFS landscape in the UK.
A virtual panel discussion was held from September to October 2023 on an online platform followed by a virtual meeting with nine healthcare professionals from across the UK selected for their expertise on IFD management and AFS. The discussion was structured across four topics: current AFS landscape, key elements of an AFS programme, diagnostics and diagnostic stewardship, and unmet needs in education and training. A thematic analysis was carried out. The results represent the collated and summarized views from these activities.
Participants reported barriers to implementing AFS and its integration within antimicrobial stewardship (AMS) programmes in the UK. The primary challenge identified was a lack of resources, including funding and staff time. Sub-optimal fungal diagnostics and limited mycology expertise was reported as a barrier to AFS, clinical IFD and AFR surveillance. Approaches to combatting these challenges may include investing in formal mycology networks to serve as centres of clinical expertise and diagnostic hubs.
National standards for AFS services and associated outcome metrics need to be established to set a benchmark for centres to improve AFS.
抗真菌药物管理（AFS）是指合理使用当今的抗真菌药物，旨在改善患者预后并保持其未来的有效性。全球范围内，抗真菌药物耐药性（AFR）正在增加，更多患者面临侵袭性真菌病（IFD）的风险，这凸显了在英国规范AFS实践的迫切需求。本立场文件的目的是了解英国当前的AFS情况。
2023年9月至10月在一个在线平台上举行了一次虚拟小组讨论，随后与来自英国各地的九名医疗保健专业人员举行了一次虚拟会议，这些人员因其在IFD管理和AFS方面的专业知识而被选中。讨论围绕四个主题展开：当前的AFS情况、AFS计划的关键要素、诊断与诊断管理以及教育和培训方面未满足的需求。进行了主题分析。结果代表了这些活动整理和总结后的观点。
参与者报告了在英国实施AFS及其融入抗菌药物管理（AMS）计划时遇到的障碍。确定的主要挑战是缺乏资源，包括资金和工作人员时间。据报告，真菌诊断欠佳和真菌学专业知识有限是AFS、临床IFD和AFR监测的障碍。应对这些挑战的方法可能包括投资建立正式的真菌学网络，作为临床专业知识中心和诊断枢纽。
需要制定AFS服务的国家标准和相关的结果指标，为各中心改善AFS设定一个基准。
