Antifungal stewardship in solid-organ transplantation: What is needed?

Transpl Infect Dis. 2022 Oct;24(5):e13894. doi: 10.1111/tid.13894.

Abstract

Background: Antifungal stewardship (AFS) lags behind antimicrobial stewardship (AMS) in terms of implementation, evidence base, and workforce experience. Solid-organ transplantation (SOT) carries a significant risk of invasive fungal infection, with high associated mortality, and is therefore associated with significant opportunities to optimize antifungal use.

Methods: A literature search for the terms "antifungal stewardship" and "solid-organ transplant" revealed a small evidence base to support AFS programs in this patient group.

Results: There is significant overlap in the methodology used in AMS and AFS programs, with notable differences in diagnostics, which are discussed in detail. The primary AFS interventions tested in SOT recipients are implementation of clinical guidelines and care bundles, digital enablers of AFS, and post-prescription review/audit and feedback.

Conclusion: There is an urgent need for further research to support effective AFS strategies in this highly susceptible population.

Keywords: antifungal stewardship; fungal infections; prescribing optimization; solid-organ transplantation.

MeSH terms

  • Antifungal Agents / therapeutic use
  • Antimicrobial Stewardship* / methods
  • Humans
  • Invasive Fungal Infections* / diagnosis
  • Invasive Fungal Infections* / drug therapy
  • Invasive Fungal Infections* / prevention & control
  • Organ Transplantation* / adverse effects
  • Organ Transplantation* / methods
  • Transplant Recipients

Substances

  • Antifungal Agents