Antifungal Stewardship in Invasive Fungal Infections, a Systematic Review

Cataldo Procacci; Luisa Marras; Leonarda Maurmo; Grazia Vivanet; Luca Scalone; Giacomo Bertolino

doi:10.1007/5584_2024_798

Antifungal Stewardship in Invasive Fungal Infections, a Systematic Review

Adv Exp Med Biol. 2024 Feb 10. doi: 10.1007/5584_2024_798. Online ahead of print.

Authors

Cataldo Procacci¹, Luisa Marras², Leonarda Maurmo³, Grazia Vivanet⁴, Luca Scalone⁵, Giacomo Bertolino⁶

Affiliations

¹ Pharmaceutical Department, ASL BAT, Barletta - Adria - Trani, Italy.
² Laboratory Service, ASL 8, Cagliari, Italy.
³ School of Specialization in Hospital Pharmacy, University of Bari "Aldo Moro", Bari, Italy.
⁴ Unity of Dermatology, Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy.
⁵ Local Health Agency Brindisi, Brindisi, Italy.
⁶ Pharmaceutical Department, Azienda Ospedaliero-Universitaria di Cagliari, Cagliari, Italy. giacomo.bertolino1985@gmail.com.

PMID: 38337088
DOI: 10.1007/5584_2024_798

Abstract

Introduction: Invasive fungal infections (IFI) are a group of life-threatening diseases associated with significant morbidity, mortality and high healthcare costs. Some modern management programs known as AFS (antifungal stewardship programs) have now been developed. The purpose of this systematic review is to evaluate the different declinations of antifungal stewardship programs (AFPs).

Methods: Articles were systematically reviewed using the PRISMA checklist 2020. EMBASE and MEDLINE/PubMED were searched using the term "antifungal stewardship" (2012-2022 data) on 2 January 2023. Eligible studies were those that described an AFS and included an intervention, performance evaluation and outcome measures.

Results: A total of 22/796 studies were included. Approximately two-thirds (16) were published between 2018 and 2022. 16 (72.7%) stated a minimal complete AFS team. 12 (54.5%) adopted a non-compulsory AFS approach, 6(27.3%) had an Educational AFS and 4(18.2%) a compulsory AFS. Cost analyses of 12 studies showed a decrease for 7 (31.8%) compared to an increase for 5 (22.7%). In terms of outcomes, 18 studies showed a lower (10;45.5%) or the same (8;36.4%) pre-post intervention mortality rate.

Conclusion: AFS programs seem to be related to lower costs and better outcomes and should thus be implemented in tandem with antimicrobial stewardship programs.

Keywords: AFS; Antifungal stewardship; Antifungal stewardship outcomes; Antifungal stewardship program; Antifungal stewardship review; IFI; Invasive fungal infection.