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Antifungal stewardship in the UK: where are we now?

Summary

Fungal infections are becoming more common and dangerous because some fungi are developing resistance to antifungal medicines. UK hospitals struggle to manage these infections due to lack of funding, staffing, and limited access to fungal testing services. The paper recommends creating regional fungal expertise centers and setting national standards to improve how antifungal medications are used and monitored across the country.

Background

Invasive fungal diseases (IFD) are increasing globally with estimated annual incidence of 6.5 million cases and 3.8 million deaths. Antifungal resistance (AFR) is rising with emerging resistant species like Candida auris and azole-resistant Aspergillus fumigatus. The UK has demonstrated limited progress in implementing standardized antifungal stewardship (AFS) practices since 2017.

Objective

This position paper aims to understand the current challenges and landscape of antifungal stewardship implementation in the UK. The study sought to identify barriers to implementing AFS and opportunities to address them through expert panel discussion.

Results

Participants reported significant barriers to AFS implementation including lack of financial and staffing resources, sub-optimal fungal diagnostics, and limited mycology expertise across UK centers. Limited progress has occurred since 2017, with COVID-19 pandemic causing workforce redeployment. Suggested solutions include regional mycology networks serving as diagnostic hubs and formal AFS programme standardization.

Conclusion

National standards for AFS services and associated outcome metrics need to be established. Investment in formal mycology networks and regional diagnostic hubs, combined with education initiatives and mandatory reporting of certain fungal pathogens, are recommended to improve AFS practices across the UK.
  • Published in:JAC Antimicrobial Resistance,
  • Study Type:Position Paper, Expert Panel Discussion,
  • Source: PMID: 39741653, DOI: 10.1093/jacamr/dlae209
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