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Antifungal stewardship in the UK: where are we now?

Summary

This paper examines how well the UK is currently managing antifungal stewardship—the appropriate use of antifungal medications to treat serious fungal infections while preventing resistance. Experts found that since 2017, progress has been limited due to lack of funding and staff expertise, difficulties accessing timely fungal diagnostic tests, and disruptions from the COVID-19 pandemic. The panel recommends creating regional mycology networks and diagnostic centres, establishing national standards for antifungal practices, and improving education about fungal infections to better prepare the UK for rising fungal disease threats.

Background

Invasive fungal diseases (IFD) are increasing globally with annual incidence of 6.5 million infections and 3.8 million deaths. Antifungal resistance (AFR) is rising, with emerging resistant species like Candida auris and azole-resistant Aspergillus fumigatus. In 2017, only 11% of NHS Trusts had dedicated antifungal stewardship (AFS) programmes, and the COVID-19 pandemic further disrupted AFS activities in the UK.

Objective

To understand the current challenges to implementing antifungal stewardship in the UK and identify opportunities to address barriers to AFS implementation. The study aimed to assess the landscape of AFS practices, key programme elements, diagnostics, and education needs.

Results

Participants unanimously agreed limited progress has been made in AFS since 2017. Primary barriers identified were lack of financial and staffing resources, sub-optimal fungal diagnostics, and limited mycology expertise. Proposals were made for core AFS team members, guideline development, surveillance approaches, diagnostic capabilities by hospital setting, and educational strategies including regional mycology networks and diagnostic hubs.

Conclusion

National standards for AFS services and associated outcome metrics must be established in the UK. Key recommendations include formal mycology networks and regional diagnostic hubs for centres, making certain fungal pathogens notifiable, and increased investment in diagnostic capacity and mycology expertise to improve AFS implementation.
  • Published in:JAC Antimicrobial Resistance,
  • Study Type:Position Paper/Expert Panel Discussion,
  • Source: PMID: 39741653, DOI: 10.1093/jacamr/dlae209
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