Antifungal Stewardship - Aspergillus and Aspergillosis

Microorganisms have the ability to adapt and evolve resistance to our established antimicrobial treatments. Antimicrobial stewardship therefore refers to the steps taken to preserve the effectiveness of these antimicrobial agents. While this is vital for the future treatment of all infectious diseases, there are features and challenges unique to antifungal stewardship (AFS):

● Development of antifungal resistance
● High fatality rates
● High drug costs
● Complexity of fungal diseases in different patient populations
● Requirement for more aggressive management of malignant & inflammatory conditions
● Relative ease of prescribing the newer antifungal drugs due to:
○ Reduced toxicity
○ Emerging resistance

● Vulnerability and complexity of patient populations:
○ Very low birthweight infants
○ Children with genetic susceptibility to infection
○ Patients treated with chemotherapy for malignant diseases
○ Transplant patients
○ Patients with chronic lung disease
○ Patients depending on long term critical care

How then do clinicians deliver AFS?

The Steering Committee of the Continuing Antifungal Research and Education (CARE) Programme, organised and funded by Gilead Sciences Europe Ltd, selected this as a topic for the eighth CARE meeting, which was held in Madrid in November 2015. A primary goal of the meeting was to bring together infectious disease clinicians, medical microbiologists, medical mycologists, haematologists, pharmacologists and others to participate in a series of lectures, clinical case presentations and debates. A selection of reviews were published in the Supplement of the Journal of Antimicrobial Chemotherapy (Vol. 71: Issue suppl. 2), reflecting a cross-section of the key information presented. Those relevant to Aspergillus have been linked below:

Preface. F. Kate Gould, Russell E. Lewis, Malcolm D. Richardson.

An introduction to antifungal stewardship. Malcolm D. Richardson

The current management landscape: aspergillosis. Johan A. Maertens, Ola Blennow, Rafael F. Duarte, Patricia Muñoz

The current treatment landscape: the need for antifungal stewardship programmes. Patricia Muñoz, Emilio Bouza; on behalf of the COMIC (Collaboration Group on Mycosis) study group

The role of the multidisciplinary team in antifungal stewardship. Samir Agrawal, Rosemary Barnes, Roger J. Brüggemann, Riina Rautemaa-Richardson, Adilia Warris.

Conclusion and future perspectives on antifungal stewardship. Jose María Aguado; Jose Tiago Silva; Emilio Bouza