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Review
. 2022 May 11;9(7):ofac234.
doi: 10.1093/ofid/ofac234. eCollection 2022 Jul.

The Role of Diagnostics-Driven Antifungal Stewardship in the Management of Invasive Fungal Infections: A Systematic Literature Review

Arunaloke Chakrabarti  1 , Naglaa Mohamed  2 , Maria Rita Capparella  3 , Andy Townsend  4 , Anita H Sung  2 , Renee Yura  5 , Patricia Muñoz  6
Affiliations
Review

The Role of Diagnostics-Driven Antifungal Stewardship in the Management of Invasive Fungal Infections: A Systematic Literature Review

Arunaloke Chakrabarti et al. Open Forum Infect Dis. .

Abstract

Antifungal stewardship (AFS) programs are key to optimizing antifungal use and improving outcomes in patients with invasive fungal infections. Our systematic literature review evaluated the impact of diagnostics in AFS programs by assessing performance and clinical measures. Most eligible studies were from Europe and the United States (n = 12/17). Diagnostic approaches included serum β-1-3-D-glucan test (n/N studies, 7/17), galactomannan test (4/17), computed tomography scan (3/17), magnetic resonance (2/17), matrix-assisted laser desorption and ionization time-of-flight mass spectrometry (MALDI-TOF MS; 2/17), polymerase chain reaction (1/17), peptide nucleic acid fluorescent in situ hybridization (PNA-FISH) assay (1/17), and other routine methods (9/17). Time to species identification decreased significantly using MALDI-TOF and PNA-FISH (n = 2). Time to targeted therapy and length of empiric therapy also decreased (n = 3). Antifungal consumption decreased by 11.6%-59.0% (7/13). Cost-savings ranged from 13.5% to 50.6% (5/10). Mortality rate (13/16) and length of stay (6/7) also decreased. No negative impact was reported on patient outcomes. Diagnostics-driven interventions can potentially improve AFS measures (antifungal consumption, cost, mortality, and length of stay); therefore, AFS implementation should be encouraged.

Keywords: antifungal stewardship; diagnostics; invasive fungal infections.

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Figures

Graphical abstract
Graphical abstract
Figure 1.
Figure 1.
PRISMA flow diagram of the search process and study selection.
See this image and copyright information in PMC

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