Consensus for antifungal stewardship in China (2024 edition)

Feng Ye¹, Shaoxi Cai², Bin Cao³, Linling Cheng¹, Hong Fan⁴, Yi Huang⁵, Shanping Jiang⁶, Guoxiang Lai⁷, Yuping Li⁸, Yi Shi⁹, Danyang She¹⁰, Xin Su¹¹, Kejing Tang¹², Hongmin Wang¹³, Lingwei Wang¹⁴, Bin Xu¹⁵, Jinfu Xu¹⁶, Jing Zhang¹⁷, Jianquan Zhang¹⁸, Tiantuo Zhang¹⁹, Wei Zhang²⁰, Yunhui Zhang²¹, Hua Zhou²², Jianda Hu²³, Xiaojun Huang²⁴, Erlie Jiang²⁵, Qifa Liu²⁶, Jingbo Wang²⁷, Depei Wu²⁸, Xi Zhang²⁹, Yan Kang³⁰, Haibo Qiu³¹, Bing Gu³², Baoqing Sun³³, Yingchun Xu³⁴, Cunwei Cao³⁵, Ruoyu Li³⁶, Weihua Pan³⁷, Chao Zhuo³⁸, Liping Zhu³⁹, Haihui Huang⁴⁰, Rongsheng Tong⁴¹, Jing Zhang⁴², Mei Jiang⁴³, Jieming Qu⁴⁴

Affiliations

¹ The First Affiliated Hospital of Guangzhou Medical University, National Center for Respiratory Medicine, National Clinical Research Center for Respiratory Disease, State Key Laboratory of Respiratory Disease, Department of Pulmonary and Critical Care Medicine, Guangzhou Institute of Respiratory Health, Guangzhou National Laboratory, Guangzhou Medical University, Guangzhou, China.
² Department of Pulmonary Medicine, Nanfang Hospital, Southern Medical University, Guangzhou, China.
³ Department of Pulmonary and Critical Care Medicine, China-Japan Friendship Hospital, Beijing, China.
⁴ Department of Pulmonary and Critical Care Medicine, West China Hospital, Sichuan University, Chengdu, China.
⁵ Department of Pulmonary and Critical Care Medicine, Shanghai Changhai Hospital, Navy Medical University, Shanghai, China.
⁶ Department of Pulmonary and Critical Care Medicine, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China.
⁷ Department of Pulmonary and Critical Care Medicine, The Second Affiliated Hospital of Fujian University of Traditional Chinese Medicine, Fuzhou, China.
⁸ Department of Pulmonary and Critical Care Medicine, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China.
⁹ Department of Pulmonary and Critical Care Medicine, Jinling Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, China.
¹⁰ Department of Pulmonary and Critical Care Medicine, the First Medical Center of Chinese PLA General Hospital, Beijing, China.
¹¹ Department of Pulmonary and Critical Care Medicine, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, China.
¹² Department of Pulmonary and Critical Care Medicine, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China.
¹³ Department of Respiratory Medicine, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China.
¹⁴ Department of Pulmonary and Critical Care Medicine, Shenzhen People's Hospital, Shenzhen, China.
¹⁵ Jiangxi Health Committee Key (JHCK) Laboratory of Tumor Metastasis, Jiangxi Cancer Hospital, Nanchang, China.
¹⁶ Department of Pulmonary and Critical Care Medicine, Tongji University Affiliated Shanghai Pulmonary Hospital, Shanghai, China.
¹⁷ Department of Pulmonary Medicine, Zhongshan Hospital, Fudan University, Shanghai, China.
¹⁸ Department of Pulmonary and Critical Care Medicine, The Eighth Affiliated Hospital, Sun Yat-sen University, Shenzhen, China.
¹⁹ Department of Pulmonary and Critical Care Medicine, The Third Affiliated Hospital, Sun Yat-sen University, Guangzhou, China.
²⁰ Department of Pulmonary and Critical Care Medicine, The First Affiliated Hospital of Nanchang University, Nanchang, China.
²¹ Department of Pulmonary and Critical Care Medicine, The First People's Hospital of Yunnan Province, Kunming, China.
²² Department of Pulmonary and Critical Care Medicine, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China.
²³ Department of Hematology, The Second Affiliated Hospital of Fujian Medical University, Fuzhou, China.
²⁴ Department of Hematology, Peking University People's Hospital, Beijing, China.
²⁵ Department of Hematology, Institute of Hematology and Blood Disease Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Tianjin, China.
²⁶ Department of Hematology, Nanfang Hospital, Southern Medical University, Guangzhou, China.
²⁷ Department of Hematology, Aerospace Center Hospital, Beijing, China.
²⁸ Department of Hematology, The First Affiliated Hospital of Soochow University, Suzhou, China.
²⁹ Department of Hematology, Xinqiao Hospital, Army Medical University, Chongqing, China.
³⁰ Department of Critical Care Medicine, West China Hospital of Sichuan University, West China Tianfu Hospital, Chengdu, China.
³¹ Department of Critical Care Medicine, Zhongda Hospital Southeast University, Nanjing, China.
³² Department of Laboratory Medicine, Guangdong Provincial People's Hospital, Guangzhou, China.
³³ Department of Clinical Laboratory, National Center for Respiratory Medicine, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China.
³⁴ Department of Laboratory Medicine, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China.
³⁵ Department of Dermatology and Venerology, The First Affiliated Hospital of Guangxi Medical University, Nanning, China.
³⁶ Department of Dermatology and Venereology, Peking University First Hospital, National Clinical Research Centre for Skin and Immune Diseases, Beijing, China.
³⁷ Department of Dermatology, Shanghai Changzheng Hospital, Shanghai, China.
³⁸ Department of Infectious Disease, State Key Laboratory of Respiratory Disease, National Center for Respiratory Medicine, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China.
³⁹ Department of Infectious Disease, Huashan Hospital, Fudan University, Shanghai, China.
⁴⁰ Department of Infectious Disease, Institute of Antibiotics, Huashan Hospital, Fudan University, Shanghai, China.
⁴¹ Department of Pharmacy, Sichuan Academy of Medical Sciences & Sichuan Provincial People's Hospital, Chengdu, China.
⁴² Department of Pharmacy, Institute of Antibiotics, Huashan Hospital, Fudan University, Shanghai, China.
⁴³ Department of Biostatistics, National Clinical Research Center for Respiratory Disease, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China.
⁴⁴ Department of Pulmonary and Critical Care Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.

PMID: 38983176
PMCID: PMC11228704
DOI: 10.21037/jtd-24-13

Review

Consensus for antifungal stewardship in China (2024 edition)

Feng Ye et al. J Thorac Dis. 2024.

. 2024 Jun 30;16(6):4016-4029.

doi: 10.21037/jtd-24-13. Epub 2024 Jun 26.

Authors

Affiliations

¹ The First Affiliated Hospital of Guangzhou Medical University, National Center for Respiratory Medicine, National Clinical Research Center for Respiratory Disease, State Key Laboratory of Respiratory Disease, Department of Pulmonary and Critical Care Medicine, Guangzhou Institute of Respiratory Health, Guangzhou National Laboratory, Guangzhou Medical University, Guangzhou, China.
² Department of Pulmonary Medicine, Nanfang Hospital, Southern Medical University, Guangzhou, China.
³ Department of Pulmonary and Critical Care Medicine, China-Japan Friendship Hospital, Beijing, China.
⁴ Department of Pulmonary and Critical Care Medicine, West China Hospital, Sichuan University, Chengdu, China.
⁵ Department of Pulmonary and Critical Care Medicine, Shanghai Changhai Hospital, Navy Medical University, Shanghai, China.
⁶ Department of Pulmonary and Critical Care Medicine, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China.
⁷ Department of Pulmonary and Critical Care Medicine, The Second Affiliated Hospital of Fujian University of Traditional Chinese Medicine, Fuzhou, China.
⁸ Department of Pulmonary and Critical Care Medicine, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China.
⁹ Department of Pulmonary and Critical Care Medicine, Jinling Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, China.
¹⁰ Department of Pulmonary and Critical Care Medicine, the First Medical Center of Chinese PLA General Hospital, Beijing, China.
¹¹ Department of Pulmonary and Critical Care Medicine, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, China.
¹² Department of Pulmonary and Critical Care Medicine, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China.
¹³ Department of Respiratory Medicine, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China.
¹⁴ Department of Pulmonary and Critical Care Medicine, Shenzhen People's Hospital, Shenzhen, China.
¹⁵ Jiangxi Health Committee Key (JHCK) Laboratory of Tumor Metastasis, Jiangxi Cancer Hospital, Nanchang, China.
¹⁶ Department of Pulmonary and Critical Care Medicine, Tongji University Affiliated Shanghai Pulmonary Hospital, Shanghai, China.
¹⁷ Department of Pulmonary Medicine, Zhongshan Hospital, Fudan University, Shanghai, China.
¹⁸ Department of Pulmonary and Critical Care Medicine, The Eighth Affiliated Hospital, Sun Yat-sen University, Shenzhen, China.
¹⁹ Department of Pulmonary and Critical Care Medicine, The Third Affiliated Hospital, Sun Yat-sen University, Guangzhou, China.
²⁰ Department of Pulmonary and Critical Care Medicine, The First Affiliated Hospital of Nanchang University, Nanchang, China.
²¹ Department of Pulmonary and Critical Care Medicine, The First People's Hospital of Yunnan Province, Kunming, China.
²² Department of Pulmonary and Critical Care Medicine, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China.
²³ Department of Hematology, The Second Affiliated Hospital of Fujian Medical University, Fuzhou, China.
²⁴ Department of Hematology, Peking University People's Hospital, Beijing, China.
²⁵ Department of Hematology, Institute of Hematology and Blood Disease Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Tianjin, China.
²⁶ Department of Hematology, Nanfang Hospital, Southern Medical University, Guangzhou, China.
²⁷ Department of Hematology, Aerospace Center Hospital, Beijing, China.
²⁸ Department of Hematology, The First Affiliated Hospital of Soochow University, Suzhou, China.
²⁹ Department of Hematology, Xinqiao Hospital, Army Medical University, Chongqing, China.
³⁰ Department of Critical Care Medicine, West China Hospital of Sichuan University, West China Tianfu Hospital, Chengdu, China.
³¹ Department of Critical Care Medicine, Zhongda Hospital Southeast University, Nanjing, China.
³² Department of Laboratory Medicine, Guangdong Provincial People's Hospital, Guangzhou, China.
³³ Department of Clinical Laboratory, National Center for Respiratory Medicine, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China.
³⁴ Department of Laboratory Medicine, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China.
³⁵ Department of Dermatology and Venerology, The First Affiliated Hospital of Guangxi Medical University, Nanning, China.
³⁶ Department of Dermatology and Venereology, Peking University First Hospital, National Clinical Research Centre for Skin and Immune Diseases, Beijing, China.
³⁷ Department of Dermatology, Shanghai Changzheng Hospital, Shanghai, China.
³⁸ Department of Infectious Disease, State Key Laboratory of Respiratory Disease, National Center for Respiratory Medicine, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China.
³⁹ Department of Infectious Disease, Huashan Hospital, Fudan University, Shanghai, China.
⁴⁰ Department of Infectious Disease, Institute of Antibiotics, Huashan Hospital, Fudan University, Shanghai, China.
⁴¹ Department of Pharmacy, Sichuan Academy of Medical Sciences & Sichuan Provincial People's Hospital, Chengdu, China.
⁴² Department of Pharmacy, Institute of Antibiotics, Huashan Hospital, Fudan University, Shanghai, China.
⁴³ Department of Biostatistics, National Clinical Research Center for Respiratory Disease, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China.
⁴⁴ Department of Pulmonary and Critical Care Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.

PMID: 38983176
PMCID: PMC11228704
DOI: 10.21037/jtd-24-13

Abstract

Background: Invasive fungal disease (IFD) has become a serious threat to human health in China and around the world, with high mortality and morbidity. Currently, the misdiagnosis rate of IFD is extremely high, compounded with the low quality of prescription antifungals and the high incidence of adverse events associated with IFD treatment, resulting in lengthy hospitalization, low clinical response, and high disease burden, which have become serious challenges in clinical practice. Antifungal stewardship (AFS) can not only significantly increase the early diagnosis rate of IFD, reduce inappropriate utilization of antifungal drugs, improve patient prognosis, but can also improve therapeutic safety and reduce healthcare expenses. Thus, it is urgent to identify key AFS metrics suitable for China's current situation.

Methods: Based on metrics recommended by international AFS consensuses, combined with the current situation of China and the clinical experience of authoritative experts in various fields, several metrics were selected, and experts in the fields of respiratory diseases, hematology, intensive care units (ICUs), dermatology, infectious diseases, microbiology laboratory and pharmacy were invited to assess AFS metrics by the Delphi method. Consensus was considered to be reached with an agreement level of ≥80% for the metric.

Results: Consensus was reached for 24 metrics, including right patient metrics (n=4), right time metrics (n=3), and right use metrics (n=17). Right use metrics were further subdivided into drug choice (n=8), drug dosage (n=4), drug de-escalation (n=1), drug duration (n=2), and drug consumption (n=2) metrics. Forty-six authoritative experts assessed and reviewed the above metrics, and a consensus was reached with a final agreement level of ≥80% for 22 metrics.

Conclusions: This consensus is the first to propose a set of AFS metrics suitable for China, which helps to establish AFS standards in China and is also the first AFS consensus in Asia, and may improve the standard of clinical diagnosis and treatment of IFD, and guide hospitals to implement AFS, ultimately promoting the rational use of antifungal drugs and improving patient prognosis.

Keywords: Antifungal stewardship (AFS); Delphi; consensus; invasive fungal disease (IFD); metrics.

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Conflict of interest statement

Conflicts of Interest: All authors have completed the ICMJE uniform disclosure form (available at https://jtd.amegroups.com/article/view/10.21037/jtd-24-13/coif). Nanshan Zhong serves as Editor-in-Chief of Journal of Thoracic Disease. F.Y. reports that this work was supported by the National Natural Science Foundation of China (Nos. 82270007, 82202544), the Natural Science Foundation of Guangdong Province (No. 8227010505) and Horizontal Project (No. 75772451). The other authors have no conflicts of interest to declare.

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Consensus for antifungal stewardship in China (2024 edition)

Affiliations

Consensus for antifungal stewardship in China (2024 edition)

Authors

Affiliations

Abstract

Conflict of interest statement

References

Publication types

LinkOut - more resources

Full Text Sources