title: Poor compliance with antifungal drug use guidelines by transplant physicians: a framework for educational guidelines and an international consensus on patient safety.
abstract: The rate of compliance with antifungal drug use guidelines by transplant physicians is mostly unknown. We performed a nationwide electronic survey to assess antifungal use by different types of transplant physicians. Sixty-one percent (53/87) of the transplant programs responded (accounting for 85% of heart transplant procedures, 65% of kidney transplantations, and 71.5% of liver transplantations). Antifungal prophylaxis was used in 41.5% programs (liver 93.3%, heart 30.8%, and kidney 16%). Prophylaxis was universal in 32% of the programs and targeted only to selected patients in 68%, mainly indicated after re-transplantation (73.3%), re-intervention (66.7%) and hemodialysis (60%). Main drugs for universal prophylaxis were fluconazole and itraconazole (42.9% each), while fluconazole (60%), L-amphotericin B (AMB), and caspofungin (13.4% each) were preferred for targeted prophylaxis. Overall, 84.9% of the programs used galactomannan for the diagnosis of invasive aspergillosis (only 34% in BAL) and 66.6% used voriconazole as first-line monotherapy. Combination first-line therapy for invasive aspergillosis was used by 31.3%, mainly with voriconazole with caspofungin (40%) or anidulafungin (26.7%) or L-AMB-caspofungin (26.7%). Adherence of transplant physicians to current recommendations on antifungal treatment and prophylaxis is poor. An international consensus that responds to differences in patients and centers and emphasizes patient safety is clearly needed.
authors.affiliation: Microbiología Clínica-Enfermedades Infecciosas, Hospital General Universitario Gregorio Marañón, Madrid, Spain. pmunoz@micro.hggm.es
authors.forename: Patricia
authors.initials: P
authors.lastname: Muñoz
authors.forename: Loreto
authors.initials: L
authors.lastname: Rojas
authors.forename: Carlos
authors.initials: C
authors.lastname: Cervera
authors.forename: Gregorio
authors.initials: G
authors.lastname: Garrido
authors.forename: Maria Carmen
authors.initials: MC
authors.lastname: Fariñas
authors.forename: Maricela
authors.initials: M
authors.lastname: Valerio
authors.forename: Maddalena
authors.initials: M
authors.lastname: Giannella
authors.forename: Emilio
authors.initials: E
authors.lastname: Bouza
mesh_terms: D000935:Antifungal Agents / Q000627:therapeutic use*; D003695:Delivery of Health Care / Q000592:standards*; D011307:Drug Prescriptions / Q000592:standards*; D019983:Guideline Adherence; D006801:Humans; D007390:International Agencies; D009181:Mycoses / Q000175:diagnosis / Q000188:drug therapy* / Q000209:etiology; D016377:Organ Transplantation / Q000009:adverse effects*; D061214:Patient Safety; D017410:Practice Guidelines as Topic / Q000592:standards*
chemical_list: D000935:Antifungal Agents