title: Training should be the first step toward an antifungal stewardship program.
abstract: The frequency of use of systemic antifungal agents has increased significantly in most tertiary centers. However, antifungal stewardship has received very little attention. The objective of this article was to assess the knowledge of prescribing physicians in our institution as a first step in the development of an antifungal stewardship program. Attending physicians from the departments that prescribe most antifungals were invited to complete a questionnaire based on current guidelines on diagnosis and therapy of invasive candidiasis and invasive aspergillosis (IA). The survey was completed by 60.8% (200/329) of the physicians who were invited to participate. The physicians belonged to the following departments: medical (60%), pediatric (19%), intensive care (15.5%), and surgical (5.5%). The mean (±SD) score of correct responses was 5.16±1.73. In the case of candidiasis, only 55% of the physicians clearly distinguished between colonization and infection, and 17.5% knew the local rate of fluconazole resistance. Thirty-three percent knew the accepted indications for antifungal prophylaxis, and 23% the indications for empirical therapy. However, most physicians knew which antifungals to choose when starting empirical therapy (73.5%). As for aspergillosis, most physicians (67%) could differentiate between colonization and infection, and 34.5% knew the diagnostic value of galactomannan. The radiological features of IA were well recognized by 64%, but only 31.5% were aware of the first line of treatment for IA, and 36% of the recommended duration of therapy. The usefulness of antifungal levels was known by 67%. This simple, easily completed questionnaire enabled us to identify which areas of our training strategy could be improved.
authors: Clinical Microbiology and Infectious Diseases Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain; Instituto de Investigación Sanitaria del Hospital Gregorio Marañón, Madrid, Spain. Electronic address: mavami_valerio@yahoo.com.mx.
authors: Maricela
authors: M
authors: Valerio
authors: Clinical Microbiology and Infectious Diseases Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain; Instituto de Investigación Sanitaria del Hospital Gregorio Marañón, Madrid, Spain; CIBER de Enfermedades Respiratorias (CIBERES), Madrid, Spain; Microbiology Department, School of Medicine, Universidad Complutense de Madrid, Spain.
authors: Patricia
authors: P
authors: Muñoz
authors: Pharmacy Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain; Instituto de Investigación Sanitaria del Hospital Gregorio Marañón, Madrid, Spain.
authors: Carmen
authors: C
authors: Rodríguez-González
authors: Pharmacy Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain; Instituto de Investigación Sanitaria del Hospital Gregorio Marañón, Madrid, Spain.
authors: María
authors: M
authors: Sanjurjo
authors: Clinical Microbiology and Infectious Diseases Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain; Instituto de Investigación Sanitaria del Hospital Gregorio Marañón, Madrid, Spain.
authors: Jesús
authors: J
authors: Guinea
authors: Clinical Microbiology and Infectious Diseases Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain; Instituto de Investigación Sanitaria del Hospital Gregorio Marañón, Madrid, Spain; CIBER de Enfermedades Respiratorias (CIBERES), Madrid, Spain; Microbiology Department, School of Medicine, Universidad Complutense de Madrid, Spain.
authors: Emilio
authors: E
authors: Bouza
mesh_terms: D000935:Antifungal Agents / Q000627:therapeutic use*; D001228:Aspergillosis / Q000188:drug therapy; D058365:Candidiasis, Invasive / Q000188:drug therapy; D002353:Carrier State / Q000175:diagnosis; D003937:Diagnosis, Differential; D011307:Drug Prescriptions / Q000706:statistics & numerical data*; D004363:Drug Utilization; D004502:Education, Medical, Continuing; D019538:Health Care Surveys; D006801:Humans; D057970:Inappropriate Prescribing / Q000517:prevention & control*; D055552:Infectious Disease Medicine / Q000193:education*; D000072742:Invasive Fungal Infections / Q000175:diagnosis / Q000188:drug therapy*; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D011795:Surveys and Questionnaires
chemical_list: D000935:Antifungal Agents
keywords: Antifungal stewardship; Antifungal use; Aspergilosis invasiva; Candinas; Candins; Control de antifúngicos; Fluconazol; Fluconazole; Invasive aspergillosis; Uso de antifúngicos