title: How much European prescribing physicians know about invasive fungal infections management?
abstract: BACKGROUND
  The use of systemic antifungal agents has increased in most tertiary care centers. However, antifungal stewardship has deserved very little attention. Our objective was to assess the knowledge of European prescribing physicians as a first step of an international program of antifungal stewardship.
  
  
  METHODS
  Staff physicians and residents of 4 European countries were invited to complete a 20-point questionnaire that was based on current guidelines of invasive candidiasis and invasive aspergillosis.
  
  
  RESULTS
  121 physicians (44.6% staff, 55.4% residents) from Spain 53.7%, Italy 17.4%, Denmark 16.5% and Germany 12.4% completed the survey. Hospital departments involved were: medical 51.2%, ICUs 43%, surgical 3.3% and pharmaceutical 2.5%. The mean score of adequate responses (± SD) was 5.8 ± 1.7 points, with statistically significant differences between study site and type of physicians. Regarding candidiasis, 69% of the physicians clearly distinguished colonization from infection and the local rate of fluconazole resistance was known by 24%. The accepted indications of antifungal prophylaxis were known by 38%. Regarding aspergillosis, 52% of responders could differentiate colonization from infection and 42% knew the diagnostic value of galactomannan. Radiological features of invasive aspergillosis were well recognized by 58% of physicians and 57% of them were aware of the antifungal considered as first line treatment. However, only 37% knew the recommended length of therapy.
  
  
  CONCLUSIONS
  This simple, easily completed questionnaire enabled us to identify some weakness in the knowledge of invasive fungal infection management among European physicians. This survey could serve as a guide to design a future tailored European training program.
authors.affiliation: Department of Clinical Microbiology and Infectious Diseases, Hospital General Universitario Gregorio Marañón, Madrid, Spain. mavami_valerio@yahoo.com.mx.|Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain. mavami_valerio@yahoo.com.mx.
authors.forename: Maricela
authors.initials: M
authors.lastname: Valerio
authors.affiliation: Department of Clinical Microbiology and Infectious Diseases, Hospital General Universitario Gregorio Marañón, Madrid, Spain. anton.vena@gmail.com.|Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain. anton.vena@gmail.com.|Department of Medicine, Facultad de Medicina, Universidad Complutense de Madrid, Madrid, Spain. anton.vena@gmail.com.
authors.forename: Antonio
authors.initials: A
authors.lastname: Vena
authors.affiliation: Department of Clinical Microbiology and Infectious Diseases, Hospital General Universitario Gregorio Marañón, Madrid, Spain. ebouza@microb.net.|Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain. ebouza@microb.net.|Department of Medicine, Facultad de Medicina, Universidad Complutense de Madrid, Madrid, Spain. ebouza@microb.net.
authors.forename: Emilio
authors.initials: E
authors.lastname: Bouza
authors.affiliation: Intensive Care Unit, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark. nannareiter@dadlnet.dk.
authors.forename: Nanna
authors.initials: N
authors.lastname: Reiter
authors.affiliation: Department of Medical and Surgical Sciences, S. Orsola-Malpighi Hospital, Alma Mater Studiorum, University of Bologna, Bologna, Italy. pierluigi.viale@unibo.it.
authors.forename: Pierluigi
authors.initials: P
authors.lastname: Viale
authors.affiliation: Department of Anesthesiology and Intensive Care Medicine, University Hospital of Heidelberg, Heidelberg, Germany. marcel.hochreiter@med.uni-heidelberg.de.
authors.forename: Marcel
authors.initials: M
authors.lastname: Hochreiter
authors.affiliation: Department of Medical and Surgical Sciences, S. Orsola-Malpighi Hospital, Alma Mater Studiorum, University of Bologna, Bologna, Italy. maddalena.giannella@libero.it.
authors.forename: Maddalena
authors.initials: M
authors.lastname: Giannella
authors.affiliation: Department of Clinical Microbiology and Infectious Diseases, Hospital General Universitario Gregorio Marañón, Madrid, Spain. pmunoz@hggm.es.|Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain. pmunoz@hggm.es.|Department of Medicine, Facultad de Medicina, Universidad Complutense de Madrid, Madrid, Spain. pmunoz@hggm.es.
authors.forename: Patricia
authors.initials: P
authors.lastname: Muñoz
mesh_terms: D000328:Adult; D000935:Antifungal Agents / Q000008:administration & dosage* / Q000627:therapeutic use; D001228:Aspergillosis / Q000188:drug therapy*; D058365:Candidiasis, Invasive / Q000188:drug therapy*; D003430:Cross-Sectional Studies; D005060:Europe; D005260:Female; D015725:Fluconazole / Q000008:administration & dosage* / Q000627:therapeutic use; D006801:Humans; D008297:Male; D010818:Practice Patterns, Physicians'; D011795:Surveys and Questionnaires
chemical_list: D000935:Antifungal Agents; D015725:Fluconazole