title: The role of the multidisciplinary team in antifungal stewardship.
abstract: There are a variety of challenges faced in the management of invasive fungal diseases (IFD), including high case-fatality rates, high cost of antifungal drugs and development of antifungal resistance. The diagnostic challenges and poor outcomes associated with IFD have resulted in excessive empirical use of antifungals in various hospital settings, exposing many patients without IFD to potential drug toxicities as well as causing spiralling antifungal drug costs. Further complexity arises as different patient groups show marked variation in their risk for IFD, fungal epidemiology, sensitivity and specificity of diagnostic tests and the pharmacokinetics and pharmacodynamics of antifungal drugs. To address these issues and to ensure optimal management of IFD, specialist knowledge and experience from a range of backgrounds is required, which extends beyond the remit of most antibiotic stewardship programmes. The first step in the development of any antifungal stewardship (AFS) programme is to build a multidisciplinary team encompassing the necessary expertise in the management of IFD to develop and implement the AFS programme. The specific roles of the key individuals within the AFS team and the importance of collaboration are discussed in this article.
authors.affiliation: Division of Haemato-Oncology, St Bartholomew's Hospital and Blizard Institute, Queen Mary University, London, UK.
authors.forename: Samir
authors.initials: S
authors.lastname: Agrawal
authors.affiliation: Department of Medical Microbiology and Infectious Diseases, Division of Infection and Immunity, School of Medicine, Cardiff University, Cardiff, UK.
authors.forename: Rosemary
authors.initials: R
authors.lastname: Barnes
authors.affiliation: Department of Pharmacy and Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands.
authors.forename: Roger J
authors.initials: RJ
authors.lastname: Brüggemann
authors.affiliation: Manchester Academic Health Science Centre, Institute of Inflammation and Repair, University of Manchester, Manchester, UK.|University Hospital of South Manchester, Wythenshawe Hospital, Manchester, UK.
authors.forename: Riina
authors.initials: R
authors.lastname: Rautemaa-Richardson
authors.affiliation: Aberdeen Fungal Group, MRC Centre for Medical Mycology, Institute of Medical Sciences, University of Aberdeen, Aberdeen, UK a.warris@abdn.ac.uk.
authors.forename: Adilia
authors.initials: A
authors.lastname: Warris
mesh_terms: D000935:Antifungal Agents / Q000191:economics / Q000627:therapeutic use*; D006801:Humans; D007400:Interprofessional Relations; D009181:Mycoses / Q000175:diagnosis* / Q000188:drug therapy* / Q000401:mortality; D010348:Patient Care Team
chemical_list: D000935:Antifungal Agents