title: Issues in antifungal stewardship: an opportunity that should not be lost.
abstract: Many countries have observed an increase in the incidence of invasive fungal infections (IFIs) over the past two decades with emergence of new risk factors and isolation of new fungal pathogens. Early diagnosis and appropriate antifungal treatment remain the cornerstones of successful outcomes. However, due to non-specific clinical presentations and limited availability of rapid diagnostic tests, in more than half of cases antifungal treatment is inappropriate. As a result, the emergence of antifungal resistance both in yeasts and mycelial fungi is becoming increasingly common. The Delhi Chapter of the Indian Association of Medical Microbiologists (IAMM-DC) organized a 1 day workshop in collaboration with BSAC on 10 December 2015 in New Delhi to design a road map towards the development of a robust antifungal stewardship programme in the context of conditions in India. The workshop aimed at developing a road map for optimizing better outcomes in patients with IFIs while minimizing unintended consequences of antifungal use, ultimately leading to reduced healthcare costs and prevention development of resistance to antifungals. The workshop was a conclave of all stakeholders, eminent experts from India and the UK, including clinical microbiologists, critical care specialists and infectious disease physicians. Various issues in managing IFIs were discussed, including epidemiology, diagnostic and therapeutic algorithms in different healthcare settings. At the end of the deliberations, a consensus opinion and key messages were formulated, outlining a step-by-step approach to tackling the growing incidence of IFIs and antifungal resistance, particularly in the Indian scenario.
authors.affiliation: Department of Clinical Microbiology and Immunology, Sir Ganga Ram Hospital, Rajinder Nagar, New Delhi 110060, India.
authors.forename: Chand
authors.initials: C
authors.lastname: Wattal
authors.affiliation: Department of Medical Microbiology, PGIMER, Chandigarh, India.
authors.forename: Arunaloke
authors.initials: A
authors.lastname: Chakrabarti
authors.affiliation: Department of Clinical Microbiology and Immunology, Sir Ganga Ram Hospital, Rajinder Nagar, New Delhi 110060, India.
authors.forename: Jaswinder Kaur
authors.initials: JK
authors.lastname: Oberoi
authors.affiliation: Studies in Supportive Care, Radboud UMC, The Netherlands.
authors.forename: J Peter
authors.initials: JP
authors.lastname: Donnelly
authors.affiliation: Department of Medical Microbiology & Infectious Diseases, Division of Infection & Immunity, School of Medicine, Cardiff University, UK.
authors.forename: Rosemary A
authors.initials: RA
authors.lastname: Barnes
authors.affiliation: Rajendra Institute of Medical Sciences, Ranchi, India.
authors.forename: B L
authors.initials: BL
authors.lastname: Sherwal
authors.affiliation: Department of Clinical Microbiology and Immunology, Sir Ganga Ram Hospital, Rajinder Nagar, New Delhi 110060, India.
authors.forename: Neeraj
authors.initials: N
authors.lastname: Goel
authors.affiliation: Department of Medical Microbiology, Lady Hardinge Medical College, New Delhi, India.
authors.forename: Sonal
authors.initials: S
authors.lastname: Saxena
authors.affiliation: Department of Infectious Diseases, Christian Medical College, Vellore, India.
authors.forename: George M
authors.initials: GM
authors.lastname: Varghese
authors.affiliation: P. D. Hinduja Hospital, Mumbai, India.
authors.forename: Rajeev
authors.initials: R
authors.lastname: Soman
authors.affiliation: G. B. Pant Institute of Post Graduate Medical Education & Research, New Delhi, India.
authors.forename: Poonam
authors.initials: P
authors.lastname: Loomba
authors.affiliation: (Pan Max) Microbiology, Saket, New Delhi, India.
authors.forename: Bansidhar
authors.initials: B
authors.lastname: Tarai
authors.affiliation: ESIPGIMSR, New Delhi, India.
authors.forename: Sanjay
authors.initials: S
authors.lastname: Singhal
authors.affiliation: Surgical Gastroenterology & Liver Transplantation, Sir Ganga Ram Hospital, New Delhi, India.
authors.forename: Naimish
authors.initials: N
authors.lastname: Mehta
authors.affiliation: Infectious Diseases & Tropical Medicine, Apollo Hospitals, Infectious Diseases, Sri Ramachandra Medical College & Research Institute, Infectious Diseases, MGR Medical University, Chennai, India.
authors.forename: V
authors.initials: V
authors.lastname: Ramasubramanian
authors.affiliation: BLK Centre for Bone Marrow Transplant, New Delhi, India.
authors.forename: Dharma
authors.initials: D
authors.lastname: Choudhary
authors.affiliation: Medanta (The Medicity), Medanta Institute of Critical Care and Anesthesiology, Gurgaon, Haryana, India.
authors.forename: Yatin
authors.initials: Y
authors.lastname: Mehta
authors.affiliation: Department of Critical Care Medicine, Fortis-Escorts Hospital, Faridabad, Haryana, India.
authors.forename: Supradip
authors.initials: S
authors.lastname: Ghosh
authors.affiliation: Apex Regional STD Teaching Training & Research Centre, Vardhman Mahavir Medical College, Safdarjung Hospital, New Delhi, India.
authors.forename: Sumathi
authors.initials: S
authors.lastname: Muralidhar
authors.affiliation: Department of Medical Microbiology, Lady Hardinge Medical College, New Delhi, India.
authors.forename: Ravinder
authors.initials: R
authors.lastname: Kaur
mesh_terms: D000935:Antifungal Agents / Q000627:therapeutic use*; D025141:Drug Resistance, Fungal; D004363:Drug Utilization / Q000592:standards*; D006291:Health Policy; D006801:Humans; D007194:India; D009181:Mycoses / Q000188:drug therapy*; D006113:United Kingdom
chemical_list: D000935:Antifungal Agents