Antifungal stewardship in solid organ transplantation

Transpl Infect Dis. 2022 May 20. doi: 10.1111/tid.13855. Online ahead of print.


BACKGROUND: Antifungal stewardship (AFS) has emerged as an important component of quality in managing invasive fungal infections (IFI), and cost-benefit calculations suggest regular training in AFS is well worth the effort.

METHODS: This review will discuss the most common IFIs in SOT-recipients, how to diagnose them, and current recommendations for antifungal treatment and prophylaxis before demonstrating key takeaway points of antifungal stewardship in this high-risk population.

RESULTS: Effective AFS starts before a patient is admitted for solid organ transplantation (SOT), through education and regular interactions of the interdisciplinary clinical team involved in patient management, considering local factors such as epidemiological data and knowledge of diagnostic options including local turnaround times. Understanding the spectrum of antifungal agents, their efficacy and safety profiles and pharmacokinetics, as well as duration of therapy is hereby essential. The most frequent IFIs in SOT recipients are caused by Candida species, followed by Aspergillus species, both with increasing resistance rates. Diagnosis of IFI can be challenging due to unspecific clinical presentation and difficult interpretation of microbiological findings and biomarkers. Prophylactic strategies, such as those for invasive aspergillosis (IA) in lung transplantation or invasive candidiasis (IC) in certain liver transplant settings, as well as the selection of the appropriate therapeutic agents require detailed knowledge on the pharmacokinetics and drug drug interactions of antifungals.

CONCLUSIONS: Here in this review, we address what constitutes good antifungal stewardship in this heterogeneous field of solid organ transplant recipients. This article is protected by copyright. All rights reserved.

PMID:35593394 | DOI:10.1111/tid.13855

Source: Industry