mycoses
Diagnosis,Therapy and Prophylaxis of Fungal Diseases
Supplement article
Advances in the management of fungal infections ~ oz,1,2,3 Maricela Valerio,1,3 Antonio Vena,1,2,3 Emilio Bouza,1,2,3 Brunella Posteraro,4 Patricia Mun € rl5 and Maurizio Sanguinetti6 Cornelia Lass-Flo 1 Clinical Microbiology and Infectious Diseases Department, Hospital General Universitario Gregorio Maran~on, Madrid, Spain, 2Department of Medicine, Complutense University of Madrid, Madrid, Spain, 3Instituto de Investigacion Sanitaria del Hospital Gregorio Maran~on, Madrid, Spain, 4Institute of Public Health, Section of Hygiene, Universita Cattolica del Sacro Cuore, Rome, Italy, 5Division of Hygiene and Medical Microbiology, Innsbruck Medical University, Innsbruck, Austria and 6Institute of Microbiology, Universita Cattolica del Sacro Cuore, Rome, Italy
The incidence of invasive fungal disease (IFD) has increased in recent years, largely due to the increasing population of patients with severe immunosuppression. Candida species are the leading cause of IFD worldwide and are one of the most common causes of hospitalacquired bloodstream infections,1 particularly in intensive care unit patients and very low birth weight infants.2 Invasive candidiasis is associated with substantial morbidity and mortality, prolonged hospital stay and increased health care costs, and, as such, is a serious public health concern.3,4 Early diagnosis and prompt initiation of antifungal therapy is essential for the control of invasive candidiasis and three main classes of antifungal drugs are currently available: azoles (e.g. voriconazole, fluconazole, posaconazole), echinocandins (e.g. anidulafungin, caspofungin, micafungin) and polyenes (e.g. amphotericin B). However, the extensive use of some antifungal agents has led to an increased selection pressure and the development of antifungal drug resistance, which has important implications for the morbidity, mortality and health care costs associated with IFD. Antifungal stewardship is an important component of drug delivery that underpins efforts to prevent the
© 2015 Blackwell Verlag GmbH Mycoses, 2015, 58 (Suppl. 2), 1
emergence of antifungal drug resistance. Antifungal stewardship programs consist of multidisciplinary interventions led by specialists in infectious disease, microbiology and pharmacy who liaise with the major prescribing departments to optimise antifungal therapies. Here, we report on antifungal drug resistance among Candida species, with a focus on resistance mechanisms and the epidemiology and clinical consequences of resistance. In addition, we review the available evidence for the use of antifungal stewardship programs and their health economic impact.
References 1
2 3
4
Pfaller MA, Diekema DJ. Epidemiology of invasive candidiasis: a persistent public health problem. Clin Microbiol Rev 2007; 20: 133–63. Barnes RA. Early diagnosis of fungal infection in immunocompromised patients. J Antimicrob Chemother 2008; 61(Suppl 1): i3–6. Falagas ME, Apostolou KE, Pappas VD. Attributable mortality of candidemia: a systematic review of matched cohort and case-control studies. Eur J Clin Microbiol Infect Dis 2006; 25: 419–25. Gagne JJ, Goldfarb NI. Candidemia in the in-patient setting: treatment options and economics. Expert Opin Pharmacother 2007; 8: 1643–50.
doi:10.1111/myc.12332
Diagnosis,Therapy and Prophylaxis of Fungal Diseases
Supplement article
Advances in the management of fungal infections ~ oz,1,2,3 Maricela Valerio,1,3 Antonio Vena,1,2,3 Emilio Bouza,1,2,3 Brunella Posteraro,4 Patricia Mun € rl5 and Maurizio Sanguinetti6 Cornelia Lass-Flo 1 Clinical Microbiology and Infectious Diseases Department, Hospital General Universitario Gregorio Maran~on, Madrid, Spain, 2Department of Medicine, Complutense University of Madrid, Madrid, Spain, 3Instituto de Investigacion Sanitaria del Hospital Gregorio Maran~on, Madrid, Spain, 4Institute of Public Health, Section of Hygiene, Universita Cattolica del Sacro Cuore, Rome, Italy, 5Division of Hygiene and Medical Microbiology, Innsbruck Medical University, Innsbruck, Austria and 6Institute of Microbiology, Universita Cattolica del Sacro Cuore, Rome, Italy
The incidence of invasive fungal disease (IFD) has increased in recent years, largely due to the increasing population of patients with severe immunosuppression. Candida species are the leading cause of IFD worldwide and are one of the most common causes of hospitalacquired bloodstream infections,1 particularly in intensive care unit patients and very low birth weight infants.2 Invasive candidiasis is associated with substantial morbidity and mortality, prolonged hospital stay and increased health care costs, and, as such, is a serious public health concern.3,4 Early diagnosis and prompt initiation of antifungal therapy is essential for the control of invasive candidiasis and three main classes of antifungal drugs are currently available: azoles (e.g. voriconazole, fluconazole, posaconazole), echinocandins (e.g. anidulafungin, caspofungin, micafungin) and polyenes (e.g. amphotericin B). However, the extensive use of some antifungal agents has led to an increased selection pressure and the development of antifungal drug resistance, which has important implications for the morbidity, mortality and health care costs associated with IFD. Antifungal stewardship is an important component of drug delivery that underpins efforts to prevent the
© 2015 Blackwell Verlag GmbH Mycoses, 2015, 58 (Suppl. 2), 1
emergence of antifungal drug resistance. Antifungal stewardship programs consist of multidisciplinary interventions led by specialists in infectious disease, microbiology and pharmacy who liaise with the major prescribing departments to optimise antifungal therapies. Here, we report on antifungal drug resistance among Candida species, with a focus on resistance mechanisms and the epidemiology and clinical consequences of resistance. In addition, we review the available evidence for the use of antifungal stewardship programs and their health economic impact.
References 1
2 3
4
Pfaller MA, Diekema DJ. Epidemiology of invasive candidiasis: a persistent public health problem. Clin Microbiol Rev 2007; 20: 133–63. Barnes RA. Early diagnosis of fungal infection in immunocompromised patients. J Antimicrob Chemother 2008; 61(Suppl 1): i3–6. Falagas ME, Apostolou KE, Pappas VD. Attributable mortality of candidemia: a systematic review of matched cohort and case-control studies. Eur J Clin Microbiol Infect Dis 2006; 25: 419–25. Gagne JJ, Goldfarb NI. Candidemia in the in-patient setting: treatment options and economics. Expert Opin Pharmacother 2007; 8: 1643–50.
doi:10.1111/myc.12332
