1. Auditing fungal disease in leukemia patients in a tertiary care center: opportunities and challenges for an antifungal stewardship program.
- Author
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Paige E, Haywood P, Xie M, Worth L, Thursky K, Urbancic K, Bajel A, and Slavin M
- Subjects
- Antifungal Agents therapeutic use, Antimicrobial Stewardship, Female, Humans, Invasive Fungal Infections drug therapy, Invasive Fungal Infections epidemiology, Invasive Fungal Infections etiology, Invasive Fungal Infections prevention & control, Leukemia drug therapy, Male, Mycoses drug therapy, Mycoses prevention & control, Quality Assurance, Health Care, Quality Improvement, Tertiary Care Centers standards, Treatment Outcome, Clinical Audit methods, Clinical Audit standards, Leukemia complications, Leukemia epidemiology, Mycoses epidemiology, Mycoses etiology
- Abstract
Invasive fungal disease (IFD) is responsible for significant morbidity and mortality in patients with acute leukemia. Antifungal stewardship (AFS) programs are utilized in this patient group but have been infrequently evaluated in clinical practice. Adults diagnosed with acute leukemia at an Australian tertiary center over two years were identified, with subsequent auditing of IFD prophylaxis and treatment, and identification of further opportunities for AFS activities. Proven or probable IFD occurred in 6% of cases, including 14% of acute lymphoblastic leukemia (ALL) patients and 6% of acute myeloid leukemia (AML) patients. Mold-active antifungal prophylaxis was used in 84% of cases overall, including in 94% of AML cases and 23% of ALL cases. Local auditing identified target areas for AFS in this complex patient cohort, including modification of clinical guidelines, enhanced patient screening, improved access to fungal diagnostics and therapeutic drug monitoring, and the establishment of a specialized, embedded AFS program.
- Published
- 2019
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