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SHR Neuro Cancer Cardio Lipid Metab Microb

Kriegl, L; Boyer, J; Egger, M; Hoenigl, M.
Antifungal stewardship in solid organ transplantation.
Transpl Infect Dis. 2022; 24(5):e13855 Doi: 10.1111/tid.13855 [OPEN ACCESS]
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Leading authors Med Uni Graz

Boyer Johannes

Hönigl Martin

Kriegl Lisa

Co-authors Med Uni Graz

Egger Matthias Florian

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Abstract:

BACKGROUND: Antifungal stewardship (AFS) has emerged as an important component of quality in managing invasive fungal infections (IFIs), and cost-benefit calculations suggest regular training in AFS is well worth the effort. METHODS: This review will discuss the most common IFIs in solid organ transplantation (SOT)-recipients, how to diagnose them, and current recommendations for antifungal treatment and prophylaxis before demonstrating key takeaway points of AFS in this high-risk population. RESULTS: Effective AFS starts before a patient is admitted for 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 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 AFS in this heterogeneous field of solid organ transplant recipients.

Find related publications in this database (using NLM MeSH Indexing)

Antifungal Agents - therapeutic use

Candida - administration & dosage

Candidiasis, Invasive - drug therapy

Humans - administration & dosage

Invasive Fungal Infections - diagnosis, drug therapy, prevention & control

Organ Transplantation - adverse effects

Find related publications in this database (Keywords)

antifungal prophylaxis

antifungal stewardship

appropriate use of antifungals

invasive fungal infection

solid organ transplantation

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