Antifungal resistance & stewardship

Antifungal resistance is an important cause of treatment failure. For detailed reviews of the mechanisms underlying resistance please see Perlin et al (2017), Cowen et al (2015) or Revie et al (2018).

From Revie et al (2018)

Breakpoints & susceptibility testing

Resistance can be either MICROBIOLOGICAL (presence of a resistance mutation) or CLINICAL (treatment failure).

EUCAST publishes lots of useful information for susceptibility testing, including validated methods, breakpoint tables for Aspergillus and Candida, and provides guidance for other organisms.

Intermediate resistance

Intrinsic resistance

Candida auris is an emerging pathogen with intrinsic multiple drug resistance (MDR) and nosocomial transmission.

Acquired resistance

Antifungal stewardship

Empirical antifungal therapy and prophylaxis save lives, but are associated with the development of antifungal resistance.

IDSA/SHEA provide guidance in setting up a stewardship programme (Dellit et al, 2007; updated by Barlam et al, 2016). A free online course is available via FutureLearn: Role of Antifungal Stewardship

Reviewed by (Hamley et al, 2017)

The cornerstones of an antifungal stewardship programme are:

  • Rapid diagnostics, including susceptibility testing
  • TDM
  • Targeted (i.e. not empirical) prescribing of antifungals
  • Check whether your hospital includes antifungals in its site-wide antibiogram

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