Auditing fungal disease in leukemia patients in a tertiary care center: opportunities and challenges for an antifungal stewardship program

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.

Keywords:

• Antifungal stewardship
• audit
• invasive fungal disease
• acute leukemia

Acknowledgments

The authors would like to thank Thao Nguyen, who is a Data Manager at Royal Melbourne Hospital.

This manuscript was presented as a poster at the Australasian Society for Infectious Diseases Annual Scientific Meeting 2018.

Potential conflict of interest

Disclosure forms provided by the authors are available with the full text of this article online at https://doi.org/10.1080/10428194.2019.1590570

Additional information

Funding

E.K.P. has received educational meeting speaking honoraria from Gilead Sciences Australia, paid directly to her institution. K.U. has served on an Antifungal Advisory Board for MSD. M.S. has received untied research grants from MSD and Gilead Sciences Australia in the last 5 years and has served on the Antifungal Advisory Boards of MSD Australia, Gilead Sciences Inc., and Pfizer Australia.