{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,2]],"date-time":"2026-11-02T23:14:34Z","timestamp":1793661274775,"version":"4.5.1"},"reference-count":41,"publisher":"Oxford University Press (OUP)","issue":"3","license":[{"start":{"date-parts":[[2022,6,23]],"date-time":"2022-06-23T00:00:00Z","timestamp":1655942400000},"content-version":"vor","delay-in-days":51,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Gilead UK & Ireland Fellowship in Invasive Fungal Disease"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2022,5,3]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:sec>\n                  <jats:title>Background<\/jats:title>\n                  <jats:p>ICUs are settings of high antifungal consumption. There are few data on prescribing practices in ICUs to guide antifungal stewardship implementation in this setting.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>An antifungal therapy (AFT) service evaluation (15 May\u201319 November 2019) across ICUs at three London hospitals, evaluating consumption, prescribing rationale, post-prescription review, de-escalation and final invasive fungal infection (IFI) diagnostic classification.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>Overall, 6.4% of ICU admissions (305\/4781) received AFT, accounting for 11.41\u2005days of therapy\/100 occupied bed days (DOT\/100 OBD). The dominant prescribing mode was empirical (41% of consumption), followed by targeted (22%), prophylaxis (18%), pre-emptive (12%) and non-invasive (7%). Echinocandins were the most commonly prescribed drug class (4.59 DOT\/100 OBD). In total, 217 patients received AFT for suspected or confirmed IFI; 12%, 10% and 23% were classified as possible, probable or proven IFI, respectively. Hence, in 55%, IFI was unlikely. Proven IFI (n\u200a=\u200a50) was mostly invasive candidiasis (92%), of which 48% had been initiated on AFT empirically before yeast identification. Where on-site (1\u200a\u2192\u200a3)-\u03b2-d-glucan (BDG) testing was available (1\u2005day turnaround), in those with suspected but unproven invasive candidiasis, median (IQR) AFT duration was 10 (7\u201315) days with a positive BDG (\u226580\u2005pg\/mL) versus 8 (5\u20139) days with a negative BDG (&amp;lt;80\u2005pg\/mL). Post-prescription review occurred in 79% of prescribing episodes (median time to review 1 [0\u20133] day). Where suspected IFI was not confirmed, 38% episodes were stopped and 4% de-escalated within 5\u2005days.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusions<\/jats:title>\n                  <jats:p>Achieving a better balance between promptly treating IFI patients and avoiding inappropriate antifungal prescribing in the ICU requires timely post-prescription review by specialist multidisciplinary teams and improved, evidence-based-risk prescribing strategies incorporating rapid diagnostics to guide AFT start and stop decisions.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1093\/jacamr\/dlac055","type":"journal-article","created":{"date-parts":[[2022,5,9]],"date-time":"2022-05-09T19:11:34Z","timestamp":1652123494000},"source":"Crossref","is-referenced-by-count":11,"title":["A multisite evaluation of antifungal use in critical care: implications for antifungal 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