{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,11]],"date-time":"2026-02-11T13:20:28Z","timestamp":1770816028681,"version":"3.50.1"},"reference-count":32,"publisher":"MDPI AG","issue":"2","license":[{"start":{"date-parts":[[2026,2,11]],"date-time":"2026-02-11T00:00:00Z","timestamp":1770768000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JoF"],"abstract":"<jats:p>Invasive fungal infections are frequent complications in patients with hematologic malignancies due to immunosuppression and intensive treatments. In Colombia, limited diagnostic availability, heterogeneous prescribing practices, and emerging antifungal resistance highlight the need for optimized use. We evaluated an interdisciplinary antifungal stewardship intervention in the hematology unit of a tertiary-care hospital. A quasi-experimental before-and-after study included 353 hospitalized patients receiving systemic antifungals between 1 January 2023 and 31 December 2024 (1154 prescriptions). Following the intervention, antifungal prescribing shifted toward increased prophylaxis and reduced therapeutic use, with substantial reduction in prophylactic Amphotericin B dosing, stable treatment dosing, and selective changes in agent choice, including decreased voriconazole and discontinuation of some broad-spectrum drugs. Microbiological sampling decreased, reflecting a more targeted diagnostic approach rather than improved documentation. Antifungal consumption patterns showed redistribution among agents rather than uniform reduction. Prophylaxis-related costs increased, while treatment-related costs decreased without statistical significance. ICU admissions and in-hospital mortality remained unchanged. These results demonstrate that structured antifungal stewardship programs are feasible and safe in hematology units in middle-income settings, supporting more rational antifungal use without compromising patient outcomes.<\/jats:p>","DOI":"10.3390\/jof12020127","type":"journal-article","created":{"date-parts":[[2026,2,11]],"date-time":"2026-02-11T09:15:12Z","timestamp":1770801312000},"page":"127","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Optimizing Antifungal Use Through Interdisciplinary Intervention in the Hematology Unit"],"prefix":"10.3390","volume":"12","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-7542-9432","authenticated-orcid":false,"given":"Maria Alejandra","family":"Caro Flautero","sequence":"first","affiliation":[{"name":"Department of Immunology, Microbiology and Parasitology, Faculty of Medicine and Nursing, University of the Basque Country (UPV\/EHU), Bizkaia Campus, 48940 Leioa, Spain"},{"name":"Hospital Internacional de Colombia HIC-Fundaci\u00f3n Cardiovascular de Colombia FCV, Km 7 Autopista Bucaramanga\u2014Piedecuesta Valle de Mensul\u00ed, Piedecuesta 680001, Colombia"},{"name":"Medical and Diagnostic Mycology Group, Department of Microbiology, Faculty of Medicine, Universidad Nacional de Colombia, Bogot\u00e1 111321, Colombia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0008-3797-3814","authenticated-orcid":false,"given":"Maria Camila","family":"Rubio","sequence":"additional","affiliation":[{"name":"Hospital Internacional de Colombia HIC-Fundaci\u00f3n Cardiovascular de Colombia FCV, Km 7 Autopista Bucaramanga\u2014Piedecuesta Valle de Mensul\u00ed, Piedecuesta 680001, Colombia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3634-8821","authenticated-orcid":false,"given":"Edgar Fabi\u00e1n","family":"Manrique-Hern\u00e1ndez","sequence":"additional","affiliation":[{"name":"Hospital Internacional de Colombia HIC-Fundaci\u00f3n Cardiovascular de Colombia FCV, Km 7 Autopista Bucaramanga\u2014Piedecuesta Valle de Mensul\u00ed, Piedecuesta 680001, Colombia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0001-7036-8500","authenticated-orcid":false,"given":"Jeimy Lorena","family":"Le\u00f3n","sequence":"additional","affiliation":[{"name":"School of Medicine, Faculty of Medicine, Universidad El Bosque, Bogot\u00e1 110121, Colombia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0009-0297-7003","authenticated-orcid":false,"given":"Olga Daniela","family":"Vega Jim\u00e9nez","sequence":"additional","affiliation":[{"name":"Hospital Internacional de Colombia HIC-Fundaci\u00f3n Cardiovascular de Colombia FCV, Km 7 Autopista Bucaramanga\u2014Piedecuesta Valle de Mensul\u00ed, Piedecuesta 680001, Colombia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0005-5823-1420","authenticated-orcid":false,"given":"Paola Cristina","family":"\u00c1lvarez Mantilla","sequence":"additional","affiliation":[{"name":"Hospital Internacional de Colombia HIC-Fundaci\u00f3n Cardiovascular de Colombia FCV, Km 7 Autopista Bucaramanga\u2014Piedecuesta Valle de Mensul\u00ed, Piedecuesta 680001, Colombia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6034-3182","authenticated-orcid":false,"given":"Pilar","family":"Rivas-Pinedo","sequence":"additional","affiliation":[{"name":"Medical and Diagnostic Mycology Group, Department of Microbiology, Faculty of Medicine, Universidad Nacional de Colombia, Bogot\u00e1 111321, Colombia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6556-1808","authenticated-orcid":false,"given":"Alejandra","family":"Mendoza-Monsalve","sequence":"additional","affiliation":[{"name":"Hospital Internacional de Colombia HIC-Fundaci\u00f3n Cardiovascular de Colombia FCV, Km 7 Autopista Bucaramanga\u2014Piedecuesta Valle de Mensul\u00ed, Piedecuesta 680001, Colombia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1629-9890","authenticated-orcid":false,"given":"Maricel","family":"Licht-Ardila","sequence":"additional","affiliation":[{"name":"Hospital Internacional de Colombia HIC-Fundaci\u00f3n Cardiovascular de Colombia FCV, Km 7 Autopista Bucaramanga\u2014Piedecuesta Valle de Mensul\u00ed, Piedecuesta 680001, Colombia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3001-2374","authenticated-orcid":false,"given":"Alexandra","family":"Hurtado-Ortiz","sequence":"additional","affiliation":[{"name":"Hospital Internacional de Colombia HIC-Fundaci\u00f3n Cardiovascular de Colombia FCV, Km 7 Autopista Bucaramanga\u2014Piedecuesta Valle de Mensul\u00ed, Piedecuesta 680001, Colombia"},{"name":"Postgraduate Department in Infectious Disease, Universidad de Santander, Bucaramanga 680003, Colombia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0530-7066","authenticated-orcid":false,"given":"Carlos Augusto","family":"Sol\u00f3rzano","sequence":"additional","affiliation":[{"name":"Hospital Internacional de Colombia HIC-Fundaci\u00f3n Cardiovascular de Colombia FCV, Km 7 Autopista Bucaramanga\u2014Piedecuesta Valle de Mensul\u00ed, Piedecuesta 680001, Colombia"},{"name":"Medical and Diagnostic Mycology Group, Department of Microbiology, Faculty of Medicine, Universidad Nacional de Colombia, Bogot\u00e1 111321, Colombia"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2026,2,11]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"73","DOI":"10.4103\/jrms.jrms_1072_21","article-title":"Invasive fungal infections in hematologic malignancies: Incidence, management, and antifungal therapy","volume":"28","author":"Shafiee","year":"2023","journal-title":"J. Res. Med. Sci."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"252","DOI":"10.1111\/myc.13205","article-title":"Epidemiology of invasive fungal disease in haematologic patients","volume":"64","author":"Souza","year":"2021","journal-title":"Mycoses"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"575","DOI":"10.1007\/s40266-018-0554-2","article-title":"International Group for Reducing Inappropriate Medication Use & Polypharmacy (IGRIMUP): Position Statement and 10 Recommendations for Action","volume":"35","author":"Mangin","year":"2018","journal-title":"Drugs Aging"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"e217","DOI":"10.1017\/ash.2023.471","article-title":"Antifungal stewardship: The Latin American experience","volume":"3","author":"Riera","year":"2023","journal-title":"Antimicrob. Steward. Healthc. Epidemiol."},{"key":"ref_5","first-page":"403","article-title":"Inappropriate antifungal prescription and the need for antifungal stewardship programs","volume":"36","year":"2019","journal-title":"Rev. Chil. Infectol."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"e70040","DOI":"10.1111\/jep.70040","article-title":"FungiCAP Survey: Insights Into Physicians\u2019 Knowledge, Attitudes and Practices in Antifungal Prescriptions in Colombia","volume":"31","year":"2025","journal-title":"J. Eval. Clin. Pract."},{"key":"ref_7","doi-asserted-by":"crossref","unstructured":"Vargas-Esp\u00edndola, L.A., Cuervo-Maldonado, S.I., Enciso-Olivera, J.L., G\u00f3mez-Rinc\u00f3n, J.C., Jim\u00e9nez-Cetina, L., S\u00e1nchez-Pedraza, R., Garc\u00eda-Guzm\u00e1n, K., L\u00f3pez-Mora, M.J., \u00c1lvarez-Moreno, C.A., and Cort\u00e9s, J.A. (2023). Fungemia in hospitalized adult patients with hematological malignancies: Epidemiology and risk factors. J. Fungi, 9.","DOI":"10.3390\/jof9040400"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"222","DOI":"10.1111\/myc.13390","article-title":"Laboratory-based surveillance of Candida auris in Colombia, 2016\u20132020","volume":"65","author":"Lizarazo","year":"2022","journal-title":"Mycoses"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"823","DOI":"10.1093\/annonc\/mdr407","article-title":"Diagnosis of invasive fungal infections in hematology and oncology\u2014Guidelines from the Infectious Diseases Working Party in Haematology and Oncology of the German Society for Haematology and Oncology (AGIHO)","volume":"23","author":"Ruhnke","year":"2012","journal-title":"Ann. Oncol."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"108","DOI":"10.1007\/s12281-023-00465-1","article-title":"Antifungal Stewardship Interventions in Patients with Hematologic Malignancies","volume":"17","author":"Vergidis","year":"2023","journal-title":"Curr. Fungal Infect. Rep."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"420","DOI":"10.1111\/myc.12628","article-title":"Improving outcome of fungal diseases\u2014Guiding experts and patients towards excellence","volume":"60","author":"Cornely","year":"2017","journal-title":"Mycoses"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"435","DOI":"10.1007\/s15010-018-01264-4","article-title":"Appropriate use of antifungals: Impact of an antifungal stewardship program on the clinical outcome of candidaemia in a French university hospital","volume":"47","author":"Benoist","year":"2019","journal-title":"Infection"},{"key":"ref_13","doi-asserted-by":"crossref","unstructured":"Alegria, W., and Patel, P.K. (2021). The Current State of Antifungal Stewardship in Immunocompromised Populations. J. Fungi, 7.","DOI":"10.3390\/jof7050352"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"ii7","DOI":"10.1093\/jac\/dkw395","article-title":"The role of the multidisciplinary team in antifungal stewardship","volume":"71","author":"Agrawal","year":"2016","journal-title":"J. Antimicrob. Chemother."},{"key":"ref_15","doi-asserted-by":"crossref","unstructured":"Zhang, H., Wang, Y., Diao, R., Huo, X., and Zhao, Q. (2024). The practice and evaluation of antifungal stewardship programs at a tertiary first-class hospital in China. BMC Infect. Dis., 24.","DOI":"10.1186\/s12879-024-09405-x"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"e1","DOI":"10.1016\/j.cmi.2018.01.002","article-title":"Diagnosis and management of Aspergillus diseases: Executive summary of the 2017 ESCMID-ECMM-ERS guideline","volume":"24","author":"Ullmann","year":"2018","journal-title":"Clin. Microbiol. Infect."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"e1","DOI":"10.1093\/cid\/ciw326","article-title":"Practice guidelines for the diagnosis and management of aspergillosis: 2016 update by the Infectious Diseases Society of America","volume":"63","author":"Patterson","year":"2016","journal-title":"Clin. Infect. Dis."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"1367","DOI":"10.1093\/cid\/ciz1008","article-title":"Revision and update of the consensus definitions of invasive fungal disease from the European Organization for Research and Treatment of Cancer and the Mycoses Study Group Education and Research Consortium","volume":"71","author":"Donnelly","year":"2020","journal-title":"Clin. Infect. Dis."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"S1","DOI":"10.1016\/j.cmi.2023.10.004","article-title":"Synthesizing pathogen- and infection-specific estimates of the burden of antimicrobial resistance in Europe for HTA: Gaps, heterogeneity, and bias","volume":"30","author":"Robotham","year":"2024","journal-title":"Clin. Microbiol. Infect."},{"key":"ref_20","doi-asserted-by":"crossref","unstructured":"Huang, Y.S., Denning, D.W., Shih, S.M., Hsiung, C.A., Wu, U.I., Sun, H.Y., Chen, P.-Y., Chen, Y.-C., and Chang, S.-C. (2019). Fungal Diseases in Taiwan\u2014National Insurance Data and Estimation. J. Fungi, 5.","DOI":"10.3390\/jof5030078"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"102333","DOI":"10.1016\/j.bjid.2022.102333","article-title":"Evaluation of a stewardship program of antifungal use at a Brazilian tertiary care hospital","volume":"26","author":"Gamarra","year":"2022","journal-title":"Braz. J. Infect. Dis."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"myad045","DOI":"10.1093\/mmy\/myad045","article-title":"Amphotericin B, itraconazole, posaconazole, and isavuconazole MICs against clinical Mucorales isolates according to EUCAST 9.4 procedure","volume":"61","author":"Escribano","year":"2023","journal-title":"Med. Mycol."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"348","DOI":"10.1056\/NEJMoa061094","article-title":"Posaconazole vs. fluconazole or itraconazole prophylaxis in patients with neutropenia","volume":"356","author":"Cornely","year":"2007","journal-title":"N. Engl. J. Med."},{"key":"ref_24","first-page":"3221","article-title":"European guidelines for primary antifungal prophylaxis in adult haematology patients: Summary of the updated recommendations from the European Conference on Infections in Leukaemia","volume":"73","author":"Maertens","year":"2018","journal-title":"J. Antimicrob. Chemother."},{"key":"ref_25","doi-asserted-by":"crossref","unstructured":"Liu, Z., Valsecchi, I., Le Meur, R.A., Simenel, C., Guijarro, J.I., Comte, C., Muszkieta, L., Mouyna, I., Henrissat, B., and Aimanianda, V. (2023). Conidium Specific Polysaccharides in Aspergillus fumigatus. J. Fungi, 9.","DOI":"10.3390\/jof9020155"},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"3596","DOI":"10.1093\/jac\/dkz364","article-title":"Clinimetric properties and suitability of selected quality indicators for assessing antibiotic use in hospitalized adults","volume":"74","author":"Kern","year":"2019","journal-title":"J. Antimicrob. Chemother."},{"key":"ref_27","doi-asserted-by":"crossref","unstructured":"Akbar, Z., Aamir, M., and Saleem, Z. (2024). Optimizing antifungal therapy: A systematic review of pharmacist interventions, stewardship approaches, and outcomes. Front. Med., 11.","DOI":"10.3389\/fmed.2024.1489109"},{"key":"ref_28","doi-asserted-by":"crossref","unstructured":"Nucci, M., Queiroz-Telles, F., Alvarado-Matute, T., Tiraboschi, I.N., Cortes, J., Zurita, J., Guzman-Blanco, M., Santolaya, M.E., Thompson, L., and Sifuentes-Osornio, J. (2013). Epidemiology of candidemia in Latin America: A laboratory-based survey. PLoS ONE, 8.","DOI":"10.1371\/journal.pone.0059373"},{"key":"ref_29","doi-asserted-by":"crossref","unstructured":"Albahar, F., Alhamad, H., Abu Assab, M., Abu-Farha, R., Alawi, L., and Khaleel, S. (2023). The Impact of Antifungal Stewardship on Clinical and Performance Measures: A Global Systematic Review. Trop. Med. Infect. Dis., 9.","DOI":"10.3390\/tropicalmed9010008"},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"14","DOI":"10.1111\/myc.12329","article-title":"Antifungal stewardship in daily practice and health economic implications","volume":"58","author":"Valerio","year":"2015","journal-title":"Mycoses"},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"S175","DOI":"10.1093\/infdis\/jiaa394","article-title":"Core Recommendations for Antifungal Stewardship","volume":"222","author":"Johnson","year":"2020","journal-title":"J. Infect. Dis."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"195","DOI":"10.7705\/biomedica.4400","article-title":"Candidemia en Colombia","volume":"40","author":"Ruiz","year":"2020","journal-title":"Biomedica"}],"container-title":["Journal of Fungi"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2309-608X\/12\/2\/127\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,2,11]],"date-time":"2026-02-11T10:07:41Z","timestamp":1770804461000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2309-608X\/12\/2\/127"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,2,11]]},"references-count":32,"journal-issue":{"issue":"2","published-online":{"date-parts":[[2026,2]]}},"alternative-id":["jof12020127"],"URL":"https:\/\/doi.org\/10.3390\/jof12020127","relation":{},"ISSN":["2309-608X"],"issn-type":[{"value":"2309-608X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,2,11]]}}}