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National mycology laboratory diagnostic capacity for invasive fungal diseases in 2017: Evidence of sub-optimal practice.
- Source :
-
The Journal of infection [J Infect] 2019 Aug; Vol. 79 (2), pp. 167-173. Date of Electronic Publication: 2019 Jun 21. - Publication Year :
- 2019
-
Abstract
- A survey of laboratory testing capabilities for systemic fungal pathogens was undertaken in the UK, to identify where improved compliance with published standards and guidelines is required and to inform antifungal stewardship (AFS). The survey captured information from laboratories in the UK on diagnostic capacity for invasive fungal diseases (IFD), including identification, serology, molecular diagnostics and susceptibility testing. The survey was circulated in March 2017 through key networks. Of 154 laboratories providing diagnostic mycology services in the UK, 80 (52%) responded to the survey. Results indicated that 85% of respondents identified fungal isolates from high risk patients to species level, and that many laboratories (78%) could access local susceptibility testing for yeasts, whereas 17% could for Aspergillus species. However, direct microscopy was only used in 49% as a first line investigation on samples where it would be appropriate. A low number of respondents identified yeasts cultured from intravascular line tips to species level (63%) and even fewer fully identified urine isolates from critically ill patients (42%) or the immunocompromised (39%). Less than half of respondents advised therapeutic drug monitoring (TDM) for flucytosine. Few laboratories had access to local β-glucan (4%) or galactomannan (20%) testing. The survey highlights that the current level of fungal diagnostics in the UK is below accepted best practice with an urgent need to improve across many diagnostic areas including the timely accessibility of fungal biomarkers, susceptibility testing and provision of TDM testing. Improvements are important to facilitate the delivery of diagnostic driven AFS strategies as well as appropriate management of IFD.<br /> (Copyright © 2019 The British Infection Association. All rights reserved.)
- Subjects :
- Antifungal Agents pharmacology
Antifungal Agents therapeutic use
Drug Monitoring
Drug Resistance, Fungal
Health Care Surveys
History, 21st Century
Humans
Invasive Fungal Infections diagnosis
Invasive Fungal Infections history
Practice Patterns, Physicians'
United Kingdom epidemiology
Clinical Audit methods
Clinical Laboratory Services standards
Diagnostic Tests, Routine methods
Diagnostic Tests, Routine standards
Invasive Fungal Infections epidemiology
Invasive Fungal Infections microbiology
Subjects
Details
- Language :
- English
- ISSN :
- 1532-2742
- Volume :
- 79
- Issue :
- 2
- Database :
- MEDLINE
- Journal :
- The Journal of infection
- Publication Type :
- Academic Journal
- Accession number :
- 31233810
- Full Text :
- https://doi.org/10.1016/j.jinf.2019.06.009