An investigation of antifungal stewardship programmes in England

English Surveillance Programme for Antimicrobial Utilisation and Resistance (ESPAUR)

Research output: Contribution to journalArticlepeer-review

20 Citations (Scopus)


Purpose. We sought to explore the current status of antifungal stewardship (AFS) initiatives across National Health Service (NHS) Trusts within England, the challenges and barriers, as well as ways to improve current AFS programmes. Methodology. An electronic survey was sent to all 155 acute NHS Trusts in England. A total of 47 Trusts, corresponding to 30% of English acute Trusts, responded to the the survey; 46 Trusts (98 %) had an antimicrobial stewardship (AMS) programme but only 5 (11 %) had a dedicated AFS programme. Overall, 20 (43 %) Trusts said they included AFS as part of their AMS programmes. From those conducting AFS programmes, 7 (28 %) have an AFS/management team, 16 (64 %) monitor and report on antifungal usage, 5 (20 %) have dedicated AFS ward rounds and 12 (48 %) are directly involved in the management of invasive fungal infections. Results/Key findings. Altogether, 13 acute Trusts (52 %) started their AFS programme to manage costs, whilst 12 (48 %) commenced the programme due to clinical need; 27 (73 %) declared that they would increase their AFS initiatives if they could. Of those without an AFS programme, 14 (67 %) responded that this was due to lack of resources/staff time. Overall, 12 Trusts (57 %) responded that the availability of rapid diagnostics and clinical support would enable them to conduct AFS activities. Conclusion. Although a minority of Trusts conduct dedicated AFS programmes, nearly half include AFS as part of routine AMS activities. Cost issues are the main driver for AFS, followed by clinical need. The availability of rapid diagnostics and clinical support could help increase AFS initiatives.

Original languageEnglish
Article number000612
Pages (from-to)1581-1589
Number of pages9
JournalJournal of Medical Microbiology
Issue number11
Publication statusPublished - Nov 2017

Bibliographical note

Funding Information:
C. M. received travel grants to attend scientific conferences from Astellas, Gilead, Pfizer and Novartis, educational grants from Pfizer and Novartis, attended a Pfizer Advisory Board Meeting and consulted for Astellas. DWD holds Founder shares in F2G, a University of Manchester spin-out antifungal discovery company. He acts or has recently acted as a consultant to Astellas, Sigma Tau, Basilea, Scy-nexis, Cidara, Biosergen, Quintiles, Pulmatrix and Pulmocide. In the last 3 years, he has been paid for talks on behalf of Astellas, Dyna-miker, Gilead, Merck and Pfizer. He is a longstanding member of the Infectious Disease Society of America Aspergillosis Guidelines group, the European Society for Clinical Microbiology and Infectious Diseases Aspergillosis Guidelines group and the British Society for Medical Mycology Standards of Care committee. S.A. has had educational grants and paid lectures from Astellas, Gilead, Merck and Pfizer and is a member of the ECIL group (European Conference for Infections in Leukaemia). S.S. received educational grants from Astellas and has acted as advisor for Basilea, Pfizer, Astellas and Gilead. D. A. E. has received funding to attend conferences from MSD, Gilead and Astellas and consulted for Astellas. P. H. has received speakers fees, educational travel grants, advisory board fees from Astellas, Gilead, MSD, Pfizer. R. P. has received funding to attend conferences or meetings from Astellas, Pfizer, Novartis, Basilea, Gilead and MSD, and delivered a paid lecture for Astellas.

Publisher Copyright:
© 2017 The Authors.


  • Antifungal management
  • Antifungal stewardship
  • Evaluation of antifungal practices
  • Stewardship


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