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National mycology laboratory diagnostic capacity for invasive fungal diseases in 2017: Evidence of sub-optimal practice

  • Author Footnotes
    1 Authors provided equal contribution to both the analysis and the article.
    Silke Schelenz
    Correspondence
    Corresponding author.
    Footnotes
    1 Authors provided equal contribution to both the analysis and the article.
    Affiliations
    Royal Brompton Hospital & Harefield Hospitals NHS FT, Sydney Street, London, UK
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  • Author Footnotes
    1 Authors provided equal contribution to both the analysis and the article.
    Katie Owens
    Footnotes
    1 Authors provided equal contribution to both the analysis and the article.
    Affiliations
    Healthcare Associated Infection & Antimicrobial Resistance Division, National Infection Service, Public Health England, 61 Colindale Avenue, London, UK
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  • Author Footnotes
    1 Authors provided equal contribution to both the analysis and the article.
    Rebecca Guy
    Footnotes
    1 Authors provided equal contribution to both the analysis and the article.
    Affiliations
    Healthcare Associated Infection & Antimicrobial Resistance Division, National Infection Service, Public Health England, 61 Colindale Avenue, London, UK
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  • Riina Rautemaa-Richardson
    Affiliations
    NHS Mycology Reference Centre, ECMM Centre of Mycological Excellence, Manchester University NHS Foundation Trust and Division of Infection, Immunity and Respiratory Medicine, University of Manchester, Wythenshawe Hospital, Manchester, UK
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  • Rohini J. Manuel
    Affiliations
    National Infection Service, Public Health England, Public Health Laboratory London, London, UK
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  • Malcolm Richardson
    Affiliations
    NHS Mycology Reference Centre, ECMM Centre of Mycological Excellence, Manchester University NHS Foundation Trust and Division of Infection, Immunity and Respiratory Medicine, University of Manchester, Wythenshawe Hospital, Manchester, UK
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  • Caroline Moore
    Affiliations
    NHS Mycology Reference Centre, ECMM Centre of Mycological Excellence, Manchester University NHS Foundation Trust and Division of Infection, Immunity and Respiratory Medicine, University of Manchester, Wythenshawe Hospital, Manchester, UK
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  • David A. Enoch
    Affiliations
    National Infection Service, Public Health England, Microbiology Laboratory, Addenbrooke`s Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
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  • Christianne Micallef
    Affiliations
    Pharmacy Department, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Addenbrooke's Hospital Biomedical Campus, Hills Road, Cambridge, UK
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  • Philip Howard
    Affiliations
    Department of Medicines Management and Pharmacy, Leeds Teaching Hospitals NHS Trust, Leeds, UK
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  • Samir G. Agrawal
    Affiliations
    Bart's Health NHS Trust and Blizard Institute, Queen Mary University of London, London, UK
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  • Elizabeth M. Johnson
    Affiliations
    Public Health England Mycology Reference Laboratory, National Infection Service, PHE South West Laboratory, Southmead Hospital, Bristol, UK
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  • Berit Muller-Pebody
    Affiliations
    Healthcare Associated Infection & Antimicrobial Resistance Division, National Infection Service, Public Health England, 61 Colindale Avenue, London, UK
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  • on behalf of theEnglish Surveillance Programme for Antimicrobial Utilisation and Resistance (ESPAUR)
  • Author Footnotes
    1 Authors provided equal contribution to both the analysis and the article.

      Highlights

      • There is a need to improve the UK diagnostic capacity for invasive fungal diseases.
      • A minority of laboratories have local access to β-glucan and galactomannan testing.
      • Susceptibility testing of Aspergillus is currently conducted by few laboratories.
      • Compliance with TDM recommendations for some antifungal agents could be improved.
      • Adequate mycology testing capabilities is fundamental for antifungal stewardship.

      Summary

      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.

      Keywords

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