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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References
- Invasive fungal infections among organ transplant recipients: results of the transplant-associated infection surveillance network (TRANSNET).Clin Infect Dis. 2010; 50: 1101-1111https://doi.org/10.1086/651262
- Estimating the burden of invasive and serious fungal disease in the United Kingdom.J Infect. 2017; 74: 60-71https://doi.org/10.1016/j.jinf.2016.10.005
- Global and multi-national prevalence of fungal diseases-estimate precision.J Fungi (Basel, Switzerland). 2017; 3https://doi.org/10.3390/jof3040057
- Invasive pulmonary aspergillosis is a frequent complication of critically ill H1N1 patients: a retrospective study.Intensive Care Med. 2012; 38: 1761-1768https://doi.org/10.1007/s00134-012-2673-2
- Invasive pulmonary aspergillosis complicating severe influenza: epidemiology, diagnosis and treatment.Curr Opin Infect Dis. 2018; 31: 471-480https://doi.org/10.1097/QCO.0000000000000504
- British Society for Medical Mycology best practice recommendations for the diagnosis of serious fungal diseases.Lancet Infect Dis. 2015; 15: 461-474https://doi.org/10.1016/S1473-3099(15)70006-X
- Candida auris.2017
- What can the clinical mycology laboratory do for clinicians today and tomorrow?.Curr Clin Microbiol Rep. 2017; 4: 96-105https://doi.org/10.1007/s40588-017-0061-y
- UK Standards for Microbiology Investigations.UK Standards for Microbiology Investigations. B 57. 2018
- Candida auris: a review of the literature.Clin Microbiol Rev. 2018; 31https://doi.org/10.1128/CMR.00029-17
- Candida auris: a rapidly emerging cause of hospital-acquired multidrug-resistant fungal infections globally.PLoS Pathog. 2017; 13e1006290https://doi.org/10.1371/journal.ppat.1006290
- Candida auris: the recent emergence of a multidrug-resistant fungal pathogen.Med Mycol. 2018; https://doi.org/10.1093/mmy/myy054
- Antifungal resistance: current trends and future strategies to combat.Infect Drug Resist. 2017; 10: 249-259https://doi.org/10.2147/IDR.S124918
- Azole-resistant aspergillosis: epidemiology, molecular mechanisms, and treatment.J Infect Dis. 2017; 216: S436-S444https://doi.org/10.1093/infdis/jix210
- English surveillance programme for antimicrobial utilisation and resistance.2016
- Standards of care for patients with invasive fungal infections within the United Kingdom: a national audit.J Infect. 2009; 58: 145-153https://doi.org/10.1016/j.jinf.2008.12.006
- Therapeutic drug monitoring (TDM) of antifungal agents: guidelines from the British Society for Medical Mycology.J Antimicrob Chemother. 2014; 69: 1162-1176https://doi.org/10.1093/jac/dkt508
- UK Standards for Microbiology Investigations.UK Standards for Microbiology Investigations. B 37(9.1). 2018
- UK Standards for Microbiology Investigations.UK Standards for Microbiology Investigations. B 26(6.2). 2018
- UK Standards for Microbiology Investigations.UK Standards for Microbiology Investigations. B 41(8.6). 2018
- Issues in antifungal susceptibility testing.J Antimicrob Chemother. 2008; 61: i13-i18https://doi.org/10.1093/jac/dkm427
- Mycology Reference Laboratory: Service User Handbook.2014 (Available at) (Accessed 2 November 2018)
- Azole antifungal resistance in Aspergillus fumigatus: 2008 and 2009.J Antimicrob Chemother. 2010; 65: 2116-2118https://doi.org/10.1093/jac/dkq279
- Azole resistance in Aspergillus fumigatus: can we retain the clinical use of mold-active antifungal azoles?.Clin Infect Dis. 2016; 62: 362-368https://doi.org/10.1093/cid/civ885
- Susceptibility test methods: yeasts and filamentous fungi.in: Jorgensen J. Pfaller M. Carroll K. Funke G. Landry M. Richter S. Manual of Clinical Microbiology. 11th ed. ASM Press, Washington, DC2015: 2255-2282
- Performance standards for antifungal susceptibility testing of yeast.CLSI Supplement M60. 1st ed. Clinical and Laroratory Standards Institute, Wayne PA2017
- Epidemiological cutoff values for antifungal susceptibility testing.CLSI Supplement M59. 2nd ed. Clinical and Laroratory Standards Institute, Wayne PA2018
European Committee on Antimicrobial Susceptibility Testing (EUCAST). Antifungal susceptibility testing (AFST). Available athttp://www.eucast.org/antifungal_susceptibility_testing_afst/. Accessed 24 October 2018, 2018.
- Clinical performance of aspergillus PCR for testing serum and plasma: a study by the european aspergillus PCR initiative.J Clin Microbiol. 2015; 53: 2832-2837https://doi.org/10.1128/JCM.00905-15
- Impact of a diagnostics-driven antifungal stewardship programme in a UK tertiary referral teaching hospital.J Antimicrob Chemother. 2018; https://doi.org/10.1093/jac/dky360
- A Candida auris outbreak and its control in an intensive care setting.N Engl J Med. 2018; 379: 1322-1331https://doi.org/10.1056/NEJMoa1714373
- Assessing routine diagnostic methods for detecting Candida auris in England.J Infect. 2018; https://doi.org/10.1016/j.jinf.2018.07.012
- Therapeutic drug monitoring for invasive mould infections and disease: pharmacokinetic and pharmacodynamic considerations.J Antimicrob Chemother. 2017; 72: i12-i18https://doi.org/10.1093/jac/dkx029
- Overview of antifungal dosing in invasive candidiasis.J Antimicrob Chemother. 2018; 73: i33-i43https://doi.org/10.1093/jac/dkx447
Medicines and Healthcare products Regulatory Agency (MHRA). Medicines Information: SPC & PILs. Available athttp://www.mhra.gov.uk/spc-pil/index.htm. Accessed 18 March 2019, 2019.
- Prospective multicenter international surveillance of azole resistance in Aspergillus fumigatus.Emerg Infect Dis. 2015; 21: 1041-1044https://doi.org/10.3201/eid2106.140717
- An investigation of antifungal stewardship programmes in England.J Med Microbiol. 2017; 66: 1581-1589https://doi.org/10.1099/jmm.0.000612
Article info
Publication history
Published online: June 21, 2019
Accepted:
June 20,
2019
Identification
Copyright
© 2019 The British Infection Association. Published by Elsevier Ltd. All rights reserved.
