Web-Based Survey on Management Practices for Invasive Fungal Disease among Clinicians

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Introduction

Invasive fungal diseases (IFD) are a serious threat posing a significant threat to human health, food biosecurity and biodiversity, but physicians in Asia lack access to many advanced diagnostics in mycology.

Recognition of the threat of invasive fungal disease (IFD) is still evolving among clinicians, microbiologists, hospital administrators and funding agencies in those countries

Aim

The Asia Fungal Working Group (AFWG) performed a web-based survey to understand the current status of clinical practice in the diagnosis and management of IFDs, identify gaps in managing IFD patients, and explore targets to achieve to close the gaps.

A gap analysis was performed to understand the challenges Asian physicians faced in medical mycology.

Methodology and Results

Over a period of 6 months, 292 physicians from the seven countries (in rank order): India (n=109), the Philippines (74), China (34), Taiwan (27), Indonesia (17), Singapore (17) and Thailand (14) completed survey.

Out of 292 respondents, 51.7% were infectious disease (ID) specialists. Only 37% of respondents had received formal training in medical mycology.

For laboratory support, most of the cases had access to direct microscopy (96%) and histopathology (87%), but galactomannan and azole levels were offered to 60% and 25% of respondents, respectively.

The largest part of them (84%) used clinical parameters for treatment response monitoring, and 77% followed the Infectious Diseases Society of America guidelines.

Many of those (84%) did not use the services of an ID physician.

74% of respondents utilized the empirical approach where febrile neutropenia was concerned.

Only 30% had an antifungal stewardship program in their hospital. Eighty percent could not use preferred antifungals due to the cost (see Fig. 1).

Summary

The survey demonstrated gaps in training, limitations in diagnostic modalities, difficulties in accessing antifungal drugs and a lack of local guidelines as major impediments to the appropriate management of IFD in Asian countries.

Moreover, data suggests that medical mycology had not been adequately emphasized in the training of doctors and specialists in the respondents’ countries.

Respondents agreed that country-specific training courses, improvement of laboratory diagnostic methods in hospitals and development of institute-based or country guidelines are crown strategies to improve the management of IFDs.

Source: Tan BH, Chakrabarti A, Patel A, et al. Clinicians’ challenges in managing patients with invasive fungal diseases in seven Asian countries: An Asia Fungal Working Group (AFWG) Survey. Int J Infect Dis. 2020;95:471–480.