Antifungal resistance is a global emergency of increasing prevalence, yet only 11% of NHS Trusts have an antifungal stewardship programme. Given the high mortality and cost associated with invasive fungal infections, it is paramount to optimise investigations and judicious use of systemic antifungals. Hospital guidelines often focus on empirical treatment, omitting diagnostics.


Patients prescribed systemic antifungals were identified using pharmacy records over a 1 year period in a district general hospital in London. Electronic patient records were interrogated for microbiological, serological, histopathological and radiological investigations based on national recommendations. Audit standards were designed to meet the NHS England Medicines Optimisation and Stewardship CQUIN.


31 adult patients were identified. Microbiological evidence of fungal infection was demonstrated in 15/31 patients (48%). 60% were speciated and 47% underwent susceptibility testing. Three patients had beta-D-glucan tests; two patients had histopathological testing; 19 patients underwent imaging, of which 42% were reported as consistent with possible fungal infection.


9 (29%) patients had no obvious indication for antifungal treatment. Systemic antifungal treatment is not without toxicity and cost and contributes to resistance. In view of this, we updated the hospital guideline to include a guide to diagnostics, incorporated antifungals into our antimicrobial stewardship ward round and submitted this audit to NHS England CQUIN. Further work will evaluate whether these changes impact upon current practice.


Micallef C 2017;66(11):1581-1589

Fisher MC 2018;360(6390):739-742

Schelenz S 2015;15(4):461–74


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