• 432 patients reviewed over 6 years (October 2010 – September 2016)
• Clinical interventions: diagnostic and therapeutic advice
• Results:
  • 82% of cases who received empirical treatment did so unnecessarily, subsequently found to have no evidence of invasive fungal infection 
  • 30% reduction in annual antifungal expenditures

• Two 4-month audits in 2014 and 2016 by the AFS team
• Clinical interventions: education and training, recruitment of AFS champions
• Results:
  • 90% reduction in inappropriate antifungal treatment initiation
  • 58% reduction in mortality due to invasive candidiasis compared with 2003–2007
  • 49% cost reduction

• 178 patients reviewed over 18 months (January 2015–June 2016)
• Clinical interventions: recommendations that included outpatient or MDT reviews, diagnostic investigations and treatment adjustments
• Results:
  • Antifungal use decreased significantly (p=0.017)
  • Improved TDM may have reduced the need for second-line therapies
  • £130,000 monthly saving in antifungal drugs, 45% cost reduction

• 173 patients reviewed on 294 occasions over 12 months (July 2013–July 2014)
• Clinical interventions: diagnostic and therapeutic advice
• Results:
  • 72% of reviews resulted in advice given, which was generally accepted
  • Increase in laboratory tests
  • £180,000 annual saving in antifungal drugs; 10% cost reduction

• 5-year review of 549 high-risk haematology and stem-cell transplant recipients
• Clinical interventions: diagnostic testing
• Results:
  • Twice-weekly PCR screening and antigen testing had 98% sensitivity and 99.6% negative predictive value when used together, and 95% specificity for accurate diagnosis of aspergillosis
  • No reported excess in morbidity or mortality
  • £124,572 reduction in overall antifungal expenditure in the initial 6-month test period

The case studies featured on this page offer a glimpse into the impact a successful AFS programme can make. To read about these cases in full, download the booklet.

a. This content provides an overview of different AFS programmes implemented in the UK, based on published data. This is not meant to be a comparative analysis, and the way the information is presented may differ between programmes.

ABS, antibacterial stewardship; AFS, antifungal stewardship; AMS, antimicrobial stewardship; MDT, multidisciplinary team; NHS, National Health Service; PCR, polymerase chain reaction.