Turkish hospital study shows benefits of antifungal stewardship

Implementing daily, pharmacist-driven antifungal stewardship activities at a tertiary care hospital in Turkey was associated with significant improvements in the appropriateness of antifungal therapy, Turkish researchers reported yesterday in Antimicrobial Agents and Chemotherapy.

The researchers evaluated and compared antifungal therapy at the hospital during three different periods. In the observation period, they evaluated the use of systemic antifungals for baseline measurement of appropriateness. In the second period, pharmacists organized monthly meetings to provide feedback and education on antifungal therapy to physicians. In the third period, pharmacists participated in daily ward rounds to evaluate appropriateness of antifungal therapy and make recommendations.

During the three periods, 105, 109, and 204 episodes of antifungal therapy, respectively, were assessed. During the third period, 157 recommendations were made and 151 (96.2%) were accepted.

The overall appropriateness of antifungal use increased significantly in the third period compared with the first two, with improvements observed in antifungal drug choice, dosage, and duration of therapy. Statistically significant increases were detected for antifungal prophylaxis (30.8%, 17.9%, and 46.3% in the three periods, respectively) and treatment of fungal disease (27.8%, 32.4%, 71.9%). Thirty-day mortality was not significantly changed between the three periods (19%, 15.6%, and 27.5%), but the authors note that was likely the result of the COVID-19 outbreak, which occurred during the third period and was accompanied by a high rate of patients with severe comorbidities.

“Considering the workload and variety of patients encountered in ward rounds, a team-based evaluation of fungal infections, including feedback and support from a clinical pharmacist, may help to increase the quality of antifungal therapies,” the study authors wrote.
Jun 21 Antimicrob Agents Chemother abstract

Manitoba reports H3N2v flu case

Public health officials in Manitoba, Canada, yesterday reported a swine-related variant H3N2 (H3N2v) flu case involving a patient in the southern part of the province, according to a government statement.

The illnesses was detected in early June when the patient sought testing after experiencing a flulike illness. They had mild symptoms and recovered. Tests were negative for COVID-19, but the virus was later identified as H3N2v as part of routine flu surveillance.

Health officials said the case appears to be isolated and is different than earlier H1N1v and H1N2v cases reported in late April. An investigation is under way to determine how the patient contracted the virus.

Health officials said the risk of human-to-human transmission is low and that the detection of the recent variant flu cases could reflect increased surveillance for respiratory viruses against the backdrop of COVID-19 or could reflect a true increase in variant cases, either from infected pigs or subsequent human-to-human transmission.
Jun 21 Manitoba press release

H9N2 avian flu infects 2 more people in China

China reported two more human H9N2 avian flu infections from in different provinces, Hong Kong’s Centre for Health Protection (CHP) said in its latest weekly avian influenza update.

One of the patients is a 78-year-old woman from Jiangsu province whose symptoms began on Apr 20, and the other is a 2-year-old boy from Sichuan province who started having symptoms on Apr 27.

The report did not say how the patients were exposed. H9N2 avian influenza is known to circulate in poultry in the region, and sporadic infections occur, typically in people who had direct or indirect contact with poultry. Sustained transmission hasn’t been reported, and the infections are usually mild and more commonly reported in children. China has reported 13 H9N2 cases so far this year.
Jun 22 CHP avian influenza update