Optimising patient outcomes and reducing cost through enhanced management of invasive fungal infection Barts Health NHS Trust

Invasive fungal infection (IFI) is a serious infection that affects not only immunocompromised cancer patients receiving stem cell or organ transplant, but also patients in intensive care who have diabetes, chronic lung disease or who have had surgery. IFI is challenging to diagnose, but mortality rates are high when it is diagnosed late. Antifungal drugs are costly and have significant side effects.

Antifungal stewardship is a neglected area, hampered by diagnostic difficulties, lack of expertise and poor quality data. Limited availability of diagnostic tests and slow turnaround has led to over treatment, spiralling drug costs and unnecessary drug toxicity. Audits have consistently shown low IFI incidence rates but high treatment rates.

A team at Barts Health is introducing a new approach that aims to improve the management of IFI, patient care and outcomes; reduce drug toxicities for patients without IFI; and decrease costs. A unique care bundle for IFI will be introduced that combines simple clinical measures with real-time diagnostics and an online audit tool.

Focusing initially on haemato-oncology patients in inpatient and day care settings across Barts Health and UCLH, the care bundle will improve the use and interpretation of diagnostic tests, and optimise antifungal drug use and monitoring. The new diagnostic service will provide centralised diagnostic assays and an online requesting and reporting system, with the rapid turnaround required for clinical decision-making. The online audit tool and database will give a comprehensive picture of IFI management in a unit and across a trust, and potentially across the NHS.

Contact details

For more information about this project, please contact Dr Rohini Manuel, Consultant Clinical Microbiologist and Lead Infection Control Doctor at Barts Health NHS Trust.