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Case of the Month - January 2018

Adrian Brink

Ampath National Laboratory Services, Milpark hospital, Johannesburg and Division of Infectious Diseases & HIV Medicine, Department of Medicine, University of Cape Town, Cape Town


At a joint infection prevention & control and stewardship meeting, the group discusses the high prevalence of fluconazole-resistant Candida species causing bloodstream infections at a large hospital. In addition, the pharmacy manager presents the escalating cost of antifungal (AF) consumption relative to antibiotics at the hospital. The clinical microbiologist provides data which indicates inconsistent utilization of blood cultures and inappropriate use of fungal biomarker laboratory assays. To address the emerging problems, a decision is made to initiate an antifungal stewardship (AFS) programme (AFSP) in a 25-bed trauma intensive-care unit (TICU) as a pilot to guide hospital-wide implementation later on.

Question 1: What is the first step in implementing an AFS programme?

Continue to Answer 1