Integrated Multidisciplinary Management of Invasive Fungal Infections Dr. Murat Akova Hacettepe...

Integrated Multidisciplinary Management of Invasive Fungal

Infections Dr. Murat Akova

Hacettepe University School of MedicineSection of Infcetious DiseasesAnkara

Survey for Management of IFD

• 18 questions• Published in Turkish Febrile

Neutropenia website• Sent to 36 internationally renowned

experts by e-mail• Sent to meeting participants

Respondants

• 36 Turkish physicians• 24 international experts• 11 meeting participants• Total 71 responses

Results of Survey

• Countries– Turkey (38)– Italy (6)– Greece (4)– Israel (3)– Germany (2)– Russia (2)– Romania (2)– Slovakia (2)– Spain (2) – The Netherlands (2)

• One of each– Austria– Belgium– Croatia– Czech Republic– France– Hungary– India– Lebanon– Poland– Switzerland

71 respondents from 20 countries

Type of SpecialityN=71

ID (40)Hematology (28)Microbiology (4)

59%

36%

5%

Size of Hospital (no. of beds)

68%

<100 101-250 251-500 >500

10%

7%

15%

N=71

How Many Patients Treated for an IFD per Month?

31%

27%

40%

2%

<56-1011-15>20

N=70

How Many Patients Treated for a Probable or Proven IFD per Month?

18%

51%

23%

8%

<12-56-10>10

N=39

Integrated Care Pathway for Managing IFD

79%

18%

3%

YesNoDon't know

N=39

Who Decides for Antifungal Therapy

60%

40%

Primary physicianID after consultation

N=71

When ID is consulted?

56%34%

10%

AlwaysWhen patient deterio-ratesNever

N=70

Other Team Members

Radiol

ogist

Chest

phy

sician

Clin. P

harm

acist

Surge

on/in

tens

ivist

0

20

40

60

80

100

%

Bedside Discussions with Team Members

15%

17%

47%

21%

DailyWeeklyWhen requiredNo

N=71

Tests Available-I

Serum GLM BAL GLM Serum BGC Fungal PCR Crypto Ag in CSF

0

20

40

60

80

100

%

Tests Available-II

HRCT Low-dose CT

MRI PET scan BAL TB biopsy0

20

40

60

80

100

%

Tests Available-III

Gra

m st

ain

PCP det

ectio

n

Funga

l cult

ure

AFST

Tissue

biop

sy

Patho

logist

Single

room

0

20

40

60

80

100

%

Where is the Biopsied Tissue Sent?

1%7%

91%

MicrobiologyPathologyBoth

N=70

How Often is an Autopsy Done?

4%4% 10

%

81%

50-80%30-50%10-30%<10%

N=68

When is Serum GM Reported?

13%

40%28%

18%

The same day2 days3 days>3 days

N=71

When is CT or MRI Reported?

57%25%

13%

6%

The same day2 days3 days>3 days

N=71

When are Pathology Results Reported?

3%13%

13%

7%65%

The same day2 days3 days4 days>4 days

N=71

Prioritised Reporting in Microbiology, Radiology and Pathology

68%

30%

3%

YesNoDon't know

N=71

Thoracic Surgical Team Available

67%

29%

4%

YesNoDon't know

N=71

Summary

• Management of IFD requires a teamwork which is an essential part of an “Integrated Care Pathway”

• Many centres in Europe and its neighbours have the baseline setup and a protocol

• Further collaboration at the team- and administrative-level is desired