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