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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