integrated multidisciplinary management of invasive fungal infections
DESCRIPTION
Integrated Multidisciplinary Management of Invasive Fungal Infections. Dr. Murat Akova Hacettepe University School of Medicine Section of Infcetious Diseases Ankara. Survey for Management of IFD. 18 questions Published in Turkish Febrile Neutropenia website - PowerPoint PPT PresentationTRANSCRIPT
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