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Antifungal prescription and stewardship in hematology and hematopoietic stem cell transplantation units worldwide: an international survey of EHA-SWG Infections in Hematology

Bone Marrow Transplantation volume 60, pages 729–732 (2025)Cite this article

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Invasive fungal infections (IFIs) constitute a major cause of mortality and morbidity in patients with hematological malignancies [1]. Patients who undergo hematopoietic cell transplantation (HCT), especially, are at an increased risk of IFIs due to various causes including immunosuppressive treatment for graft-versus-host disease, high-dose glucocorticoids, and haploidentical/ unrelated allogeneic HCT (allo-HCT) [2, 3]. Aspergillus spp. and Candida spp. are the most commonly identified fungal pathogens in patients with hematological malignancies [4]. Primary antifungal (AF) prophylaxis has been established as a standard of care in high-risk patients [5].

An increase in the prescription and use of AF agents has been described in the hematology setting, leading to an increase in total costs and AF resistance [6]. Antimicrobial stewardship programs have developed worldwide aiming to improve and measure the appropriate use of antimicrobial agents [7]. AF stewardship has been recognized as an important part of any antimicrobial stewardship program [8]. Several benefits of AF stewardship programs have been described: decrease in inappropriate AF prescriptions, reduction in overall costs, and fungal species’ resistance [9].

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Acknowledgements

We would like to thank the study respondents for participating in the survey.

Author information

Author notes

  1. These authors contributed equally: Eleni Gavriilaki, Paschalis Evangelidis.

Authors and Affiliations

  1. Hematology Department - BMT Unit, G. Papanicolaou Hospital, Thessaloniki, Greece

    Eleni Gavriilaki & Ioanna Sakellari

  2. Second Propedeutic Department of Internal Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece

    Eleni Gavriilaki, Paschalis Evangelidis & Nikolaos Kotsiou

  3. Institute of Translational Research, Cologne Excellence Cluster on Cellular Stress Responses in Aging-Associated Diseases (CECAD), Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany

    Oliver A. Cornely & Jon Salmanton-García

  4. Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf (CIO ABCD) and Excellence Center for Medical Mycology (ECMM), Faculty of Medicine and University Hospital Cologne, Cologne, University of Cologne, Cologne, Germany

    Oliver A. Cornely & Jon Salmanton-García

  5. German Centre for Infection Research (DZIF), Partner Site Bonn-Cologne, Cologne, Germany

    Oliver A. Cornely & Jon Salmanton-García

  6. Clinical Trials Centre Cologne (ZKS Köln), Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany

    Oliver A. Cornely

  7. Department of Hematology, Fondazione Policlinico Universitario A. Gemelli -IRCCS- Universita Cattolica del Sacro Cuore, Roma, Italy

    Livio Pagano

Authors
  1. Eleni Gavriilaki
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Contributions

EG performed the investigation, data curation, and statistical analysis and edited the manuscript. PE designed the questionnaire, helped with the statistical and thematic analysis, and wrote the original manuscript. NK assisted in data curation and thematic analysis. IS edited the questionnaire and the final manuscript. OAC participated in the questionnaire design, statistical analysis, and editing of the final manuscript. LP edited the questionnaire and the final manuscript. JSC supervised the work, assisted in statistical and thematic analysis, and wrote the original manuscript.

Corresponding author

Correspondence to Paschalis Evangelidis.

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Competing interests

JS-G has received payment or honoraria for lectures, presentations, speakers’ bureaus, manuscript writing or educational events and support for attending meetings and/or travel from AstraZeneca, outside of the submitted work. The remaining authors have no relevant financial or non-financial interests to disclose. No external funding was received for this work.

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Gavriilaki, E., Evangelidis, P., Kotsiou, N. et al. Antifungal prescription and stewardship in hematology and hematopoietic stem cell transplantation units worldwide: an international survey of EHA-SWG Infections in Hematology. Bone Marrow Transplant 60, 729–732 (2025). https://doi.org/10.1038/s41409-025-02545-x

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