Authors' objectives: Invasive candidiasis is a fungal infection of the blood or organs that is associated with high morbidity and mortality in critically ill patients. Current diagnosis is based on blood culture, which typically takes 2 days to confirm the presence of Candida, and longer for differentiating the species and sensitivities to antifungal drugs. Administration of antifungal treatment is time-critical, hence critically ill patients considered ‘at-risk’ of Candida infection are often started on antifungal treatment pending test results. However, many of these patients may not have empirical treatment stopped when test results become available because of concerns about the sensitivity of blood culture. The Antifungal STewardship Opportunities study is a multisite national diagnostic test accuracy study investigating the use of rapid tests in the intensive care unit that have the potential to influence decision-making. Our aim is to understand patient and physician risk preferences for using the Antifungal STewardship Opportunities testing strategy to discontinue empirical antifungal therapy using semi-structured interviews. An a priori sample size of 30 National Health Service staff and 10 patient interviews was selected to elicit information relating to the aims. Interview schedules were developed, and all interviews were conducted via video or teleconferencing between December 2021 and December 2022 and lasted between 10 and 60 minutes. Interviews were recorded, transcribed and subjected to thematic analysis.

Authors' results and conclusions: If found to have high accuracy and cost-effectiveness, the potential of the Antifungal STewardship Opportunities diagnostic strategy to aid decision-making on antifungal prescribing could change intensive care unit clinicians practice, as they are risk-averse to stopping empirical antifungal treatment. However, consideration of the resources needed including staff, and lab facilities, adequate training as well as established guidelines to facilitate its adoption is required.

Authors' methods: There was a potential for selection bias as interview participants being from participating sites. The target recruitment numbers of patients and their legal representatives was not achieved due to low retention rates.

Project Status: Completed

URL for project: https://www.journalslibrary.nihr.ac.uk/programmes/hta/NIHR136136

Year Published: 2025

URL for published report: https://www.journalslibrary.nihr.ac.uk/hta/published-articles/GJRM3321

URL for additional information: English

English language abstract: An English language summary is available

Publication Type: Full HTA

Country: England, United Kingdom

DOI: 10.3310/GJRM3321

Organisation Name: NIHR Health Technology Assessment programme

Contact Address: NIHR Journals Library, National Institute for Health and Care Research, Evaluation, Trials and Studies Coordinating Centre, Alpha House, University of Southampton Science Park, Southampton SO16 7NS, UK

Contact Name: journals.library@nihr.ac.uk

Contact Email: journals.library@nihr.ac.uk