MYcology Stewardship Tool (MyST): a retrospective, descriptive multidisciplinary team review of antifungal prescribing practice in a UK tertiary centre.

Background: Antifungal stewardship (AFS) is essential to managing antimicrobial resistance (AMR), yet remains less well established than antibacterial stewardship. This project aimed to support development of an AFS programme at Oxford University Hospitals NHS Foundation Trust (OUHFT) by characterizing antifungal use and identifying priorities for service improvement. Methods: This retrospective service evaluation reviewed all adult patients prescribed systemic antifungal therapy between 1 November 2021 and 28 February 2022. Data were collected using the MYcology Stewardship Tool (MyST) and included patient demographics, underlying diagnosis, fungal infection investigations, antifungal indication, prescribing details and reason for stopping treatment. Guideline compliance and stewardship appropriateness were reviewed independently by two pharmacists. Categorical variables were summarized using counts and percentages, and continuous variables using medians and interquartile ranges. Results were reviewed at fortnightly AFS project team meetings to identify opportunities for service improvement. Results: Two hundred patients, comprising 210 patient episodes, were captured in MyST. Median age was 65 years (IQR 56-73), and 61.5% (123/200) were haematology/oncology patients. Among 140 antifungal prophylaxis prescriptions, 91% (128/140) were guideline compliant and 87% (122/140) were stewardship appropriate. Incorrect duration and poor documentation were the main reasons for inappropriateness. Among 165 antifungal treatment prescriptions, 84% (138/165) were guideline compliant and 85% (140/165) were stewardship appropriate. Incorrect dose or dosing frequency were the main reasons for inappropriateness. AFS project team review identified priority areas for improvement, including staff education, patient information resources and improved therapeutic drug monitoring guidance for complex patients. Conclusion: This project established the foundations for an AFS strategy at OUHFT and identified priorities for further development, including patient information resources, healthcare worker education and therapeutic drug monitoring guidance. Although MyST supported structured data capture and analysis, its use was labour intensive. A dashboard integrated with electronic patient records and capable of providing real-time antifungal prescribing data would facilitate more sustainable, timely and targeted stewardship interventions.