Triggers for driving treatment of at-risk patients with invasive fungal disease

This Phase 1B study showed that a single tablet of 300 mg of posaconazole, given once daily as prophylaxis to 210 patients at risk for invasive fungal disease, was as safe as that reported for posaconazole oral suspension and achieved steady-state >500 ng/mL for all but one patient.

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Allo-HSCT recipients with invasive fungal disease and ongoing immunosuppression have a high risk for developing tuberculosis

Scientific Reports ◽

10.1038/s41598-019-56013-w ◽

2019 ◽

Vol 9 (1) ◽

Cited By ~ 2

Author(s):

Apeng Yang ◽

Jimin Shi ◽

Yi Luo ◽

Yishan Ye ◽

Yamin Tan ◽

...

Keyword(s):

Risk Factors ◽

High Risk ◽

Invasive Fungal Disease ◽

Fungal Disease ◽

Control Group ◽

High Dose ◽

Hematopoietic Stem ◽

Risk Patients ◽

Independent Risk Factors ◽

Nested Case Control

AbstractPatients underwent allogeneic hematopoietic stem cell transplantation (allo-HSCT) are at high risk of acquiring tuberculosis (TB) due to a status of immunosuppression. We conducted a nested case control study to investigate the incidence and risk factors for TB after allo-HSCT. Between 2012 and 2017, 730 consecutive allo-HSCT recipients were enrolled, and 14 patients (1.92%) were diagnosed with TB. Relatively, 54 allo-HSCT recipients were selected as control. Patients who suffered TB had a significantly higher 3-year non-relapse mortality rate than the control group (30.36% vs 5.39%, P < 0.01). In multivariate analysis, invasive fungal disease (HR 4.87, 95% CI 1.39–17.09), treatment with a relatively high dose of prednisone (HR 10.34, 95% CI 1.12–95.47) and treatment with tacrolimus (HR 4.79, 95% CI 1.18–19.44) were identified independent risk factors for TB occurrence post allo-HSCT (P < 0.05). Meanwhile, donor type, dose and type of anti-thymocyte globulin (ATG) administrated, as well as treatment intensity, did not alter the incidence of TB. Therefore, allo-HSCT recipients with unexplained fever, especially those who suffer from invasive fungal disease and ongoing immunosuppression with a relatively high dose of prednisone or tacrolimus, are at a high-risk of developing active TB. Closely Monitoring TB occurrence, making a timely diagnosis and administering the proper treatment may be beneficial to those high-risk patients.

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Phase 3 pharmacokinetics and safety study of a posaconazole tablet formulation in patients at risk for invasive fungal disease

Journal of Antimicrobial Chemotherapy ◽

10.1093/jac/dkw079 ◽

2016 ◽

Vol 71 (6) ◽

pp. 1747-1747 ◽

Cited By ~ 15

Author(s):

Oliver A. Cornely ◽

Rafael F. Duarte ◽

Shariq Haider ◽

Pranatharthi Chandrasekar ◽

David Helfgott ◽

...

Keyword(s):

At Risk ◽

Invasive Fungal Disease ◽

Fungal Disease ◽

Tablet Formulation ◽

Safety Study ◽

Phase 3 ◽

Patients At Risk

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Screening for Fungal Endophthalmitis in Children at Risk

PEDIATRICS ◽

10.1542/peds.90.3.451 ◽

1992 ◽

Vol 90 (3) ◽

pp. 451-457

Author(s):

Robert W. Enzenauer ◽

Alex V. Levin ◽

James E. Elder ◽

J. Donald Morin ◽

Stan Calderwood

Keyword(s):

At Risk ◽

Invasive Fungal Disease ◽

Fungal Colonization ◽

Fungal Culture ◽

Deep Tissue ◽

Fungal Endophthalmitis ◽

Endogenous Fungal Endophthalmitis ◽

Risk Patients ◽

Group 2 ◽

Group 1

To evaluate the efficacy of screening ophthalmologic examinations in high-risk children, we reviewed the medical records for all patients hospitalized from 1985 through 1989 at The Hospital for Sick Children, Toronto, Ontario, who underwent ophthalmological consultation to rule out endogenous fungal endophthalmitis (n = 176). The patients were divided into groups: Group 1 (n = 47), those with deep-tissue fungal infection, and Group 2 (n = 129), those at risk for invasive fungal disease. Group 2 was subdivided further into two subgroups: Group 2a (n = 48), those with evidence of superficial fungal colonization (positive fungal culture) but no deep-tissue involvement, and Group 2b (n = 81), those with no evidence of fungal colonization (negative fungal culture). Of these 176 patients, 7 were diagnosed with endogenous fungal endophthalmitis: 6 from Group 1, 1 from Group 2a, and 0 from Group 2b. We found a significant association between the development of endogenous fungal endophthalmitis and the status of the fungal culture result (P < .005). The odds ratio indicated the risk of endogenous fungal endophthalmitis in Group 1 patients with deep-tissue infection was at least 19 times that of Group 2 at-risk patients. The risk of endogenous fungal endophthalmitis in Group 1 patients was at least 7 times that of Group 2a colonized patients and 12 times that of Group 2b patients with no positive fungal culture. Our study confirms the necessity of careful dilated ophthalmoscopic examination in patients with invasive fungal disease and suggests screening for those at-risk patients with superficial fungal colonization. Our results, however, do not document the value of routine ophthalmoscopic consultation in at-risk children without evidence of any fungal colonization.

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Lessons from an Educational Invasive Fungal Disease Conference on Hospital Antifungal Stewardship Practices across the UK and Ireland

Journal of Fungi ◽

10.3390/jof7100801 ◽

2021 ◽

Vol 7 (10) ◽

pp. 801

Author(s):

Alida Fe Talento ◽

Malcolm Qualie ◽

Laura Cottom ◽

Matthijs Backx ◽

P. Lewis White

Keyword(s):

At Risk ◽

Treatment Strategies ◽

Invasive Fungal Disease ◽

Fungal Disease ◽

Diagnostic Tools ◽

Optimal Time ◽

Rapid Diagnostics ◽

Antifungal Stewardship ◽

Patients At Risk ◽

The Uk

Invasive fungal disease (IFD) is a growing health burden. High mortality rates, increasing numbers of at-risk hosts, and a limited availability of rapid diagnostics and therapeutic options mean that patients are increasingly exposed to unnecessary antifungals. High rates of prescriptions promote patient exposure to undue toxicity and drive the emergence of resistance. Antifungal stewardship (AFS) aims to guide antifungal usage and reduce unnecessary exposure and antifungal consumption whilst maintaining or improving outcomes. Here, we examine several AFS approaches from hospitals across the UK and Ireland to demonstrate the benefits of AFS practices and support the broader implementation of AFS as both a necessary and achievable strategy. Since the accuracy and turnaround times (TATs) of diagnostic tools can impact treatment decisions, several AFS strategies have included the development and implementation of diagnostic-driven care pathways. AFS informed treatment strategies can help stratify patients on a risk basis ensuring the right patients receive antifungals at the optimal time. Using a multidisciplinary approach is also key due to the complexity of managing and treating patients at risk of IFD. Through knowledge sharing, such as The Gilead Antifungal Information Network (GAIN), we hope to drive practices that improve patient management and support the preservation of antifungals for future use.

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Exploring the Validity and Operational Impact of Using Allied Health Assistants to Conduct Dysphagia Screening for Low-Risk Patients Within the Acute Hospital Setting

American Journal of Speech-Language Pathology ◽

10.1044/2020_ajslp-19-00060 ◽

2020 ◽

Vol 29 (4) ◽

pp. 1944-1955 ◽

Cited By ~ 1

Author(s):

Maria Schwarz ◽

Elizabeth C. Ward ◽

Petrea Cornwell ◽

Anne Coccetti ◽

Pamela D'Netto ◽

...

Keyword(s):

At Risk ◽

Allied Health ◽

Assessment Tool ◽

Hospital Setting ◽

Low Risk ◽

False Negatives ◽

Exact Agreement ◽

Risk Patients ◽

Impact Phase ◽

Operational Impact

Purpose The purpose of this study was to examine (a) the agreement between allied health assistants (AHAs) and speech-language pathologists (SLPs) when completing dysphagia screening for low-risk referrals and at-risk patients under a delegation model and (b) the operational impact of this delegation model. Method All AHAs worked in the adult acute inpatient settings across three hospitals and completed training and competency evaluation prior to conducting independent screening. Screening (pass/fail) was based on results from pre-screening exclusionary questions in combination with a water swallow test and the Eating Assessment Tool. To examine the agreement of AHAs' decision making with SLPs, AHAs ( n = 7) and SLPs ( n = 8) conducted an independent, simultaneous dysphagia screening on 51 adult inpatients classified as low-risk/at-risk referrals. To examine operational impact, AHAs independently completed screening on 48 low-risk/at-risk patients, with subsequent clinical swallow evaluation conducted by an SLP with patients who failed screening. Results Exact agreement between AHAs and SLPs on overall pass/fail screening criteria for the first 51 patients was 100%. Exact agreement for the two tools was 100% for the Eating Assessment Tool and 96% for the water swallow test. In the operational impact phase ( n = 48), 58% of patients failed AHA screening, with only 10% false positives on subjective SLP assessment and nil identified false negatives. Conclusion AHAs demonstrated the ability to reliably conduct dysphagia screening on a cohort of low-risk patients, with a low rate of false negatives. Data support high level of agreement and positive operational impact of using trained AHAs to perform dysphagia screening in low-risk patients.

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