Antimicrobial Stewardship: Fungal Infections

J. Njeri Wainaina, MD, FACP

SUMMARY
Invasive fungal infections are an important cause of morbidity and mortality in hospitalized patients and are of particular significance in immunocompromised patients. As this population has expanded with advances in medical progress in the last few decades, so has the incidence of fungal infections. As a result, hospitalists are likely to be involved in the care of patients with or at risk for invasive fungal infections. As first-line care providers, it is important to have a good grasp of the changing epidemiology, current and emerging diagnostic approaches, and principles of rational and responsible deployment of antifungal therapies so as to maximize the probability of favorable patient outcomes. This is in line with the goals of antimicrobial stewardship, which are designed to optimize patient outcomes, while minimizing antimicrobial harms such as toxicity, unfavorable drug-drug interactions, selection of resistant organisms, and promotion of dysbiosis. 
 
GOAL
To provide an overview of the approach to diagnosis and management of patients with invasive fungal infections, while incorporating the principles of antimicrobial stewardship using invasive candidiasis as a model.
 
TARGET AUDIENCE
This activity is designed for hospitalists. 
 
LEARNING OBJECTIVES

After completing the module, the participant should be able to:

  • APPLY epidemiologic and patient specific factors to stratify risk for invasive fungal infections and select empiric antifungal therapy effectively.
  • IDENTIFY the components of effective treatment of invasive fungal infections.
  • DISTINGUISH fungal colonization from invasive disease.
CME INFORMATION
This activity has been planned and implemented in accordance with the Essential Areas and Policies of the Accreditation Council for Continuing Medical Education through the joint sponsorship of University of Virginia School of Medicine, ASiM, and the Society of Hospital Medicine. The University of Virginia School of Medicine is accredited by the ACCME to provide continuing medical education for physicians.
 
The University of Virginia School of Medicine designates this enduring material for a maximum of 1 AMA PRA Category 1 Credit.TM Physicians should claim only the credit commensurate with the extent of their participation in the activity.
 
Release date: May 12, 2016                             Expiration date: May 12, 2019 
 
Estimated time to complete activity: 1 hour
 
FACULTY  & FACULTY DISCLOSURES
Full Disclosure Policy Affecting CME Activities:
The University of Virginia School of Medicine, as an ACCME accredited provider, endorses and strives to comply with the Accreditation Council for Continuing Medical Education (ACCME) Standards of Commercial Support, Commonwealth of Virginia statutes, University of Virginia policies and procedures, and associated federal and private regulations and guidelines on the need for disclosure and monitoring of proprietary and financial interests that may affect the scientific integrity and balance of content delivered in continuing medical education activities under our auspices.
 
The University of Virginia School of Medicine requires that all CME activities accredited through this institution be developed independently and be scientifically rigorous, balanced and objective in the presentation/discussion of its content, theories and practices.
 
All faculty presenters participating in an accredited CME activity are expected to disclose relevant financial relationships with commercial entities occurring within the past 12 months (such as grants or research support, employee, consultant, stock holder, member of speakers bureau, etc.). The University of Virginia School of Medicine will employ appropriate mechanisms to resolve potential conflicts of interest to maintain the standards of fair and balanced education to the participant. Questions about specific strategies can be directed to the Office of Continuing Medical Education, University of Virginia School of Medicine, Charlottesville, Virginia.
 
The faculty and staff of the University of Virginia Office of Continuing Medical Education and ASiM have no financial affiliations to disclose.
 
The following relationships have been reported for faculty of this activity:
 
Leonard Feldman, MD, FACP, SFHM (Chair)
Associate Professor of Medicine and Pediatrics
Johns Hopkins University School of Medicine 
Med-Peds Urban Health Residency Program Director
Associate Program Director, Osler Medical Residency
Director, Comprehensive General Medicine Consult Service
Editor, Consultative & Perioperative Medicine Essentials for Hospitalists
Baltimore, Maryland
Dr Feldman reports having no significant financial or advisory relationships with corporate organizations related to this activity.
 
J. Njeri Wainaina, MD, FACP
Assistant Professor
Section of Perioperative Medicine/Division of Infectious Diseases
Department of Medicine
Medical College of Wisconsin
Medical Director, Antimicrobial Stewardship Program, Froedtert Hospital
Milwaukee, Wisconsin
Dr Wainaina reports having no significant financial or advisory relationships with corporate organizations related to this activity.
 
Chris Arnold, MD (Peer Reviewer)
Assistant Professor 
Division of Infectious Diseases and International Health
University of Virginia Health System 
Charlottesville, Virginia
Dr Arnold reports receiving grants/research support for RSV treatment as part of a multicenter trial from Alios BioPharma Inc.
 
Disclosure of Discussion of Non-FDA–Approved Uses for Pharmaceutical Products and/or Medical Devices
The University of Virginia School of Medicine, as an ACCME provider, requires that all faculty presenters identify and disclose any off-label uses for pharmaceutical and medical device products.  The University of Virginia School of Medicine recommends that each physician fully review all the available data on new products or procedures prior to clinical use.
 
All faculty have indicated that they have not referenced unlabeled or unapproved uses of drugs or devices.
 
DISCLAIMER
The opinions and recommendations expressed by faculty and other experts are based on current scientific evidence and standards of care and their professional expertise. This enduring material is produced for educational purposes only. The University of Virginia School of Medicine implements specific educational planning processes to ensure that content is patient-centric and independent. The University of Virginia School of Medicine recommends that each physician fully review all the available data on new products or procedures prior to clinical use.
 
Click here to download the references for this educational activity.
 
INSTRUCTIONS

The following is an interactive case-based module designed to help you gauge your basic knowledge of bacterial infections and then direct you to specific areas you may need to focus on. It consists of 3 sections: a non-designated pre-test, the interactive activity, and a CME post-test and evaluation. All 3 sections must be completed to receive CME credit. Participants must receive a post-test score of 70% or higher to pass and will have 3 chances to do so. A certificate of participation will be available online immediately following successful completion of the activity.

 
Supported by an educational grant from Merck & Co, Inc. 
Course summary
Available credit: 
  • 1.00 AMA PRA Category 1 Credit™
  • 1.00 Equivalent Credit
Course opens: 
05/12/2016
Course expires: 
05/12/2019
Cost:
$0.00
Parent activity set: 
Rating: 
0

Available Credit

  • 1.00 AMA PRA Category 1 Credit™
  • 1.00 Equivalent Credit

Accreditation Period

Course opens: 
05/12/2016
Course expires: 
05/12/2019

Price

Cost:
$0.00
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