The Challenges of Invasive Fungal Infections in Community Hospitals: A CME Guidebook to Improve Therapy and Clinical Outcomes

This interactive digital guidebook addresses the unique challenges of the community hospital to aid community practitioners, emergency-department physicians, critical-care physicians, hematologists, oncologists, and transplant surgeons in the treatment of patients with invasive fungal infections (IFIs), particularly in immunocompromised or immunosuppressed patients. Chapter topics include the epidemiology and burden of IFIs, ensuring a timely and accurate diagnosis, and the selection of appropriate antifungal therapy across diverse patients with IFIs.

The management of invasive fungal infections (IFI) is centered on establishing an early and reliable diagnosis. Early diagnosis allows timely initiation of antifungal agents, yet challenges exist, such as access to prompt antifungal susceptibility testing. Due to challenges with diagnostic uncertainty, inappropriate prescribing of antifungal agents results. These unnecessary treatments result in toxicities, resistance, and cost implications, as well as unnecessary morbidity/mortality. Recent guidelines for the management of IFI have been released, yet awareness and adherence to guideline recommendations is suboptimal. Even so, many aspects of IFI management require clinical judgement and may not be supported by evidence, whereby a multidisciplinary discussion and expert opinion provide critical guidance for community clinicians.

Upon completion of these educational activities, learners should be able to:
• Identify patients who have a high-risk of IFIs and those who require preemptive therapy or prophylaxis
• Discuss available diagnostic tests and emerging technologies to ensure early detection of IFIs
• Select antifungal therapy based on clinical presentation and susceptibility testing
• Outline considerations in the toxicity, pharmacokinetic/pharmacodynamic profiles, and monitoring of antifungal agents for diverse patients with IFIs