How can you manage IFIs promptly and effectively?

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3D image of Fusarium

HOW CAN YOU MANAGE IFIs PROMPTLY AND EFFECTIVELY?

Annually, over 150 million severe cases of fungal infections occur worldwide, resulting in approximately 1.7 million deaths per year.1 When time is of the essence for patients with invasive fungal infections (IFIs), how can you stay one step ahead?

Photo of a patient in hospital bed, doctor taking notes and nurse fixing the IV drips

SUSPECT EARLY

A lack of definitive disease confirmation and access to timely test results can often lead to delayed treatment, increasing the risk of IFI-related mortality.2,3

Early diagnosis and prompt treatment of IFIs in high-risk patients is key to ensuring favourable outcomes.3-5

  • If invasive pulmonary aspergillosis is not diagnosed and treated promptly, mortality rates can be as high as 80%6
  • In patients with candidaemia,* mortality is high when antifungal therapy is delayed or inadequate and/or when the source control is not quickly achieved3
Patient in hospital bed with doctor listening to patient's heart beat using stethoscope

IDENTIFY YOUR AT-RISK PATIENTS

Over the last decade, the number of patients at risk of developing an IFI has increased, including immunocompromised patients and those admitted to intensive care units (ICUs).4,7 Of further concern is the increasing variety of rare, resistant and post-viral fungal infections.5,8,9 There are many factors that may lead to increased risk, such as underlying conditions, hospital care or treatment, and concomitant or prior medications.7,10-18
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KNOW THE SIGNS AND SYMPTOMS

The symptoms of an IFI can often be non-specific, leading to difficulty when diagnosing.19 Some of the signs your patient may present with include:19,20

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Fever

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Cough

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Dyspnoea

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Hypotension

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Vomiting

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Diarrhoea

Rapid diagnosis may be hampered by numerous factors:21

  • Limited access to modern diagnostic tests21,22
  • Lack of hospital surveillance systems23
  • Diagnostic differences across hospitals and regions24,25
  • Low sensitivity of antibody tests21
  • In critically ill patients, biopsy carries risks that might not outweigh the benefits of such procedures21
  • The length of time it takes for culture-based tests to yield positive results21
  • Biomarkers may be expensive or not readily available21
  • Resistant strains are not always identified26
  • Accuracy may be reduced by other treatments27

Lack of definitive disease confirmation means patients’ treatment is often delayed, increasing the risk of IFI-associated mortality.2,3,23

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TREAT PROMPTLY

When the diagnosis or fungal pathogen is unknown, treating eligible patients empirically with a broad-spectrum antifungal therapy may help to reduce mortality.3,28 Timely initiation of an appropriate antifungal is a major determinant of survival in IFI patients.3

Methods to improve clinical outcomes include choosing a treatment based on susceptibility data, administering a sufficient dose, and achieving source control quickly.3,26,29,30

RELATIONSHIP BETWEEN HOSPITAL MORTALITY AND THE TIMING OF ANTIFUNGAL TREATMENT†13
Bar chart showing relationship between hospital mortality and the timing of antifungal treatment

Time is of the essence for patients with invasive candidaemia31

The mortality rate of patients with a Candida bloodstream infection more than doubles when treatment is delayed by 12-24 hours compared with treatment within 12 hours from detection.**31
Photo of doctor caring for patient with oxygen mask

Suspect early, treat promptly, treat broad.

Consider an empiric, broad-spectrum and fungicidal treatment for your at-risk patients with febrile neutropenia.

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Footnotes

*Invasive candidiasis includes three clinical conditions: candidaemia, deep-seated candidiasis and deep-seated candidiasis with associated candidaemia.32

**Retrospective cohort analysis of 157 hospitalised patients with a positive blood culture for Candida over a 4-year period. Among the hospital non-survivors, the causes of death included sepsis and multiorgan failure not directly attributed to Candida infection (n=31), sepsis and multiorgan failure directly attributed to Candida infection (n=11), cardiac arrest (n=6), and pulmonary embolism (n=2). Risk of hospital mortality was lower in those treated within 12 hours (n=9) than those treated after 12 hours (n=148) (11.1% vs. 33.1%, p=0.169).31

†The timing of antifungal therapy was determined to be from the time when the first culture-positive blood sample was drawn to the time when antifungal treatment was first administered to the patient.31

‡Not statistically significant.31

References

  1. Kainz K et al. Microb Cell. 2020;7(6):143-145.
  2. Valentine JC. BMC Infect Dis. 2019;19(1):274.
  3. Pappas PG et al. Nat Rev Dis Primers. 2018;11;4:18026.
  4. Chatelon J et al. Adv Ther. 2019;36(12):3308-3320.
  5. Pagano L and Mayor S. Future Sci OA. 2018;14;4(6):FSO307.
  6. Shen H et al. J Emerg Crit Care Med. 2019;3:54.
  7. Bongomin F et al. J Fungi (Basel). 2017;3(4):57.
  8. Bougnoux ME et al. Anti Res Inf Con. 2018;7:45.
  9. Ajmal S et al. Infection. 2018;46(4):555-558.
  10. Gangneux JP et al. J Mycol Méd. 2020;30:100971.
  11. Peman J et al. Rev Iberoam Micol. 2020;37(2):41–46.
  12. Cornely OA et al. Clin Infect Dis. 2007;44(10):1289–1297.
  13. Kuse E-R et al. Lancet. 2007;369(9572):1519–1527.
  14. Walsh TJ et al. N Engl J Med. 2002;346(4):225–234.
  15. Walsh TJ et al. N Engl J Med. 1999;340(10):764–771.
  16. Walsh TJ et al. N Engl J Med. 2004;351(14):1391–1402.
  17. De Pascale G et al. Curr Opin Crit Care. 2015;21:421–429.
  18. Bassetti M et al. Intensive Care Med. 2014;40:839–845.
  19. Zhang Z et al. BMJ Open. 2020;10(7):e036452.
  20. Armstrong-James D et al. BMJ Case Rep. 2020;13:e233072.
  21. Falci D et al. Infect Dis Ther. 2017;6:213–223.
  22. Talento AF et al. J Fungi (Basel). 2021;7(10):801.
  23. Lass-Flörl C and Cuenca-Estrella M. J Antimicrob Chemother. 2017;46(1):62–68.
  24. Wang H et al. J Microb Imm Inf. 2020;53(6);845-853.
  25. Hassan A et al. J Clin Pathol. 2006;59:759-763.
  26. Vergidis P et al. PloS One. 2016;11(4):e0153247.
  27. Calmettes C et al. Oncotarget. 2018;9(42):26724-26736.
  28. Chandrasekar P. J Antimicrob Chemother. 2011;66(3):457–465.
  29. Kollef M et al. Clin Infect Dis. 2012;54(12):1739-1746.
  30. Andes DR et al. Clin Inf Dis. 2012;54(8):1110-1122.
  31. Morrell M et al. Antimicrob Agents Chemother. 2005;49(9):3640–3645.
  32. Logan C et al. Intensive Care Med. 2020;46(11):2001-2014.

Date of preparation: April 2022. Job code: IHQ-AMB-0425.