Development of the invasive candidiasis discharge [I Can discharge] model: a mixed methods analysis.

Patients with invasive candidiasis (IC) have complex medical and infectious disease problems that often require continued care after discharge. This study aimed to assess echinocandin use at hospital discharge and develop a transition of care (TOC) model to facilitate discharge for patients with IC. This was a mixed method study design that used epidemiologic assessment to better understand echinocandin use at hospital discharge TOC. Using grounded theory methodology focused on patients given echinocandins during their last day of hospitalization, a TOC model for patients with IC, the invasive candidiasis [I Can] discharge model was developed to better understand discharge barriers. A total of 33% (1405/4211) echinocandin courses were continued until the last day of hospitalization. Of 536 patients chosen for in-depth review, 220 (41%) were discharged home, 109 (20%) were transferred, and 207 (39%) died prior to discharge. Almost half (46%, 151/329) of patients discharged alive received outpatient echinocandin therapy. Independent predictors for outpatient echinocandin use were osteomyelitis (OR, 4.1; 95% CI, 1.1-15.7; p = 0.04), other deep-seated infection (OR, 4.4; 95% CI, 1.7-12.0; p = 0.003), and non-home discharge location (OR, 3.9, 95% CI, 2.0-7.7; p < 0.001). The I Can discharge model was developed encompassing four distinct themes which was used to identify potential barriers to discharge. Significant echinocadin use occurs at hospital discharge TOC. The I Can discharge model may help clinical, policy, and research decision-making processes to facilitate smoother and earlier hospital discharges.

Significant Publications on Infectious Diseases Pharmacotherapy in 2019.

PURPOSE: To provide a summary of the most prominent peer-reviewed infectious diseases (ID) pharmacotherapy and Human Immunodeficiency Virus (HIV)-related articles published in 2019. SUMMARY: Houston Infectious Diseases Network (HIDN) members were asked to nominate articles that they believed were most influential within the ID and HIV pharmacotherapy science communities. A total of 48 general ID and 6 HIV-related articles were nominated. Following nominations, an online survey was distributed via e-mail to Society of Infectious Diseases Pharmacists (SIDP) members, with a total of 156 and 54 members voting for general ID and HIV-related articles, respectively. The results of this survey were ranked to determine the top 10 general ID and top HIV articles. The top articles were then summarized by HIDN members, including residents, fellows, and clinical pharmacists. CONCLUSION: This review covers many of the most influential ID articles published in 2019, including 3 practice guideline updates. Due to the high rate of ID literature published each year, this review continues to help summarize these articles for the ID community, allowing clinicians to remain up-to-date on practice-changing publications in ID and HIV pharmacotherapy.

Antifungal Resistance: a Concerning Trend for the Present and Future.

PURPOSE OF REVIEW: The global emergence of antifungal resistance among Candida spp. and Aspergillus spp. is a growing threat to public health, driven largely by the expanding use of antifungals in both the clinical and agricultural settings. As treatment options remain limited, understanding mechanisms and risk factors for antifungal resistance is essential to retaining their clinical utility. RECENT FINDINGS: Invasive candidiasis is increasingly caused by non-albicans Candida species with reduced susceptibility to first-line antifungals, making empiric treatment decisions difficult. Echinocandin resistance in C. glabrata is increasing at some high-risk centers, and multi-drug-resistant isolates are increasingly encountered. Of large concern is the rapid and global emergence of C. auris, a species associated with a high propensity for developing multi-drug resistance and nosocomial transmission. Azole resistance is now becoming more common in Aspergillus isolates as well, with breakthrough infections occurring in patients previously managed with azoles antifungals. The appearance of azole-resistant Aspergillus isolates in azole-naïve patients is also concerning, given it is now accepted that this may be due to the use of non-human azole compounds in pesticides. Due to the climbing use of antifungals in both the clinical and agricultural sectors, the frequency of encounters with antifungal-resistant isolates will undoubtedly rise in parallel. Antifungal stewardship will need to become a new priority for antimicrobial stewardship programs in order to preserve our current selection of antifungal agents. Rapid diagnostics may help stewardship efforts by decreasing the time it takes to determine if an antifungal agent is indicated for a patient.