Thread by @ErinMcCreary

Antifungal Stewardship in Solid Organ Transplantation presented by @JGPharmD at #ACCPAM19

@JGPharmD hard to follow the CAP guidelines, but Dr. Gallagher starts with a nice overview of the kingdom myceteae #ACCPAM19

@JGPharmD incidence of fungal infections in solid organ transplant patients: small bowel > lung> liver > panc > heart > kidney #accpam19

@JGPharmD .@JGPharmD shows us how in all groups except lungs, candidiasis is the most common and occurs quicker than mold infections. Molds predominate in lung infections.

@JGPharmD Odds ratio for mortality > 6 for SOT patients who develop invasive fungal infections 😵

@JGPharmD great pictures made by @JGPharmD to show antifungal targets #accpam19

@JGPharmD in vitro activity of systemic antifungal agents (slide designed by @JGPharmD) #accpam19

@JGPharmD .@JGPharmD: "antifungal resistance is rising and if you aren't testing, you don't know." #accpam19

@JGPharmD .@jgpharmd: "antifungal resistance is likely underappreciated since many institution do not routinely test Candida species susceptibilities" #accpam19
C. auris concerning due to multi-drug resistance + it is extremely hard to eradicate.

@JGPharmD so how do fungi become resistant? most common resistance of Candida spp. to echinocandins is mutations in fks genes which change glucan synthetase so the drugs are ineffective. #accpam19

@JGPharmD CLSI breakpoints only exist for Candida spp., EUCAST has Aspergillus breakpoints. #ACCPAM19

@JGPharmD opportunities for antifungal stewie: RDT with stewie team intervention, early suspicion/detection of fungal infections, and discontinuing empiric therapy if it is no longer necessary #accpam19 @JGPharmD points out how invasive fungal disease is both overtreated and underdiagnosed

@JGPharmD .@JGPharmD shows importance of early initiation of antifungal therapy in patients with candidemia, published by @GareyKgarey and colleagues #accpam19
ncbi.nlm.nih.gov/pubmed/16758414

@JGPharmD @GareyKgarey old and new developments in antifungal rapid diagnostics (table created by @JGPharmD) #ACCPAM19

@JGPharmD @GareyKgarey .@jgpharmd: "the stewardship implication is clear- you should start therapy for candidemia with an echinocandin" #accpam19 ncbi.nlm.nih.gov/pubmed/17568028
ncbi.nlm.nih.gov/pubmed/30289478

@JGPharmD @GareyKgarey infectious diseases consultation improves candidemia outcomes #accpam19

@JGPharmD @GareyKgarey step-by-step antifungal stewardship #accpam19

@JGPharmD @GareyKgarey examples of antifungal stewardship programs #accpam19