Treatment Failure in Mycology: Addressing the Root Cause
Released On
October 10, 2023
Expires On
October 10, 2024
Media Type
Internet
Completion Time
2 hours
Specialty
Critical Care, Hematology-Oncology, Hospitalist, Infectious Disease, Medical Microbiology, Pathology, Pharmacy, Pulmonology, Surgery
Topic(s)
Fungal Infections
This activity is jointly provided by Postgraduate Institute for Medicine; Terranova Medica, LLC; and the Mycoses Study Group Education & Research Consortium.
This educational initiative was funded in part by a cooperative agreement with the Centers for Disease Control and Prevention (CDC-RFA-CK20-2003) to the University of Alabama at Birmingham. The University of Alabama at Birmingham is collaborating with the Mycoses Study Group Education & Research Consortium and Terranova Medica, LLC, on this initiative. The Centers for Disease Control and Prevention is an agency within the Department of Health and Human Services (HHS). The contents of this resource center do not necessarily represent the policy of CDC or HHS and should not be considered an endorsement by the Federal Government.
Credit Available
- Physicians — maximum of 2 AMA PRA Category 1 Credit(s)™
- Nurses — 2 Nursing Contact Hours, 1 Contact Hour of Pharmacotherapy Credit
- Pharmacy — 2.0 Contact Hours of the Accreditation Council for Pharmacy Education
- Interprofessional - 2.0 Interprofessional Continuing Education Credit
All other healthcare professionals completing this course will be issued a statement of participation.
Target Audience
This activity is directed to physicians with specialties in infectious diseases, pulmonary/critical care medicine, and pathology/laboratory medicine as well as other health care providers who care for patients at risk for or diagnosed with invasive fungal infections.
Program Overview
This case-based CME/CPE/CNE activity is focused on addressing causes of treatment failure in serious fungal infections to improve patient outcomes. Using a multidisciplinary approach, the faculty will address inadequate testing, antifungal resistance, adherence issues, source control, and pharmacologic issues, including inadequate use of therapeutic drug monitoring. The cases will span resistant dermatophytes, coccidioidomycosis, candidemia, and an invasive mold infection.
Learning Objectives
Upon completion of this activity, participants should be able to:
- Evaluate potential causes of treatment failure with antifungal therapy
- Optimize the pharmacology of antifungal therapies, with a particular eye to therapeutic drug monitoring
- Select appropriate antifungal therapy for patients who have failed first-line therapy
- Educate patients about antifungal resistance, adherence issues, and pharmacologic challenges that can lead to antifungal treatment failure
- Work as an interdisciplinary team to identify and remedy causes of antifungal treatment failure
Faculty
CHAIRPERSON
Peter G. Pappas, MD, FACP
Emeritus Professor
Chair, Scientific Committee MSGERC
Department of Medicine, Division of Infectious Diseases
University of Alabama at Birmingham
Birmingham, Alabama
Dr Peter G. Pappas is the Emeritus Professor of Medicine in the Division of Infectious Diseases at the University of Alabama in Birmingham (UAB). Dr Pappas was the inaugural William E. Dismukes Professor of Medicine and the first Tinsley Harrison Clinical Scholar at UAB. He attended medical school at the UAB, graduating in 1978. He completed his residency in internal medicine, chief medical residency, and infectious diseases fellowship at the University of Washington in Seattle. Following completion of his fellowship, he was on the clinical faculty at the University of North Carolina School of Medicine in Chapel Hill, NC, through its affiliated hospital in Wilmington, NC. In 1988, he joined the faculty at the University of Alabama in Birmingham School of Medicine, with a focus on HIV and transplant-associated opportunistic infections, especially the invasive mycoses. His main areas of interest over the last three decades have included the development of new therapies for fungal infections, fungal diagnostics, and understanding the epidemiology of candidiasis, the endemic mycoses, and cryptococcosis. He has performed numerous clinical trials in candidiasis, cryptococcosis, aspergillosis, sporotrichosis, blastomycosis, and histoplasmosis through his involvement with the NIAID Mycoses Study Group and the Mycosis Study Group Education and Research Consortium (MSGERC).
Dr Pappas is Chair of the Scientific Committee of the MSGERC. He is also the principal investigator for the MSG Central Unit at the University of Alabama in Birmingham from which most MSG clinical trials are administered. He has served as principal investigator of a national network of transplant centers, TRANSNET, in conjunction with the US Centers for Disease Control and Prevention and a consortium of industry co-sponsors to provide important epidemiologic and treatment information to transplant recipients who develop proven and probable invasive fungal infections. More recently, he served as co-principal investigator of the Organ Transplant Infection Detection and Prevention Program (OTIP), a collaborative multicenter group funded by the CDC.
Jeremy Gold, MD, MS
Epidemiologist
Mycotic Diseases Branch
Division of Foodborne, Waterborne, and Environmental Diseases
Centers for Disease Control and Prevention
Atlanta, Georgia
Jeremy Gold, MD, MS graduated from medical school at Albert Einstein College of Medicine and completed his residency in internal medicine at Columbia University Medical Center/New York Presbyterian Hospital in 2019. After residency, he served as epidemic intelligence service officer with CDC’s Mycotic Diseases Branch, where he continues to work as a medical epidemiologist. His primary interests include the epidemiology and prevention of mold infections.
James S. Lewis, II, PharmD, FIDS
Adjunct Associate Professor
Departments of Pharmacy & Infectious Disease
Oregon Health & Sciences University
Portland, Oregon
James Lewis is the clinical supervisor for Infectious Disease. His responsibilities include co-directing the OHSU antibiotic stewardship program and serving as the infectious diseases clinical pharmacist for OHSU. He is the co-chair of the antibiotic subcommittee of the Clinical Knowledge and Therapeutics Executive Committee (formerly Pharmacy and Therapeutics Committee) and serves as the PGY-1 &2 ID rotation preceptor. Dr Lewis’ professional interests are antibiotic susceptibility testing, antibiotic/antifungal utilization, and the optimal integration of rapid microbiology diagnostics in antibiotic stewardship. Dr Lewis also currently serves as the co-chair of the breakpoint working group of the Clinical and Laboratory Standards Institute and is a member of the editorial board for Antimicrobial Agents and Chemotherapy.
Meghan Lyman, MD
Medical Officer
Mycotic Diseases Branch
Division of Foodborne, Waterborne, and Environmental Diseases
Centers for Disease Control and Prevention
Atlanta, Georgia
Meghan Lyman, MD, is a medical officer in the Mycotic Diseases Branch, Centers for Disease Control and Prevention. She began her career at CDC focusing on health care-associated infections and infection control and is now leveraging that experience within the Mycotic Diseases Branch to prevent a wide range of fungal diseases.
Rob Purdie
Founding Member, MyCARE
Coccidioidal Meningitis Patient
Patient and Program Coordinator, Valley Fever Institute
Bakersfield, California
With over a decade of experience fighting coccidioidal meningitis, Robert (Rob) Purdie brings a unique perspective and passion to mycology advocacy. Rob is the patient and program development coordinator at the Valley Fever Institute at Kern Medical Center and a founding member of MyCARE. He is a lifelong Bakersfield resident who was diagnosed with coccidioidomycosis in 2012. Since his diagnosis, he has been dedicated to raising awareness of the impact Valley Fever has on individuals and communities and fighting to improve outcomes for his fellow patients fighting this challenging fungal infection.
Rob has spearheaded several awareness campaigns for Valley Fever. He has shared his personal knowledge and experience with many media entities at the local, state, and national level and internationally. His efforts include bringing community awareness through events such as the Valley Fever Walk, which he has helped organize since 2016.
Rob’s legislative efforts have included involvement in multiple aspects of California Assembly Bills on Valley Fever, resulting in $8 million in budget allocations for awareness and research. Rob has continued his efforts at the federal level working with patients and stakeholders to support legislation to improve patient outcomes.
Rob has been a sponsored participant and presenter at workshops hosted by the NIH and FDA, provided patient advocacy at a Valley Fever Roundtable in Washington DC and recently at an international roundtable on fungal infections. He coauthored an article published in Clinical Infectious Diseases(CID), a leading journal in the field of infectious diseases with a broad international readership. Rob has many additional presentations scheduled, providing a voice for patients at several research and policy symposiums and meetings in 2023.
Rob’s desire to become involved in broader advocacy efforts springs from the relationships he has built with researchers, clinicians, and stakeholders and the realization that the issues experienced by Valley Fever patients are similar to those of other patients with fungal disease. His path to addressing the broader need was provided through collaborations established under a CDC cooperative agreement in mycology. Through these collaborations, Rob connected with additional members of the mycology community who shared his passion and vision for improving the lives of those battling fungal diseases. With Rob’s passion and guidance, MyCARE will make a difference for patients across the mycology spectrum.
Dallas Smith, PharmD
Epidemic Intelligence Officer
Mycotic Diseases Branch
Division of Foodborne, Waterborne, and Environmental Diseases
Centers for Disease Control and Prevention
Atlanta, Georgia
Dallas Smith, PharmD, is an epidemic intelligence service officer with the Mycotic Diseases Branch at the Centers for Disease Control and Prevention. He received his doctor of pharmacy degree from the University of Findlay in 2017. He then joined the United States Peace Corps, serving in Cambodia from 2017–2019 as a community health educator and Malawi from 2019–2020 as a clinical pharmacy and pharmacognosy lecturer. His main research interests are endemic mycoses and fungal neglected tropical diseases.
Mitsuru Toda, MS, PhD
Epidemiologist, Outbreaks & Endemics Unit (OEU) Lead
Mycotic Diseases Branch
Division of Foodborne, Waterborne, and Environmental Diseases
Centers for Disease Control and Prevention
Atlanta, Georgia
Mitsuru Toda, MS, PhD is an epidemiologist and the lead of Outbreaks &aamp; Endemics Unit at CDC’s Mycotic Diseases Branch at the National Center for Emerging and Zoonotic Infectious Diseases (NCEZID). Dr Toda received her PhD from Nagasaki University Graduate School of Biomedical Sciences, and her master’s degree in science from Harvard University T.H. Chan School of Public Health. Dr Toda joined CDC as an epidemic intelligence service (EIS) officer in 2017.
Jo-Anne Young, MD
Professor of Medicine
Division of Infectious Diseases and International Medicine
University of Minnesota Medical School
Minneapolis, Minnesota
Jo-Anne Young (née van Burik), MD, is a professor of medicine and medical director of the Program in Adult Transplant Infectious Disease. She joined the faculty in 1999. She received both her BA and MD from Case Western Reserve University and completed a residency in medicine at Vanderbilt University Medical Center. Her fellowship in infectious disease and several years of junior faculty service were at the University of Washington with the Fred Hutchinson Cancer Research Center. Dr Young's primary area of interest is bringing diagnostic and treatment opportunities to the bedside for transplant patients. She has worked on developing diagnostic testing for complicated fungal infections of the immunocompromised host. Currently, Dr Young is lead investigator at the University of Minnesota for multiple clinical trials on bacterial, viral, and fungal agents, as well as vaccines, for transplant patients.
Accreditation Statement
In support of improving patient care, this activity has been planned and implemented by the Postgraduate Institute for Medicine (PIM); Terranova Medica, LLC; and the Mycoses Study Group Education and Research Consortium (MSGERC), Postgraduate Institute for Medicine is jointly accredited by the Accreditation Council for Continuing Medical Education (ACCME), the Accreditation Council for Pharmacy Education (ACPE), and the American Nurses Credentialing Center (ANCC), to provide continuing education for the health care team.
Credit Designation
Physician Continuing Medical Education
The Postgraduate Institute for Medicine designates this enduring material for a maximum of 2 AMA PRA Category 1 Credit™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.
Continuing Nursing Education
The maximum number of hours awarded for this Continuing Nursing Education activity is 2.0 contact hour. Designated for 1 contact hour of pharmacotherapy credit for Advanced Practice Registered Nurses.
Continuing Pharmacy Education
Postgraduate Institute for Medicine designates this continuing education activity for 2.0 contact hours (0.20 CEUs) of the Accreditation Council for Pharmacy Education.
Universal Activity Number JA4008162-9999-23-219-H01-P
Type of Activity: Knowledge
Interprofessional Continuing Education
This activity was planned by and for the health care team, and learners will receive 2.0 Interprofessional Continuing Education (IPCE) credit for learning and change.
Disclosures of Conflicts of Interest
- Peter G. Pappas, MD, FACP
- RESEARCH SUPPORT: Melinta, Astellas, Scynexis
- CONSULTANT: F2G, Melinta, Matinas, Scynexis
Jeremy Gold, MD, MS, has nothing to disclose.
- James S. Lewis, II, PharmD, FIDSA
- CONSULTANT: Merck, Cidara, SeLux
Meghan Lyman, MD, has nothing to disclose.
- Rob Purdie
- CONSULTANT: Clinical Outcome Solutions
Dallas Smith, PharmD, has nothing to disclose.
Mitsuru Toda, MS, PhD, has nothing to disclose.
- Jo-Anne Young, MD
- RESEARCH SUPPORT: F2G, Pulmocide, Scynexis
- CONSULTANT: AlloVir
Managers and Planning Committee Disclosures
Lisa A. Tushla, PhD, H(ASCP) of Terranova Medica, LLC, discloses research support from Bristol Myers Squibb and Novartis. The PIM planners have nothing to disclose.
Instructions for Participation and Credit
There are no fees for participating and receiving CME credit for this enduring activity. To receive CME credit participants must:
- Read the CME/CE information and faculty disclosures.
- Participate in the online activity.
- Submit the evaluation form.
Certificates will be emailed to the participant.
Course Viewing Requirements
Supported Browsers:
Internet Explorer 8.0+ for Windows 2003, Vista, XP, Windows 7, Windows 8.1 and above
Google Chrome 28.0+ for Windows, Mac OS, or Linux
Mozilla Firefox 23.0+ for Windows, Mac OS, or Linux
Safari 6.0+ for Mac OSX 10.7 and above
Supported Phones & Tablets:
Android 4.0.3 and above
iPhone/iPad with iOS 6.1 or above
Disclosure of Unlabeled Use
This educational activity may contain discussion of published and/or investigational uses of agents that are not indicated by the US Food and Drug Administration (FDA). The planners of this activity do not recommend the use of any agent outside of the labeled indications. The opinions expressed in the educational activity are those of the faculty and do not necessarily represent the views of the planners. Please refer to the official prescribing information for each product for discussion of approved indications, contraindications, and warnings.
Disclaimer
Participants have an implied responsibility to use the newly acquired information to enhance patient outcomes and their own professional development. The information presented in this activity is not meant to serve as a guideline for patient management. Any procedures, medications, or other courses of diagnosis or treatment discussed or suggested in this activity should not be used by clinicians without evaluation of their patient’s conditions and possible contraindications and/or dangers in use, review of any applicable manufacturer’s product information, and comparison with recommendations of other authorities.
Contact Information
For CME questions please contact: [email protected].