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Care Step Pathway for a Suspected Pulmonary COVID-19-Associated IFI

The primary goal of this initiative is educating and preparing clinical providers and public health workers to address the needs of the population of COVID-19 patients most seriously compromised by the disease, specifically those with respiratory failure requiring mechanical ventilation who are at risk for or who subsequently develop COVID-19-associated pulmonary aspergillosis (CAPA) or other COVID-19-associated invasive fungal infections (CA-IFIs).

Through the use of a proprietary step-based pathway (Care Step Pathway, CSP), we have operationalized this content in an easy-to-use format that can be reproduced for in-clinic application, printed from the web, and updated regularly on our web resource page.

We also provide a companion document that reviews the process for creating the CSP, the rationale for the recommendations, and the literature to support it. The companion document also discusses key points regarding antifungal stewardship and infection control and prevention.

The CSP format has been designed for use by the entire multidisciplinary care team and thus can draw together the critical care/nursing care staff and intensivists/infectious diseases specialists in a meaningful manner (https://aimwithimmunotherapy.org/care-step-pathways/). The CSP has been recognized as an effective educational tool for multidisciplinary care (Wood 2019).

The CSP content focuses on

• Identifying at-risk patients who meet clinical criteria
• Diagnostic strategy
• CAPA definitions and management recommendations
• Non-CAPA IFIs to evaluate for
• Pharmacologic considerations, infection control/prevention, antifungal stewardship, and implementation strategies

The literature, epidemiologic data, and ongoing research will evolve over the course of the year, and we will update the CSP with refined information/guidance in real time.

Reference
Wood LS, Wood LS, Hoffner B, Rubin K, Davies MJ, Tushla LA, Guild V, Guild SR. Managing immune-related adverse events (irAEs): A new educational  resource for health care professionals (HCPs) and patients. Poster C9. Poster presented at the ASCO-SITC Clinical Immuno-Oncology Symposium, February 28-March 2, 2019, San Francisco, CA.