Prolonged neutropenia, corticosteroid use, and hematologic malignancy are major risk factors for invasive fungal infections like aspergillosis and candidiasis. Other risk factors include solid organ transplant, HIV infection, diabetes, burns, and prolonged ICU stay. Treatment of candidemia typically involves an echinocandin as primary therapy which can be stepped down to fluconazole for stable patients with susceptible isolates. Voriconazole is recommended as primary treatment for invasive aspergillosis.

1. This Practice Aid has been provided as a quick reference to help learners apply the information to their daily practice and care of patients.
Risk Factors for Invasive Fungal Infections
PRACTICE AID
Invasive Aspergillosis1-3
Prolonged neutropenia—main risk factor
Allogeneic hematopoietic stem cell transplant
Solid organ transplant
Immunodeficiency
Corticosteroid use
Hematologic malignancy
Influenza
Prolonged ICU stay
Chronic obstructive pulmonary disease
Renal or liver dysfunction
Invasive Candidiasis4
Immunosuppression
Neutropenia
Mucositis
Advanced age
Deteriorating health
Catheter use
Total parenteral nutrition
Surgical intervention
(notably major intra-abdominal procedures)
Prolonged use of broad-spectrum antibiotics
Prolonged hospital stay
Corticosteroid use
Pancreatitis
Any type of dialysis
Access the activity, “Overcoming Barriers to Optimal Diagnosis and Treatment of Invasive Fungal Infections:
Practical Guidance for the Hospital-Based Healthcare Provider,” at www.peerview.com/PDT40.

2. This Practice Aid has been provided as a quick reference to help learners apply the information to their daily practice and care of patients.
Risk Factors for Invasive Fungal Infections
1. Oren I, Paul M. Clin Microbiol Infect. 2014;20(suppl 6):1-4. 2. Patterson TF et al. Clin Infect Dis. 2016;63:433-442. 3. Vazquez L. Mediterr J Hematol Infect Dis. 2016;8:e2016040. 4. Yapar N. Ther Clin Risk Manag. 2014;10:95-105. 5. Ibrahim AS et al. Clin Infect Dis. 2012;54(suppl 1):s16-s22.
6. Petrikkos G et al. Clin Infect Dis. 2012;54(suppl 1):s23-s34. 7. Pyrgos V et al. PLoS One. 2013;8:e56269. 8. Lin YY et al. PLoS One. 2015;10:e0119090.
PRACTICE AID
Access the activity, “Overcoming Barriers to Optimal Diagnosis and Treatment of Invasive Fungal Infections:
Practical Guidance for the Hospital-Based Healthcare Provider,” at www.peerview.com/PDT40.
Mucormycosis5,6
Uncontrolled diabetes with ketoacidosis
Immunosuppression
Organ transplant
Neutropenia
Trauma and burns
Hematologic malignancy
Deferoxamine therapy in hemodialysis
Elevated serum iron level
Malnutrition
Renal or liver dysfunction
Cryptococcal Meningitis7,8
HIV
Immunosuppressive therapy
Corticosteroid use
Chemotherapy
Autoimmune disease
Liver disease

3. This Practice Aid has been provided as a quick reference to help learners apply the information to their daily practice and care of patients.
Treatment of Candidemia and
Invasive Candidiasis in Adults1,a
a
Refer to the guidelines for detail prescribing information and additional clinical information.
1. Pappas PG et al. Clin Infect Dis. 2016;62:e1-e50.
PRACTICE AID
Access the activity, “Overcoming Barriers to Optimal Diagnosis and Treatment of Invasive Fungal Infections:
Practical Guidance for the Hospital-Based Healthcare Provider,” at www.peerview.com/PDT40.
Non-Neutropenic Adults Neutropenic Adults
• Recommended: an echinocandin
• Alternatives: lipid formulation of
amphotericin B (potential for toxicity),
fluconazole (not critically ill and
no prior azole exposure), voriconazole
(when additional mold coverage desired)
• Recommended: an echinocandin
• Alternatives: fluconazole (not critically ill
and considered unlikely to have
fluconazole-resistant Candida species),
lipid formulation of amphotericin B
(if there is intolerance, limited availability,
or resistance to other antifungals)
• Transition from an echinocandin or lipid
formulation amphotericin B to fluconazole:
appropriate (usually within 5-7 days)
in patients who are clinically stable,
have isolates that are susceptible to
fluconazole, and have negative repeat
blood cultures following initiation of
antifungal therapy
• Transition to higher-dose fluconazole or
voriconazole for Candida glabrata infection:
only consider for patients with fluconazole-
susceptible or voriconazole-susceptible
isolates
• Fluconazole during persistent neutropenia:
clinically stable patients who have
fluconazole-susceptible isolates and
documented bloodstream clearance
• Voriconazole during neutropenia:
clinically stable patients who have
voriconazole-susceptible isolates and
documented bloodstream clearance
Primary
Therapy
Step-Down
Therapy

4. This Practice Aid has been provided as a quick reference to help learners apply the information to their daily practice and care of patients.
Treatment of Invasive Syndromes
of Aspergillus1,a
ABLC: amphotericin B lipid complex; AmB: amphotericin B; GM: galactomannan; IA: invasive aspergillosis; IFI: invasive fungal infection.
a
Refer to the guidelines for detailed prescribing information and additional clinical information.
1. Patterson TF et al. Clin Infect Dis. 2016;63:e1-e60.
PRACTICE AID
Access the activity, “Overcoming Barriers to Optimal Diagnosis and Treatment of Invasive Fungal Infections:
Practical Guidance for the Hospital-Based Healthcare Provider,” at www.peerview.com/PDT40.
Primary
• Voriconazole
Alternative
• Primary: liposomal AmB, isavuconazole
• Salvage: ABLC, caspofungin, micafungin, posaconazole, itraconazole suspension
Prophylaxis against IA
• Primary: posaconazole
• Alternative: voriconazole, itraconazole suspension, micafungin,
caspofungin
Empiric and preemptive antifungal therapy
• Empiric antifungal therapy: liposomal AmB, caspofungin,
micafungin, voriconazole
• Preemptive therapy is a logical extension of empiric antifungal therapy in
defining a high-risk population with evidence of IFI
(eg, pulmonary infiltrate, positive GM assay result)
Invasive pulmonary
aspergillosis
Invasive sinus
aspergillosis
Aspergillosis
of the CNS
Aspergillus
infections of
the heart
Aspergillus
osteomyelitis and
septic arthritis
Cutaneous
aspergillosis
Aspergillus
peritonitis