A Care Step Pathway for the Diagnosis and Treatment of COVID-19-Associated Invasive Fungal Infections in the Intensive Care Unit

Carolynn T Jones; R Scott Kopf; Lisa Tushla; Sarah Tran; Caroline Hamilton; Meghan Lyman; Rachel McMullen; Drashti Shah; Angela Stroman; Eryn Wilkinson; Daniel Kelmenson; Jose Vazquez; Peter G Pappas

doi:10.4037/ccn2022237

A Care Step Pathway for the Diagnosis and Treatment of COVID-19-Associated Invasive Fungal Infections in the Intensive Care Unit

Crit Care Nurse. 2022 Dec 1;42(6):36-46. doi: 10.4037/ccn2022237.

Authors

Carolynn T Jones¹, R Scott Kopf², Lisa Tushla³, Sarah Tran⁴, Caroline Hamilton⁵, Meghan Lyman⁶, Rachel McMullen⁷, Drashti Shah⁸, Angela Stroman⁹, Eryn Wilkinson¹⁰, Daniel Kelmenson¹¹, Jose Vazquez¹², Peter G Pappas¹³

Affiliations

¹ Carolynn T. Jones is a clinical professor at The Ohio State University, College of Nursing, Columbus, Ohio, and the Executive Director and Nurse Planner for the Mycoses Study Group Education and Research Consortium.
² R. Scott Kopf is a nurse practitioner, Division of Pulmonary and Critical Care Medicine at the University of Alabama at Birmingham, Birmingham, Alabama.
³ Lisa Tushla is the President of Terranova Medica, LLC, Colorado Springs, Colorado.
⁴ Sarah Tran is an assistant professor of medicine, Division of Infectious Diseases at Augusta University, Augusta, Georgia.
⁵ Caroline Hamilton is an antibiotic stewardship physician assistant, Division of Infectious Diseases at Augusta University.
⁶ Meghan Lyman is a medical officer in the Mycotic Diseases Branch at the Centers for Disease Control and Prevention, Atlanta, Georgia.
⁷ Rachel McMullen is a clinical research administrator III and manages the Mycoses Study Group Central Unit at the University of Alabama at Birmingham.
⁸ Drashti Shah is a researcher I at the Mycoses Study Group Central Unit at the University of Alabama at Birmingham.
⁹ Angela Stroman is a nurse clinician, Infectious Diseases Translational Research Unit and a Doctor of Nursing Practice student at Augusta University.
¹⁰ Eryn Wilkinson was a student worker at Terranova Medica LLC, at the time this article was written.
¹¹ Daniel Kelmenson is an assistant professor of medicine, Division of Pulmonary and Critical Care Medicine at the University of Alabama at Birmingham.
¹² Jose Vazquez is a professor of medicine and the Section Chief of the Division of Infectious Diseases at Augusta University. He is on the Board of Directors of the Mycoses Study Group Education and Research Consortium.
¹³ Peter G. Pappas is the William E. Dismukes Professor of Medicine in the Division of Infectious Diseases, and Tinsley Harrison Clinical Scholar, Department of Medicine, at the University of Alabama at Birmingham. He is Chair of the Mycoses Study Group Education and Research Consortium Scientific Committee.

PMID: 35940595
DOI: 10.4037/ccn2022237

Abstract

Background: In March 2020, the World Health Organization declared COVID-19, caused by the SARS-CoV-2 virus, a pandemic. Patients with severe cases resulting in hospitalization and mechanical ventilation are at risk for COVID-19-associated pulmonary aspergillosis, an invasive fungal infection, and should be screened for aspergillosis if they have persistent hemodynamic instability and fever. Early detection and treatment of this fungal infection can significantly reduce morbidity and mortality in this population.

Objective: To develop an evidence-based care step pathway tool to help intensive care unit clinicians assess, diagnose, and treat COVID-19-associated pulmonary aspergillosis.

Methods: A panel of 18 infectious disease experts, advanced practice registered nurses, pharmacists, and clinical researchers convened in a series of meetings to develop the Care Step Pathway tool, which was modeled on a tool developed by advanced practice nurses to evaluate and manage side effects of therapies for melanoma. The Care Step Pathway tool addresses various aspects of disease management, including assessment, screening, diagnosis, antifungal treatment, pharmacological considerations, and exclusion of other invasive fungal coinfections.

Results: The Care Step Pathway tool was applied in the care of a patient with COVID-19-associated aspergillosis. The patient was successfully treated.

Conclusion: The Care Step Pathway is an effective educational tool to help intensive care unit clinicians consider fungal infection when caring for COVID-19 patients receiving mechanical ventilation in the intensive care unit, especially when the clinical course is deteriorating and antibiotics are ineffective.

MeSH terms

COVID-19*
Humans
Intensive Care Units
Invasive Fungal Infections*
Pulmonary Aspergillosis*
SARS-CoV-2