Archive for January, 2009
Prevalence of esophageal candidiasis among patients treated with inhaled fluticasone propionate
The American Journal of Gastroenterology Mar 2004 V.98 N.10 p.2146-2148
Naoki Kanda, M.D. a , Hirotaka Yasuba, M.D., Ph.D. b , Teruko Takahashi, M.D. c , Yuka Mizuhara, M.D. c , Syuji Yamazaki, M.D. c , Yuko Imada, M.D. c , Yoshio Izumi, M.D. c , Yoshiki Kobayashi, M.D. b , Kenzo Yamashita, M.D. b , Hideo Kita, M.D., Ph.D. b , Takashi Tamada, M.D., Ph.D. c , Tsutomu Chiba, M.D., Ph.D. a *
a Department of Gastroenterology and Hepatology, Kyoto University Graduate School of Medicine, Kyoto, Japan
b Department of Respiratory Medicine, Takatsuki Red Cross Hospital, Osaka, Japan
c Department of Internal Medicine, Takatsuki Red Cross Hospital, Osaka, Japan
Objectives Development of oropharyngeal candidiasis is a frequently reported adverse effect of inhaled corticosteroid use, but the prevalence of esophageal candidiasis is unknown. The aim of this study was to estimate the prevalence of esophageal candidiasis among patients treated with an inhaled corticosteroid, fluticasone propionate.
Methods Upper GI endoscopy was performed on 49 patients treated with inhaled fluticasone propionate to examine the prevalence of esophageal candidiasis. Of the patients, 36 had bronchial asthma and 13 had chronic obstructive pulmonary disease. To compare the prevalence with control patients, upper GI endoscopy was performed on 700 consecutive patients without malignancy or immunosuppression.
Results The prevalence of esophageal candidiasis was 37% among patients treated with inhaled fluticasone propionate, whereas only 0.3% of the control patients had the infection. The prevalence was especially high among patients with diabetes mellitus or those who were treated with a high dose of inhaled fluticasone propionate. Moreover, a reduction in the daily dose of inhaled fluticasone propionate eliminated the infection in four of five patients.
Conclusions Esophageal candidiasis is a common complication of inhaled corticosteroid use.
abstract
http://www3.interscience.wiley.com/journal/118862316/abstract?CRETRY=1&SRETRY=0
http://www3.interscience.wiley.com/cgi-bin/fulltext/118862316/PDFSTART
Add comment January 31, 2009
Risk Factors for Esophageal Candidiasis
European Journal of Clinical Microbiology & Infectious Diseases Mar 2000 V.19 N.2 p.96-100
A. Chocarro Martínez1, F. Galindo Tobal1, G. Ruiz-Irastorza2, A. González López1, F. Alvarez Navia1, C. Ochoa Sangrador3 and M.I. Martín Arribas1
(1) Department of Internal Medicine, Hospital “Virgen de la Concha”, Avenida de Requejo 31-33, 49022 Zamora, Spain e-mail: achocarrom@medynet.com, ES
(2) Department of Internal Medicine, Hospital de Mendaro, Mendaro, Guipúzcoa, Spain, ES
(3) Unit of Research, Hospital “Virgen de la Concha”, Avenida de Requejo 31-33, 49022 Zamora, Spain, ES
Abstract The role of gastric acid inhibitors as predisposing factors for Candida esophagitis is unknown. A retrospective case-control study of esophageal candidiasis was conducted in human immunodeficiency virus (HIV)-negative patients diagnosed from January 1991 to December 1997. The diagnosis of esophageal candidiasis was always made on the basis of endoscopic and histological criteria. Fifty-one patients were diagnosed with esophageal candidiasis, 15 of whom had esophageal complaints and 48 of whom suffered from another previous chronic disease (17 had cancer). In addition, 20 patients had previously been treated with antibiotics, 13 with steroids and 14 with omeprazole. In the multivariate analysis, neoplasm (odds ratio, 5.50; 95% confidence interval, 1.94–15.56) and therapy with antibiotics (odds ratio, 11.97; 95% confidence interval, 3.82–37.45), steroids (odds ratio, 35.52; 95% confidence interval, 3.90–324.01) or omeprazole (odds ratio, 18.23; 95% confidence interval, 4.67–71.03) were all associated with esophageal candidiasis. These data suggest that Candida esophagitis tends to occur in patients with chronic diseases, most of whom have been previously treated with antibiotics, steroids or omeprazole. The findings support the hypothesis that treatment with omeprazole favors the development of esophageal candidiasis.
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Add comment January 31, 2009
Candidiasis esofágica en pacientes inmunocompetentes: Estudio clínico e inmunológico
Revista Médica de Chile Nov. 2004 V.132 p.1394-1389
Clinical and immunological study of 10 immunocompetent patients with esophageal candidiasis
Claudia Cortés M1, Danny Oksenberg R2, Alejandro Afani S3, Carlos Defilippi C2, Ana María Madrid S2.
1Sección Medicina Interna, Hospital Clínico Universidad de Chile, Chile.
2Centro de Gastroenterología, Hospital Clínico Universidad de Chile, Chile.
3Sección Inmunología, Hospital Clínico Universidad de Chile, Chile.
Background: Esophageal candidiasis is associated with conditions that cause an immune depression. It is a defining disease for AIDS, is observed in poorly controlled diabetics, in patients with renal or hepatic failure, in patients with cancer and in subjects using medications causing immunosuppression or broad spectrum antimicrobials.
Aim: To report the features of 10 immunocompetent patients with esophageal candidiasis.
Patients and methods: Six males and four females aged between 48 and 82 years, without conditions associated with immunosuppression, in whom an esophageal candidiasis was found on an upper gastrointestinal endoscopy. Delayed skin hypersensitivity to eight antigens, Iymphocyte subpopulations, yeast phagocytosis and neutrophil chemotaxis were measured.
Results: Six patients had a low CD4 Iymphocyte count and seven had a low CD8 count. Seven patients were anergic on skin hypersensitivity challenge. Yeast phagocytosis was abnormal in one patient and neutrophil chemotaxis was abnormal in two. Humoral immunity was normal in all subjects. All patients were treated with oral fluconazole in doses of 150 mg/day for 14 days, with complete resolution of candidiasis in all.
Conclusions: Patients with esophageal candidiasis, have frequent alterations of cellular immunity, that must be diagnosed and treated.
Full Text
http://www.scielo.cl/scielo.php?pid=S0034-98872004001100008&script=sci_arttext
Add comment January 31, 2009
Vancomycin Ototoxicity: a Reevaluation in an Era of Increasing Doses
Antimicrobial Agents and Chemotherapy 1 Feb 2009 V.53 N.2 p.483-486
Avisheh Forouzesh,1 Pamela A. Moise,2 and George Sakoulas1,3*
Division of Infectious Diseases, New York Medical College, Valhalla, New York,1 University of the Pacific School of Pharmacy, Stockton,2 Department of Medicine, Sharp Memorial Hospital, San Diego, California3
Nephrotoxicity and ototoxicity have historically been documented as relatively rare complications of vancomycin monotherapy. Recent reports have linked aggressive vancomycin dosing strategies to significant risks of nephrotoxicity. We evaluated the rate of high-frequency hearing loss detected by audiometry for patients on vancomycin therapy. For this purpose, we used retrospective case-control analysis of audiometry results for patients on vancomycin therapy for whom baseline and follow-up exams were available. Analysis of 89 patients for whom audiograms were performed after an average of 27 days of vancomycin therapy showed a 12% rate of high-frequency hearing loss, with a trend in univariate analysis toward a higher rate with advanced age. The mean of the highest vancomycin trough levels for both patients with worsening audiograms and those without worsening audiograms was 19 mg/liter. Regression tree modeling demonstrated that for patients <53 years old, the rate of high-frequency hearing loss detected by audiogram was 0%, while for patients >53 years old, the incidence was 19% (P = 0.008). We conclude that a significant rate of high-frequency hearing loss in older patients receiving vancomycin monotherapy was detected by audiometry. While these data urge caution against continued indiscriminate vancomycin dose escalation to treat infections caused by Staphylococcus aureus strains for which vancomycin MICs are 2 mg/liter, further prospective studies are needed to determine the clinical significance and reversibility of these effects.
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Add comment January 29, 2009
Reassessment of Recommended Imipenem Doses in Febrile Neutropenic Patients with Hematological Malignancies
Antimicrobial Agents and Chemotherapy 1 Feb 2009 V.53 N.2 p.785-787
F. Lamoth,1, T. Buclin,2, C. Csajka,2 A. Pascual,1 T. Calandra,1 and O. Marchetti1*
Infectious Diseases Service,1 Division of Clinical Pharmacology and Toxicology, Department of Medicine, Centre Hospitalier Universitaire Vaudois and University of Lausanne, Lausanne, Switzerland2
Imipenem plasma concentrations were analyzed in 57 febrile neutropenic patients using the NONMEM program. The recommended 2-g/day regimen achieved coverage of the most common bacteria (MIC90 = 1 mg/liter) during the whole dosing interval in only 53% of patients. This goal was achieved in 90% of patients with 3 g/day.
abstract
Add comment January 29, 2009
Changing Challenges of Bacterial Enteric Infection in the United States
The Journal of Infectious Diseases 15 February 2009 V.199 N.4 p.465-466
EDITORIAL COMMENTARY
Timothy F. Jones
Tennessee Department of Health, Nashville
abstract
http://www.journals.uchicago.edu/doi/full/10.1086/596556
Add comment January 28, 2009
Tri-County Comprehensive Assessment of Risk Factors for Sporadic Reportable Bacterial Enteric Infection in Children
The Journal of Infectious Diseases 15 February 2009 V.199 N.4 p.467–476
Donna M. Denno,1 William E. Keene,9 Carolyn M. Hutter,2 Jennifer K. Koepsell,4 Marianne Patnode,6
Denny Flodin-Hursh,6 Laurie K. Stewart,4 Jeffrey S. Duchin,3,4 Laurette Rasmussen,7 Robert Jones,5 and Phillip I. Tarr8
Departments of 1Pediatrics and Global Health and 2Epidemiology and Biostatistics and 3Division of Allergy and Infectious Diseases, University of Washington, 4Public Health—Seattle and King County, and 5Craic Computing, Seattle, 6Yakima Health District, Union Gap, 7Whatcom County Health Department, Bellingham, Washington; 8Departments of Pediatrics and Molecular Microbiology, Washington University, St. Louis, Missouri; 9State of Oregon Public Health Division, Portland
Background.The aim of this study was to determine risk factors for childhood sporadic reportable enteric infection (REI) caused by bacteria, specifically Campylobacter, Salmonella, Escherichia coli O157, or Shigella (REI-B).
Methods.Matched case-control study. Case patients aged <19 years who were reported to 3 Washington State county health departments and matched control subjects were interviewed from November 2003-November 2005. Matched odds ratios (ORs) were calculated by using conditional logistic regression. Population attributable risk percentages were calculated for exposures associated with infection.
Results.Two hundred ninety-six case patients were matched to 580 control subjects. Aquatic recreation was the most important factor associated with all REI-Bs studied (beach water exposure [OR for Salmonella infection, 28.3 {CI, 7.2–112.2}; OR for Shigella infection, 14.5 {CI 1.5–141.0} or any recreational water exposure [OR for Campylobacter infection, 2.7 {CI, 1.5–4.8}; OR for Escherichia coli O157 infection, 7.4 {CI, 2.1–26.1}]). Suboptimal kitchen hygiene after preparation of raw meat or chicken (OR, 7.1 [CI, 2.1–24.1]) and consumption of food from restaurants were additional risks for Campylobacter infection. Infection with Salmonella was associated with the use of private wells as sources of drinking water (OR, 6.5 [CI, 1.4–29.7]), and the use of residential septic systems was a risk for both Salmonella (OR, 3.2 [CI, 1.3–7.8]) and E. coli (OR, 5.7 [CI, 1.2–27.2]) O157 infection.
Conclusions.Overall, non-food exposures were as important as food-related exposures with regard to their contributions to the proportion of cases. Infection prevention efforts should address kitchen hygiene practices and non-food exposures, such as recreational water exposure, in addition to food-consumption risks.
abstract
http://www.journals.uchicago.edu/doi/abs/10.1086/596555
Add comment January 28, 2009
Daptomycin Pharmacokinetics in Adult Oncology Patients with Neutropenic Fever
Antimicrobial Agents and Chemotherapy 1 Feb 2009 V.53 N.2 p.428-434
Joseph S. Bubalo,1 Myrna Y. Munar,2* Ganesh Cherala,2 Brandon Hayes-Lattin,3 and Richard Maziarz3
Department of Pharmacy Services, Oregon Health & Science University, 3181 SW Sam Jackson Park Road, CR9-4, Portland, Oregon 97239,1 Department of Pharmacy Practice, Oregon State University/Oregon Health & Science University College of Pharmacy, 3303 SW Bond Avenue, CH12C, Portland, Oregon 97239,2 Bone Marrow Transplant Program, Oregon Health & Science University, 3181 SW Sam Jackson Park Road, Portland, Oregon 972393
Daptomycin is the first antibacterial agent of the cyclic lipopeptides with in vitro bactericidal activity against gram-positive organisms, including vancomycin-resistant enterococci, methicillin-resistant staphylococci, and glycopeptide-resistant Staphylococcus aureus. The pharmacokinetics of daptomycin were determined in 29 adult oncology patients with neutropenic fever. Serial blood samples were drawn at 0, 0.5, 1, 2, 4, 8, 12, and 24 h after the initial intravenous infusion of 6 mg/kg of body weight daptomycin. Daptomycin total and free plasma concentrations were determined by high-pressure liquid chromatography. Concentration-time data were analyzed by noncompartmental methods. The results (presented as means ± standard deviations and ranges, unless indicated otherwise) were as follows: the maximum concentration of drug in plasma (Cmax) was 49.04 ± 12.42 µg/ml (range, 21.54 to 75.20 µg/ml), the 24-h plasma concentration was 6.48 ± 5.31 µg/ml (range, 1.48 to 29.26 µg/ml), the area under the concentration-time curve (AUC) from time zero to infinity was 521.37 ± 523.53 µg·h/ml (range, 164.64 to 3155.11 µg·h/ml), the volume of distribution at steady state was 0.18 ± 0.05 liters/kg (range, 0.13 to 0.36 liters/kg), the clearance was 15.04 ± 6.09 ml/h/kg (range, 1.90 to 34.76 ml/h/kg), the half-life was 11.34 ± 14.15 h (range, 5.17 to 83.92 h), the mean residence time was 15.67 ± 20.66 h (range, 7.00 to 121.73 h), and the median time to Cmax was 0.6 h (range, 0.5 to 2.5 h). The fraction unbound in the plasma was 0.06 ± 0.02. All patients achieved Cmax/MIC and AUC from time zero to 24 h (AUC0-24)/MIC ratios for a bacteriostatic effect against Streptococcus pneumoniae. Twenty-seven patients (93%) achieved a Cmax/MIC ratio for a bacteriostatic effect against S. aureus, and 28 patients (97%) achieved an AUC0-24/MIC ratio for a bacteriostatic effect against S. aureus. Free plasma daptomycin concentrations were above the MIC for 50 to 100% of the dosing interval in 100% of patients for S. pneumoniae and 90% of patients for S. aureus. The median time to defervescence was 3 days from the start of daptomycin therapy. In summary, a 6-mg/kg intravenous infusion of daptomycin every 24 h was effective and well tolerated in neutropenic cancer patients.
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Add comment January 28, 2009
Postantibiotic Effect of Tigecycline against 14 Gram-Positive Organisms
Antimicrobial Agents and Chemotherapy 1 Feb 2009 V.53 N.2 p.782-784
G. A. Pankuch and P. C. Appelbaum*
Department of Pathology, Hershey Medical Center, Hershey, Pennsylvania 17033
The in vitro postantibiotic effects (PAEs), postantibiotic sub-MIC effects (PA-SMEs), and sub-MIC effects of tigecycline were determined for 14 gram-positive and gram-negative organisms. The pneumococcal, staphylococcal, and enterococcal PAEs were 1.9 to 5.1, 2.9 to 5.7, and 3.9 to 6.1 h, respectively, and those for Haemophilus influenzae, Escherichia coli, Klebsiella pneumoniae, Enterobacter cloacae, and Acinetobacter baumannii were 1.1 to 5.0, 1.9 to 2.1, 1.7 to 1.8, 1.0 to 1.7, and 0.7 to 3 h, respectively. The PA-SMEs (four times the MIC) ranged from 6.7 to >11 h for gram-positive organisms and from 2.3 to >11.3 h for gram-negative organisms.
abstract
Add comment January 28, 2009
Exclusive Staphylococcus aureus Throat Carriage At-Risk Populations
Archives of Internal Medicine Jan 26, 2009 V.169 N.2 p.172-178
Dominik Mertz, MD; Reno Frei, MD; Nadine Periat, MD; Melanie Zimmerli, MD; Manuel Battegay, MD; Ursula Flückiger, MD; Andreas F. Widmer, MD, MS
Division of Infectious Diseases and Hospital Epidemiology (Drs Mertz, Periat, Zimmerli, Battegay, Flückiger, and Widmer) and Microbiology Laboratory (Dr Frei), University Hospital Basel, Basel, Switzerland.
Background Approximately 25% of Staphylococcus aureus carriers have exclusive throat carriage. We aimed to identify the populations at risk for exclusive throat carriage to improve sensitivity to detect carriers.
Methods Four groups underwent nasal and throat screening for S aureus. Three groups of individuals in the community (n = 2632) with different estimated levels of exposure to the health care system (HCS) were screened, including 1500 healthy blood donors, 498 patients from a school of dental medicine, and 634 health care workers (HCWs) at a trade fair. The fourth group comprised in-hospital patients and HCWs (n = 832) and was considered the group with the highest estimated exposure to the HCS. As a primary outcome, we analyzed risk factors for exclusive throat carriage in exclusive throat carriers vs all nasal c arriers.
Results Of 3464 individuals screened, 428 (12.4%) had exclusive throat carriage, and 1260 (36.4%) had carriage in the nares only or in the nares and the throat. The most important independent risk factor for exclusive throat carriage was age 30 years or younger (odds ratio, 1.66; P < .001). Exposure to the HCS was a significant protective factor for exclusive throat carriage (odds ratio, 0.67; P = .001). Healthy blood donors were almost twice as likely to have exclusive throat carriage than in-hospital patients and HCWs (30.2% vs 18.4% of all carriers, P < .001).
Conclusions Absence of exposure to the HCS and younger age predicted exclusive throat carriers, a population at high risk for community-onset methicillin-resistant S aureus. Screening for S aureus should include swabs from the anterior nares and from the throat to improve the likelihood of detecting carriers.
abstract
Add comment January 28, 2009
