Posts filed under ‘Antimicoticos’

Candiduria: A Randomized, Double-Blind Study of Treatment with Fluconazole and Placebo

Clinical Infectious Diseases January 2000 V.30 N.1 P.19-24

D. Sobel, C. A. Kauffman, D. McKinsey, M. Zervos, J. A. Vazquez, A. W. Karchmer, J. Lee, C. Thomas, H. Panzer, W. E. Dismukes, and the National Institute of Allergy and Infectious Diseases (NIAID) Mycoses Study Group

1Wayne State University, Detroit, Michigan

2University of Michigan and Veterans Affairs Medical Center, Ann Arbor, Michigan

3Infectious Disease Associates of Kansas City, Kansas City, Missouri

4Harvard Medical School, Boston, Massachusetts

5University of Alabama at Birmingham, Birmingham, Alabama

6Pfizer, Inc., Groton, Connecticut

Management of candiduria is limited by the lack of information about its natural history and lack of data from controlled studies on the efficacy of treating it with antimycotic agents.

We compared fungal eradication rates among 316 consecutive candiduric (asymptomatic or minimally symptomatic) hospitalized patients treated with fluconazole (200 mg) or placebo daily for 14 days.

In an intent-to-treat analysis, candiduria cleared by day 14 in 79 (50%) of 159 receiving fluconazole and 46 (29%) of 157 receiving placebo (P < .001), with higher eradication rates among patients completing 14 days of therapy (P < .0001), including 33 (52%) of 64 catheterized and 42 (78%) of 54 noncatheterized patients.

Pretreatment serum creatinine levels were inversely related to candiduria eradication.

Fluconazole initially produced high eradication rates, but cultures at 2 weeks revealed similar candiduria rates among treated and untreated patients.

Oral fluconazole was safe and effective for short-term eradication of candiduria, especially following catheter removal. Long-term eradication rates were disappointing and not associated with clinical benefit.

PDF

http://cid.oxfordjournals.org/content/30/1/19.full.pdf

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December 2, 2017 at 7:56 am

Infección por Candida spp. sobre prótesis articulares

Rev Esp Quimioter 2011:24(1):37-41

GARCÍA-OLTRA, S. GARCÍA-RAMIRO, J. C MARTÍNEZ, R. TIBAU, G. BORI, J. BOSCH, J. MENSA, A. SORIANO

Introducción

Las infecciones periprotésicas por Candida spp.constituyen una entidad poco frecuente. El objetivo de este trabajo fue revisar la experiencia en dos centros hospitalarios.

Material y métodos

Se realizó una revisión retrospectiva de los casos de infección protésica de etiología fúngica atendidos en dos hospitales de Barcelona entre febrero de 2002 y octubre de 2010. Se incluyeron todos aquellos pacientes con criterios clínicos de infección y aislamiento de Candida spp. Se recogieron las principales variables demográficas, microbiológicas, terapéuticas y evolutivas.

Resultados

Se identificaron 10 casos, 8 mujeres y 2 varones, cuya edad media fue de 77,7 (rango 66-92) años. Nueve pacientes habían tenido una infección bacteriana previa, por la que recibieron tratamiento antibiótico durante más de 15 días y precisaron desbridamiento en más de una ocasión. La especie más frecuente fue Candida albicans con 6 casos. Todos los pacientes recibieron fluconazol y tratamiento quirúrgico consistente en desbridamiento sin retirada de la prótesis en 3 casos y recambio en 2 tiempos con un espaciador en los 7 restantes. El tratamiento fracasó en los 10 casos y fue necesario practicar un desbridamiento adicional en 1 caso, artroplastia de resección en 8 y tratamiento “supresivo”con fluconazol en uno. Tras un seguimiento medio de 31 meses (rango 2-67) dos pacientes estaban libres de enfermedad.

Conclusión

La infección protésica por Candida spp. se observa en pacientes que han recibido tratamiento antibiótico previo prolongado y han sido intervenidos en más de una ocasión. El tratamiento con fluconazol y desbridamiento o recambio en 2 tiempos con un espaciador se asoció a una elevada tasa de fracaso.

PDF

http://seq.es/seq/0214-3429/24/1/garciaoltra.pdf

September 3, 2017 at 7:05 pm

Efficacy of anidulafungin in 539 patients with invasive candidiasis: a patient-level pooled analysis of six clinical trials

Journal of Antimicrobial Chemotherapy August 2017 V.72 N.8 P.2368–2377

Bart Jan Kullberg; José Vasquez; Piroon Mootsikapun; Marcio Nucci; José-Artur Paiva …

Objectives

To evaluate the efficacy of anidulafungin for the treatment of candidaemia and invasive candidiasis in a large dataset, including patients with deep-seated tissue candidiasis, neutropenia and infection due to non-albicans Candida species.

Methods

Data were pooled from six prospective, multicentre, multinational studies: four open-label, non-comparative studies of anidulafungin and two double-blind, double-dummy, randomized studies of anidulafungin versus caspofungin (clinical trial registrations: NCT00496197, NCT00548262, NCT00537329, NCT00689338, NCT00806351 and NCT00805740; ClinicalTrials.gov). In all studies, patients with culture-confirmed invasive candidiasis received a single intravenous (iv) loading dose of anidulafungin 200 mg on day 1, followed by 100 mg once-daily. Switch to oral fluconazole or voriconazole was permitted after 5–10 days of iv treatment in all studies except one. Antifungal treatment (iv plus oral therapy if applicable) was maintained for ≥14 days after the last positive Candida culture. The primary endpoint was successful global response at end of iv therapy (EOivT) in the modified ITT (mITT) population.

Results

In total, 539 patients were included (mITT population). The most common baseline Candida species were Candida albicans (47.9%), Candida glabrata (21.0%), Candida tropicalis (13.7%), Candida parapsilosis (13.2%) and Candida krusei (3.5%). Median duration of anidulafungin iv treatment was 10.0 days. The global response success rate at EOivT was 76.4% (95% CI 72.9%–80.0%). All-cause mortality was 13.0% on day 14 and 19.1% on day 28. Adverse events (AEs) were consistent with the known AE profile for anidulafungin.

Conclusions

These data demonstrate that anidulafungin is effective for treatment of candidaemia and invasive candidiasis in a broad patient population.

PDF

https://oup.silverchair-cdn.com/oup/backfile/Content_public/Journal/jac/72/8/10.1093_jac_dkx116/1/dkx116.pdf?Expires=1502546596&Signature=Mg2uM36lH-8nSWnYuT4WYbUGBOTc4ofTGhDEgaygmz475z1wnBF9V2Y1Wewe52fMW7QyxzzWNh5HoLiQ7fcxlToVF7RDaLUWhXq~wiA39hRQiZfZjLnkI9c~0pN~jOy34zNuSMfYUqbxqiqiRJxfY5TX0psBD4LPIX1Ol7ZFzW9LZfIcFftCGe0WlNtHD12hpVApZApaBuvbMRrevdlU-cc8sx66P9hsL99JQyxw34sHRNEEibg4OOpMENZ6fW-QVB~6WjxClzJcL9QBObYLKe11e2Pqxb~Mk9d1YQAqOZjz3~XCG2iTfR~Kz1pl3HfpQX5XLV9NW2p4iHnNf8zRnw__&Key-Pair-Id=APKAIUCZBIA4LVPAVW3Q

August 11, 2017 at 9:11 am

Candida vertebral osteomyelitis (CVO) 28 cases from a 10-year retrospective study in France

MEDICINE August 2017 V.96 N.31

Richaud, Clémence; De Lastours, Victoire; Panhard, Xavière; Petrover, David; Bruno, Fantin; Lefort, Agnès

Abstract

Although increasingly frequent, little is known about the clinical presentation, radiological signs, and outcome of Candida vertebral osteomyelitis (CVO).

We performed a nationwide retrospective study of laboratory-confirmed cases of CVO over a 10 year-period in France with a prolonged follow-up.

We describe demographic, clinical, biological, and radiological characteristics of patients with CVO, patients’ management, and long-term outcome and determine factors associated with a poor outcome.

In total, 28 patients with laboratory-confirmed CVO were included. A prior systemic Candida infection was evidenced in 13/28 (46%), occurring a median of 6 weeks before CVO was diagnosed.

Twenty-six of 28 (93%) had at least 1 underlying condition at risk of invasive fungal disease, and in 19/28 (68%) CVO was health-care related.

C albicans was most frequently identified (21/28; 75%) Lumbo-sacral involvement was the most prevalent (20/28—71%). Nearly half patients had no fever at presentation, but all had pain.

Initial antifungal therapy consisted in fluconazole in 15/28 (53%); surgery was needed in 5 (18%) cases.

One-year mortality was 21% (6/28), directly related to fungal infection in 2 patients.

Risk-factors associated with 1-year mortality were age (P=.02), a high Charlson comorbidity index (P = .001), and a shorter treatment duration (median, 3 months vs 6 months; P = .02).

Among 22 patients who survived, the median follow up duration was 15.5 months (8–93.5); 10 had sequelae, consisting in pain in all and neurological deficit in one.

A longer treatment duration was significantly associated with healing without sequelae (P = .04).

CVO concerns patients with serious underlying conditions and risk-factors for invasive candidiasis.

Prolonged antifungal treatment appears to improve survival without sequelae.

FULL TEXT

http://journals.lww.com/md-journal/Fulltext/2017/08040/Candida_vertebral_osteomyelitis__CVO__28_cases.7.aspx

August 5, 2017 at 9:18 am

Rapid and Accurate Molecular Identification of the Emerging Multidrug-Resistant Pathogen Candida auris

Journal of Clinical Microbiology August 2017 V.55 N.8 P.2445-2452

Milena Kordalewska, Yanan Zhao, Shawn R. Lockhart, Anuradha Chowdhary, Indira Berrio, and David S. Perlin

aPublic Health Research Institute, Rutgers Biomedical and Health Sciences, Newark, New Jersey, USA

bMycotic Diseases Branch, Centers for Disease Control and Prevention, Atlanta, Georgia, USA

cDepartment of Medical Mycology, Vallabhbhai Patel Chest Institute, University of Delhi, Delhi, India

dClínica El Rosario, Medellín, Colombia

eMedical and Experimental Mycology Group, Corporación para Investigaciones Biológicas (CIB), Medellín, Colombia

fHospital General de Medellin Luz Castro de Gutiérrez ESE, Medellín, Colombia

Candida auris is an emerging multidrug-resistant fungal pathogen causing nosocomial and invasive infections associated with high mortality. C. auris is commonly misidentified as several different yeast species by commercially available phenotypic identification platforms. Thus, there is an urgent need for a reliable diagnostic method. In this paper, we present fast, robust, easy-to-perform and interpret PCR and real-time PCR assays to identify C. auris and related species: Candida duobushaemulonii, Candida haemulonii, and Candida lusitaniae. Targeting rDNA region nucleotide sequences, primers specific for C. auris only or C. auris and related species were designed. A panel of 140 clinical fungal isolates was used in both PCR and real-time PCR assays followed by electrophoresis or melting temperature analysis, respectively. The identification results from the assays were 100% concordant with DNA sequencing results. These molecular assays overcome the deficiencies of existing phenotypic tests to identify C. auris and related species.

PDF

http://jcm.asm.org/content/55/8/2445.full.pdf+html

July 26, 2017 at 9:29 am

Aspergilosis. Formas clínicas y tratamiento

Enf Infecciosas & Microbiologia Clínica Abril 2012 V.30 N.4

Jesús Fortún, Yolanda Meije, Gema Fresco, Santiago Moreno.

Servicio de Enfermedades Infecciosas, Hospital Ramón y Cajal, Madrid, España

Resumen

La aspergilosis invasiva junto con la aspergilosis crónica pulmonar y la aspergilosis broncopulmonar alérgica, constituyen las formas clínicas de aspergilosis.

Aunque el número de especies de Aspergillus spp. es muy numeroso, Aspergillus fumigatus-complex es el agente etiológico más frecuente, independientemente de la forma clínica y la afección de base del paciente.

El incremento de los diferentes tratamientos inmunosupresores y el mayor uso de corticoides en pacientes con enfermedad obstructiva crónica han condicionado un mayor protagonismo de la aspergilosis en los últimos años.

El uso de galactomanano y las pruebas de imagen complementan las limitaciones microbiológicas en el diagnóstico de estos pacientes. Voriconazol y anfotericina liposomal constituyen la base del tratamiento en todas las formas de aspergilosis, y posaconazol, itraconazol, caspofungina y otras equinocandinas son alternativas eficaces.

El pronóstico depende de la forma clínica y las características del huésped, pero es sombrío fundamentalmente en las formas invasivas diseminadas.

abstract

http://www.elsevier.es/es-revista-enfermedades-infecciosas-microbiologia-clinica-28-articulo-aspergilosis-formas-clinicas-tratamiento-S0213005X12000316

PDF (hacer CLIC en “DESCARGAR PDF”)

July 17, 2017 at 8:11 am

Ongoing Transmission of Candida auris in Health Care Facilities – United States, June 2016-May 2017.

Morbidity and Mortality Weekly Report. May 19, 2017 V.66 N.19 P.514-515

Notes from the Field

Tsay S, Welsh RM, Adams EH, Chow NA, Gade L, Berkow EL, Poirot E, Lutterloh E, Quinn M, Chaturvedi S, Kerins J, Black SR, Kemble SK, Barrett PM; MSD, Barton K, Shannon DJ, Bradley K, Lockhart SR, Litvintseva AP, Moulton-Meissner H, Shugart A, Kallen A, Vallabhaneni S, Chiller TM, Jackson BR.

In June 2016, CDC released a clinical alert about the emerging, and often multidrug-resistant, fungus Candida auris and later reported the first seven U.S. cases of infection through August 2016 (1).

Six of these cases occurred before the clinical alert and were retrospectively identified.

As of May 12, 2017, a total of 77 U.S. clinical cases of C. auris had been reported to CDC from seven states: New York (53 cases), New Jersey (16), Illinois (four), Indiana (one), Maryland (one), Massachusetts (one), and Oklahoma (one) (Figure). All of these cases were identified through cultures taken as part of routine patient care (clinical cases).

Screening of close contacts of these patients, primarily of patients on the same ward in health care facilities, identified an additional 45 patients with C. auris isolated from one or more body sites (screening cases), resulting in a total of 122 patients from whom C. auris has been isolated…..

PDF

https://www.cdc.gov/mmwr/volumes/66/wr/pdfs/mm6619a7.pdf

June 28, 2017 at 5:53 am

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