Posts filed under ‘Infecciones en neutropenicos’

Bloodstream infections in cancer patients. Risk factors associated with mortality

International Journal of Infectious Diseases June 2018 V.71 P.59-64

Beda Islas-Muñoz, Patricia Volkow-Fernández, Cynthia Ibanes-Gutiérrez, Alberto Villamar-Ramírez, Diana Vilar-Compte, Patricia Cornejo-Juárez

Highlights

  • Bloodstream infections (BSI) cause severe complications in cancer patients.
  • Secondary BSI and central-related BSI were the most common in solid tumors.
  • Primary BSI and mucosal barrier injury BSI were described in hematological patients.
  • Mortality at 30-days was increased with multidrug resistant Gram-negative bacteria.
  • Inappropriate antimicrobial treatment in the first 24 h was related with mortality.

Objective

The aim of this study was to evaluate the clinical characteristics and risk factors associated with mortality in cancer patients with bloodstream infections (BSI), analyzing multidrug resistant bacteria (MDR).

Methods

We conducted a prospective observational study at a cancer referral center from August 2016 to July 2017, which included all BSI.

Results

4220 patients were tested with blood cultures; 496 were included. Mean age was 48 years. In 299 patients with solid tumors, secondary BSI and Central Line-Associated BSI (CLABSI) were the most common (55.9% and 31.8%, respectively). In 197 hematologic patients, primary and mucosal barrier injury (MBI) BSI were the main type (38.6%). Gram-negative were the most frequent bacteria (72.8%), with Escherichia coli occupying the first place (n = 210, 42.3%), 48% were Extended-Spectrum Beta-Lactamase (ESBL) producers, and 1.8% were resistant to carbapenems. Mortality at day 30, was 22%, but reached 70% when patients did not receive an appropriate antimicrobial treatment. Multivariate analysis showed that progression or relapse of the oncologic disease, inappropriate antimicrobial treatment, and having resistant bacteria were independently associated with 30-day mortality.

Conclusions

Emergence of MDR bacteria is an important healthcare problem worldwide. Patients with BSI, particularly those patients with MDR bacteria have a higher mortality risk.

PDF

https://www.ijidonline.com/article/S1201-9712(18)30081-X/pdf

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July 14, 2018 at 7:25 pm

Pharmacokinetics of anidulafungin in critically ill patients with candidemia/invasive candidiasis.

Antimicrob Agents Chemother. 2013 Apr;57(4):1672-6.

Liu P1, Ruhnke M, Meersseman W, Paiva JA, Kantecki M, Damle B.

Author information

1 Clinical Pharmacology, Specialty Care, Pfizer Inc, Groton, Connecticut, USA.

Abstract

The pharmacokinetics of intravenous anidulafungin in adult intensive care unit (ICU) patients were assessed in this study and compared with historical data from a general patient population and healthy subjects. Intensive plasma sampling was performed over a dosing interval at steady state from 21 ICU patients with candidemia/invasive candidiasis. All patients received the recommended dosing regimen (a 200-mg loading dose on day 1, followed by a daily 100-mg maintenance dose), except for a 54-year-old 240-kg female patient (who received a daily 150-mg maintenance dose instead). Plasma samples were assayed for anidulafungin using a validated liquid chromatography-tandem mass spectrometry method. Pharmacokinetic parameters in ICU patients were calculated by a noncompartmental method. With the exclusion of the 240-kg patient, the median (minimum, maximum) age, weight, and body mass index (BMI) of 20 ICU patients were 57 (39, 78) years, 65 (48, 106) kg, and 23.3 (16.2, 33.8) kg/m(2), respectively. The average anidulafungin area under the curve over the 24-hour dosing interval (AUC(0-24)), maximum concentration (C(max)), and clearance (CL) in 20 ICU patients were 92.7 mg · h/liter, 7.7 mg/liter, and 1.3 liters/h, respectively. The exposure in the 240-kg patient at a daily 150-mg dose was within the range observed in ICU patients overall. The average AUC(0-24) and Cmax in the general patient population and healthy subjects were 110.3 and 105.9 mg · h/liter and 7.2 and 7.0 mg/liter, respectively. The pharmacokinetics of anidulafungin in ICU patients appeared to be comparable to those in the general patient population and healthy subjects at the same dosing regimen.

PDF

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3623353/pdf/zac1672.pdf

July 7, 2018 at 3:36 pm

Clinical practice guidelines for the management of candidiasis: 2009 update by the Infectious Diseases Society of America.

Clinical Infectious Diseases  March 1, 2009 V.48 N.5 P. 503-35.

Pappas PG1, Kauffman CA, Andes D, Benjamin DK Jr, Calandra TF, Edwards JE Jr, Filler SG, Fisher JF, Kullberg BJ, Ostrosky-Zeichner L, Reboli AC, Rex JH, Walsh TJ, Sobel JD; Infectious Diseases Society of America.

Author information

1 Department of Medicine, Division of Infectious Diseases, University of Alabama at Birmingham, Birmingham, Alabama 35294-0006, USA. pappas@uab.edu

Abstract

Guidelines for the management of patients with invasive candidiasis and mucosal candidiasis were prepared by an Expert Panel of the Infectious Diseases Society of America. These updated guidelines replace the previous guidelines published in the 15 January 2004 issue of Clinical Infectious Diseases and are intended for use by health care providers who care for patients who either have or are at risk of these infections. Since 2004, several new antifungal agents have become available, and several new studies have been published relating to the treatment of candidemia, other forms of invasive candidiasis, and mucosal disease, including oropharyngeal and esophageal candidiasis. There are also recent prospective data on the prevention of invasive candidiasis in high-risk neonates and adults and on the empiric treatment of suspected invasive candidiasis in adults. This new information is incorporated into this revised document.

abstract

https://academic.oup.com/cid/article/48/5/503/382619

PDF (CLIC en PDF)

July 7, 2018 at 3:34 pm

Anidulafungin versus fluconazole for invasive candidiasis.

N Engl J Med. June 14, 2007 V.356 N.24 P.2472-82.

Reboli AC1, Rotstein C, Pappas PG, Chapman SW, Kett DH, Kumar D, Betts R, Wible M, Goldstein BP, Schranz J, Krause DS, Walsh TJ; Anidulafungin Study Group.

Author information

1 University of Medicine and Dentistry of New Jersey-Robert Wood Johnson Medical School and Cooper University Hospital, Camden, NJ 08103, USA. reboli-annette@cooperhealth.edu

Abstract

BACKGROUND:

Anidulafungin, a new echinocandin, has potent activity against candida species. We compared anidulafungin with fluconazole in a randomized, double-blind, noninferiority trial of treatment for invasive candidiasis.

METHODS:

Adults with invasive candidiasis were randomly assigned to receive either intravenous anidulafungin or intravenous fluconazole. All patients could receive oral fluconazole after 10 days of intravenous therapy. The primary efficacy analysis assessed the global response (clinical and microbiologic) at the end of intravenous therapy in patients who had a positive baseline culture. Efficacy was also assessed at other time points.

RESULTS:

Eighty-nine percent of the 245 patients in the primary analysis had candidemia only. Candida albicans was isolated in 62% of the 245 patients. In vitro fluconazole resistance was infrequent. Most of the patients (97%) did not have neutropenia. At the end of intravenous therapy, treatment was successful in 75.6% of patients treated with anidulafungin, as compared with 60.2% of those treated with fluconazole (difference, 15.4 percentage points; 95% confidence interval [CI], 3.9 to 27.0). The results were similar for other efficacy end points. The statistical analyses failed to show a “center effect”; when data from the site enrolling the largest number of patients were removed, success rates at the end of intravenous therapy were 73.2% in the anidulafungin group and 61.1% in the fluconazole group (difference, 12.1 percentage points; 95% CI, -1.1 to 25.3). The frequency and types of adverse events were similar in the two groups. The rate of death from all causes was 31% in the fluconazole group and 23% in the anidulafungin group (P=0.13).

CONCLUSIONS:

Anidulafungin was shown to be noninferior to fluconazole in the treatment of invasive candidiasis. (ClinicalTrials.gov number, NCT00056368 [ClinicalTrials.gov]).

FULL TEXT

https://www.nejm.org/doi/10.1056/NEJMoa066906?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub%3dwww.ncbi.nlm.nih.gov

PDF

https://www.nejm.org/doi/pdf/10.1056/NEJMoa066906

July 7, 2018 at 3:31 pm

Curso virtual Inmunocomprometidos – SADI MAYO 2018

Infecciones en inmunocomprometidos: una visión actual y práctica para un huesped complejo.

Inicio del Curso: mayo 2018 – Duración 5 meses.

Destinatarios: Infectólogos de adultos y pediátricos, clínicos, pediatras, hematólogos, oncólogos, intensivistas.

PROGRAMA DEL CURSO

INFECCIONES EN INMUNOCOMPROMETIDOS: una visión actual y práctica para un huésped complejo

DIRECCIÓN: Dra. Rosana Jordán; Dra. Claudia Salgueira

COORDINACIÓN: Dra. Patricia Costantini

OBJETIVOS: En este curso nos proponemos actualizar aspectos infectológicos en el manejo de los pacientes inmunocomprometidos no trasplantados, brindando herramientas prácticas y promoviendo la educación continua.

 

MÓDULO 1- ¿QUÉ DEBEMOS CONSIDERAR ANTES DE INICIAR LA INMUNOSUPRESIÓN?

Coordinadora: Dra. Graciela Guerrini

1.1 EVALUACIÓN INICIAL SEGÚN EL TIPO DE INMUNOCOMPROMISO: TESTEO, PROFILAXIS E INMUNIZACIÓN.

Docentes: Dr Hugo Peretti – Dra Claudia Salgueira

1.2 PATOLOGÍA ONCOHEMATOLÓGICA Y HIV: PROFILAXIS Y COMORBILIDADES. INTERACCIONES DE TARV Y DROGAS QUIMIOTERAPICAS.

Docentes: Dra Andrea Nenna. Dra Valeria Fink

 

MÓDULO 2- UNA ETAPA COMPLEJA: NEUTROPENIA FEBRIL

Coordinador: Dr. Anibal Calmaggi

2.1 ENFOQUE DEL PACIENTE NEUTROPÉNICO FEBRIL. MICROORGANISMOS MULTIRESISTENTES: CUANDO SOSPECHAR Y QUE

CONDUCTA ADOPTAR?

Docente: Dra Sandra Lambert

2.2. MANEJO DEL NEUTROPÉNICO FEBRIL DE BAJO RIESGO.

Docente: Dra Patricia Costantini

2.3. NEUTROPÉNICO FEBRIL DE ALTO RIESGO. PERSISTENCIA DE LA FIEBRE: COMO SEGUIR? PODEMOS DESCALAR?

Docente: Dr. Anibal Calmaggi

 

MÓDULO 3- INFECCIONES MICÓTICAS: EL VALOR DE LOS METODOS DIAGNÓSTICO Y DE LA PROFILAXIS.

Coordinador: Dr. Fabián Herrera

3.1 ACERCANDO EL LABORATORIO A LA CAMA DEL PACIENTE.

Docente: Dr. Javier Afeltra

3.2 EL ROL DE LAS IMÁGENES: CT, RMN, PET.

Docente: Dr. Santiago Rossi

3.3 PROFILAXIS ANTIFÚNGICAS: EN QUIÉNES, QUE Y COMO.

Docente: Dr. Fabián Herrera

 

MÓDULO 4- DESAFÍOS EN EL MANEJO DE LAS INFECCIONES FÚNGICAS

Coordinador: Dr. José Cozzi

4.1 MANEJO EMPíRICO ANTE LA SOSPECHA DE INFECCÓN FÚNGICA INVASIVA DURANTE LA NEUTROPENIA. ESTRATEGIAS SEGÚN

EL RIESGO

Docente: Dra. Rosana Jordán

4.2 TRATAMIENTO ANTIFÚNGICO DE Aspergillus spp, Mucorales, y Fusarium spp.

Docente: Dr. Javier Afeltra

 

MÓDULO 5 – DIAGNÓSTICO Y MANEJO DE LAS INFECCIONES VIRALES RESPIRATORIAS.

Coordinadora: Dra. Cecilia Dignani

5.1 IMPACTO EN EL ADULTO INMUNOCOMPROMETIDO

Docente: Dra Cecilia Dignani

5.1 EL VALOR DEL DIAGNÓSTICO VIROLÓGICO.

Docente: Dra. Cristina Videla

5.2 INFECCIONES VIRALES RESPIRATORIAS EN PEDIATRÍA: MÁS ALLÁ DE LA INFLUENZA.

Docente: Dra. Andrea Mónaco – Dr. Santiago Lopez Papucci

 

MÓDULO 6 – ENFOQUE DE LOS SINDROMES CLÍNICOS COMPLEJOS Y FRECUENTES

Coordinador: Dr. Fabián Herrera

6.1 ABORDAJE DIAGNÓSTICO DEL PACIENTE CON INFILTRADO PULMONAR.

Docente: Dra Inés Rocia Rossi

6.2 ENTERITIS NEUTROPENICA: UNA CONDICIÓN SEVERA, UN CONTINUO DESAFIO.

Docente: Dra Ana Laborde

6.3 INFECCIONES ASOCIADAS A CATÉTERES VASCULARES.

Docente: Dr Lucas Tula

 

MÓDULO 7 – TERAPIAS DIRIGIDAS EN LOS DIFERENTES HUÉSPEDES: ¿QUÉ INFECCIONES DEBEMOS ESPERAR? ¿CUÁLES PREVENIR?

Coordinadora: Dra. Alejandra Valledor

7.1 EN EL PACIENTE CON ENFERMEDAD AUTOINMUNE.

Docente: Dra Rosana Jordán – Dra Alejandra Valledor

7.2 TUMORES SÓLIDOS: TERAPIAS DIRIGIDAS E INMUNOLÓGICA

Docente: Dra Patricia Costantini

7.3 Y CUANDO ES UN PACIENTE ONCOHEMATOLÓGICO..?

Docente: Dra Claudia Salgueira

 

Más Información

http://www.sadi.org.ar/index.php?option=com_k2&view=item&id=530:curso-virtual-inmunocomprometidos&Itemid=217

May 4, 2018 at 7:51 pm

Septic arthritis in a native knee due to Corynebacterium striatum.

Reumatol Clin. 2017 Mar 7. 

Septic arthritis in a native knee due to Corynebacterium striatum.

[Article in English, Spanish]

Molina Collada J1, Rico Nieto A2, Díaz de Bustamante Ussia M3, Balsa Criado A4.

Author information

1 Servicio de Reumatología, Hospital Universitario La Paz, Madrid, España. Electronic address: molinacolladajuan@gmail.com.

2 Unidad de Enfermedades Infecciosas, Servicio de Medicina Interna, Hospital Universitario La Paz, Madrid, España.

3 Servicio de Geriatría, Hospital Universitario La Paz, Madrid, España.

4 Servicio de Reumatología, Hospital Universitario La Paz, Madrid, España.

Abstract

We describe a case of septic arthritis in a native knee due to Corynebacterium striatum, gram-positive bacilli that are usually commensal organisms of skin and mucosal membranes, but are seldom implicated in native septic arthritis. An 84-year-old man with Corynebacterium striatum septic arthritis of his native left knee and no response to conventional antibiotic therapy. Thus, the patient was allowed to take dalbavancin for compassionate use, with an excellent clinical outcome. This case emphasizes de role of Corynebacterium striatum in native joint infections and highlights the importance of early detection and appropriate treatment in improving the clinical outcome.

PDF (CLIC en PDF)

http://www.reumatologiaclinica.org/es/linkresolver/artritis-septica-rodilla-nativa-por/S1699258X17300335/

October 22, 2017 at 12:43 pm

Septic arthritis of a native knee joint due to Corynebacterium striatum.

J Clin Microbiol. 2014 May;52(5):1786-8.

Westblade LF1, Shams F, Duong S, Tariq O, Bulbin A, Klirsfeld D, Zhen W, Sakaria S, Ford BA, Burnham CA, Ginocchio CC.

Author information

1 Department of Pathology and Laboratory Medicine, Hofstra North Shore-LIJ School of Medicine, Hempstead, New York, USA.

Abstract

We report a case of septic arthritis of a native knee joint due to Corynebacterium striatum, a rare and unusual cause of septic arthritis of native joints. The isolate was identified by a combination of phenotypic, mass spectrometric, and nucleic acid-based assays and exhibited high-level resistance to most antimicrobials.

PDF

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3993712/pdf/zjm1786.pdf

October 22, 2017 at 12:41 pm

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