Posts filed under ‘Infecciones en transplantados’

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

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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

Clinical and Epidemiological Features of Enterococcus casseliflavus/flavescens and Enterococcus gallinarum Bacteremia: A Report of 20 Cases

Clinical Infectious Diseases June 1, 2001 V.32 N.11 P.1540-1546

Karlene C. Reid  Franklin R. Cockerill, III  Robin Patel

The clinical significance of intrinsically vancomycin-resistant enterococci is not yet fully established, as these organisms are infrequently recovered from clinical specimens. We report our experience with 20 cases of Enterococcus gallinarum and Enterococcus casseliflavus/flavescens bacteremia in humans from 1992 through 1998. Sixteen cases of bacteremia were caused by E. gallinarum. Underlying conditions were present in 19 (95%) of the patients and included malignancy, receipt of transplant, and Caroli’s disease. Polymicrobial bacteremia was present in 9 patients (45%). E. gallinarum and E. casseliflavus/flavescens, although they are infrequently isolated from clinical specimens, may cause serious invasive infections.

La importancia clínica de los enterococos intrínsecamente resistentes a la vancomicina todavía no está completamente establecida, ya que estos organismos se recuperan con poca frecuencia de las muestras clínicas. Presentamos nuestra experiencia con 20 casos de bacteriemias en humanos por Enterococcus gallinarum y Enterococcus casseliflavus/flavescens bacteriemia 1992 hasta 1998.

Dieciséis casos de bacteriemia fueron causados por E. gallinarum. Las condiciones subyacentes estuvieron presentes en 19 (95%) de los pacientes e incluyeron malignidad, recepción de trasplante y enfermedad de Caroli.

La bacteriemia polimicrobiana estuvo presente en 9 pacientes (45%). E. gallinarum y E. casseliflavus / flavescens, aunque rara vez se aíslan de muestras clínicas, pueden causar infecciones invasivas graves.

FULL TEXT

https://academic.oup.com/cid/article/32/11/1540/461246

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June 8, 2018 at 8:23 am

Relative vaccine effectiveness of high-dose vs standard-dose influenza vaccines among Veterans Health Administration patients.

Journal of Infectious Diseases May 5,  2018  V.217 N.11 P.1718-1727  

Young-Xu Y et al.

We examined whether a high-dose inactivated influenza vaccine was more efficacious in preventing hospitalizations than a standard-dose vaccine in the Veterans Health Administration (VHA) senior population.

Methods

This study estimated the relative vaccine effectiveness (rVE) of high dose versus standard dose using a retrospective cohort of VHA patients 65 years of age or older in the 2015–2016 influenza season. To adjust for measured confounders, we matched each high-dose recipient with up to 4 standard-dose recipients vaccinated at the same location within a 2-week period and having 2 or more pre-existing medical comorbidities. We used the previous event rate ratio method (PERR), a type of difference-in-differences analysis, to adjust for unmeasured confounders.

Results

We evaluated 104965 standard-dose and 125776 high-dose recipients; matching decreased the population to 49091 standard-dose and 24682 high-dose recipients. The matched, PERR-adjusted rVE was 25% (95% confidence interval [CI], 2%–43%) against influenza- or pneumonia-associated hospitalization, 7% (95% CI, −2% to 14%) against all-cause hospitalization, 14% (95% CI, −8% to 32%) against influenza- or pneumonia-associated outpatient visit, 5% (95% CI, 2%–8%) against all-cause outpatient visit, and 38% (95% CI, −5% to 65%) against laboratory-confirmed influenza.

Conclusions

In protecting senior VHA patients against influenza- or pneumonia-associated hospitalization, a high-dose influenza vaccine is more effective than a standard-dose vaccine.

FULL TEXT

https://academic.oup.com/jid/article/217/11/1718/4858294

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May 31, 2018 at 8:30 am

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

A spontaneous joint infection with Corynebacterium striatum.

J Clin Microbiol. 2007 Feb;45(2):656-8.

Scholle D1.

Author information

1 Department of Medicine, Legacy Emanuel and Good Samaritan Hospitals, 1015 NW 22nd Ave., Portland, OR 97210, USA. dscholle@fastmail.fm

Abstract

Corynebacterium striatum is a ubiquitous saprophyte with the potential to cause bacteremia in immunocompromised patients. Until now, spontaneous infection of a natural joint has not been reported. When phenotyping failed, gene sequencing was used to identify the species. The isolate demonstrated high-level resistance to most antibiotics.

PDF

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1829050/pdf/0827-06.pdf

 

October 22, 2017 at 12:39 pm

The Brief Case: Bacteremia Caused by Helicobacter cinaedi

Journal of Clinical Microbiology January 2017 V.55 N.1 P.5-9

Allen C. Bateman and Susan M. Butler-Wu* Department of Laboratory Medicine, University of Washington, Seattle, Washington, USA

Carey-Ann D. Burnham, Editor Washington University School of Medicine

CASE

A 61-year-old male with relapsed multiple myeloma presented to clinic with fatigue and chills.

The patient had undergone two rounds of autologous stem cell transplantation in 2012 and was undergoing chemotherapy with pomalidomide, cyclophosphamide, and dexamethasone.

He was admitted for neutropenic fever (absolute neutrophil count of 1.4 × 109/liter, temperature of 38.4°C). His physical exam was normal, and he denied any other symptoms.

Two sets of blood cultures were obtained (VersaTREK Redox; Trek Diagnostic Systems), and the patient was started on levofloxacin, vancomycin, and cefepime. His fever subsided after 24 h, and he was discharged home to complete a 30-day course of oral levofloxacin…

PDF

http://jcm.asm.org/content/55/1/5.full.pdf+html

October 19, 2017 at 3:04 pm

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