Posts filed under ‘Infecciones micoticas’

A Guide to Utilization of the Microbiology Laboratory for Diagnosis of Infectious Diseases: 2018 Update by the Infectious Diseases Society of America and the American Society for Microbiology

Clinical Infectious Diseases September 15, 2018 V.67 N.6 P.813–816


J Michael Miller; Matthew J Binnicker; Sheldon Campbell; Karen C Carroll; Kimberle C Chapin …

The critical nature of the microbiology laboratory in infectious disease diagnosis calls for a close, positive working relationship between the physician/advanced practice provider and the microbiologists who provide enormous value to the healthcare team.

This document, developed by experts in laboratory and adult and pediatric clinical medicine, provides information on which tests are valuable and in which contexts, and on tests that add little or no value for diagnostic decisions.

This document presents a system-based approach rather than specimen-based approach, and includes bloodstream and cardiovascular system infections, central nervous system infections, ocular infections, soft tissue infections of the head and neck, upper and lower respiratory infections, infections of the gastrointestinal tract, intra-abdominal infections, bone and joint infections, urinary tract infections, genital infections, and other skin and soft tissue infections; or into etiologic agent groups, including arthropod-borne infections, viral syndromes, and blood and tissue parasite infections.

Each section contains introductory concepts, a summary of key points, and detailed tables that list suspected agents; the most reliable tests to order; the samples (and volumes) to collect in order of preference; specimen transport devices, procedures, times, and temperatures; and detailed notes on specific issues regarding the test methods, such as when tests are likely to require a specialized laboratory or have prolonged turnaround times.

In addition, the pediatric needs of specimen management are also emphasized. There is intentional redundancy among the tables and sections, as many agents and assay choices overlap.

The document is intended to serve as a guidance for physicians in choosing tests that will aid them to quickly and accurately diagnose infectious diseases in their patients.




September 2, 2018 at 10:40 am

Periprosthetic fungal infection of a hip caused by Trichosporon inkin.

Arthroplast Today. July 28, 2017 V.4 N.1 P.24-26.

Burgo FJ1, Mengelle DE1, Abraham A1, Kremer G1, Autorino CM1.

Author information

1 Department of Orthopedic Surgery, Austral University Hospital, Adult Reconstruction Section, Buenos Aires, Argentina.


An immunocompromised patient with a history of multiple hip implant revisions extended courses of empiric antibiotic treatment, and a retained metallic rod in the femoral medullary canal was transferred for diagnostic studies and treatment. A high suspicion of fungal infection and utilization of extended and specific fungal cultures were the diagnostic keys for infection with Trichosporon inkin. The treatment consisted in a debridement surgery with the use of a functional spacer with cement supplemented with voriconazole and vancomycin plus a 6-month systemic treatment with voriconazole. After 2 years of follow-up, the patient is free of symptoms.


August 28, 2018 at 11:58 am

Vancomycin Prophylaxis for Total Joint Arthroplasty: Incorrectly Dosed and Has a Higher Rate of Periprosthetic Infection Than Cefazolin.

Clin Orthop Relat Res. 2017 Jul;475(7):1775-1778.

Soriano A1.

Author information

1 Service of Infectious Diseases, IDIBAPS, Hospital Clinic Universitari, University of Barcelona, C/ Villarroel 170, Barcelona, Catalonia, 08036, Spain.


August 1, 2018 at 8:17 am

Shotgun Metagenomic Detection of Pathogens: a Micro-Comic Strip

Journal of Clinical Microbiology  August 2018 V.56 N.8


Alexander J. McAdam

Next-generation sequencing has made shotgun metagenomic testing of primary clinical specimens for detection of pathogens feasible (1).

These technologies can routinely detect a range of pathogens (bacterial, viral, fungal, and eukaryotic parasites), allowing for hypothesis-free testing, in which test selection does not depend on knowing what pathogens are likely to be present.

Such testing has been applied for detecting infections or colonization of the nervous system (2–4), gastrointestinal tract (5, 6), prosthetic joints (7, 8), and blood or serum (9, 10).

Shotgun metagenomic testing for pathogens is now available for patient testing at a small number of academic and commercial laboratories, and it is expensive compared to other microbiology tests.

Where do the cost of and diversity of pathogens detected by shotgun metagenomic testing fit into the range of available microbiology tests?



July 28, 2018 at 6:32 pm

First report of sporadic cases of Candida auris in Colombia

International Journal of Infectious Diseases April 2018 V.69 P.63-67

Claudia M. Parra-Giraldo, Sandra L. Valderrama, Gloria Cortes-Fraile, Javier R. Garzón, Beatriz E. Ariza, Florent Morio, Melva Y. Linares-Linares, Andrés Ceballos-Garzón, Alejandro de la Hoz, Catalina Hernandez, Carlos Alvarez-Moreno, Patrice Le Pape

  • El hongo emergente Candida auris es una amenaza global seria. A menudo es resistente a múltiples fármacos, es un problema de salud pública.
  • La levadura Candida auris es difícil de identificar con herramientas de laboratorio estándar, y puede identificarse erróneamente en laboratorios sin tecnología específica.
  • Candida auris se ha diseminado rápidamente y ha causado infecciones en más de una docena de países, este es el primer caso reportado con Candida auris en Colombia.


Candida auris is a recently reported Candida species that is phenotypically similar to Candida haemulonii and related to hospital outbreaks. This organism can be misidentified as Candida haemulonii, Candida famata, Candida catenulata, or Rhodotorula glutinis by phenotypic approaches. Matrix-assisted laser desorption/ionization time-of-flight mass spectrometry (MALDI-TOF MS) and DNA sequence analysis using internal transcribed spacer rDNA bar-coding provide an accurate identification.

Case reports

Three cases of C. auris infection in patients with risk factors for fungal infection (one admitted to the intensive care unit, one with lymphoma, and one with HIV; all three with previous antibiotic use) are reported; these infections were not epidemiologically related. Yeast isolates were recovered from blood, ocular secretion, and bronchoalveolar lavage and were misidentified as C. catenulata and Candida albicans by the phenotypic MicroScan method. The isolates were confirmed to be C. auris by means of MALDI-TOF MS and DNA sequence analysis. Antifungal susceptibility testing was performed on these C. auris isolates, which exhibited high minimum inhibitory concentrations to triazoles and amphotericin B. One patient survived and the other two died. Only one of these deaths was related to fungemia.


C auris is an emerging and opportunistic multidrug-resistant human pathogen. It is necessary to strengthen measures to achieve an accurate and quick identification and also to avoid its dissemination. This will require improvements in health and infection control measures, as well as the promotion of antifungal stewardship in healthcare facilities.


July 14, 2018 at 7:05 pm

β-Lactam antibiotics and vancomycin inhibit the growth of planktonic and biofilm Candida spp.: An additional benefit of antibiotic-lock therapy?

Internat J of Antimicrob Agents April 2015 V.45 N.4

José J.C. Sidrim, Carlos E.C. Teixeira, Rossana A. Cordeiro, Raimunda S.N. Brilhante, Débora S.C.M. Castelo-Branco, Silviane P. Bandeira, Lucas P. Alencar, Jonathas S. Oliveira, André J. Monteiro, José L.B. Moreira, Tereza J.P.G. Bandeira, Marcos F.G. Rocha


  • β-Lactams and vancomycin reduced Candida biofilm formation.
  • β-Lactams and vancomycin inhibited the maintenance of mature Candida biofilms.
  • Antibiotic-lock therapy with these drugs might control Candida biofilm formation and maintenance.

The aim of this study was to evaluate the effects of cefepime, meropenem, piperacillin/tazobactam (TZP) and vancomycin on strains of Candida albicans and Candida tropicalis in planktonic and biofilm forms. Twenty azole-derivative-resistant strains of C. albicans (n = 10) and C. tropicalis (n = 10) were tested. The susceptibility of planktonic Candida spp. to the antibacterial agents was investigated by broth microdilution. The XTT reduction assay was performed to evaluate the viability of growing and mature biofilms following exposure to these drugs. Minimum inhibitory concentrations (MICs) ranged from 0.5 mg/mL to 2 mg/mL for cefepime, TZP and vancomycin and from 0.5 mg/mL to 1 mg/mL for meropenem and the drugs also caused statistically significant reductions in biofilm cellular activity both in growing and mature biofilm. Since all of the tested drugs are commonly used in patients with hospital-acquired infections and in those with catheter-related infections under antibiotic-lock therapy, it may be possible to obtain an additional benefit from antibiotic-lock therapy with these drugs, namely the control of Candida biofilm formation.



July 8, 2018 at 5:50 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.


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.


July 7, 2018 at 3:36 pm

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