Posts filed under ‘Infecciones micoticas’

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.

Background

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.

Conclusions

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.

PDF

https://www.ijidonline.com/article/S1201-9712(18)30035-3/pdf

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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

Highlights

  • 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.

FULL TEXT

https://www.ijaaonline.com/article/S0924-8579(15)00006-0/fulltext

PDF

https://www.ijaaonline.com/article/S0924-8579(15)00006-0/pdf

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.

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

Diagnostic Performance of a Molecular Test versus Clinician Assessment of Vaginitis

Clin. Microbiol. June 2018 56:13 e00252-18

Jane R. Schwebke, Charlotte A. Gaydos, Paul Nyirjesy, Sonia Paradis, Salma Kodsi, and Charles K. Cooper

Vaginitis is a common complaint, diagnosed either empirically or using Amsel’s criteria and wet mount microscopy. This study sought to determine characteristics of an investigational test (a molecular test for vaginitis), compared to reference, for detection of bacterial vaginosis, Candida spp., and Trichomonas vaginalis. Vaginal specimens from a cross-sectional study were obtained from 1,740 women (≥18 years old), with vaginitis symptoms, during routine clinic visits (across 10 sites in the United States).

Specimens were analyzed using a commercial PCR/fluorogenic probe-based investigational test that detects bacterial vaginosis, Candida spp., and Trichomonas vaginalis. Clinician diagnosis and in-clinic testing (Amsel’s test, potassium hydroxide preparation, and wet mount) were also employed to detect the three vaginitis causes.

All testing methods were compared to the respective reference methods (Nugent Gram stain for bacterial vaginosis, detection of the Candida gene its2, and Trichomonas vaginalis culture). The investigational test, clinician diagnosis, and in-clinic testing were compared to reference methods for bacterial vaginosis, Candida spp., and Trichomonas vaginalis.

The investigational test resulted in significantly higher sensitivity and negative predictive value than clinician diagnosis or in-clinic testing. In addition, the investigational test showed a statistically higher overall percent agreement with each of the three reference methods than did clinician diagnosis or in-clinic testing.

The investigational test showed significantly higher sensitivity for detecting vaginitis, involving more than one cause, than did clinician diagnosis. Taken together, these results suggest that a molecular investigational test can facilitate accurate detection of vaginitis.

abstract

http://jcm.asm.org/content/56/6/e00252-18.abstract

PDF

http://jcm.asm.org/content/56/6/e00252-18.full.pdf+html

June 12, 2018 at 7:34 am

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

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