ESCMID & ECMM Joint Guidelines on Diagnosis and Management of Hyalohyphomycosis: Fusarium spp, Scedosporium spp, and others.

ESCMID & ECMM Joint Guidelines on Diagnosis and Management of Hyalohyphomycosis: Fusarium spp, Scedosporium spp, and others.

Clin Microbiol Infect. 2014 Feb 19;

Authors: Tortorano AM, Richardson M, Roilides E, van Diepeningen A, Caira M, Munoz P, Johnson E, Meletiadis J, Pana ZD, Lackner M, Verweij P, Freiberger T, Cornely OA, Arikan-Akdagli S, Dannaoui E, Groll AH, Lagrou K, Chakrabarti A, Lanternier F, Pagano L, Skiada A, Akova M, Arendrup MC, Boekhout T, Chowdhary A, Cuenca-Estrella M, Guinea J, Guarro J, de Hoog S, Hope W, Kathuria S, Lortholary O, Meis JF, Ullmann AJ, Petrikkos G, Lass-Flörl C

Abstract
Mycoses summarized in the hyalohyphomycosis group are heterogeneous, defined by the presence of hyaline (non-dematiaceous) hyphae. The number of organisms implicated in hyalohyphomycosis is increasing and the most clinically important species belong to the genera Fusarium, Scedosporium, Acremonium, Scopulariopsis, Purpureocillium and Paecilomyces. Severely immunocompromised patients are particularly vulnerable to infection, and clinical manifestations range from colonization to chronic localized lesions to acute invasive and/or disseminated diseases. Diagnosis usually requires isolation and identification of the infecting pathogen. A poor prognosis is associated with fusariosis and early therapy of localized disease is important to prevent progression to a more aggressive or disseminated infection. Therapy should include voriconazole and surgical debridement where possible or posaconazole as salvage treatment. Voriconazole represents the first line treatment of infections due to members of the genus Scedosporium. For Acremonium spp., Scopulariopsis spp., Purpureocillium spp. and Paecilomyces spp. the optimal antifungal treatment has not been established. Management usually consists of surgery and antifungal treatment, depending on the clinical presentation. This article is protected by copyright. All rights reserved.

PMID: 24548001 [PubMed – as supplied by publisher]

Epidemiology and antimicrobial susceptibility of Gram-negative aerobic bacteria causing intra-abdominal infections during 2010-2011.

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Epidemiology and antimicrobial susceptibility of Gram-negative aerobic bacteria causing intra-abdominal infections during 2010-2011.

J Chemother. 2014 Feb 18;:1973947814Y0000000164

Authors: Hawser S, Hoban DJ, Badal RE, Bouchillon SK, Biedenbach D, Hackel M, Morrissey I

Abstract
The study for monitoring antimicrobial resistance trends (SMART) surveillance program monitors the epidemiology and trends in antibiotic resistance of intra-abdominal pathogens to currently used therapies. The current report describes such trends during 2010-2011. A total of 25 746 Gram-negative clinical isolates from intra-abdominal infections were collected and classified as hospital-associated (HA) if the hospital length of stay (LOS) at the time of specimen collection was ≧48 hours, community-associated (CA) if LOS at the time of specimen collection was <48 hours, or unknown (no designation given by participating centre). A total of 92 different species were collected of which the most common was Escherichia coli: 39% of all isolates in North America to 55% in Africa. Klebsiella pneumoniae was the second most common pathogen: 11% of all isolates from Europe to 19% of all isolates from Asia. Isolates were from multiple intra-abdominal sources of which 32% were peritoneal fluid, 20% were intra-abdominal abscesses, and 16·5% were gall bladder infections. Isolates were further classified as HA (55% of all isolates), CA (39% of all isolates), or unknown (6% of all isolates). The most active antibiotics tested were imipenem, ertapenem, amikacin, and piperacillin-tazobactam. Resistance rates to all other antibiotics tested were high. Considering the current data set and high-level resistance of intra-abdominal pathogens to various antibiotics, further monitoring of the epidemiology of intra-abdominal infections and their susceptibility to antibiotics through SMART is warranted.

PMID: 24548089 [PubMed – as supplied by publisher]

Successful caspofungin treatment of persistent candidemia in extreme prematurity at 23 and 24 weeks’ gestation.

Successful caspofungin treatment of persistent candidemia in extreme prematurity at 23 and 24 weeks’ gestation.

J Formos Med Assoc. 2014 Feb 14;

Authors: Jeon GW, Sin JB

Abstract
Systemic fungal infection continues to be a major cause of mortality in extremely low-birth-weight premature infants. Amphotericin B has been recommended as the primary treatment; however, its use is limited due to drug-induced nephrotoxicity and amphotericin B-resistant candidemia. Caspofungin therapy was initiated in seven extremely premature infants at 23 and 24 weeks’ gestation with persistent systemic candidiasis despite liposomal amphotericin B treatment. The gestational age was 23(+1)-24(+6) weeks, and birth weight was 530-825 g. Of the seven patients, the peripheral blood cultures of six patients were positive for Candida parapsilosis and one had positive culture for Candida albicans. The dosage of caspofungin was 2 mg/kg/day, and the mean treatment duration was 14 days. All of the persistent candidemia resolved on caspofungin therapy. There was no recurrent candidemia after discontinuing caspofungin. There were no adverse effects, hepatotoxicity, nephrotoxicity, anemia, or thrombocytopenia. Caspofungin successfully treated persistent candidemia in extremely premature infants at 23 and 24 weeks’ gestational age.

PMID: 24534016 [PubMed – as supplied by publisher]

Caspofungin versus liposomal amphotericin B for treatment of invasive fungal infections or febrile neutropenia.

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Caspofungin versus liposomal amphotericin B for treatment of invasive fungal infections or febrile neutropenia.

Chin Med J (Engl). 2014 Feb;127(4):753-7

Authors: Zhang J, Gong Y, Wang K, Kong J, Chen Y

Abstract
BACKGROUND: Nowadays, there are published trials in regards to the comparison of caspofungin with liposomal amphotericin B (L-AmB). However, these studies have a modest sample size and convey inconclusive results. The aim of this study was to review the efficacy and safety of caspofungin for the treatment of invasive fungal infections (IFIs), compared with L-AmB.
METHODS: Electronic databases (up to July 31, 2013) PubMed and Embase databases, the Cochrane Library, and Google Scholar were searched to identify relevant trials of caspofungin and L-AmB. Analyses of efficacy and adverse outcomes were performed by relative risks (RRs) and 95% confidence intervals (CIs). Heterogeneity was assessed by χ(2)-test and the I(2)-statistic.
RESULTS: Three trials were included in this meta-analysis with 1249 modified intention-to-treat (MITT) patients. The results showed that caspofungin produced equal efficacy in favorable overall response (RR = 1.02, 95% CI 0.88-1.18; P = 0.81) and mortality rate (RR = 1.53, 95% CI 0.38-6.27, P = 0.55), safer in clinical adverse events (RR = 0.20, 95% CI 0.08-0.54; P = 0.001), laboratory adverse events (RR = 0.69, 95% CI 0. 57-0.84; P = 0.0002), and discontinuation rate (RR = 0.26, 95% CI 0.08-0.83, P = 0.02), compared with L-AmB in the treatment of patients with IFIs.
CONCLUSION: Based on the results of this meta-analysis, it would appear that caspofungin was measured to have equal efficacy in clinical outcomes and safer in terms of adverse events.

PMID: 24534235 [PubMed – in process]

Mandatory infectious diseases approval of outpatient parenteral antimicrobial therapy (OPAT): clinical and economic outcomes of averted cases.

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Mandatory infectious diseases approval of outpatient parenteral antimicrobial therapy (OPAT): clinical and economic outcomes of averted cases.

J Antimicrob Chemother. 2014 Feb 13;

Authors: Conant MM, Erdman SM, Osterholzer D

Abstract
OBJECTIVES: The use of outpatient parenteral antimicrobial therapy (OPAT) has been increasing worldwide due to its evident clinical utility; however, there is also concern about overuse and increased risk to patients in terms of antibiotic toxicity and intravenous line-associated complications. At our university-affiliated county teaching hospital with mandatory Infectious Diseases (ID) approval for all OPAT courses, we looked at clinical outcomes and cost savings of patients denied OPAT.
METHODS: Electronic medical records of patients denied OPAT were retrospectively reviewed. Demographic, medical, infection-specific and drug-specific data were collected for each patient, including the regimen ultimately recommended by ID in lieu of OPAT. Patients were determined to have clinical cure, probable cure or treatment failure based on resolution or recurrence of infection for up to 1 year after OPAT denial. The amount of money saved in direct OPAT costs in these patients was calculated.
RESULTS: Fifty-six patients were denied OPAT during the study period and were discharged with either oral or no additional antibiotics. Clinical cure was documented in 42 patients (75%), probable cure in 7 patients (12.5%) and treatment failure in 7 patients (12.5%). Of the seven treatment failures, only one patient (1.8%) was deemed to be a true failure after thorough chart review. Overall, the estimated OPAT-specific cost saving was $215 424 or $3847 per patient.
CONCLUSIONS: Mandatory ID approval of all OPAT courses can decrease healthcare costs while maintaining good clinical outcomes.

PMID: 24532684 [PubMed – as supplied by publisher]

Synergistic activity and effectiveness of a double-carbapenem regimen in pandrug-resistant Klebsiella pneumoniae bloodstream infections.

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Synergistic activity and effectiveness of a double-carbapenem regimen in pandrug-resistant Klebsiella pneumoniae bloodstream infections.
J Antimicrob Chemother. 2014 Feb 11;
Authors: Oliva A, D’Abramo A, D’Ag…