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Gando Y, Yasu T. A Simple HPLC-UV Method for Ivosidenib Determination in Human Plasma. J Chromatogr Sci 2024; 62:580-584. [PMID: 37873880 DOI: 10.1093/chromsci/bmad082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2022] [Revised: 07/17/2023] [Accepted: 09/30/2023] [Indexed: 10/25/2023]
Abstract
Ivosidenib is used for the treatment of acute myeloid leukemia (AML) with isocitrate dehydrogenase 1 (IDH1) mutations. However, increased blood concentrations of ivosidenib are associated with a risk of a prolonged QT interval in patients with AML. Therapeutic drug monitoring in patients with AML with IDH1 mutation offers the potential to improve treatment efficacy while minimizing toxicity. In this study, we developed an efficient high-performance liquid chromatography-ultraviolet (HPLC-UV) method for the quantification of ivosidenib in plasma. Human plasma samples (50 μL) were processed by protein precipitation using acetonitrile, followed by chromatographic separation on a reversed-phase column with an isocratic mobile phase of 0.5% KH₂PO₄ (pH 4.5) and acetonitrile (45:55, v/v) at a flow rate of 1.0 mL/min, with ultraviolet detection at 245 nm. Calibration curves were linear over the range of 0.25-20 μg/mL with a coefficient of determination (r2) of 0.99999. Intra-day and inter-day precision were 1.20-8.04% and 0.69-4.20%, respectively. The assay accuracy was -2.00% to 1.93% and recovery was >91.2%. These findings support the effectiveness of the newly developed HPLC-UV method for the quantification of ivosidenib in human plasma. This simple and cost-effective method is expected to expand ivosidenib monitoring in laboratories lacking LC-MS/MS instruments.
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Affiliation(s)
- Yoshito Gando
- Department of Medicinal Therapy Research, Pharmaceutical Education and Research Center, Meiji Pharmaceutical University, 2-522-1, Noshio, Kiyose, Tokyo 204-8588, Japan
| | - Takeo Yasu
- Department of Medicinal Therapy Research, Pharmaceutical Education and Research Center, Meiji Pharmaceutical University, 2-522-1, Noshio, Kiyose, Tokyo 204-8588, Japan
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Tverdek F, Escobar ZK, Liu C, Jain R, Lindsay J. Antimicrobials in patients with hematologic malignancies and recipients of hematopoietic cell transplantation and other cellular therapies. Transpl Infect Dis 2023; 25 Suppl 1:e14129. [PMID: 37594221 DOI: 10.1111/tid.14129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Revised: 07/28/2023] [Accepted: 08/07/2023] [Indexed: 08/19/2023]
Abstract
BACKGROUND Appropriate use of antimicrobials for hematologic malignancy, hematopoietic stem cell transplant recipients, and other cellular therapies is vital, with infection causing significant morbidity and mortality in this unique population of immunocompromised hosts. However, often in this population the choice and management of antimicrobial therapy is complex. When selecting an antimicrobial agent, key considerations include the need for dose adjustments due to renal or hepatic impairment, managing drug interactions, the potential for additive drug toxicity among those receiving polypharmacy and therapeutic drug monitoring. Other factors include leveraging pharmacodynamic principles to enable optimization of directed therapy against challenging pathogens, as well as judicious use of antimicrobials to limit drug resistance and adverse drug reactions. SUMMARY This review summarizes the clinical considerations for commonly used antimicrobials in this setting, including antibacterial, antiviral, and antifungal agents.
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Affiliation(s)
- Frank Tverdek
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Center, Seattle, Washington, USA
- Department of Pharmacy, University of Washington Medicine, Seattle, Washington, USA
- School of Pharmacy, University of Washington, Seattle, Washington, USA
| | - Zahra Kassamali Escobar
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Center, Seattle, Washington, USA
- Department of Pharmacy, University of Washington Medicine, Seattle, Washington, USA
- School of Pharmacy, University of Washington, Seattle, Washington, USA
| | - Catherine Liu
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Center, Seattle, Washington, USA
- Division of Allergy and Infectious Diseases, University of Washington, Seattle, Washington, USA
| | - Rupali Jain
- Department of Pharmacy, University of Washington Medicine, Seattle, Washington, USA
- School of Pharmacy, University of Washington, Seattle, Washington, USA
- Division of Allergy and Infectious Diseases, University of Washington, Seattle, Washington, USA
| | - Julian Lindsay
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Center, Seattle, Washington, USA
- National Centre for Infection in Cancer and Transplantation (NCICT), Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
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Villalobos APC, Bow EJ. Isavuconazole as an alternative for antifungal prophylaxis in patients with hematological malignancies: Is the signal sufficient to support clinical practice? Transpl Infect Dis 2023; 25:e14046. [PMID: 36864665 DOI: 10.1111/tid.14046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Accepted: 01/30/2023] [Indexed: 03/04/2023]
Affiliation(s)
- Armelle Perez-Cortes Villalobos
- Department of Medical Microbiology and Infectious Diseases, Max Rady School of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada.,Section of Infectious Diseases, Department of Internal Medicine, Max Rady School of Medicine, The University of Manitoba, Winnipeg, Manitoba, Canada
| | - Eric J Bow
- Department of Medical Microbiology and Infectious Diseases, Max Rady School of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada.,Section of Infectious Diseases, Department of Internal Medicine, Max Rady School of Medicine, The University of Manitoba, Winnipeg, Manitoba, Canada.,Section of Haematology/Oncology, Department of Internal Medicine, Max Rady School of Medicine, The University of Manitoba, Winnipeg, Manitoba, Canada.,Department of Medical Oncology and Haematology, CancerCare Manitoba, Winnipeg, Manitoba, Canada.,Infection Control Services, CancerCare Manitoba, Winnipeg, Manitoba, Canada
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Uneno Y, Imura H, Makuuchi Y, Tochitani K, Watanabe N. Pre-emptive antifungal therapy versus empirical antifungal therapy for febrile neutropenia in people with cancer. Cochrane Database Syst Rev 2022; 11:CD013604. [PMID: 36440894 PMCID: PMC9703870 DOI: 10.1002/14651858.cd013604.pub2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND Intensive cytotoxic chemotherapy for people with cancer can cause severe and prolonged cytopenia, especially neutropenia, a critical condition that is potentially life-threatening. When manifested by fever and neutropenia, it is called febrile neutropenia (FN). Invasive fungal disease (IFD) is one of the serious aetiologies of chemotherapy-induced FN. In pre-emptive therapy, physicians only initiate antifungal therapy when an invasive fungal infection is detected by a diagnostic test. Compared to empirical antifungal therapy, pre-emptive therapy may reduce the use of antifungal agents and associated adverse effects, but may increase mortality. The benefits and harms associated with the two treatment strategies have yet to be determined. OBJECTIVES: To assess the relative efficacy, safety, and impact on antifungal agent use of pre-emptive versus empirical antifungal therapy in people with cancer who have febrile neutropenia. SEARCH METHODS We searched CENTRAL, MEDLINE Ovid, Embase Ovid, and ClinicalTrials.gov to October 2021. SELECTION CRITERIA We included randomised controlled trials (RCTs) that compared pre-emptive antifungal therapy with empirical antifungal therapy for people with cancer. DATA COLLECTION AND ANALYSIS We identified 2257 records from the databases and handsearching. After removing duplicates, screening titles and abstracts, and reviewing full-text reports, we included seven studies in the review. We evaluated the effects on all-cause mortality, mortality ascribed to fungal infection, proportion of antifungal agent use (other than prophylactic use), duration of antifungal use (days), invasive fungal infection detection, and adverse effects for the comparison of pre-emptive versus empirical antifungal therapy. We presented the overall certainty of the evidence for each outcome according to the GRADE approach. MAIN RESULTS This review includes 1480 participants from seven randomised controlled trials. Included studies only enroled participants at high risk of FN (e.g. people with haematological malignancy); none of them included participants at low risk (e.g. people with solid tumours). Low-certainty evidence suggests there may be little to no difference between pre-emptive and empirical antifungal treatment for all-cause mortality (risk ratio (RR) 0.97, 95% confidence interval (CI) 0.72 to 1.30; absolute effect, reduced by 3/1000); and for mortality ascribed to fungal infection (RR 0.92, 95% CI 0.45 to 1.89; absolute effect, reduced by 2/1000). Pre-emptive therapy may decrease the proportion of antifungal agent used more than empirical therapy (other than prophylactic use; RR 0.71, 95% CI 0.47 to 1.05; absolute effect, reduced by 125/1000; very low-certainty evidence). Pre-emptive therapy may reduce the duration of antifungal use more than empirical treatment (mean difference (MD) -3.52 days, 95% CI -6.99 to -0.06, very low-certainty evidence). Pre-emptive therapy may increase invasive fungal infection detection compared to empirical treatment (RR 1.70, 95% CI 0.71 to 4.05; absolute effect, increased by 43/1000; very low-certainty evidence). Although we were unable to pool adverse events in a meta-analysis, there seemed to be no apparent difference in the frequency or severity of adverse events between groups. Due to the nature of the intervention, none of the seven RCTs could blind participants and personnel related to performance bias. We identified considerable clinical and statistical heterogeneity, which reduced the certainty of the evidence for each outcome. However, the two mortality outcomes had less statistical heterogeneity than other outcomes. AUTHORS' CONCLUSIONS For people with cancer who are at high-risk of febrile neutropenia, pre-emptive antifungal therapy may reduce the duration and rate of use of antifungal agents compared to empirical therapy, without increasing over-all and IFD-related mortality; but the evidence regarding invasive fungal infection detection and adverse events was inconsistent and uncertain.
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Affiliation(s)
- Yu Uneno
- Department of Therapeutic Oncology, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Haruki Imura
- Department of Health Informatics, School of Public Health in Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Yosuke Makuuchi
- Hematology, Graduate School of Medicine, Osaka Metropolitan University, Osaka, Japan
| | - Kentaro Tochitani
- Department of Heathcare Epidemiology, School of Public Health in the Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Norio Watanabe
- Department of Psychiatry, Soseikai General Hospital, Kyoto, Japan
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Hawes AM, Permpalung N. Diagnosis and Antifungal Prophylaxis for COVID-19 Associated Pulmonary Aspergillosis. Antibiotics (Basel) 2022; 11:antibiotics11121704. [PMID: 36551361 PMCID: PMC9774425 DOI: 10.3390/antibiotics11121704] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2022] [Revised: 11/19/2022] [Accepted: 11/23/2022] [Indexed: 11/29/2022] Open
Abstract
The COVID-19 pandemic has redemonstrated the importance of the fungal-after-viral phenomenon, and the question of whether prophylaxis should be used to prevent COVID-19-associated pulmonary aspergillosis (CAPA). A distinct pathophysiology from invasive pulmonary aspergillosis (IPA), CAPA has an incidence that ranges from 5% to 30%, with significant mortality. The aim of this work was to describe the current diagnostic landscape of CAPA and review the existing literature on antifungal prophylaxis. A variety of definitions for CAPA have been described in the literature and the performance of the diagnostic tests for CAPA is limited, making diagnosis a challenge. There are only six studies that have investigated antifungal prophylaxis for CAPA. The two studied drugs have been posaconazole, either a liquid formulation via an oral gastric tube or an intravenous formulation, and inhaled amphotericin. While some studies have revealed promising results, they are limited by small sample sizes and bias inherent to retrospective studies. Additionally, as the COVID-19 pandemic changes and we see fewer intubated and critically ill patients, it will be more important to recognize these fungal-after-viral complications among non-critically ill, immunocompromised patients. Randomized controlled trials are needed to better understand the role of antifungal prophylaxis.
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Affiliation(s)
- Armani M. Hawes
- Correspondence: ; Tel.: +1-410-955-5000; Fax: +1-210-892-3847
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Harrison T, Partridge D. Should serum biomarker monitoring replace primary antifungal chemoprophylaxis in patients with acute leukaemia receiving systemic anti-cancer therapy? A PRO/CON debate. JAC Antimicrob Resist 2022; 4:dlac075. [PMID: 35873179 PMCID: PMC9305506 DOI: 10.1093/jacamr/dlac075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Fungal infection exacts a severe burden on patients with acute leukaemia. Azole prophylaxis attempts to mitigate this impact but is associated with toxicity and cost as well as the potential to select for resistance. The development of biomarkers including galactomannan and β-1,3-d-glucan may improve detection of early disease and thus reduce the need for prophylaxis, though these assays also have their limitations. In this debate, Howard et al. argue in favour of continuing chemoprophylaxis in patients with acute leukaemia receiving systemic chemotherapy, citing the multiple randomized control trials and meta-analyses that demonstrate its efficacy. Taynton et al. argue that fungal biomarker surveillance in the absence of primary antifungal chemoprophylaxis is a safe alternative that could reduce antifungal use and the development of resistance.
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Affiliation(s)
- Thomas Harrison
- Department of Infectious Diseases, Sheffield Teaching Hospitals NHS
Foundation Trust, Sheffield, UK
| | - David Partridge
- Department of Microbiology, Sheffield Teaching Hospitals NHS Foundation
Trust, Sheffield, UK
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Zeng H, Wu Z, Yu B, Wang B, Wu C, Wu J, Lai J, Gao X, Chen J. Network meta-analysis of triazole, polyene, and echinocandin antifungal agents in invasive fungal infection prophylaxis in patients with hematological malignancies. BMC Cancer 2021; 21:404. [PMID: 33853560 PMCID: PMC8048157 DOI: 10.1186/s12885-021-07973-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2020] [Accepted: 02/25/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND AND AIM Triazole, polyene, and echinocandin antifungal agents are extensively used to treat invasive fungal infections (IFIs); however, the optimal prophylaxis option is not clear. This study aimed to determine the optimal agent against IFIs for patients with hematological malignancies. METHODS Randomized controlled trials (RCTs) comparing the effectiveness of triazole, polyene, and echinocandin antifungal agents with each other or placebo for IFIs in patients with hematological malignancies were searched. This Bayesian network meta-analysis was performed for all agents. RESULTS The network meta-analyses showed that all triazoles, amphotericin B, and caspofungin, but not micafungin, reduced IFIs. Posaconazole was superior to fluconazole [odds ratio (OR), 0.30; 95% credible interval (CrI), 0.12-0.60], itraconazole (OR, 0.40; 95% CrI, 0.15-0.85), and amphotericin B (OR, 4.97; 95% CrI, 1.73-11.35). It also reduced all-cause mortality compared with fluconazole (OR, 0.35; 95% CrI, 0.08-0.96) and itraconazole (OR, 0.33; 95% CrI, 0.07-0.94), and reduced the risk of adverse events compared with fluconazole (OR, 0.02; 95% CrI, 0.00-0.03), itraconazole (OR, 0.01; 95% CrI, 0.00-0.02), posaconazole (OR, 0.02; 95% CrI, 0.00-0.03), voriconazole (OR, 0.005; 95% CrI, 0.00 to 0.01), amphotericin B (OR, 0.004; 95% CrI, 0.00-0.01), and caspofungin (OR, 0.05; 95% CrI, 0.00-0.42) despite no significant difference in the need for empirical treatment and the proportion of successful treatment. CONCLUSIONS Posaconazole might be an optimal prophylaxis agent because it reduced IFIs, all-cause mortality, and adverse events, despite no difference in the need for empirical treatment and the proportion of successful treatment.
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Affiliation(s)
- Huilan Zeng
- Department of Hematology, the First Affiliated Hospital of Jinan University, No.613 West Huangpu street, Guangzhou, 510630, P. R. China
| | - Zhuman Wu
- Emergency Department, the First Affiliated Hospital of Jinan University, No.613 West Huangpu street, Guangzhou, 510630, P. R. China
| | - Bing Yu
- Department of Hematology, the First Affiliated Hospital of Jinan University, No.613 West Huangpu street, Guangzhou, 510630, P. R. China
| | - Bo Wang
- Department of Hematology, the First Affiliated Hospital of Jinan University, No.613 West Huangpu street, Guangzhou, 510630, P. R. China
| | - Chengnian Wu
- Department of Hematology, the First Affiliated Hospital of Jinan University, No.613 West Huangpu street, Guangzhou, 510630, P. R. China
| | - Jie Wu
- Department of Hematology, the First Affiliated Hospital of Jinan University, No.613 West Huangpu street, Guangzhou, 510630, P. R. China
| | - Jing Lai
- Department of Hematology, the First Affiliated Hospital of Jinan University, No.613 West Huangpu street, Guangzhou, 510630, P. R. China
| | - Xiaoyan Gao
- Department of Hematology, the First Affiliated Hospital of Jinan University, No.613 West Huangpu street, Guangzhou, 510630, P. R. China
| | - Jie Chen
- Department of Urology Surgery, the First Affiliated Hospital of Jinan University, No.613 West Huangpu street, Guangzhou, 510630, P. R. China.
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Abstract
The management of febrile neutropenia is a backbone of treating patients with hematologic malignancies and has evolved over the past decades. This article reviews my approach to the evaluation and treatment of febrile neutropenic patients. Key topics discussed include antibacterial and antifungal prophylaxis, the initial workup for fever, the choice of the empiric antibiotic regimen and its modifications, and criteria for discontinuation. For each of these questions, I review the literature and present my perspective.
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Peseski AM, McClean M, Green SD, Beeler C, Konig H. Management of fever and neutropenia in the adult patient with acute myeloid leukemia. Expert Rev Anti Infect Ther 2020; 19:359-378. [PMID: 32892669 DOI: 10.1080/14787210.2020.1820863] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
INTRODUCTION Febrile neutropenia represents one of the most common treatment-associated complications in the management of acute myeloid leukemia (AML) and is considered an oncologic emergency. Rapid and detailed workup as well as the initiation of empiric broad-spectrum antibiotic therapy are critical to avoid sepsis and to reduce mortality. Although a definitive source of infection is frequently not identified, the severely immunosuppressed status of the AML patient undergoing cytotoxic therapy results in a high risk for a wide array of bacterial, fungal, and viral etiologies. AREAS COVERED The authors herein review the diagnostic and therapeutic approach to the neutropenic leukemia patient based on the current knowledge. Special consideration is given to the rapidly changing therapeutic landscape in AML, creating new challenges in the management of infectious complications. EXPERT OPINION Multidrug-resistant organisms pose a major challenge in the management of neutropenic fever patients with hematologic malignancies - including AML. Future directions to improve outcomes demand innovative treatment approaches as well as advances in biomarker research to facilitate diagnosis and disease monitoring. Recent achievements in AML-targeted therapy led to an increased incidence of differentiation syndrome, a potentially life-threatening side effect that frequently resembles clinical infection and requires prompt recognition and aggressive intervention.
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Affiliation(s)
- Andrew M Peseski
- Department of Internal Medicine, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Mitchell McClean
- Department of Internal Medicine, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Steven D Green
- Melvin and Bren Simon Comprehensive Cancer Center, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Cole Beeler
- Division of Infectious Diseases, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Heiko Konig
- Melvin and Bren Simon Comprehensive Cancer Center, Indiana University School of Medicine, Indianapolis, IN, USA
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Chen Z, Huang H, Yang J, Cai H, Yu Y. The diagnostic value of magnetic resonance urography for detecting ureteric obstruction: a systematic review and meta-analysis. Ann Med 2020; 52:275-282. [PMID: 32233669 PMCID: PMC7877960 DOI: 10.1080/07853890.2020.1741672] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
Abstract
OBJECTIVE To evaluate the diagnostic accuracy of magnetic resonance urography (MRU) and determine its value for detecting ureteric obstruction. METHODS The electronic databases, including PubMed, Embase and the Cochrane library, were systematically searched for studies published throughout September 2018. The summary of sensitivity, specificity, positive likelihood ratio (PLR), negative likelihood ratio (NLR), diagnostic odds ratio (DOR) and receiver operating characteristic (ROC) curves was assessed to evaluate the diagnostic accuracy of MRU. Subgroup analyses were conducted based on the mean age of the included patients (adults or children). RESULTS Eight studies with a total of 594 patients were included. The summary of the sensitivity and specificity of MRU for diagnosing ureteric obstruction was 0.94 and 0.87, respectively. Furthermore, the pooled PLR and NLR were 7.33 and 0.07, respectively. The DOR of MRU for detecting ureteric obstruction was 95.12. In addition, the summary of the area under the ROC of MRU was 0.96. Finally, the specificity, PLR and area under the ROC of MRU for diagnosing ureteric obstruction in adults were higher than children, while the sensitivity of MRU in adults was lower than children. CONCLUSIONS These findings suggested a relatively high diagnostic value of MRU for detecting ureteric obstruction. Moreover, the diagnostic accuracy of MRU in adults was higher than in children. KEY MESSAGE Magnetic resonance urography (MRU) in detecting ureteric obstruction has relatively better sensitivity, specificity, PLR, NLR, DOR and AUC. The diagnostic value, including specificity, PLR and AUC of MRU in adults, was higher than in children, while the sensitivity of MRU in adults was lower than in children.
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Affiliation(s)
- Zhongping Chen
- Department of Medical Imaging, Shenzhen Longhua District Central Hospital, Shenzhen, China
| | - Huayu Huang
- Department of Medical Imaging, Shenzhen Longhua District Central Hospital, Shenzhen, China
| | - Jun Yang
- Department of Medical Imaging, Shenzhen Longhua District Central Hospital, Shenzhen, China
| | - Hongtao Cai
- Department of Medical Imaging, Shenzhen Longhua District Central Hospital, Shenzhen, China
| | - Yali Yu
- Department of Medical Imaging, Shenzhen Longhua District Central Hospital, Shenzhen, China
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Abstract
PURPOSE OF REVIEW With the introduction of new targeted therapies for hematological malignancies comes the challenges of both assessing the risk of developing an IFD while being treated with these agents, as well as managing the drug--drug interactions between azole antifungals and the agents. RECENT FINDINGS New targeted therapies for hematological malignancy include chimeric antigen receptor T cells (CAR T cells), Bi-specific T-cell Engager (BiTE) blinatumomab, and the antibody-drug conjugate (ADC) of calicheamicin inotuzumab ozogamicin for acute lymphoblasic leukemia (ALL) and lymphoma; the Bruton's tyrosine kinase (BTK) inhibitor ibrutinib and phosphatidylinositol 3-kinase (PI3Kδ) inhibitor idelalisib for lymphoma and graft-versus-host disease (GVHD); FMS-like tyrosine kinase 3 (FLT3) inhibitors, such as midostaurin, sorafenib and gilteritinib for acute myeloid leukemia (AML); and the BCL-2 inhibitor venetoclax for a range of hematological malignancies including lymphoma and leukemia. This review summarizes recommendations for IFD prophylaxis using these therapies and evidence for managing concomitant azole administration. SUMMARY Whilst some evidence exists to guide IFD prophylaxis using new targeted therapies for hematological malignancies, there is an overall lack of descriptive, robust studies specifically describing IFD risk and management. With the emergence of novel agents, clinical judgment must be used to assess the risk of developing an IFD. Care must also be taken when administering azoles with drug--drug interactions, often requiring dose adjustment of the cancer therapies.
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Zhang T, Bai J, Huang M, Li R, Liu Y, Liu A, Liu J. Posaconazole and fluconazole prophylaxis during induction therapy for pediatric acute lymphoblastic leukemia. JOURNAL OF MICROBIOLOGY, IMMUNOLOGY, AND INFECTION = WEI MIAN YU GAN RAN ZA ZHI 2020; 54:1139-1146. [PMID: 32828790 DOI: 10.1016/j.jmii.2020.07.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/27/2020] [Revised: 07/09/2020] [Accepted: 07/22/2020] [Indexed: 11/17/2022]
Abstract
PURPOSE To assess and compare the efficacy and safety of posaconazole with fluconazole for the prevention of invasive fungal infections in children who were undergoing induction therapy for acute lymphoblastic leukemia (ALL). To develop an approach to predict invasive fungal infections in ALL patients who accepted posaconazole prophylaxis. METHODS This was a single-center, retrospective cohort study of patients with newly diagnosed ALL, comparing invasive fungal infections in patients who received no prophylaxis, posaconazole prophylaxis, or fluconazole prophylaxis during induction therapy. A propensity score-weighted logistic regression model was used to adjust for confounders. Hepatotoxicity was assessed according to the Common Terminology Criteria for Adverse Events (CTCAE) criteria. RESULTS Out of the 155 ALL patients, 60 received no prophylaxis, 70 received posaconazole prophylaxis, and 25 received fluconazole prophylaxis. Posaconazole prophylaxis reduced the odds of invasive fungal infections by > 60%, prolonged infection-free survival significantly, and did not increase the risk of hepatotoxicity. Additionally, we found that the combination of age at diagnosis, clinically documented bacterial infection in the first 15 days of induction therapy, and absolute neutrophil count (ANC) curve enabled significant prediction of the susceptibility to infections after receiving posaconazole prophylaxis. CONCLUSIONS Our findings supported using targeted prophylaxis with posaconazole in ALL children undergoing induction chemotherapy. Age, clinically documented bacterial infection and ANC are important predictors of invasive fungal infections in patients with posaconazole prophylaxis.
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Affiliation(s)
- Tian Zhang
- Center for Brain Imaging, School of Life Science and Technology, Xidian University, Xi'an, 710126, PR China; Engineering Research Center of Molecular and Neuro Imaging, Ministry of Education, Xi'an, 710126, PR China
| | - Jie Bai
- The Affiliated Children's Hospital of Xi'an Jiaotong University, Shaanxi Children's Medical Center, Xi'an Children's Hospital, Xi'an, 710061, PR China
| | - Mingxia Huang
- The Affiliated Children's Hospital of Xi'an Jiaotong University, Shaanxi Children's Medical Center, Xi'an Children's Hospital, Xi'an, 710061, PR China
| | - Ruixiao Li
- Center for Brain Imaging, School of Life Science and Technology, Xidian University, Xi'an, 710126, PR China; Engineering Research Center of Molecular and Neuro Imaging, Ministry of Education, Xi'an, 710126, PR China
| | - Yang Liu
- Center for Brain Imaging, School of Life Science and Technology, Xidian University, Xi'an, 710126, PR China; Engineering Research Center of Molecular and Neuro Imaging, Ministry of Education, Xi'an, 710126, PR China
| | - Ansheng Liu
- The Affiliated Children's Hospital of Xi'an Jiaotong University, Shaanxi Children's Medical Center, Xi'an Children's Hospital, Xi'an, 710061, PR China.
| | - Jixin Liu
- Center for Brain Imaging, School of Life Science and Technology, Xidian University, Xi'an, 710126, PR China; Engineering Research Center of Molecular and Neuro Imaging, Ministry of Education, Xi'an, 710126, PR China; The Affiliated Children's Hospital of Xi'an Jiaotong University, Shaanxi Children's Medical Center, Xi'an Children's Hospital, Xi'an, 710061, PR China.
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13
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Uneno Y, Imura H, Makuuchi Y, Tochitani K, Watanabe N. Pre-emptive antifungal therapy versus empirical antifungal therapy for febrile neutropenia in people with cancer. Hippokratia 2020. [DOI: 10.1002/14651858.cd013604] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Yu Uneno
- Department of Therapeutic Oncology; Graduate School of Medicine, Kyoto University; Kyoto Japan
| | - Haruki Imura
- Department of Health Informatics; School of Public Health in Graduate School of Medicine, Kyoto University; Kyoto Japan
| | - Yosuke Makuuchi
- Department of Hematology; Graduate School of Medicine, Osaka City University; Osaka Japan
| | - Kentaro Tochitani
- Department of Heathcare Epidemiology; School of Public Heath in the Graduate School of Medicine, Kyoto University; Kyoto Japan
| | - Norio Watanabe
- Department of Health Promotion and Human Behavior; Kyoto University Graduate School of Medicine/School of Public Health; Kyoto Japan
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Sheikhbahaei S, Mohammadi A, Sherkat R, Naeini AE, Yaran M, Najafi S. Invasive Fungal Infection in Febrile Patients with Hematologic Malignancies Undergoing Chemotherapy in Iran. Endocr Metab Immune Disord Drug Targets 2019; 19:302-307. [PMID: 30747087 DOI: 10.2174/1871530319666190211163245] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2017] [Revised: 05/15/2018] [Accepted: 01/02/2019] [Indexed: 11/22/2022]
Abstract
BACKGROUND Patients with hematological malignancies undergoing cytotoxic chemotherapy are susceptible to develop invasive fungal infections particularly Aspergillus and Candida spp. Early detection of these infections is required to start immediate antifungal therapy and increase the survival of these patients. METHOD Our study included consecutive patients of any age with hematologic malignancies who were hospitalized to receive chemotherapy and suffer from persistent fever (rectal temperature >38.5°C) for more than 5 days despite receiving broad-spectrum antibiotics. A whole blood sample was taken and sent for blood culture. PCR was also conducted for Aspergillus and Candida species. RESULTS One hundred and two patients were investigated according to the inclusion criteria. The most common hematologic malignancy was AML affecting 38 patients (37.2%). Six patients were diagnosed with invasive fungal infections (A. fumigatus n=3, C. albicans n=2, A. flavus n=1) by PCR (5.8%) while blood culture showed fungus only in 1 patient. Three more cases were known as probable IFI since they responded to antifungal therapy but the PCR result was negative for them. AML was the most prevalent malignancy in IFI patients (83.3%) and odds ratio for severing neutropenia was 21.5. Odds for each of the baseline characteristics of patients including gender, age>60, diabetes mellitus, previous IFI, history of using more than 3 antibiotics, antifungal prophylaxis, episodes of chemotherapy> 8 and chemotherapy regimen of daunarubicin+cytarabine were calculated. CONCLUSION We found that multiplex real-time PCR assay is more accurate than blood culture in detecting fungal species and the results are prepared sooner. Among all factors, the only type of cancer (AML) and severe neutropenia, were found to be risk factors for the development of fungal infections in all hematologic cancer patients and previous IFI was a risk factor only AML patients.
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Affiliation(s)
- Saba Sheikhbahaei
- Acquired Immunodeficiency Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Alireza Mohammadi
- Acquired Immunodeficiency Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Roya Sherkat
- Acquired Immunodeficiency Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Alireza Emami Naeini
- Infectious Diseases and Tropical Medicine Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Majid Yaran
- Nosocomial Infection Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Somaye Najafi
- Acquired Immunodeficiency Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
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Wang L, Wang Y, Hu J, Sun Y, Huang H, Chen J, Li J, Ma J, Li J, Liang Y, Wang J, Li Y, Yu K, Hu J, Jin J, Wang C, Wu D, Xiao Y, Huang X. Clinical risk score for invasive fungal diseases in patients with hematological malignancies undergoing chemotherapy: China Assessment of Antifungal Therapy in Hematological Diseases (CAESAR) study. Front Med 2019; 13:365-377. [PMID: 30604166 DOI: 10.1007/s11684-018-0641-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2017] [Accepted: 04/25/2018] [Indexed: 01/22/2023]
Abstract
Invasive fungal disease (IFD) is a major infectious complication in patients with hematological malignancies. In this study, we examined 4889 courses of chemotherapy in patients with hematological diseases to establish a training dataset (n = 3500) by simple random sampling to develop a weighted risk score for proven or probable IFD through multivariate regression, which included the following variables: male patients, induction chemotherapy for newly diagnosed or relapsed disease, neutropenia, neutropenia longer than 10 days, hypoalbuminemia, central-venous catheter, and history of IFD. The patients were classified into three groups, which had low (0-10, ~1.2%), intermediate (11-15, 6.4%), and high risk ( > 15, 17.5%) of IFD. In the validation set (n = 1389), the IFD incidences of the groups were ~1.4%, 5.0%, and 21.4%. In addition, we demonstrated that antifungal prophylaxis offered no benefits in low-risk patients, whereas benefits were documented in intermediate (2.1% vs. 6.6%, P = 0.007) and high-risk patients (8.4% vs. 23.3%, P = 0.007). To make the risk score applicable for clinical settings, a pre-chemo risk score that deleted all unpredictable factors before chemotherapy was established, and it confirmed that anti-fungal prophylaxis was beneficial in patients with intermediate and high risk of IFD. In conclusion, an objective, weighted risk score for IFD was developed, and it may be useful in guiding antifungal prophylaxis.
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Affiliation(s)
- Ling Wang
- Blood & Marrow Transplantation Center, Department of Hematology, Collaborative Innovation Center of Hematology, Ruijin Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, China
| | - Ying Wang
- Blood & Marrow Transplantation Center, Department of Hematology, Collaborative Innovation Center of Hematology, Ruijin Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, China
| | - Jiong Hu
- Blood & Marrow Transplantation Center, Department of Hematology, Collaborative Innovation Center of Hematology, Ruijin Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, China.
| | - Yuqian Sun
- Beijing Key Laboratory of Hematopoietic Stem Cell Transplantation, Peking University Institute of Hematology, Peking University, People's Hospital, Beijing, 100044, China
| | - He Huang
- Department of Hematology, The First Affiliated Hospital of Medical School of Zhejiang University, Hangzhou, 310003, China
| | - Jing Chen
- Department of Hematology-Oncology, Shanghai Children's Medical Center, Shanghai, 200127, China
| | - Jianyong Li
- Department of Hematology, Jiangsu Province Hospital, Nanjing, 210029, China
| | - Jun Ma
- Harbin Hematologic Tumor Institution, Harbin, 150010, China
| | - Juan Li
- Department of Hematology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, 510080, China
| | - Yingmin Liang
- Department of Hematology, Tangdu Hospital, Fourth Military Medical University, Xi'an, 710032, China
| | - Jianmin Wang
- Department of Hematology, Changhai Hospital of the Second Military Medical University, Shanghai, 200082, China
| | - Yan Li
- Department of Hematology, The First Affiliated Hospital of China Medical University, Shenyang, 110001, China
| | - Kang Yu
- Department of Hematology, The First Affiliated Hospital of Wenzhou Medical College, Wenzhou, 325000, China
| | - Jianda Hu
- Department of Hematology, Fujian Medical University Union Hospital, Fuzhou, 350001, China
| | - Jie Jin
- Department of Hematology, The First Affiliated Hospital of Medical School of Zhejiang University, Hangzhou, 310003, China
| | - Chun Wang
- Department of Hematology, The First People's Hospital of Shanghai, Shanghai, 200080, China
| | - Depei Wu
- Department of Hematology, The First Affiliated Hospital of Soochow University, Suzhou, 215006, China
| | - Yang Xiao
- Department of Hematology, The General Hospital of Guangzhou Military Command of PLA, Guangzhou, 510010, China
| | - Xiaojun Huang
- Beijing Key Laboratory of Hematopoietic Stem Cell Transplantation, Peking University Institute of Hematology, Peking University, People's Hospital, Beijing, 100044, China.
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16
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Kotsopoulou M, Papadaki C, Anargyrou K, Spyridonidis A, Baltadakis I, Papadaki HA, Angelopoulou M, Pappa V, Liakou K, Tzanetakou M, Moustaka M, Vassilopoulos G. Effectiveness and Safety of Micafungin in Managing Invasive Fungal Infections among Patients in Greece with Hematologic Disorders: The ASPIRE Study. Infect Dis Ther 2019; 8:255-268. [PMID: 30767170 PMCID: PMC6522581 DOI: 10.1007/s40121-019-0236-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2018] [Indexed: 11/24/2022] Open
Abstract
INTRODUCTION Invasive candidiasis (IC) can be a life-threatening infection in immunocompromised patients, particularly those with cancer, hematologic diseases and/or hematopoietic stem cell transplantation (HSCT) recipients. The objective of this study was to evaluate the effectiveness of micafungin in patients with hematologic malignancies or HSCT recipients, relevant to clinical presentation of IC, in real-life practice in Greece. METHODS ASPIRE was a phase IV, multicenter, non-interventional, prospective cohort study, conducted at ten tertiary hospitals in Greece, in adults with hematologic disease. Micafungin treatment for IC or prophylaxis for Candida infection was administered per standard clinical practice until a clinical outcome (success or failure) was reached. Treatment success was defined by the EORTC/MSG criteria for invasive fungal infections (IFI) and was assessed by the investigator. Treatment discontinuation and safety were also evaluated. RESULTS One hundred forty-three patients were enrolled. Median age was 62; 85 (59.4%) patients were male, and 133 (93.0%) had Greek ethnicity. One hundred twenty-six (88.1%) patients had hematologic malignancies, and 21 (14.7%) had received HSCT. Prophylaxis was administered to 74 (51.7%) patients [median (range) dose: 50 (50-150) mg/day] with no signs of IFI. Overall, 52 (36.4%) patients with possible IFI at baseline received micafungin treatment [100 (50-125) mg/day] versus 12 (17.2%) with probable [100 (75-150) mg/day] and 5 (3.5%) with confirmed [125 (100-150) mg/day] IFI. Treatment success was 91.6% (95% CI 85.80-95.59; n = 131) overall and 90.5% (n = 67) in patients receiving prophylaxis. Median time on treatment was 13 days. Treatment discontinuation (n = 26; 18.2%) was not related to adverse events. No treatment-related serious adverse events were reported. CONCLUSION Micafungin treatment for IC or prophylaxis for Candida infection was effective and well tolerated in patients with hematologic disorders in clinical practice in Greece. These results demonstrate that micafungin could be used more widely for prophylaxis. Further work is required to determine the efficacy and safety of micafungin for the management of IFIs in hematologic settings. FUNDING Astellas Pharma Inc.
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Affiliation(s)
| | | | | | | | - Ioannis Baltadakis
- Department of Hematology and Bone Marrow Transplantation Unit, Evaggelismos Hospital, Athens, Greece
| | - Helen A Papadaki
- University of Crete School of Medicine and University General Hospital of Heraklion, Heraklion, Greece
| | - Maria Angelopoulou
- Department of Hematology, National and Kapodistrian University of Athens, Laikon General Hospital, Athens, Greece
| | - Vasiliki Pappa
- Second Department of Internal Medicine and Research Institute, Attikon University General Hospital, Athens, Greece
| | - Kleoniki Liakou
- Medical Affairs, Astellas Pharmaceuticals AEBE, Athens, Greece
| | | | - Marina Moustaka
- Medical Affairs, Astellas Pharmaceuticals AEBE, Athens, Greece
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Busca A, Pagano L. Prophylaxis for aspergillosis in patients with haematological malignancies: pros and cons. Expert Rev Anti Infect Ther 2018; 16:531-542. [DOI: 10.1080/14787210.2018.1496329] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Affiliation(s)
- Alessandro Busca
- Stem Cell Transplant Center, AOU Citta’ della Salute e Della Scienza, Turin, Italy
| | - Livio Pagano
- Institute of Hematology, Policlinico Universitario Agostino Gemelli, Rome, Italy
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18
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Cataldi V, Di Campli E, Fazii P, Traini T, Cellini L, Di Giulio M. Candida species isolated from different body sites and their antifungal susceptibility pattern: Cross-analysis of Candida albicans and Candida glabrata biofilms. Med Mycol 2018; 55:624-634. [PMID: 27915303 DOI: 10.1093/mmy/myw126] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2016] [Accepted: 09/23/2016] [Indexed: 12/27/2022] Open
Abstract
Candida species are regular commensal in humans, but-especially in immunocompromised patients-they represent opportunistic pathogens giving rise to systemic infection. The aim of the present work was to isolate and characterize for their antifungal profile Candida species from different body sites and to analyze the biofilms produced by C. albicans and C. glabrata isolates. Eighty-one strains of Candida species from 77 patients were identified. Epidemiological study showed that the most isolated species were C. albicans (44), C. glabrata (13) and C. parapsilosis (13) mainly from Hematology, Infectious Diseases, Medicine, Neonatology and Oncology Divisions, the majority of the biological samples were swabs (44) and blood cultures (16). The analysis of the biofilm formation was performed at 24 and 48-hours comparing resistant and susceptible strains of C. albicans to resistant and susceptible strains of C. glabrata. Candida albicans has a greater ability to form biofilm compared to C. glabrata, both in the susceptible and resistant strains reaching maturity after 24 hours with a complex structure composed of blastospores, pseudohyphae, and hyphae embedded in a matrix. On the contrary, C. glabrata biofilm was composed exclusively of blastospores that in the resistant strain, after 24 hours, were organized in a compact multilayer different to the discontinuous structure observed in the susceptible analyzed strains. In conclusion, the increasing of the incidence of Candida species infection together with their emerging drug resistance also related to the biofilm forming capability underline the need to monitor their distribution and susceptibility patterns for improving the surveillance and for a correct management of the infection.
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Affiliation(s)
- Valentina Cataldi
- Departments of Pharmacy and Medical, Oral and Biotechnological Sciences, University "G. d'Annunzio," Chieti-Pescara, Chieti, Italy
| | - Emanuela Di Campli
- Departments of Pharmacy and Medical, Oral and Biotechnological Sciences, University "G. d'Annunzio," Chieti-Pescara, Chieti, Italy
| | - Paolo Fazii
- Clinical Microbiology and Virology, Spirito Santo Hospital, Pescara, Italy
| | - Tonino Traini
- Medical, Oral and Biotechnological Sciences, University "G.d'Annunzio", Chieti-Pescara, Chieti, Italy
| | - Luigina Cellini
- Departments of Pharmacy and Medical, Oral and Biotechnological Sciences, University "G. d'Annunzio," Chieti-Pescara, Chieti, Italy
| | - Mara Di Giulio
- Departments of Pharmacy and Medical, Oral and Biotechnological Sciences, University "G. d'Annunzio," Chieti-Pescara, Chieti, Italy
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19
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Epstein DJ, Seo SK, Brown JM, Papanicolaou GA. Echinocandin prophylaxis in patients undergoing haematopoietic cell transplantation and other treatments for haematological malignancies. J Antimicrob Chemother 2018; 73:i60-i72. [PMID: 29304213 PMCID: PMC7189969 DOI: 10.1093/jac/dkx450] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
Antifungal prophylaxis is the standard of care for patients undergoing intensive chemotherapy for haematological malignancy or haematopoietic cell transplantation (HCT). Prophylaxis with azoles reduces invasive fungal infections and may reduce mortality. However, breakthrough infections still occur, and the use of azoles is sometimes complicated by pharmacokinetic variability, drug interactions, adverse events and other issues. Echinocandins are highly active against Candida species, including some organisms resistant to azoles, and have some clinical activity against Aspergillus species as well. Although currently approved echinocandins require daily intravenous administration, the drugs have a favourable safety profile and more predictable pharmacokinetics than mould-active azoles. Clinical data support the efficacy and safety of echinocandins for antifungal prophylaxis in haematology and HCT patients, though data are less robust than for azoles. Notably, sparse evidence exists supporting the use of echinocandins as antifungal prophylaxis for patients with significant graft-versus-host disease (GvHD) after HCT. Two drugs that target (1,3)-β-d-glucan are in development, including an oral glucan synthase inhibitor and an echinocandin with unique pharmacokinetics permitting subcutaneous and weekly administration. Echinocandins are a reasonable alternative to azoles and other agents for antifungal prophylaxis in patients undergoing intensive chemotherapy for haematological malignancy or those receiving HCT, excluding those with significant GvHD.
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Affiliation(s)
- David J Epstein
- Division of Infectious Diseases, Stanford University, Palo Alto, CA, USA
| | - Susan K Seo
- Infectious Disease Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA
- Department of Medicine, Weill Cornell Medical College, New York, NY, USA
| | - Janice M Brown
- Division of Infectious Diseases, Stanford University, Palo Alto, CA, USA
| | - Genovefa A Papanicolaou
- Infectious Disease Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA
- Department of Medicine, Weill Cornell Medical College, New York, NY, USA
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20
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Abstract
Infection is a major complication of patients with hematological malignancies. Prophylaxis is a key element in the management of these patients, and is composed by two main components: infection control measures and antimicrobial chemoprophylaxis. Infection control measures are safe, but not always effective. Antimicrobial prophylaxis is usually effective but may increase resistance rates, toxicity, and cost. Therefore, a careful evaluation of the actual risk for infection, the pathogens that predominate in a particular setting, and the periods at risk are important in order to define the most appropriate strategy. In this chapter we review the most important parameters to assess the risk on an individual basis, and the evidences and recommendations supporting infection control measures and antimicrobial prophylaxis against bacteria, fungi, viruses, and parasites.
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21
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McCarthy MW, Walsh TJ. Checkpoint inhibitors and the risk of infection. EXPERT REVIEW OF PRECISION MEDICINE AND DRUG DEVELOPMENT 2017. [DOI: 10.1080/23808993.2017.1380517] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Matthew William McCarthy
- Hospital Medicine, Joan and Sanford I Weill Medical College of Cornell University, New York, NY, USA
| | - Thomas J. Walsh
- Transplantation-Oncology Infectious Diseases Program, Weill Cornell Medical Center, New York, NY, USA
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Abstract
PURPOSE OF REVIEW Improved management of infectious complications of acute myeloid leukemia (AML) has contributed substantially to the success of care over the past half century. An important approach to reducing infectious complications during the induction period of chemotherapy involves the use of prophylactic antibacterial, antiviral, and antifungal agents targeting likely pathogens. RECENT FINDINGS There is not a one-size-fits-all approach to prophylaxis; every patient undergoing induction therapy should be evaluated individually and within the context of local microbiologic epidemiology and host risk factors. Pharmacologic and non-pharmacologic interventions as well as novel diagnostic platforms can help mitigate the risk of life-threatening infection in patients with AML who undergo induction chemotherapy.
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Affiliation(s)
- Matthew W McCarthy
- Division of General Internal Medicine, Weill Cornell Medical College, New York-Presbyterian Hospital, 525 East 68th Street, Box 331, New York, NY, 10065, USA.
| | - Thomas J Walsh
- Transplantation-Oncology Infectious Diseases Program, Medical Mycology Research Laboratory, Weill Cornell Medical Center, New York, NY, USA
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23
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Enfermedades invasoras por hongos levaduriformes en pacientes neutropénicos. Rev Iberoam Micol 2016; 33:170-5. [DOI: 10.1016/j.riam.2015.11.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2015] [Revised: 11/15/2015] [Accepted: 11/19/2015] [Indexed: 11/18/2022] Open
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Patterson TF, Thompson GR, Denning DW, Fishman JA, Hadley S, Herbrecht R, Kontoyiannis DP, Marr KA, Morrison VA, Nguyen MH, Segal BH, Steinbach WJ, Stevens DA, Walsh TJ, Wingard JR, Young JAH, Bennett JE. Practice Guidelines for the Diagnosis and Management of Aspergillosis: 2016 Update by the Infectious Diseases Society of America. Clin Infect Dis 2016; 63:e1-e60. [PMID: 27365388 DOI: 10.1093/cid/ciw326] [Citation(s) in RCA: 1635] [Impact Index Per Article: 204.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2016] [Accepted: 05/11/2016] [Indexed: 12/12/2022] Open
Abstract
It is important to realize that guidelines cannot always account for individual variation among patients. They are not intended to supplant physician judgment with respect to particular patients or special clinical situations. IDSA considers adherence to these guidelines to be voluntary, with the ultimate determination regarding their application to be made by the physician in the light of each patient's individual circumstances.
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Affiliation(s)
- Thomas F Patterson
- University of Texas Health Science Center at San Antonio and South Texas Veterans Health Care System
| | | | - David W Denning
- National Aspergillosis Centre, University Hospital of South Manchester, University of Manchester, United Kingdom
| | - Jay A Fishman
- Massachusetts General Hospital and Harvard Medical School
| | | | | | | | - Kieren A Marr
- Johns Hopkins University School of Medicine and the Sidney Kimmel Comprehensive Cancer Center, Baltimore, Maryland
| | - Vicki A Morrison
- Hennepin County Medical Center and University of Minnesota, Minneapolis
| | | | - Brahm H Segal
- University at Buffalo Jacobs School of Medicine and Biomedical Sciences, and Roswell Park Cancer Institute, New York
| | | | | | - Thomas J Walsh
- New York-Presbyterian Hospital/Weill Cornell Medical Center, New York
| | | | | | - John E Bennett
- Laboratory of Clinical Infectious Diseases, National Institute of Allergy and Infectious Disease, National Institutes of Health, Bethesda, Maryland
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25
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Heinz WJ, Buchheidt D, Ullmann AJ. Clinical evidence for caspofungin monotherapy in the first-line and salvage therapy of invasiveAspergillusinfections. Mycoses 2016; 59:480-93. [DOI: 10.1111/myc.12477] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2015] [Accepted: 01/08/2016] [Indexed: 11/29/2022]
Affiliation(s)
- Werner J. Heinz
- Medizinische Klinik and Poliklinik II; Infectious Diseases University of Würzburg Medical Center; Würzburg Germany
| | - Dieter Buchheidt
- Department of Hematology and Oncology; Mannheim University Hospital; University of Heidelberg; Mannheim Germany
| | - Andrew J. Ullmann
- Medizinische Klinik and Poliklinik II; Infectious Diseases University of Würzburg Medical Center; Würzburg Germany
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26
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Garnica M, Sinhorelo A, Madeira L, Portugal R, Nucci M. Diagnostic-driven antifungal therapy in neutropenic patients using the D-index and serial serum galactomannan testing. Braz J Infect Dis 2016; 20:354-9. [PMID: 27280789 PMCID: PMC9427580 DOI: 10.1016/j.bjid.2016.04.007] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2015] [Revised: 03/09/2016] [Accepted: 04/05/2016] [Indexed: 11/27/2022] Open
Abstract
Introduction Invasive mold disease is an important complication of patients with hematologic malignancies, and is associated with high mortality. A diagnostic-driven approach has been an alternative to the classical empiric antifungal therapy. In the present study we tested an algorithm that incorporated risk stratification using the D-index, serial serum galactomannan and computed tomographic-scan to guide the decision to start antifungal therapy in neutropenic patients. Patients and methods Between May 2010 and August 2012, patients with acute leukemia in induction remission were prospectively monitored from day 1 of chemotherapy until discharge or death with the D-index and galactomannan. Patients were stratified in low, intermediate and high risk according to the D-index and an extensive workup for invasive mold disease was performed in case of positive galactomannan (≥0.5), persistent fever, or the appearance of clinical manifestations suggestive of invasive mold disease. Results Among 29 patients, 6 (21%), 11 (38%), and 12 (41%) were classified as high, intermediate, and low risk, respectively. Workup for invasive mold disease was undertaken in 67%, 73% and 58% (p = 0.77) of patients in each risk category, respectively, and antifungal therapy was given to 67%, 54.5%, and 17% (p = 0.07). Proven or probable invasive mold disease was diagnosed in 67%, 45.5%, and in none (p = 0.007) of high, intermediate, and low risk patients, respectively. All patients survived. Conclusion A risk stratification using D-index was a useful instrument to be incorporated in invasive mold disease diagnostic approach, resulting in a more comprehensive antifungal treatment strategy, and to guide an earlier start of treatment in afebrile patients under very high risk.
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Affiliation(s)
- Marcia Garnica
- Universidade Federal do Rio de Janeiro (UFRJ), Hospital Universitário, Departmento de Medicina Interna, Rio de Janeiro, RJ, Brazil
| | - Aline Sinhorelo
- Universidade Federal do Rio de Janeiro (UFRJ), Hospital Universitário, Departmento de Medicina Interna, Rio de Janeiro, RJ, Brazil
| | - Laura Madeira
- Universidade Federal do Rio de Janeiro (UFRJ), Hospital Universitário, Departmento de Medicina Interna, Rio de Janeiro, RJ, Brazil
| | - Rodrigo Portugal
- Universidade Federal do Rio de Janeiro (UFRJ), Hospital Universitário, Departmento de Medicina Interna, Rio de Janeiro, RJ, Brazil
| | - Marcio Nucci
- Universidade Federal do Rio de Janeiro (UFRJ), Hospital Universitário, Departmento de Medicina Interna, Rio de Janeiro, RJ, Brazil.
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Lighter-Fisher J, Stanley K, Phillips M, Pham V, Klejmont LM. Preventing Infections in Children with Cancer. Pediatr Rev 2016; 37:247-58. [PMID: 27252180 DOI: 10.1542/pir.2015-0059] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Affiliation(s)
| | - Kaitlin Stanley
- Department of Pediatrics, New York University Langone Medical Center, New York, NY
| | - Michael Phillips
- Department of Medicine, New York University Langone Medical Center, New York, NY
| | - Vinh Pham
- Department of Medicine, New York University Langone Medical Center, New York, NY
| | - Liana M Klejmont
- Department of Pharmacy, New York University Langone Medical Center, New York, NY
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28
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Tang JL, Kung HC, Lei WC, Yao M, Wu UI, Hsu SC, Lin CT, Li CC, Wu SJ, Hou HA, Chou WC, Huang SY, Tsay W, Chen YC, Chen YC, Chang SC, Ko BS, Tien HF. High Incidences of Invasive Fungal Infections in Acute Myeloid Leukemia Patients Receiving Induction Chemotherapy without Systemic Antifungal Prophylaxis: A Prospective Observational Study in Taiwan. PLoS One 2015; 10:e0128410. [PMID: 26061179 PMCID: PMC4462587 DOI: 10.1371/journal.pone.0128410] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2015] [Accepted: 04/28/2015] [Indexed: 11/18/2022] Open
Abstract
Invasive fungal infections (IFIs) is an important complication for acute myeloid leukemia (AML) patients receiving induction chemotherapy. However, the epidemiological information is not clear in Southeastern Asia, an area of potential high incidences of IFIs. To clarify it, we enrolled 298 non-M3 adult AML patients receiving induction chemotherapy without systemic anti-fungal prophylaxis from Jan 2004 to Dec 2009, when we applied a prospective diagnostic and treatment algorithm for IFIs. Their demographic parameters, IFI characters, and treatment outcome were collected for analysis. The median age of these patients was 51 years. Standard induction chemotherapy was used for 246 (82.6%) patients, and 66.8% of patients achieved complete remission (CR) or partial remission. The incidence of all-category IFIs was 34.6% (5.7% proven IFIs, 5.0% probable IFIs and 23.8% possible IFIs). Candida tropicalis was the leading pathogen among yeast, and lower respiratory tract was the most common site for IFIs (75.4%, 80/106). Standard induction chemotherapy and failure to CR were identified as risk factors for IFIs. The presence of IFI in induction independently predicted worse survival (hazard ratio 1.536 (1.100–2.141), p value = 0.012). Even in those who survived from the initial IFI insults after 3 months, the presence of IFIs in induction still predicted a poor long-term survival. This study confirms high incidences of IFIs in Southeastern Asia, and illustrates potential risk factors; poor short-term and long-term outcomes are also demonstrated. This epidemiological information will provide useful perspectives for anti-fungal prophylaxis and treatment for AML patients during induction, so that best chances of cure and survival can be provided.
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Affiliation(s)
- Jih-Luh Tang
- Division of Hematology, Department of Internal Medicine, National Taiwan University, Taipei, Taiwan
- Tai-Cheng Stem Cell Therapy Center, National Taiwan University, Taipei, Taiwan
| | - Hsiang-Chi Kung
- Division of Infection, Department of Internal Medicine, National Taiwan University, Taipei, Taiwan
| | - Weng-Chi Lei
- Division of Hematology, Department of Internal Medicine, National Taiwan University, Taipei, Taiwan
| | - Ming Yao
- Division of Hematology, Department of Internal Medicine, National Taiwan University, Taipei, Taiwan
| | - Un-In Wu
- Clinical Trial Center, National Taiwan University Hospital, Taipei, Taiwan
| | - Szu-Chun Hsu
- Department of Laboratory Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Chien-Ting Lin
- Tai-Cheng Stem Cell Therapy Center, National Taiwan University, Taipei, Taiwan
| | - Chi-Cheng Li
- Tai-Cheng Stem Cell Therapy Center, National Taiwan University, Taipei, Taiwan
| | - Shang-Ju Wu
- Division of Hematology, Department of Internal Medicine, National Taiwan University, Taipei, Taiwan
| | - Hsin-An Hou
- Division of Hematology, Department of Internal Medicine, National Taiwan University, Taipei, Taiwan
| | - Wen-Chien Chou
- Department of Laboratory Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Shang-Yi Huang
- Division of Hematology, Department of Internal Medicine, National Taiwan University, Taipei, Taiwan
| | - Woei Tsay
- Division of Hematology, Department of Internal Medicine, National Taiwan University, Taipei, Taiwan
| | - Yao-Chang Chen
- Department of Laboratory Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Yee-Chun Chen
- Division of Infection, Department of Internal Medicine, National Taiwan University, Taipei, Taiwan
- National Institute of Infectious Diseases and Vaccinology, National health Research Institute, Miaoli, Taiwan
| | - Shan-Chwen Chang
- Division of Infection, Department of Internal Medicine, National Taiwan University, Taipei, Taiwan
| | - Bor-Sheng Ko
- Division of Hematology, Department of Internal Medicine, National Taiwan University, Taipei, Taiwan
- * E-mail:
| | - Hwei-Fang Tien
- Division of Hematology, Department of Internal Medicine, National Taiwan University, Taipei, Taiwan
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Kang SH, Kim HS, Bae MN, Kim J, Yoo JY, Lee KY, Lee DG, Kim HJ. Fatal Breakthrough Mucormycosis in an Acute Myelogenous Leukemia Patient while on Posaconazole Prophylaxis. Infect Chemother 2015; 47:49-54. [PMID: 25844263 PMCID: PMC4384455 DOI: 10.3947/ic.2015.47.1.49] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2013] [Revised: 01/20/2014] [Accepted: 04/21/2014] [Indexed: 12/30/2022] Open
Abstract
Posaconazole is a new oral triazole with broad-spectrum antifungal activity. Posaconazole has also shown a significant advantage of preventing invasive fungal infection compared to fluconazole or itraconazole in patients with prolonged neutropenia. Indeed, posaconazole has been commonly used for antifungal prophylaxis in patients undergoing remission induction chemotherapy for acute myelogenous leukemia or myelodysplastic syndrome. We experienced a case of fatal mucormycosis despite posaconazole prophylaxis. To our knowledge, this is the first reported case of fatal breakthrough mucormycosis in a patient receiving posaconazole prophylaxis during remission induction chemotherapy in Korea. This case demonstrated that breakthrough fungal infection can occurs in patients receiving posaconazole prophylaxis because of its limited activity against some mucorales.
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Affiliation(s)
- Seung Hun Kang
- Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Hyun Seon Kim
- Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Myoung Nam Bae
- Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Jihye Kim
- Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Ji Yeon Yoo
- Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Kwan Yong Lee
- Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Dong-Gun Lee
- Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea
- Catholic Blood and Marrow Transplantation Center, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Hee-Je Kim
- Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea
- Catholic Blood and Marrow Transplantation Center, College of Medicine, The Catholic University of Korea, Seoul, Korea
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30
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Fleming S, Yannakou CK, Haeusler GM, Clark J, Grigg A, Heath CH, Bajel A, van Hal SJ, Chen SC, Milliken ST, Morrissey CO, Tam CS, Szer J, Weinkove R, Slavin MA. Consensus guidelines for antifungal prophylaxis in haematological malignancy and haemopoietic stem cell transplantation, 2014. Intern Med J 2014; 44:1283-97. [DOI: 10.1111/imj.12595] [Citation(s) in RCA: 95] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- S. Fleming
- Malignant Haematology and Stem Cell Transplantation Service; Alfred Health; Prahran Victoria
| | - C. K. Yannakou
- Department of Clinical Haematology and Bone Marrow Transplant Service; The Royal Melbourne Hospital; Parkville Victoria
| | - G. M. Haeusler
- Department of Infectious Diseases and Infection Control; Peter MacCallum Cancer Centre; East Melbourne Victoria
- Department of Paediatric Infectious Diseases; Monash Children's Hospital; Monash Health; Clayton Victoria
- Paediatric Integrated Cancer Service; Parkville Victoria
| | - J. Clark
- Infection Management and Prevention Service; The Royal Children's Hospital Brisbane; Queensland Health; Herston Queensland
| | - A. Grigg
- Department of Clinical Haematology; Austin Health; Heidelberg Victoria
- School of Medicine; The University of Melbourne; Melbourne Victoria
| | - C. H. Heath
- Department of Microbiology and Infectious Diseases; Royal Perth Hospital; Perth Western Australia
- School of Medicine and Pharmacology (RPH Unit); University of Western Australia; Perth Western Australia
| | - A. Bajel
- Department of Clinical Haematology and Bone Marrow Transplant Service; The Royal Melbourne Hospital; Parkville Victoria
| | - S. J. van Hal
- Department of Microbiology and Infectious Diseases; Royal Prince Alfred Hospital; Camperdown New South Wales
| | - S. C. Chen
- Centre for Infectious Diseases and Microbiology Laboratory Services; ICPMR - Pathology West; Westmead New South Wales
- Department of Infectious Diseases; Westmead Hospital; Westmead New South Wales
- Sydney Medical School; The University of Sydney; Sydney New South Wales
| | - S. T. Milliken
- Department of Haematology; St Vincent's Hospital; Darlinghurst New South Wales
- Faculties of Medicine and Pathology; The University of NSW; Kensington New South Wales
| | - C. O. Morrissey
- Department of Infectious Diseases; Alfred Health and Monash University; Prahran Victoria
- Department of Clinical Haematology; Alfred Health; Prahran Victoria
| | - C. S. Tam
- School of Medicine; The University of Melbourne; Melbourne Victoria
- Department of Haematology; Peter MacCallum Cancer Centre; East Melbourne Victoria
| | - J. Szer
- Department of Clinical Haematology and Bone Marrow Transplant Service; The Royal Melbourne Hospital; Parkville Victoria
- School of Medicine; The University of Melbourne; Melbourne Victoria
| | - R. Weinkove
- Wellington Blood and Cancer Centre; Capital and Coast District Health Board; Wellington New Zealand
- Vaccine Research Group; Malaghan Institute of Medical Research; Wellington New Zealand
| | - M. A. Slavin
- Department of Infectious Diseases and Infection Control; Peter MacCallum Cancer Centre; East Melbourne Victoria
- School of Medicine; The University of Melbourne; Melbourne Victoria
- Victorian Infectious Diseases Service; The Doherty Institute for Infection and Immunity; Parkville Victoria
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Treatment of febrile neutropenia and prophylaxis in hematologic malignancies: a critical review and update. Adv Hematol 2014; 2014:986938. [PMID: 25525436 PMCID: PMC4265549 DOI: 10.1155/2014/986938] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2014] [Revised: 10/18/2014] [Accepted: 11/03/2014] [Indexed: 01/27/2023] Open
Abstract
Febrile neutropenia is one of the most serious complications in patients with haematological malignancies and chemotherapy. A prompt identification of infection and empirical antibiotic therapy can prolong survival. This paper reviews the guidelines about febrile neutropenia in the setting of hematologic malignancies, providing an overview of the definition of fever and neutropenia, and categories of risk assessment, management of infections, and prophylaxis.
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Faksri K, Kaewkes W, Chaicumpar K, Chaimanee P, Wongwajana S. Epidemiology and identification of potential fungal pathogens causing invasive fungal infections in a tertiary care hospital in northeast Thailand. Med Mycol 2014; 52:810-8. [PMID: 25231771 DOI: 10.1093/mmy/myu052] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
Invasive fungal infections (IFIs) are life threatening and associated with a high mortality rate. Here, we describe the distribution of pathogens, host risk factors, and significance of fungi isolated from patients with IFIs. The study included 861 fungal isolates recovered between 2006 and 2011 from 802 patients at Srinagarind Hospital, Thailand. Based on the European Organization for Research and Treatment of Cancer/Invasive Fungal Infections Cooperative Group and the National Institute of Allergy and Infectious Diseases Mycoses Study Group 2008 criteria, 28.5% (245/861 isolates) of the fungal isolates were considered to be causative agents of IFIs. The most common fungus was Candida albicans (46%, 396/861 isolates). However, the most common yeast causing IFIs was Cryptococcus neoformans (34.7%, 85/245 isolates), while the most common mould was Penicillium marneffei (10.6%, 26/245 isolates). Cryptococcosis was significantly associated with human immunodeficiency virus infections (P < 0.001). Trend analysis revealed that there was no significant increase in IFI cases (P = 0.34) from 2006 to 2011 or from 2007 to 2011 (P = 0.05), but there was a trend toward significant increases in candidiasis (P = 0.04). The fungal isolates were categorized according to the positive predictive value of their recovery in cultures as being true (>95%), moderate (5%-95%), and rare (<5%) pathogens. This classification system could facilitate the prediction of the likelihood of diseases caused by the isolated fungi.
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Affiliation(s)
- Kiatichai Faksri
- Department of Microbiology, Faculty of Medicine, Khon Kaen University, Thailand Research and Diagnostic Center for Emerging Infectious Diseases, Khon Kaen University, Thailand
| | - Wanlop Kaewkes
- Department of Microbiology, Faculty of Medicine, Khon Kaen University, Thailand
| | - Kunyaluk Chaicumpar
- Department of Microbiology, Faculty of Medicine, Khon Kaen University, Thailand
| | - Prajuab Chaimanee
- Clinical Microbiology Unit, Srinagarind Hospital, Faculty of Medicine, Khon Kaen University, Thailand
| | - Suwin Wongwajana
- Department of Microbiology, Faculty of Medicine, Khon Kaen University, Thailand
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Johansen HK, Gøtzsche PC. Amphotericin B versus fluconazole for controlling fungal infections in neutropenic cancer patients. Cochrane Database Syst Rev 2014; 2014:CD000239. [PMID: 25188769 PMCID: PMC6457742 DOI: 10.1002/14651858.cd000239.pub2] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND Systemic fungal infection is considered to be an important cause of morbidity and mortality in cancer patients, particularly those with neutropenia. Antifungal drugs are often given prophylactically, or empirically to patients with persistent fever. OBJECTIVES To compare the effect of fluconazole and amphotericin B on morbidity and mortality in patients with cancer complicated by neutropenia. SEARCH METHODS We searched PubMed from 1966 to 7 July 2014 and the reference lists of identified articles. SELECTION CRITERIA Randomised clinical trials comparing fluconazole with amphotericin B. DATA COLLECTION AND ANALYSIS The two review authors independently assessed trial eligibility and risk of bias, and abstracted data. MAIN RESULTS Seventeen trials (3798 patients, 381 deaths) were included. In two large three-armed trials, results for amphotericin B were combined with results for nystatin in a 'polyene' group. Because nystatin is an ineffective drug in these circumstances, this approach creates a bias in favour of fluconazole. Furthermore, most patients were randomised to oral amphotericin B, which is poorly absorbed and poorly documented. There was overlap among the 'polyene' trials but we were unable to obtain any information from the trial authors or from Pfizer, the manufacturer of fluconazole, to clarify these issues. There were no significant differences in effect between fluconazole and amphotericin B, but the confidence intervals were wide. More patients dropped out of the study when they received amphotericin B, but as none of the trials were blinded decisions on premature interruption of therapy could have been biased. Furthermore, amphotericin B was not given under optimal circumstances, with premedication to reduce infusion-related toxicity, slow infusion, and with fluid, potassium and magnesium supplements to prevent nephrotoxicity. The major harms were hepatic impairment and gastrointestinal adverse effects with fluconazole and infusion-related toxicity, renal impairment and gastrointestinal adverse effects with amphotericin B. For the 2011 and 2014 updates no additional trials were identified for inclusion. AUTHORS' CONCLUSIONS Amphotericin B has been disfavoured in several of the trials through their design or analysis, or both. Since intravenous amphotericin B is the only antifungal agent for which an effect on mortality has been shown, and since it is considerably cheaper than fluconazole, it should be the preferred agent.
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Affiliation(s)
- Helle Krogh Johansen
- RigshospitaletThe Nordic Cochrane CentreBlegdamsvej 9, 3343CopenhagenDenmarkDK 2100
| | - Peter C Gøtzsche
- RigshospitaletNordic Cochrane CentreBlegdamsvej 9, 7811CopenhagenDenmarkDK‐2100
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Baseline and Bimonthly High-Resolution Computed Tomographic Imaging of the Chest in the Early Detection and Treatment of Pulmonary Mold Infections in Patients With Leukemia With Prolonged Neutropenia. INFECTIOUS DISEASES IN CLINICAL PRACTICE 2014. [DOI: 10.1097/ipc.0000000000000111] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Faulk K, Gore L, Cooper T. Overview of therapy and strategies for optimizing outcomes in de novo pediatric acute myeloid leukemia. Paediatr Drugs 2014; 16:213-27. [PMID: 24639021 DOI: 10.1007/s40272-014-0067-3] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Although acute myelogenous leukemia (AML) accounts for <20 % of leukemia in children, it is responsible for over half of all pediatric leukemia deaths. Improvement in event-free survival rates, now over 50 %, are due largely to intensification of chemotherapy, aggressive supportive care, development of risk stratification based on cytogenetic and molecular markers, and improved salvage regimens. Despite this improvement over the past few decades, the survival rates have recently plateaued, and further improvement will need to take into account advances in molecular characterization of AML, development of novel agents, and better understanding of host factors influencing toxicity and response to chemotherapy. This article reviews the epidemiology and biology trends in diagnosis and treatment of pediatric acute myelogenous leukemia.
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Affiliation(s)
- Kelly Faulk
- Department of Pediatrics, University of Colorado School of Medicine/Anschutz Medical Campus, Aurora, CO, USA
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37
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Abstract
Febrile neutropenia (FN) can occur at any time during the course of a malignancy, especially hematologic malignancies, from diagnosis to end-stage disease. The majority of FN episodes are typically confined to the period of initial diagnosis and active treatment. Because of suppressed inflammatory responses, fever is often the sole sign of infection. As FN is a true medical emergency, prompt identification of and intervention in FN can prolong survival and improve quality of life. This article reviews FN in the setting of hematologic malignancies, specifically myelodysplastic syndromes and acute leukemias, providing an overview of the definition of fever and neutropenia, diagnostic approach, categories of risk/risk assessment, management in patients at low and high risk, and prophylaxis of infections.
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38
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Lv X, Zhang Y, Zeng F, Yin A, Ye N, Ouyang H, Feng D, Li D, Ling W, Zhang X. The association between the polymorphism rs2231142 in the ABCG2 gene and gout risk: a meta-analysis. Clin Rheumatol 2014; 33:1801-5. [DOI: 10.1007/s10067-014-2635-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2013] [Revised: 03/17/2014] [Accepted: 04/15/2014] [Indexed: 12/31/2022]
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Lin R, Xu X, Li Y, Sun J, Fan Z, Jiang Q, Huang F, Zhou H, Nie D, Guo Z, Mao Y, Xiao Y, Liu Q. Comparison of long-term and short-term administration of itraconazole for primary antifungal prophylaxis in recipients of allogeneic hematopoietic stem cell transplantation: a multicenter, randomized, open-label trial. Transpl Infect Dis 2014; 16:286-94. [PMID: 24593273 DOI: 10.1111/tid.12192] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2013] [Revised: 08/19/2013] [Accepted: 09/07/2013] [Indexed: 11/30/2022]
Abstract
BACKGROUND The optimal agents and duration of primary antifungal prophylaxis in recipients of allogeneic hematopoietic stem cell transplantation (allo-HSCT) remain a matter of discussion. OBJECTIVE Our objective was to compare the efficacy and safety of long-term and short-term administration of itraconazole (ITCZ) for primary antifungal prophylaxis in allo-HSCT recipients. METHODS This multicenter, randomized, open-label pilot study was performed in 4 transplant centers in China. Recipients of allo-HSCT without a history of invasive fungal disease (IFD) were randomly assigned to the long-term or the short-term arm. Randomization was carried out by a center computer system. Intravenous ITCZ was given to the patients in both study arms with a loading dose of 400 mg/day for 2 days followed by 200 mg/day until day +14 or when the white blood cell count was >1.0 × 10(9) /L, and then switched to oral ITCZ solution; prophylaxis was continued until day +30 post transplantation in the short-term arm or until day +90 in the long-term arm. The trough serum concentrations of ITCZ also were measured. The primary study endpoint was the incidence of IFD (proven, probable, and possible) within day +90 post transplantation. RESULTS A total of 128 recipients were enrolled in this study; 59 of them were randomized to the long-term arm and 62 were randomized to the short-term arm, forming the modified intent-to-treat (mITT) set. The incidence of IFD within day +90, the primary endpoint, was not significantly different between the 2 arms for the mITT set (6.78% in the long-term arm vs. 6.45% in the short-term arm, P = 0.94), or for the per-protocol set (6.90% in the long-term arm vs. 6.67% in the short-term arm, P = 0.96). From day +30 to day +90, the incidence of IFD was 0% and 6.45%, respectively, in the patients with long-term and short-term prophylaxis for the mITT set (P = 0.11). The mean trough serum concentrations of ITCZ was maintained at >500 ng/mL throughout administration. The incidences of withdrawal because of drug-related adverse events in patients with long-term and short-term prophylaxis were 6.78% and 0%, respectively (P = 0.05). CONCLUSIONS Long-term and short-term administration of ITCZ both seemed effective in preventing IFD in recipients of allo-HSCT. Further study with large sample size should be performed to evaluate this result. ITCZ shows the same pharmacokinetics in recipients of allo-HSCT as in non-recipients.
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Affiliation(s)
- R Lin
- Department of Hematology, Nanfang Hospital, Southern Medical University, Guangzhou, China
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Science M, Robinson PD, MacDonald T, Rassekh SR, Dupuis LL, Sung L. Guideline for primary antifungal prophylaxis for pediatric patients with cancer or hematopoietic stem cell transplant recipients. Pediatr Blood Cancer 2014; 61:393-400. [PMID: 24424789 DOI: 10.1002/pbc.24847] [Citation(s) in RCA: 69] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2013] [Accepted: 10/14/2013] [Indexed: 12/30/2022]
Abstract
This guideline provides clinicians with evidence-based recommendations on the use of antifungal prophylaxis in children with cancer and undergoing hematopoietic stem cell transplantation (HSCT). Recommendations are divided into: (1) allogeneic HSCT (2) autologous HSCT (3) acute myeloid leukemia or myelodysplastic syndrome and (4) patients with malignancy and neutropenia for >7 days. A systematic review was conducted and evidence summaries compiled. The quality of evidence and strength of each recommendation was determined using GRADE. Implementation of these recommendations will require adaptation to local context. The contribution of this guideline in the prevention of invasive fungal infections requires prospective evaluation.
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Affiliation(s)
- Michelle Science
- Division of Infectious Diseases, The Hospital for Sick Children, Toronto, Ontario; Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton Health Sciences, Hamilton, Ontario
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Owusu Obeng A, Egelund EF, Alsultan A, Peloquin CA, Johnson JA. CYP2C19 polymorphisms and therapeutic drug monitoring of voriconazole: are we ready for clinical implementation of pharmacogenomics? Pharmacotherapy 2014; 34:703-18. [PMID: 24510446 DOI: 10.1002/phar.1400] [Citation(s) in RCA: 91] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Since its approval by the U.S. Food and Drug Administration in 2002, voriconazole has become a key component in the successful treatment of many invasive fungal infections including the most common, aspergillosis and candidiasis. Despite voriconazole's widespread use, optimizing its treatment in an individual can be challenging due to significant interpatient variability in plasma concentrations of the drug. Variability is due to nonlinear pharmacokinetics and the influence of patient characteristics such as age, sex, weight, liver disease, and genetic polymorphisms in the cytochrome P450 2C19 gene (CYP2C19) encoding for the CYP2C19 enzyme, the primary enzyme responsible for metabolism of voriconazole. CYP2C19 polymorphisms account for the largest portion of variability in voriconazole exposure, posing significant difficulty to clinicians in targeting therapeutic concentrations. In this review, we discuss the role of CYP2C19 polymorphisms and their influence on voriconazole's pharmacokinetics, adverse effects, and clinical efficacy. Given the association between CYP2C19 genotype and voriconazole concentrations, as well as the association between voriconazole concentrations and clinical outcomes, particularly efficacy, it seems reasonable to suggest a potential role for CYP2C19 genotype to guide initial voriconazole dose selection followed by therapeutic drug monitoring to increase the probability of achieving efficacy while avoiding toxicity.
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Affiliation(s)
- Aniwaa Owusu Obeng
- Icahn School of Medicine at Mount Sinai, The Charles Bronfman Institute for Personalized Medicine, New York, New York; Department of Pharmacy, The Mount Sinai Hospital, New York, New York
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Abstract
In susceptible patients, invasive aspergillosis has a high incidence and a mortality of up to 80%. The diagnosis of this condition is difficult, especially in the early stages of the disease and, as a consequence, antifungal therapy, despite its expense and toxicity, is often initiated empirically. Until recently, there were very few effective antifungal agents for established invasive aspergillosis, but the introduction of two new drugs, voriconazole and caspofungin, has increased the treatment options. These newer antifungal therapies, combined with improved early diagnosis due to the introduction of newer microbiologic techniques, offer the hope that there will be a significant improvement in the substantial morbidity and mortality associated with invasive aspergillosis over the next 5 years.
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Affiliation(s)
- S R Doffman
- Barts & the London NHS Trust, West Smithfield, London, EC1A 7BE, UK.
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Hakim H, Shenep JL. Managing fungal and viral infections in pediatric leukemia. Expert Rev Hematol 2014; 3:603-24. [DOI: 10.1586/ehm.10.58] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Abstract
Patients with cancer vary regarding the nature and level of immunocompromise. Both the underlying malignancy and therapy can influence risk of infectious complications. Therefore, decisions about antimicrobial prophylaxis must be guided by a number of factors: (1) the risk of infection; (2) the potential severity of infection and the likelihood of response to therapy; and (3) the safety and efficacy of antimicrobial prophylaxis. The potential for selection for antibiotic-resistant pathogens should also inform decisions about prophylaxis. When assessing clinical trial data on antimicrobial prophylaxis, two major criteria should be considered: the quality of studies supporting prophylaxis (randomized, blinded studies are optimal) and the expected benefit of prophylaxis, measured in terms of prevention of morbidity and potentially mortality. This chapter reviews the epidemiology and clinical trial data on prophylaxis against the major bacterial, viral, and fungal diseases in patients with cancer. Gaps in knowledge and alternative approaches, such as the use of newer diagnostics, are discussed.
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Affiliation(s)
- Diana Pomakova
- School of Medicine and Biomedical Sciences, University of Buffalo School of Medicine, Buffalo, NY, USA
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45
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Ahmadzadeh A, Varnasseri M, Jalili MH, Maniavi F, Valizadeh A, Mahmoodian M, Keyhani M. Infection Pattern of Neutropenic Patients in Post-chemotherapy Phase of Acute Leukemia Treatment. Hematol Rep 2013; 5:e15. [PMID: 24416500 PMCID: PMC3883062 DOI: 10.4081/hr.2013.e15] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2013] [Revised: 10/08/2013] [Accepted: 10/17/2013] [Indexed: 11/23/2022] Open
Abstract
Neutropenia following chemotherapy regimens in leukemia patients is of major concern since it makes these patients vulnerable to infections. If we can identify which germs are causing these infections, they can be annihilated or, at least, the most appropriate antibiotic therapy can be started immediately, even before we have the results of the culture. This retrospective multi-center study took place in 2012 and included patients with acute leukemia who had already undergone chemotherapy and who had been febrile for at least 16 hours. In order to assess the type of infection, different environments were chosen and the results were compared by t-test and χ(2) tests. This study took place in four hospitals in Tehran and Ahwaz, Iran. The study population was made up of 89 patients: 37 with acute lymphoblastic leukemia and 52 with acute myeloid leukemia. The results revealed that blood was the most common site of infection. From all our positive cultures, it was seen that 85.4% of them had gram-negative bacteria with a dominance of E. coli of 25.8% over the other colonies. Also, antibiograms revealed the sensitivity of almost all the gram-negatives to amino glycosides. In contrast with most of the literature, in our patients, gram-negatives are the most common cause of infection and, therefore, administering amino glycosides would be the safest antibiotic therapy to prescribe before culture results are available.
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Affiliation(s)
- Ahmad Ahmadzadeh
- Research Center of Thalassemia and Hemoglobinopathy, Ahvaz Jundishapur University of Medical Science , Ahvaz
| | - Mehran Varnasseri
- Department of Infectious Disease, Razi Hospital, Ahvaz Jundishapur University of Medical Science , Ahvaz
| | | | - Fatemeh Maniavi
- Department of Infection Control, Shafa Hospital, Ahvaz Jundishapur University of Medical Sciences , Ahvaz
| | - Armita Valizadeh
- Department of Anatomy, Ahvaz Jundishapur University of Medical Sciences , Ahvaz
| | - Mojtaba Mahmoodian
- Department of Medicine, Ahvaz Jundishapur University of Medical Sciences , Ahvaz
| | - Manouchehr Keyhani
- Hematology and Oncology Research Center, Vali Asr Hospital, Tehran University of Medical Science , Tehran, Iran
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Fisher BT, Kavcic M, Li Y, Seif AE, Bagatell R, Huang YS, Zaoutis T, Torp K, Leckerman KH, Aplenc R. Antifungal prophylaxis associated with decreased induction mortality rates and resources utilized in children with new-onset acute myeloid leukemia. Clin Infect Dis 2013; 58:502-8. [PMID: 24270167 DOI: 10.1093/cid/cit781] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Invasive fungal infections cause significant morbidity and mortality for children with acute myeloid leukemia (AML). Data on the comparative effectiveness of antifungal prophylaxis in this population are limited. METHODS A pediatric AML cohort was assembled from the Pediatric Health Information System database using ICD-9 codes and pharmacy data. Antifungal prophylaxis status was determined by pharmaceutical data review within 21 days of starting induction chemotherapy. Patients were followed until end of induction, death, or loss to follow-up. Cox regression analyses compared induction mortality and resources utilized between patients receiving and not receiving antifungal prophylaxis. A propensity score accounted for variation in demographic factors, location of care, and severity of illness at presentation. RESULTS Eight hundred seventy-one AML patients were identified; the induction case fatality rate was 3.7%. In the adjusted Cox regression model, patients receiving antifungal prophylaxis (57%) had a decreased hazard for induction mortality (hazard ratio [HR], 0.42; 95% confidence interval [CI], .19-.90). Children receiving prophylaxis were less frequently exposed to broad-spectrum gram-positive (incidence rate ratio [IRR], 0.87; 95% CI, .79-.97) and antipseudomonal β-lactam agents (HR, 0.91; 95% CI, .85-.96), had fewer blood cultures (IRR, 0.78; 95% CI, .71-.86), and had fewer chest CT scans (IRR, 0.73; 95% CI, .60-.88). CONCLUSIONS Antifungal prophylaxis in pediatric AML patients was associated with reduced induction mortality rates and supportive care resources. Further investigation is necessary to determine whether antifungal prophylaxis should include antimold activity.
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Namikawa T, Kitagawa H, Yamatsuji T, Naomoto Y, Kobayashi M, Hanazaki K. Pre-emptive treatment of fungal infection based on plasma β-D-glucan levels after gastric surgery for gastric cancer in elderly patients. J Gastroenterol Hepatol 2013; 28:1457-61. [PMID: 23574148 DOI: 10.1111/jgh.12219] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/31/2013] [Indexed: 02/05/2023]
Abstract
BACKGROUND AND AIM Invasive fungal infection (IFI) related to surgery in elderly patients is often associated with high morbidity and mortality. The aim of the present study was to determine 1,3-β-D-glucan (βDG) levels after gastric cancer surgery in elderly patients and to prospectively evaluate the efficacy of pre-emptive antifungal therapy using βDG as an aid for the early diagnosis of IFI. METHODS In all, 81 patients aged ≥70 years who had undergone gastric cancer surgery between 2009 and 2011 were prospectively enrolled in the study. Patients with plasma βDG levels >11 pg/mL (the cut-off value) were randomly assigned to either receive antifungal treatment or not (n=13 in each group). Postoperative outcomes were assessed using various clinical parameters. RESULTS After gastric cancer surgery, plasma βDG levels were ≥11 pg/mL in 26 of 81 elderly patients (32.1%). Of the βDG-positive patients, significantly more had stages III and IV rather than stages I and II disease (44.1% vs 23.4%, respectively; P=0.049). Fever on postoperative day 8 was significantly reduced in the pre-emptive antifungal-treated group than in the control group (36.8°C vs 37.2°C, respectively; P=0.045). However, there were no significant differences in mortality, morbidity, βDG levels, white blood cell count, and C-reactive protein levels between the two groups. CONCLUSIONS Pre-emptive antifungal treatment based on βDG after gastric surgery in elderly patients may help reduce the incidence of postoperative fever and suppress IFI. However, this needs to be confirmed in a larger prospective randomized, controlled trial.
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Affiliation(s)
- Tsutomu Namikawa
- Department of Surgery, Kochi Medical School, Nankoku, Kochi, Japan
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Gamaletsou MN, Walsh TJ, Zaoutis T, Pagoni M, Kotsopoulou M, Voulgarelis M, Panayiotidis P, Vassilakopoulos T, Angelopoulou MK, Marangos M, Spyridonidis A, Kofteridis D, Pouli A, Sotiropoulos D, Matsouka P, Argyropoulou A, Perloretzou S, Leckerman K, Manaka A, Oikonomopoulos P, Daikos G, Petrikkos G, Sipsas NV. A prospective, cohort, multicentre study of candidaemia in hospitalized adult patients with haematological malignancies. Clin Microbiol Infect 2013; 20:O50-7. [PMID: 23889746 DOI: 10.1111/1469-0691.12312] [Citation(s) in RCA: 77] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2012] [Revised: 03/22/2013] [Accepted: 06/19/2013] [Indexed: 01/06/2023]
Abstract
Invasive candidiasis is a life-threatening infection in patients with haematological malignancies. The objective of our study was to determine the incidence, microbiological characteristics and clinical outcome of candidaemia among hospitalized adult patients with haematological malignancies. This is a population-based, prospective, multicentre study of patients ≥ 18 years admitted to haematology and/or haematopoietic stem cell transplantation units of nine tertiary care Greek hospitals from January 2009 through to February 2012. Within this cohort, we conducted a nested case-control study to determine the risk factors for candidaemia. Stepwise logistic regression was used to identify independent predictors of 28-day mortality. Candidaemia was detected in 40 of 27,864 patients with haematological malignancies vs. 967 of 1,158,018 non-haematology patients for an incidence of 1.4 cases/1000 admissions vs. 0.83/1000 respectively (p <0.001). Candidaemia was caused predominantly (35/40, 87.5%) by non-Candida albicans species, particularly Candida parapsilosis (20/40, 50%). In vitro resistance to at least one antifungal agent was observed in 27% of Candida isolates. Twenty-one patients (53%) developed breakthrough candidaemia while receiving antifungal agents. Central venous catheters, hypogammaglobulinaemia and a high APACHE II score were independent risk factors for the development of candidaemia. Crude mortality at day 28 was greater in those with candidaemia than in control cases (18/40 (45%) vs. 9/80 (11%); p <0.0001). In conclusion, despite antifungal prophylaxis, candidaemia is a relatively frequent infection associated with high mortality caused by non-C. albicans spp., especially C. parapsilosis. Central venous catheters and hypogammaglobulinaemia are independent risk factors for candidaemia that provide potential targets for improving the outcome.
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Affiliation(s)
- M N Gamaletsou
- Laikon General Hospital and Medical School, National and Kapodistrian University of Athens, Athens, Greece; Weill Cornell Medical Center of Cornell University, New York, NY, USA
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Yeh TC, Liu HC, Wang LY, Chen SH, Liang DC. Invasive fungal infection in children undergoing chemotherapy for cancer. ACTA ACUST UNITED AC 2013; 27:141-7. [PMID: 17565811 DOI: 10.1179/146532807x192516] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
BACKGROUND In children with cancer, invasive fungal infection is a serious complication of anticancer therapy. Successful treatment is a major challenge for clinical oncologists. METHODS The records of all episodes of invasive fungal infection occurring in children with cancer undergoing chemotherapy at Mackay Memorial Hospital, Taipei between January 1987 and October 2005 were reviewed. The following were documented: general characteristics, clinical presentation, predisposing factors, pathogens, antifungal treatment, association with anticancer therapy and outcome. We endeavoured to preserve renal function by administration of new antifungal agents. Anticancer therapy was given as soon as possible after diagnosis and the dose of chemotherapeutic agents was adjusted as required to prevent unduly prolonged interruption of chemotherapy and minimise the risk of leukaemia relapse. RESULTS Twenty-six patients with 29 episodes of invasive fungal infection were reviewed. Candida species were the leading pathogens (14/29) followed by Aspergillus species (11/29). In six episodes there was both visceral dissemination and fungaemia. In 23/29 patients, antibiotic therapy preceded fungal infection with a median of 11 days. Three children died from extensive fungal infection and four from progression of malignancy; the remainder survived with a median follow-up of 40 months (range 12-233). The actuarial 12-month survival rate was 87%; in patients with invasive candidiasis and aspergillosis the rates were 75% and 100%, respectively. CONCLUSIONS In children with cancer, most invasive fungal infections can be treated successfully. Current antifungal prophylaxis should protect patients from fungal infection.
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Affiliation(s)
- Ting-Chi Yeh
- Department of Pediatrics, Mackay Memorial Hospital, Taipei, Taiwan
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Colombo AL, Guimarães T, Camargo LFA, Richtmann R, Queiroz-Telles FD, Salles MJC, Cunha CAD, Yasuda MAS, Moretti ML, Nucci M. Brazilian guidelines for the management of candidiasis - a joint meeting report of three medical societies: Sociedade Brasileira de Infectologia, Sociedade Paulista de Infectologia and Sociedade Brasileira de Medicina Tropical. Braz J Infect Dis 2013; 17:283-312. [PMID: 23693017 PMCID: PMC9427385 DOI: 10.1016/j.bjid.2013.02.001] [Citation(s) in RCA: 79] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2013] [Accepted: 02/16/2013] [Indexed: 01/07/2023] Open
Abstract
Candida infections account for 80% of all fungal infections in the hospital environment, including bloodstream, urinary tract and surgical site infections. Bloodstream infections are now a major challenge for tertiary hospitals worldwide due to their high prevalence and mortality rates. The incidence of candidemia in tertiary public hospitals in Brazil is approximately 2.5 cases per 1000 hospital admissions. Due to the importance of this infection, the authors provide a review of the diversity of the genus Candida and its clinical relevance, the therapeutic options and discuss the treatment of major infections caused by Candida. Each topography is discussed with regard to epidemiological, clinical and laboratory diagnostic and therapeutic recommendations based on levels of evidence.
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