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Jeck J, Jakobs F, Kurte MS, Cornely OA, Kron F. Health-economic modelling of cost savings due to the use of rezafungin based on a German cost-of-illness study of candidiasis. JAC Antimicrob Resist 2023; 5:dlad079. [PMID: 37342199 PMCID: PMC10279419 DOI: 10.1093/jacamr/dlad079] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Accepted: 06/01/2023] [Indexed: 06/22/2023] Open
Abstract
Objective Candida species are responsible for fungal diseases and the development of nosocomial bloodstream infections. Treatment is resource-intensive and economically challenging for healthcare systems. Cost analyses of drugs against candidiasis, such as rezafungin, are thus of great interest to healthcare payers. Methods We conducted a cost-of-illness study of patients with Candida infections based on real-word data of the Department I of Internal Medicine, University Hospital Cologne (Germany) between 2016 and 2021. Health-economic parameters were analysed to describe the economic impact of Candida infections. Potential cost savings due to the administration of rezafungin were modelled for patients with invasive candidiasis or candidaemia based on a 5 day reduction of ICU length of stay (LOS) shown by the STRIVE study. Results We found 724 cases (652 patients) with Candida infections, of which 61% received ICU treatment (n = 442) and 29% were mechanically ventilated (n = 207). Twenty-six percent died during hospitalization (n = 185). Median LOS was 25 and 15 days, on normal wards and ICU, respectively. Median total treatment costs per case accounted for €22 820. Based on the ICU LOS reduction, the retrospective model showed a median cost-saving potential of €7175 per hospital case with invasive candidiasis or candidaemia. Accumulated cost savings for 37 patients of €283 335 were found. Conclusions Treatment of candidiasis is cost intensive due to increased hospital LOS. The ICU LOS reduction rezafungin showed in STRIVE would lead to sustainable cost savings.
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Affiliation(s)
- Julia Jeck
- Department I of Internal Medicine, Faculty of Medicine and University Hospital Cologne, University of Cologne, Kerpener Straße 62, 50937 Cologne, Germany
- VITIS GmbH, Am Morsdorfer Hof 12, 50933 Cologne, Germany
| | - Florian Jakobs
- Department of Haematology and Stem Cell Transplantation, Faculty of Medicine and Essen University Hospital, University of Duisburg-Essen, Hufelandstraße 55, 45147 Essen, Germany
| | - Melina S Kurte
- VITIS GmbH, Am Morsdorfer Hof 12, 50933 Cologne, Germany
| | - Oliver A Cornely
- Department I of Internal Medicine, Faculty of Medicine and University Hospital Cologne, University of Cologne, Kerpener Straße 62, 50937 Cologne, Germany
- Center for Integrated Oncology Cologne (CIO ABCD), Faculty of Medicine and University Hospital Cologne, University of Cologne, Kerpener Straße 28 62, 50937 Cologne, Germany
- Clinical Trials Centre Cologne (ZKS Köln), Faculty of Medicine and University Hospital Cologne, University of Cologne, Gleueler Straße 269, 50935 Cologne, Germany
- CECAD Cologne, Translational Research, Cologne Excellence Cluster on Cellular Stress Responses in Aging-Associated Diseases (CECAD), Faculty of Medicine and University Hospital Cologne, University of Cologne, Joseph-Stelzmann-Straße 26, 50931 Cologne, Germany
- Excellence Centre for Medical Mycology (ECMM), Faculty of Medicine and University Hospital Cologne, University of Cologne, Kerpener Straße 62, 50937 Cologne, Germany
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Zhang Y, Liu YC, Chen SM, Zong H, Hou WT, Qiu XR, Guo SY, Sun YF, Jiang YY, An MM, Shen H. Evaluation of the in vitro Activity and in vivo Efficacy of Anidulafungin-Loaded Human Serum Albumin Nanoparticles Against Candida albicans. Front Microbiol 2022; 12:788442. [PMID: 34970244 PMCID: PMC8712755 DOI: 10.3389/fmicb.2021.788442] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2021] [Accepted: 11/24/2021] [Indexed: 01/03/2023] Open
Abstract
Recent decades have seen a significant increase in invasive fungal infections, resulting in unacceptably high mortality rates. Anidulafungin (AN) is the newest echinocandin and appears to have several advantages over existing antifungals. However, its poor water solubility and burdensome route of administration (i.e., repeated, long-term intravenous infusions) have limited its practical use. The objective of this study was to develop anidulafungin-loaded Human Serum Albumin (HSA) nanoparticles (NP) so as to increase both its solubility and antifungal efficacy. HSA was reduced using SDS and DTT, allowing liberation of free thiols to form the intermolecular disulfide network and nanoassembly. Reduced HSA was then added to MES buffer (0.1 M, pH 4.8) and magnetically stirred at 350 rpm and 25°C with AN (m/m 50:1) for 2 h to form nanoparticles (AN NP). We next performed routine antifungal susceptibility testing of Candida strains (n = 31) using Clinical and Laboratory Standards Institute (CLSI) methodologies. Finally, the in vivo efficacy of both AN and AN NP was investigated in a murine model of invasive infection by one of the most common fungal species—C. albicans. The results indicated that our carrier formulations successfully improved the water solubility of AN and encapsulated AN, with the latter having a particle size of 29 ± 1.5 nm with Polymer dispersity index (PDI) equaling 0.173 ± 0.039. In vitro AN NP testing revealed a stronger effect against Candida species (n = 31), with Minimum Inhibitory Concentration (MIC) values 4- to 32-fold lower than AN alone. In mice infected with Candida and having invasive candidiasis, we found that AN NP prolonged survival time (P < 0.005) and reduced fungal burden in kidneys compared to equivalent concentrations of free drug (P < 0.0001). In conclusion, the anidulafungin nanoparticles developed here have the potential to improve drug administration and therapeutic outcomes for individuals suffering from fungal diseases.
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Affiliation(s)
- Yu Zhang
- Department of Pharmacology, Shanghai Tenth People's Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Yan-Chao Liu
- Department of Pharmacology, Shanghai Tenth People's Hospital, School of Medicine, Tongji University, Shanghai, China.,Department of Clinical Pharmacy, Shanghai General Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Si-Min Chen
- Department of Pharmacology, Shanghai Tenth People's Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Hui Zong
- Department of Pharmacology, Shanghai Tenth People's Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Wei-Tong Hou
- Department of Pharmacology, Shanghai Tenth People's Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Xi-Ran Qiu
- Department of Pharmacology, Shanghai Tenth People's Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Shi-Yu Guo
- Department of Pharmacology, Shanghai Tenth People's Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Yu-Fang Sun
- Department of Pharmacology, Shanghai Tenth People's Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Yuan-Ying Jiang
- Department of Pharmacology, Shanghai Tenth People's Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Mao-Mao An
- Department of Pharmacology, Shanghai Tenth People's Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Hui Shen
- Department of Clinical Laboratory Medicine, Shanghai Tenth People's Hospital, School of Medicine, Tongji University, Shanghai, China
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Updates in Ocular Antifungal Pharmacotherapy: Formulation and Clinical Perspectives. CURRENT FUNGAL INFECTION REPORTS 2019. [DOI: 10.1007/s12281-019-00338-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Bui A, Nguyen V, Hsu C, Hyde B, Simms-Waldrip T. Invasive Fungal Infections While on Voriconazole, Liposomal Amphotericin B, or Micafungin for Antifungal Prophylaxis in Pediatric Stem Cell Transplant Patients. J Pediatr Pharmacol Ther 2019; 24:220-226. [PMID: 31093021 DOI: 10.5863/1551-6776-24.3.220] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
OBJECTIVE This study aimed to report the incidence of invasive fungal infections (IFIs) in pediatric hematopoietic stem cell transplant (HSCT) patients who received voriconazole, liposomal amphotericin B (L-AMB), or micafungin for primary antifungal prophylaxis (PAP). METHODS Using data retrospectively collected from institution's electronic records, this study analyzed the incidence of IFIs in pediatric HSCT patients between November 2012 and November 2016. RESULTS A total of 103 patients were screened. Of the 84 patients who met inclusion criteria, 76.2%, 29.8%, and 19% patients received voriconazole, L-AMB, and micafungin, respectively. The incidence of overall IFIs was 2.08 per 1000 prophylaxis days. There were 2 mold infections identified in 2 patients. Among 3 antifungal agents, the rates of IFIs were 2.67 per 1000 prophylaxis days in L-AMB group, 2.08 per 1000 prophylaxis days in micafungin group, and 1.17 per 1000 prophylaxis days in voriconazole group. CONCLUSION Patients who received L-AMB or micafungin had higher rates of IFIs than those who received voriconazole for PAP.
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Honarvar B, Bagheri Lankarani K, Taghavi M, Vahedi G, Mortaz E. Biomarker-guided antifungal stewardship policies for patients with invasive candidiasis. Curr Med Mycol 2018; 4:37-44. [PMID: 30815616 PMCID: PMC6386506 DOI: 10.18502/cmm.4.4.385] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2018] [Revised: 12/10/2018] [Accepted: 01/02/2018] [Indexed: 02/05/2023] Open
Abstract
Invasive fungal infections (IFIs) are among the life-threatening issues in patients with impaired immune system. High administration of antifungals in these patients imposes a heavy economic burden on the national health system. In addition, despite the usually expensive antifungal regimens, the mortality rate due to fungal infections is still high, resulting in the loss of hundreds of lives per year. Survival rate is an indicator of the success of national healthcare policies. Early diagnosis of IFI is critical because any delays may be fatal. The weakness of the old-fashioned culture-based diagnostic methods lies in their time-consuming laboratory procedures. To overcome this problem, several diagnostic approaches have been developed to facilitate the early diagnosis of invasive candidiasis as the most prevalent IFI. These methods are based on the detection of serologic and molecular footprints. However, nowadays, antibiotic resistance and proper and cost-effective use of antibiotics are given special attention in national healthcare policies. The instructions for controlling these indices have been collected under the name of antibiotic stewardship. The present review study was targeted toward providing insight into novel diagnostic biomarkers and antifungal stewardship programs. The simultaneous investigation of these two issues facilitates the achievement of a novel health policy for the treatment of systemic candidiasis in immunocompromised patients.
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Affiliation(s)
- Behnam Honarvar
- Health Policy Research Center, Institute of Health, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Kamran Bagheri Lankarani
- Health Policy Research Center, Institute of Health, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mehdi Taghavi
- Health Policy Research Center, Institute of Health, Shiraz University of Medical Sciences, Shiraz, Iran
- Mycology Research Center, Faculty of Veterinary Medicine, University of Tehran, Tehran, Iran
| | - Ghasem Vahedi
- Mycology Research Center, Faculty of Veterinary Medicine, University of Tehran, Tehran, Iran
| | - Esmaeil Mortaz
- Department of Immunology, Faculty of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
- Division of Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Faculty of Sciences, Utrecht University, Utrecht, the Netherlands
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Patil A, Majumdar S. Echinocandins in antifungal pharmacotherapy. J Pharm Pharmacol 2017; 69:1635-1660. [DOI: 10.1111/jphp.12780] [Citation(s) in RCA: 73] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2016] [Accepted: 06/05/2017] [Indexed: 12/12/2022]
Abstract
Abstract
Objectives
Echinocandins are the newest addition of the last decade to the antifungal armamentarium, which, owing to their unique mechanism of action, selectively target the fungal cells without affecting mammalian cells. Since the time of their introduction, they have come to occupy an important niche in the antifungal pharmacotherapy, due to their efficacy, safety, tolerability and favourable pharmacokinetic profiles. This review deals with the varying facets of echinocandins such as their chemistry, in-vitro and in-vivo evaluations, clinical utility and indications, pharmacokinetic and pharmacodynamic profiles, and pharmacoeconomic considerations.
Key findings
Clinical studies have demonstrated that the echinocandins – caspofungin, micafungin and anidulafungin – are equivalent, if not superior, to the mainstay antifungal therapies involving amphotericin B and fluconazole. Moreover, echinocandin regimen has been shown to be more cost-effective and economical. Hence, the echinocandins have found favour in the management of invasive systemic fungal infections.
Conclusions
The subtle differences in echinocandins with respect to their pharmacology, clinical therapy and the mechanisms of resistance are emerging at a rapid pace from the current pool of research which could potentially aid in extending their utility in the fungal infections of the eye, heart and nervous system.
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Affiliation(s)
- Akash Patil
- Department of Pharmaceutics and Drug Delivery, School of Pharmacy, University of Mississippi, Oxford, MS, USA
| | - Soumyajit Majumdar
- Department of Pharmaceutics and Drug Delivery, School of Pharmacy, University of Mississippi, Oxford, MS, USA
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Armaganidis A, Nanas S, Antoniadou E, Mandragos K, Liakou K, Koutsoukou A, Baltopoulos G, Nakos G, Kounougeri A, Ganas K, Prekates A, Kompoti M, Georgopoulos D, Pneumatikos I, Zakynthinos E. Clinical factors affecting costs in patients receiving systemic antifungal therapy in intensive care units in Greece: Results from the ESTIMATOR study. Mycoses 2017; 60:454-461. [PMID: 28425571 DOI: 10.1111/myc.12616] [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: 09/09/2016] [Revised: 02/16/2017] [Accepted: 02/17/2017] [Indexed: 11/30/2022]
Abstract
Invasive fungal infections are common in intensive care units (ICUs) but there is a great variability in factors affecting costs of different antifungal treatment strategies in clinical practice. To determine factors affecting treatment cost in adult ICU patients with or without documented invasive fungal infection receiving systemic antifungal therapy (SAT) we have performed a prospective, multicentre, observational study enrolling patients receiving SAT in participating ICUs in Greece. During the study period, 155 patients received SAT at 14 participating ICUs: 37 (23.9%) for proven fungal infection before treatment began, 10 (6.5%) prophylactically, 77 (49.7%) empirically and 31 (20.0%) pre-emptively; 66 patients receiving early SAT (55.9%) were subsequently confirmed to have proven infection with Candida spp. (eight while on treatment). The most frequently used antifungal drugs were echinocandins (89/155; 57.4%), fluconazole (31/155; 20%) and itraconazole (20/155; 12.9%). Mean total cost per patient by SAT strategy was €20 458 (proven), €15 054 (prophylaxis), €23 594 (empiric) and €22 184 (pre-emptive). Factors associated with significantly increased cost were initial treatment failure, length of stay (LOS) in ICU before starting SAT (i.e. from admission until treatment start), fever and proven candidaemia (all P≤.05). CONCLUSION Early administration of antifungal drugs was not a substantial component of total hospital costs. However, there was a significant adverse impact on costs with increasing LOS in febrile patients in ICU for whom diagnosis of fungaemia was delayed before starting SAT, and with initial treatment failure. Awareness of potential candidaemia and initiation of pre-emptive or empirical strategy as early appropriate treatment may improve ICU patient outcomes while reducing direct medical costs.
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Affiliation(s)
- A Armaganidis
- Second Critical Care Department, ATTIKON University Hospital, National and Kapodistrian University of Athens Medical School, Athens, Greece
| | - S Nanas
- First Critical Care Department, General Hospital of Athens "Evangelismos", National and Kapodistrian University of Athens Medical School, Athens, Greece
| | - E Antoniadou
- Intensive Care Unit, "G. Gennimatas" General Hospital, Thessaloniki, Greece
| | - K Mandragos
- Intensive Care Unit, "Korgialenio Benakio" Red Cross General Hospital, Athens, Greece
| | - K Liakou
- Medical Department, Astellas Pharma, Athens, Greece
| | - A Koutsoukou
- Intensive Care Unit, 1st Department of Respiratory Diseases, Sotiria Chest Hospital, National and Kapodistrian University of Athens Medical School, Athens, Greece
| | - G Baltopoulos
- Athens University Faculty of Nursing, ICU "Agioi Anargyroi" Hospital of Kifissia, Athens, Greece
| | - G Nakos
- Intensive Care Unit, University Hospital of Ioannina, Ioannina, Greece
| | - A Kounougeri
- Intensive Care Unit, Konstantopoulio General Hospital "Agia Olga", Athens, Greece
| | - K Ganas
- Intensive Care Unit, General Hospital of Nikaia "Agios Panteleimonas", Piraeus, Greece
| | - A Prekates
- Intensive Care Unit, Tzaneio General Hospital, Piraeus, Greece
| | - M Kompoti
- Intensive Care Unit, General Hospital of Eleusis "Thriassion", Athens, Greece
| | - D Georgopoulos
- Intensive Care Unit, University Hospital of Heraklion, Crete, Greece
| | - I Pneumatikos
- Department of Intensive Care Medicine, University Hospital of Alexandroupolis, Alexandroupoli, Greece
| | - E Zakynthinos
- Department of Critical Care, University Hospital of Larissa, Larissa, Greece
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Diaz JRA, Fernández Baldo M, Echeverría G, Baldoni H, Vullo D, Soria DB, Supuran CT, Camí GE. A substituted sulfonamide and its Co (II), Cu (II), and Zn (II) complexes as potential antifungal agents. J Enzyme Inhib Med Chem 2016; 31:51-62. [PMID: 27232977 DOI: 10.1080/14756366.2016.1187143] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
A sulfonamide 1-tosyl-1-H-benzo(d)imidazol-2-amine (TBZA) and three new complexes of Co(II), Cu(II), and Zn(II) have been synthesized. The compounds have been characterized by elemental analyses, FTIR, 1H, and 13C-NMR spectroscopy. The structure of the TBZA, and its Co(II) and Cu(II) complexes, was determined by X-ray diffraction methods. TBZA and its Co(II) complex crystallize in the triclinic P-1 space group, while the Cu(II) complex crystallizes in the monoclinic P21/c space group. Antifungal activity was screened against eight pathogenic yeasts: Candida albicans (DMic 972576), Candida krusei (DMic 951705), Candida glabrata (DMic 982882), Candida tropicalis (DMic 982884), Candida dubliniensis (DMic 93695), Candida guilliermondii (DMic 021150), Cryptococcus neoformans (ATCC 24067), and Cryptococcus gattii (ATCC MYA-4561). Results on the inhibition of various human (h) CAs, hCA I, II, IV, VII, IX, and XII, and pathogenic beta and gamma CAs are also reported.
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Affiliation(s)
- Jorge R A Diaz
- a INTEQUI (CONICET, CCT-San Luis), Área de Química General e Inorgánica, Facultad de Química, Bioquímica y Farmacia, Universidad Nacional de San Luis , San Luis , Argentina
| | - Martín Fernández Baldo
- b INQUISAL (CONICET, CCT-San Luis), Departamento de Química, Facultad de Química, Bioquímica y Farmacia, Universidad Nacional de San Luis , San Luis , Argentina
| | - Gustavo Echeverría
- c LANADI - IFLP (CONICET, CCT-La Plata), Departamento de Física, Facultad de Ciencias Exactas, Universidad Nacional de La Plata , La Plata , Argentina
| | - Héctor Baldoni
- d Instituto de Matemática Aplicada San Luis (IMASL-CONICET), Universidad Nacional de San Luis , San Luis , Argentina
| | - Daniela Vullo
- e Neurofarba Department, University of Florence , Sesto Fiorentino (Firenze) , Italy , and
| | - Delia B Soria
- f CEQUINOR (CONICET, CCT-La Plata), Departamento de Química, Facultad de Ciencias Exactas, Universidad Nacional de la Plata , La Plata , Argentina
| | - Claudiu T Supuran
- e Neurofarba Department, University of Florence , Sesto Fiorentino (Firenze) , Italy , and
| | - Gerardo E Camí
- a INTEQUI (CONICET, CCT-San Luis), Área de Química General e Inorgánica, Facultad de Química, Bioquímica y Farmacia, Universidad Nacional de San Luis , San Luis , Argentina
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Empirical and targeted therapy of candidemia with fluconazole versus echinocandins: a propensity score-derived analysis of a population-based, multicentre prospective cohort. Clin Microbiol Infect 2016; 22:733.e1-8. [PMID: 27189197 DOI: 10.1016/j.cmi.2016.05.008] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2016] [Revised: 05/05/2016] [Accepted: 05/08/2016] [Indexed: 11/23/2022]
Abstract
We compared the clinical efficacy of fluconazole and echinocandins in the treatment of candidemia in real practice. The CANDIPOP study is a prospective, population-based cohort study on candidemia carried out between May 2010 and April 2011 in 29 Spanish hospitals. Using strict inclusion criteria, we separately compared the impact of empirical and targeted therapy with fluconazole or echinocandins on 30-day mortality. Cox regression, including a propensity score (PS) for receiving echinocandins, stratified analysis on the PS quartiles and PS-based matched analyses, were performed. The empirical and targeted therapy cohorts comprised 316 and 421 cases, respectively; 30-day mortality was 18.7% with fluconazole and 33.9% with echinocandins (p 0.02) in the empirical therapy group and 19.8% with fluconazole and 27.7% with echinocandins (p 0.06) in the targeted therapy group. Multivariate Cox regression analysis including PS showed that empirical therapy with fluconazole was associated with better prognosis (adjusted hazard ratio 0.38; 95% confidence interval 0.17-0.81; p 0.01); no differences were found within each PS quartile or in cases matched according to PS. Targeted therapy with fluconazole did not show a significant association with mortality in the Cox regression analysis (adjusted hazard ratio 0.77; 95% confidence interval 0.41-1.46; p 0.63), in the PS quartiles or in PS-matched cases. The results were similar among patients with severe sepsis and septic shock. Empirical or targeted treatment with fluconazole was not associated with increased 30-day mortality compared to echinocandins among adults with candidemia.
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M Harriott M. In Vitro Antifungal-Antibacterial Combinations are Effective Against MRSA in Candida albicans-Staphylococcus aureus Polymicrobial Biofilms. ACTA ACUST UNITED AC 2016. [DOI: 10.15406/jmen.2016.03.00090] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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Rossi SA, Trevijano-Contador N, Scorzoni L, Mesa-Arango AC, de Oliveira HC, Werther K, de Freitas Raso T, Mendes-Giannini MJS, Zaragoza O, Fusco-Almeida AM. Impact of Resistance to Fluconazole on Virulence and Morphological Aspects of Cryptococcus neoformans and Cryptococcus gattii Isolates. Front Microbiol 2016; 7:153. [PMID: 26909069 PMCID: PMC4754443 DOI: 10.3389/fmicb.2016.00153] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2015] [Accepted: 01/29/2016] [Indexed: 01/12/2023] Open
Abstract
Cryptococcus sp. are responsible for around 1 million cases of meningitis every year. Fluconazole (FLU) is commonly used in the treatment of cryptococcosis, mainly in immunocompromised patients and the resistance is usually reported after long periods of treatment. In this study, the morphological characterization and virulence profile of FLU-susceptible and FLU-resistant clinical and environmental isolates of C. neoformans and C. gattii were performed both in vitro and in vivo using the Galleria mellonella model. FLU-susceptible isolates from C. neoformans were significantly more virulent than the FLU-resistant isolates. FLU-susceptible C. gattii isolates showed a different virulence profile from C. neoformans isolates where only the environmental isolate, CL, was more virulent compared with the resistant isolates. Cell morphology and capsule size were analyzed and the FLU-resistant isolates did not change significantly compared with the most sensitive isolates. Growth at 37°C was also evaluated and in both species, the resistant isolates showed a reduced growth at this temperature, indicating that FLU resistance can affect their growth. Based on the results obtained is possible suggest that FLU resistance can influence the morphology of the isolates and consequently changed the virulence profiles. The most evident results were observed for C. neoformans showing that the adaptation of isolates to antifungal selective pressure influenced the loss of virulence.
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Affiliation(s)
- Suélen A Rossi
- Faculdade de Ciências Farmacêuticas, UNESP - Universidade Estadual Paulista, Campus Araraquara, Departamento de Análises Clíncas São Paulo, Brazil
| | - Nuria Trevijano-Contador
- Centro Nacional de Microbiologia, Unidad de Micologia, Instituto de Salud Carlos III, Majadahonda Madrid, Spain
| | - Liliana Scorzoni
- Faculdade de Ciências Farmacêuticas, UNESP - Universidade Estadual Paulista, Campus Araraquara, Departamento de Análises Clíncas São Paulo, Brazil
| | | | - Haroldo C de Oliveira
- Faculdade de Ciências Farmacêuticas, UNESP - Universidade Estadual Paulista, Campus Araraquara, Departamento de Análises Clíncas São Paulo, Brazil
| | - Karin Werther
- Faculdade de Medicina Veterinária e Zootecnia, USP - Universidade de São Paulo, Departamento de Patologia São Paulo, Brazil
| | - Tânia de Freitas Raso
- Faculdade de Medicina Veterinária e Zootecnia, USP - Universidade de São Paulo, Departamento de Patologia São Paulo, Brazil
| | - Maria J S Mendes-Giannini
- Faculdade de Ciências Farmacêuticas, UNESP - Universidade Estadual Paulista, Campus Araraquara, Departamento de Análises Clíncas São Paulo, Brazil
| | - Oscar Zaragoza
- Centro Nacional de Microbiologia, Unidad de Micologia, Instituto de Salud Carlos III, Majadahonda Madrid, Spain
| | - Ana M Fusco-Almeida
- Faculdade de Ciências Farmacêuticas, UNESP - Universidade Estadual Paulista, Campus Araraquara, Departamento de Análises Clíncas São Paulo, Brazil
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van der Geest PJ, Rijnders BJA, Vonk AG, Groeneveld ABJ. Echinocandin to fluconazole step-down therapy in critically ill patients with invasive, susceptible Candida albicans infections. Mycoses 2015; 59:179-85. [PMID: 26707572 DOI: 10.1111/myc.12450] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2015] [Revised: 10/24/2015] [Accepted: 11/22/2015] [Indexed: 01/24/2023]
Abstract
Invasive Candida spp. infections are increasingly diagnosed in critically ill patients. For initial treatment, an echinocandin is recommended with a possible step-down to fluconazole when the patients' condition is improving and the isolate appears susceptible, but there are no data to support such policy. We studied the safety and efficacy of step-down therapy in critically ill patients with culture proven deep seated or bloodstream infections by C. albicans susceptible to fluconazole. All patients admitted into the intensive care unit from January 2010 to December 2014, who had a culture proven invasive C. albicans infection and received initial treatment with an echinocandin for at least 4 days were included. Data on patient characteristics, treatment and vital outcomes were assessed. Of the 56 patients, 32 received step-down fluconazole therapy, at median day 5, whereas the echinocandin was continued in the other 24. No differences where seen in baseline characteristics or risk factors for invasive C. albicans infection between the two groups. Response rates were similar and no difference where seen in 28-day or 90-day mortality between the groups. Step-down therapy to fluconazole may be safe and effective in critically ill patients with invasive infections by C. albicans, susceptible to fluconazole, who have clinically improved as early as 4 days after start of treatment with an echinocandin.
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Affiliation(s)
| | - Bart J A Rijnders
- Department of Medical Microbiology and Infectious Diseases, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Alieke G Vonk
- Department of Medical Microbiology and Infectious Diseases, Erasmus Medical Center, Rotterdam, The Netherlands
| | - A B Johan Groeneveld
- Department of Intensive Care Medicine, Erasmus Medical Center, Rotterdam, The Netherlands
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Grau S, Pozo JC, Romá E, Salavert M, Barrueta JA, Peral C, Rodriguez I, Rubio-Rodríguez D, Rubio-Terrés C. Cost-effectiveness of three echinocandins and fluconazole in the treatment of candidemia and/or invasive candidiasis in nonneutropenic adult patients. CLINICOECONOMICS AND OUTCOMES RESEARCH 2015; 7:527-35. [PMID: 26508881 PMCID: PMC4610791 DOI: 10.2147/ceor.s91587] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
OBJECTIVE To estimate the cost-effectiveness of three echinocandins (anidulafungin, caspofungin, and micafungin) and generic fluconazole in the treatment of nonneutropenic adult patients with candidemia and/or invasive candidiasis in intensive care units in Spain. MATERIALS AND METHODS A decision-tree model was applied. The success and safety (hepatic and renal adverse effects) of first-line treatments were obtained from meta-analyses and systematic reviews of clinical trials. In the case of failure, a second-line treatment (liposomal amphotericin B after the echinocandins, or one of the echinocandins after fluconazole) was administered. The duration of the treatments (14 days total) was established by a panel of clinical experts using the Delphi method and according to Infectious Diseases Society of America guidelines. The cost of the medications and renal toxicity were considered. Deterministic and probabilistic sensitivity analysis using Monte Carlo simulations were carried out. RESULTS The total cost of the treatment of candidemia and/or invasive candidiasis with anidulafungin, caspofungin, micafungin, and fluconazole was €5,483, €5,968, €6,231, and €2,088, respectively. Anidulafungin was the dominant treatment (more effective, less expensive) compared to micafungin and caspofungin. The cost of achieving one more patient successfully treated with anidulafungin, caspofungin, and micafungin compared to fluconazole was €17,199, €23,962, and €27,339, respectively. The result remained stable, despite modification of the duration of the first-line and second-line treatments, as well as most of the dosing regimens. The probabilistic analysis also remained stable. CONCLUSION In accordance with this economic study, anidulafungin would produce savings and would be the dominant treatment compared with micafungin and caspofungin in nonneutropenic adult patients with candidemia and/or invasive candidiasis in intensive care units in Spain.
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Affiliation(s)
- S Grau
- Hospital del Mar (IMIM), Barcelona, Spain
| | - JC Pozo
- Hospital Universitario Reina Sofía, Córdoba, Spain
| | - E Romá
- Hospital Universitario Reina Sofía, Córdoba, Spain
| | - M Salavert
- Hospital Universitario y Politécnico La Fe, Valencia, Spain
| | | | - C Peral
- Pfizer SLU, Alcobendas, Spain
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Tagliaferri E, Menichetti F. Treatment of invasive candidiasis: between guidelines and daily clinical practice. Expert Rev Anti Infect Ther 2015; 13:685-9. [PMID: 25818660 DOI: 10.1586/14787210.2015.1029916] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Invasive candidiasis, including candidemia (IC/C), is a major cause of morbidity and mortality among hospitalized patients. While incidence is higher in intensive care units, the majority of cases of candidemia are documented in medical wards. Although Candida albicans is still the most frequently isolated species, IC/C due to non-albicans species, usually less susceptible to fluconazole, is increasing. Early identification of patients at risk, knowledge of local epidemiology and prompt efforts to define etiologic diagnosis play a pivotal role for appropriateness. Starting therapy with an echinocandin, switching then to fluconazole when possible, seems to represent a potentially useful strategy for the management of IC/C. The choice between the three echinocandins should be based on the specific indications, pharmacokinetic/pharmacodynamic profile, clinical experience and relative cost.
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Affiliation(s)
- Enrico Tagliaferri
- UOC Malattie Infettive, Azienda Ospedaliera Universitaria Pisana, Pisa, Italy
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Cattel F, Ancona F, Chiumente M, Miliacca A, Motta I, De Rosa FG. Economic impact of antifungal treatment in IFD by Candidaspecies: anidulafungin administration as a cost-effective alternative for critical care patients. Eur J Hosp Pharm 2015. [DOI: 10.1136/ejhpharm-2013-000408] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
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Castanheira M, Messer SA, Jones RN, Farrell DJ, Pfaller MA. Activity of echinocandins and triazoles against a contemporary (2012) worldwide collection of yeast and moulds collected from invasive infections. Int J Antimicrob Agents 2014; 44:320-6. [PMID: 25129315 DOI: 10.1016/j.ijantimicag.2014.06.007] [Citation(s) in RCA: 58] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2013] [Revised: 05/12/2014] [Accepted: 06/03/2014] [Indexed: 02/03/2023]
Abstract
In this study, 1717 fungal clinical isolates causing invasive fungal infections were evaluated against nine antifungal agents using Clinical and Laboratory Standards Institute (CLSI) reference broth microdilution methods. The isolates comprised 1487 Candida spp., 109 Aspergillus spp., 86 non-Candida yeasts (including 52 isolates of Cryptococcus neoformans) and 35 rare moulds obtained during 2012 from 72 hospitals worldwide. Echinocandin resistance among Candida spp. was low, and resistance rates to anidulafungin, caspofungin and micafungin varied from 0.0% to 2.8% among different species. Echinocandin-resistant Candida glabrata were shown to have fks mutations (fks2 HS1 F659Y, F659del, S663F and S663P), and fluconazole resistance was also observed in those strains. One Candida krusei and one Candida dubliniensis had L701M or S645P fks1 mutations, respectively. Candida tropicalis and C. glabrata had higher fluconazole resistance rates of 6.1% and 6.9%, respectively, compared with other Candida spp. Fluconazole-resistant C. tropicalis were collected in five countries (USA, China, Germany, Belgium and Thailand). Voriconazole was active against all Candida spp., inhibiting 91.2-99.7% of isolates using species-specific breakpoints. All agents except for the echinocandins and posaconazole were active against Cr. neoformans. Triazoles were active against other yeasts [MIC90 (minimum inhibitory concentration encompassing 90% of isolates tested), 2μg/mL]. The echinocandins and the mould-active triazoles were active against Aspergillus [MIC/MEC90 (minimum effective concentration encompassing 90% of isolates tested) range, 0.015-2μg/mL], but the activity of these agents was limited against uncommon mould species (MIC/MEC90 range, 4μg/mL to >16μg/mL).
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Affiliation(s)
- Mariana Castanheira
- JMI Laboratories, 345 Beaver Kreek Center, Ste A, North Liberty, IA 52317, USA
| | - Shawn A Messer
- JMI Laboratories, 345 Beaver Kreek Center, Ste A, North Liberty, IA 52317, USA
| | - Ronald N Jones
- JMI Laboratories, 345 Beaver Kreek Center, Ste A, North Liberty, IA 52317, USA
| | - David J Farrell
- JMI Laboratories, 345 Beaver Kreek Center, Ste A, North Liberty, IA 52317, USA
| | - Michael A Pfaller
- JMI Laboratories, 345 Beaver Kreek Center, Ste A, North Liberty, IA 52317, USA.
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Castanheira M, Messer SA, Rhomberg PR, Dietrich RR, Jones RN, Pfaller MA. Isavuconazole and nine comparator antifungal susceptibility profiles for common and uncommon Candida species collected in 2012: application of new CLSI clinical breakpoints and epidemiological cutoff values. Mycopathologia 2014; 178:1-9. [PMID: 24952015 DOI: 10.1007/s11046-014-9772-2] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2014] [Accepted: 06/11/2014] [Indexed: 12/28/2022]
Abstract
The in vitro activity of isavuconazole and nine antifungal comparator agents was assessed using reference broth microdilution methods against 1,421 common and uncommon species of Candida from a 2012 global survey. Isolates were identified using CHROMagar, biochemical methods and sequencing of ITS and/or 28S regions. Candida spp. were classified as either susceptible or resistant and as wild type (WT) or non-WT using CLSI clinical breakpoints or epidemiological cutoff values, respectively, for the antifungal agents. Isolates included 1,421 organisms from 21 different species of Candida. Among Candida spp., resistance to all 10 tested antifungal agents was low (0.0-7.9 %). The vast majority of each species of Candida, with the exception of Candida glabrata, Candida krusei, and Candida guilliermondii (modal MICs of 0.5 µg/ml), were inhibited by ≤0.12 µg/ml of isavuconazole (99.0 %; range 94.3 % [Candida tropicalis] to 100.0 % [Candida lusitaniae and Candida dubliniensis]). C. glabrata, C. krusei, and C. guilliermondii were largely inhibited by ≤1 µg/ml of isavuconazole (89.7, 96.9 and 92.8 %, respectively). Decreased susceptibility to isavuconazole was most prominent with C. glabrata where the modal MIC for isavuconazole was 0.5 µg/ml for those strains that were SDD to fluconazole or WT to voriconazole, and was 4 µg/ml for those that were either resistant or non-WT to fluconazole or voriconazole, respectively. In conclusion, these data document the activity of isavuconazole and generally the low resistance levels to the available antifungal agents in a large, contemporary (2012), global collection of molecularly characterized species of Candida.
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Affiliation(s)
- Mariana Castanheira
- JMI Laboratories, 345 Beaver Kreek Centre, Suite A, North Liberty, IA, 52317, USA
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Dimopoulos G, Antonopoulou A, Armaganidis A, Vincent JL. How to select an antifungal agent in critically ill patients. J Crit Care 2014; 28:717-27. [PMID: 24018296 DOI: 10.1016/j.jcrc.2013.04.006] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2012] [Revised: 04/11/2013] [Accepted: 04/13/2013] [Indexed: 12/29/2022]
Abstract
Fungal infections are common in critically ill patients and are associated with increased morbidity and mortality. Candida spp are the most commonly isolated fungal pathogens. The last 2 decades have seen an increased incidence of fungal infections in critical illness and the emergence of new pathogenic fungal species and also the development of more effective (better bioavailability) and safer (less toxicity, fewer drug interactions) drugs. The distinction between colonization and infection can be difficult, and problems diagnosing infection may delay initiation of antifungal treatment. A number of factors have been identified that can help to distinguish patients at high risk for fungal infection. The antifungal agents that are most frequently used in the intensive care unit are the first- and second-generation azoles and the echinocandins; amphotericin B derivatives (mainly the liposomal agents) are less widely used because of adverse effects. The choice of antifungal agent in critically ill patients will depend on the aim of therapy (prophylaxis, pre-emptive, empiric, definitive), as well as on local epidemiology and specific properties of the drug (antifungal spectrum, efficacy, toxicity, pharmacokinetic/pharmacodynamic properties, cost). In this article we will review all these aspects and propose an algorithm to guide selection of antifungal agents in critically ill patients.
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Affiliation(s)
- George Dimopoulos
- 2nd Department of Critical Care Medicine, Medical School, University of Athens, University Hospital ATTIKON, Athens, Greece
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[Diagnostic markers and assessment of efficacy of antibacterial therapy]. Med Klin Intensivmed Notfmed 2014; 109:187-90. [PMID: 24699883 DOI: 10.1007/s00063-013-0312-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2014] [Accepted: 02/28/2014] [Indexed: 10/25/2022]
Abstract
In anti-infective therapy, there is a need for objective diagnostic markers to guide the appropriate selection and duration of antibacterial treatment. In the diagnosis and treatment of bacterial infections, three aspects must be considered: the appropriateness of antibacterial therapy, the initiation and evaluation of an effective initial therapy, and termination of the antimicrobial treatment. Repetitive monitoring of procalcitonin (PCT) has been proposed as such a marker in conjunction with the clinical presentation and microbiological sampling of blood, urine, and/or sputum. Different threshold values for PCT in pulmonary infections vs. severe systemic infections (e.g., sepsis) have been proposed. However, a single PCT determination is not sufficient, only consecutive measurements can give feedback of the appropriateness and success of the antibacterial therapy. Furthermore, it is important to realize that besides bacterial infection, other disease states can elevate PCT levels. Examples are calcitonin-producing tumors, medullary C-cell thyroid carcinoma, and acute respiratory distress syndrome (ARDS). PCT can also be elevated in fungal infections. On the other hand, localized and encapsulated infections (e.g., abscess, endocarditis and early stages of infections) can be associated with lowered PCT values.
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de la Torre P, Reboli AC. Micafungin: an evidence-based review of its place in therapy. CORE EVIDENCE 2014; 9:27-39. [PMID: 24596542 PMCID: PMC3940642 DOI: 10.2147/ce.s36304] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
Invasive fungal infections have increased throughout the world. Many of these infections occur in patients with multiple comorbidities who are receiving medications with the potential for interactions with antifungal therapy that could lead to renal and hepatic dysfunction. The second marketed echinocandin, micafungin, was approved in 2005 for the treatment of esophageal candidiasis and prophylaxis of invasive Candida infections in patients undergoing hematopoietic stem cell transplantation. The indication for use was later expanded to include candidemia, acute disseminated candidiasis, Candida abscesses, and peritonitis. Like other echinocandins it is fungicidal against Candida species, including those that are polyene- and azole-resistant and fungistatic against Aspergillus species. Its formulation is by the intravenous route only and it is dosed once daily without a loading dose as 85% of the steady state concentration is achieved after three daily doses. It has a favorable tolerability profile with no significant drug interactions and does not need adjustment for renal or hepatic insufficiency.
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Yeh TC, Liu HC, Hou JY, Chen KH, Huang TH, Chang CY, Liang DC. Severe infections in children with acute leukemia undergoing intensive chemotherapy can successfully be prevented by ciprofloxacin, voriconazole, or micafungin prophylaxis. Cancer 2014; 120:1255-62. [DOI: 10.1002/cncr.28524] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2013] [Revised: 10/31/2013] [Accepted: 11/19/2013] [Indexed: 01/03/2023]
Affiliation(s)
- Ting-Chi Yeh
- Department of Medicine; Mackay Medical College; New Taipei Taiwan
- Division of Pediatric Hematology-Oncology; Mackay Memorial Hospital; Taipei Taiwan
| | - Hsi-Che Liu
- Department of Medicine; Mackay Medical College; New Taipei Taiwan
- Division of Pediatric Hematology-Oncology; Mackay Memorial Hospital; Taipei Taiwan
| | - Jen-Yin Hou
- Department of Medicine; Mackay Medical College; New Taipei Taiwan
- Division of Pediatric Hematology-Oncology; Mackay Memorial Hospital; Taipei Taiwan
| | - Kuan-Hao Chen
- Division of Pediatric Hematology-Oncology; Mackay Memorial Hospital; Taipei Taiwan
| | - Ting-Huan Huang
- Division of Pediatric Hematology-Oncology; Mackay Memorial Hospital; Taipei Taiwan
| | - Ching-Yi Chang
- Division of Pediatric Hematology-Oncology; Mackay Memorial Hospital; Taipei Taiwan
| | - Der-Cherng Liang
- Division of Pediatric Hematology-Oncology; Mackay Memorial Hospital; Taipei Taiwan
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Vogiatzi L, Katragkou A, Roilides E. Antifungal Prophylaxis in the Pediatric Intensive Care Unit. CURRENT FUNGAL INFECTION REPORTS 2013. [DOI: 10.1007/s12281-013-0154-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Bhattacharyya S, Gupta P, Banerjee G, Jain A, Singh M. In-vitro Inhibition of Biofilm Formation in Candida albicans and Candida tropicalis by Heat Stable Compounds in Culture Filtrate of Aspergillus flavus. J Clin Diagn Res 2013; 7:2167-9. [PMID: 24298466 DOI: 10.7860/jcdr/2013/6020.3460] [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: 03/08/2013] [Accepted: 06/03/2013] [Indexed: 11/24/2022]
Abstract
BACKGROUND Invasive candidiasis, caused mostly by Candida albicans and C. tropicalis is one of the most common causes of bloodstream infection with a substantial attributable mortality. This disease is associated with formation of structured, multilayered microbial communities known as biofilms over indwelling devices. Treatment is rendered difficult owing to factors like poor drug penetration through biofilms and high cost of the available antifungal drugs. Hence there is imminent need of developing low-cost natural compounds inhibiting Candidal biofilm formation in vitro. Organohalgen compounds derived from crude culture filtrate of Aspergillus flavus have been documented to impair in vitro Candidal survival. AIM We aimed to detect the effect of preheated and unheated crude culture filtrate of Aspergillus flavus on biofilm formation of Candida albicans and C. tropicalis in vitro. Setting and Designs: Ours was a laboratory-based observational study with clinical isolates of the microorganisms selected randomly. MATERIAL AND METHODS In this study, we showed for the first time by microtitre plate method that heat stable compounds which were present in preheated and unheated culture filtrates of Aspergillus flavus inhibited biofilm formation of Candida albicans and C. tropicalis and also lipase activities of these pathogens, and filtrate was non-toxic on human cell line as checked microscopically. STATISTICAL ANALYSIS USED Z-test of significance was used to calculate significant difference between Candidal biofilm formation in normal liquid medium and culture filtrate, respectively. RESULTS AND CONCLUSION Heat stable compounds present in culture filtrate of Aspergillus flavus inhibit biofilm formation of Candida albicans and C. tropicalis and also in-vitro lipase activity of these pathogens and could pave the way for development of low-cost alternatives to treat invasive candidiasis.
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Affiliation(s)
- Sayan Bhattacharyya
- Post MD-PhD Scholar, Department of Microbiology, King George's Medical University , Lucknow-226003, U.P., India
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Marcelin JR, Jones JM, Costello BA. 41-year-old woman with fever, neutropenia, and elevated transaminase levels. Mayo Clin Proc 2013; 88:113-6. [PMID: 23274024 DOI: 10.1016/j.mayocp.2012.06.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2012] [Revised: 06/03/2012] [Accepted: 06/07/2012] [Indexed: 11/28/2022]
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Ullmann A, Cornely O, DonneNy J, Akova M, Arendrup M, Arikan-Akdagli S, Bassetti M, Bille J, Calandra T, Castagnola E, Garbino J, Groll A, Herbrecht R, Hope W, Jensen H, Kullberg B, Lass-Flörl C, Lortholary O, Meersseman W, Petrikkos G, Richardson M, Roilides E, Verweij P, Viscoli C, Cuenca-Estrella M. ESCMID* *Information in this manuscript was presented in part at ECCMID 2011. European Society for Clinical Microbiology and Infectious Diseases guideline for the diagnosis and management of Candida diseases 2012: developing European guidelines in clinical microbiology and infectious diseases. Clin Microbiol Infect 2012; 18 Suppl 7:1-8. [DOI: 10.1111/1469-0691.12037] [Citation(s) in RCA: 71] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Revankar SG, Sobel JD. Are Echinocandins Better Than Azoles for Invasive Candidiasis? CURRENT FUNGAL INFECTION REPORTS 2012. [DOI: 10.1007/s12281-012-0124-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
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Ng TB, Cheung RCF, Ye XJ, Fang EF, Chan YS, Pan WL, Dan XL, Yin CM, Lam SK, Lin P, Kui Ngai PH, Xia LX, Liu F, Ye XY, Wang HX, Wong JH. Pharmacotherapy approaches to antifungal prophylaxis. Expert Opin Pharmacother 2012; 13:1695-705. [DOI: 10.1517/14656566.2012.698263] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
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Wade RL, Chaudhari P, Campbell RS, Hays HD, Nathanson BH, Yi J, Horn D. Treatment of candidemia with echinocandins: data on hospital resource use from a real world setting. J Med Econ 2012; 15:1130-8. [PMID: 22788668 DOI: 10.3111/13696998.2012.708690] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
OBJECTIVE Real-world data on patients treated with echinocandins for candidemia are limited. This study examined the effect of three echinocandin-based treatment regimens on resource utilization in patients with Candida infection. RESEARCH DESIGN AND METHODS A retrospective cohort study of patients hospitalized between 2005 and 2010 with a blood culture positive for Candida. Length of stay (LOS) following AF initiation (post-AF LOS) and total days with AF treatment were compared in patients treated with three different echinocandin regimens: patients with echinocandin only, patients who received fluconazole prior to an echinocandin (fluconazole-echinocandin), and patients who received an echinocandin prior to fluconazole (echinocandin-fluconazole). Generalized linear models were used to adjust for confounders. RESULTS A total of 647 patients met inclusion criteria. Patients treated with echinocandin only were more acutely ill, having more organ dysfunction and sepsis. Unadjusted post-AF LOS was significantly greater in the groups that received both echinocandin and fluconazole (mean, 13.1 days for echinocandin-only vs 25.5 and 21.2 days for fluconazole-echinocandin and echinocandin-fluconazole groups, respectively, p<0.001). These groups also had a higher total number of days with AF orders. These differences remained after multivariate adjustment and in survivor-only analyses. Compared with echinocandin-only treatment, the average marginal effect of fluconazole-echinocandin and echinocandin-fluconazole regimens were associated with significantly longer adjusted post-AF LOS (by 7.2 days and 9.3 days, respectively, p<0.001) and significantly more adjusted total AF days (by 5.3 days for fluconazole-echinocandin and 6.5 days for echinocandin-fluconazole patients, p<0.001). Limitations included lack of visibility to specific reasons for therapy changes. CONCLUSIONS Fluconazole before or after echinocandin was associated with significantly greater resource utilization than echinocandin use alone.
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Affiliation(s)
- Rolin L Wade
- Cerner LifeSciences, Culver City, CA 90230, USA.
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