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Ye H, Su FF, Cui XY, Guo XX, Zhu TY, Kong DY, Miao XG. Evaluation of Different Blood Culture Bottles for the Diagnosis of Bloodstream Infections in Patients with HIV. Infect Dis Ther 2023; 12:2611-2620. [PMID: 37870693 PMCID: PMC10651575 DOI: 10.1007/s40121-023-00883-1] [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: 09/03/2023] [Accepted: 10/03/2023] [Indexed: 10/24/2023] Open
Abstract
INTRODUCTION Bloodstream infection (BSI) is a significant factor contributing to hospitalization and high mortality rates among human immunodeficiency virus(HIV)-positive patients. Therefore, the timely detection of this condition is of utmost importance. Blood culture is considered the gold standard for diagnosing BSIs. Currently, BD BACTEC™ Plus Aerobic/F culture bottles and the BD BACTEC™ Myco/F Lytic culture bottles can be used for blood culture. This study aimed to evaluate the efficacy of two different types of culture bottles in diagnosing BSIs in patients with HIV. METHODS A retrospective analysis was conducted on HIV-positive patients hospitalized in the Infection Department of Wenzhou Central Hospital between July 2019 and October 2021. A total of 246 pairs of blood samples were included, consisting of an aerobic culture vial and a Myco/F culture vial. Blood culture results and clinical diagnosis were utilized to identify the presence of BSI. RESULTS Out of 246 cases, 84 cases had positive blood cultures. Fungal BSIs, particularly Talaromyces marneffei BSIs, were the most prevalent among patients with HIV. The positive rate of Myco/F culture bottles (89.29%) was significantly higher compared with aerobic culture bottles (69.05%; P = 0.001). In the diagnosis of fungal BSIs, the positive rate of Myco/F culture bottles was 88.57%, which was significantly higher than that of aerobic culture bottles (72.86%; P = 0.018). The Myco/F culture bottle has more advantages in diagnosing Talaromyces marneffei BSIs (P=0.028). In addition, mycobacteria were exclusively detected in Myco/F culture bottles. CONCLUSIONS Fungal BSIs are the predominant type of infections in HIV-positive patients. Myco/F culture bottles exhibit noteworthy attributes of high positive rate in diagnosing HIV combined with BSI. These advantages are conducive to obtaining accurate culture results and minimizing missed diagnoses.
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Affiliation(s)
- Hui Ye
- Department of Infectious Diseases, Wenzhou Central Hospital, The Dingli Clinical College of Wenzhou Medical University, The Second Affiliated Hospital of Shanghai University, Zhejiang, 325000, China
- Department of Infectious Diseases, The Sixth People's Hospital of Wenzhou, Nanbaixiang Street, Ouhai District, Wenzhou City, 325000, Zhejiang Province, China
| | - Fei-Fei Su
- Department of Infectious Diseases, Wenzhou Central Hospital, The Dingli Clinical College of Wenzhou Medical University, The Second Affiliated Hospital of Shanghai University, Zhejiang, 325000, China
- Department of Infectious Diseases, The Sixth People's Hospital of Wenzhou, Nanbaixiang Street, Ouhai District, Wenzhou City, 325000, Zhejiang Province, China
| | - Xiao-Ya Cui
- Department of Infectious Diseases, Wenzhou Central Hospital, The Dingli Clinical College of Wenzhou Medical University, The Second Affiliated Hospital of Shanghai University, Zhejiang, 325000, China
- Department of Infectious Diseases, The Sixth People's Hospital of Wenzhou, Nanbaixiang Street, Ouhai District, Wenzhou City, 325000, Zhejiang Province, China
| | - Xiu-Xiu Guo
- Department of Infectious Diseases, Wenzhou Central Hospital, The Dingli Clinical College of Wenzhou Medical University, The Second Affiliated Hospital of Shanghai University, Zhejiang, 325000, China
- Department of Infectious Diseases, The Sixth People's Hospital of Wenzhou, Nanbaixiang Street, Ouhai District, Wenzhou City, 325000, Zhejiang Province, China
| | - Tian-Ye Zhu
- Department of Infectious Diseases, Wenzhou Central Hospital, The Dingli Clinical College of Wenzhou Medical University, The Second Affiliated Hospital of Shanghai University, Zhejiang, 325000, China
- Department of Infectious Diseases, The Sixth People's Hospital of Wenzhou, Nanbaixiang Street, Ouhai District, Wenzhou City, 325000, Zhejiang Province, China
| | - De-Yong Kong
- Department of Infectious Diseases, Wenzhou Central Hospital, The Dingli Clinical College of Wenzhou Medical University, The Second Affiliated Hospital of Shanghai University, Zhejiang, 325000, China
- Department of Infectious Diseases, The Sixth People's Hospital of Wenzhou, Nanbaixiang Street, Ouhai District, Wenzhou City, 325000, Zhejiang Province, China
| | - Xing-Guo Miao
- Department of Infectious Diseases, Wenzhou Central Hospital, The Dingli Clinical College of Wenzhou Medical University, The Second Affiliated Hospital of Shanghai University, Zhejiang, 325000, China.
- Department of Infectious Diseases, The Sixth People's Hospital of Wenzhou, Nanbaixiang Street, Ouhai District, Wenzhou City, 325000, Zhejiang Province, China.
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Keck JM, Cretella DA, Stover KR, Wagner JL, Barber KE, Jhaveri TA, Vijayvargiya P, Garrigos ZE, Wingler MJB. Evaluation of an Antifungal Stewardship Initiative Targeting Micafungin at an Academic Medical Center. Antibiotics (Basel) 2023; 12:antibiotics12020193. [PMID: 36830104 PMCID: PMC9952013 DOI: 10.3390/antibiotics12020193] [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: 12/28/2022] [Revised: 01/12/2023] [Accepted: 01/13/2023] [Indexed: 01/19/2023] Open
Abstract
Delays in the treatment of proven invasive fungal disease have been shown to be harmful. However, empiric treatment for all patients at risk of infection has not demonstrated benefit. This study evaluates the effects of a micafungin stewardship initiative on the duration of therapy and clinical outcomes at the University of Mississippi Medical Center in Jackson, Mississippi. This single-center quasi-experiment evaluated patients who received micafungin. Adult inpatients who received at least one treatment dose of micafungin in the pre-intervention (1 October 2020 to 30 September 2021) or post-intervention (1 October 2021 to 30 April 2022) groups were included. Patients were placed on micafungin for prophylaxis and those who required definitive micafungin therapy were excluded. An algorithm was used to provide real-time recommendations in order to assess change in the treatment days of micafungin therapy. A total of 282 patients were included (141 pre-group versus 141 post-group). Over 80% of the patients included in the study were in an intensive care unit, and other baseline characteristics were similar. The median number of treatment days with micafungin was 4 [IQR 3-6] in the pre-group and 3 [IQR 2-6] in the post-group (p = 0.005). Other endpoints, such as time to discontinuation or de-escalation, hospital mortality, and hospital length of stay, were not significantly different between the groups. An antifungal stewardship initiative can be an effective way to decrease unnecessary empiric antifungal therapy for patients who are at risk of invasive fugal disease.
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Affiliation(s)
- J. Myles Keck
- Department of Pharmacy, University of Arkansas for Medical Sciences, Little Rock, AR 72205, USA
| | - David A. Cretella
- Division of Infectious Diseases, University of Mississippi Medical Center, Jackson, MS 39216, USA
| | - Kayla R. Stover
- Department of Pharmacy Practice, University of Mississippi School of Pharmacy, Jackson, MS 39216, USA
- Correspondence:
| | - Jamie L. Wagner
- Department of Pharmacy Practice, University of Mississippi School of Pharmacy, Jackson, MS 39216, USA
| | - Katie E. Barber
- Department of Pharmacy Practice, University of Mississippi School of Pharmacy, Jackson, MS 39216, USA
| | - Tulip A. Jhaveri
- Division of Infectious Diseases, University of Mississippi Medical Center, Jackson, MS 39216, USA
| | - Prakhar Vijayvargiya
- Division of Infectious Diseases, University of Mississippi Medical Center, Jackson, MS 39216, USA
| | - Zerelda Esquer Garrigos
- Division of Infectious Diseases, University of Mississippi Medical Center, Jackson, MS 39216, USA
| | - Mary Joyce B. Wingler
- Division of Infectious Diseases, University of Mississippi Medical Center, Jackson, MS 39216, USA
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Chen SCA, Perfect J, Colombo AL, Cornely OA, Groll AH, Seidel D, Albus K, de Almedia JN, Garcia-Effron G, Gilroy N, Lass-Flörl C, Ostrosky-Zeichner L, Pagano L, Papp T, Rautemaa-Richardson R, Salmanton-García J, Spec A, Steinmann J, Arikan-Akdagli S, Arenz DE, Sprute R, Duran-Graeff L, Freiberger T, Girmenia C, Harris M, Kanj SS, Roudbary M, Lortholary O, Meletiadis J, Segal E, Tuon FF, Wiederhold N, Bicanic T, Chander J, Chen YC, Hsueh PR, Ip M, Munoz P, Spriet I, Temfack E, Thompson L, Tortorano AM, Velegraki A, Govender NP. Global guideline for the diagnosis and management of rare yeast infections: an initiative of the ECMM in cooperation with ISHAM and ASM. THE LANCET. INFECTIOUS DISEASES 2021; 21:e375-e386. [PMID: 34419208 DOI: 10.1016/s1473-3099(21)00203-6] [Citation(s) in RCA: 89] [Impact Index Per Article: 29.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/05/2020] [Revised: 03/21/2021] [Accepted: 03/22/2021] [Indexed: 01/10/2023]
Abstract
Uncommon, or rare, yeast infections are on the rise given increasing numbers of patients who are immunocompromised or seriously ill. The major pathogens include those of the genera Geotrichum, Saprochaete, Magnusiomyces, and Trichosporon (ie, basidiomycetes) and Kodamaea, Malassezia, Pseudozyma (ie, now Moesziomyces or Dirkmeia), Rhodotorula, Saccharomyces, and Sporobolomyces (ie, ascomycetes). A considered approach to the complex, multidisciplinary management of infections that are caused by these pathogens is essential to optimising patient outcomes; however, management guidelines are either region-specific or require updating. In alignment with the One World-One Guideline initiative to incorporate regional differences, experts from diverse geographical regions analysed publications describing the epidemiology and management of the previously mentioned rare yeasts. This guideline summarises the consensus recommendations with regards to the diagnostic and therapeutic options for patients with these rare yeast infections, with the intent of providing practical assistance in clinical decision making. Because there is less clinical experience of patients with rare yeast infections and studies on these patients were not randomised, nor were groups compared, most recommendations are not robust in their validation but represent insights by use of expert opinions and in-vitro susceptibility results. In this Review, we report the key features of the epidemiology, diagnosis, antifungal susceptibility, and treatment outcomes of patients with Geotrichum, Saprochaete, Magnusiomyces, and Trichosporon spp infections.
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Affiliation(s)
- Sharon C-A Chen
- Centre for Infectious Diseases and Microbiology Laboratory Services, Institute of Clinical Pathology and Medical Research, New South Wales Health Pathology, Sydney, NSW, Australia; Centre for Infectious Diseases and Microbiology, Westmead Hospital, The University of Sydney, Sydney, NSW, Australia.
| | | | - Arnaldo L Colombo
- Division of Infectious Diseases, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Oliver A Cornely
- Department I of Internal Medicine, Excellence Center for Medical Mycology, Faculty of Medicine, University of Cologne and University Hospital Cologne, Cologne, Germany; Translational Research, Cologne Excellence Cluster on Cellular Stress Responses in Aging-Associated Diseases, Faculty of Medicine, University of Cologne and University Hospital Cologne, Cologne, Germany; Clinical Trials Centre Cologne (ZKS Köln), Cologne, Germany
| | - Andreas H Groll
- Infectious Disease Research Program, Centre for Bone Marrow Transplantation and Department of Paediatric Hematology and Oncology, University Children's Hospital Münster, Münster, Germany
| | - Danila Seidel
- Department I of Internal Medicine, Excellence Center for Medical Mycology, Faculty of Medicine, University of Cologne and University Hospital Cologne, Cologne, Germany; Translational Research, Cologne Excellence Cluster on Cellular Stress Responses in Aging-Associated Diseases, Faculty of Medicine, University of Cologne and University Hospital Cologne, Cologne, Germany
| | - Kerstin Albus
- Department I of Internal Medicine, Excellence Center for Medical Mycology, Faculty of Medicine, University of Cologne and University Hospital Cologne, Cologne, Germany; Translational Research, Cologne Excellence Cluster on Cellular Stress Responses in Aging-Associated Diseases, Faculty of Medicine, University of Cologne and University Hospital Cologne, Cologne, Germany
| | - Joao N de Almedia
- Central Laboratory Division, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil; Center for Discovery and Innovation, Hackensack Meridian Health, Nutley, NJ, USA
| | - Guillermo Garcia-Effron
- Laboratorio de Micología y Diagnóstico Molecular, Cátedra de Parasitología y Micología, Facultad de Bioquímica y Ciencias Biológicas, Universidad Nacional del Litoral, Santa Fe, Argentina; Consejo Nacional de Investigaciones Científicas y Tecnológicas, CCT Santa Fe, Santa Fe, Argentina
| | - Nicole Gilroy
- Centre for Infectious Diseases and Microbiology, Westmead Hospital, The University of Sydney, Sydney, NSW, Australia
| | - Cornelia Lass-Flörl
- Institute of Hygiene and Medical Microbiology, ECMM Excellence Centre, Medical University of Innsbruck, Innsbruck, Austria
| | | | - Livio Pagano
- Fondazione Policlinico Universitario A Gemelli-IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Tamas Papp
- Fungal Pathogenicity Mechanisms Research Group, Department of Microbiology, University of Szeged, Szeged, Hungary
| | - Riina Rautemaa-Richardson
- Wythenshawe Hospital, ECMM Excellence Centre, Manchester University NHS Foundation Trust, Manchester, UK; Division of Infection, Immunity and Respiratory Medicine, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - Jon Salmanton-García
- Department I of Internal Medicine, Excellence Center for Medical Mycology, Faculty of Medicine, University of Cologne and University Hospital Cologne, Cologne, Germany; Translational Research, Cologne Excellence Cluster on Cellular Stress Responses in Aging-Associated Diseases, Faculty of Medicine, University of Cologne and University Hospital Cologne, Cologne, Germany
| | - Andrej Spec
- Division of Infectious Disease, School of Medicine, Washington University in St Louis, St Louis, MO, USA
| | - Joerg Steinmann
- Institute of Clinical Hygiene, Medical Microbiology and Infectiology, Paracelsus Medical University, Nuremberg, Germany; Institute of Medical Microbiology, University Hospital Essen, Essen, Germany
| | - Sevtap Arikan-Akdagli
- Department of Medical Microbiology, Hacettepe University Medical School, Ankara, Turkey
| | - Dorothee E Arenz
- Department I of Internal Medicine, Excellence Center for Medical Mycology, Faculty of Medicine, University of Cologne and University Hospital Cologne, Cologne, Germany; German Centre for Infection Research, Partner Site Bonn-Cologne, Cologne, Germany
| | - Rosanne Sprute
- Department I of Internal Medicine, Excellence Center for Medical Mycology, Faculty of Medicine, University of Cologne and University Hospital Cologne, Cologne, Germany; German Centre for Infection Research, Partner Site Bonn-Cologne, Cologne, Germany
| | - Luisa Duran-Graeff
- Clínica Las Condes, Departamento de Medicina Interna, Unidad de Infectología, Santiago, Chile
| | - Tomas Freiberger
- Centre for Cardiovascular Surgery and Transplantation, Brno, Czech Republic; Medical Faculty, Masaryk University, Brno, Czech Republic
| | - Corrado Girmenia
- Department of Hematology, Umberto I Policlinico di Roma, Rome, Italy
| | | | - Souha S Kanj
- Department of Internal Medicine, Division of Infectious Diseases, American University of Beirut Medical Centre, Beirut, Lebanon
| | - Maryam Roudbary
- Department of Parasitology and Mycology, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Olivier Lortholary
- Service des Maladies Infectieuses et Tropicales, Hôpital Necker-Enfants malades, Université Paris V, Paris, France
| | - Joseph Meletiadis
- Clinical Microbiology Laboratory, Attikon University Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Esther Segal
- Department of Clinical Microbiology and Immunology, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Felipe Francisco Tuon
- Laboratory of Emerging Infectious Diseases, Pontifícia Universidade Católica do Paraná, Curitiba, Brazil
| | - Nathan Wiederhold
- Fungus Testing Laboratory, University of Texas Health Science Center, San Antonio, TX, USA
| | - Tihana Bicanic
- Institute of Infection and Immunity, St George's University of London, London, UK
| | - Jagdish Chander
- Department of Microbiology, Government Medical College Hospital, Chandigarh, India
| | - Yee-Chun Chen
- Division of Infectious Diseases, Department of Internal Medicine, National Taiwan University College of Medicine, Taipeh, Taiwan; Department of Medicine, National Taiwan University College of Medicine, Taipeh, Taiwan
| | - Po-Ren Hsueh
- Division of Infectious Diseases, Department of Internal Medicine, National Taiwan University College of Medicine, Taipeh, Taiwan; Department of Laboratory Medicine, National Taiwan University College of Medicine, Taipeh, Taiwan
| | - Margaret Ip
- Department of Microbiology, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, China
| | - Patricia Munoz
- Infectious Diseases and Clinical Microbiology Department, Hospital General Universitario Gregorio Marañón, Servicio de Microbiología-Enfermedades Infecciosas, Madrid, Spain
| | - Isabel Spriet
- Department of Pharmaceutical and Pharmacological Sciences, KU Leuven, Leuven, Belgium; Pharmacy Department, University Hospitals Leuven, Leuven, Belgium
| | - Elvis Temfack
- Internal Medicine Unit, Douala General Hospital, Douala, Cameroon; National Public Health Laboratory, Yaounde, Cameroon
| | - Luis Thompson
- Clinica Alemana-Universidad del Desarrollo, Departamento de Medicina Interna, Unidad de Infectología, Santiago, Chile
| | - Anna Maria Tortorano
- Department of Biomedical Science for Research, Universita degli Studi di Milano, Milan, Italy
| | - Aristea Velegraki
- Mycology Research Laboratory and UOA/HCPF Culture Collection, Department of Microbiology, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Nelesh P Govender
- National Institute for Communicable Diseases (Centre for Healthcare-Associated Infections, Antimicrobial Resistance and Mycoses), a Division of the National Health Laboratory Service, Johannesburg, South Africa; School of Pathology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
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