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Riera F, Cortes Luna J, Rabagliatti R, Scapellato P, Caeiro JP, Chaves Magri MM, Sotomayor CE, Rodrigues Falci D. Antifungal stewardship: the Latin American experience. ANTIMICROBIAL STEWARDSHIP & HEALTHCARE EPIDEMIOLOGY : ASHE 2023; 3:e217. [PMID: 38156226 PMCID: PMC10753509 DOI: 10.1017/ash.2023.471] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Revised: 09/20/2023] [Accepted: 09/21/2023] [Indexed: 12/30/2023]
Abstract
Antifungal stewardship is a critical component of healthcare management that focuses on optimizing the use of antifungal medications to improve patient outcomes, minimize resistance, and reduce healthcare costs. In resource-limited settings, the prevalence of fungal infections remains a significant health concern, often exacerbated by factors such as compromised immune systems, inadequate diagnostic capabilities, and limited access to antifungal agents. This paper reviews the current state of antifungal stewardship practices in developing countries, addressing the unique socioeconomic and healthcare landscape.
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Affiliation(s)
- Fernando Riera
- Division of Infectious Diseases, Sanatorio Allende Córdoba, Córdoba, Argentina
- Infectious Diseases, Universidad Nacional de Córdoba, Córdoba, Argentina
| | - Jorge Cortes Luna
- Medicine Department of Internal Medicine School of Medicine, Universidad Nacional de Colombia, Colombia
| | - Ricardo Rabagliatti
- Departamento de Enfermedades Infecciosas del Adulto, Escuela de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Pablo Scapellato
- Chief Infectious Diseases Unit, Hospital D.F. Santojanni, Medicina Universidad Favaloro, Argentina
| | - Juan Pablo Caeiro
- HIV/Infectious Diseases Services at AltaMed, Infectious Diseases, Universidad Nacional de Córdoba, Córdoba, Argentina
| | - Marcello Mihalenko Chaves Magri
- Infectious Diseases Services, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Claudia Elena Sotomayor
- CIBICI-CONICET, Facultad de Ciencias Químicas, Universidad Nacional de Córdoba, Laboratory of Innate Immunity to Fungal Pathogens, Córdoba, Argentina
- Departamento de Bioquímica Clínica, Facultad de Ciencias Químicas, Universidad Nacional de Córdoba, Córdoba, Argentina
| | - Diego Rodrigues Falci
- Infectious Diseases Service, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
- Infectious Diseases at the School of Medicine, Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre, Brazil
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Shen M, Li PT, Wu YJ, Lin CH, Chai E, Chang TC, Chen CT. The antifungal activities and biological consequences of BMVC-12C-P, a carbazole derivative against Candida species. Med Mycol 2020; 58:521-529. [PMID: 31281934 DOI: 10.1093/mmy/myz071] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2019] [Revised: 05/19/2019] [Accepted: 06/05/2019] [Indexed: 11/14/2022] Open
Abstract
Fungal infections, particularly Candida species, have increased worldwide and caused high morbidity and mortality rates. The toxicity and development of resistance in present antifungal drugs justify the need of new drugs with different mechanism of action. BMVC-12C-P, a carbazole-type compound, has been found to dysfunction mitochondria. BMVC-12C-P displayed the strongest antifungal activities among all of the BMVC derivatives. The minimal inhibitory concentration (MIC) of BMVC-12C-P against Candida species ranged from 1 to 2 μg/ml. Fluconazole-resistant clinical isolates of Candida species were highly susceptible to BMVC-12C-P. The potent fungicidal activity of BMVC-12C-P relates to its impairing mitochondrial function. Furthermore, we found that the hyphae growth and biofilm formation were suppressed in C. albicans survived from BMVC-12C-P treatment. This study demonstrates the potential of BMVC-12C-P as an antifungal agent for treating Candida infections.
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Affiliation(s)
- Mandy Shen
- Department of Biochemical Science and Technology, National Taiwan University, Taipei 10617, Taiwan
| | - Pei-Tzu Li
- Department of Biochemical Science and Technology, National Taiwan University, Taipei 10617, Taiwan
| | - Yan-Jia Wu
- Department of Biochemical Science and Technology, National Taiwan University, Taipei 10617, Taiwan
| | - Ching-Hsuan Lin
- Department of Biochemical Science and Technology, National Taiwan University, Taipei 10617, Taiwan
| | - Eric Chai
- Department of Biochemical Science and Technology, National Taiwan University, Taipei 10617, Taiwan
| | - Ta-Chau Chang
- Institute of Atomic and Molecular Sciences, Academia Sinica, Taipei 10617, Taiwan
| | - Chin-Tin Chen
- Department of Biochemical Science and Technology, National Taiwan University, Taipei 10617, Taiwan
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Mu S, Tang Z, Novotny W, Tawashi M, Li TK, Ou Y, Sahasranaman S. Effect of rifampin and itraconazole on the pharmacokinetics of zanubrutinib (a Bruton's tyrosine kinase inhibitor) in Asian and non-Asian healthy subjects. Cancer Chemother Pharmacol 2019; 85:391-399. [PMID: 31875923 PMCID: PMC7015960 DOI: 10.1007/s00280-019-04015-w] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2019] [Accepted: 12/14/2019] [Indexed: 02/06/2023]
Abstract
PURPOSE Zanubrutinib (BGB-3111) is a potent Bruton's tyrosine kinase inhibitor with promising clinical activity in B-cell malignancies. Zanubrutinib was shown to be mainly metabolized through cytochrome P450 3A (CYP3A) in vitro. We evaluated the effect of steady-state rifampin (a strong CYP3A inducer) and steady-state itraconazole (a strong CYP3A inhibitor) on the pharmacokinetics (PK), safety, and tolerability of zanubrutinib in healthy Asian and non-Asian subjects. METHODS In this open-label, two-part clinical study, 20 participants received a single oral dose of zanubrutinib (320 mg) and oral rifampin (600 mg) in Part A, and 18 participants received a single oral dose of zanubrutinib (20 mg) and oral itraconazole (200 mg) in Part B. Serial blood samples were collected after administration of zanubrutinib alone and zanubrutinib in combination with rifampin or itraconazole for the measurement of PK parameters. RESULTS Coadministration with rifampin decreased AUC0-∞ of zanubrutinib by 13.5-fold and Cmax by 12.6-fold. Coadministration with itraconazole increased the AUC0-∞ of zanubrutinib by 3.8-fold and Cmax by 2.6-fold. The PK of zanubrutinib was consistent between Asian and non-Asian subjects, and zanubrutinib was well tolerated in this study. CONCLUSIONS These results confirm that zanubrutinib is primarily metabolized by CYP3A in humans. The PK of zanubrutinib was comparable between Asian and non-Asian subjects and, therefore, no dose modifications are necessary for zanubrutinib in these ethnic populations.
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Affiliation(s)
- Song Mu
- Clinical Pharmacology, BeiGene USA, 2955 Campus Drive, Suite 300, San Mateo, CA, 94403, USA
| | - Zhiyu Tang
- Clinical Pharmacology, BeiGene USA, 2955 Campus Drive, Suite 300, San Mateo, CA, 94403, USA
| | | | - Manal Tawashi
- Clinical Operations, BeiGene USA, San Mateo, CA, USA
| | - Ta-Kai Li
- Drug Safety and Pharmacovigilance, BeiGene USA, San Mateo, CA, USA
| | - Ying Ou
- Clinical Pharmacology, BeiGene USA, 2955 Campus Drive, Suite 300, San Mateo, CA, 94403, USA
| | - Srikumar Sahasranaman
- Clinical Pharmacology, BeiGene USA, 2955 Campus Drive, Suite 300, San Mateo, CA, 94403, USA.
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Huang MC, Shen M, Huang YJ, Lin HC, Chen CT. Photodynamic Inactivation Potentiates the Susceptibility of Antifungal Agents against the Planktonic and Biofilm Cells of Candida albicans. Int J Mol Sci 2018; 19:ijms19020434. [PMID: 29389883 PMCID: PMC5855656 DOI: 10.3390/ijms19020434] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2017] [Revised: 01/23/2018] [Accepted: 01/29/2018] [Indexed: 11/16/2022] Open
Abstract
Photodynamic inactivation (PDI) has been shown to be a potential treatment modality against Candida infection. However, limited light penetration might leave some cells alive and undergoing regrowth. In this study, we explored the possibility of combining PDI and antifungal agents to enhance the therapeutic efficacy of Candida albicans and drug-resistant clinical isolates. We found that planktonic cells that had survived toluidine blue O (TBO)-mediated PDI were significantly susceptible to fluconazole within the first 2 h post PDI. Following PDI, the killing efficacy of antifungal agents relates to the PDI dose in wild-type and drug-resistant clinical isolates. However, only a 3-log reduction was found in the biofilm cells, suggesting limited therapeutic efficacy under the combined treatment of PDI and azole antifungal drugs. Using confocal microscopic analysis, we showed that TBO-mediated PDI could partially remove the extracellular polymeric substance (EPS) of biofilm. Finally, we showed that a combination of PDI with caspofungin could result in the complete killing of biofilms compared to those treated with caspofungin or PDI alone. These results clearly indicate that the combination of PDI and antifungal agents could be a promising treatment against C. albicans infections.
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Affiliation(s)
- Mu-Ching Huang
- Department of Biochemical Science and Technology, National Taiwan University, Taipei 106, Taiwan.
| | - Mandy Shen
- Department of Biochemical Science and Technology, National Taiwan University, Taipei 106, Taiwan.
| | - Yi-Jhen Huang
- Department of Biochemical Science and Technology, National Taiwan University, Taipei 106, Taiwan.
| | - Hsiao-Chi Lin
- Department of Biochemical Science and Technology, National Taiwan University, Taipei 106, Taiwan.
| | - Chin-Tin Chen
- Department of Biochemical Science and Technology, National Taiwan University, Taipei 106, Taiwan.
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Boğa C, Bolaman Z, Çağırgan S, Karadoğan İ, Özcan MA, Özkalemkaş F, Saba R, Sönmez M, Şenol E, Akan H, Akova M. Recommendations for Risk Categorization and Prophylaxis of Invasive Fungal Diseases in Hematological Malignancies: A Critical Review of Evidence and Expert Opinion (TEO-4). Turk J Haematol 2017; 32:100-17. [PMID: 26316478 PMCID: PMC4451478 DOI: 10.4274/tjh.2014.0277] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
This is the last of a series of articles on invasive fungal infections prepared by opinion leaders in Turkey. The aim of these articles is to guide clinicians in managing invasive fungal diseases in hematological malignancies and stem cell transplantation based on the available best evidence in this field. The previous articles summarized the diagnosis and treatment of invasive fungal disease and this article aims to explain the risk categorization and guide the antifungal prophylaxis in invasive fungal disease.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | - Hamdi Akan
- Ankara University Faculty of Medicine, Department of Hematology, Ankara, Turkey Phone: +90 532 424 26 40 E-mail:
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Yılmaz G, Coşkun B, Elhan A, Azap A, Akan H. D-index: A New Scoring System in Febrile Neutropenic Patients for Predicting Invasive Fungal Infections. Turk J Haematol 2016; 33:102-6. [PMID: 26376689 PMCID: PMC5100719 DOI: 10.4274/tjh.2014.0070] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2014] [Accepted: 05/21/2014] [Indexed: 12/01/2022] Open
Abstract
OBJECTIVE Neutropenia is a critical risk factor for invasive fungal infections (IFIs). We retrospectively performed this study to assess the performance of the D-index, a new test that combines both the duration and the severity of neutropenia, in predicting IFIs among patients with acute myelogenous leukemia.
MATERIALS AND METHODS Fifteen patients with IFIs and 28 patients who did not develop IFIs were enrolled in the study. The D-index was defined as the area over the neutrophil curve, whereas the cumulative-D-index (c-D-index) was the area over the neutrophil curve from the start of neutropenia until the first clinical manifestation of IFI.
RESULTS The D-index and the c-D-index tended to be significantly higher in patients with IFIs, with medians of 10,150 (range: 4000-22,000) and 5300 (range: 2300-22,200), respectively (p=0.037 and p=0.003, respectively). The receiver operating characteristic analyses showed that there was a cutoff point of 3875 for the D-index in predicting IFI; the sensitivity, specificity, and positive and negative predictive values were 100%, 67.9%, 35.4%, and 100%, respectively. There was also a cutoff point of 4225 for the c-D-index in predicting IFI; the sensitivity, specificity, and positive and negative predictive values for the c-D-index were 93.3%, 71.4%, 36.6%, and 98.4%.
CONCLUSION The D-index and especially the c-D-index could be useful tools with high negative predictive value to exclude as well as to predict IFIs in the management of neutropenic patients.
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Affiliation(s)
- Gülden Yılmaz
- Ankara University Faculty of Medicine, Department of Clinical Microbiology and Infectious Diseases, Ankara, Turkey, Phone : +90 312 508 27 15, E-mail :
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Gu Z, Buelow DR, Petraitiene R, Petraitis V, Walsh TJ, Hayden RT. Quantitative multiplexed detection of common pulmonary fungal pathogens by labeled primer polymerase chain reaction. Arch Pathol Lab Med 2015; 138:1474-80. [PMID: 25357108 DOI: 10.5858/arpa.2013-0592-oa] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
CONTEXT Invasive fungal infections are an important cause of morbidity and mortality among immunocompromised patients. OBJECTIVE To design and evaluate a multiplexed assay aimed at quantitative detection and differentiation of the 5 molds that are most commonly responsible for pulmonary infections. DESIGN Using labeled primer polymerase chain reaction chemistry, an assay was designed to target the 5.8S and 28S ribosomal RNA genes of Aspergillus spp, Fusarium spp, Scedosporium spp, and members of the order Mucorales ( Rhizopus oryzae , Rhizopus microsporus, Cunninghamella bertholletiae, Mucor circinelloides, Lichtheimia corymbifera, and Rhizomucor pusillus). This assay was split into 2 multiplexed reactions and was evaluated using both samples seeded with purified nucleic acid from 42 well-characterized clinical fungal isolates and 105 archived samples (47 blood [45%], 42 bronchoalveolar lavage fluid [40%], and 16 tissue [15%]) collected from rabbit models of invasive pulmonary fungal infections. RESULTS Assay detection sensitivity was less than 25 copies of the target sequence per reaction for Aspergillus spp, 5 copies for Fusarium spp and Scedosporium spp, and 10 copies for the Mucorales. The assay showed quantitative linearity from 5 × 10(1) to 5 × 10(5) copies of target sequence per reaction. Sensitivities and specificities for bronchoalveolar lavage fluid, tissue, and blood samples were 0.86 and 0.99, 0.60 and 1.00, and 0.46 and 1.00, respectively. CONCLUSIONS Labeled primer polymerase chain reaction permits rapid, quantitative detection and differentiation of common agents of invasive fungal infection. The assay described herein shows promise for clinical implementation that may have a significant effect on the rapid diagnosis and treatment of patients' severe infections caused by these pulmonary fungal pathogens.
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Affiliation(s)
- Zhengming Gu
- From the Department of Pathology, St. Jude Children's Research Hospital, Memphis, Tennessee (Drs Gu, Buelow, and Hayden); and the Transplantation-Oncology Infectious Diseases Program, Weill Cornell Medical Center, New York, New York (Drs Petraitiene, Petraitis, and Walsh)
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