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Karthaus M, Rüping MJGT, Cornely OA, Steinbach A, Groll AH, Lass-Flörl C, Ostermann H, Ruhnke M, Vehreschild JJ. Current issues in the clinical management of invasive candida infections--the AGIHO, DMykG, ÖGMM and PEG web-based survey and expert consensus conference 2009. Mycoses 2011; 54:e546-56. [PMID: 21554423 DOI: 10.1111/j.1439-0507.2010.01988.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
The objectives of this study were to identify unsolved issues in the management of invasive candidiasis, identify controversies and achieve consensus. The German Speaking Mycological Society (Deutschsprachige Mykologische Gesellschaft, DMykG e.V.) asked other German infectious diseases (ID) and mycological societies to submit unsolved issues concerning the diagnosis and treatment of fungal infections. Based on these contributions, a digital web-based questionnaire of 12 questions on Candida infections was designed to be completed by experts of the participating societies. Controversial results were identified by a mathematical model and were discussed at a consensus conference during the 43rd Annual Meeting of the DMykG e.V. in Cologne, Germany. Forty-two individuals completed the questionnaire. Analysis showed a strong consensus on treatment indications, choice of antifungals for clinical situations, handling of central venous catheters, duration of treatment and role of susceptibility testing. Opinions diverged on: initial treatment of haemodynamically stable neutropenic and haemodynamically unstable non-neutropenic patients, step down to oral treatment and the differential role of the echinocandins. These questions were presented for discussion at the expert consensus conference. In three of four questions, consensus was achieved. A two-step approach - web-based survey plus classical panel discussion - allows to capture expeditiously the opinions of a large and diverse group of individuals, to identify controversial issues and to resolve them in a personal, interactive setting. Thus, expert consensus was achieved on nine of 12 important questions on how to treat invasive candidiasis.
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Affiliation(s)
- M Karthaus
- Cancer Center Munich South, Klinikum Neuperlach and Harlaching, Munich, Germany
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Vehreschild JJ, Rüping MJGT, Wisplinghoff H, Farowski F, Steinbach A, Sims R, Stollorz A, Kreuzer KA, Hallek M, Bangard C, Cornely OA. Clinical effectiveness of posaconazole prophylaxis in patients with acute myelogenous leukaemia (AML): a 6 year experience of the Cologne AML cohort. J Antimicrob Chemother 2010; 65:1466-71. [PMID: 20410061 DOI: 10.1093/jac/dkq121] [Citation(s) in RCA: 97] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Large randomized controlled trials have shown significant decreases in morbidity and mortality in leukaemia patients with posaconazole prophylaxis. However, the value of prophylaxis has been questioned in centres with a low incidence of invasive fungal diseases (IFDs) and pre-emptive treatment strategies. METHODS We prospectively evaluated the epidemiology of IFDs in acute myelogenous leukaemia (AML) patients undergoing first remission-induction chemotherapy before and after posaconazole prophylaxis had been introduced as a standard of care. Patients admitted from January 2003 to December 2005 received topical polyenes as antifungal prophylaxis (first group), while those admitted between January 2006 and December 2008 received 200 mg of oral posaconazole three times daily (second group). Other diagnostic and therapeutic standard operating procedures remained unchanged. RESULTS A total of 82 patients in the polyene prophylaxis group and 77 in the posaconazole prophylaxis group were included in the final analysis. Baseline characteristics were well matched between groups. Patients receiving topical polyene prophylaxis were more likely to experience breakthrough IFDs (19.5% and 3.9%; P = 0.003) or breakthrough aspergillosis (13.4% and 2.6%; P = 0.018) than patients receiving systemic posaconazole prophylaxis. They also had more febrile days (mean 10.7 +/- 9.66 and 7.3 +/- 5.73; P = 0.007), longer need for inpatient treatment (mean 53.0 +/- 24.16 and 46.0 +/- 14.39; P = 0.026) and a shorter fungal-free survival (78.7 and 90.4 days; P = 0.024). No significant differences were observed for persistent fever, pneumonia, lung infiltrates indicative of invasive pulmonary aspergillosis, or attributable and overall mortality. CONCLUSIONS After introduction of posaconazole prophylaxis for patients with AML, the number of febrile days, the incidence rate of IFDs and aspergillosis and the duration of hospitalization decreased significantly.
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Affiliation(s)
- J J Vehreschild
- Klinik I für Innere Medizin, Klinikum der Universität zu Köln, Köln, Germany.
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Kohl V, Müller C, Cornely OA, Abduljalil K, Fuhr U, Vehreschild JJ, Scheid C, Hallek M, Rüping MJGT. Factors influencing pharmacokinetics of prophylactic posaconazole in patients undergoing allogeneic stem cell transplantation. Antimicrob Agents Chemother 2010; 54:207-12. [PMID: 19858252 PMCID: PMC2798545 DOI: 10.1128/aac.01027-09] [Citation(s) in RCA: 62] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2009] [Revised: 09/30/2009] [Accepted: 10/19/2009] [Indexed: 11/20/2022] Open
Abstract
The objectives of the present study were to elucidate the factors influencing the pharmacokinetics of prophylactically administered posaconazole in allogeneic hematopoietic stem cell transplant (SCT) recipients. Between May 2007 and November 2008, clinical data were obtained from all SCT recipients at the University Hospital of Cologne undergoing therapeutic drug monitoring (TDM) of serum prophylactic posaconazole concentrations. The posaconazole concentrations were determined by high-performance liquid chromatography. We developed a population pharmacokinetic model using nonlinear mixed-effect modeling (NONMEM). The list of covariates tested included age; body weight; body height; gender; posaconazole dose; race; coadministration of antineoplastic chemotherapy; day of stem cell transplantation; concomitant ranitidine, pantoprazole, cyclosporine, or tacrolimus administration; coincident fever; diarrhea; and plasma gamma-glutamyltransferase activity. A total of 149 serum posaconazole concentrations from 32 patients were obtained. A one-compartment model with first-order absorption and elimination as the basic structural model appropriately described the data, with the apparent clearance being 75.8 liters/h (95% confidence interval [CI], 65.2 to 86.4 liters/h) and the apparent volume being distribution of 835 liters (95% CI, 559 to 1,111 liters). Among the covariates tested, significant effects were found for age (decrease in the volume of distribution of 123 liters per year of age) and the presence of diarrhea (59% loss of bioavailability). A basis for prediction of the mean posaconazole concentrations in allogeneic SCT recipients with hematological malignancies is provided for a given dose. Corresponding adjustments of the starting dose according to the presence of diarrhea and according to age appear to be justified before TDM results are available.
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Affiliation(s)
- V. Kohl
- Department of Pharmacology, University of Cologne, Cologne, Germany, Department I of Internal Medicine, University of Cologne, Cologne, Germany, Clinical Trials Center Cologne, ZKS Köln, BMBF 01KN0706, University of Cologne, Cologne, Germany, Simcyp Limited, Sheffield, United Kingdom, Stem Cell Transplantation Program, Department I of Internal Medicine, University of Cologne, Cologne, Germany
| | - C. Müller
- Department of Pharmacology, University of Cologne, Cologne, Germany, Department I of Internal Medicine, University of Cologne, Cologne, Germany, Clinical Trials Center Cologne, ZKS Köln, BMBF 01KN0706, University of Cologne, Cologne, Germany, Simcyp Limited, Sheffield, United Kingdom, Stem Cell Transplantation Program, Department I of Internal Medicine, University of Cologne, Cologne, Germany
| | - O. A. Cornely
- Department of Pharmacology, University of Cologne, Cologne, Germany, Department I of Internal Medicine, University of Cologne, Cologne, Germany, Clinical Trials Center Cologne, ZKS Köln, BMBF 01KN0706, University of Cologne, Cologne, Germany, Simcyp Limited, Sheffield, United Kingdom, Stem Cell Transplantation Program, Department I of Internal Medicine, University of Cologne, Cologne, Germany
| | - K. Abduljalil
- Department of Pharmacology, University of Cologne, Cologne, Germany, Department I of Internal Medicine, University of Cologne, Cologne, Germany, Clinical Trials Center Cologne, ZKS Köln, BMBF 01KN0706, University of Cologne, Cologne, Germany, Simcyp Limited, Sheffield, United Kingdom, Stem Cell Transplantation Program, Department I of Internal Medicine, University of Cologne, Cologne, Germany
| | - U. Fuhr
- Department of Pharmacology, University of Cologne, Cologne, Germany, Department I of Internal Medicine, University of Cologne, Cologne, Germany, Clinical Trials Center Cologne, ZKS Köln, BMBF 01KN0706, University of Cologne, Cologne, Germany, Simcyp Limited, Sheffield, United Kingdom, Stem Cell Transplantation Program, Department I of Internal Medicine, University of Cologne, Cologne, Germany
| | - J. J. Vehreschild
- Department of Pharmacology, University of Cologne, Cologne, Germany, Department I of Internal Medicine, University of Cologne, Cologne, Germany, Clinical Trials Center Cologne, ZKS Köln, BMBF 01KN0706, University of Cologne, Cologne, Germany, Simcyp Limited, Sheffield, United Kingdom, Stem Cell Transplantation Program, Department I of Internal Medicine, University of Cologne, Cologne, Germany
| | - C. Scheid
- Department of Pharmacology, University of Cologne, Cologne, Germany, Department I of Internal Medicine, University of Cologne, Cologne, Germany, Clinical Trials Center Cologne, ZKS Köln, BMBF 01KN0706, University of Cologne, Cologne, Germany, Simcyp Limited, Sheffield, United Kingdom, Stem Cell Transplantation Program, Department I of Internal Medicine, University of Cologne, Cologne, Germany
| | - M. Hallek
- Department of Pharmacology, University of Cologne, Cologne, Germany, Department I of Internal Medicine, University of Cologne, Cologne, Germany, Clinical Trials Center Cologne, ZKS Köln, BMBF 01KN0706, University of Cologne, Cologne, Germany, Simcyp Limited, Sheffield, United Kingdom, Stem Cell Transplantation Program, Department I of Internal Medicine, University of Cologne, Cologne, Germany
| | - M. J. G. T. Rüping
- Department of Pharmacology, University of Cologne, Cologne, Germany, Department I of Internal Medicine, University of Cologne, Cologne, Germany, Clinical Trials Center Cologne, ZKS Köln, BMBF 01KN0706, University of Cologne, Cologne, Germany, Simcyp Limited, Sheffield, United Kingdom, Stem Cell Transplantation Program, Department I of Internal Medicine, University of Cologne, Cologne, Germany
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