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Stein J, Latz S, Ellinger J, Fechner G, Safi M, Krausewitz P, Müller S, Weyer K, Müller SC. Fungaemia caused by obstructive renal candida bezoars leads to bilateral chorioretinitis: a case report. BMC Urol 2018; 18:21. [PMID: 29548319 PMCID: PMC5857136 DOI: 10.1186/s12894-018-0335-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2017] [Accepted: 03/12/2018] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Renal fungal bezoars are remarkably rare and mostly occur in immunodeficient patients. Only a small number of cases with immunocompetent patients have been published so far. The published treatment approaches comprised systemic antimycotic therapy and surgical or minimal invasive removal of the fungal balls. In some cases irrigation of the renal duct system with amphotericin B was performed. By obstruction of the urinary tract bezoars can lead to infected hydronephrosis and severe urosepsis with high lethality. Fungaemia can cause fungal colonization in different distant organs. Fulminant chorioretinitis and irreversible visual impairment can be the consequence of ocular fundus colonization. The following report highlights that a co-operation between urologists and ophthalmologists is absolutely indispensible in case of fungaemia. CASE PRESENTATION Hereinafter we describe a case of an immunocompetent 56 years old woman, presenting with flank pain and shivering. The diagnosis turned out to be difficult due to initially negative urine culture. The fungaemia caused by obstructive nephropathy led to bilateral candida chorioretinitis. The patient was treated with intravenous amphotericin b and the bezoar was removed by percutaneous "nephrolitholapaxy". After two months, a follow up revealed the patient felt well, chorioretinal lesions regressed and urine culture did not show any fungal growth. CONCLUSION To the best of our knowledge, this is the first case reporting on obstructive renal bezoars, which lead to haematogenous fungus spread and bilateral chorioretinitis. It points out that extensive ophthalmologic examination should be performed in case of fungaemia even if the patient is not suffering from any visual impairment.
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Affiliation(s)
- Johannes Stein
- Department of Urology, University of Bonn, Sigmund-Freud-Str. 25, D-53127 Bonn, Germany
| | - Stefan Latz
- Department of Urology, University of Bonn, Sigmund-Freud-Str. 25, D-53127 Bonn, Germany
| | - Jörg Ellinger
- Department of Urology, University of Bonn, Sigmund-Freud-Str. 25, D-53127 Bonn, Germany
| | - Guido Fechner
- Department of Urology, University of Bonn, Sigmund-Freud-Str. 25, D-53127 Bonn, Germany
| | - Maher Safi
- Department of Urology, University of Bonn, Sigmund-Freud-Str. 25, D-53127 Bonn, Germany
| | - Philipp Krausewitz
- Department of Urology, University of Bonn, Sigmund-Freud-Str. 25, D-53127 Bonn, Germany
| | - Simone Müller
- Department of Ophthalmology, University of Bonn, Sigmund-Freud-Str. 25, D-53127 Bonn, Germany
| | - Karin Weyer
- Department of Urology, University of Bonn, Sigmund-Freud-Str. 25, D-53127 Bonn, Germany
| | - Stefan C. Müller
- Department of Urology, University of Bonn, Sigmund-Freud-Str. 25, D-53127 Bonn, Germany
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Bahloul M, Chtara K, Turki O, Khlaf Bouaziz N, Regaieg K, Hammami M, Ben Amar W, Chabchoub I, Ammar R, Ben Hamida C, Chelly H, Ayedi A, Bouaziz M. Yarrowia lipolytica fungemia in patients with severe polytrauma requiring intensive care admission: analysis of 32 cases. Intensive Care Med 2017; 43:1921-1923. [PMID: 28780658 DOI: 10.1007/s00134-017-4900-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2017] [Accepted: 07/27/2017] [Indexed: 12/18/2022]
Affiliation(s)
- Mabrouk Bahloul
- Department of Intensive Care, Habib Bourguiba University Hospital, 3029, Sfax, Tunisia.
| | - Kamilia Chtara
- Department of Intensive Care, Habib Bourguiba University Hospital, 3029, Sfax, Tunisia
| | - Olfa Turki
- Department of Intensive Care, Habib Bourguiba University Hospital, 3029, Sfax, Tunisia
| | | | - Kais Regaieg
- Department of Intensive Care, Habib Bourguiba University Hospital, 3029, Sfax, Tunisia
| | - Maha Hammami
- Department of Intensive Care, Habib Bourguiba University Hospital, 3029, Sfax, Tunisia
| | - Wiem Ben Amar
- Department of Forensic Medicine, Habib Bourguiba University Hospital, Sfax, Tunisia
| | - Imen Chabchoub
- Department of Pediatrics, Hedi Chaker University Hospital, Sfax, Tunisia
| | - Rania Ammar
- Department of Intensive Care, Habib Bourguiba University Hospital, 3029, Sfax, Tunisia
| | - Chokri Ben Hamida
- Department of Intensive Care, Habib Bourguiba University Hospital, 3029, Sfax, Tunisia
| | - Hedi Chelly
- Department of Intensive Care, Habib Bourguiba University Hospital, 3029, Sfax, Tunisia
| | - Ali Ayedi
- Fungal and Parasitic Molecular Biology Laboratory, Habib Bourguiba University Hospital, Sfax, Tunisia
| | - Mounir Bouaziz
- Department of Intensive Care, Habib Bourguiba University Hospital, 3029, Sfax, Tunisia
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Lin KY, Cheng A, Chang YC, Hung MC, Wang JT, Sheng WH, Hseuh PR, Chen YC, Chang SC. Central line-associated bloodstream infections among critically-ill patients in the era of bundle care. J Microbiol Immunol Infect 2015; 50:339-348. [PMID: 26316008 DOI: 10.1016/j.jmii.2015.07.001] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/26/2015] [Revised: 07/15/2015] [Accepted: 07/15/2015] [Indexed: 01/13/2023]
Abstract
BACKGROUND/PURPOSE Patients admitted to intensive care units (ICUs) are at high risk for central line-associated bloodstream infections (CLABSIs). Bundle care has been documented to reduce CLABSI rates in Western countries, however, few reports were from Asian countries and the differences in the epidemiology or outcomes of critically-ill patients with CLABSIs after implementation of bundle care remain unknown. We aimed to evaluate the incidence, microbiological characteristics, and factors associated with mortality in critically-ill patients after implementation of bundle care. METHODS Prospective surveillance was performed on patients admitted to ICUs at the National Taiwan University Hospital, Taipei, Taiwan from January 2012 to June 2013. The demographic, microbiological, and clinical data of patients who developed CLABSI according to the National Healthcare Safety Network definition were reviewed. A total of 181 episodes of CLABSI were assessed in 156 patients over 46,020 central-catheter days. RESULTS The incidence of CLABSI was 3.93 per 1000 central-catheter days. The predominant causative microorganisms isolated from CLABSI episodes were Gram-negative bacteria (39.2%), followed by Gram-positive bacteria (33.2%) and Candida spp. (27.6%). Median time from insertion of a central catheter to occurrence of CLABSI was 8 days. In multivariate analysis, the independent factors associated with mortality were higher Pitt bacteremia score [odds ratio (OR) 1.41; 95% confidence interval (CI) 1.18-1.68] and longer interval between onset of CLABSIs and catheter removal (OR 1.10; 95% CI 1.02-1.20), respectively. CONCLUSION In institutions with a high proportion of CLABSI caused by Gram-negative bacteria, severity of bacteremia and delay in catheter removal were significant factors associated with mortality.
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Affiliation(s)
| | - Aristine Cheng
- Department of Internal Medicine, National Taiwan University Hospital Hsin-Chu Branch, Hsin-Chu, Taiwan
| | - Yu-Ching Chang
- Infection Control Center, National Taiwan University Hospital, Taipei, Taiwan
| | - Mei-Chuan Hung
- Infection Control Center, National Taiwan University Hospital, Taipei, Taiwan
| | - Jann-Tay Wang
- Departments of Internal Medicine and Laboratory Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
| | - Wang-Huei Sheng
- Departments of Internal Medicine and Laboratory Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan.
| | - Po-Ren Hseuh
- Department of Laboratory Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
| | - Yee-Chun Chen
- Departments of Internal Medicine and Laboratory Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
| | - Shan-Chwen Chang
- Departments of Internal Medicine and Laboratory Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
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Bi HJ, Wei QF. [Clinical analysis of 17 preterm infants with fungal septicemia]. Zhongguo Dang Dai Er Ke Za Zhi 2013; 15:311-312. [PMID: 23607958] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Affiliation(s)
- Hong-Juan Bi
- Department of Neonatology, Guangxi Maternal and Child Health Hospital, Nanning, China
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Liu CX, Yang JH, Dong L, Mai JY, Zhang L, Zhu JH. [Clinical features and homological analysis of Pichia ohmeri-caused hospital-acquired fungemia in premature infants]. Zhonghua Yi Xue Za Zhi 2013; 93:285-288. [PMID: 23578509] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
OBJECTIVE To analyze the clinical features of fungemia caused by Pichia ohmeri (P. ohmeri) in neonate intensive care unit and explore its molecular biological characteristics so as to improve its diagnosis and treatment level. METHODS The clinical data of 6 infected infants were retrospectively analyzed. The strains obtained from them were identified and homological analysis was performed through randomly amplified polymorphic assay to explore the epidemiological characteristics of this nosocomial infection. RESULTS Before the isolation of P. ohmeri, they received intravenous antibacterial therapy for 13 - 45 days. Among them, 4 received mechanical ventilation and 5 had a peripheral insertion of central venous catheters. Five infants were healed after a therapy of caspofungin for 15 - 30 days. One neonate recurred after a 30-day administration of fluconazole. The strain was identified and confirmed as P. ohmeri. RAPD genotyping results showed that all 6 strains were from the same clone. No similar cases occurred after positive control measures despite a negative epidemiological sampling. CONCLUSIONS P. ohmeri may cause premature infant fungemia and lead to its spread in hospital. Hospital infection control is a key point. And caspofungin is both safe and effective in the therapy of neonate fungemia.
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Affiliation(s)
- Cai-xia Liu
- Departments of Clinical Microbiology, Affiliated Yuying Children's Hospital, Wenzhou Medical College, Wenzhou 325027, China
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Ciecko SC, Scher R. Invasive fungal rhinitis caused by Paecilomyces lilacinus infection: Report of a case and a novel treatment. Ear Nose Throat J 2010; 89:594-595. [PMID: 21174278] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/30/2023] Open
Abstract
Invasive fungal infections of the sinonasal tract are a rare but known entity in immunocompromised patients. Paecilomyces lilacinus is a nematophagous fungi with septate hyphae that has afflicted humans in multiple forms, causing cutaneous, ocular, and sinonasal infections. Only 4 cases of P lilacinus and 2 cases of Paecilomyces variotii in the sinonasal tract have been reported in the literature. We present a case of invasive fungal rhinitis secondary to P lilacinus infection in an immunocompromised patient. She was managed successfully with a novel treatment: voriconazole and endonasal microdebridement.
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Affiliation(s)
- Shawn C Ciecko
- ENT and Allergy Associates, 1887 Richmond Ave., Suite 5, Staten Island, NY 10314, USA.
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Yu Z, Jiang J, Liao RF, Zeng ZP, Jiang LY. [Risk factors for death due to fungal septicemia and prognostic analysis]. Nan Fang Yi Ke Da Xue Xue Bao 2008; 28:2018-2021. [PMID: 19033117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
OBJECTIVE To analyze the incidence, clinical features and the predisposing factors of fungal septicemia, and investigate the risk factors for death due to fungal septicemia and the prognosis of the patients. METHODS We retrospectively analyzed the clinical data of 91 patients with fungal septicemia diagnosed in the last 17 years, including 60 patients with clinical cure or improvement, and 31 who die of the disease. Based on the results by univariate analysis, the data were analyzed using logistic multiple regression and Fisher's discriminant analysis. RESULTS Fungal septicemia had many predisposing factors with high mortality rate. Univariate analysis revealed significant differences between the cured/improved cases and the fatal cases for 12 variables, including advanced age, complication by bacterial infection, septic shock, multiple organ dysfunction syndrome (MODS), ICU patients, cortical hormone therapy, surgery, chemotherapy, use of immunopotentiating agents, length of hospital stay before antifungal therapy, time of anti-fungus therapy and types of invasive procedures. Logistic multiple regression analysis showed that the types of invasive procedures, MODS, surgery and prolonged hospital stay before antifungal therapy were the independent risk factors for fungal septicemia-related death. Fisher's linear discriminant equation was established for predicting the prognosis of the disease. CONCLUSION The types of invasive procedure, MODS, surgery and prolonged hospital stay before antifungal therapy are the independent risk factors for fungal septicemia-related death, and the patients' prognosis can be predicted using Fisher's linear discriminant equation.
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Affiliation(s)
- Zhong Yu
- Department of Gastroenterology, Second Affiliated Hospital of Sun Yat-sen University, Guangzhou 510120, China.
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Chen CK, Wan SH, Kou SK. A rare cutaneous fungal infection complicating bacterial necrotising fasciitis. Hong Kong Med J 2008; 14:314-316. [PMID: 18685166] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/26/2023] Open
Abstract
We report a case of bacterial necrotising fasciitis complicated by the rare fungus Absidia corymbifera. Although this fungal infection is rare, the prognosis is poor and it therefore requires attention. Only 30 cases have been reported since 1874, and we are the first group to report this clinical scenario in our locality. Using a comprehensive journal review, we discuss the expected clinical course and optimal management.
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Affiliation(s)
- C K Chen
- Department of Orthopaedics and Traumatology, Pamela Youde Nethersole Eastern Hospital, Chai Wan, Hong Kong.
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Cisneros-Herreros JM, Cobo-Reinoso J, Pujol-Rojo M, Rodríguez-Baño J, Salavert-Lletí M. [Guidelines for the diagnosis and treatment of patients with bacteriemia. Guidelines of the Sociedad Española de Enfermedades Infecciosas y Microbiología Clínica]. Enferm Infecc Microbiol Clin 2007; 25:111-30. [PMID: 17288909 DOI: 10.1016/s0213-005x(07)74242-8] [Citation(s) in RCA: 74] [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] [Indexed: 11/21/2022]
Abstract
Bacteremia is a complex clinical syndrome in constant transformation that is an important, growing cause of morbidity and mortality. Even though there is a great deal of specific information about bacteremia, few comprehensive reviews integrate this information with a practical AIM. The main objective of these Guidelines, which target hospital physicians, is to improve the clinical care provided to patients with bacteremia by integrating blood culture results with clinical data, and optimizing the use of diagnostic procedures and antimicrobial testing. The document is structured into sections that cover the epidemiology and etiology of bacteremia, stratified according to the various patient populations, and the diagnostic work-up, therapy, and follow-up of patients with bacteremia. Diagnostic and therapeutic decisions are presented as recommendations based on the grade of available scientific evidence.
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Affiliation(s)
- Stephen R Smith
- Massachusetts Eye and Ear Infirmary, Department of Ophthalmology, Boston, MA 02114, USA
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Abstract
This infection has a high death rate and is predominantly associated with healthcare. Population-based surveillance for candidemia in Australia from 2001 to 2004 identified 1,095 cases. Annual overall and hospital-specific incidences were 1.81/100,000 and 0.21/1,000 separations (completed admissions), respectively. Predisposing factors included malignancy (32.1%), indwelling vascular catheters (72.6%), use of antimicrobial agents (77%), and surgery (37.1%). Of 919 episodes, 81.5% were inpatient healthcare associated (IHCA), 11.6% were outpatient healthcare associated (OHCA), and 6.9% were community acquired (CA). Concomitant illnesses and risk factors were similar in IHCA and OHCA candidemia. IHCA candidemia was associated with sepsis at diagnosis (p<0.001), death <30 days after infection (p<0.001), and prolonged hospital admission (p<0.001). Non–Candida albicans species (52.7%) caused 60.5% of cases acquired outside hospitals and 49.9% of IHCA candidemia (p = 0.02). The 30-day death rate was 27.7% in those >65 years of age. Adult critical care stay, sepsis syndrome, and corticosteroid therapy were associated with the greatest risk for death. Systematic epidemiologic studies that use standardized definitions for IHCA, OHCA, and CA candidemia are indicated.
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Affiliation(s)
- Sharon Chen
- Westmead Hospital, Westmead, New South Wales, Australia.
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Shorr AF, Tabak YP, Killian AD, Gupta V, Liu LZ, Kollef MH. Healthcare-associated bloodstream infection: A distinct entity? Insights from a large U.S. database*. Crit Care Med 2006; 34:2588-95. [PMID: 16915117 DOI: 10.1097/01.ccm.0000239121.09533.09] [Citation(s) in RCA: 206] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
OBJECTIVE To gain a better understanding of the epidemiology, microbiology, and outcomes of early-onset, culture-positive, community-acquired, healthcare-associated, and hospital-acquired bloodstream infections. DESIGN We analyzed a large U.S. database (Cardinal Health, MediQual, formerly MedisGroups) to identify patients with bacterial or fungal bloodstream isolates from 2002 to 2003. SETTING The data set included administrative and clinical variables (physiologic, laboratory, culture, and other clinical) from 59 hospitals. Bloodstream infections were identified in those hospitals collecting clinical and culture data for at least the first 5 days of admission. PATIENTS Patients with bloodstream infection within 2 days of admission were classified as having community-acquired bloodstream infection. Those with a prior hospitalization within 30 days, transfer from another facility, ongoing chemotherapy, or long-term hemodialysis were classified as having healthcare-associated bloodstream infection. Bloodstream infections that developed after day 2 of admission were classified as hospital-acquired bloodstream infection. A total of 6,697 patients were identified as having bloodstream infection. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS Healthcare-associated bloodstream infection accounted for more than half (55.3%) of all bloodstream infections. Nearly two thirds (62.3%) of hospitalized patients with bloodstream infection suffered from either hospital-acquired bloodstream infection or healthcare-associated bloodstream infection and had higher morbidity and mortality rates than those with community-acquired bloodstream infection. Of all bloodstream infection pathogens, fungal organisms were associated with the highest crude mortality, longest length of stay in hospital, and greatest total charges. Of all bacterial bloodstream infections, methicillin-resistant Staphylococcus aureus was associated with the highest crude mortality rate (22.5%), the longest mean length of stay (11.1 +/- 10.7 days), and the highest median total charges ($36,109). After we controlled for confounding factors, methicillin-resistant S. aureus was associated with the highest independent mortality risk (odds ratio 2.70; confidence interval 2.03-3.58). S. aureus was the most commonly encountered pathogen in all types of early-onset bacteremia. CONCLUSIONS Healthcare-associated bloodstream infection constitutes a distinct entity of bloodstream infection with its unique epidemiology, microbiology, and outcomes. Methicillin-resistant Staphylococcus aureus carries the highest relative mortality risk among all pathogens.
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Abstract
OBJECTIVE To report the survival of fungal sepsis in extracorporeal membrane oxygenation. DESIGN Single case report. SETTING Tertiary referral children's hospital pediatric intensive care unit. PATIENTS A single case report of an infant with congenital heart disease who developed candida sepsis while supported postoperatively with extracorporeal membrane oxygenation. RESULTS This infant survived a prolonged episode of candidemia after repair of congenital heart disease, which required extracorporeal membrane oxygenation support. The patient has no identified sequelae at 6-month follow-up and continues on long-term fluconazole therapy for candida endocarditis. CONCLUSIONS Candidemia, particularly Candida albicans species, may not be a contraindication for extracorporeal membrane oxygenation support. With antifungal therapy and adequate inotropic use to counter the effects of septicemia, survival can be maintained until the patient adequately recovers, allowing decannulation, removal of all catheters, and eventual bloodstream sterility.
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Affiliation(s)
- Mary S Minette
- Division of Pediatric Cardiology, Department of Pediatrics, Oregon Health Sciences University, Portland, OR, USA
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Abstract
OBJECTIVES To determine the frequency of bloodstream fungal infections in children who were admitted to our tertiary institution over an 11-year period. METHODS We conducted a retrospective cohort study of patients who were aged 0 to 21 years, had bloodstream fungal infections, and were admitted to the University of California, Los Angeles from 1991 through 2001. Patients were identified through the microbiology laboratory database. All positive fungal cultures for pediatric inpatients were reviewed. For each fungemic patient, a review of clinical course, cause, and outcome was performed. RESULTS Over 11 years, 1124 pediatric inpatients with 3633 positive cultures had evidence of fungal colonization or infection. The mean incidence of positive fungal cultures increased from 105 between 1991 and 1996 to 129 patients per year between 1997 and 2001. Fungal isolates were mainly Candida species (85%) obtained primarily from respiratory (41%) and urine (27%) cultures. Only 7.5% of positive fungal cultures were from blood, although 24490 pediatric admissions prompted 72960 bacterial and fungal blood cultures, at charges of 2.52 million dollars. Of 14592 fungal blood cultures, <2% (n = 272) were positive, involving <1% (n = 97) of patients. The mean rise in number of children with fungemia was significant, from 6.8 between 1991 and 1996 to 13.0 patients per year between 1997 and 2001. Fungemia was associated with a high all-cause mortality rate (46%), particularly in immunocompromised patients (57%). Organisms recovered were primarily Candida species (91%). There was a decline in C albicans and C glabrata fungemia and an increase in C parapsilosis organisms. In 84% of patients, fungal organisms were isolated from both bacterial and fungal blood cultures, and in 74%, the same organism was isolated from additional body sites. CONCLUSIONS Episodes of fungemia increased significantly over 11 years as compared with a moderate increase in positive fungal cultures and were associated with high all-cause mortality rates. More sensitive assays for early identification of fungal bloodstream infections are warranted.
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Abstract
A total of 211 episodes of bloodstream yeast infections in 207 patients, hospitalized in 28 Belgian hospitals participating in a National Surveillance Program, were evaluated. A total of 81% of the patients were more than 50 years of age. Candida albicans was the cause of infections in 55% of patients, 22% were due to C. glabrata and 13% to C. parapsilosis. The most common predisposing factors were antibacterial therapy (42%), residence in an intensive care unit (32.9%) and presence of an intravascular catheter (29.7%). Most patients had more than one predisposing factor. Fluconazole alone or in association with another antifungal agent was the treatment of choice for 89.7% of the cases. In vitro susceptibility testing of the isolates revealed that 99% were susceptible to amphotericin B, 95% to 5-fluorocytosine, 82% to fluconazole and 69% to itraconazole. Resistance to azoles was more common among C. glabrata isolates in the elderly. We conclude that the frequency of C. albicans infection is decreasing in Belgium and this is associated with the emergence of other species, most notably, C. glabrata.
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Affiliation(s)
- D Swinne
- Mycology Section, Scientific Institute of Public Health, Brussels, Belgium.
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Abstract
HISTORY AND CLINICAL FINDINGS A 48-year-old diabetic with multiple co-morbidities presented with generalized micro- and macroangiopathy including peripheral artery disease stage IV with necroses in several digits of both feet. He was admitted to the department of surgery for the insertion of femoropopliteal bypasses. INVESTIGATIONS Infectious parameters were elevated (CRP 66.1 mg/l, sedimentation rate 90/96), accompanied by anemia (Hb 7.1 mmol/l), leukocytosis (14.8 Gpt/l) and thrombocytosis (514 Gpt/l). Body temperature was normal (36.8 degrees C). With insulin treatment the patient became nearly normoglycemic (HbA1c 6.8 %). TREATMENT AND FOLLOW UP After receiving different broad-spectrum antibiotics over seven weeks the patient developed Clostridium difficile toxin-positive diarrhea that resolved after administration of oral metronidazole and Saccharomyces boulardii (Perenterol ((R))). Three days after bypass insertion, both legs had to be amputated due to infection and beginning sepsis. The condition of the patient improved. However, eight days after bypass-insertion the patient developed a toxic megacolon and sepsis. Blood cultures yielded the growth of Saccharomyces cerevisae. Despite of intensive care treatment the patient died five days later from to multi-organ failure. CONCLUSION S. boulardii (synonym: S. cerevisiae) is considered an non-pathogenic probiotic yeast, and live yeast cells are used for supportive therapy of diarrhea. The present case and a review of the literature demonstrate that fungemia and sepsis are rare complications of the administration of S. boulardii in immunocompromised patients. For this reason the therapeutic usage of probiotics should be carefully considered regarding its risk-benefit potential.
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Affiliation(s)
- F Lestin
- Institut für Medizinische Mikrobiologie, Virologie und Hygiene, Abteilung Medizinische Mikrobiologie und Krankenhaushygiene, Universität Rostock.
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Safdar A, Hanna HA, Boktour M, Kontoyiannis DP, Hachem R, Lichtiger B, Freireich EJ, Raad II. Impact of high-dose granulocyte transfusions in patients with cancer with candidemia. Cancer 2004; 101:2859-65. [PMID: 15529309 DOI: 10.1002/cncr.20710] [Citation(s) in RCA: 90] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND The efficacy and feasibility of donor granulocyte transfusion therapy (GTX) have changed considerably over the past four decades. The authors sought to determine the impact of high-dose (approximately 5.5 x 10(10) cells) GTX in patients with candidemia. METHODS The authors' case-control retrospective analysis comprised 491 consecutive patients treated at The University of Texas M. D. Anderson Cancer Center (Houston,TX) from 1993 to 2000. The cohort included 29 patients with Candida species bloodstream infection who had received GTX and 462 who had not. RESULTS Both groups were comparable in age, gender, APACHE II score, recent chemotherapy received, broad-spectrum antibiotics, systemic corticosteroids, radiotherapy, intravascular catheter, and concordant antifungal therapy (P > or = 0.1). The patients who received GTX compared with those who did not had a higher incidence of underlying leukemia (86% vs. 29%, P <0.001), persistent neutropenia (59% vs. 18%, P <0.001), non-Candida albicans candidemia (Candida glabrata, 35%; Candida krusei, 31%: 90% vs. 67%, P=0.01), and breakthrough invasive mycosis (62% vs. 23%, P <0.001). Neutropenia was more prolonged in patients who received GTX (28 vs. 10 days, P <0.001). Also, more of the patients who received GTX had received hematopoietic stem cell transplantations (28% vs. 13%, P = 0.03), exposure (within 4 weeks) to antifungals (79% vs. 38%, P <0.001), and stays in critical care units (62% vs. 40%, P=0.02). The overall attributable mortality rate for 25 evaluable recipients of GTX was 48% (n=12), compared with 45% (n=115) of 254 evaluable patients in the control group (P=0.5). Of the 158 patients with leukemia, 25 (16%) had received GTX. In patients with leukemia, more of those who had received GTX experienced disseminated candidiasis (44% vs. 26%; P <0.07) and persistent neutropenia (68% vs. 43%, P <0.02), had candidemia that was more prolonged (> 72 hours, P <0.02), and had more stays in critical care units (68% vs. 44%, P <0.03). On the bases of a reduced multivariate model, a significantly increased risk of death was found for patients with hematopoietic stem cell transplantation (odds ratio [OR]=2.51; 95% confidence interval [95% CI], 0.99-6.31; P <0.05), for patients with persistent neutropenia (OR=4.57; 95% CI, 1.99-10.47; P <0.0003), and for patients with leukemia who also had prolonged candidemia (OR=3.59; 95% CI, 1.61-7.98; P <0.002), disseminated candidiasis (OR=5.19; 95% CI, 2.17-12.42; P <0.0002), or non-C. albicans candidemia (OR=5.02; 95% CI, 1.07-23.64; P <0.04). In patients with leukemia, death was attributable to candidemia in 50% of the GTX recipients, compared with 59% of the non-GTX patients who had received antifungal therapy alone (P=0.4). CONCLUSIONS Despite the presence of multiple predictors of increased mortality, high-dose GTX therapy in these high-risk patients with cancer was associated with better than expected survival rates.
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Affiliation(s)
- Amar Safdar
- Department of Infectious Diseases, Infection Control, and Employee Health, The University of Texas M. D. Anderson Cancer Center, Houston, Texas 77030, USA.
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21
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Wasim Yusuf N, Assaf HM, Rotowa NA. Invasive gastrointestinal Basidiobolus ranarum infection in an immunocompetent child. Pediatr Infect Dis J 2003; 22:281-2. [PMID: 12664879] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/01/2023]
Affiliation(s)
- Noshin Wasim Yusuf
- Department of Pathology and Laboratory Medicine, Security Forces Hospital, Riyadh, Saudi Arabia.
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22
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Affiliation(s)
- Ramin Monshizadeh
- Vitreoretinal Service, Inland Eye Institute, 1990 E Washington St, Colton, CA 92324, USA.
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23
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Feman SS, Nichols JC, Chung SM, Theobald TA. Endophthalmitis in patients with disseminated fungal disease. Trans Am Ophthalmol Soc 2002; 100:67-70; discussion 70-1. [PMID: 12545679 PMCID: PMC1358948] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/28/2023]
Abstract
BACKGROUND/PURPOSE Fungal endophthalmitis caused by dissemination from extraocular fungal infections has been reported to vary between 9% and 45%. However, recent clinical experience disagrees with that. This study is an investigation of patients in an inner city teaching hospital, the risks associated with endogenous fungal endophthalmitis, and this incidence. METHODS All ophthalmology consultations between February 1995 and August 2000 that might be associated with disseminated fungal infection were examined in a prospective manner. Patients were excluded if there was no evidence of a positive fungal culture from any site at any time. Visual symptoms were recorded along with ophthalmologic and systemic examination features. Information was gathered, including the identity of cultured organisms, the sites from which the organisms were obtained, and the patients' disposition. RESULTS During this interval, 170 consultation requests contained the words "endophthalmitis" or "retinitis" and/or indicated concern about disseminated fungal infections. Extraocular fungal infections were found in 114 patients, but only 82 of them had evidence of systemic dissemination. Some patients had more than one organism. The following are listed in decreasing frequency of occurrence: Candida albicans, Torulopsis glabrata, Candida tropicalis, Candida parapsilosis, Candida krusei, Aspergillus niger, and others. Only two patients had evidence of chorioretinitis and progressed to fungal endophthalmitis. CONCLUSIONS Endophthalmitis was rare among these patients with known fungal infections. Less than 2% had any related ophthalmic manifestations. Nevertheless, since treatment can save vision, evidence of intraocular infection should be sought as eagerly as before.
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Affiliation(s)
- Stephen S Feman
- Department of Ophthalmology, Saint Louis University Health Sciences Center, St Louis, Missouri, USA
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24
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Sung JM, Ko WC, Huang JJ. Candidaemia in patients with dialysis-dependent acute renal failure: aetiology, predisposing and prognostic factors. Nephrol Dial Transplant 2001; 16:2348-56. [PMID: 11733626 DOI: 10.1093/ndt/16.12.2348] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Infections remain the major cause of death among patients with acute renal failure (ARF), especially in severe ARF necessitating dialysis therapy (ARF(d)). Although the clinical features and outcomes of candidaemia in various patient populations have been described, data concerning candidaemic episodes among patients with ARF(d) are scarce. This study investigated the aetiology, predisposing, and prognostic factors for candidaemia in the ARF(d) patient population. Three patient groups were investigated in this study. METHODS During an 8-year study period from January 1992 to December 1999, 37 candidaemic episodes that developed among 653 ARF(d) patients were assigned to ARF(d) candidaemic group, and 170 candidaemic episodes developing in patients without ARF(d) or chronic uraemia as the non-ARF(d) candidaemic group, and 28 matched ARF(d) patients without candidaemia were assigned to the ARF(d) control group. Among these groups, clinical characteristics in ARF(d) candidaemia patients, predisposing factors, and outcomes were compared. Four management strategies including central catheter removal, anti-fungal therapy, both, or neither were applied. The prognostic factors for attributable death were evaluated by univariate analysis followed by the multivariate logistic regression analysis. RESULTS The proportion of ARF(d) patients with candidaemia was significantly higher than in patients who had no ARF(d) or chronic uraemia (5.7% vs 0.15%, P<0.001). Compared with the non-ARF(d) candidaemic group, systemic lupus erythematosus (SLE), administration of corticosteroid, and central venous catheter-associated candidaemia were more common in the ARF(d) candidaemic group (P<0.05). In matched case-control study, multiple antibiotic usage was shown to be a predisposing factor for developing candidaemia in patients with ARF(d), and corticosteroid therapy has a marginal significance (P=0.059). The occurrence of candidaemia increased the mortality rate of ARF(d) (71% vs 39.2% in ARF(d) control group, P<0.05). By multivariate logistic analysis, the variables associated with attributable death in ARF(d) candidaemic group were identified to be an APACHE II score of >or=18, and anti-fungal therapy for >48 h. Central venous catheters were removed in 32 (86.5%) of the 37 ARF(d) candidaemic patients, among whom the 18 patients who had received anti-fungal therapy for >48 h had a lower attributable death rate than those patients who had not (27.8% vs 64.3%, P<0.05). Of the remaining five patients who did not have their catheter removed, three patients subsequently died and two patients improved only after catheter removal. CONCLUSIONS The higher prevalence of candidaemia in ARF(d) patients is due to their underlying illnesses and multiplicity of predisposing factors, rather than ARF and dialysis therapy per se. Predisposing factors include SLE, indwelling central venous catheter, multiple antibiotic usage, and corticosteroid therapy. Prompt anti-fungal therapy and catheter removal should be mandatory for ARF(d) patients with candidaemia.
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Affiliation(s)
- J M Sung
- Department of Internal Medicine, National Cheng Kung University Hospital, Tainan, Taiwan, ROC
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25
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Affiliation(s)
- T P Nissen
- Department of Orthopedic Surgery, University of California-San Francisco, 94143-0728, USA
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26
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Houghton D. A fungus among us: disseminated Aspergillosis. J Trauma Nurs 2001; 8:23-6. [PMID: 16422382] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/06/2023]
Affiliation(s)
- D Houghton
- Trauma Intensive Care Unit, Ryder Trauma Center, University of Miami/Jackson Health System, Miami, FL, USA
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27
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Krupova Y, Sejnova D, Dzatkova J, Kaiserova E, Kiskova M, Babela R, Mateicka F, Sabo A, Pichnova E, Jurga L, Sulcova M, Krcmery V. Prospective study on fungemia in children with cancer: analysis of 35 cases and comparison with 130 fungemias in adults. Support Care Cancer 2000; 8:427-30. [PMID: 10975694 DOI: 10.1007/s005200050013] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
The aim of this prospective study on fungemia in children with cancer compared with adults with cancer appearing during the last 10 years in a pediatric hospital and in national cancer institutions was to investigate risk factors, etiology, therapy, complications and outcome. Univariate analysis showed significant differences in 35 children with cancer and fungemia in comparison with 130 cases of fungemias in adults with cancer. It was found that (1) therapy with corticosteroids (40 vs 18.5%, P<0.03), (2) breakthrough fungemia during ketoconazole prophylaxis (20 vs 7.7%, P<0.025), and (3) meningitis as a complication of fungemia (11.4 vs 0.8%, P< 0.001) occurred more frequently in the pediatric subgroup with fungemia. Candida albicans was more common as the causative agent of fungemia among adults (58.5 vs 37.1, P<0.02) than in children. However, mortality was similar in children with cancer and in adults with cancer and fungemia (31.4 vs 23.1%, NS). Comparison of risk factors revealed no differences between adults and children with cancer and fungemia except in etiology, breakthrough fungemia during prophylaxis with ketoconazole, prior therapy with corticosteroids and meningitis as a complication. The outcome was also similar in pediatric and adult cancer patients with fungal bloodstream infection.
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Affiliation(s)
- Y Krupova
- St. Elizabeth and National Cancer Institute, Bratislava, Slovak Republic
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28
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Black CA, Eyers FM, Russell A, Dunkley ML, Clancy RL, Beagley KW. Increased severity of Candida vaginitis in BALB/c nu/nu mice versus the parent strain is not abrogated by adoptive transfer of T cell enriched lymphocytes. J Reprod Immunol 1999; 45:1-18. [PMID: 10660259 DOI: 10.1016/s0165-0378(99)00017-0] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
The role of the host immune system in combating candidal infections in the vagina is poorly understood. A murine model of Candida vaginitis was used to elucidate the role of T cells in a candidal infection. Athymic BALB/c nu/nu mice or normal BALB/c mice were induced into estrus and then infected with 1 x 10(6) Candida albicans intravaginally. The infection was monitored over 1 week. Samples from blood, small intestine, tongue, kidney, spleen, liver, uterus and vagina were tested for recoverable C. albicans. Histology of the vagina was assessed for both inflammation and extent of infection. Results indicated that the BALB/c nu/nu mice had similar levels of vaginal yeast load to the normal BALB/c mice. In 25-30% of nude mice Candida was also recovered from extra vaginal sites (kidney, liver, small intestine), however, extra vaginal dissemination was not observed in any normal BALB/c animals. Histologically, both the nu/nu and control BALB/c had similar levels of vaginal inflammation; however, the nu/nu mice had more florid fungal growth in the vaginal epithelium. Adoptive transfer of either immune or non-immune BALB/c T cells into nude mice had no affect on either infection or vaginal inflammation. Immunohistochemical staining of vaginal tissues from normal BALB/c mice or nude mice adoptively transferred with either immune or non-immune T cells with anti-CD3 monoclonal antibody revealed no significant difference between groups in the numbers of CD3+ vaginal T cells. However, in mice receiving either immune or non-immune T cells no yeast was recovered from any tissues except the vagina. These data show that T cells have a limited role in protecting the vagina from C. albicans infection.
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MESH Headings
- Animals
- Candida albicans/isolation & purification
- Candidiasis, Vulvovaginal/etiology
- Candidiasis, Vulvovaginal/immunology
- Candidiasis, Vulvovaginal/microbiology
- Candidiasis, Vulvovaginal/pathology
- Candidiasis, Vulvovaginal/prevention & control
- Disease Models, Animal
- Epithelial Cells/immunology
- Epithelial Cells/microbiology
- Estradiol/pharmacology
- Estrus
- Female
- Fungemia/etiology
- Fungemia/immunology
- Fungemia/therapy
- Genetic Predisposition to Disease
- Immunity, Cellular
- Immunologic Deficiency Syndromes/complications
- Immunologic Deficiency Syndromes/therapy
- Immunotherapy, Adoptive
- Interleukin-3/metabolism
- Mice
- Mice, Inbred BALB C
- Mice, Nude/immunology
- Severity of Illness Index
- T-Lymphocytes/immunology
- T-Lymphocytes/metabolism
- T-Lymphocytes/transplantation
- Vagina/immunology
- Vagina/microbiology
- Vagina/pathology
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Affiliation(s)
- C A Black
- Department of Obstetrics, Gynaecology and Reproductive Sciences, Magee-Womens Research Institute, Pittsburgh, PA 15213, USA
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29
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Krcmery V, Spanik S, Kunova A, Trupl J, Grausova S, Krupova I, Mateicka F, Pichnova E, Grey E, Sabo A. Nosocomial Candida krusei fungemia in cancer patients: report of 10 cases and review. J Chemother 1999; 11:131-6. [PMID: 10326744 DOI: 10.1179/joc.1999.11.2.131] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
The risk factors, therapy and outcome of ten cases of fungemia due to Candida krusei, appearing during the last 10 years in a single national cancer institution, are analyzed. Univariate analyses did not find any specific risk factors in comparison to 51 Candida albicans fungemias appearing at the same institution and with a similar antibiotic policy. Association with prior fluconazole prophylaxis was not confirmed because only one case appeared in a patient previously treated with fluconazole. However, attributable and crude mortality due to C. krusei fungemias was higher than for C. albicans fungemia. The authors review 172 C. krusei fungemias published within the last 10 years to compare with the incidence, therapy and outcome of C. krusei fungemia from our cancer institute.
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Affiliation(s)
- V Krcmery
- National and St. Elizabeth Cancer Institutes, Bratislava, Slovak Republic.
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30
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Elishoov H, Or R, Strauss N, Engelhard D. Nosocomial colonization, septicemia, and Hickman/Broviac catheter-related infections in bone marrow transplant recipients. A 5-year prospective study. Medicine (Baltimore) 1998; 77:83-101. [PMID: 9556701 DOI: 10.1097/00005792-199803000-00002] [Citation(s) in RCA: 75] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
In this 5-year prospective study of 242 bone marrow transplantation (BMT) recipients from whom daily blood cultures via the indwelling Broviac/Hickman catheter were obtained, there was a median of 35 catheter-days during hospitalization, mean of 40 days, and total of 9,667 catheter-days which were divided almost equally between neutropenic (4,771) and non-neutropenic (4,896) days. One hundred twenty (50%) patients had a total of 161 episodes of nosocomial bacterial or candidal infections. Overall, 81 (33%) patients experienced 100 episodes of catheter-related infections and 90 (37%) patients experienced 112 episodes of septicemia, including 51 episodes of catheter-related septicemia. There was an incidence of 11.59 septicemia episodes, including 5.28 catheter-related septicemia episodes, 2.48 colonization only (without subsequent septicemia), and 2.59 exit site infections only, per 1,000 catheter-days. Over a period of a total of 6,593 afebrile days, 34 (14%) patients developed 40 episodes of colonization, a rate of 6.07 per 1,000 afebrile days, of which 16 developed into septicemia. Twenty-five patients had 1 episode each of exit site infection without bacteremia. There were 10 (4%) septicemia-related deaths, 4 of which were catheter-related; 50% of all deaths involved Pseudomonas aeruginosa. The mortality due to catheter-related septicemic episodes was not greater than that of the non-catheter-related episodes. Neutropenia was found to be a significant risk factor in our study: 76% of the septicemia episodes (85/112) and 65% of the catheter-related infectious episodes (65/100) occurred during neutropenia. There was a higher incidence of septicemic episodes during neutropenia than during non-neutropenic periods, 17.82 versus 5.51 per 1,000 days (p < 0.0001), and a higher rate of catheter-related infections during the neutropenic period, 13.62 versus 7.15 during non-neutropenic days per 1,000 days (0.001). Fourteen of 16 colonization episodes developed into septicemia during neutropenia versus 2/24 during non-neutropenic periods, a rate of 5.47 versus 0.47 per 1,000 afebrile days, respectively (p < 0.0001), and 9/10 deaths occurred during neutropenia.
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Affiliation(s)
- H Elishoov
- Department of Pediatrics, Hadassah University Hospital, Jerusalem, Israel
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31
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Inoue Y, Yozu R, Ueda T, Kawada S. A case report of Candida parapsilosis endocarditis. J Heart Valve Dis 1998; 7:240-2. [PMID: 9587869] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
A 57-year-old male was treated for fungal endocarditis caused by Candida parapsilosis which precipitated severe cardiac valve vegetation and insufficiency. His condition resulted from a three-month installation of a central venous catheter for hyperalimentation and chemotherapy following total gastrectomy for gastric cancer. Aortic valve replacement combined with fluconazole administration resulted in satisfactory recovery with no adverse events during an 18-month follow up period.
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Affiliation(s)
- Y Inoue
- Department of Surgery, Keio University School of Medicine, Tokyo, Japan
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32
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Catanzarite VA, Willms DC, Holdy KE, Gardner SE, Ludwig DM, Cousins LM. Brain death during pregnancy: tocolytic therapy and aggressive maternal support on behalf of the fetus. Am J Perinatol 1997; 14:431-4. [PMID: 9263566 DOI: 10.1055/s-2007-994175] [Citation(s) in RCA: 23] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
We report a case of maternal brain death at 25 weeks gestation in which aggressive maternal hemodynamic, respiratory, and metabolic support and tocolytic drug therapy resulted in prolongation of pregnancy for 25 days. The indication for delivery was torulopsis giabrata amnionitis, which may have occurred due to transmembrane or transplacental route. The baby was treated for fungal sepsis, and did well. Premature labor may occur spontaneously after maternal brain death, and may be precipitated by infection or by maternal drug therapy. The myriad of hemodynamic and endocrine issues associated with maternal brain death complicate the choice of tocolytic drugs, but this case illustrates that uterine activity can be successfully blocked, potentially diminishing risks to the newborn, following the tragedy of maternal brain death during pregnancy.
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MESH Headings
- Adult
- Amphotericin B/therapeutic use
- Brain Death
- Candidiasis/diagnosis
- Candidiasis/therapy
- Cerebral Hemorrhage/diagnosis
- Cerebral Hemorrhage/therapy
- Disease-Free Survival
- Fatal Outcome
- Female
- Fungemia/diagnosis
- Fungemia/therapy
- Humans
- Infant, Newborn
- Infant, Newborn, Diseases/diagnosis
- Infant, Newborn, Diseases/therapy
- Male
- Obstetric Labor, Premature/etiology
- Obstetric Labor, Premature/prevention & control
- Pneumonia/diagnosis
- Pneumonia/therapy
- Pregnancy
- Pregnancy Complications, Cardiovascular/diagnosis
- Pregnancy Complications, Cardiovascular/therapy
- Pregnancy Outcome
- Pregnancy Trimester, Second
- Tocolysis/methods
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Affiliation(s)
- V A Catanzarite
- Maternal-Fetal Medicine, Sharp Memorial Hospital, San Diego, California, USA
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33
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Di Mario A, Sica S, Salutari P, Ortu La Barbera E, Marra R, Leone G. Granulocyte colony-stimulating factor-primed leukocyte transfusions in candida tropicalis fungemia in neutropenic patients. Haematologica 1997; 82:362-3. [PMID: 9234594] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
Optimal management of fungemia in neutropenic patients is still controversial. Several reports have already stressed the poor prognosis in invasive candidiasis (80% mortality in several reports). Therefore granulocyte transfusions would appear to be useful in the management of these infections. We report the use of rhG-CSF-primed granulocyte transfusions plus amphotericin B in two neutropenic patients who developed life-threatening systemic fungal infections. This approach was successful and both patients fully recovered from the infection.
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Affiliation(s)
- A Di Mario
- Hematology Chair, Università Cattolica S. Cuore, Rome, Italy
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Weinstein MP, Towns ML, Quartey SM, Mirrett S, Reimer LG, Parmigiani G, Reller LB. The clinical significance of positive blood cultures in the 1990s: a prospective comprehensive evaluation of the microbiology, epidemiology, and outcome of bacteremia and fungemia in adults. Clin Infect Dis 1997; 24:584-602. [PMID: 9145732 DOI: 10.1093/clind/24.4.584] [Citation(s) in RCA: 780] [Impact Index Per Article: 28.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
To assess changes since the mid-1970s, we reviewed 843 episodes of positive blood cultures in 707 patients with septicemia. The five most common pathogens were Staphylococcus aureus, Escherichia coli, coagulase-negative staphylococci (CNS), Klebsiella pneumoniae, and Enterococcus species. Although CNS were isolated most often, only 12.4% were clinically significant. Half of all episodes were nosocomial, and a quarter had no recognized source. Leading identifiable sources included intravenous catheters, the respiratory and genitourinary tracts, and intraabdominal foci. Septicemia-associated mortality was 17.5%. Patients who received appropriate antimicrobial therapy throughout the course of infection had the lowest mortality (13.3%). Multivariate analysis showed that age (relative risk [RR], 1.80), microorganism (RR, 2.27), source of infection (RR, 2.86), predisposing factors (RR, 1.98), blood pressure (RR, 2.29), body temperature (RR, 2.04), and therapy (RR, 2.72) independently influenced outcome. Bloodstream infections in the 1990s are notable for the increased importance of CNS as both contaminants and pathogens, the proportionate increase in fungi and decrease in anaerobes as pathogens, the emergence of Mycobacterium avium complex as an important cause of bacteremia in patients with advanced human immunodeficiency virus infection, and the reduction in mortality associated with infection.
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Affiliation(s)
- M P Weinstein
- Department of Medicine, University of Medicine and Dentistry of New Jersey-Robert Wood Johnson Medical School, New Brunswick 08903-0019, USA
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35
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Abstract
To diminish the risk of serious complications from catheter-related bacteremias or fungemias, an optimized diagnosis and antimicrobial therapy is essential and early catheter removal should be considered. Prompt removal of the catheter and targeted antimicrobial treatment remains a common approach for febrile episodes in patients on total parenteral nutrition. However, novel tools allow diagnosis of catheter-related infections with the catheter in situ. Moreover, many of the established catheter-related infections caused by coagulase-negative staphylococci can successfully be treated with the catheter still in place. The use of these advanced management options depends widely on the resource of the microbiology laboratory as well as the type of catheter and severity of the patient's disease.
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Affiliation(s)
- A F Widmer
- Division of Clinical Epidemiology, University of Basel Hospitals, Switzerland
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36
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Abstract
Arteriovenous fistula infection is an exceedingly rare manifestation of Candida infection, with only one case previously reported in the English literature. This report describes three cases of Candida arteriovenous fistula infection seen in a prospective study and reviews the previously reported case. All cases involved the polytetrafluoroethylene graft. The presentations can be either acute or subacute in onset, with drainage at the fistula site as the most common sign. The diagnosis of Candida arteriovenous fistula infection relies on the isolation of the organism from an intraoperative culture of the fistula. Candida was isolated from blood in three of four cases, and wound drainage in two of three cases. Antifungal therapy should be given, but complete removal of the arteriovenous fistula may be necessary for long-term cure.
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Affiliation(s)
- M H Nguyen
- Department of Medicine, University of Pittsburgh School of Medicine, PA 15213, USA
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37
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Abstract
A case of disseminated cryptococcosis in an HIV-negative patient presenting with cutaneous lesions is described for the first time in Egypt. The patient, a 16-year-old male, presented with cough, expectoration, loss of weight, and cutaneous lesions, mainly on the face and trunk. The lesions consisted of vegetating crusted plaques discharging purulent to sanguinous fluid and flattened, shiny, erythematous to brownish plaques. Anorexia, headache and personality changes soon followed. Histopathological examination of lesions was highly suggestive of a deep mycosis, particularly cryptococcosis. The fulminant disease advanced with central nervous system involvement. The progression was not arrested when systemic antifungal therapy was administered late in the disease course. Pathological examination of lungs, liver, pancreas and spleen revealed disseminated infection with no evidence of other underlying pathology. Disseminated cryptococcosis is a morbid infection, rare in an area where heightened awareness and raised index of suspicion will surely allow earlier diagnosis, management and better prognosis.
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Affiliation(s)
- W Z Mostafa
- Department of Dermatology, Cairo University, Egypt
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38
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Abstract
A 16-day-old premature male infant developed rapidly expanding necrotic facial plaques. Histology and cultures of tissue biopsy specimens revealed infection with Rhizopus arrhizius. The patient was treated aggressively with surgical debridement, amphotericin B, and rifampin, but had a progressive spread of the cutaneous infection and a fatal clinical course. He had gastrointestinal and pulmonary involvement on autopsy. Zygomycoses are rapidly progressive infections which generally affect immunocompromised hosts. Premature infants should be included as individuals at risk for disseminated zygomycotic disease.
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MESH Headings
- Anti-Bacterial Agents/therapeutic use
- Debridement
- Dermatomycoses/diagnosis
- Dermatomycoses/physiopathology
- Dermatomycoses/therapy
- Fatal Outcome
- Fungemia/diagnosis
- Fungemia/physiopathology
- Fungemia/therapy
- Humans
- Infant, Newborn
- Infant, Premature
- Infant, Premature, Diseases/diagnosis
- Infant, Premature, Diseases/microbiology
- Infant, Premature, Diseases/physiopathology
- Infant, Premature, Diseases/therapy
- Male
- Mucormycosis/diagnosis
- Mucormycosis/physiopathology
- Mucormycosis/therapy
- Rhizopus/isolation & purification
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Affiliation(s)
- N M Craig
- Department of Dermatology, Northwestern University Medical School, Chicago, Illinois
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39
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Grauer ME, Bokemeyer C, Bautsch W, Freund M, Link H. Successful treatment of a Trichosporon beigelii septicemia in a granulocytopenic patient with amphotericin B and granulocyte colony-stimulating factor. Infection 1994; 22:283-6. [PMID: 7528173 DOI: 10.1007/bf01739918] [Citation(s) in RCA: 28] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Invasive fungal infections have become an increasing problem in severely immunocompromised hosts. We here report a case of septicemia, caused by Trichosporon beigelii, an unusual pathogen of systemic infections. This infection was acquired during a period of severe neutropenia after chemotherapy for relapsed acute myelogenous leukemia following allogeneic bone marrow transplantation. The patient recovered from a life-threatening T. beigelii septicemia due to early intensified treatment with amphotericin B and a rapid neutrophil recovery, enhanced by granulocyte colony-stimulating factor (G-CSF). According to the current literature, amphotericin B is the treatment of choice for systemic T. beigelii infections. In patients with severe granulocytopenia, the rapid recovery of neutrophils remains the most important factor for the outcome of this infection.
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Affiliation(s)
- M E Grauer
- Abteilung Hämatologie und Onkologie, Medizinische Hochschule, Hannover, Germany
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40
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Lechner AJ, Lamprech KE, Potthoff LH, Tredway TL, Matuschak GM. Recombinant GM-CSF reduces lung injury and mortality during neutropenic Candida sepsis. Am J Physiol 1994; 266:L561-8. [PMID: 8203549 DOI: 10.1152/ajplung.1994.266.5.l561] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
Cyclophosphamide (CY)-induced neutropenia exacerbates septic shock and acute lung injury during Candida albicans (CA) fungemia in conscious rats. We hypothesized that treatment of such animals with recombinant murine granulocyte-macrophage colony-stimulating factor (GM-CSF) improves host defense during disseminated candidiasis by increasing peripheral neutrophils (PMNs) and enhancing endogenous production of antifungal cytokines including tumor necrosis factor-alpha (TNF). Naive (neutrophil-replete) or neutropenic rats were infected with 10(7) yeast-phase CA; subgroups received GM-CSF (25 micrograms/kg sc) or sterile 0.9% NaCl (NS) twice a day beginning 3 days before CA infection. Arterial hemodynamics, formed blood elements, bioactive TNF in serum and bronchoalveolar lavage fluid (BALF), and lung histopathology were monitored for up to 72 h after infection. All naive animals receiving GM-CSF (n = 5) and 78% of naive rats given NS (n = 9) remained normotensive through 72 h with no lung injury, differing principally in baseline PMNs before CA infection (8.8 +/- 1.8 x 10(3)/microliters, mean +/- SE, vs. 3.7 +/- 0.4 x 10(3)/microliters, respectively, P < 0.01). Neutropenic rats given NS (baseline PMN = 41 +/- 10/microliters, n = 7) were sensitized to CA, and 100% died of hypothermic shock with severe respiratory distress within 56 h of infection. Pulmonary periarterial and alveolar hemorrhage were prominent. Although GM-CSF did not increase baseline PMNs in CY animals by the outset of infection (162 +/- 58/microliters, n = 8), 62% of these rats remained normotensive and eupneic through 72 h (P < 0.01), and their lungs showed no perivascular hemorrhage, alveolar disruption, or fungi.(ABSTRACT TRUNCATED AT 250 WORDS)
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Affiliation(s)
- A J Lechner
- Department of Pharmacological and Physiological Science, Saint Louis University School of Medicine, Missouri
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41
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Abstract
The risk of infective endocarditis following pulmonary artery catheterisation in patients with sepsis remains unquantified. Although catheter-induced endocardial and valvular injury are well recognised, valve infection is rare. A case of mixed pulmonary valve endocarditis associated with the use of a pulmonary artery catheter (PAC) in a patient with multisystem failure following liver trauma is described. This illustrates that diagnosis of infective endocarditis in critically ill patients can be difficult because concurrent illness and therapy may mimic or mask the usual presenting signs. The value of transoesophageal echocardiography in this context is emphasised.
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Affiliation(s)
- P F Soding
- Department of Anaesthesia, Addenbrooke's Hospital, Cambridge, UK
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42
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Slotman GJ, Shapiro E, Moffa SM. Fungal sepsis: multisite colonization versus fungemia. Am Surg 1994; 60:107-13. [PMID: 8304640] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
The indications for therapy and the best treatment regimens for systemic fungal infections are not well defined. The purpose of this study was to evaluate retrospectively patient management and outcome in critically ill patients with multiple sites of fungal colonization and/or fungemia. Medical records of 36 fungemic patients and 76 patients without fungemia who had two or more anatomic sites colonized with fungal organisms were reviewed. There were 53 males and 59 females, with a mean age of 58 years (range 15-86). Eighty-four patients (74%) underwent 238 operations (41% elective, 59% emergent). Gastrointestinal (37%), thoracic (15%), and orthopedic (13%) procedures were most common. Concomitant, nonfungal bacteremia was present in 56 patients (50%). Seventy-one patients (63%) received systemic antifungal therapy. Mortality differences between patients with fungemia (17/36; 47%) and fungus-colonized patients (31/76; 41%) were not statistically significant. Amphotericin B treatment of fungemia reduced mortality overall (26% vs 71%, P < 0.05) and compared with fungemic patients receiving other antifungals (26% vs 50%, P < 0.05). Among fungus-colonized patients, mortality was higher with amphotericin B than without (70% vs 36%, P < 0.05) and was not changed by treatment with other antifungals (37% vs 34%). Increased gastrointestinal operations, wound infections, and intraperitoneal fungi and bacteria in fungus-colonized patients receiving amphotericin B suggest that these patients were the most critically ill. The mortality of multisite fungal colonization is as high as that of fungemia. Only amphotericin B improves survival in fungemia. The best treatment for multisite colonization is not clear from the data.
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Affiliation(s)
- G J Slotman
- Department of Surgery, Cooper Hospital/University Medical Center, University of Medicine and Dentistry of New Jersey, Robert Wood Johnson Medical School at Camden 08103
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43
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Pöyhönen MJ, Takala JA, Pitkänen O, Kari A, Alakuijala LA, Eloranta TO. Differential effects of sepsis and trauma on urinary excretion of polyamines. Nutrition 1993; 9:406-10. [PMID: 8286878] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
Urinary excretion of polyamines increases in patients with trauma and infection. To separate the effect of infection from the general metabolic response to sepsis, we studied 7 patients with sepsis and 13 patients with multiple trauma in the intensive-care unit. Urinary excretion of total and free polyamines, putrescine, spermidine, spermine, and their metabolites N1-acetylspermidine (N1-AcSPD) and N8-acetylspermidine (N8-AcSPD), and energy and nitrogen balance were measured. The patients were randomized to receive either hypocaloric glucose alone or with amino acids for 2 days. The excretion of individual polyamines, except spermine, significantly exceeded normal values in both patient groups; the excretion of total polyamines was 530 and 323% higher than normal in patients with sepsis and trauma, respectively. The excretion of N1-AcSPD and total spermidine was 141 and 74% higher in patients with sepsis than in patients with trauma, respectively (p < 0.05), whereas the excretion of N8-AcSPD was equal in both patient groups. This was also reflected as a significantly increased urinary ratio of N1-AcSPD to N8-AcSPD in septic patients (6.37 +/- 1.61; mean +/- SE) compared with patients after injury (2.69 +/- 0.27, p < 0.01) or a healthy population (1.08 +/- 0.04, p < 0.001). Amino acid infusion had no effect on polyamine excretion. The mean energy balance was -17.0 +/- 1.1 and -19.1 +/- 1.1 kcal.kg-1.day-1, and the mean nitrogen balance was -0.17 +/- 0.03 and -0.15 +/- 0.02 g.kg-1.day-1 in patients with sepsis and trauma, respectively (NS).(ABSTRACT TRUNCATED AT 250 WORDS)
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Affiliation(s)
- M J Pöyhönen
- Critical Care Research Program, Kuopio University Central Hospital, Finland
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44
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Lecciones JA, Lee JW, Navarro EE, Witebsky FG, Marshall D, Steinberg SM, Pizzo PA, Walsh TJ. Vascular catheter-associated fungemia in patients with cancer: analysis of 155 episodes. Clin Infect Dis 1992; 14:875-83. [PMID: 1576282 DOI: 10.1093/clinids/14.4.875] [Citation(s) in RCA: 227] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
We reviewed all 155 episodes of central venous catheter-associated fungemia among inpatients at the National Cancer Institute during a 10-year period. Candida species accounted for 98% of episodes. Fungemia was documented by culture of blood drawn through catheters in 50% of cases and by culture of both catheter-drawn and peripheral blood in 39%; mortality and the rate of dissemination were similar for these two groups. Four management strategies were used: catheter removal, antifungal therapy (with amphotericin B), both, or neither; indications for the use of both modes of treatment included fever, neutropenia, long-term indwelling catheterization, positive cultures of both catheter-drawn and peripheral blood, isolation of Candida tropicalis, and fungal isolation from two or more blood cultures. Disseminated fungal infection was documented in 82% of cases with these features but also in 35% of the less severe cases treated only with catheter removal. In addition, nine (82%) of 11 cases managed only with antifungal therapy had a negative outcome (either death from disseminated infection or the recurrence of fevers and/or fungemia), a finding suggesting that intravascular catheters should be removed in fungemia. Virtually all cases of catheter-associated fungemia in patients with cancer are clinically significant and require prompt therapy with amphotericin B.
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Affiliation(s)
- J A Lecciones
- Infectious Diseases Section, National Cancer Institute, National Institutes of Health, Bethesda, Maryland 20892
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