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Bienvenu AL, Leray V, Guichon C, Bourget S, Chapuis C, Duréault A, Pavese P, Roux S, Kahale E, Chaabane W, Subtil F, Maucort-Boulch D, Talbot F, Dode X, Ghesquières H, Leboucher G. ANTIFON-CLIC®, a new clinical decision support system for the treatment of invasive aspergillosis: is it clinically relevant? Ann Pharm Fr 2024; 82:514-521. [PMID: 38000506 DOI: 10.1016/j.pharma.2023.11.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Revised: 11/17/2023] [Accepted: 11/20/2023] [Indexed: 11/26/2023]
Abstract
BACKGROUND Invasive aspergillosis (IA) is increasing especially in new groups of patients. Despite advances in management, morbidity and mortality related to IA remain high. Thus, Clinical Decision Support System (CDSS) dedicated to IA are needed to promote the optimal antifungal for each group of patients. PATIENTS AND METHODS This was a retrospective multicenter cohort study involving intensive care units and medical units. Adult patients who received caspofungin, isavuconazole, itraconazole, liposomal amphotericin B, posaconazole, or voriconazole, for the treatment of IA were eligible for enrollment. The primary objective was the concordance between the clinician's prescription and the prescription recommended by the CDSS. The secondary objective was the concordance according to different hospitals, departments, and indications. RESULTS Eighty-eight patients (n=88) from three medical hospitals were included. The overall concordance was 97% (85/88) including 100% (41/41) for center A, 92% (23/25) for center B, and 95% (21/22) for center C. There was no significant difference in concordance among the hospitals (P=0.973), the departments (P=1.000), and the indications (P=0.799). The concordance was 70% (7/10) for isavuconazole due to its use as an empirical treatment and 100% (78/78) for the other antifungals. DISCUSSION The concordance rate was high whatever the hospital, the department, and the indication. The only discrepancy was attributed to the use of isavuconazole as an empirical treatment which is a therapeutic option not included in the CDSS. CONCLUSIONS This new CDSS dedicated to IA is meeting the clinical practice. Its implementation in routine will help to support antifungal stewardship.
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Affiliation(s)
- A-L Bienvenu
- Service pharmacie, groupement hospitalier nord, hospices civils de Lyon, Lyon, France; Univ Lyon, Malaria Research Unit, SMITh, ICBMS UMR 5246, Lyon, France.
| | - V Leray
- Service d'anesthésie-réanimation, groupement hospitalier centre, hospices civils de Lyon, Lyon, France
| | - C Guichon
- Service d'anesthésie-réanimation, groupement hospitalier nord, Hospices civils de Lyon, Lyon, France
| | - S Bourget
- Service pharmacie, CH de Valence, Valence, France
| | - C Chapuis
- Service de pharmacie, CHU de Grenoble, Grenoble-Alpes, France
| | - A Duréault
- Service des maladies infectieuses, centre hospitalier de Valence, Valence, France
| | - P Pavese
- Service des maladies infectieuses, CHU de Grenoble, Grenoble-Alpes, France
| | - S Roux
- Service des maladies infectieuses et tropicales, hospices civils de Lyon, Lyon, France
| | - E Kahale
- Direction de l'innovation, hospices civils de Lyon, Lyon, France
| | - W Chaabane
- Direction des services numériques, hospices civils de Lyon, Lyon, France
| | - F Subtil
- Service de biostatistique-bioinformatique, hospices civils de Lyon, Lyon, France
| | - D Maucort-Boulch
- Service de biostatistique-bioinformatique, hospices civils de Lyon, Lyon, France
| | - F Talbot
- Direction des services numériques, hospices civils de Lyon, Lyon, France
| | - X Dode
- Service pharmacie, groupement hospitalier est, hospices civils de Lyon, Lyon, France
| | - H Ghesquières
- Service d'hématologie, groupement hospitalier sud, hospices civils de Lyon, Lyon, France
| | - G Leboucher
- Service pharmacie, groupement hospitalier nord, hospices civils de Lyon, Lyon, France
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Blanchard E, Gabriel F, Jeanne-Leroyer C, Servant V, Dumas PY. [Invasive pulmonary aspergillosis]. Rev Mal Respir 2018; 35:171-187. [PMID: 29478757 DOI: 10.1016/j.rmr.2018.01.002] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2017] [Accepted: 04/11/2017] [Indexed: 12/13/2022]
Abstract
INTRODUCTION Invasive pulmonary aspergillosis (IPA) is an important cause of morbidity and mortality in a wide range of patients. Early recognition and diagnosis have become a major focus in improving the management and outcomes of this life-threatening disease. BACKGROUND IPA typically occurs during a period of severe and prolonged neutropenia. However, solid organ transplant recipients, patients under immunosuppressive therapy or hospitalized in intensive care units are also at risk. The diagnosis is suspected in the presence of a combination of clinical, biological and CT scan evidence. The microbiological diagnostic strategy should be adapted to the patient's profile. Conventional methods with culture and species identification remain the standard but early diagnosis has been improved by the use of biomarkers such as galactomannan antigen in serum or in bronchoalveolar lavage. OUTLOOK The epidemiology of IPA should change with the increased use of antifungal prophylactic regimens and the arrival of targeted therapies. Other microbiological tools, such as PCR and other biomarkers, are currently being assessed. CONCLUSIONS IPA must be considered in a wide range of patients. Its prognosis remains poor despite progress in the microbiological diagnosis and therapeutic management.
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Affiliation(s)
- E Blanchard
- Service des maladies respiratoires, CHU de Bordeaux, 33604 Bordeaux, France.
| | - F Gabriel
- Service de parasitologie et de mycologie, CHU de Bordeaux, 33604 Bordeaux, France
| | - C Jeanne-Leroyer
- Service d'hygiène hospitalière, CHU de Bordeaux, 33604 Bordeaux, France
| | - V Servant
- Service de pharmacie à usage intérieur, groupe hospitalier Sud, CHU de Bordeaux, 33604 Bordeaux, France
| | - P-Y Dumas
- Service d'hématologie clinique et de thérapie cellulaire, CHU de Bordeaux, 33604 Bordeaux, France
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Chekiri-Talbi M, Denning DW. [The burden of fungal infections in Algeria]. J Mycol Med 2017; 27:139-145. [PMID: 28342778 DOI: 10.1016/j.mycmed.2017.02.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2016] [Revised: 02/12/2017] [Accepted: 02/16/2017] [Indexed: 10/19/2022]
Abstract
In Algeria, superficial mycoses are very commonly diagnosed. Deep fungal infections are less often observed. Few data from Algeria are found in the literature. We report for the first time the main causes of these diseases in our country and provide burden estimates. We searched for existing data and estimated the incidence and prevalence of fungal diseases based on the population at risk and available epidemiological data. Demographic data were derived from the Service (Office) of the Statistics (ONES), World Health Organization (WHO), The Joint Nations Programme on HIV/AIDS (UNAIDS) and national published reports. When no data existed, risk populations were used to estimate frequencies of fungal infections, using previously described methodology. Algeria has 40.4 million inhabitants and probably at least 568,900 (1.41 %) of Algerians have a serious fungal infection each year. Recurrent vulvovaginal candidiasis (485,000) and fungal asthma (72,000) are probably the commonest problems as there are over 1 million adult asthmatics. Candidaemia is estimated in 2020, invasive aspergillosis in 2865, intra-abdominal candidiasis in 303 people and are the most common life-threatening problems. AIDS is uncommon, but cancer is not (45,000 new cases of cancer among including 1500 in children) and nor is COPD (an estimated 317,762 patients of whom 20.3 % are admitted to hospital each year). A focus on improving the diagnosis and epidemiological data related to fungal infection is necessary in Algeria.
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Affiliation(s)
- M Chekiri-Talbi
- Pharmacy department, university Saad Dahlab, Blida, Algérie.
| | - D W Denning
- National Aspergillosis Centre, Manchester Academic Health Science Centre, The University of Manchester, University Hospital of South Manchester, Manchester, Royaume-Uni
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Metan G, Elmali F. The influence of the control group characteristics for the diagnostic performance of 1,3-beta-D-glucan in invasive aspergillosis. J Mycol Med 2016; 26:408-410. [PMID: 27663204 DOI: 10.1016/j.mycmed.2016.08.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2016] [Revised: 08/12/2016] [Accepted: 08/20/2016] [Indexed: 12/25/2022]
Affiliation(s)
- G Metan
- Department of Infectious Diseases and Clinical Microbiology, Faculty of Medicine, Hacettepe University, Ankara, Turkey.
| | - F Elmali
- Department of Biostatistics, Faculty of Medicine, Erciyes University, Kayseri, Turkey
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Dodémont M, Hites M, Bailly B, Trepant AL, De Mendonça R, Denis O, Jacobs F, Montesinos I. When you can't see the wood for the trees. Mucor circinelloides: A rare case of primary cutaneous zygomycosis. J Mycol Med 2015; 25:151-4. [PMID: 25840851 DOI: 10.1016/j.mycmed.2015.02.043] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2014] [Revised: 02/13/2015] [Accepted: 02/19/2015] [Indexed: 12/28/2022]
Abstract
A patient with refractory diffuse lymphoma treated for pulmonary invasive aspergillosis developed a concomitant primary cutaneous mucormycosis. The mucormycete was identified by sequencing as Mucor circinelloides. This case confirms the importance of a rapid pathogen diagnosis in immunocompromised patients and the usefulness of molecular methods for identification of rare fungal species.
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Affiliation(s)
- M Dodémont
- Laboratory of Bacteriology, Department of Microbiology, Hôpital Erasme, Université Libre de Bruxelles, Brussels, Belgium.
| | - M Hites
- Department of Infectious Diseases, Hôpital Erasme, Université Libre de Bruxelles, Brussels, Belgium
| | - B Bailly
- Department of Haematology, Hôpital Erasme, Université Libre de Bruxelles, Brussels, Belgium
| | - A-L Trepant
- Department of Pathology, Hôpital Erasme, Université Libre de Bruxelles, Brussels, Belgium
| | - R De Mendonça
- Laboratory of Bacteriology, Department of Microbiology, Hôpital Erasme, Université Libre de Bruxelles, Brussels, Belgium
| | - O Denis
- Laboratory of Bacteriology, Department of Microbiology, Hôpital Erasme, Université Libre de Bruxelles, Brussels, Belgium
| | - F Jacobs
- Department of Infectious Diseases, Hôpital Erasme, Université Libre de Bruxelles, Brussels, Belgium
| | - I Montesinos
- Laboratory of Bacteriology, Department of Microbiology, Hôpital Erasme, Université Libre de Bruxelles, Brussels, Belgium
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Desplanques PY, Burlacu R, Poinsignon V, Boussion H, Borget I, Wyplosz B, de Botton S, Billaud E, Chachaty E, Gachot B, Netzer F, Micol JB. Factors influencing posaconazole plasmatic concentrations in patients presenting with acute myeloid leukemia. Med Mal Infect 2014; 44:174-9. [PMID: 24656841 DOI: 10.1016/j.medmal.2014.02.005] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2013] [Revised: 01/08/2014] [Accepted: 02/12/2014] [Indexed: 11/16/2022]
Abstract
PURPOSE The effectiveness of posaconazole (PSZ) prophylaxis on invasive fungal infections, in patients presenting with acute myeloid leukemia (AML), seems to be correlated to its blood plasma concentration. Our goal was to identify the risk factors for underdosing. PATIENTS AND METHODS We retrospectively reviewed the records of patients treated for AML treated with PSZ, during a 2-year period. Assays<500ng/mL were considered as under dosed. RESULTS Fifty-nine assays (43 patients) were performed during induction (n=22) or consolidation (n=37) chemotherapy. PSZ treatment was initiated within a median of 3 days before neutropenia with a first assay performed at 8 days (3-28). The median PSZ blood plasma concentration was 375ng/mL (<200-1900). Forty-one (69%) treatment were maintained until the end of neutropenia. One patient presented with candidemia, 9 with possible invasive aspergillosis, without any significant association with underdosing. The univariate analysis showed that co-administration of proton pump inhibitors (PPIs) (P=0.01) and cause of hospitalization (induction chemotherapy vs consolidation, P=0.008) were associated with underdosing, contrary to feeding difficulties (P=0.07) and digestive disorders (P=0.5). The multivariate analysis confirmed the impact of PPI use (P=0.01) and the cause of hospitalization (P=0.003). CONCLUSION This study highlights the major impact of PPI administration on PSZ blood plasma levels and stresses the risk of non-effective prophylaxis during induction treatment of AML.
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Affiliation(s)
- P-Y Desplanques
- Service de pharmacie clinique, Institut Gustave-Roussy, 94805 Villejuif cedex, France
| | - R Burlacu
- Service d'hématologie, Institut Gustave Roussy, 94805 Villejuif cedex, France
| | - V Poinsignon
- Service de pharmacologie et toxicologie, Hôpital Européen George-Pompidou, 75015 Paris, France
| | - H Boussion
- Service d'hématologie, Institut Gustave Roussy, 94805 Villejuif cedex, France
| | - I Borget
- Service de biostatistique et d'épidémiologie, Institut Gustave-Roussy, université Paris-Sud, 94805 Villejuif cedex, France
| | - B Wyplosz
- Service de maladies infectieuses, Hôpital Bicêtre, 94270 Le Kremlin-Bicêtre, France
| | - S de Botton
- Service d'hématologie, Institut Gustave Roussy, 94805 Villejuif cedex, France
| | - E Billaud
- Service de pharmacologie et toxicologie, Hôpital Européen George-Pompidou, 75015 Paris, France
| | - E Chachaty
- Service de microbiologie, Institut Gustave-Roussy, 94805 Villejuif cedex, France
| | - B Gachot
- Département de soins aigus, Institut Gustave-Roussy, 94805 Villejuif cedex, France
| | - F Netzer
- Service de pharmacie clinique, Institut Gustave-Roussy, 94805 Villejuif cedex, France
| | - J-B Micol
- Service d'hématologie, Institut Gustave Roussy, 94805 Villejuif cedex, France.
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