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Vladimir Krcmery - One of the best experts on this subject based on the ideXlab platform.
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Persistent Fungemia--risk factors and outcome in 40 episodes.
Journal of chemotherapy (Florence Italy), 2001Co-Authors: G. Kovacicova, Juraj Hanzen, A. Roidova, Marcela Lovaszova, F. Mateicka, M Lesay, Vladimir KrcmeryAbstract:The aim of this multicenter survey was to assess risk factors and mortality in patients with persistent Fungemia (PF). Cases of persistent Fungemia, defined as positive blood culture for at least 3 causative days of antifungal therapy were selected. Forty cases of persistent Fungemia (lasting more than 3 days) were compared with 270 non-persistent Fungemias appearing within the same period, and analyzed by univariate and multivariate analysis for risk factors and outcome. The median number of days of positive culture was 4.4 (3 - 20): 22 episodes were due to Candida albicans, 1 due to non-albicans Candida spp., 6 episodes due to non-Candida spp. Yeasts: 15 were catheter related, 16 patients had yeast-infected surgical wounds, 12 were neutropenic, 4 cases were caused by species resistant in vitro, 2 to amphotericin B (Trichosporon spp.) and 2 to fluconazole (C. laurentii, C. glabrata). Fifteen patients (37.5%) died, 7 of whom due to Fungemia. Nineteen cases had one known risk factor (10 had infected wound, 4 infected vascular catheter, 3 were neutropenic and 2 had inappropriate therapy). Fourteen cases had two known risk factors (4 had wound and infected catheter, 4 neutropenia and infected catheter, 2 neutropenia and resistant organism, 4 other combinations. Two cases had 3 known risk factors and one had 4 risk factors for persistent Fungemia. Artificial ventilation, C. glabrata etiology, non-Candida spp. yeasts such as Trichosporon spp. and Cryptococcus spp. and prior surgery were significantly associated with persistent Fungemia in univariate, whereas only C. glabrata etiology in multivariate analysis. Breakthrough Fungemia during empiric therapy with fluconazole was also observed more frequently in patients with persistent Fungemia. However, there was no difference in both attributable and overall mortality between both groups.
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Fungemia in neonates: report of 80 cases from seven University hospitals.
Pediatrics, 2000Co-Authors: Vladimir Krcmery, J. Trupl, M. Huttova, K. Kralinsky, J. Filka, M. Frič, M. Pisarcikova, H. Hupkova, Juraj Hanzen, M. LiskováAbstract:To the Editor. Candidemia is an emerging infection in neonatology, due to multiple risk factors for fungal infections in neonates, eg, central venous catheter (CVC) insertion, total parenteral nutrition (TPN), corticosteroid and antibiotic therapy, very low birth weight (VLBW) and arteriovenous support (AV).1–3 Within 10 years, from 1989 to 1998, a prospective nation-wide survey of Fungemia in 7 university children's clinics in Slovakia was performed. A total of 310 Fungemias developed; 145 appeared in children (48.5%) and 80 (55.3% of all children and 23.3% of all cases) appeared in neonates. The most common risk factors (Table 1) for Fungemia in neonates were prior antibiotic therapy, CVC insertion, and TPN, which appeared in …
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Nosocomial Candida krusei Fungemia in cancer patients: report of 10 cases and review.
Journal of chemotherapy (Florence Italy), 1999Co-Authors: Vladimir Krcmery, Stanislav Spanik, A. Kunova, J. Trupl, S. Grausova, I. Krupova, F. Mateicka, E. Pichnova, E. Grey, A. SaboAbstract: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. Howewer, 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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Candida glabrata Fungemia in a tertiary cancer institution in Slovakia.
Journal of infection and chemotherapy : official journal of the Japan Society of Chemotherapy, 1999Co-Authors: Vladimir Krcmery, Stanislav Spanik, A. Kunova, I. Krupova, F. Mateicka, L. Jurga, M. Sulcova, J. NovotnyAbstract:Because of controversial data on virulence and mortality, six cases of Fungemia caused by Candida glabrata were reviewed in a single cancer institution within 8 years. Risk factors and outcome of C. glabrata, Candida albicans, and other non-albicans Candida spp. appearing within the same period under the same antibiotic policy at the same institution were compared. Among other non-albicans Candida spp. in 1990–1997 C. glabrata Fungemias showed a decreasing tendency, from 9% to 4.5% in 1997. Analyzing the proportion of C. glabrata among blood cultures, among 170 positive blood cultures 12 were caused by C. glabrata (6.2% among all pathogens and 24% among non-albicans Candida spp.). C. glabrata among all Fungemias was diagnosed as the fourth most common pathogen after C. albicans, C. krusei, and C. parapsilosis. Three of six C. glabrata Fungemias were breakthrough. Two appeared during prophylaxis with itraconazole and one during fluconazole prophylaxis. Five of six received broadspectrum antibiotic therapy with third-generation cephalosporines, five of six had vascular catheter insertion, four of six were neutropenic, and two of six received amphotericin B therapy. One patient died before his blood cultures were reported to be positive. Overall mortality of C. glabrata Fungemia was 16.7%. One patient died of underlying disease with Fungemia. There were no significant differences in risk factors between C. glabrata and C. albicans. However, overall and crude mortality was lower in C. glabrata than in C. albicans (25.5% vs. 16.7%; P = 0.03). Attributable mortality was lower in comparison to C. albicans (0 vs. 15.7% in C. albicans; P = 0.001).
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Candida Fungemia in neonates treated with fluconazole: report of forty cases, including eight with meningitis.
The Pediatric infectious disease journal, 1998Co-Authors: M. Huttova, Iveta Hartmanova, K. Kralinsky, J. Filka, Jozef Uher, Jozef Kurak, Stanislav Krizan, Vladimir KrcmeryAbstract:To assess efficacy and safety of fluconazole in neonates with Candida Fungemia. Multicenter prospective protocol of all Fungemias appearing between January 1, 1993, and December 31, 1997, in four major university hospitals. Forty neonates, 28 of them with very low birth weight (<1500 g; 30.5 median gestation week), with documented Candida albicans Fungemia were treated with intravenous fluconazole in a daily dosage of 6 mg/kg once daily for 6 to 48 days. Thirty-four received fluconazole as monotherapy and 6 received it in combination with amphotericin B. Thirty-two (80%) were cured; 4 of them relapsed despite at least 14 days of therapy, but they were ultimately cured without sequelae. Eight other neonates died, 4 because of fungal infection and 4 because of prematurity or hemorrhage or lung failure, with Fungemia (20% overall and 10% attributable mortality). Two neonates had elevated liver enzymes during fluconazole therapy and 2 others had elevated serum creatinine during fluconazole monotherapy. In none of them did these abnormalities necessitate discontinuation of antifungal therapy. In 8 neonates fungal meningitis developed as a complication of Fungemia. All but 3 Fungemias were C. albicans; 3 were Candida parapsilosis. Fluconazole was safe and effective antifungal therapy even in complicated or Candida Fungemia in neonates and in infants with very low birth weight.
Graeme N. Forrest - One of the best experts on this subject based on the ideXlab platform.
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Rhodotorula glutinis Fungemia in a liver-kidney transplant patient.
Transplant Infectious Disease, 2007Co-Authors: D.j. Riedel, J.k. Johnson, Graeme N. ForrestAbstract:A 54-year-old man underwent simultaneous liver-kidney transplantation. During his prolonged hospitalization, he developed catheter-related Fungemia with Rhodotorula glutinis and azole-resistant Candida glabrata. Management of the Rhodotorula Fungemia was complicated by his renal insufficiency, hepatic insufficiency, and the concurrent Fungemia with multi-azole resistant C. glabrata. He was treated with combination therapy with voriconazole and micafungin with subsequent clearance of the Fungemia. Rhodotorula species are emerging as human pathogens with the increasing number of immunosuppressed patients in the last few decades. This is the first report of a R. glutinis Fungemia in a solid organ transplant recipient.
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Prevalence of Candida dubliniensis Fungemia at a large teaching hospital.
Clinical infectious diseases : an official publication of the Infectious Diseases Society of America, 2005Co-Authors: Mary Ann Jabra-rizk, Graeme N. Forrest, Jennifer K. Johnson, Kristina Mankes, Timothy F. Meiller, Richard A. VeneziaAbstract:Six cases of Candida dubliniensis Fungemia were identified during an 8-month period in hospitalized patients with various conditions, including human immunodeficiency virus infection. Peptide nucleic acid fluorescent in situ hybridization analysis was used as a rapid and reliable test for differentiating C. dubliniensis from Candida albicans, making it feasible to determine the prevalence of C. dubliniensis Fungemia.
Issam I Raad - One of the best experts on this subject based on the ideXlab platform.
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Risk Factors for Candida tropicalis Fungemia in Patients with Cancer
Clinical infectious diseases : an official publication of the Infectious Diseases Society of America, 2001Co-Authors: Dimitrios P. Kontoyiannis, Hend Hanna, Gerald P Bodey, Ray Y Hachem, Irfan Vaziri, Maha Boktour, Jack I. Thornby, Issam I RaadAbstract:The risk factors for and presentation of Candida tropicalis Fungemia, in comparison with those of Candida albicans, have been incompletely characterized. We compared 43 cases of C. tropicalis Fungemia with 148 cases of C. albicans Fungemia. In univariate analysis, patients with C. tropicalis Fungemia were more likely to have leukemia (P=.0006), prolonged neutropenia (P=.03), and a positive blood culture for more days (P=.02). The 2 groups did not differ with regard to baseline Acute Physiology and Chronic Health Evaluation (APACHE) II score, frequency of catheter-associated Fungemia, or response to antifungals. In multivariate analysis, patients with C. tropicalis Fungemia were more likely to have leukemia (P=.02), previous neutropenia (P=.002), and a longer stay in the intensive care unit during the infectious episode (P=.01). Also, the response of the breakthrough C. tropicalis Fungemia was lower (P=.05). In conclusion, the host determinants associated with susceptibility to C. tropicalis are leukemia and prolonged neutropenia.
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Candida lusitaniae: A cause of breakthrough Fungemia in cancer patients
Clinical infectious diseases : an official publication of the Infectious Diseases Society of America, 2000Co-Authors: Afaf Minari, Ray Y Hachem, Issam I RaadAbstract:Candida lusitaniae is an infrequent cause of Fungemia. We identified 12 cases of C. lusitaniae Fungemia that occurred at the University of Texas M. D. Anderson Cancer Center from 1988 to 1999. The mean age of patients was 48 years (range 20--70 years). Eight patients had hematologic malignancy or had received a bone marrow transplant, and 4 had a solid tumor. Most patients (75%) were neutropenic (
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candida krusei Fungemia an escalating serious infection in immunocompromised patients
JAMA Internal Medicine, 2000Co-Authors: Jalal Abbas, Masoud Mardani, Hend Hanna, Essam Girgawy, Gerald P Bodey, Dima Abisaid, Estella Whimbey, Ray Y Hachem, Issam I RaadAbstract:Background: Candida krusei is inherently resistant to fluconazole and is emerging as a frequent cause of Fungemia in patients with hematologic malignant neoplasms. Objective: To determine the risk and prognostic factors associated with C krusei Fungemia in comparison with Candida albicans Fungemia in patients with cancer. Methods: Retrospective study of 57 cases of C krusei Fungemia occurring at the M. D. Anderson Cancer Center, Houston, Tex, from 1989 to 1996. The C krusei cases were compared with 57 cases of C albicans Fungemia with respect to demographics, underlying cancer, Acute Physiology and Chronic Health Evaluation II score, immunosuppression status, chemotherapy, and the use of central venous catheters, as well as fluconazole prophylaxis. Results: At our institution, C krusei accounted for 5% of Fungemias during 1989 through 1992 and for 10% during 1993 through 1996. Patients with C krusei Fungemia more often had leukemia than patients with C albicans (77% vs 11%; P= .02), whereas catheterrelated infections were more common among patients with C albicans Fungemia (42% vs 0%; P,.001). Patients with C krusei Fungemia had a lower response rate (51% vs 69%; P = .05), largely because they more frequently were neutropenic and had disseminated infection. Mortality related to Fungemia was 49% in the cases with C krusei vs 28% in C albicans. Multiple logistic regression analysis showed that persistent neutropenia (P=.02) and septic shock (P=.002) were predictors of poor prognosis. Conclusion: In neutropenic patients, C krusei Fungemia is associated with high mortality. It should be suspected in patients with leukemia who are receiving fluconazole prophylaxis and should be treated aggressively with an amphotericin B regimen. Arch Intern Med. 2000;160:2659-2664
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Nosocomial Candida guilliermondii Fungemia in cancer patients.
Infection Control & Hospital Epidemiology, 2000Co-Authors: Masoud Mardani, Hend Hanna, Essam Girgawy, Issam I RaadAbstract:From 1988 to 1998, we identified nine patients with Candida guilliermondii Fungemia. Four of the five patients with nosocomial infection died, while all of the non-nosocomial cases survived, even though one half of them (2/4) did not receive any treatment Nosocomial C guilliermondii Fungemia is often associated with poor outcome despite aggressive antifungal therapy.
Carol A Kauffman - One of the best experts on this subject based on the ideXlab platform.
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candida glabrata Fungemia experience in a tertiary care center
Clinical Infectious Diseases, 2005Co-Authors: Anurag N Malani, Jareer Hmoud, Loretta Chiu, Peggy L Carver, Andrew Bielaczyc, Carol A KauffmanAbstract:Background. During the past decade, Candida glabrata has emerged as an important cause of Fungemia. We reviewed demographic data, risk factors, treatment, and outcomes associated with C. glabrata Fungemia from 1995-2002 and performed susceptibility testing of isolates. Methods. Data on all episodes of Fungemia were prospectively recorded, and the associated isolates were saved. Medical records were reviewed retrospectively. Susceptibility testing was performed for fluconazole, itraconazole, and voriconazole. Results. C. glabrata caused 103 (17%) of 609 fungemic episodes during the 8-year period that we studied. Medical records and isolates were available for 94 episodes that occurred in 91 patients. The patients included 42 men and 49 women. The mean age was 51 years. Thirty-four episodes (36%) occurred in patients >60 years old; only 3 episodes occurred in patients <1 year old. The most common predisposing factors were use of broad-spectrum antibiotics (in 86% of episodes), use of central venous catheters (77%), stay in an intensive care unit (48%), renal failure (46%), and receipt of parenteral nutrition (45%). Of the 94 episodes, 83 were treated with antifungal agents. The overall mortality rate at day 30 was 29%. For the 11 episodes that were not treated, the mortality rate was 64% (7 of 11 episodes). Outcome appeared to be unrelated to whether fluconazole or amphotericin B was administered. In vitro, 60% of isolates were resistant to fluconazole, 83% to itraconazole, and 44% to voriconazole. Susceptibility to these azoles did not change over the 8 years of the study. Conclusion. C. glabrata Fungemia was most often seen in older adults and was associated with a mortality rate of 29%. Outcomes appeared to be unrelated to in vitro susceptibility results and to the antifungal agent used.
Po-ren Hsueh - One of the best experts on this subject based on the ideXlab platform.
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Central venous catheter-associated Fungemia due to Wangiella dermatitidis.
Journal of the Formosan Medical Association = Taiwan yi zhi, 2005Co-Authors: Ping-huei Tseng, Pei-lin Lee, Tzu-hsiu Tsai, Po-ren HsuehAbstract:Central venous catheter-related Wangiella dermatitidis infection has been increasingly reported in the recent literature. We report a case of central venous catheter (Port-A-Cath)-related Fungemia caused by W．dermatitidis in a 58-year-old woman with lung cancer. Two W．dermatitidis isolates were recovered from 2 blood samples drawn from a peripheral vein and the Port-A-Cath 4 months after its placement. The minimum inhibitory concentrations of 2 isolates to fluconazole and amphotericin B using the standard broth microdilution method were 48µg/mL and 0.19µg/mL, respectively. The Port-A-Cath was removed and the Fungemia responded to amphotericin B treatment. W．dermatitidis should be categorized as a pathogen that can cause central venous catheter-associated Fungemia, particularly in immunocompromised patients.
