Candida Infections in Surgical Patients Dose Requirements and Toxicity of Amphotericin B

Solomkin, Joseph S.; Flohr, Anna; Simmons, Richard L.

doi:10.1097/00000658-198202000-00010

Cited by 81 publications

(23 citation statements)

References 25 publications

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“…Initial treatment with amphotericin B is usually advised [15], but optimal duration of therapy is controversial [16], particularly when infection is not associated with a removable source such as an intravenous catheter. Solomkin et al [17] suggest that a total dose of 6 mg-8 mg/kg may be sufficient to clear fungemia in postsurgical patients [17]. Ex-perience with the new imidazole drugs for treatment of systemic candidiasis and candidemia is limited [18,19].…”

Section: Discussionmentioning

confidence: 99%

Candidemia from a Urinary Tract Source: Microbiological Aspects and Clinical Significance

Ang

Telenti

King

et al. 1993

Clinical Infectious Diseases

124

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Twenty-six cases of candidemia associated with a well-defined urinary tract source were retrospectively identified and reviewed. Urinary tract abnormalities were present in 23 of 26 patients (88%), 19 (73%) of whom had urinary tract obstruction. Nineteen patients had undergone urinary tract procedures before the onset of candidemia. Episodes of candidemia were brief and low-grade in intensity (median duration, 1 day; median colony count, 1.5 cfu/10 mL of blood).Only eight patients (31%) received >500 mg of amphotericin B. There were five in-hospital deaths (19%); two of these deaths were attributed to candidiasis. No late complications of candidemia were documented for the surviving patients. Patients with urologic pathology and candiduria who undergo surgery or manipulation of the urinary tract are at significant risk for candidemia, and further studies should examine the issue of administration of prophylaxis to this group.Candiduria often presents a dilemma to the clinician, as it may represent colonization or infection. The prevalence of candiduria has been estimated at 0.2%-6% [1, 2] among asymptomatic volunteers and at 6.5%-20% among hospitalized patients [2,3]. Despite the high prevalence of candiduria, it is not well known which patients will develop complications such as candidemia. For patients in the critical care setting, the mortality associated with urine cultures positive for Candida species was 50%, as opposed to 19% for such patients without cultures positive for Candida [4]. On the other hand, Schonebeck and Ansehn [5] observed 40 patients with candiduria that persisted from 1 to 12 months and found that the infection spontaneously resolved in the majority of patients, although five remained candiduric after >12 months. The goal of this retrospective study was to describe the characteristics of candidemia arising in patients with a well-defined urinary tract source of infection. Materials and MethodsAll patients with blood cultures positive for Candida species at the Mayo Clinic from March 1985 to December 1987 were identified through a review of microbiological records. Patients with candidemia were eligible for inclusion in the study if they had concomitant candiduria and no alternative source of candidemia. Candiduria was defined as the pres- ence of Candida species in urine cultures or the presence of yeast in the urine on microscopy. Recovery of Candida species from skin, sputum, or mucous membranes did not constitute criteria for exclusion. All in-patient and out-patient records were reviewed, and the following data were recorded: age, sex, underlying diseases, potential risk factors, clinical and laboratory features, radiological study findings, pathology reports, and treatment and outcome. Blood cultures were done for patients if they had fever or if the clinical circumstances suggested the possibility of systemic infection.The onset of fungemia was defined as the first day on which blood cultures positive for Candida were obtained. Potential risk factors were defined as: (1) administra...

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Section: Discussionmentioning

confidence: 99%

Candidemia from a Urinary Tract Source: Microbiological Aspects and Clinical Significance

Ang

Telenti

King

et al. 1993

Clinical Infectious Diseases

124

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“…The linearity of the relation should permit use of the checkerboard method to assess the interaction between amphotericin B and other drugs, providing that these drugs show the same property. However, whether efficacy of amphotericin B correlates with the dose remains controversial (1, 5,16,24,26). Failures and relapses are numerous despite amphotericin B therapy.…”

Section: Discussionmentioning

confidence: 99%

In vitro evaluation of various antifungal agents alone and in combination by using an automatic turbidimetric system combined with viable count determinations

Auwera¹,

Ceuppens²,

Heymans³

et al. 1986

Antimicrob Agents Chemother

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A new method combining automatic turbidimetry and sequential viable count determinations was developed to evaluate the in vitro activity of various antifungal agents alone and in combination against three clinical isolates of Candida spp. (two Candida albicans and one C. tropicalis) at two inocula (105 and 106 CFU/ml). Specific parameters were derived from the time-kill curves: the maximal rate of killing, the lowest biomass, and the overnight biomass. Their intra-assay and between-assay reproducibilities were high, with respective standard deviations of 0.4 and 0.25 to 1.4 log CFU/ml. Amphotericin B alone showed a linear relationship between rate of killing or lowest biomass and the log of concentration from 0.03 to 4 mg/liter that was similar for the three strains tested. 5-Fluorocytosine (flucytosine) alone showed a dose-related reduction of overnight biomass for concentrations up to 8 mg/liter with no further increase at higher concentrations for one strain of C. albicans and a paradoxical decrease for one strain of C. tropicalis. Ketoconazole alone was found to be only fungistatic with no increased activity at concentrations up to 16 mg/liter. Amphotericin B plus flucytosine interacted synergistically in 46 to 60% of the combinations tested against C. tropicalis depending on the initial inoculum. Indifference was observed for the two strains of C. albicans. Amphotericin B or flucytosine plus ketoconazole was usually indifferent against the three tested strains.

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“…Dosage recommendations for candidemia were initially based upon doses employed for histoplasmosis, 1 mg/kg per day. More recent work has demonstrated the efficacy of lower dose regimens of 0.3-0.7 mg/kg per day, with treatment courses of 7-10 days [61,62]. Amphotericin B toxicity predominantly consists of fever, chills, nausea, vomiting, hypotension and, most importantly, renal tubular damage.…”

Section: Amphotericin Bmentioning

confidence: 99%

Epidemiology, diagnosis and treatment of systemic Candida infection in surgical patients under intensive care

et al. 1998

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The incidence of systemic Candida infections in patients requiring intensive care has increased substantially in recent years as a result of a combination of factors. More patients with severe underlying disease or immunosuppression from anti-neoplastic or anti-rejection chemotherapy and at risk from fungal infection are now admitted to the ICU. Improvements in supportive medical and surgical care have led to many patients who would previously have died as a result of trauma or disease surviving to receive intensive care. Moreover, some therapeutic interventions used in the ICU, most notably broad-spectrum antibiotics and intravascular catheters, are also associated with increased risks of candidiasis. Systemic Candida infections are associated with a high morbidity and mortality, but remain difficult to diagnose and ICU staff need to be acutely aware of this often insidious pathogen. A number of studies have identified risk factors for systemic Candida infection which may be used to identify those at highest risk. Such patients may be potential candidates for early, presumptive therapy. Here we review the epidemiology, pathogenesis, morbidity and mortality of systemic Candida infections in the ICU setting, and examine predisposing risk factors. Antifungal treatment, including the use of amphotericin B, flucytosine and fluconazole, and the roles of early presumptive therapy and prophylaxis, is also reviewed.

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Candida Infections in Surgical Patients Dose Requirements and Toxicity of Amphotericin B

Cited by 81 publications

References 25 publications

Candidemia from a Urinary Tract Source: Microbiological Aspects and Clinical Significance

Candidemia from a Urinary Tract Source: Microbiological Aspects and Clinical Significance

In vitro evaluation of various antifungal agents alone and in combination by using an automatic turbidimetric system combined with viable count determinations

Epidemiology, diagnosis and treatment of systemic Candida infection in surgical patients under intensive care

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