Defining Invasive Fungal Diseases for Clinical Research: A Work in Progress

Rogers, Thomas R

doi:10.1093/cid/ciz1013

Cited by 2 publications

(1 citation statement)

References 19 publications

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“…Before the beginning of the AFS program, febrile neutropenic patients universally receiving empiric antifungal therapy after 3-5 days of sustained fever without judicious use of state-of-the-art available diagnostic tests, including non-invasive tests such as automated blood culture systems, specific none culture-based mycologic assays (such as fungal polymerase chain reaction, galactomannan, and mannan) and interventional diagnostic modalities such as bronchoscopy/ bronchoalveolar lavage, CT/ultrasound-guided lung biopsy, and sinus/skin biopsy. Indeed, our approach to febrile neutropenia changed from an empiric approach to a diagnostic-driven approach or pre-emptive treatment as suggested by experts and newer guidelines [45][46][47][48][49][50] . As we mentioned earlier in the result section, fluconazole prescription decreased per patient/1000 admission/year during the post-AFS period, but with the correct dose and duration.…”

Section: Discussionmentioning

confidence: 99%

Impact of antifungal stewardship interventions on the susceptibility of colonized Candida species in pediatric patients with malignancy

Amanati

Badiee

Jafarian

et al. 2021

Sci Rep

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There is a worldwide concern regarding the antimicrobial resistance and the inappropriate use of antifungal agents, which had led to an ever-increasing antifungal resistance. This study aimed to identify the antifungal susceptibility of colonized Candida species isolated from pediatric patients with cancer and evaluate the clinical impact of antifungal stewardship (AFS) interventions on the antifungal susceptibility of colonized Candida species. Candida species colonization was evaluated among hospitalized children with cancer in a tertiary teaching hospital, Shiraz 2017–2018. Samples were collected from the mouth, nose, urine, and stool of the patients admitted to our center and cultured on sabouraud dextrose agar. The isolated yeasts identified by polymerase chain reaction–restriction fragment length polymorphisms (PCR–RFLP). DNA Extracted and PCR amplification was performed using the ITS1 and ITS4 primer pairs and Msp I enzyme. The broth microdilution method was used to determine the minimum inhibitory concentrations (MICs) for amphotericin B, caspofungin, and azoles. The prevalence of Candida albicans in the present study was significantly higher than other Candida species. Candida albicans species were completely susceptible to the azoles. The susceptibility rate of C. albicans to amphotericin B and caspofungin was 93.1% and 97.1%, respectively. The fluconazole MIC values of Candida albicans decreased significantly during the post-AFS period (P < 0.001; mean difference: 72.3; 95% CI of the difference: 47.36–98.62). We found that ‏52.5% (53/117) of the isolated C. albicans were azole-resistant before AFS implementation, while only 1.5% (2/102) of the isolates were resistant after implementation of the AFS program (P < 0.001). C. albicans fluconazole and caspofungin resistant rate also decreased significantly (P < 0.001) after implementation of the AFS program [26 (32.9%) versus 0 (0.0%) and 11 (10.9%) versus 1 (0.9%), respectively]. Besides, fluconazole use (p < 0.05) and fluconazole expenditure reduced significantly (about one thousand US$ per year) after the AFS program. Our results confirm the positive effect of optimized antifungal usage and bedside intervention on the susceptibility of Candida species after the implementation of the AFS program. C. albicans and C. glabrata exhibited a significant increase in susceptibility after the execution of the AFS program.

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Section: Discussionmentioning

confidence: 99%

Impact of antifungal stewardship interventions on the susceptibility of colonized Candida species in pediatric patients with malignancy

Amanati

Badiee

Jafarian

et al. 2021

Sci Rep

View full text Add to dashboard Cite

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Aspergillosis: Emerging risk groups in critically ill patients

et al. 2021

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Information on invasive aspergillosis (IA) and other invasive filamentous fungal infections is limited in non-neutropenic patients admitted to the intensive care unit (ICU) and presenting with no classic IA risk factors. This review is based on the critical appraisal of relevant literature, on the authors' own experience and on discussions that took place at a consensus conference. It aims to review risk factors favouring aspergillosis in ICU patients, with a special emphasis on often overlooked or neglected conditions. In the ICU patients, corticosteroid use to treat underlying conditions such as chronic obstructive pulmonary disease (COPD), sepsis, or severe COVID-19, represents a cardinal risk factor for IA. Important additional host risk factors are COPD, decompensated cirrhosis, liver failure, and severe viral pneumonia (influenza, COVID-19). Clinical observations indicate that patients admitted to the ICU because of sepsis or acute respiratory distress syndrome are more likely to develop probable or proven IA, suggesting that sepsis could also be a possible direct risk factor for IA, as could small molecule inhibitors used in oncology. There are no recommendations for prophylaxis in ICU patients; posaconazole mould-active primary prophylaxis is used in some centres according to guidelines for other patient populations and IA treatment in critically ill patients is basically the same as in other patient populations. A combined evaluation of clinical signs and imaging, classical biomarkers such as the GM assay, and fungal cultures examination, remain the best option to assess response to treatment. Lay Summary The use of corticosteroids and the presence of co-morbidities such as chronic obstructive pulmonary disease, acute or chronic advanced liver disease, or severe viral pneumonia caused by influenza or Covid-19, may increase the risk of invasive aspergillosis in intensive care unit patients.

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Defining Invasive Fungal Diseases for Clinical Research: A Work in Progress

Cited by 2 publications

References 19 publications

Impact of antifungal stewardship interventions on the susceptibility of colonized Candida species in pediatric patients with malignancy

Impact of antifungal stewardship interventions on the susceptibility of colonized Candida species in pediatric patients with malignancy

Aspergillosis: Emerging risk groups in critically ill patients

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