Fungal colonization and invasive fungal infections following allogeneic BMT using metronidazole, ciprofloxacin and fluconazole or ciprofloxacin and fluconazole as intestinal decontamination

Trenschel, Rudolf; Peceny, Rudolf; Runde, Volker; Elmaagacli, Ahmet H.; Dermoumi, Heide; Heinegg, Evelyn Heintschel von; Müller, Karl-Dieter; Schaefer, U. W.; Beelen, Dietrich W.

doi:10.1038/sj.bmt.1702655

Cited by 23 publications

(10 citation statements)

References 12 publications

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“…Many variables can impact colonization by Candida species; for instance, the use of metronidazole for intestinal decontamination has been shown to increase yeast colonization in hematopoietic stem cell transplant recipients (42). Based on our molecular analyses, isolates appear dissimilar; we cannot confirm that nosocomial or horizontal transmission has occurred or make any conclusions regarding specific patterns of acquisition.…”

Section: Discussioncontrasting

confidence: 42%

Epidemiology of Candida kefyr in Patients with Hematologic Malignancies

et al. 2014

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g Candida kefyr is an emerging pathogen among patients with hematologic malignancies (HM). We performed a retrospective study at Johns Hopkins Hospital to evaluate the epidemiology of C. kefyr colonization and infection in HM patients between 2004 and 2010. Eighty-three patients were colonized and/or infected with C. kefyr, with 8 (9.6%) having invasive candidiasis (IC). The yearly incidence of C. kefyr colonization and candidemia increased over the study period (P < 0.01), particularly after 2009. In 2010, C. kefyr caused 16.7% of candidemia episodes. The monthly incidence of C. kefyr was higher during the summer throughout the study. In a cohort of patients with acute myelogenic leukemia receiving induction chemotherapy, risks for C. kefyr colonization included the summer season (odds ratio [OR], 3.1; P ‫؍‬ 0.03); administration of an azole (OR, 0.06; P < 0.001) or amphotericin B (OR, 0.35; P ‫؍‬ 0.05) was protective. Fingerprinting of 16 isolates by repetitive sequence-based PCR showed that all were different genotypes. The epidemiology of C. kefyr candidemia was evaluated in another hospital in Montreal, Canada; data confirmed higher rates of C. kefyr infection in the summer. C. kefyr appears to be increasing in HM patients, with prominent summer seasonality. These findings raise questions about the effect of antifungal agents and health care exposures (e.g., yogurt) on the epidemiology of this yeast.

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Section: Discussioncontrasting

confidence: 42%

Epidemiology of Candida kefyr in Patients with Hematologic Malignancies

et al. 2014

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“…Specifically, antibacterial drugs with predominant effects on anaerobic bacteria, such as metronidazole and clindamycin, were shown to promote intestinal colonization by C. glabrata in an animal model (22). In another study, the addition of metronidazole to a gastrointestinal decontamination regimen that included ciprofloxacin and fluconazole increased intestinal yeast colonization (26). Second, many antibacterial agents have some degree of antifungal activity (1), which could explain selective pressure similar to that induced by azole exposure.…”

Section: Discussionmentioning

confidence: 99%

Antibiotic Exposure as a Risk Factor for Fluconazole-Resistant Candida Bloodstream Infection

Ben‐Ami

Olshtain‐Pops

Krieger

et al. 2012

Antimicrob Agents Chemother

149

117

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Candida species have emerged as frequent causes of nosocomial bloodstream infection (BSI) in association with well-defined risk factors, including prolonged hospitalization, abdominal surgery, antibiotic treatment, neutropenia and central venous catheterization (14). Candidemia is associated with high rates of attributable mortality, prolongation of hospital stay, and excessive costs (28). In recent years, there has been a shift in the distribution of Candida species causing invasive infection, with non-albicans species now surpassing Candida albicans in many institutions (14,25). Of particular concern is the rising incidence of the azolenonsusceptible species C. glabrata and the inherently fluconazoleresistant species C. krusei (11,25,27).Fluconazole is often used as empirical treatment of candidemia. However, given the correlation between the survival rate and the timely initiation of appropriate treatment for candidemia (8), accurate assessment of the risk of fluconazole-resistant Candida (FRC) BSI is of prime importance. Patients who were recently treated with an azole drug are at increased risk of infection with FRC (9) and should be treated initially with an echinocandin agent according to current guidelines (18). However, experimental and clinical data support the notion that nonantifungal antimicrobial agents also affect the risk of colonization and infection with FRC (15,17,22). Since exposure to antibacterial drugs among at-risk patients far exceeds exposure to antifungal agents, even modest effects of individual antibacterials could translate into significant overall changes in the susceptibility patterns of Candida spp. Nevertheless, the collateral effects of antibacterial drugs on Candida spp. are poorly understood. To address this question, we analyzed prospectively collected data from a nationwide study of candidemia in Israel and examined the association between exposure to antifungal and antibacterial agents and the risk of infection with FRC. MATERIALS AND METHODS Study design.We performed a prospective nationwide study of candidemia in Israel from November 2005 through June 2007. Eighteen medical centers, which together account for 75% of the hospital beds in Israel, were included. All candidemia episodes that occurred in the participating centers during the study period were eligible for inclusion in this study. Clinical data were prospectively entered into standardized data forms by on-site investigators at each of the centers. The Candida sp. clinical isolates underwent preliminary identification and susceptibility testing in each center according to local practices. Subsequently, the isolates were transferred together with the corresponding data forms to the central study site, where species identification and susceptibility testing were performed as detailed below. The data forms were collected by the study coordinator, reviewed by the principal investigator, and entered into a computerized database. The study was approved by the ethics committee of each of the participating centers.Data...

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“…Several variables contribute to its clinical expression, including immunosuppression, mucosal injury, and salivary dysfunction. In addition, antibiotics may alter the oral flora, thereby creating a favorable environment for fungal overgrowth [155]. The most common forms of intraoral candidiasis reported in oncology patients are pseudomembranous and erythematous candidiasis [156].…”

Section: Infectionsmentioning

confidence: 99%

Oral Complications in Hematopoietic Stem Cell Recipients: The Role of Inflammation

Haverman

Raber-Durlacher

Rademacher

et al. 2014

Mediators of Inflammation

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Hematopoietic stem cell transplantation (HSCT) is widely used as a potentially curative treatment for patients with various hematological malignancies, bone marrow failure syndromes, and congenital immune deficiencies. The prevalence of oral complications in both autologous and allogeneic HSCT recipients remains high, despite advances in transplant medicine and in supportive care. Frequently encountered oral complications include mucositis, infections, oral dryness, taste changes, and graft versus host disease in allogeneic HSCT. Oral complications are associated with substantial morbidity and in some cases with increased mortality and may significantly affect quality of life, even many years after HSCT. Inflammatory processes are key in the pathobiology of most oral complications in HSCT recipients. This review article will discuss frequently encountered oral complications associated with HSCT focusing on the inflammatory pathways and inflammatory mediators involved in their pathogenesis.

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Fungal colonization and invasive fungal infections following allogeneic BMT using metronidazole, ciprofloxacin and fluconazole or ciprofloxacin and fluconazole as intestinal decontamination

Cited by 23 publications

References 12 publications

Epidemiology of Candida kefyr in Patients with Hematologic Malignancies

Epidemiology of Candida kefyr in Patients with Hematologic Malignancies

Antibiotic Exposure as a Risk Factor for Fluconazole-Resistant Candida Bloodstream Infection

Oral Complications in Hematopoietic Stem Cell Recipients: The Role of Inflammation

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