Indications for Therapy for Fungemia in Postoperative Patients

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

doi:10.1001/archsurg.1982.01380340008003

Cited by 96 publications

(22 citation statements)

References 16 publications

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“…Yet despite treatment with fluconazole (FLC) or amphotericin B (AMB) monotherapy, the mortality associated with deep-seated candidal infections remains substantial (2,22,23,25,30).…”

mentioning

confidence: 99%

Impact of the Order of Initiation of Fluconazole and Amphotericin B in Sequential or Combination Therapy on Killing of Candida albicans In Vitro and in a Rabbit Model of Endocarditis and Pyelonephritis

Louie

Kaw

Banerjee

et al. 2001

Antimicrob Agents Chemother

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In vitro time-kill studies and a rabbit model of endocarditis and pyelonephritis were used to define the impact that the order of exposure of Candida albicans to fluconazole (FLC) and amphotericin B (AMB), as sequential and combination therapies, had on the susceptibility of C. albicans to AMB and on the outcome. The contribution of FLC-induced resistance to AMB for C. albicans also was assessed. In vitro, AMB monotherapy rapidly killed each of four C. albicans strains; FLC alone was fungistatic. Preincubation of these fungi with FLC for 18 h prior to exposure to AMB decreased their susceptibilities to AMB for 8 to >40 h. Induced resistance to AMB was transient, but the duration of resistance increased with the length of FLC preincubation. Yeast sequentially incubated with FLC followed by AMB plus FLC (FLC3AMB؉FLC) showed fungistatic growth kinetics similar to that of fungi that were exposed to FLC alone. This antagonistic effect persisted for at least 24 h. Simultaneous exposure of C. albicans to AMB and FLC [AMB؉FLC(simult)] demonstrated activity similar to that with AMB alone for AMB concentrations of >1 g/ml; antagonism was seen using an AMB concentration of 0.5 g/ml. The in vitro findings accurately predicted outcomes in our rabbit infection model. In vivo, AMB monotherapy and treatment with AMB for 24 h followed by AMB plus FLC (AMB3AMB؉FLC) rapidly sterilized kidneys and cardiac vegetations. AMB؉FLC(simult) and FLC3AMB treatments were slower in clearing fungi from infected tissues. FLC monotherapy and FLC3AMB؉FLC were both fungistatic and were the least active regimens. No adverse interaction was observed between AMB and FLC for the AMB3FLC regimen. However, FLC3AMB treatment was slower than AMB alone in clearing fungi from tissues. Thus, our in vitro and in vivo studies both demonstrate that preexposure of C. albicans to FLC reduces fungal susceptibility to AMB. The length of FLC preexposure and whether AMB is subsequently used alone or in combination with FLC determine the duration of induced resistance to AMB.With the increased capacity of medical science to prolong the lives of the immunocompromised host, the incidence of systemic Candida albicans infections is rising (5). Yet despite treatment with fluconazole (FLC) or amphotericin B (AMB) monotherapy, the mortality associated with deep-seated candidal infections remains substantial (2,22,23,25,30).In an attempt to improve survival rates, there is much interest in using FLC and AMB in combination. However, the interaction between FLC and AMB remains poorly characterized when these drugs are used concurrently or sequentially. In vitro studies in which FLC and AMB were simultaneously or sequentially introduced to cultures of C. albicans frequently showed this drug combination to be antagonistic (13,19,21,28; P. Banerjee, Q.-F. Liu, A. Louie, M. Shayegani, H. Taber, G. Drusano, and M. Miller, Abstr. 97th Gen. Meet. Am. Soc. Microbiol., abstr. C-252a, p. 164, 1997). Further, using time-kill studies, Vazquez et al. (28) demonstrated that sequential expo...

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“…Yet despite treatment with fluconazole (FLC) or amphotericin B (AMB) monotherapy, the mortality associated with deep-seated candidal infections remains substantial (2,22,23,25,30).…”

mentioning

confidence: 99%

Impact of the Order of Initiation of Fluconazole and Amphotericin B in Sequential or Combination Therapy on Killing of Candida albicans In Vitro and in a Rabbit Model of Endocarditis and Pyelonephritis

Louie

Kaw

Banerjee

et al. 2001

Antimicrob Agents Chemother

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“…However, D Genne et al have confirmed E coli to be the most common microbe isolated from the peritoneal fluid cultures, in 26% cases followed closely by anaerobes in 25% of cases. 11,[16][17][18] E coli and Klebsiella isolated in almost all cases have been uniformly sensitive to meropenem and almost 90% of them have been sensitive to third generation cephalosporin with sulbactam. Klebsiella isolates have been more sensitive to piperacillin with tazobactam and quinolones than E coli, while their sensitivity to other drugs have been less than 50%.…”

Section: Discussionmentioning

confidence: 99%

Study of bacterial flora and their antibiotic sensitivity in peritonitis of various causes

et al. 2017

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Background: Peritonitis is a common emergency encountered by surgeons the world over. Despite a better understanding of pathophysiology, advances in diagnosis, surgery, antimicrobial therapy and intensive care support, peritonitis remains a potentially fatal affliction. Intra-abdominal sepsis is important causes of mortality and morbidity. The treatment is based on rapid fluid resuscitation, initiation of antibiotic therapy and surgical intervention. The antibiotic chosen must cover the most frequently expected bacterial species depending upon the site of perforation. Objectives of the study was done to identify the type of organism present in bowel perforation and their sensitivity pattern to different antibiotics. A guideline will be framed for advising antibiotics to be used for different kinds of perforation.Methods: This was a prospective study of one year on 50 patients of secondary peritonitis due to bowel perforation, conducted in Amaltas institute of Medical Sciences, Dewas.Results: This study included 50 patients with an average age of 36 years (range: 3 days-75 years). There were 40 males and 10 females. The mean duration of hospitalization was 10.6 days (range: 3-25 days) with predominant site of perforation was ileum. E. coli emerged as main pathogenic microbe even in site specific culture, was closely followed by Klebsiella. A combination of third generation cephalosporins with sulbactam and metronidazole has been the most promising therapy to treat secondary bacterial peritonitis due to bowel perforation. It needs to be emphasized that although the sensitivity studies reveal an edge for meropenem over cefaperazone sulbactam, yet the preference of cephalosporin with sulbactam over meropenem is justified, considering the economic constraints and with a suitable foresight, to keep meropenem as a reserve drug because trends indicate that our microbes are fast becoming resistant to the promising combination of third generation cephalosporin with sulbactam and metronidazole.Conclusions: This study suggests that the current recommended empirical antibiotics need to be reassessed.

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“…In clinical practice, it is often the case that treatmentmust be initiated while the diagnosis is still in doubt, taking into consideration the risk of delayed treatment. Delayed diagnosis is attributed to the fact that since many fungi are a component of the normal resident flora in humans, differentiating whether an isolate is part of the normal resident flora or the causative agent of the infection is difficult by culture test alone [16,17]. Serological diagnosis is used as an adjunctive method at many institutions in Japan, and has proven to be very effective [18].…”

Section: Discussionmentioning

confidence: 99%

Evaluation of the clinical cutoff level of serum (1 → 3)-β-d-glucan in patients with connective tissue diseases complicated by deep fungal infections

Kato¹,

Onoda²,

Asano³

et al. 2010

Mod Rheumatol

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Serum (1 --> 3)-beta-D-glucan levels and clinical findings were evaluated in 229 inpatients with connective tissue diseases (CTDs) during the period between June and October 2004. The mean serum (1 --> 3)-beta-D-glucan level was 129.7 +/- 207.6 pg/mL in patients with a definitive diagnosis of fungal infections and 10.5 +/- 8.6 pg/mL in patients without fungal infections. Analysis of the diagnostic sensitivity/specificity for various (1 --> 3)-beta-D-glucan cutoff levels gave the best results for a cutoff level of 15 pg/mL, with a sensitivity of 92.3% and specificity of 81.3%. This level was therefore determined to be the optimal cutoff in patients with CTDs.

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Indications for Therapy for Fungemia in Postoperative Patients

Cited by 96 publications

References 16 publications

Impact of the Order of Initiation of Fluconazole and Amphotericin B in Sequential or Combination Therapy on Killing of Candida albicans In Vitro and in a Rabbit Model of Endocarditis and Pyelonephritis

Impact of the Order of Initiation of Fluconazole and Amphotericin B in Sequential or Combination Therapy on Killing of Candida albicans In Vitro and in a Rabbit Model of Endocarditis and Pyelonephritis

Study of bacterial flora and their antibiotic sensitivity in peritonitis of various causes

Evaluation of the clinical cutoff level of serum (1 → 3)-β-d-glucan in patients with connective tissue diseases complicated by deep fungal infections

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