Invasive Candida infections are associated with high morbidity and mortality. Due to an increased incidence in patients with hematological or oncological malignancies, fluconazole prophylaxis became a common practice in many centers in the late 1990s. Until recently, there was insufficient data on the effect of the use of azoles on the incidence of Candida blood stream infections and species distribution. Here we present a single center retrospective study of the epidemiology of Candida blood stream infections in hospitalized patients at a German university medical center from 2003-2009. Twenty-one Candida species were isolated in culture from blood specimens of 20 patients. The annual rate of candidemia approached 1.1 per thousand hospitalizations, during the first 5 years of the survey, but showed a significant increase after 2007. Candida albicans, although still the dominant species, was recovered as the responsible pathogen from only 28.6% of the cases. A high rate of fatal outcomes was noted at 30 days (56%) and 100 days (67%) after the first positive finding of Candida in blood culture. These results underline the clinical significance of this infectious complication, and the need for continuous monitoring for Candida blood stream infections in order to improve the clinical and therapeutic management of this specific patient population.

For posaconazole, drug monitoring is suggested, but the relevance of timing for the determination of posaconazole concentration (PC) remains unclear. We investigated the variation of PC before and 4 and 8 h after the administration of 400 mg of posaconazole. Mean concentrations were 645, 678, and 616 ng/ml. The differences between trough and maximum concentrations were below 20% in 17 and below 30% in 20 of 25 patients. Hence, untimed posaconazole plasma concentrations give reliable information for most patients.Posaconazole was shown to be effective in preventing invasive fungal infections (4, 21). Additionally, the compound is recommended for salvage therapy of invasive fungal infections (1, 15). Low posaconazole plasma concentrations have been associated with a reduced success rate of salvage therapy (22) and an increased risk of clinical failure in the prophylactic indication (8).Remarkable interindividual variation and low or undetectable plasma concentrations in a significant number of patients have been published (6,11,17). Posaconazole has a terminal elimination half-life of 15 to 35 h (6) and is only available for oral administration. Pharmacokinetics may be altered by numerous factors (2, 7, 13), e.g., absorption is impaired by reduced gastric acidity or diarrhea and can be improved by administration together with a fat-containing meal (6,12,18).Several assays for the determination of posaconazole concentration (PC) have been published (5, 9, 19), but for adequate therapeutic drug monitoring, additional issues have to be clarified. Particularly, the time point for sampling after the administration of the drug remains an open question. In clinical practice, the trough level is most often determined in the morning. In the case of suspected toxicity or a breakthrough infection, PC might be of immediate interest, and delaying sampling can become difficult. The purpose of this study is to evaluate first the impact of timing and then the intradaily variability of posaconazole plasma concentration.This study was conducted as an open, single-center trial, in accordance with the local ethical regulations. Patients with hematological malignancies, receiving posaconazole for any indication with a dosage of 400 mg twice a day (BID), were enrolled. Other doses and intervals, particularly 200 mg three times a day (TID), have been excluded, as higher doses and longer intervals are expected to cause a more pronounced variation in daily drug concentration. The aim of the study was to investigate the magnitude of variation in posaconazole drug concentrations at steady state. Therefore, patients were not enrolled before 7 days (mean, 31 days) of posaconazole administration, and patients with severe mucositis, gastrointestinal graft-versus-host disease (GVHD), or diarrhea (more than 3 times daily) were excluded.For pharmacokinetic sampling, blood was drawn in the morning, 12 (11 to 13) h after the last evening dose and before the first daily dose (C trough [C 0h ]), both at the time of maximum expected concentration (4 h ...

The visual bias in the West has decisively shaped literary and cultural criticism in the past decades. Perpetuated by the linguistic turn, this bias has seen the written word placed firmly at the heart of (post-)humanist critique. Surveying current trends in contemporary theory, it soon becomes evident that, coinciding with the decline of the linguistic turn, Animal and Sound Studies have been on a steady rise. Increasingly shaping the global literary imagination, canine poetics, in particular, are enmeshed in a complex ideological web. Basing my investigation on literary and dramatic works from the Global South, such as Mark Fleishman et al.’s Antigone (Not Quite/Quiet) (2019), Craig Higginson’s Dream of the Dog (2007), and Ari Gauthier’s Carnet secret de Lakshmi (2015), I argue that, analogous to the way sound has gained increased agency in the Global South, so too canine figurations point to the way acoustic symbols can be rearticulated.