Improvement of a clinical prediction rule for clinical trials on prophylaxis for invasive candidiasis in the intensive care unit

Ostrosky-Zeichner, Luis; Pappas, Peter G.; Shoham, Shmuel; Reboli, Annette C.; Barron, Michelle A.; Sims, Charles R.; Wood, C.; Sobel, Jack D.

doi:10.1111/j.1439-0507.2009.01756.x

Cited by 109 publications

(76 citation statements)

References 16 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…[2][3][4][5] However, IC is frequently not confirmed until after 3-5 days of empirical treatment, and in this case whether to stop or to continue antifungal agents is a real clinical challenge with influence in antifungal stewardship programmes. In the last decade, strategies including biomarkers [b-D-glucan (BDG) or Candida albicans germ tube antibodies (CAGTA)], surveillance cultures or predictive scores have been investigated not only for starting [7][8][9] but also for discontinuing empirical antifungals. 10,11 Our own data, and those of Nucci et al…”

Section: Introductionmentioning

confidence: 99%

T2Candida MR as a predictor of outcome in patients with suspected invasive candidiasis starting empirical antifungal treatment: a prospective pilot study

Muñóz

Machado

Gioia

et al. 2018

Journal of Antimicrobial Chemotherapy

View full text Add to dashboard Cite

Section: Introductionmentioning

confidence: 99%

T2Candida MR as a predictor of outcome in patients with suspected invasive candidiasis starting empirical antifungal treatment: a prospective pilot study

Muñóz

Machado

Gioia

et al. 2018

Journal of Antimicrobial Chemotherapy

View full text Add to dashboard Cite

“…In accordance with recent studies, using antifungal susceptibility tests that are considered gold standards (CLSI and EUCAST microbroth assays), the rates of fluconazole resistance in blood stream C parapsilosis isolates ranges from 3.4 to 7.5% in the USA [17,25,26], 0 to 6.3% in Europe and up to 5.4 in Asia [17,27,28].…”

Section: Discussionsupporting

confidence: 67%

“…observed when this species is tested against drugs of this class [17]. (i) Molecular identification of C. parapsilosis (sensu lato) isolates by real time TaqMan® PCR assays.…”

Section: Análise Estatísticamentioning

confidence: 99%

Surto de candidemia por candida parapsilosis resistente ao fluconazol, em um hospital em Brasília : caracterização clínica, molecular e avaliação dos fatores associados

Pinhati¹

View full text Add to dashboard Cite

Introduction: Hematogenous candidiasis is an increasing problem in tertiary hospitals around the world, where there are large variations in incidence rates, mortality and agents involved. C. parapsilosis is the main species of non-albicans candida in many hospitals in Latin America, with a low resistance to various antifungal agents and lower mortality rates than C albicans. This is a report of the first outbreak of candidemia by fluconazole resistant C parapsilosis whose patients had mortality beyond the expected. Material and Methods:It is cross-sectional, observational study. We collect clinical and microbiological data of all candidemia episodes diagnosed from July/2011 to february/2012 in a tertiary hospital of 200 beds in Brasília. Initial identification and susceptibility testing were performed by the VITEK 2 -Bio-Mérieux system. Isolates of Candida parapsilosis Fluco-R were sent to reference laboratory (LEMI-UNIFESP) for confirmation of the identification by molecular typing and to antifungal resistance profile by CLSI microdilution test. Univariate (Chi Square and Fisher) and Multivariate analysis was performed to identify associated factors related to C parapsilosis fluconazole resistant (CPFR) infection. Results:We identified a total of 42 episodes of candidemia in the period, 15 in women. The median age was 72 years. The incidence of candidemia in the period was 4.05 per 1000 admissions, 30 cases (71.4%) by Candida parapsilosis, 23 of which (54.8%) were resistant to fluconazole (MIC50% = 16mcg/ml). 95.2% of patients were in the ICU at the time of diagnosis of CPRF. Previous use of fluconazole occurred in only 21.7% of cases of candidemia CPFR . The only risk factor for infection founded for CPRF was diabetes. Overall mortality of candidemia was 45.2% and 43.5% for CPFR infection . INTRODUÇÃO ______________________________________________________ 14 (2) A mutação do gene ERG11, que codifica a enzima alvo 14α-esteroldimetilase, reduzindo a afinidade pelos azois. Esse mecanismo está associado à resistência intrínseca da C. krusei ao fluconazol.(3) A hiperexpressão da enzima alvo 14α-esterol-dimetilase alterada.(4) A mutação do gene ERG3, o qual gera um substituto ao ergosterol.Há um efeito aditivo das mutações descrita, ou seja, as CIM para fluconazol são maiores na medida em que se acrescentam mutações da bomba de efluxo e da afinidade à enzima alvo (46). parapsilosis, e nenhuma em 118 amostras de C. tropicalis (52). A CANDIDA PARAPSILOSISA partir do final dos anos 90 a incidência de isolados de Candida parapsilosis, tem dramaticamente aumentado. Esta já vem frequentemente sendo identificada como a segunda mais comum espécie de cândida de isolada na hemocultura na Overall mortality from candidemia was 45.2%, and mortality from episodes of FRCP infections was 43.5%. Conclusions:The clustering of incident cases in the ICU and the limited prior exposure of infected patients to fluconazole suggest horizontal transmission of FRCP. Accurate vigilant monitoring for new nosocomial strains of FRCP is ...

show abstract

“…This cost-effectiveness model was applied to a cohort of nonneutropenic patients at risk for IC. This population, referred to as the test population, was defined as inpatients with signs and symptoms sufficient to conduct a blood culture that had at least one risk factor for IC (12). Within this test population, we assumed the prevalence of IC was 3% for the baseline model (13).…”

Section: Methodsmentioning

confidence: 99%

Cost-Effectiveness Analysis of Multiplex PCR with Magnetic Resonance Detection versus Empiric or Blood Culture-Directed Therapy for Management of Suspected Candidemia

et al. 2016

View full text Add to dashboard Cite

c Candida bloodstream infections (BSI) are associated with significant morbidity, mortality, and increased health care costs. Early treatment is essential, because delayed therapy detrimentally impacts clinical outcomes. The FDA recently approved the first culture-independent direct molecular detection method for Candida BSIs (T2Candida). The speed and sensitivity of this assay give it the potential to improve patient care, but the reagents and instrumentation are expensive. We used an analytic decision tree model to compare the cost-effectiveness of T2Candida-directed antifungal therapy (T2DT) to that of either empirical therapy (ET) or blood culture-directed therapy (BCDT). The costs included those of T2Candida testing, antifungal treatment, and hospital length of stay. The effectiveness measure was survival status at hospital discharge. T2DT was less costly and more effective than BCDT but was less costly and less effective than ET with an echinocandin (incremental cost-effectiveness ratio, $111,084 per additional survivor). One-way sensitivity analyses demonstrated that the cost-effectiveness of T2DT was highly dependent on Candida BSI prevalence and the cost of antifungal therapy and T2Candida test reagents. The use of T2DT reduced the number of unnecessarily treated patients by 98% relative to that with ET. Reduced drug exposure might lessen the possibility of drug-related adverse events and may also prevent the development of antifungal resistance or emergence of drug-resistant Candida species. The greatest benefit of T2Candida appears to be the ability to confidently withhold or stop empirical antifungal therapy in low-to-moderate-risk patients who are unlikely to benefit from treatment. C andida spp. are the fourth leading cause of bloodstream infections (BSI) in hospitalized patients and the third most common cause of BSI in the intensive care unit (ICU) (1). These infections are not only prevalent but are also associated with significant morbidity, mortality, and increased heath care costs. Attributable mortality rates range from 5 to 71%, depending on the patient population (2). Early treatment of infected patients is critical, because delays in effective therapy significantly impact outcomes (3-5), but difficulties in making a microbiological diagnosis often contribute to delayed treatment.Blood culture is the current gold standard for diagnosing Candida BSI; however, culture is relatively insensitive and requires several days to complete. As a result of the limitations of culture, patients with risk factors for invasive candidiasis (IC) are often given immediate empirical antifungal therapy (6). Although empirical therapy reduces delays, it also subjects some patients to unnecessary treatment, which in turn increases expenses, may cause adverse side effects, and potentially contributes to the emergence of antifungal resistance (7-10). More rapid and sensitive diagnostic methods are needed for the early and accurate diagnosis of Candida BSI.The U.S. Food and Drug Administration (FDA) recently approv...

show abstract

Improvement of a clinical prediction rule for clinical trials on prophylaxis for invasive candidiasis in the intensive care unit

Cited by 109 publications

References 16 publications

T2Candida MR as a predictor of outcome in patients with suspected invasive candidiasis starting empirical antifungal treatment: a prospective pilot study

T2Candida MR as a predictor of outcome in patients with suspected invasive candidiasis starting empirical antifungal treatment: a prospective pilot study

Surto de candidemia por candida parapsilosis resistente ao fluconazol, em um hospital em Brasília : caracterização clínica, molecular e avaliação dos fatores associados

Cost-Effectiveness Analysis of Multiplex PCR with Magnetic Resonance Detection versus Empiric or Blood Culture-Directed Therapy for Management of Suspected Candidemia

Contact Info

Product

Resources

About