Treatment of<i>Scedosporium apiospermum</i>Brain Abscesses with Posaconazole

Mellinghoff, Ingo K.; Winston, Drew J.; Mukwaya, Geoffrey; Schiller, Gary J.

doi:10.1086/340522

Cited by 119 publications

(66 citation statements)

References 17 publications

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“…apiospermum is generally considered to be resistant to amphotericin B, to which its clinical response is very poor (3), whereas both posaconazole and voriconazole have successfully been used for the treatment of central nervous system abscesses (57,58). MICs for posaconazole ranged from 0.5 to 2 g/ml and for voriconazole from 0.12 to 1 g/ml against the 4 S. apiospermum isolates in the present study (see the supplemental material).…”

Section: Different Laboratories (2003 To 2007 At the University Of Iomentioning

confidence: 63%

Echinocandin and Triazole Antifungal Susceptibility Profiles for Clinical Opportunistic Yeast and Mold Isolates Collected from 2010 to 2011: Application of New CLSI Clinical Breakpoints and Epidemiological Cutoff Values for Characterization of Geographic and Temporal Trends of Antifungal Resistance

et al. 2013

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The SENTRY Antimicrobial Surveillance Program monitors global susceptibility and resistance rates of newer and established antifungal agents. We report the echinocandin and triazole antifungal susceptibility patterns for 3,418 contemporary clinical isolates of yeasts and molds. The isolates were obtained from 98 laboratories in 34 countries during 2010 and 2011. Yeasts not presumptively identified by CHROMagar, the trehalose test, or growth at 42°C and all molds were sequence identified using internal transcribed spacer (ITS) and 28S (yeasts) or ITS, translation elongation factor (TEF), and 28S (molds) genes. Susceptibility testing was performed against 7 antifungals (anidulafungin, caspofungin, micafungin, fluconazole, itraconazole, posaconazole, and voriconazole) using CLSI methods. Rates of resistance to all agents were determined using the new CLSI clinical breakpoints and epidemiological cutoff value criteria, as appropriate. Sequencing of fks hot spots was performed for echinocandin non-wildtype (WT) strains. Isolates included 3,107 from 21 Candida spp., 146 from 9 Aspergillus spp., 84 from Cryptococcus neoformans, 40 from 23 other mold species, and 41 from 9 other yeast species. Among Candida spp., resistance to the echinocandins was low (0.0 to 1.7%). Candida albicans and Candida glabrata that were resistant to anidulafungin, caspofungin, or micafungin were shown to have fks mutations. Resistance to fluconazole was low among the isolates of C. albicans (0.4%), Candida tropicalis (1.3%), and Candida parapsilosis (2.1%); however, 8.8% of C. glabrata isolates were resistant to fluconazole. Among echinocandin-resistant C. glabrata isolates from 2011, 38% were fluconazole resistant. Voriconazole was active against all Candida spp. except C. glabrata (10.5% non-WT), whereas posaconazole showed decreased activity against C. albicans (4.4%) and Candida krusei (15.2% non-WT). All agents except for the echinocandins were active against C. neoformans, and the triazoles were active against other yeasts (MIC 90 , 2 g/ml). The echinocandins and triazoles were active against Aspergillus spp. (MIC 90 /minimum effective concentration [MEC 90 ] range, 0.015 to 2 g/ml), but the echinocandins were not active against other molds (MEC 90 range, 4 to >16 g/ml). Overall, echinocandin and triazole resistance rates were low; however, the fluconazole and echinocandin coresistance among C. glabrata strains warrants continued close surveillance.

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Section: Different Laboratories (2003 To 2007 At the University Of Iomentioning

confidence: 63%

Echinocandin and Triazole Antifungal Susceptibility Profiles for Clinical Opportunistic Yeast and Mold Isolates Collected from 2010 to 2011: Application of New CLSI Clinical Breakpoints and Epidemiological Cutoff Values for Characterization of Geographic and Temporal Trends of Antifungal Resistance

et al. 2013

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“…S. apiospermum is a well-known cause of mycetoma and may cause deep-seated infections (e.g., central nervous system [CNS] abscesses) and disseminated infection in BMT recipients and other neutropenic, immunosuppressed individuals (61,70). This organism is generally considered resistant to amphotericin B, the MICs of which are elevated (Table 4) and to which the clinical response is very poor, despite the use of high doses (106).…”

Section: Downloaded Frommentioning

confidence: 99%

“…This organism is generally considered resistant to amphotericin B, the MICs of which are elevated (Table 4) and to which the clinical response is very poor, despite the use of high doses (106). The extended-spectrum triazoles are active in vitro against S. apiospermum, and both posaconazole and voriconazole have successfully been used for the treatment of CNS abscesses (61,70). In addition to antifungal therapy, restoration of immune competence is essential for survival in these often fatal infections (106).…”

Section: Downloaded Frommentioning

confidence: 99%

Rare and Emerging Opportunistic Fungal Pathogens: Concern for Resistance beyondCandida albicansandAspergillus fumigatus

Pfaller

Diekema²

2004

J Clin Microbiol

652

513

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“…It appears that few antifungal agents have consistent activity against S. prolificans but, due to general amphotericin B resistance, the extended-spectrum triazoles such as voriconazole or posaconazole may become the agents of choice for S. prolificans infections. There are a growing number of anecdotal successes with newer agents against disseminated scedosporiosis (18,27,41,(43)(44)(45)57). However, some case reports are confounded by adjunctive surgical management and varying recovery of host defenses (40).…”

mentioning

confidence: 99%

Scedosporium prolificans Osteomyelitis in an Immunocompetent Child Treated with Voriconazole and Caspofungin, as Well as Locally Applied Polyhexamethylene Biguanide

et al. 2003

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Scedosporium species are increasingly isolated from immunocompromised and immunocompetent patients. Unfortunately, Scedosporium infections are generally resistant to amphotericin B, and Scedosporium prolificans strains are particularly resistant to the antifungal agents now in use. We report here on an immunocompetent child with S. prolificans-associated osteomyelitis successfully treated with debridement, local irrigation with polyhexamethylene biguanide, and the systemic administration of voriconazole and caspofungin despite poor in vitro activity of voriconazole alone against the isolate. We also review the treatments and outcomes of 28 reported cases of osteomyelitis or septic arthritis caused by Scedosporium species in immunocompetent patients.

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Treatment ofScedosporium apiospermumBrain Abscesses with Posaconazole

Cited by 119 publications

References 17 publications

Echinocandin and Triazole Antifungal Susceptibility Profiles for Clinical Opportunistic Yeast and Mold Isolates Collected from 2010 to 2011: Application of New CLSI Clinical Breakpoints and Epidemiological Cutoff Values for Characterization of Geographic and Temporal Trends of Antifungal Resistance

Echinocandin and Triazole Antifungal Susceptibility Profiles for Clinical Opportunistic Yeast and Mold Isolates Collected from 2010 to 2011: Application of New CLSI Clinical Breakpoints and Epidemiological Cutoff Values for Characterization of Geographic and Temporal Trends of Antifungal Resistance

Rare and Emerging Opportunistic Fungal Pathogens: Concern for Resistance beyondCandida albicansandAspergillus fumigatus

Scedosporium prolificans Osteomyelitis in an Immunocompetent Child Treated with Voriconazole and Caspofungin, as Well as Locally Applied Polyhexamethylene Biguanide

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