1/25. trichosporon beigelii infection: experience in a regional burn center.trichosporon beigelii is a fungus once thought to cause only superficial infections, but recently has been increasingly identified as an opportunistic systemic pathogen in immunocompromised patients. There have been very limited reports of this organism in the burn patient population. We describe the first report of pharmacological management of invasive T. beigelii with a combination of amphotericin b and high dose fluconazole in a burn patient. Antifungal susceptibility testing of T. beigelii determined a change in minimum inhibitory concentrations (MICs) of amphotericin b and a consistent resistance pattern with the use of flucytosine. This paper will review our experience with T. beigelii fungus in a regional burn treatment center and review the literature on other experiences in the burn population.- - - - - - - - - - ranking = 1keywords = susceptibility (Clic here for more details about this article) |
2/25. Nosocomial cluster of Candida lipolytica fungemia in pediatric patients.Candida lipolytica has rarely been reported as a human pathogen. An apparent outbreak of Candida lipolytica fungemia (n = 5 cases) occurred in a pediatric ward over a 9-week period. The five patients infected were hospitalized in three adjacent rooms and cared for by the same healthcare workers. The index patient had central venous catheter-related fungemia, whereas the second patient, who was in the adjacent single room, had transient fungemia. Three additional cases of fungemia occurred in patients with hematological disorders who shared the same room; all three patients had central venous catheters and had been receiving oral fluconazole prophylaxis (50 mg/day for more than 3 weeks) at the time of infection. in vitro susceptibility testing of the strains showed that the MIC of fluconazole for all the isolates was 32 microg/ml. Random amplified polymorphic dna analysis provided evidence of the clonal origin of the isolates, but the source of the outbreak was not identified. All four patients with persistent fungemia were successfully treated via catheter removal or empiric amphotericin b treatment. This outbreak shows the potential for the nosocomial epidemic transmission of Candida lipolytica.- - - - - - - - - - ranking = 1keywords = susceptibility (Clic here for more details about this article) |
3/25. Clinical manifestations and molecular epidemiology of late recurrent candidemia, and implications for management.The aim of this study was to define the epidemiology and clinical manifestations of late recurrent candidemia. For this purpose, late recurrent candidemia was defined as an episode of candidemia occurring at least 1 month after the apparent complete resolution of an infectious episode caused by the same Candida sp. A total of five patients with recurrent candidemia were investigated. For all patients, isolates from the initial and recurrent episodes of candidemia were available for in vitro susceptibility testing and genetic characterization by dna-based techniques. The results revealed the following salient features: prolonged duration between the initial and recurrent episodes (range, 1-8 months); recurrence of candidemia despite anti-fungal therapy; importance of retained intravascular catheters, neutropenia, and corticosteroids as factors predisposing to recurrence; high morbidity and mortality; no emergence of antifungal drug resistance between the initial and recurrent episodes; and relapse of infection due to the original infecting strain, rather than reinfection with a new strain. These findings raise several issues about the management and follow-up of patients with candidemia, which require assessment in future studies.- - - - - - - - - - ranking = 1keywords = susceptibility (Clic here for more details about this article) |
4/25. Breakthrough candidaemias during empirical therapy with fluconazole in non-cancer and non-hiv adults caused by in vitro-susceptible Candida spp.: report of 33 cases.The objective of this study was to assess risk factors and the outcome of breakthrough fungaemias (BFs) occurring during fluconazole (FLU) therapy in non-cancer and non-hiv individuals. Thirty-three fungaemias occurring during therapy with FLU among a total of 310 fungaemias observed within a 10-y national survey were analysed. The agar disk diffusion method was used for antifungal susceptibility testing and the Vitek system for species identification. Univariate and multivariate analysis was performed to determine risk factors for BF. All BFs were due to species known to be susceptible to FLU: candida albicans (25/33), C. parapsilosis (6/33) and C. guillermondii (2/33). The mean number of positive blood cultures per episode was 2.4. The MIC of Candida spp. to FLU was 0.5-8 mg/ml (all strains were susceptible in vitro). Neonatal age (< 4 weeks), very low birth weight, prior surgery, central venous catheter placement, artificial ventilation, total parenteral nutrition and C. parapsilosis were significantly related to BF in univariate analysis, but only central venous catheter placement was significantly related in multivariate analysis. However, the outcome of BFs and non-BFs was similar. All BFs occurred in non-hiv patients who were not previously treated with azoles, and were caused by in vitro FLU-susceptible species (C. albicans and C. tropicalis). Thus factors other than in vitro susceptibility play a role in BFs.- - - - - - - - - - ranking = 2keywords = susceptibility (Clic here for more details about this article) |
5/25. Transient fungemia caused by an amphotericin b-resistant isolate of Candida haemulonii.A bloodstream infection due to Candida haemulonii afflicting a patient with fever and a medical history of megaloblastic anemia is reported. The clinical isolate was misidentified by the API 20C and VITEK identification systems. The results of susceptibility tests showed that the MIC of amphotericin b for C. haemulonii was 4 microg/ml. Additional susceptibility testing procedures based on the use of antibiotic medium 3 and Iso-Sensitest broth were performed, and killing curves were determined. Two collection strains of C. haemulonii were employed as controls. The three isolates exhibited resistance to amphotericin b in vitro regardless of the antifungal susceptibility testing method employed. In addition, the MICs of fluconazole for the three isolates were high. Further studies are needed in order to ascertain whether this species exhibits innate or acquired resistance to amphotericin b and other antifungal agents.- - - - - - - - - - ranking = 3keywords = susceptibility (Clic here for more details about this article) |
6/25. Two cases of fungemia due to Candida lusitaniae and a literature review.Reported here are two cases of candidemia caused by Candida lusitaniae that occurred in two immunocompromised patients at Hospital Universitario "La Fe" in Valencia, spain. Case 1 involved a low-birth-weight premature infant with congenital nephrotic syndrome who was successfully treated with amphotericin b, and case 2 involved a 50-year old woman with a high-grade malignancy lymphoma who succumbed to the infection. Antifungal susceptibility testing of the Candida lusitaniae isolates recovered from both patients revealed sensitivity to amphotericin, 5-flucytosine and fluconazole. Results are presented and discussed together with a comprehensive review of the literature, covering all previously reported cases of fungemia caused by this emerging pathogen.- - - - - - - - - - ranking = 1keywords = susceptibility (Clic here for more details about this article) |
7/25. Colony morphology switching of Candida lusitaniae and acquisition of multidrug resistance during treatment of a renal infection in a newborn: case report and review of the literature.Candida lusitaniae is an emerging opportunistic pathogen which exhibits an unusual antifungal susceptibility pattern. We describe a case of fatal renal infection due to C. lusitaniae in a very low birth weight neonate who was treated with short courses of fluconazole given alternately with amphotericin b. A colony morphology switching was detected on the standard primary culture medium by changes in colony size. Switching was shown to affect deeply the susceptibility to amphotericin b. Afterwards, the switched phenotype developed a cross resistance to fluconazole and itraconazole. Several issues raised by this case are discussed in the light of an extensive review of the literature. Our observations point out the importance of both the detection of colony morphology switching and the close monitoring of antifungal susceptibility in the management of infections due to C. lusitaniae. A judicious therapeutic strategy should prevent the acquisition of multidrug resistance during antifungal therapy.- - - - - - - - - - ranking = 3keywords = susceptibility (Clic here for more details about this article) |
8/25. Genotyping and antifungal susceptibility profile of dipodascus capitatus isolates causing disseminated infection in seven hematological patients of a tertiary hospital.Seven cases of disseminated infection due to dipodascus capitatus are reported. Infections occurred in a hematological unit of a tertiary hospital during a period of 5 years. Five cases were refractory to antifungal therapy. Antifungal susceptibility testing of seven isolates was performed, and strains were typed by PCR fingerprinting with the core sequence of phage M13 and by random amplification of polymorphic dna with two primers, Ap12h and W-80A. A very short range of MICs of each antifungal agent was observed. The MICs of amphotericin b ranged between 0.50 and 2 microg/ml. Strains were susceptible in vitro to flucytosine and susceptible (dose-dependent) to fluconazole and itraconazole. Voriconazole exhibited an activity in vitro comparable to that of itraconazole. Typing techniques allowed seven additional isolates of D. capitatus neither geographically nor temporally related to be classified into two different genomic patterns. The genomic type of the seven strains from the hematological unit was identical regardless of typing technique utilized. It would indicate that the seven cases of disseminated infection could be related epidemiologically.- - - - - - - - - - ranking = 5keywords = susceptibility (Clic here for more details about this article) |
9/25. fungemia caused by Zygoascus hellenicus in an allogeneic stem cell transplant recipient.Zygoascus hellenicus (Candida hellenica) was isolated from a blood culture from a patient who had received an allogeneic stem cell transplant. The isolate displayed an antifungal susceptibility pattern of decreased susceptibility to fluconazole and itraconazole, high susceptibility to voriconazole, and low susceptibility to caspofungin. The organism was misidentified by a commercial yeast identification system. This is the first reported case of human infection with this rare ascomycetous yeast.- - - - - - - - - - ranking = 4keywords = susceptibility (Clic here for more details about this article) |
10/25. Nonmycetomic Actinomadura madurae infection in a patient with AIDS.Actinomadura madurae is an aerobic actinomycete which is best known worldwide as the cause of actinomycotic mycetomas. It has not previously been reported to have caused invasive pulmonary or disseminated infection in humans. We describe an AIDS patient with opportunistic A. madurae-induced pneumonia and bacteremia. The isolate from the patient's blood was subjected to dilutional antimicrobial susceptibility tests with 12 antimicrobial agents and was found to have a wide spectrum of susceptibility. This unusual microorganism may be a cause of infections in severely immunosuppressed patients.- - - - - - - - - - ranking = 2keywords = susceptibility (Clic here for more details about this article) |
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