RESUMO
The study presented here was performed in order to create a rule that identifies subjects at high risk for invasive candidiasis in the intensive care setting. Retrospective review and statistical modelling were carried out on 2,890 patients who stayed at least 4 days in nine hospitals in the USA and Brazil; the overall incidence of invasive candidiasis in this group was 3% (88 cases). The best performing rule was as follows: Any systemic antibiotic (days 1-3) OR presence of a central venous catheter (days 1-3) AND at least TWO of the following-total parenteral nutrition (days 1-3), any dialysis (days 1-3), any major surgery (days -7-0), pancreatitis (days -7-0), any use of steroids (days -7-3), or use of other immunosuppressive agents (days -7-0). The rate of invasive candidiasis among patients meeting the rule was 9.9%, capturing 34% of cases in the units, with the following performance: relative risk 4.36, sensitivity 0.34, specificity 0.90, positive predictive value 0.01, and negative predictive value 0.97. The rule may identify patients at high risk of invasive candidiasis.
Assuntos
Candidíase/epidemiologia , Infecção Hospitalar/epidemiologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Brasil/epidemiologia , Candidíase/diagnóstico , Candidíase/microbiologia , Infecção Hospitalar/diagnóstico , Infecção Hospitalar/microbiologia , Feminino , Humanos , Unidades de Terapia Intensiva , Masculino , Pessoa de Meia-Idade , Modelos Estatísticos , Valor Preditivo dos Testes , Reprodutibilidade dos Testes , Estudos Retrospectivos , Fatores de Risco , Sensibilidade e Especificidade , Estados Unidos/epidemiologiaRESUMO
The isolation and structure determination of a new chlorinated benzophenone antibiotic, pestalone (1), is described. The new compound was produced by a cultured marine fungus only when a unicellular marine bacterium, strain CNJ-328, was co-cultured in the fungal fermentation. The fungus, isolated from the surface of the brown alga Rosenvingea sp. collected in the Bahamas Islands, was identified as an undescribed member of the genus Pestalotia. The structure of 1, initially assigned with only modest confidence by combined spectral and chemical data, was confirmed by single-crystal X-ray analysis. Pestalone (1) exhibits moderate in vitro cytotoxicity in the National Cancer Institute's 60 human tumor cell line screen (mean GI(50) = 6.0 microM). More importantly, pestalone shows potent antibiotic activity against methicillin-resistant Staphylococcus aureus (MIC = 37 ng/mL) and vancomycin-resistant Enterococcus faecium (MIC = 78 ng/mL), indicating that pestalone should be evaluated in advanced models of infectious disease.
Assuntos
Antibacterianos/isolamento & purificação , Antibióticos Antineoplásicos/isolamento & purificação , Benzofenonas/isolamento & purificação , Fungos Mitospóricos/química , Antibacterianos/química , Antibacterianos/farmacologia , Antibióticos Antineoplásicos/química , Antibióticos Antineoplásicos/farmacologia , Bahamas , Benzofenonas/química , Benzofenonas/farmacologia , Cromatografia Líquida de Alta Pressão , Cristalografia por Raios X , Avaliação Pré-Clínica de Medicamentos , Enterococcus faecium/metabolismo , Resistência a Meticilina , Estrutura Molecular , Ressonância Magnética Nuclear Biomolecular , Phaeophyceae , Espectrofotometria Ultravioleta , Staphylococcus aureus/metabolismo , Células Tumorais Cultivadas/efeitos dos fármacos , Resistência a VancomicinaRESUMO
A symposium was held on May 8, 2000 to discuss the management of deep infections with Candida species. Among the findings discussed were the following. Candiduria is most often benign, though it occurs in patients with serious underlying diseases. Candida species are now the fourth most common cause of nosocomial bloodstream infections, usually arising from an intravenous catheter. Candida albicans represents only 50-60% of the isolates. There has been no change in the frequency of fluconazole resistance in C. albicans but some of the other species now being isolated from blood are constitutively more resistant to this drug. Nevertheless, for most non-neutropenic patients with candidemia, fluconazole is a reasonable choice for initial therapy. In the neutropenic patient, candidemia is now uncommon. Deep candida infections in neutropenic patients are usually being treated empirically with an amphotericin B formulation. Hepatosplenic candidiasis is usually detected only after recovery from neutropenia but can be suspected by imaging techniques. Improved diagnostic techniques for deep candidiasis in the neutropenic patient remain a critical requirement.
Assuntos
Candida , Candidíase , Fungemia , Neutropenia/complicações , Antifúngicos/uso terapêutico , Candida/crescimento & desenvolvimento , Candida/isolamento & purificação , Candida/patogenicidade , Candidíase/diagnóstico , Candidíase/tratamento farmacológico , Candidíase/epidemiologia , Candidíase/microbiologia , Fungemia/diagnóstico , Fungemia/tratamento farmacológico , Fungemia/epidemiologia , Fungemia/microbiologia , Humanos , Agências Internacionais , Infecções Urinárias/diagnóstico , Infecções Urinárias/microbiologiaRESUMO
PIP: This article describes an adolescent, peer-education training program in Jamaica that was developed and operated by the Red Cross Societies of Jamaica and the US and was funded by AIDSCAP. The program aimed to develop a training system to prepare youth peer educators in preventing the spread of HIV infections and sexually transmitted diseases. The goal was to increase knowledge about, change attitudes toward, and develop prevention skills for HIV/AIDS. The initial program was to be replicated on a large scale and be sustainable over time. The program was developed in response to the 1500+ Jamaicans diagnosed with AIDS and the 20,000 or so with HIV infections. Transmission is mostly heterosexual. 15% of girls and 47% of boys are sexually active by 14 years of age, and almost 50% of syphilis and gonorrhea cases are among adolescents. The national training program relies on peer educators, aged 14-19 years, who are literate to the 6th-grade level. Training sessions are conducted for 10-21 persons/session for 27 hours over 3 weekends. Training relies on engaging games and activities. Trainees are taught how to facilitate 14 specific activities, including the correct way to use a condom. Peer educators work together in groups of twos or threes among groups of 10-15 adolescents, aged 10-15 years. By the third year of operation, most of the systems and materials were in place and the program expanded; cost-benefit analysis revealed that costs were returned. The program has continued with a variety of funds and delivery systems and new funding will likely shift the program emphasis. The program has survived with the enthusiasm and support of the trainers. Other start-up programs should ensure the involvement of youth at all stages of development.^ieng
Assuntos
Adolescente , Infecções por HIV , Educação em Saúde , Grupo Associado , Avaliação de Programas e Projetos de Saúde , Educação Sexual , Infecções Sexualmente Transmissíveis , Ensino , Fatores Etários , América , Região do Caribe , Comunicação , Demografia , Países em Desenvolvimento , Doença , Educação , Conhecimentos, Atitudes e Prática em Saúde , Infecções , Jamaica , América do Norte , Organização e Administração , População , Características da População , VirosesRESUMO
Although single-dose amphotericin B therapy appears to be immunostimulatory in mice, no data are available regarding the effects of chronic anti-fungal drug therapy on the immune system. We studied the effects on the guinea-pig cellular immune system of 4 weeks of treatment with amphotericin B, 5-fluorocytosine, or the combination of both drugs. The in vitro lymphocyte response to phytohaemagglutinin and the specific antigen, picryl human serum albumin (picHSA), were not affected by anti-fungal drug treatment. At 1.5 weeks of therapy with amphotericin B, skin test reactivity to picHSA was significantly reduced but returned toward normal by the end of 3.5 weeks of drug therapy. Macrophage migration inhibitory factor production by guinea-pig peripheral blood lymphocytes was significantly reduced after 4 weeks of amphotericin B therapy. No immunostimulatory properties could be ascribed to amphotericin B. 5-fluorocytosine had no effect on cellular immunity.