RESUMO
Se presenta el primer caso de fungemia por una especie de Candida relacionada con Candida pseudorugosa. La identificación de las especies de levaduras es de importancia a nivel epidemiológico y para el tratamiento de los pacientes que cursan una infección por levaduras.
Assuntos
Humanos , Feminino , Pessoa de Meia-Idade , Candida/classificação , Candida/patogenicidade , Fungemia/complicações , Fungemia/diagnóstico , Fungemia/terapia , Leveduras/classificação , Leveduras/patogenicidadeRESUMO
Se presenta el primer caso de fungemia por una especie de Candida relacionada con Candida pseudorugosa. La identificación de las especies de levaduras es de importancia a nivel epidemiológico y para el tratamiento de los pacientes que cursan una infección por levaduras. (AU)
Assuntos
Humanos , Feminino , Pessoa de Meia-Idade , Fungemia/complicações , Fungemia/diagnóstico , Fungemia/terapia , Candida/classificação , Candida/patogenicidade , Leveduras/classificação , Leveduras/patogenicidadeRESUMO
BACKGROUND: Patients with candidemia frequently have a central venous catheter (CVC) in place, and its early removal is considered the standard of care. METHODS: We performed a subgroup analysis of 2 phase III, multicenter, double-blind, randomized, controlled trials of candidemia to examine the effects of early CVC removal (within 24 or 48 h after treatment initiation) on the outcomes of 842 patients with candidemia. Inclusion criteria were candidemia, age >16 years, CVC at diagnosis, and receipt of 1 dose of the study drug. Six outcomes were evaluated: treatment success, rates of persistent and recurrent candidemia, time to mycological eradication, and survival at 28 and 42 days. Univariate and multivariate analyses were performed, controlling for potential confounders. RESULTS: In univariate analysis, early CVC removal did not improve time to mycological eradication or rates of persistent or recurrent candidemia but was associated with better treatment success and survival. These benefits were lost in multivariate analysis, which failed to show any beneficial effect of early CVC removal on all 6 outcomes and identified Acute Physiology and Chronic Health Evaluation II score, older age, and persistent neutropenia as the most significant variables. Our findings were consistent across all outcomes and time points (removal within 24 or 48 h and survival at 28 and 42 days). The median time to eradication of candidemia was similar between the 2 study groups. CONCLUSIONS: In this cohort of 842 adults with candidemia followed up prospectively, early CVC removal was not associated with any clinical benefit. These findings suggest an evidence-based re-evaluation of current treatment recommendations.
Assuntos
Antifúngicos/uso terapêutico , Candidíase/tratamento farmacológico , Candidíase/terapia , Infecções Relacionadas a Cateter/tratamento farmacológico , Infecções Relacionadas a Cateter/terapia , Fungemia/tratamento farmacológico , Fungemia/terapia , Adulto , Idoso , Idoso de 80 Anos ou mais , Sangue/microbiologia , Método Duplo-Cego , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Análise de Sobrevida , Fatores de Tempo , Resultado do TratamentoRESUMO
Foi realizado um estudo para verificar a ocorrência de leveduras do gênero Rhodotorula, em hemocultura por um período de 8 anos. Os pacientes identificados foram descritos clinicamente segundo variáveis de interesse incluindo dados sobre terapêutica e desfecho. Determinou-se também as concentrações inibitórias mínimas de 20 cepas frente a diferentes antifúngicos de acordo com NCCLS e EUCAST. Realizou-se tipagem molecular através da cariotipagem eletroforética em campo pulsátil.
A study was conducted to verify the frequency of occurrence of Rhodotorula spp. from blood cultures over an 8-year period, clinically and microbiologically characterizing patients affected, including data regarding antifungal treatment and outcome. The minimal inhibitory concentrations of antifungal agents were determined against 20 isolates. Molecular typing of the strains were performed using pulsed field gel electrophoresis method.