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Svidzinski, Terezinha Inez Estivalet
Texto completo
[PMID]:29262785
[Au] Autor:da Silva EM; Mansano ESB; Miazima ES; Rodrigues FAV; Hernandes L; Svidzinski TIE
[Ad] Endereço:Department of Medical Mycology, State University of Maringá, Av. Colombo, 5760, C.P, Maringá, PR, 87020-900, Brazil.
[Ti] Título:Radiation used for head and neck cancer increases virulence in Candida tropicalis isolated from a cancer patient.
[So] Source:BMC Infect Dis;17(1):783, 2017 Dec 20.
[Is] ISSN:1471-2334
[Cp] País de publicação:England
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: Studies have shown that radiation from radiotherapy increases the yeast colonization of patients. However it is not clear, if such radiation alters the yeast itself. The aim of the present study was therefore to report the direct impact of gamma radiation on Candida tropicalis. METHODS: C. tropicalis was obtained from a patient with a carcinoma, a suspension of this yeast containing 2.0 × 10 colony forming units per milliliter was prepared. It was submitted to gamma radiation dosage similar to that used in the treatment of head and neck cancer. After a cumulative dose of 7200 cGy some virulence attributes of C. tropicalis, including macro and micromorphological characteristics, adhesion and biofilm abilities, murine experimental infection and phagocytosis resistance were evaluated on irradiated and non-irradiated yeasts. RESULTS: After irradiation the colony morphology of the yeast was altered from a ring format to a smooth appearance in most colonies. Scanning electron microscopy revealed notable differences in the structures of both these colonies and the yeast cells, with the loss of pseudohyphae following irradiation and an increase in extracellular matrix production. The adherence and biofilm production of the yeast was greater following irradiation, both in terms of the number of yeasts and total biomass production on several abiotic surfaces and TR146 cells. The phagocytic index of the irradiated yeasts was not statistically different; however, the presence of cellular debris was detected in the kidneys of infected animals. Mice infected with irradiated yeasts developed an infection at the site of the yeast inoculation, although systemic infection was unchanged. CONCLUSIONS: Our findings show for the first time that C. tropicalis, one of the most important yeasts from colonization, which cause fatal candidemia in cancer patients, is affected by gamma irradiation, with changes to its virulence profile.
[Mh] Termos MeSH primário: Candida tropicalis
Candidíase Invasiva
Neoplasias de Cabeça e Pescoço
Radioterapia/efeitos adversos
Virulência/efeitos da radiação
[Mh] Termos MeSH secundário: Biofilmes
Candida tropicalis/patogenicidade
Candida tropicalis/efeitos da radiação
Neoplasias de Cabeça e Pescoço/complicações
Neoplasias de Cabeça e Pescoço/radioterapia
Seres Humanos
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1803
[Cu] Atualização por classe:180309
[Lr] Data última revisão:
180309
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:171222
[St] Status:MEDLINE
[do] DOI:10.1186/s12879-017-2879-6


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Registro de Ensaios Clínicos
Registro de Ensaios Clínicos
Registro de Ensaios Clínicos
Registro de Ensaios Clínicos
Registro de Ensaios Clínicos
Registro de Ensaios Clínicos
Texto completo
[PMID]:28459966
[Au] Autor:Kullberg BJ; Vasquez J; Mootsikapun P; Nucci M; Paiva JA; Garbino J; Yan JL; Aram J; Capparella MR; Conte U; Schlamm H; Swanson R; Herbrecht R
[Ad] Endereço:Department of Medicine and Radboud Center for Infectious Diseases, Radboud University Medical Center, PO Box 9101, Geert Grooteplein 8, 6525 GA Nijmegen, The Netherlands.
[Ti] Título:Efficacy of anidulafungin in 539 patients with invasive candidiasis: a patient-level pooled analysis of six clinical trials.
[So] Source:J Antimicrob Chemother;72(8):2368-2377, 2017 Aug 01.
[Is] ISSN:1460-2091
[Cp] País de publicação:England
[La] Idioma:eng
[Ab] Resumo:Objectives: To evaluate the efficacy of anidulafungin for the treatment of candidaemia and invasive candidiasis in a large dataset, including patients with deep-seated tissue candidiasis, neutropenia and infection due to non- albicans Candida species. Methods: Data were pooled from six prospective, multicentre, multinational studies: four open-label, non-comparative studies of anidulafungin and two double-blind, double-dummy, randomized studies of anidulafungin versus caspofungin (clinical trial registrations: NCT00496197, NCT00548262, NCT00537329, NCT00689338, NCT00806351 and NCT00805740; ClinicalTrials.gov). In all studies, patients with culture-confirmed invasive candidiasis received a single intravenous (iv) loading dose of anidulafungin 200 mg on day 1, followed by 100 mg once-daily. Switch to oral fluconazole or voriconazole was permitted after 5-10 days of iv treatment in all studies except one. Antifungal treatment (iv plus oral therapy if applicable) was maintained for ≥14 days after the last positive Candida culture. The primary endpoint was successful global response at end of iv therapy (EOivT) in the modified ITT (mITT) population. Results: In total, 539 patients were included (mITT population). The most common baseline Candida species were Candida albicans (47.9%), Candida glabrata (21.0%), Candida tropicalis (13.7%), Candida parapsilosis (13.2%) and Candida krusei (3.5%). Median duration of anidulafungin iv treatment was 10.0 days. The global response success rate at EOivT was 76.4% (95% CI 72.9%-80.0%). All-cause mortality was 13.0% on day 14 and 19.1% on day 28. Adverse events (AEs) were consistent with the known AE profile for anidulafungin. Conclusions: These data demonstrate that anidulafungin is effective for treatment of candidaemia and invasive candidiasis in a broad patient population.
[Mh] Termos MeSH primário: Antifúngicos/administração & dosagem
Candidíase Invasiva/tratamento farmacológico
Equinocandinas/administração & dosagem
[Mh] Termos MeSH secundário: Administração Intravenosa
Adolescente
Adulto
Idoso
Idoso de 80 Anos ou mais
Ensaios Clínicos como Assunto
Feminino
Seres Humanos
Masculino
Meia-Idade
Resultado do Tratamento
Adulto Jovem
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Nm] Nome de substância:
0 (Antifungal Agents); 0 (Echinocandins); 9HLM53094I (anidulafungin)
[Em] Mês de entrada:1801
[Cu] Atualização por classe:180308
[Lr] Data última revisão:
180308
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170502
[Cl] Clinical Trial:ClinicalTrial
[St] Status:MEDLINE
[do] DOI:10.1093/jac/dkx116


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[PMID]:29049184
[Au] Autor:Yang Y; Guo F; Kang Y; Zang B; Cui W; Qin B; Qin Y; Fang Q; Qin T; Jiang D; Cai B; Li R; Qiu H; China-SCAN Team
[Ad] Endereço:aNanjing Zhongda Hospital, Southeastern University School of Medicine, Nanjing bWest China Hospital of Sichuan University, Chengdu cShengjing Hospital of China Medical University, Shenyang dThe Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou eHenan Provincial People's Hospital, Zhengzhou fTianjin Third Central Hospital, Tianjin gThe First Affiliated Hospital of Medical School of Zhejiang University, Hangzhou hGuangdong General Hospital, Guangzhou iDaping Hospital, Chongqing jMSD (China) Holding Co., Ltd. kResearch Center for Medical Mycology, Peking University First Hospital, Peking University, Beijing, China.
[Ti] Título:Epidemiology, clinical characteristics, and risk factors for mortality of early- and late-onset invasive candidiasis in intensive care units in China.
[So] Source:Medicine (Baltimore);96(42):e7830, 2017 Oct.
[Is] ISSN:1536-5964
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:To identify the epidemiology, treatments, outcomes, and risk factors for patients with early- or late-onset invasive candidiasis (EOIC or LOIC) in intensive care units in China.Patients were classified as EOIC (≤10 days) or LOIC (>10 days) according to the time from hospital admission to IC onset to identify distinct clinical characteristics.There were 105 EOIC cases and 201 LOIC cases in this study. EOIC was related to more severe clinical conditions at ICU admission or prior to IC. Significantly, more cases of Candida parapsilosis infection were found in patients with LOIC than in those with EOIC. The mortality of EOIC was significantly lower than that for LOIC. Sequential Organ Failure Assessment (SOFA) score at ICI diagnosis in the EOIC group and the interval from ICU admission to ICI occurrence in the LOIC group were identified as risk factors for mortality. Susceptibility to the first-line agent was associated with a lower risk of mortality in the LOIC group.The mortality rate was significantly lower in the EOIC group, and there were more cases of non-albicans infection in the LOIC group. Susceptibility to the first-line agent was an important predictor of mortality in the LOIC group. SOFA score at ICI diagnosis in the EOIC group and interval from ICU admission to ICI occurrence in the LOIC group were identified as risk factors for mortality.
[Mh] Termos MeSH primário: Candida
Candidíase Invasiva/mortalidade
Infecção Hospitalar/mortalidade
Mortalidade Hospitalar
Unidades de Terapia Intensiva/estatística & dados numéricos
[Mh] Termos MeSH secundário: Adulto
Idoso
Candidíase Invasiva/microbiologia
Candidíase Invasiva/patologia
China/epidemiologia
Infecção Hospitalar/microbiologia
Infecção Hospitalar/patologia
Feminino
Seres Humanos
Masculino
Meia-Idade
Escores de Disfunção Orgânica
Fatores de Risco
Fatores de Tempo
[Pt] Tipo de publicação:JOURNAL ARTICLE; MULTICENTER STUDY; OBSERVATIONAL STUDY
[Em] Mês de entrada:1710
[Cu] Atualização por classe:171122
[Lr] Data última revisão:
171122
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:171020
[St] Status:MEDLINE
[do] DOI:10.1097/MD.0000000000007830


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[PMID]:28911043
[Au] Autor:Arendrup MC; Patterson TF
[Ad] Endereço:Unit of Mycology, Statens Serum Institut.
[Ti] Título:Multidrug-Resistant Candida: Epidemiology, Molecular Mechanisms, and Treatment.
[So] Source:J Infect Dis;216(suppl_3):S445-S451, 2017 Aug 15.
[Is] ISSN:1537-6613
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:Invasive Candida infections remain an important cause of morbidity and mortality, especially in hospitalized and immunocompromised or critically ill patients. A limited number of antifungal agents from only a few drug classes are available to treat patients with these serious infections. Resistance can be either intrinsic or acquired. Resistance mechanisms are not exchanged between Candida; thus, acquired resistance either emerges in response to an antifungal selection pressure in the individual patient or, more rarely, occur due to horizontal transmission of resistant strains between patients. Although multidrug resistance is uncommon, increasing reports of multidrug resistance to the azoles, echinocandins, and polyenes have occurred in several Candida species, most notably Candida glabrata and more recently Candida auris. Drivers are overall antifungal use, subtherapeutic drug levels at sites of infection/colonization, drug sequestration in the biofilm matrix, and, in the setting of outbreaks, suboptimal infection control. Moreover, recent research suggests that DNA mismatch repair gene mutations may facilitate acquisition of resistance mutations in C. glabrata specifically. Diagnosis of antifungal-resistant Candida infections is critical to the successful management of patients with these infections. Reduction of unnecessary use of antifungals via antifungal stewardship is critical to limit multidrug resistance emergence.
[Mh] Termos MeSH primário: Candida glabrata/efeitos dos fármacos
Candida/efeitos dos fármacos
Candidíase Invasiva/tratamento farmacológico
Farmacorresistência Fúngica Múltipla
[Mh] Termos MeSH secundário: Animais
Antifúngicos/farmacologia
Azóis/farmacologia
Candida/classificação
Candidíase Invasiva/epidemiologia
Estado Terminal/epidemiologia
Estado Terminal/terapia
Modelos Animais de Doenças
Equinocandinas/farmacologia
Seres Humanos
Testes de Sensibilidade Microbiana
[Pt] Tipo de publicação:JOURNAL ARTICLE; REVIEW
[Nm] Nome de substância:
0 (Antifungal Agents); 0 (Azoles); 0 (Echinocandins)
[Em] Mês de entrada:1709
[Cu] Atualização por classe:170921
[Lr] Data última revisão:
170921
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:170916
[St] Status:MEDLINE
[do] DOI:10.1093/infdis/jix131


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[PMID]:28693479
[Au] Autor:Ou HT; Lee TY; Chen YC; Charbonneau C
[Ad] Endereço:Institute of Clinical Pharmacy and Pharmaceutical Sciences, College of Medicine, National Cheng Kung University, Tainan, Taiwan. huangtz@mail.ncku.edu.tw.
[Ti] Título:Pharmacoeconomic analysis of antifungal therapy for primary treatment of invasive candidiasis caused by Candida albicans and non-albicans Candida species.
[So] Source:BMC Infect Dis;17(1):481, 2017 Jul 10.
[Is] ISSN:1471-2334
[Cp] País de publicação:England
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: Cost-effectiveness studies of echinocandins for the treatment of invasive candidiasis, including candidemia, are rare in Asia. No study has determined whether echinocandins are cost-effective for both Candida albicans and non-albicans Candida species. There have been no economic evaluations that compare non-echinocandins with the three available echinocandins. This study was aimed to assess the cost-effectiveness of individual echinocandins, namely caspofungin, micafungin, and anidulafungin, versus non-echinocandins for C. albicans and non-albicans Candida species, respectively. METHODS: A decision tree model was constructed to assess the cost-effectiveness of echinocandins and non-echinocandins for invasive candidiasis. The probability of treatment success, mortality rate, and adverse drug events were extracted from published clinical trials. The cost variables (i.e., drug acquisition) were based on Taiwan's healthcare system from the perspective of a medical payer. One-way sensitivity analyses and probability sensitivity analyses were conducted. RESULTS: For treating invasive candidiasis (all species), as compared to fluconazole, micafungin and caspofungin are dominated (less effective, more expensive), whereas anidulafungin is cost-effective (more effective, more expensive), costing US$3666.09 for each life-year gained, which was below the implicit threshold of the incremental cost-effectiveness ratio in Taiwan. For C. albicans, echinocandins are cost-saving as compared to non-echinocandins. For non-albicans Candida species, echinocandins are cost-effective as compared to non-echinocandins, costing US$652 for each life-year gained. The results were robust over a wide range of sensitivity analyses and were most sensitive to the clinical efficacy of antifungal treatment. CONCLUSIONS: Echinocandins, especially anidulafungin, appear to be cost-effective for invasive candidiasis caused by C. albicans and non-albicans Candida species in Taiwan.
[Mh] Termos MeSH primário: Antifúngicos/economia
Antifúngicos/uso terapêutico
Candidíase Invasiva/tratamento farmacológico
[Mh] Termos MeSH secundário: Candida/efeitos dos fármacos
Candida/patogenicidade
Candida albicans/efeitos dos fármacos
Candida albicans/patogenicidade
Candidemia/tratamento farmacológico
Candidemia/economia
Candidemia/mortalidade
Candidíase Invasiva/economia
Candidíase Invasiva/mortalidade
Análise Custo-Benefício
Equinocandinas/economia
Equinocandinas/uso terapêutico
Farmacoeconomia
Fluconazol/economia
Fluconazol/uso terapêutico
Seres Humanos
Lipopeptídeos/economia
Lipopeptídeos/uso terapêutico
Taiwan
Resultado do Tratamento
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Nm] Nome de substância:
0 (Antifungal Agents); 0 (Echinocandins); 0 (Lipopeptides); 8VZV102JFY (Fluconazole); 9HLM53094I (anidulafungin); F0XDI6ZL63 (caspofungin); R10H71BSWG (micafungin)
[Em] Mês de entrada:1710
[Cu] Atualização por classe:171010
[Lr] Data última revisão:
171010
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170712
[St] Status:MEDLINE
[do] DOI:10.1186/s12879-017-2573-8


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[PMID]:28617137
[Au] Autor:McCarthy MW; Walsh TJ
[Ad] Endereço:a Medicine, Weill Cornell Medical Center , Division of General Internal Medicine , New York , NY , USA.
[Ti] Título:Drugs currently under investigation for the treatment of invasive candidiasis.
[So] Source:Expert Opin Investig Drugs;26(7):825-831, 2017 Jul.
[Is] ISSN:1744-7658
[Cp] País de publicação:England
[La] Idioma:eng
[Ab] Resumo:INTRODUCTION: The widespread implementation of immunosuppressants, immunomodulators, hematopoietic stem cell transplantation and solid organ transplantation in clinical practice has led to an expanding population of patients who are at risk for invasive candidiasis, which is the most common form of fungal disease among hospitalized patients in the developed world. The emergence of drug-resistant Candida spp. has added to the morbidity associated with invasive candidiasis and novel therapeutic strategies are urgently needed. Areas covered: In this paper, we explore investigational agents for the treatment of invasive candidiasis, with particular attention paid to compounds that have recently entered phase I or phase II clinical trials. Expert opinion: The antifungal drug development pipeline has been severely limited due to regulatory hurdles and a systemic lack of investment in novel compounds. However, several promising drug development strategies have recently emerged, including chemical screens involving Pathogen Box compounds, combination antifungal therapy, and repurposing of existing agents that were initially developed to treat other conditions, all of which have the potential to redefine the treatment of invasive candidiasis.
[Mh] Termos MeSH primário: Antifúngicos/uso terapêutico
Candidíase Invasiva/tratamento farmacológico
Drogas em Investigação/uso terapêutico
[Mh] Termos MeSH secundário: Animais
Candida/efeitos dos fármacos
Candida/isolamento & purificação
Candidíase Invasiva/epidemiologia
Candidíase Invasiva/microbiologia
Desenho de Drogas
Reposicionamento de Medicamentos
Farmacorresistência Fúngica
Seres Humanos
Fatores de Risco
[Pt] Tipo de publicação:JOURNAL ARTICLE; REVIEW
[Nm] Nome de substância:
0 (Antifungal Agents); 0 (Drugs, Investigational)
[Em] Mês de entrada:1707
[Cu] Atualização por classe:170718
[Lr] Data última revisão:
170718
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170616
[St] Status:MEDLINE
[do] DOI:10.1080/13543784.2017.1341488


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Camargos, Paulo Augusto Moreira
Texto completo SciELO Brasil
[PMID]:28286016
[Au] Autor:Rios JFDS; Camargos PAM; Corrêa LP; Romanelli RMC
[Ad] Endereço:Universidade Federal de Minas Gerais, Santa Efigênia, BH, Brazil. Electronic address: juriosalvim@yahoo.com.br.
[Ti] Título:Fluconazole prophylaxis in preterm infants: a systematic review.
[So] Source:Braz J Infect Dis;21(3):333-338, 2017 May - Jun.
[Is] ISSN:1678-4391
[Cp] País de publicação:Brazil
[La] Idioma:eng
[Ab] Resumo:OBJECTIVE: This article aims to review the use of antifungal prophylaxis with intravenous fluconazole in premature newborns and the occurrence of Invasive Candidiasis. METHODS: This is a systematic review with search at databases: PubMed, Capes Portal, Virtual Health Library (BVS - Biblioteca Virtual em Saúde)/Lilacs, Scopus and Cochrane. The keywords used were: "Antifungal", "Candida" "Fluconazole prophylaxis" and "Preterm infants". RESULTS: Invasive Candidiasis was evaluated in all the twelve items. In eleven of them, there was a statistically significant difference between the groups receiving prophylactic fluconazole, with lower frequency of Invasive Candidiasis, compared to placebo or no prophylaxis group. Colonization by Candida species was also evaluated in five studies; four of them presented statistically lower proportion of colonization in patients with Fluconazole prophylaxis, compared to placebo or no drugs. In one study, there was a significant difference, favoring the use of fluconazole, and reduction of death. CONCLUSION: Studies indicate the effectiveness of prophylaxis with fluconazole, with reduction in the incidence of colonization and invasive fungal disease. The benefits of prophylaxis should be evaluated considering the incidence of candidiasis in the unit, the mortality associated with candidiasis, the safety and toxicity of short and long-term medication, and the potential for development of resistant pathogens.
[Mh] Termos MeSH primário: Antifúngicos/administração & dosagem
Candidíase Invasiva/prevenção & controle
Fluconazol/administração & dosagem
Doenças do Prematuro/prevenção & controle
Recém-Nascido Prematuro
[Mh] Termos MeSH secundário: Seres Humanos
Recém-Nascido
[Pt] Tipo de publicação:JOURNAL ARTICLE; REVIEW
[Nm] Nome de substância:
0 (Antifungal Agents); 8VZV102JFY (Fluconazole)
[Em] Mês de entrada:1710
[Cu] Atualização por classe:171003
[Lr] Data última revisão:
171003
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170314
[St] Status:MEDLINE


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[PMID]:28285752
[Au] Autor:Leonart LP; Tonin FS; Ferreira VL; Tavares da Silva Penteado S; de Araújo Motta F; Pontarolo R
[Ad] Endereço:Department of Pharmacy, Universidade Federal do Paraná, Curitiba, PR, Brazil.
[Ti] Título:Fluconazole Doses Used for Prophylaxis of Invasive Fungal Infection in Neonatal Intensive Care Units: A Network Meta-Analysis.
[So] Source:J Pediatr;185:129-135.e6, 2017 Jun.
[Is] ISSN:1097-6833
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:OBJECTIVES: To evaluate the safety and efficacy of different doses of fluconazole used for invasive prophylaxis of fungal infection in neonates. STUDY DESIGN: A systematic search was conducted with PubMed, Scopus, and Web of Science. A manual search was performed as well. Only randomized controlled trials of neonates in a neonatal intensive care unit (NICU) who received fluconazole prophylaxis for invasive fungal infection, regardless of the dose or therapeutic regimen, were included in this review. Data on baseline characteristics, outcomes incidence of proven invasive Candida infection, overall mortality, and invasive Candida infection-related mortality were extracted. RESULTS: Eleven studies were included in the review, with fluconazole doses of 3, 4, or 6?mg/kg. When the incidence of invasive Candida and invasive Candida-related mortality were considered as outcomes, the 3 and 6?mg/kg fluconazole doses were found to be statistically superior to placebo (OR, 5.48 [95% credible interval, 1.81-18.94] and 2.63 [1.18-7.02], respectively, and 15.32 [1.54-54.31] and 9.14 [1.26-142.7], respectively), but data for the 3 doses were not statistically significantly different. CONCLUSIONS: Use of the lowest fluconazole dose (3?mg/kg) should be recommended for Candida prophylaxis in neonates, given that increasing the fluconazole dose is not associated with higher efficacy and has greater potential for toxicity and increased cost.
[Mh] Termos MeSH primário: Antifúngicos/administração & dosagem
Candidíase Invasiva/prevenção & controle
Fluconazol/administração & dosagem
[Mh] Termos MeSH secundário: Relação Dose-Resposta a Droga
Seres Humanos
Unidades de Terapia Intensiva Neonatal
Metanálise em Rede
[Pt] Tipo de publicação:JOURNAL ARTICLE; META-ANALYSIS; REVIEW
[Nm] Nome de substância:
0 (Antifungal Agents); 8VZV102JFY (Fluconazole)
[Em] Mês de entrada:1709
[Cu] Atualização por classe:170906
[Lr] Data última revisão:
170906
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:170314
[St] Status:MEDLINE


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[PMID]:28160958
[Au] Autor:Garbee DD; Pierce SS; Manning J
[Ad] Endereço:Department of Adult Health Nursing, School of Nursing, Louisiana State University Health Sciences Center, Louisiana Center for Promotion of Optimal Health Outcomes: A JBI Center of Excellence, 1900 Gravier Street, 4A21, New Orleans, LA 70112, USA. Electronic address: dgarbe@lsuhsc.edu.
[Ti] Título:Opportunistic Fungal Infections in Critical Care Units.
[So] Source:Crit Care Nurs Clin North Am;29(1):67-79, 2017 Mar.
[Is] ISSN:1558-3481
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:Fungal infections are rare compared with bacterial infections, but they are on the increase in critical care units. Diagnosis can be difficult, resulting in increased mortality. Immunocompromised patients are at higher risk for fungal infections, including organ transplant, oncology, and HIV/AIDS patients. Fatigue and fever are common symptoms that require critical care nurses to remain vigilant in assessment to identify at-risk patients and promote use of timely cultures and appropriate treatments for fungal infections. Critical care nurses can contribute to decreasing risk for fungal infections by controlling glucose levels, decreasing the use of invasive lines, and preventing unnecessary antibiotic use.
[Mh] Termos MeSH primário: Prática Clínica Baseada em Evidências
Hospedeiro Imunocomprometido
Unidades de Terapia Intensiva
Micoses/epidemiologia
[Mh] Termos MeSH secundário: Aspergilose/epidemiologia
Aspergilose/imunologia
Candidíase Invasiva/epidemiologia
Candidíase Invasiva/imunologia
Coccidioidomicose/epidemiologia
Coccidioidomicose/imunologia
Cuidados Críticos
Histoplasmose
Seres Humanos
Hospedeiro Imunocomprometido/imunologia
Micoses/imunologia
Fatores de Risco
[Pt] Tipo de publicação:JOURNAL ARTICLE; REVIEW
[Em] Mês de entrada:1704
[Cu] Atualização por classe:170417
[Lr] Data última revisão:
170417
[Sb] Subgrupo de revista:N
[Da] Data de entrada para processamento:170206
[St] Status:MEDLINE


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[PMID]:28114898
[Au] Autor:Cui N; Wang H; Su L; Qiu H; Li R; Liu D; China-SCAN Team
[Ad] Endereço:Department of Critical Care Medicine, Peking Union Medical College Hospital, Peking Union Medical College & Chinese Academy of Medical Sciences, Beijing, 100730, China.
[Ti] Título:Initial therapeutic strategy of invasive candidiasis for intensive care unit patients: a retrospective analysis from the China-SCAN study.
[So] Source:BMC Infect Dis;17(1):93, 2017 Jan 23.
[Is] ISSN:1471-2334
[Cp] País de publicação:England
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: To investigate the impact of initial antifungal therapeutic strategies on the prognosis of invasive Candida infections (ICIs) in intensive care units (ICUs) in China. METHODS: A total of 306 patients with proven ICIs in the China-SCAN study were analyzed retrospectively. Empiric, pre-emptive, and targeted therapy were adopted based on starting criteria including clinical, microbiological, and other conventional prediction rules. The primary outcome was hospital mortality and the secondary endpoints were duration days in ICU and duration days in hospital. The global responses (clinical and microbiological) at the end of the empirical therapy were also assessed. RESULTS: A total of 268/306 (87.6%) ICI patients received antifungal therapy, including 142/268 (53.0%) initial empirical therapy, 53/268 (19.8%) initial pre-emptive therapy, and 73/268 (27.2%) initial targeted therapy. Compared with the initial empirical antifungal therapy and targeted antifungal therapy, patients with initial pre-emptive antifungal therapy had significantly less clinical remission [11/53 (21.2%) vs. 61/142 (43.3%) vs. 22/73 (30.1%), P = 0.009], higher ICU [26/53 (57.8%) vs. 42/142 (32.2%) vs. 27/73 (43.5%), P = 0.008] and hospital mortality [27/53 (60.0%) vs. 43/142 (32.8%) vs. 29/73 (46.8%), P = 0.004] and more microbiological persistence [9/53 (17.0%) vs. 6/142 (4.2%) vs. 9/73 (12.3%), P = 0.011]. Kaplan-Meier survival analysis revealed that ICI patients with initial pre-emptive antifungal therapy and targeted antifungal therapy were associated with reduced hospital duration compared with patients with initial empirical antifungal therapy after confirmation of fungal infection (log-rank test: P = 0.021). Multivariate regression analysis provided evidence that initial empirical antifungal therapy was an independent predictor for DECREASING the hospital mortality in ICI patients on ICU admission and at ICI diagnosis (odds ratio 0.327, 95% confidence interval 0.160-0.667, P = 0.002; odds ratio 0.351, 95% confidence interval 0.168-0.735, P = 0.006). CONCLUSIONS: The initial therapeutic strategy for invasive candidiasis was independently associated with hospital mortality. Prompt empirical antifungal therapy could be critical to decrease early hospital mortality. TRIAL REGISTRATION: Clinicaltrials.gov NCT01253954 (retrospectively registration date: December 3, 2010).
[Mh] Termos MeSH primário: Antifúngicos/uso terapêutico
Candidíase Invasiva/tratamento farmacológico
[Mh] Termos MeSH secundário: Adulto
Idoso
Idoso de 80 Anos ou mais
Candidíase
Candidíase Invasiva/mortalidade
China
Cuidados Críticos
Feminino
Mortalidade Hospitalar
Hospitalização
Seres Humanos
Unidades de Terapia Intensiva
Estimativa de Kaplan-Meier
Tempo de Internação
Modelos Logísticos
Masculino
Meia-Idade
Razão de Chances
Fosfotransferases (Aceptor do Grupo Álcool)
Estudos Retrospectivos
Resultado do Tratamento
[Pt] Tipo de publicação:JOURNAL ARTICLE; OBSERVATIONAL STUDY
[Nm] Nome de substância:
0 (Antifungal Agents); EC 2.7.1.- (AGK protein, human); EC 2.7.1.- (Phosphotransferases (Alcohol Group Acceptor))
[Em] Mês de entrada:1707
[Cu] Atualização por classe:170707
[Lr] Data última revisão:
170707
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170125
[Cl] Clinical Trial:ClinicalTrial
[St] Status:MEDLINE
[do] DOI:10.1186/s12879-017-2207-1



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