The evaluation of antifungal consumption: a point-prevalence survey

WOS: 00041171580024

Multicenter Analysis of Anidulafungin Use in Invasive Candida Infections

Introduction: Fungal infections are vital problems worldwide and their incidence have increased along with changing patient profile. Particularly candida species is still the most commonfungal agent, and the significance of non-albicans candida species have gained importance in recent years. In the present study, it was aimed to evaluate retrospectively the risk factors and distribution of candida species in patients with invasive candida infections, who were treated with anidulafungin.Materials and Methods: In the first three years (1 January 2012 to 31 December 2014) when anidulafungin came out in our country, we retrospectively evaluated the data of the patients with invasive candida infections who were treated by anidulafungin for more than 48 hours in seven university hospitals. Data were recorded to the case report forms.Results: Two hundreds and fifty-seven patients were included into the study. Fifty-six percent of the patients were male and mean age was 58.57 +/- 19.5 years. Two hundreds and three patients (79%) were hospitalized in intensive care units, 37 (14.3%) in internal medicine services, and 17 (0.07%) in surgery services. As previously described, we detected antibiotic usage in the last month (%96.9), presence of urinary catheter (90.3%) and presence of central venous catheter (82.1%) as risk factors for invasive candida infections. More than half of the patients (57.1%) with central venous catheter had candidemia. Sixty-six (47.7%) of the blood isolates were Candida albicans, 33 (23.7%) were Candida parapsilosis, 17 (12.2%) were Candida tropicalis and 13 (9.4%) were Candida glabrata. During follow up, 64.5% of 124 patients whose catheters couldn't be taken off and 47.6% of 86 patients whose catheters could be taken off died. During anidulafungin treatment, one anaphylaxis, one skin eruption and one thrombocytopenia were seen as side effects.Conclusion: In our study, we found that removal of central venous catheter of the patients with candidemia was a positive effect on mortality. We suggest that patients with candidemia, insisting on catheter removal besides antifungal treatment is necessary. We observed that anidulafungin is an effective and safe choice in invasive candida infections.C1 [Isikgoz Tasbakan, Meltem; Pullukcu, Husnu; Mermut, Gulsen] Univ Ege, Fac Med, Dept Infect Dis & Clin Microbiol, Izmir, Turkey.[Eren Kutsoylu, Oya; Alp Cavus, Sema; Avkan Oguz, Vildan; Yapar, Nur] Univ Dokuz Eylul, Fac Med, Dept Infect Dis & Clin Microbiol, Izmir, Turkey.[Sayin Kutlu, Selda; Kutlu, Murat] Univ Pamukkale, Fac Med, Dept Infect Dis & Clin Microbiol, Denizli, Turkey.[Ozturk, Barcin; Ertugrul, Mustafa Bulent] Adnan Menderes Univ, Fac Med, Dept Infect Dis & Clin Microbiol, Aydin, Turkey.[Kaya, Onur] Univ Suleyman Demirel, Fac Med, Dept Infect Dis & Clin Microbiol, Isparta, Turkey.[Turhan, Ozge] Univ Akdeniz, Fac Med, Dept Infect Dis & Clin Microbiol, Antalya, Turkey.[Senol Akat, Sebnem; Cetin, Cigdem Banu] Univ Celal Bayar, Fac Med, Dept Infect Dis & Clin Microbiol, Manisa, Turkey.[Metin, Dilek Yesim] Univ Ege, Fac Med, Dept Med Microbiol, Izmir, Turkey.[Ozhak, Betil] Univ Akdeniz, Fac Med, Dept Med Microbiol, Antalya, Turkey.[Ergin, Cagri] Univ Pamukkale, Fac Med, Dept Med Microbiol, Denizli, Turkey

Semuloparin for prevention of venous thromboembolism after major orthopedic surgery: Results from three randomized clinical trials, SAVE-HIP1, SAVE-HIP2 and SAVE-KNEE

Background: Semuloparin is a novel ultra-low-molecular-weight heparin under development for venous thromboembolism (VTE) prevention in patients at increased risk, such as surgical and cancer patients. Objectives: Three Phase III studies compared semuloparin and enoxaparin after major orthopedic surgery: elective knee replacement (SAVE-KNEE), elective hip replacement (SAVE-HIP1) and hip fracture surgery (SAVE-HIP2). Patients/Methods: All studies were multinational, randomized and double-blind. Semuloparin and enoxaparin were administered for 7-10days after surgery. Mandatory bilateral venography was to be performed between days 7 and 11. The primary efficacy endpoint was a composite of any deep vein thrombosis, non-fatal pulmonary embolism or all-cause death. Safety outcomes included major bleeding, clinically relevant non-major (CRNM) bleeding, and any clinically relevant bleeding (major bleeding plus CRNM). Results: In total, 1150, 2326 and 1003 patients were randomized in SAVE-KNEE, SAVE-HIP1 and SAVE-HIP2, respectively. In all studies, the incidences of the primary efficacy endpoint were numerically lower in the semuloparin group vs. the enoxaparin group, but the difference was statistically significant only in SAVE-HIP1. In SAVE-HIP1, clinically relevant bleeding and major bleeding were significantly lower in the semuloparin vs. the enoxaparin group. In SAVE-KNEE and SAVE-HIP2, clinically relevant bleeding tended to be higher in the semuloparin group, but rates of major bleeding were similar in the two groups. Other safety parameters were generally similar between treatment groups. Conclusions: Semuloparin was superior to enoxaparin for VTE prevention after hip replacement surgery, but failed to demonstrate superiority after knee replacement surgery and hip fracture surgery. Semuloparin and enoxaparin exhibited generally similar safety profiles. \ua9 2012 International Society on Thrombosis and Haemostasis