Current and Future Therapies for Hepatitis C Virus Infection

To the Editor: In their review of drug therapy for chronic hepatitis C infection, Liang and Ghany (May 16 issue)(1) summarize boceprevir- and telaprevir-based regimens. Figure 2 of the article describes the regimens according to the response to the previous therapy, the response-guided therapy, and the stopping rules. The boceprevir regimen they describe represents the labeling information in the United States.(2) However, the information about boceprevir in European regimens has some differences(3) the duration of therapy for patients who have not had a response to previous therapy (whether the patient had a relapse, a partial response, or no response) ..

Invasive infections due to Saprochaete and Geotrichum species: Report of 23 cases from the FungiScope Registry

Saprochaete and Geotrichum spp. are rare emerging fungi causing invasive fungal diseases in immunosuppressed patients and scarce evidence is available for treatment decisions. Among 505 cases of rare IFD from the FungiScope\u2122 registry, we identified 23 cases of invasive infections caused by these fungi reported from 10 countries over a 12-year period. All cases were adults and previous chemotherapy with associated neutropenia was the most common co-morbidity. Fungaemia was confirmed in 14 (61%) cases and deep organ involvement included lungs, liver, spleen, central nervous system and kidneys. Fungi were S.\ua0capitata (n=14), S.\ua0clavata (n=5), G.\ua0candidum (n=2) and Geotrichum spp. (n=2). Susceptibility was tested in 16 (70%) isolates. All S.\ua0capitata and S.\ua0clavata isolates with the exception of one S.\ua0capitata (MIC 4\ua0mg/L) isolate had MICs>32\ua0mg/L for caspofungin. For micafungin and anidulafungin, MICs varied between 0.25 and >32\ua0mg/L. One case was diagnosed postmortem, 22 patients received targeted treatment, with voriconazole as the most frequent first line drug. Overall mortality was 65% (n=15). Initial echinocandin treatment was associated with worse outcome at day 30 when compared to treatment with other antifungals (amphotericin B \ub1 flucytosine, voriconazole, fluconazole and itraconazole) (P=.036). Echinocandins are not an option for these infections

Mortality indicators in pneumococcal meningitis: therapeutic implications

Background: The aim of this study was to delineate mortality indicators in pneumococcal meningitis with special emphasis on therapeutic implications

Mortality indicators in pneumococcal meningitis: therapeutic implications

Background: The aim of this study was to delineate mortality indicators in pneumococcal meningitis with special emphasis on therapeutic implications. Methods: This retrospective, multicenter cohort study involved a 15-year period (1998-2012). Culture-positive cases (n = 306) were included solely from 38 centers. Results: Fifty-eight patients received ceftriaxone plus vancomycin empirically. The rest were given a third-generation cephalosporin alone. Overall, 246 (79.1%) isolates were found to be penicillin-susceptible, 38 (12.2%) strains were penicillin-resistant, and 22 (7.1%) were oxacillin-resistant (without further minimum inhibitory concentration testing for penicillin). Being a critical case (odds ratio (OR) 7.089, 95% confidence interval (CI) 3.230-15.557) and age over 50 years (OR 3.908, 95% CI 1.820-8.390) were independent predictors of mortality, while infection with a penicillin-susceptible isolate (OR 0.441, 95% CI 0.195-0.996) was found to be protective. Empirical vancomycin use did not provide significant benefit (OR 2.159, 95% CI 0.949-4.912). Conclusions: Ceftriaxone alone is not adequate in the management of pneumococcal meningitis due to penicillin-resistant pneumococci, which is a major concern worldwide. Although vancomycin showed a trend towards improving the prognosis of pneumococcal meningitis, significant correlation in statistical terms could not be established in this study. Thus, further studies are needed for the optimization of pneumococcal meningitis treatment. (C) 2013 The Authors. Published by Elsevier Ltd on behalf of International Society for Infectious Diseases. All rights reserved