Epidemiology and mortality of the multidrug resistant gram-negative bloodstream infection in acute myeloid leukemia

Universidade Federal de São Paulo, Escola Paulista Med, Infectol Dept, São Paulo, BrazilUniversidade Federal de São Paulo, Escola Paulista Med, Dept Hematol, São Paulo, BrazilUniversidade Federal de São Paulo, Escola Paulista Med, Infectol Dept, São Paulo, BrazilUniversidade Federal de São Paulo, Escola Paulista Med, Dept Hematol, São Paulo, BrazilWeb of Scienc

Ten golden rules for optimal antibiotic use in hospital settings: the WARNING call to action

Antibiotics are recognized widely for their benefits when used appropriately. However, they are often used inappropriately despite the importance of responsible use within good clinical practice. Effective antibiotic treatment is an essential component of universal healthcare, and it is a global responsibility to ensure appropriate use. Currently, pharmaceutical companies have little incentive to develop new antibiotics due to scientific, regulatory, and financial barriers, further emphasizing the importance of appropriate antibiotic use. To address this issue, the Global Alliance for Infections in Surgery established an international multidisciplinary task force of 295 experts from 115 countries with different backgrounds. The task force developed a position statement called WARNING (Worldwide Antimicrobial Resistance National/International Network Group) aimed at raising awareness of antimicrobial resistance and improving antibiotic prescribing practices worldwide. The statement outlined is 10 axioms, or “golden rules,” for the appropriate use of antibiotics that all healthcare workers should consistently adhere in clinical practice

Doenças fúngicas invasivas em pacientes oncohematológicos e receptores de transplante de células-tronco hematopoéticas: série histórica e aspectos evolutivos

Objective: To describe the epidemiology of invasive fungal diseases (IFDs) in hematologic patients and hematopoietic cell transplant (HCT) recipients, managed with fluconazole prophylaxis and an antifungal diagnostic-driven approach for mold infection. Methods: This is a retrospective, single-center cohort study of all consecutive cases of proven or probable IFDs according to the European Organization for Research and Treatment of Cancer and the Mycoses Study Group Education and Research Consortium (EORTC/MSGERC) diagnosed between 2009 and 2019 (11-year period), in adult hematologic patients and HCT recipients, managed with fluconazole prophylaxis and an antifungal diagnostic-driven approach for mold infection. Cases of possible IFDs and pneumocistosis were excluded from analysis. Results: During the study period, 94 cases of IFDs occurred among 664 hematologic patients and 316 HCT recipients. The frequency of IFDs among patients with allogeneic HCT, autologous HCT, acute leukemia and other hematologic malignancies was 8.9%, 1.6%, 17.3%, and 6.4%, respectively. Aspergillosis was the leading IFD (53.2%), followed by fusariosis (18.1%), candidiasis (10.6%), and cryptococcosis (8.5%).The overall 6-week mortality rate was 37.2%, and varied according to the host and the etiology ofIFD, from 28% in aspergillosis to 52.9% in fusariosis. Although IFDs occurred frequently in our cohort of patients managed with an antifungal diagnostic driven approach, mortality rates were comparable to other studies. In the face of challenges posed by the use of anti-mold prophylaxis, this strategy remains a reasonable alternative.Objetivo: Descrever a epidemiologia de doenças fúngicas invasivas (DFIs) em uma coorte de pacientes onco-hematológicos e receptores de TCTH acompanhados ao longo de 11 anos e abordados com regime de profilaxia com fluconazol complementada por terapêutica antifúngica dirigida por dagnóstico precoce (terapia preemptiva). Métodos: Trata-se de estudo de coorte retrospectivo, realizado em um centro único terciário e universitário, de todos os casos consecutivos de DFIs diagnosticados entre janeiro/2009 a dezembro/2019 (11 anos de observação) em pacientes adultos, oncohematológicos e receptores de TCTH. Apenas casos de DFI provada e provável, de acordo com os critérios revisados pela European Organization for Research and Treatment of Cancer and the Mycoses Study Group Education and Research Consortium (EORTC/MSGERC) foram incluídos. Casos de DFI possível e pneumocistose foram excluídos das análises. Resultados: Durante o período estudado, ocorreram 94 casos de DFI em 664 pacientes onco-hematológicos e 316 receptores de TCTH. A frequência de DFIs entre receptores de TCTH-alogênico, TCTH-autólogo, leucemias agudas e outras doenças onco-hematológicas foi 8,9%; 1,6%; 17,3% e 6,4%, respectivamente. Aspergilose foi a principal DFI (53,2%), seguida de fusariose (18,1%), candidíase (10,6%), e criptococose (8.5%). A mortalidade geral em 6 semanas foi 37,2%, e variou de acordo com a doença de base e DFI, de 28% em aspergilose a 52,9% em fusariose. Embora as DFIs tenham sido frequentes nesta coorte de pacientes abordados com estratégia de fluconazol profilático complementada por terapêutica antifúngica dirigida por dagnóstico precoce (terapia preemptiva), as taxas de mortalidade foram comparáveis às de outros estudos. Diante dos desafios impostos pelo uso de profilaxia anti-fungo filamentoso, a terapia preemptiva permanece como alternativa razoável.Dados abertos - Sucupira - Teses e dissertações (2021

Epidemiology of candidemia in patients with hematologic malignancies and solid tumors

Candidemia is an important problem in hospitals worldwide, with documented geographic variance in its epidemiology. Cancer is the most prevalent underlying diseases reported in most series of candidemia, and in this specific setting, there are also regional differences in epidemiologic aspects. Furthermore, there is evidence showing different characteristics of this infection among patients with hematologic mailgnancies (HM) and solid tumors (ST) that need to be better characterized. The aims of this study were to describe the epidemiology of candidemia in cancer in Brazilian medical centers, comparing characteristics in HM and ST; and to analyze predictors of 30-day poor outcome. A retrospective study was performed, based on three data bases prospectively collected from laboratory-based surveillance in 18 tertiary care hospitals of 12 cities in Brazil, between march/2003 and december/2007. All patients with cancer who developed candidemia were included for analysis. During the study period, 365 candidemia episodes ocurred in 117 HM and 248 ST patients. C.albicans, C.tropicalis and C.parapsilosis were the most frequent species isolated in the two cancer populations. Comparatively, there was a higher proportion of C.parapsilosis in the HM group (23.1% versus 14.9%, p 0.06) and a higher proportion of C.albicans (40.7% vs 30.8%, p 0.07) and C.glabrata (12.1% vs 6.0%, p 0.07) in patients with ST, although not statistically significant. Decreased fluconazole susceptibility rate (MIC ≥ 16mg/mL) among all Candida species was similar in patients with HM and ST (9.1% and 12.2% respectively, p 0,39). Thirty-day mortality was higher in the ST population, 65% versus 46% in patients with HM, p < 0.001. Factors significantly associated with 30-day mortality in multiple logistic regression model were older age and intensive care admission at the time of candidemia for HM and ST patients. C.parapsilosis infection was associated with 30-day survival only for HM patients. In conclusion, in Brazilian medical centers C.albicans, C.tropicalis and C.parapsilosis were the leading causative agents of candidemia in cancer. Different predisposing factors for candidemia, more related to the underlying disease in patients with HM and invasive procedures in ST occurred and were probably associated with the greater mortality rate in ST. Besides, predictors of poor outcome were mostly host factors: advanced age and ICU admission.A candidemia representa um importante problema em hospitais de todo o mundo e há variações geográficas documentadas em sua epidemiologia. O câncer é a doença de base mais prevalente reportada na maioria das séries de candidemia e neste cenário particular, também há variações regionais na etiologia e história natural. Além disto, diferentes aspectos da infecção são observados em pacientes com neoplasias hematológicas (NH) e tumores sólidos (TS) que precisam ser caracterizados. Os objetivos deste estudo foram descrever a epidemiologia de candidemia em câncer em centros médicos brasileiros, comparando as características em portadores de NH e TS e avaliar os fatores associados ao óbito em 30 dias. Foi realizado um estudo retrospectivo, baseado em três bancos de dados coletados prospectivamente, a partir de vigilância laboratorial de candidemia em 18 hospitais terciários distribuídos por 12 cidades brasileiras, no período entre março de 2003 e dezembro de 2007. Todos os pacientes com câncer, admitidos nos centros participantes e que desenvolveram candidemia foram incluídos para análise. No período avaliado, ocorreram 365 episódios de candidemia em 117 pacientes portadores de NH e 248 portadores de TS. C.albicans, C.tropicalis e C.parapsilosis foram as espécies mais prevalentes nas duas populações. Comparativamente houve maior proporção de C.parapsilosis nos pacientes hematológicos (23,1% VS 14,9%; p 0,06) e maior proporção de C.albicans (40,7% VS 30,8%; p 0.07) e C.glabrata (12,1% VS 6,0%; p 0,07) nos pacientes com TS, embora sem significância estatística. A freqüência de susceptibilidade reduzida ao fluconazol (MIC ≥ 16μg/mL) entre todas as espécies foi similar nos portadores de NH e TS (9,1% e 12,2% respectivamente; p 0,39). A mortalidade em 30 dias foi maior nos pacientes com TS, 65% versus 46% em HM, p 0,001. Os fatores preditivos de mortalidade em 30 dias no modelo de regressão logística múltipla foram: idade avançada e admissão em UTI para ambos os grupos. Infecção por C.parapsilosis associou-se a sobrevida em 30 dias apenas nos pacientes hematológicos. Conclui-se que em centros médicos brasileiros, C.albicans, C.tropicalis e C.parapsilosis foram os principais agentes causadores de candidemia em câncer. Diferentes fatores predisponentes ocorreram, sendo mais relacionados ao período de aplasia e quimioterapia nos pacientes com NH e a procedimentos invasivos naqueles com TS. A mortalidade em 30 dias foi maior nos portadores de TS, provavelmente pela idade mais avançada e maior gravidade clínica. Os fatores preditivos de mortalidade em 30 dias nas duas populações foram basicamente relacionados ao hospedeiro: idade avançada e admissão em UTI.TEDEBV UNIFESP: Teses e dissertaçõe

Successful use of gentamycin as an antibiotic prophylaxis regimen to reduce the rate of healthcare-associated infections after renal transplantation

At our institution, we observed an increase in the incidence of healthcare-associated infections (HAI) due to Gram-negative bacilli, including three cases of carbapenem-resistant Klebsiella pneumoniae, among patients who underwent renal transplantation. In addition to strengthening infection control measures, we chose to add gentamycin to the antibiotic prophylaxis regimen of patients undergoing renal transplantation. We assessed the number of HAI occurring within 30 days of renal transplantation during two time periods: (1) the preintervention period, between September 2009 and June 2010, and (2) the post-intervention period, between July 2010 and April 2011. The intervention consisted of the addition of gentamycin to the surgical antibiotic prophylaxis regimen. The percentage of patients with HAIs was 31% lower during the post-intervention period (p = 0.03), with the greatest reductions observed for urinary tract infections (p = 0.024). Carbapenem-resistant K. pneumoniae was not isolated during this period. The investigated patients did not exhibit worsening renal function. Further studies are needed to assess antibiotic prophylaxis in renal transplantation patients at institutions where there is a high prevalence of multidrug-resistant Gram-negative bacteria

Epidemiology of Invasive Fungal Diseases in Patients with Hematologic Malignancies and Hematopoietic Cell Transplantation Recipients Managed with an Antifungal Diagnostic Driven Approach

Patients with hematologic malignancies and hematopoietic cell transplant recipients (HCT) are at high risk for invasive fungal disease (IFD). The practice of antifungal prophylaxis with mold-active azoles has been challenged recently because of drug–drug interactions with novel targeted therapies. This is a retrospective, single-center cohort study of consecutive cases of proven or probable IFD, diagnosed between 2009 and 2019, in adult hematologic patients and HCT recipients managed with fluconazole prophylaxis and an antifungal diagnostic-driven approach for mold infection. During the study period, 94 cases of IFD occurred among 664 hematologic patients and 316 HCT recipients. The frequency among patients with allogeneic HCT, autologous HCT, acute leukemia and other hematologic malignancies was 8.9%, 1.6%, 17.3%, and 6.4%, respectively. Aspergillosis was the leading IFD (53.2%), followed by fusariosis (18.1%), candidiasis (10.6%), and cryptococcosis (8.5%). The overall 6-week mortality rate was 37.2%, and varied according to the host and the etiology of IFD, from 28% in aspergillosis to 52.9% in fusariosis. Although IFD occurred frequently in our cohort of patients managed with an antifungal diagnostic driven approach, mortality rates were comparable to other studies. In the face of challenges posed by the use of anti-mold prophylaxis, this strategy remains a reasonable alternative