Invasive aspergillosis in patients with COVID-19 in intensive care units: results of a multicenter study

Objective. To study risk factors, clinical and radiological features and effectiveness of the treatment of invasive aspergillosis (IA) in adult patients with COVID-19 (COVID-IA) in intensive care units (ICU). Materials and Methods. A total of 60 patients with COVID-IA treated in ICU (median age 62 years, male – 58%) were included in this multicenter prospective study. The comparison group included 34 patients with COVID-IA outside the ICU (median age 62 years, male – 68%). ECMM/ISHAM 2020 criteria were used for diagnosis of CAPA, and EORTC/MSGERC 2020 criteria were used for evaluation of the treatment efficacy. A case-control study (one patient of the main group per two patients of the control group) was conducted to study risk factors for the development and features of CAPA. The control group included 120 adult COVID-19 patients without IA in the ICU, similar in demographic characteristics and background conditions. The median age of patients in the control group was 63 years, male – 67%. Results. 64% of patients with COVID-IA stayed in the ICU. Risk factors for the COVID-IA development in the ICU: chronic obstructive pulmonary disease (OR = 3.538 [1.104–11.337], p = 0.02), and prolonged (> 10 days) lymphopenia (OR = 8.770 [4.177–18.415], p = 0.00001). The main location of COVID-IA in the ICU was lungs (98%). Typical clinical signs were fever (97%), cough (92%), severe respiratory failure (72%), ARDS (64%) and haemoptysis (23%). Typical CT features were areas of consolidation (97%), hydrothorax (63%), and foci of destruction (53%). The effective methods of laboratory diagnosis of COVID-IA were test for galactomannan in BAL (62%), culture (33%) and microscopy (22%) of BAL. The main causative agents of COVID-IA are A. fumigatus (61%), A. niger (26%) and A. flavus (4%). The overall 12-week survival rate of patients with COVID-IA in the ICU was 42%, negative predictive factors were severe respiratory failure (27.5% vs 81%, p = 0.003), ARDS (14% vs 69%, p = 0.001), mechanical ventilation (25% vs 60%, p = 0.01), and foci of destruction in the lung tissue on CT scan (23% vs 59%, p = 0.01). Conclusions. IA affects predominantly ICU patients with COVID-19 who have concomitant medical conditions, such as diabetes mellitus, hematological malignancies, cancer, and COPD. Risk factors for COVID-IA in ICU patients are prolonged lymphopenia and COPD. The majority of patients with COVID-IA have their lungs affected, but clinical signs of IA are non-specific (fever, cough, progressive respiratory failure). The overall 12-week survival in ICU patients with COVID-IA is low. Prognostic factors of poor outcome in adult ICU patients are severe respiratory failure, ARDS, mechanical ventilation as well as CT signs of lung tissue destruction

POSACONAZOLE — NEW AZOLE BROAD-SPECTRUM ANTIFUNGAL AGENT FOR PREVENTION AND TREATMENT OF INVASIVE MYCOSES

Invasive mycoses are a common complication of various categories of immune depressed patients that are characterized with heavy clinical presentations and high lethal rate. Many causatives of invasive mycoses are resistant to currently applied antifungal medications, and some are polybresistant. Posaconazole (Noksafil) is a new triazole antimycotic of second generation that is active both in vitro and in vivo against most causatives of invasive mycoses, including poly resistant microbmycets. Clinical study demonstrate high efficiency and safety of applying this medication. in russia posaconazole is allowed for prevention of invasive mycoses for hematological patients with longbrunning neutropenia resulting from chemical therapy, who are prescribed large doses of immune suppressors, recipients of transplants of hemapoietic stem cells, as well as for treatment of invasive candidoses, aspergillus, zigomicosys, criptococcosis, fuzariosis, chromomycosis and micetoma, as well as cocsidiodosis that are refractory towards other anti fungal medications, or in cases of intolerance.Key words: mycoses, posaconazole, treatment.</strong

POSACONAZOLE — NEW AZOLE BROAD-SPECTRUM ANTIFUNGAL AGENT FOR PREVENTION AND TREATMENT OF INVASIVE MYCOSES

Invasive mycoses are a common complication of various categories of immune depressed patients that are characterized with heavy clinical presentations and high lethal rate. Many causatives of invasive mycoses are resistant to currently applied antifungal medications, and some are polybresistant. Posaconazole (Noksafil) is a new triazole antimycotic of second generation that is active both in vitro and in vivo against most causatives of invasive mycoses, including poly resistant microbmycets. Clinical study demonstrate high efficiency and safety of applying this medication. in russia posaconazole is allowed for prevention of invasive mycoses for hematological patients with longbrunning neutropenia resulting from chemical therapy, who are prescribed large doses of immune suppressors, recipients of transplants of hemapoietic stem cells, as well as for treatment of invasive candidoses, aspergillus, zigomicosys, criptococcosis, fuzariosis, chromomycosis and micetoma, as well as cocsidiodosis that are refractory towards other anti fungal medications, or in cases of intolerance.Key words: mycoses, posaconazole, treatment

PHARMACOECONOMIC ASPECT OF OMALIZUMAB APPLICATION AMONG THE PATIENTS, SUFFERING FROM THE BRONCHIAL ASTHMA

In the given article, the authors discuss the most difficult issue of the pediatrics, which is the treatment of the severe bronchial asthma. Our columnist is professor A.S. Kolbin introduces omalizumab, a new medication from the monoclonal antibodies group, to our readers. It allows practitioners to control the severe persistent bronchial asthma. The article accentuates the clinical effectiveness and pharmacoeconomic aspects of the medication application.Key words: bronchial asthma, severe run, treatment, monoclonal antibodies, children

PHARMACOECONOMIC ANALYSIS OF MICAFUNGIN USING IN THE TREATMENT OF INVASIVE CANDIDIASIS IN NEWBORNS

Invasive candidiasis is a common cause of neonatal sepsis, especially in children with very low birth weight. This study, for the first time in the world of medical research, shows the results of the clinico-economical expertise of using micafungin to treat invasive candidosis in newborns. Mathematical modeling methods were applied to calculate the total cost of treatment while considering such factors as the effectiveness of treatment and the possibility of fatal cases in comparison groups. In the research a group of newborns (the first 28 days of life) received primary prevention with azole antifungal drugs (fluconazole). Results showed that micafungin is more expensive but more effective and safer compared with amphotericin B. At the same time, the additional costs associated with micafungin, were below the society’s willingness-to-pay threshold, therefore there are no restrictions for micafungin use in newborns. The costs justifiability coefficient for using micafungin in the treatment of invasive candidiasis in newborns was also higher compared with using amphotericin B (by 57%).Key words: invasive candidiasis, newborns, micafungin, pharmacoeconomics

PHARMACOECONOMIC ANALYSIS OF MICAFUNGIN USING IN THE TREATMENT OF INVASIVE CANDIDIASIS IN NEWBORNS

Invasive candidiasis is a common cause of neonatal sepsis, especially in children with very low birth weight. This study, for the first time in the world of medical research, shows the results of the clinico-economical expertise of using micafungin to treat invasive candidosis in newborns. Mathematical modeling methods were applied to calculate the total cost of treatment while considering such factors as the effectiveness of treatment and the possibility of fatal cases in comparison groups. In the research a group of newborns (the first 28 days of life) received primary prevention with azole antifungal drugs (fluconazole). Results showed that micafungin is more expensive but more effective and safer compared with amphotericin B. At the same time, the additional costs associated with micafungin, were below the society’s willingness-to-pay threshold, therefore there are no restrictions for micafungin use in newborns. The costs justifiability coefficient for using micafungin in the treatment of invasive candidiasis in newborns was also higher compared with using amphotericin B (by 57%).Key words: invasive candidiasis, newborns, micafungin, pharmacoeconomics

SUCCESSFUL APPLICATION OF CASPOFUNGIN TO AN INFANT WITH A MAJOR BURNING INJURY COMPLICATED BY INTRUSIVE CANDIDOSIS

In recent years, the mycotic infections have become to take an important place in the structure of the infective complications in children with a major burning injury. Thus, the rate of intrusive candidosis amounts to 30%. In the event of the intrusive mycoses, the attributive mortality is very high and comes to 40 to 90%. Today, the doctors have new anti mycotic medications at their disposal, which have proved to be highly efficient and safe in the controlled clinical studies of adults. The authors describe their own experience in efficient application of caspofungin, a modern antimycotic, to fight intrusive candidosis of an infant with a major burning injury and analyze the relevant literature. Based on the literary data and their experience, the authors recommend using caspofungin in treatment of intrusive candidosis in children with a major burning injury.Key words: intrusive candidosis, major burning injury, children, caspofungin

SUCCESSFUL APPLICATION OF CASPOFUNGIN TO AN INFANT WITH A MAJOR BURNING INJURY COMPLICATED BY INTRUSIVE CANDIDOSIS

In recent years, the mycotic infections have become to take an important place in the structure of the infective complications in children with a major burning injury. Thus, the rate of intrusive candidosis amounts to 30%. In the event of the intrusive mycoses, the attributive mortality is very high and comes to 40 to 90%. Today, the doctors have new anti mycotic medications at their disposal, which have proved to be highly efficient and safe in the controlled clinical studies of adults. The authors describe their own experience in efficient application of caspofungin, a modern antimycotic, to fight intrusive candidosis of an infant with a major burning injury and analyze the relevant literature. Based on the literary data and their experience, the authors recommend using caspofungin in treatment of intrusive candidosis in children with a major burning injury.Key words: intrusive candidosis, major burning injury, children, caspofungin

PHARMACOECONOMIC ANALYSIS OF TREATMENT OF OUT-OF-HOSPITAL COMPLICATED ABDOMINAL INFECTIONS WITH NEW-GENERATION CARBAPENEM — ERTAPENEM

In a surgeon’s practice, complicated intra-abdominal infections (CII) are one of the most frequent nosological entities. E. Proteus spp., Klebsiella spp. are considered to be leading activators of out-of-hospital CII. For the first time in a Russian economic environment the authors, using mathematical modeling methods, have conducted a clinical and economic research of the new carbapenem, ertapenem, for monotherapy of complicated intra-abdominal infections. They have calculated the total cost, including the cost of CII treatment subject to indicators such as efficiency of treatment and infection-related probability of death (attributive lethality). Results of the «susceptible-infected-susceptible» model were used to assess the impact of acquired bacterial resistance on the efficacy of treating complicated intra-abdominal infections. As a result it was found that in the case of out-of-hospital complicated intraabdominal infections, it is more advisable from the clinical and economic standpoint to start treatment with ertapenem; less advisable is to start with the combination of ceftriaxone and metronidazole or the combination of ciprofloxacin and metronidazole. Key words: clinical and economic analysis, ertapenem, complicated intra-abdominal infections, resistance. (Pediatric Pharmacology. – 2010; 7(1):29-40