Early initiation of appropriate treatment is associated with increased survival in cancer patients with Candida glabrata fungaemia: a potential benefit from infectious disease consultation

AbstractIn patients with malignancies, Candida glabrata is one of the most frequent non-albicans Candida clinical isolates. As antifungal resistance in C. glabrata is common, we investigated the relationship between early appropriate antifungal treatment, infectious disease (ID) consultation and mortality in a contemporary cohort of cancer patients with C. glabrata fungaemia. We included patients with at least one C. glabrata-positive blood culture and symptoms or signs of infection seen at the MD Anderson Cancer Center between March 2005 and September 2013. In vitro susceptibility to antifungals was defined according to the 2010 CLSI clinical breakpoints. One-hundred and forty-six episodes of candidaemia were studied. Thirty isolates (20.5%) had fluconazole MIC ≥ 64 mg/L and 15 (10.3%) were caspofungin-resistant. Early (within 48 h after blood culture collection) initiation of appropriate antifungal treatment (hazard ratio 0.374, p 0.003) and early ID consultation (hazard ratio 0.421, p 0.004) were associated with decreased mortality, after adjustment for significant confounders. Thirty-two of 58 patients (55.2%) followed by ID were on appropriate antifungals within 48 h, compared with 16/88 patients (18.2%) who were not followed by ID an ID specialist (p <0.001). The median time-to-reporting of blood culture positivity for yeast was 71 h. Delayed time-to-reporting was associated with increased 28-day all-cause mortality (log-rank p 0.023). The benefits from early initiation of appropriate antifungal treatment and ID consultation were more prominent in patients with non-catheter-related candidaemia. In conclusion, in cancer patients with C. glabrata fungaemia, early ID consultation may lead to timely initiation of appropriate treatment and improved clinical outcomes

Ocorrência e diversidade de bactérias diazotróficas associadas a gramíneas forrageiras do Pantanal Sul Matogrossense Occurrence and diversity of diazotrophic bacteria associated to forage grasses of the Pantanal in the state of Mato Grosso do Sul

Este trabalho teve por objetivo avaliar a ocorrência e a diversidade genética de bactérias fixadoras de N2 associadas às gramíneas nativas Elyonurus muticus (capim carona) e Axonopus purpusii (capim mimoso) e à gramínea exótica Brachiaria humidicola (braquiária) que formam as pastagens na região da Nhecolândia. As coletas das plantas e solo foram feitas nos períodos de seca e de cheia para determinar a população de bactérias diazotróficas. Identificaram-se Azospirillum brasilense, A. lipoferum, A. amazonense, Herbaspirillum spp., Burkholderia spp. em amostras de solo, raízes e folhas das três espécies forrageiras. As populações dessas bactérias foram menores na época da cheia em comparação com a época da seca. A diversidade genética das bactérias isoladas foi avaliada por meio da técnica de análise de restrição do DNA ribossomal amplificado (ARDRA). Os isolados foram divididos em cinco grupos genotípicos distintos. Os isolados de A. brasilense e A. lipoferum apresentaram cerca de 50 % de similaridade, enquanto A. amazonense formou um grupo a parte, com apenas 25 % de similaridade em relação ao grupo das espécies do gênero. As bactérias do gênero Herbaspirillum formaram um grupo isolado com apenas 25 % de similaridade em relação ao gênero Azospirillum. O quinto grupo foi formado por apenas um isolado com 25 % de similaridade em relação aos demais.<br>This study was carried out to verify the occurrence and genetic diversity of diazotrophic bacteria associated to the native graminaceus plants Elyonurus muticus (Carona grass) and Axonopus purpusii (Mimoso grass) and the exotic Brachiaria humidicola (Brachiaria) that form the pastures in the Nhecolândia region of the Pantanal in the state of Mato Grosso do Sul, Brazil. The plants were harvested in the dry and rainy seasons and the diazotrophic bacteria populations in the soil and on roots and leaves of the three grasses were determined. Strains belonging to the species Azospirillum brasilense, A. lipoferum, A. amazonense; Herbaspirillum spp., and Burkholderia spp. were isolated. The number of diazotrophic bacteria associated to the three forage grass species during the rainy season was smaller than in the dry season. Genetic diversity in the isolated bacteria was studied by amplified rDNA restriction analysis (ARDRA) using the amplified 16S rDNA region. The isolates were divided into five different genotype groups. A. brasilense and A. lipoferum presented 50 % similarity while A. amazonense was included in another group with 25 % similarity to other species of the genus. The bacteria of genus Herbaspirillum formed a separate group with only 25 % similarity to genus Azospirillum. The fifth group consisted of only one isolate with 25 % similarity to the other groups