scholarly journals Thirteen-Year Evolution of Azole Resistance in Yeast Isolates and Prevalence of Resistant Strains Carried by Cancer Patients at a Large Medical Center

1998 ◽  
Vol 42 (4) ◽  
pp. 734-738 ◽  
Author(s):  
Cynthia R. Boschman ◽  
Ulana R. Bodnar ◽  
Michelle A. Tornatore ◽  
Arlene A. Obias ◽  
Gary A. Noskin ◽  
...  
Keyword(s):  
Antifungal Agents ◽  
Hematologic Malignancy ◽  
Medical Center ◽  
High Risk Patient ◽  
Clinical Isolates ◽  
Microbial Pathogens ◽  
Resistant Isolate ◽  
Transplant Patients ◽  
Susceptibility Tests ◽  
Therapeutic Decision Making

ABSTRACT Drug resistance is emerging in many important microbial pathogens, including Candida albicans. We performed fungal susceptibility tests with archived isolates obtained from 1984 through 1993 and fresh clinical isolates obtained from 1994 through 1997 by testing their susceptibilities to fluconazole, ketoconazole, and miconazole and compared the results to the rate of fluconazole use. All isolates recovered prior to 1993 were susceptible to fluconazole. Within 3 years of widespread azole use, we detected resistance to all agents in this class. In order to assess the current prevalence of resistant isolates in our hematologic malignancy and transplant patients, we obtained rectal swabs from hospitalized, non-AIDS, immunocompromised patients between June 1995 and January 1996. The swabs were inoculated onto sheep’s blood agar plates containing 10 μg of vancomycin and 20 μg of gentamicin/ml of agar. One hundred one yeasts were recovered from 97 patients and were tested for their susceptibilities to amphotericin B, fluconazole, flucytosine, ketoconazole, and miconazole. The susceptibility pattern was then compared to those for all clinical isolates obtained throughout the medical center. The antifungal drug histories for each patient were also assessed. The yeasts from this surveillance study were at least as susceptible as the overall hospital strains. There did not appear to be a direct linkage between prior receipt of antifungal agent therapy and carriage of a new, drug-resistant isolate. Increased resistance to newer antifungal agents has occurred at our medical center, but it is not focal to any high-risk patient population that we studied. Monitoring of susceptibility to antifungal agents appears to be necessary for optimizing clinical therapeutic decision making.

A(H1N1)v cases of the 2009/2010 and 2010/2011 influenza seasons in the Medical and Health Sciences Centre of Debrecen University

2012 ◽  
Vol 153 (17) ◽  
pp. 649-654
Author(s):  
Piroska Orosi ◽  
Judit Szidor ◽  
Tünde Tóthné Tóth ◽  
József Kónya
Keyword(s):  
High Risk ◽  
Influenza Season ◽  
National Level ◽  
Organ Transplant ◽  
High Risk Patient ◽  
Risk Groups ◽  
Health Sciences ◽  
World Health ◽  
Transplant Patients ◽  
Health Organization

The swine-origin new influenza variant A(H1N1) emerged in 2009 and changed the epidemiology of the 2009/2010 influenza season globally and at national level. Aims: The aim of the authors was to analyse the cases of two influenza seasons. Methods: The Medical and Health Sciences Centre of Debrecen University has 1690 beds with 85 000 patients admitted per year. The diagnosis of influenza was conducted using real-time polymerase chain reaction in the microbiological laboratories of the University and the National Epidemiological Centre, according to the recommendation of the World Health Organization. Results: The incidence of influenza was not higher than that observed in the previous season, but two high-risk patient groups were identified: pregnant women and patients with immunodeficiency (oncohematological and organ transplant patients). The influenza vaccine, which is free for high-risk groups and health care workers in Hungary, appeared to be effective for prevention, because in the 2010/2011 influenza season none of the 58 patients who were administered the vaccination developed influenza. Conclusion: It is an important task to protect oncohematological and organ transplant patients. Orv. Hetil., 2012, 153, 649–654.

scholarly journals 735. Trends and Cost Analysis of Aspergillus Galactomannan testing at a Tertiary Medical Center

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S417-S417
Author(s):  
Peyton R Treutel ◽  
Anna Carr ◽  
Pradeep Bathina
Keyword(s):  
Stem Cell ◽  
Hematologic Malignancy ◽  
Medical Center ◽  
Organ Transplant ◽  
The Self ◽  
Solid Organ ◽  
Data Set ◽  
Hematopoietic Stem ◽  
Patients Âgés ◽  
Optical Density Index

Abstract Background Aspergillus is a fungus spread by inhalation of spores that can lead to invasive (IA), chronic, or allergic aspergillosis. Risk factors for IA include neutropenia, hematological malignancy, allogenic stem cell (HSCT) or solid organ transplant, severe immunodeficiency, or prolonged steroid use. An alternative to invasive tissue sampling, the serum Galactomannan (AGM) test detects a polysaccharide cell wall component of Aspergillus and can be used to determine a probable diagnosis of IA. Accuracy of AGM is related to disease burden and thus has the highest sensitivity and specificity in patients with hematologic malignancy or Hematopoietic stem cell transplantation (HSCT) at 70-82% and 86-92%, respectively. Studies have shown sensitivity to decline in other populations, with solid organ transplants as low as 20%. Methods We performed a retrospective study of all patients who received the AGM test at UMMC from January 3, 2013 to December 31, 2019. Patient Cohort Explorer was used to obtain de-identified patient data from EPIC. We obtained the number of encounters and patients on whom the AGM test was performed along with other variables. Billing offices provided the self-pay cost per AGM test. Results A total of 6,404 AGM tests were performed on 2,126 patients during 4,315 encounters in the study period. With a total of 499, 574, 984, 1140, 851, 1175 and 1181 tests done respectively from 2013 to 2019, a increasing trend was noted. The patients ages ranged from 1 to 89 with a median age of 52 years. A total of 3,055 tests were ordered in females, and 3,349 were ordered in males. At a cut off value (optical density index) of > 0.5, 183 AGM tests resulted positive in 108 patients and at a cut of > 1.0, 113 tests are positive in 70 patients. The rate of a positive AGM tests at > 0.5 was at 2.85% and at > 1.0 was at 1.76% over the study period. With the self-pay cost of each test at $134.54 in 2019 USD, the total cost of 6,404 tests was $861,594.16. Conclusion To our knowledge this data set constitutes the largest sample size of AGM testing. From our data, it seems that the rate of ordering this test has increased yearly. Relatively low percentage of these tests are positive, suggesting that it is most likely a large amount of these tests could have been ordered inappropriately or in the wrong clinical context. Disclosures All Authors: No reported disclosures

scholarly journals Donor-Derived Myeloid Sarcoma in Two Kidney Transplant Recipients from a Single Donor

2015 ◽  
Vol 2015 ◽  
pp. 1-5 ◽  
Author(s):  
Amudha Palanisamy ◽  
Paul Persad ◽  
Patrick P. Koty ◽  
Laurie L. Douglas ◽  
Robert J. Stratta ◽  
...  
Keyword(s):  
Kidney Transplant ◽  
Hematologic Malignancy ◽  
Deceased Donor ◽  
Myeloid Sarcoma ◽  
Kidney Transplant Recipients ◽  
Systemic Involvement ◽  
Transplant Patients ◽  
Single Donor ◽  
Allograft Nephrectomy ◽  
One Year

We report the rare occurrence of donor-derived myeloid sarcoma in two kidney transplant patients who received organs from a single deceased donor. There was no evidence of preexisting hematologic malignancy in the donor at the time of organ recovery. Both recipients developed leukemic involvement that appeared to be limited to the transplanted organ. Fluorescencein situhybridization (FISH) and molecular genotyping analyses confirmed that the malignant cells were of donor origin in each patient. Allograft nephrectomy and immediate withdrawal of immunosuppression were performed in both cases; systemic chemotherapy was subsequently administered to one patient. Both recipients were in remission at least one year following the diagnosis of donor-derived myeloid sarcoma. These cases suggest that restoration of the immune system after withdrawal of immunosuppressive therapy and allograft nephrectomy may be sufficient to control HLA-mismatched donor-derived myeloid sarcoma without systemic involvement.

Effectiveness of ZnO Nano Particles against the Foodborne Microbial Pathogens E. coli and S. aureus

2020 ◽  
Vol 15 (2) ◽  
pp. 87-94
Keyword(s):  
Antimicrobial Agents ◽  
Inhibitory Concentration ◽  
Antimicrobial Effect ◽  
Nano Particles ◽  
Microbial Pathogens ◽  
Gram Positive ◽  
Gram Negative ◽  
E Coli ◽  
Antimicrobial Susceptibility Tests ◽  
Susceptibility Tests

In this work, various concentrations of ZnO nano particles, prepared by the coprecipitation method with a size range of 47-68 nm, have been investigated as antimicrobial agents. Dilution antimicrobial susceptibility tests were carried out on two kinds of microbes (Gram-positive Staphylococcus aureus and Gram-negative Escherichia coli) according to the standard method recommended by Clinical and Laboratory Standards Institute, CLSI-2015-M07-A10. The results showed that the antimicrobial effect is larger, the higher the concentration of ZnO nano particles in solution. It was also found that Gram-positive microbes are more sensitive to ZnO nano particles when compared with the Gram-negative ones. The minimum inhibitory concentration (MIC) for E. coli was found to be 50 mg/mL while that for S. aureus was 25 mg/mL. The minimum bactericidal concentration (MBC) was 1600 mg/mL for E. coli and 800 mg/mL for S. aureus.

scholarly journals Characterization of the Proliferating Cell Nuclear Antigen of Leishmania donovani Clinical Isolates and Its Association with Antimony Resistance

2014 ◽  
Vol 58 (6) ◽  
pp. 2997-3007 ◽  
Author(s):  
Rati Tandon ◽  
Sharat Chandra ◽  
Rajendra Kumar Baharia ◽  
Sanchita Das ◽  
Pragya Misra ◽  
...  
Keyword(s):  
Clinical Isolate ◽  
Proliferating Cell Nuclear Antigen ◽  
Leishmania Donovani ◽  
Clinical Isolates ◽  
Resistant Isolate ◽  
Nuclear Antigen ◽  
Wild Type ◽  
Content Type ◽  
Sensitive Isolate ◽  
Proliferating Cell

ABSTRACTPreviously, through a proteomic analysis, proliferating cell nuclear antigen (PCNA) was found to be overexpressed in the sodium antimony gluconate (SAG)-resistant clinical isolate compared to that in the SAG-sensitive clinical isolate ofLeishmania donovani. The present study was designed to explore the potential role of the PCNA protein in SAG resistance inL. donovani. For this purpose, the protein was cloned, overexpressed, purified, and modeled. Western blot (WB) and real-time PCR (RT-PCR) analyses confirmed that PCNA was overexpressed by ≥3-fold in the log phase, stationary phase, and peanut agglutinin isolated procyclic and metacyclic stages of the promastigote form and by ∼5-fold in the amastigote form of the SAG-resistant isolate compared to that in the SAG-sensitive isolate.L. donovaniPCNA (LdPCNA) was overexpressed as a green fluorescent protein (GFP) fusion protein in a SAG-sensitive clinical isolate ofL. donovani, and modulation of the sensitivities of the transfectants to pentavalent antimonial (SbV) and trivalent antimonial (SbIII) drugs was assessedin vitroagainst promastigotes and intracellular (J774A.1 cell line) amastigotes, respectively. Overexpression of LdPCNA in the SAG-sensitive isolate resulted in an increase in the 50% inhibitory concentrations (IC50) of SbV(from 41.2 ± 0.6 μg/ml to 66.5 ± 3.9 μg/ml) and SbIII(from 24.0 ± 0.3 μg/ml to 43.4 ± 1.8 μg/ml). Moreover, PCNA-overexpressing promastigote transfectants exhibited less DNA fragmentation compared to that of wild-type SAG-sensitive parasites upon SbIIItreatment. In addition, SAG-induced nitric oxide (NO) production was found to be significantly inhibited in the macrophages infected with the transfectants compared with that in wild-type SAG-sensitive parasites. Consequently, we infer that LdPCNA has a significant role in SAG resistance inL. donovaniclinical isolates, which warrants detailed investigations regarding its mechanism.

scholarly journals Utility of Routine Genomic Sequencing for Infection Control Surveillance

2017 ◽  
Vol 4 (suppl_1) ◽  
pp. S35-S35
Author(s):  
Richard T Ellison ◽  
Andrew Hoss ◽  
Jomol Mathew ◽  
Jeff Halperin ◽  
Brian Gross ◽  
...  
Keyword(s):  
Infection Control ◽  
Medical Center ◽  
Academic Medical Center ◽  
Microbial Pathogens ◽  
Genomic Sequencing ◽  
Sequencing Analysis ◽  
Nucleotide Polymorphisms ◽  
Philips Healthcare ◽  
Recent Transmission ◽  
Research Grant

Abstract Background Recent work indicates that comprehensive genomic sequencing can be a highly effective tool in defining the transmission of microbial pathogens. We have studied the utility of the routine use of genomic sequencing for infection control surveillance in an academic medical center. Methods The genomes of inpatient and emergency department isolates of Staphylococcus aureus, Pseudomonas aeruginosa, Klebsiella pneumoniae, and Enterococcus faecium were sequenced. Within each species, single-nucleotide polymorphisms (SNP) were identified in the core genome for all isolates using alignment-based methods. The number of SNP differences between isolate pairs was determined and used, in combination with the patient’s electronic medical records to identify potential transmission events. Results Between September 2016 and March 2017, 388 S. aureus, 66 P. aeruginosa, 48 K. pneumoniae, and 29 E. faecium isolates were sequenced from 373 patients. There was variation in the distribution of SNP differences between intrapatient isolates for the four pathogens; with the least variability for E. faecium and greatest for P. aeruginosa. The majority of the bacterial isolates from separate patients appeared to be genetically unique exhibiting marked SNP differences from other isolates. There were 19 sets of isolates where the SNP variation between interpatient isolates was either comparable to that of intrapatient variation (12) and suggestive of recent transmission events, or with SNP variation somewhat greater than the intrapatient SNP variation (7) suggesting relative relatedness. Only one of the highly related sets had been previously identified by standard infection control surveillance. Likely transmissions appeared to have occurred both in the inpatient and outpatient settings, and the transmission routes were not always apparent. Conclusion The routine use of genomic sequencing analysis identified previously unrecognized likely transmission events within the institution’s patient population that are of relevance to infection control surveillance. This capacity should significantly enhance our understanding of the epidemiology of hospital acquired infections, and assist in developing and implementing new prevention strategies. Disclosures R. T. Ellison III, Philips Healthcare: Consultant and Grant Investigator, Consulting fee and Research grant; A. Hoss, Philips: Employee, Salary; J. Mathew, Philips Healthcare: Investigator, Research grant; J. Halperin, Philips Healthcare: Employee and Shareholder, Salary; B. Gross, Philips: Employee and Shareholder, Salary; D. V. Ward, Philips Healthcare: Consultant, Investigator and Research Contractor, Consulting fee, Research support and Salary

scholarly journals Epidemiology and Antifungal Susceptibility Profile of Aspergillus Species: Comparison between Environmental and Clinical Isolates from Patients with Hematologic Malignancies

2019 ◽  
Vol 57 (7) ◽  
Author(s):  
Sung-Yeon Cho ◽  
Dong-Gun Lee ◽  
Won-Bok Kim ◽  
Hye-Sun Chun ◽  
Chulmin Park ◽  
...  
Keyword(s):  
Invasive Aspergillosis ◽  
Cryptic Species ◽  
Hematologic Malignancy ◽  
Antifungal Susceptibility ◽  
Hematologic Malignancies ◽  
Clinical Isolates ◽  
Environmental Isolates ◽  
Content Type ◽  
Culture Positive ◽  
Global Data

ABSTRACT Global data on the epidemiology and susceptibility of Aspergillus are crucial in the management of invasive aspergillosis. Here, we aimed to determine the characteristics of clinical and environmental Aspergillus isolates, focusing mainly on hematologic malignancy patients. We prospectively collected all consecutive cases and clinical isolates of culture-positive proven/probable invasive aspergillosis patients from January 2016 to April 2018 and sampled the air inside and outside the hospital. Cryptic species-level identification of Aspergillus, antifungal susceptibilities, and cyp51 gene sequencing were performed, and clinical data were analyzed. This study was conducted as part of the Catholic Hematology Hospital Fungi Epidemiology (CAFÉ) study. A total of 207 proven/probable invasive aspergillosis and 102 clinical and 129 environmental Aspergillus isolates were included in this analysis. The incidence of proven/probable invasive aspergillosis was 1.3 cases/1,000 patient-days during the study period. Cryptic Aspergillus species accounted for 33.8%, with no differences in proportions between the clinical and environmental isolates. Section Nigri presented a high proportion (70.5%) of cryptic species, mainly from A. tubingensis and A. awamori: the former being dominant in environmental samples, and the latter being more common in clinical isolates (P < 0.001). Of 91 A. fumigatus isolates, azole-resistant A. fumigatus was found in 5.3% of all A. fumigatus isolates. Three isolates presented the TR34/L98H mutation of the cyp51A gene. Patients with invasive aspergillosis caused by azole-resistant A. fumigatus showed 100% all-cause mortality at 100 days. This study demonstrates the significant portion of cryptic Aspergillus species and clinical implications of azole resistance and underscores the comparison between clinical and environmental isolates.

Sign in / Sign up

Export Citation Format

Share Document