scholarly journals Epidemiology of Candidemia in Children over 7 Years in a Medical Center in Turkey

2021 ◽  
Author(s):  
Dilek Yılmaz-Ciftdoğan ◽  
Ahu Kara-Aksay ◽  
Gülcan Erbaş ◽  
Ümit Başak Sarkış ◽  
Eda Karadağ-Oncel ◽  
...  
Keyword(s):  
Antifungal Agents ◽  
Candida Parapsilosis ◽  
Medical Center ◽  
Fluconazole Resistance ◽  
Content Type ◽  
Epidemiologic Data

In our study, the changing epidemiology of Candida species in candidemia in children was evaluated. The dominance of Candida parapsilosis species in the changing epidemiology was remarkable. We found that fluconazole resistance was high in both parapsilosis and nonparapsilosis groups. Updating local epidemiologic data at certain intervals in candidemia cases is important in determining both the changing epidemiology and empirical antifungal agents.

scholarly journals Antifungal Activity of SCY-078 and Standard Antifungal Agents against 178 Clinical Isolates of Resistant and Susceptible Candida Species

2017 ◽  
Vol 61 (11) ◽  
Author(s):  
Wiley A. Schell ◽  
A. M. Jones ◽  
Katyna Borroto-Esoda ◽  
Barbara D. Alexander
Keyword(s):  
Candida Glabrata ◽  
Antifungal Agents ◽  
Candida Parapsilosis ◽  
Candida Krusei ◽  
Wild Type ◽  
Content Type ◽  
Clinical Resistance ◽  
Excellent Activity ◽  
Candida Lusitaniae

ABSTRACT SCY-078 in vitro activity was determined for 178 isolates of resistant or susceptible Candida albicans, Candida dubliniensis, Candida glabrata, Candida krusei, Candida lusitaniae, and Candida parapsilosis, including 44 Candida isolates with known genotypic (FKS1 or FKS2 mutations), phenotypic, or clinical resistance to echinocandins. Results were compared to those for anidulafungin, caspofungin, micafungin, fluconazole, and voriconazole. SCY-078 was shown to have excellent activity against both wild-type isolates and echinocandin- and azole-resistant isolates of Candida species.

scholarly journals Antifungal Susceptibilities of Candida Isolates Causing Bloodstream Infections at a Medical Center in Taiwan, 2009-2010

2014 ◽  
Vol 58 (7) ◽  
pp. 3814-3819 ◽  
Author(s):  
Yu-Tsung Huang ◽  
Chia-Ying Liu ◽  
Chun-Hsing Liao ◽  
Kuei-Pin Chung ◽  
Wang-Huei Sheng ◽  
...  
Keyword(s):  
Antifungal Agents ◽  
Medical Center ◽  
Bloodstream Infections ◽  
Wild Type ◽  
Diagnostic Systems ◽  
Content Type ◽  
Clinical Breakpoints ◽  
Candida Infections ◽  
Almost All ◽  
Dose Dependent

ABSTRACTWe used the Sensititre YeastOne (SYO) method (Trek Diagnostic Systems) to determine the MICs of nine antifungal agents against 474 nonduplicate bloodCandidaisolates. The MIC results were interpreted according to updated clinical breakpoints (CBPs) recommended by the Clinical and Laboratory Standards Institute (CLSI; document M27-S4) or epidemiology cutoff values (ECVs). The rates of fluconazole susceptibility were 99.2% (234/236) inCandida albicans, 86.7% (85/98) inC. tropicalis, and 97.7% (42/43) inC. parapsilosis. Among the 77 isolates ofC. glabrata, 90.9% showed dose-dependent susceptibility (S-DD) to fluconazole. Nearly all isolates ofC. albicans,C. parapsilosis, andC. kruseiwere susceptible to voriconazole; however, rates of voriconazole susceptibility were 78.6% inC. tropicalis. Few isolates ofC. albicans(n= 5; 2.1%) andC. glabrata(n= 3; 3.9%), no isolates ofC. parapsilosis,C. krusei, andC. guilliermondii, but 62.2% (n= 51) ofC. tropicalisisolates were non-wild type for posaconazole susceptibility. For itraconazole susceptibility, 98.3% ofC. albicansisolates were wild type, and 3.9% (n= 3) ofC. glabrataisolates were non-wild type. Almost all of the isolates tested (>97% for all species) were susceptible to both micafungin and anidulafungin. All isolates tested were found to be wild type for amphotericin B susceptibility, with MICs of <1μg/ml. Further evaluation is needed to establish CBPs of antifungal agents by the 24-h SYO method for the management of patients with candidemia or other invasive candida infections.

scholarly journals Molecular Mechanisms of Fluconazole Resistance in Candida parapsilosis Isolates from a U.S. Surveillance System

2014 ◽  
Vol 59 (2) ◽  
pp. 1030-1037 ◽  
Author(s):  
Nina T. Grossman ◽  
Cau D. Pham ◽  
Angela A. Cleveland ◽  
Shawn R. Lockhart
Keyword(s):  
Molecular Mechanisms ◽  
Candida Parapsilosis ◽  
Efflux Pump ◽  
Point Mutations ◽  
Resistance Rate ◽  
Primary Therapy ◽  
Fluconazole Resistance ◽  
Content Type ◽  
Fluconazole Resistant ◽  
Dose Dependent

ABSTRACTCandida parapsilosisis the second or third most common cause of candidemia in many countries. The Infectious Diseases Society of America recommends fluconazole as the primary therapy forC. parapsilosiscandidemia. Although the rate of fluconazole resistance amongC. parapsilosisisolates is low in most U.S. institutions, the resistance rate can be as high as 7.5%. This study was designed to assess the mechanisms of fluconazole resistance in 706 incident bloodstream isolates from U.S. hospitals. We sequenced theERG11andMRR1genes of 122C. parapsilosisisolates with resistant (30 isolates; 4.2%), susceptible dose-dependent (37 isolates; 5.2%), and susceptible (55 isolates) fluconazole MIC values and used real-time PCR of RNA from 17 isolates to investigate the regulation ofMDR1. By comparing these isolates to fully fluconazole-susceptible isolates, we detected at least two mechanisms of fluconazole resistance: an amino acid substitution in the 14-α-demethylase geneERG11and overexpression of the efflux pumpMDR1, possibly due to point mutations in theMRR1transcription factor that regulatesMDR1. TheERG11single nucleotide polymorphism (SNP) was found in 57% of the fluconazole-resistant isolates and in no susceptible isolates. TheMRR1SNPs were more difficult to characterize, as not all resulted in overexpression ofMDR1and not allMDR1overexpression was associated with an SNP inMRR1. Further work to characterize theMRR1SNPs and search for overexpression of other efflux pumps is needed.

scholarly journals Candida parapsilosis Resistance to Fluconazole: Molecular Mechanisms andIn VivoImpact in Infected Galleria mellonella Larvae

2015 ◽  
Vol 59 (10) ◽  
pp. 6581-6587 ◽  
Author(s):  
Ana Carolina R. Souza ◽  
Beth Burgwyn Fuchs ◽  
Henrique M. S. Pinhati ◽  
Ricardo A. Siqueira ◽  
Ferry Hagen ◽  
...  
Keyword(s):  
Molecular Mechanisms ◽  
Candida Parapsilosis ◽  
Galleria Mellonella ◽  
Common Mutation ◽  
Fluconazole Resistance ◽  
Content Type ◽  
Clonal Origin ◽  
Fluconazole Resistant ◽  
Resistant Strains

ABSTRACTCandida parapsilosisis the main non-albicans Candidaspecies isolated from patients in Latin America. Mutations in theERG11gene and overexpression of membrane transporter proteins have been linked to fluconazole resistance. The aim of this study was to evaluate the molecular mechanisms in fluconazole-resistant strains ofC. parapsilosisisolated from critically ill patients. The identities of the nine collectedC. parapsilosisisolates at the species level were confirmed through molecular identification with a TaqMan qPCR assay. The clonal origin of the strains was checked by microsatellite typing. TheGalleria mellonellainfection model was used to confirmin vitroresistance. We assessed the presence ofERG11mutations, as well as the expression ofERG11and two additional genes that contribute to antifungal resistance (CDR1andMDR1), by using real-time quantitative PCR. All of theC. parapsilosis(sensu stricto) isolates tested exhibited fluconazole MICs between 8 and 16 μg/ml. Thein vitrodata were confirmed by the failure of fluconazole in the treatment ofG. mellonellainfected with fluconazole-resistant strains ofC. parapsilosis. Sequencing of theERG11gene revealed a common mutation leading to a Y132F amino acid substitution in all of the isolates, a finding consistent with their clonal origin. After fluconazole exposure, overexpression was noted forERG11,CDR1, andMDR1in 9/9, 9/9, and 2/9 strains, respectively. We demonstrated that a combination of molecular mechanisms, including the presence of point mutations in theERG11gene, overexpression ofERG11, and genes encoding efflux pumps, are involved in fluconazole resistance inC. parapsilosis.

Safety and efficacy of stereotactic radiosurgery for tumors of the spine

2004 ◽  
pp. 413-418 ◽  
Author(s):  
Deborah L. Benzil ◽  
Mehran Saboori ◽  
Alon Y. Mogilner ◽  
Ronald Rocchio ◽  
Chitti R. Moorthy
Keyword(s):  
Spinal Cord ◽  
Single Dose ◽  
Pain Relief ◽  
Total Dose ◽  
Stereotactic Radiosurgery ◽  
Medical Center ◽  
Primary Tumors ◽  
Content Type ◽  
Increased Risk ◽  
Fine Print

Object. The extension of stereotactic radiosurgery treatment of tumors of the spine has the potential to benefit many patients. As in the early days of cranial stereotactic radiosurgery, however, dose-related efficacy and toxicity are not well understood. The authors report their initial experience with stereotactic radiosurgery of the spine with attention to dose, efficacy, and toxicity. Methods. All patients who underwent stereotactic radiosurgery of the spine were treated using the Novalis unit at Westchester Medical Center between December 2001 and January 2004 are included in a database consisting of demographics on disease, dose, outcome, and complications. A total of 31 patients (12 men, 19 women; mean age 61 years, median age 63 years) received treatment for 35 tumors. Tumor types included 26 metastases (12 lung, nine breast, five other) and nine primary tumors (four intradural, five extradural). Thoracic tumors were most common (17 metastases and four primary) followed by lumbar tumors (four metastases and four primary). Lesions were treated to the 85 to 90% isodose line with spinal cord doses being less than 50%. The dose per fraction and total dose were selected on the basis of previous treatment (particularly radiation exposure), size of lesion, and proximity to critical structures. Conclusions. Rapid and significant pain relief was achieved after stereotactic radiosurgery in 32 of 34 treated tumors. In patients treated for metastases, pain was relieved within 72 hours and remained reduced 3 months later. Pain relief was achieved with a single dose as low as 500 cGy. Spinal cord isodoses were less than 50% in all patients except those with intradural tumors (mean single dose to spinal cord 268 cGy and mean total dose to spinal cord 689 cGy). Two patients experienced transient radiculitis (both with a biological equivalent dose (BED) > 60 Gy). One patient who suffered multiple recurrences of a conus ependymoma had permanent neurological deterioration after initial improvement. Pathological evaluation of this lesion at surgery revealed radiation necrosis with some residual/recurrent tumor. No patient experienced other organ toxicity. Stereotactic radiosurgery of the spine is safe at the doses used and provides effective pain relief. In this study, BEDs greater than 60 Gy were associated with an increased risk of radiculitis.

Development of neurosurgery in Southern California and the Los Angeles County/University of Southern California Medical Center

1993 ◽  
Vol 79 (1) ◽  
pp. 145-148
Author(s):  
John H. Schneider ◽  
Martin H. Weiss ◽  
William T. Couldwell
Keyword(s):  
Los Angeles ◽  
Los Angeles County ◽  
Southern California ◽  
Medical Center ◽  
University Of Southern California ◽  
Content Type ◽  
School Of Medicine ◽  
Integral Role ◽  
Southern California School ◽  
The University

✓ The Los Angeles County General Hospital has played an integral role in the development of medicine and neurosurgery in Southern California. From its fledgling beginnings, the University of Southern California School of Medicine has been closely affiliated with the hospital, providing the predominant source of clinicians to care for and to utilize as a teaching resource the immense and varied patient population it serves.

Gender inequalities in perceived stress and the factors affecting it in infertile couples in Iranian society: a case in one of the provinces of Iran

2021 ◽  
Vol ahead-of-print (ahead-of-print) ◽  
Author(s):  
Sima Mirzaei Moghadam ◽  
Hassan Mahmoodi ◽  
Farzaneh Zaheri ◽  
Azad Shokri
Keyword(s):  
Social Support ◽  
Perceived Stress ◽  
Medical Center ◽  
Self Esteem ◽  
Gender Inequalities ◽  
Social Emotional ◽  
Content Type ◽  
Emotional Loneliness ◽  
Infertile Couples ◽  
Related Stress

Purpose The aim of this study is to investigate the gender inequalities in perceived stress and the influencing factors in infertile couples in Iranian society. Design/methodology/approach This cross-sectional study was conducted on infertile couples who were referring to Kurdistan Infertility Diagnosis and Treatment Medical Center in 2019. Demographic and clinical information questionnaire, Newton's Infertility perceived stress questionnaire, Rosenberg's standard self-confidence questionnaire and the multidimensional scale of social support were used. Multiple linear logistic models were also used. Findings A total of 560 couples (1,120 people) participated in the study. The average perceived infertility-related stress, self-esteem scores and social support and social-emotional loneliness were 173.95 ± 41.87, 13.99 ± 2.29 and 27.81 ± 7.33, respectively, which were significantly different scores across infertility cause and sex (P < 0.05). Males compared to females had lower perceived infertility-related stress (169.93 ± 42.51 vs 177.97 ± 40.86, P = 0.001) and self-esteem scores (14.33 ± 2.29 vs 13.66 ± 2.24, P < 0.001) and social support and social-emotional loneliness (32.92 ± 9.31 vs 30.94 ± 9.04, P < 0.001). The partners who reported themselves as infertile, compared significantly higher in perceived infertility-related stress than those who reported their spouse being infertile (194.24 ± 35.33 vs 141.90 ± 39.28), lower self-esteem scores (12.77 ± 2.21 vs 13.94 ± 1.56) and social support and social-emotional loneliness score (27.81 ± 7.33 vs 30.11 ± 7.70). Also, after taking potential confounders into account with increase in each score of self-esteem, 12.19 units of stress decreases (P < 0.001, 95% CI: 11.40–12.99) and with increase in each score of social support and social-emotional loneliness, 3.45 units of stress decreases (P < 0.001, 95% CI: 3.28–3.63). Originality/value There is perceived stress among infertile couples, and this rate is higher among infertile people and women. Therefore, it seems that specific intervention programs for infertile couples should be implemented based on the results of this study, and their stress levels in a way that self-esteem and support for both partners be increased and the perceived stress among women and infertile individuals be decreased.

Validating the primary provider theory in emergency medicine

2008 ◽  
Vol 21 (2) ◽  
pp. 120-130 ◽  
Author(s):  
Joseph S. Guarisco ◽  
Stefoni A. Bavin
Keyword(s):  
Emergency Department ◽  
Patient Satisfaction ◽  
Pay For Performance ◽  
Medical Center ◽  
Waiting Times ◽  
Emergency Department Visits ◽  
Business Success ◽  
Content Type ◽  
The Impact

PurposeThe purpose of this paper is to provide a case study testing the Primary Provider Theory proposed by Aragon that states that: disproportionate to any other variables, patient satisfaction is distinctly and primarily linked to physician behaviors and secondarily to waiting times.Design/methodology/approachThe case study began by creating incentives motivating physicians to reflect and improve behaviors (patient interactions) and practice patterns (workflow efficiency). The Press Ganey Emergency Department Survey was then utilized to track the impact of the incentive programs and to ascertain any relationship between patient satisfaction with the provider and global patient satisfaction with emergency department visits by measuring patient satisfaction over an eight quarter period.FindingsThe findings were two‐fold: firstly, the concept of “pay for performance” as a tool for physician motivation was valid; and secondly, the impact on global patient satisfaction by increases in patient satisfaction with the primary provider was significant and highly correlated, as proposed by Aragon.Practical implicationsThese findings can encourage hospitals and physician groups to place a high value on the performance of primary providers of patient care, provide incentives for appropriate provider behaviors through “pay for performance” programs and promote physician understanding of the links between global patient satisfaction with physician behaviors and business growth, malpractice reduction, and other key measures of business success.Originality/valueThere are no other case studies prior to this project validating the Primary Provider Theory in an urban medical center; this project adds to the validity and credibility of the theory in this setting.

scholarly journals Albumin Enhances Caspofungin Activity against Aspergillus Species by Facilitating Drug Delivery to Germinating Hyphae

2015 ◽  
Vol 60 (3) ◽  
pp. 1226-1233 ◽  
Author(s):  
Petros Ioannou ◽  
Aggeliki Andrianaki ◽  
Tonia Akoumianaki ◽  
Irene Kyrmizi ◽  
Nathaniel Albert ◽  
...  
Keyword(s):  
Drug Delivery ◽  
Cell Culture ◽  
Antifungal Agents ◽  
Fold Increase ◽  
Culture Conditions ◽  
The Other ◽  
Related Factors ◽  
Content Type

The modestin vitroactivity of echinocandins againstAspergillusimplies that host-related factors augment the action of these antifungal agentsin vivo. We found that, in contrast to the other antifungal agents (voriconazole, amphotericin B) tested, caspofungin exhibited a profound increase in activity against variousAspergillusspecies under conditions of cell culture growth, as evidenced by a ≥4-fold decrease in minimum effective concentrations (MECs) (P= 0. 0005). Importantly, the enhanced activity of caspofungin againstAspergillusspp. under cell culture conditions was strictly dependent on serum albumin and was not observed with the other two echinocandins, micafungin and anidulafungin. Of interest, fluorescently labeled albumin bound preferentially on the surface of germinatingAspergillushyphae, and this interaction was further enhanced upon treatment with caspofungin. In addition, supplementation of cell culture medium with albumin resulted in a significant, 5-fold increase in association of fluorescently labeled caspofungin withAspergillushyphae (P< 0.0001). Collectively, we found a novel synergistic interaction between albumin and caspofungin, with albumin acting as a potential carrier molecule to facilitate antifungal drug delivery toAspergillushyphae.

scholarly journals Candida parapsilosis Candidemia Resistance Patterns and Treatment Outcomes: An Opportunity for Antifungal Stewardship

2017 ◽  
Vol 4 (suppl_1) ◽  
pp. S86-S86
Author(s):  
Gary Fong ◽  
Kim Ngo ◽  
Hannah Russo ◽  
Nicholas Beyda
Keyword(s):  
Combination Therapy ◽  
Treatment Outcomes ◽  
Candida Parapsilosis ◽  
Medical Center ◽  
Antifungal Susceptibility ◽  
Antifungal Stewardship ◽  
Resistance Patterns ◽  
Fluconazole Therapy ◽  
The Impact ◽  
Research Grant

Abstract Background Candida parapsilosis has emerged as an important fungal pathogen with mortality rates up to 30%. Recent studies show no difference in treatment outcomes for patients treated both empirically and definitively with either echinocandins or fluconazole. However, the impact of antifungal susceptibility testing and opportunities for antifungal stewardship are less clear in this patient population. The purpose of this study was to assess antifungal susceptibility rates, treatment patterns, and outcomes among patients with C. parapsilosis candidemia. Methods This was a single-center, retrospective cohort review of adult patients with a positive blood culture for C. parapsilosis hospitalized at Baylor St. Luke’s Medical Center, between 2006 and 2016. Patients with mixed or breakthrough candidemia were excluded as well as patients who expired within 3 days of candidemia onset. Results Eighty patients with C. parapsilosis candidemia were identified of which 48 met inclusion criteria. Nine patients had infections caused by fluconazole non-susceptible isolates (19%). The most common empiric treatment choice was an echinocandin (33/48, 69%), followed by fluconazole (9/48, 19%), and combination therapy (6/48, 13%). Of the 39 patients with fluconazole susceptible isolates, only 17 were treated with fluconazole definitively (44%). Among patients who received empiric echinocandin vs. fluconazole therapy, there was no difference in 14-day mortality (9% vs. 11%, P = 1.00) or in-hospital mortality (12% vs. 11%, P = 1.00). Empiric combination therapy was the only independent risk factor for treatment failure (OR, 13.8; 95% CI, 1.4–138.3; P = 0.03). Conclusion Treatment outcomes for patients receiving echinocandins were similar for those receiving fluconazole. At our institution, the increased incidence of fluconazole non-susceptible isolates warrants the use of echinocandins empirically. Patients were more likely to remain on echinocandin therapy even when fluconazole susceptible isolates were identified. This study reinforces the guideline suggestion that neither echinocandins nor fluconazole treatment leads to superior outcomes, but also identifies a cohort of patients in need of antifungal stewardship. Disclosures N. Beyda, Astellas: Grant Investigator and Scientific Advisor, Research grant

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