scholarly journals Nadir Etken Bir Maya: Üçüncü Basamak Üniversite Hastanesinde İzlenen Rhodotorula mucilaginosa Enfeksiyonu Olguları

2021 ◽  
Vol 55 (1) ◽  
pp. 91-98
Author(s):  
Çağlayan Merve Ayaz ◽  
Dolunay Gülmez ◽  
Sevtap Arıkan Akdağlı ◽  
Ömrüm Uzun
Keyword(s):  
Risk Factors ◽  
Blood Culture ◽  
Broad Spectrum ◽  
Urinary Catheter ◽  
Rhodotorula Mucilaginosa ◽  
Invasive Procedures ◽  
Lipid Complex ◽  
Amphotericin B Lipid Complex ◽  
Rhodotorula Species

Rhodotorula species are yeasts that are common in the environment,but are not frequently encountered as an infectious agent in humans. Rhodotorula mucilaginosa, Rhodotorula glutinis and Rhodotorula minuta are the species that cause disease in humans. Although its isolation from mucosa is doubtful in terms of the presence of true infection, it is more frequently encountered in daily practice due to the increasing number of invasive procedures, immune system deficiencies caused by immunosuppressive drugs and diseases. R.mucilaginosa growth isolated from various clinical samples between 2000 and 2018 in a tertiary university hospital was presented in this case report. The first case was an 82-year-old man with chronic lung disease, hypertension, congestive heart failure and acute leukemia causing severe immunosuppression. Use of broad spectrum antibiotics, history of immunosuppressive therapy, presence of jugular catheter were the risk factors in this patient. R.mucilaginosa was isolated from blood culture while the patient was receiving fluconazole treatment for Candida albicans grown in urine culture and the patient died before starting the treatment. The second case was a 34-year-old female patient with congenital heart disease. Discharge was observed at the intracardiac defibrillator site of the patient, a temporary pacemaker was inserted, and she used broad spectrum antibiotics for a long time. When the yeast growth was reported in the blood culture, caspofungin treatment was initiated. Although the treatment was switched to amphotericin B lipid complex after the culture result was reported as R.mucilaginosa, the patient died after 12 hours. The third case was a 70-year-old woman with hypertension, dementia, diabetes mellitus and rheumatoid arthritis admitted to the intensive care unit due to cerebrovascular accident. She received different immunosuppressive treatments and had invasive procedures. R.mucilaginosa was isolated from the blood culture taken from the patient’s catheter, and there was no growth in the blood culture obtained from the peripheral vein. Anidulafungin was started empirically, which was changed to amphotericin B lipid complex after the identification of the yeast. The patient died for various reasons 10 days after the antifungal treatment was stopped. Our last case was a 55-year-old woman with metastatic ovarian cancer and secondary ascites. Broad-spectrum multiple antibiotics were used and invasive procedures were performed. R.mucilaginosa and C.albicans were isolated from the urine of the patient who had a urinary catheter. No growth was detected from urine after changing the urinary catheter. Therefore, growths were evaluated as colonization, and fluconazole was administered for C.albicans due to the high risk of invasive infection. The patient was lost for different reasons. The development and diversity of the treatment methods lead to the emergence of some opportunistic infectious agents that were not observed previously. Rhodotorula species are one of the rare agents that have increased over the years. Rhodotorula species should be considered as the cause of an infection if no clinical response is obtained after echinocandin and/or fluconazole treatment in patients with long-term immunosuppression and invasive procedures. Data on clinical pictures, treatment responses, follow-up and treatment results of this rare yeast are still limited. This case series was presented to draw attention to the risk factors related to R.mucilaginosa infection/colonization, clinical characteristics of the patients, follow-up results and treatment options and to contribute to the literature.

scholarly journals Safety, tolerance, and pharmacokinetics of amphotericin B lipid complex in children with hepatosplenic candidiasis.

1997 ◽  
Vol 41 (9) ◽  
pp. 1944-1948 ◽  
Author(s):  
T J Walsh ◽  
P Whitcomb ◽  
S Piscitelli ◽  
W D Figg ◽  
S Hill ◽  
...  
Keyword(s):  
Steady State ◽  
Amphotericin B ◽  
Plasma Concentrations ◽  
Area Under The Curve ◽  
Lipid Complex ◽  
Pediatric Cancer Patients ◽  
Hepatosplenic Candidiasis ◽  
Amphotericin B Lipid Complex ◽  
Hepatic Lesions

The safety, tolerance, and pharmacokinetics of amphotericin B lipid complex (ABLC) were studied in a cohort of pediatric cancer patients. Six children with hepatosplenic candidiasis (HSC) received 2.5 mg of ABLC/kg of body weight/day for 6 weeks for a total dosage of 105 mg/kg. Mean serum creatinine (0.85 +/- 0.12 mg/dl at baseline) was stable at the end of therapy at 0.85 +/- 0.18 mg/dl and at 1-month follow-up at 0.72 +/- 0.12 mg/dl. There was no increase in hepatic transaminases. Mean plasma concentrations over the dosing interval (C(ave)) and area under the curve from 0 to 24 h (AUC(0-24h)) increased between the first and seventh doses but were similar between doses 7 and 42, suggesting that steady state was achieved by day 7 of therapy. Following the final (42nd) dose of ABLC, mean AUC(0-24h) was 11.9 +/- 2.6 microg h/ml, C(ave) was 0.50 +/- 0.11 microg/ml, maximum concentration of the drug in whole blood was 1.69 +/- 0.75 microg/ml, and clearance was 3.64 +/- 0.78 ml/min/kg. Response of hepatic and splenic lesions was monitored by serial computerized tomographic and magnetic resonance imaging scans. The five evaluable patients responded to ABLC with complete or partial resolution of physical findings and of lesions of HSC. During the course of ABLC infusions and follow-up, there was no progression of HSC, breakthrough fungemia, or posttherapy recurrence. Hepatic lesions continued to resolve after the completion of administration of ABLC. Thus, ABLC administered in multiple doses to children was safe, was characterized by a steady state attainable within 1 week of therapy, and was effective in treatment of HSC.

scholarly journals Invasive aspergillosis a complication severe respiratory viral infections (influenza and COVID-19)

2021 ◽  
Vol 13 (4) ◽  
pp. 14-24
Author(s):  
N. N. Klimko ◽  
O. V. Shadrivova
Keyword(s):  
Risk Factors ◽  
Invasive Aspergillosis ◽  
Amphotericin B ◽  
Viral Infections ◽  
Underlying Disease ◽  
Lipid Complex ◽  
Sabouraud Agar ◽  
Severe Influenza ◽  
Life Threatening ◽  
Amphotericin B Lipid Complex

Invasive aspergillosis is a life-threatening complication in patients with severe influenza and COVID-19 in intensive care units. Risk factors for the invasive aspergillosis development are transitory immunosuppression associated with severe influenza and COVID-19, as well as the use of glucocorticosteroids and immunosuppressive therapy. In the presence of risk factors, suspected clinical and radiological signs of invasive aspergillosis, bronchoscopy and examination of material from the lower respiratory tract are necessary: test for galactomannan, microscopy with white calcofluor staining and inoculation on Sabouraud agar medium. Voriconazole or are recommended as first-line treatment for invasive aspergillosis in patients with severe influenza and COVID-19. Amphotericin B Liposomal, Amphotericin B Lipid Complex, and Caspofungin are the alternative options for the invasive aspergillosis treatment. Combination therapy is possible. It is necessary to control the underlying disease with eliminate or reduce the severity of risk factors. 

scholarly journals Evaluation of Amphotericin B Lipid Formulations for Treatment of Severe Coccidioidomycosis

2018 ◽  
Vol 62 (7) ◽  
pp. e02293-17 ◽  
Author(s):  
Ritam Sidhu ◽  
David B. Lash ◽  
Arash Heidari ◽  
Piruthiviraj Natarajan ◽  
Royce H. Johnson
Keyword(s):  
Amphotericin B ◽  
Complement Fixation ◽  
Kidney Injury ◽  
Outcome Data ◽  
Inclusion Criteria ◽  
Lipid Complex ◽  
Meningeal Involvement ◽  
Amphotericin B Lipid Complex ◽  
Lipid Formulations

ABSTRACT Patients with severe coccidioidomycosis infections are often treated with either amphotericin B lipid complex (ABLC) or liposomal amphotericin B (L-AmB). Outcome data with these agents in severe coccidioidomycosis cases are currently lacking. The purpose of this study is to evaluate the efficacy and toxicity of ABLC and L-AmB in treating severe coccidioidomycosis. A retrospective pre-post study design was employed. Chart reviews were completed from 1 January 2005 to 31 December 2014 for all patients who received lipid-based amphotericin B. Inclusion criteria included having a follow-up complement fixation (CF) titer or a treatment emergent adverse event (TEAE) prior to follow-up. Patients with meningeal involvement and pregnant patients were excluded. Treatment outcomes were assessed based on documented completion of therapy as well on symptoms, complement fixation titer, and changes to laboratory monitoring parameters. A total of 108 patients were identified, 69 of whom met the inclusion criteria. There were no statistical differences in demographics or disease burden in those that received ABLC and those that received L-AmB, except that those who received L-AmB were more likely to have previously diagnosed chronic kidney disease (nL-AmB = 4, 12.5% vs nABLC = 0, 0.0%; P = 0.042) and to have a lower creatinine clearance at the start of therapy (L-AmB = 79.6 mg/dl versus ABLC = 100.4 mg/dl; P = 0.008). Successful treatment was achieved in 27 (73.0%) of ABLC patients and 22 (68.8%) of L-AmB patients (P = 0.700). Amphotericin B was discontinued due to documented completion of therapy for 17 (45.9%) ABLC patients and 18 (56.3%) L-AmB patients (P = 0.553). Acute kidney injury (AKI) was the documented reason of treatment cessation for 10 (27.0%) ABLC and 1 (3.1%) L-AmB patient (P = 0.007). ABLC and L-AmB both appear to be equally efficacious in the treatment of severe coccidioidomycosis. L-AmB may have less renal toxicity than ABLC and may be the preferred agent in baseline renal impairment.

scholarly journals Risk Factors for Positive Follow-Up Blood Cultures in Gram-Negative Bacilli Bacteremia: Implications for Selecting Who Needs Follow-Up Blood Cultures

2020 ◽  
Vol 7 (4) ◽  
Author(s):  
Hayato Mitaka ◽  
Tessa Gomez ◽  
Young Im Lee ◽  
David C Perlman
Keyword(s):  
Risk Factors ◽  
Cohort Study ◽  
Blood Culture ◽  
Retrospective Cohort Study ◽  
Retrospective Cohort ◽  
Multivariate Logistic Regression Analysis ◽  
Blood Cultures ◽  
Gram Negative ◽  
Intravascular Devices

Abstract Background The value of follow-up blood cultures (FUBCs) to document clearance of bacteremia due to Gram-negative bacilli (GNB) has not been well established. Although previous studies suggested that the yield of FUBCs for GNB bacteremia is low, it remains to be elucidated for whom FUBC may be beneficial and for whom it is unnecessary. Methods A retrospective cohort study was performed at 4 acute care hospitals to identify risk factors for positive FUBCs with GNB bacteremia and to better guide clinicians’ decisions as to which patients may or may not benefit from FUBCs. Participants included adult patients with GNB bacteremia who had FUBCs and were admitted between January 2017 and December 2018. The primary outcomes were the factors associated with positive FUBCs and the yield of FUBCs with and without the factors. Results Of 306 patients with GNB bacteremia who had FUBCs, 9.2% (95% confidence interval, 6.2%–13.0%) had the same GNB in FUBCs. In the multivariate logistic regression analysis, end-stage renal disease on hemodialysis, intravascular device, and bacteremia due to extended-spectrum β-lactamase or carbapenemase-producing organism were identified as independent predictors of positive FUBCs with GNB bacteremia. Approximately 7 FUBCs and 30 FUBCs were needed for patients with ≥1 or no risk factors, respectively, to yield 1 positive result. SummaryThis multi-site retrospective cohort study found that among patients with gram-negative bacilli (GNB) bacteremia, having ESRD on hemodialysis, intravascular devices, or bacteremia due to multi-drug resistant GNB were each independently associated with having a positive follow-up blood culture. Conclusions Follow-up blood culture may not be necessary for all patients with GNB bacteremia and has the highest yield in patients with 1 or more risk factors.

Complementary Effects of Multivitamin and Omega-3 Fatty Acid Supplementation on Indices of Cardiovascular Health in Individuals with Elevated Homocysteine

2012 ◽  
Vol 82 (1) ◽  
pp. 41-52 ◽  
Author(s):  
P. Earnest ◽  
S. Kupper ◽  
M. Thompson ◽  
Guo ◽  
S. Church
Keyword(s):  
Risk Factors ◽  
Cardiovascular Health ◽  
Omega 3 Fatty Acids ◽  
Omega 3 ◽  
C Reactive Protein ◽  
Fatty Acid Supplementation ◽  
Omega 3 Fatty Acid ◽  
Reactive Protein ◽  
Daily Ingestion

Homocysteine (HCY), C-reactive protein (hsCRP), and triglycerides (TG) are risk factors for cardiovascular disease (CVD). While multivitamins (MVit) may reduce HCY and hsCRP, omega-3 fatty acids (N3) reduce TG; yet, they are seldom studied simultaneously. We randomly assigned 100 participants with baseline HCY (> 8.0 umol/L) to the daily ingestion of: (1) placebo, (2) MVit (VitC: 200 mg; VitE: 400 IU; VitB6: 25 mg; Folic Acid: 400 ug; VitB12: 400 ug) + placebo, (3) N3 (2 g N3, 760 mg EPA, 440 mg DHA)+placebo, or (4) MVit + N3 for 12 weeks. At follow-up, we observed significant reductions in HCY (umol/L) for the MVit (- 1.43, 95 %CI, - 2.39, - 0.47) and MVit + N3 groups (- 1.01, 95 %CI, - 1.98, - 0.04) groups, both being significant (p < 0.05) vs. placebo (- 0.57, 95 %CI, - 1.49, 0.35) and N3 (1.11, 95 % CI, 0.07, 2.17). hsCRP (nmol/L) was significantly reduced in the MVit (- 6.00, 95 %CI, - 1.04, - 0.15) and MVit + N3 (- 0.98, 95 %CI, - 1.51, - 0.46) groups, but not vs. placebo (- 0.15, 95 %CI, - 0.74, 0.43) or N3 (- 0.53, 95 %CI, - 1.18, 0.12). Lastly, we observed significant reductions in TG for the N3 (- 0.41, 95 %CI, - 0.69, - 0.13) and MVit + N3 (- 0.71, 95 %CI, - 0.93, - 0.46) groups, both significant vs. placebo (- 0.10, 95 %CI, - 0.36, 0.17) and MVit groups (0.15, 95 %CI, - 12, 0.42). The co-ingestion of MVit + N3 provides synergistic affects on HCY, hsCRP, and plasma TG.

Psychological Resilience Provides No Independent Protection From Suicidal Risk

Crisis ◽  
2016 ◽  
Vol 37 (2) ◽  
pp. 130-139 ◽  
Author(s):  
Danica W. Y. Liu ◽  
A. Kate Fairweather-Schmidt ◽  
Richard Burns ◽  
Rachel M. Roberts ◽  
Kaarin J. Anstey
Keyword(s):  
Risk Factors ◽  
Well Being ◽  
Current Status ◽  
Psychological Resilience ◽  
Cross Sectional ◽  
Life Project ◽  
Resilience Factors ◽  
First Time

Abstract. Background: Little is known about the role of resilience in the likelihood of suicidal ideation (SI) over time. Aims: We examined the association between resilience and SI in a young-adult cohort over 4 years. Our objectives were to determine whether resilience was associated with SI at follow-up or, conversely, whether SI was associated with lowered resilience at follow-up. Method: Participants were selected from the Personality and Total Health (PATH) Through Life Project from Canberra and Queanbeyan, Australia, aged 28–32 years at the first time point and 32–36 at the second. Multinomial, linear, and binary regression analyses explored the association between resilience and SI over two time points. Models were adjusted for suicidality risk factors. Results: While unadjusted analyses identified associations between resilience and SI, these effects were fully explained by the inclusion of other suicidality risk factors. Conclusion: Despite strong cross-sectional associations, resilience and SI appear to be unrelated in a longitudinal context, once risk/resilience factors are controlled for. As independent indicators of psychological well-being, suicidality and resilience are essential if current status is to be captured. However, the addition of other factors (e.g., support, mastery) makes this association tenuous. Consequently, resilience per se may not be protective of SI.

Risk factors and diabetic foot wound classification: ten years of follow-up

2013 ◽  
Author(s):  
Marta Nobrega ◽  
Victor Colares ◽  
Roque Aras ◽  
Priscilla Campelo ◽  
Marcos Nunes
Keyword(s):  
Risk Factors ◽  
Diabetic Foot ◽  
Wound Classification

Evaluation of the correlation between risk factors and mortality in elderly patients with femoral neck fracture with 5-year follow-up

2008 ◽  
Vol 149 (11) ◽  
pp. 493-503 ◽  
Author(s):  
Andor Sebestyén ◽  
Imre Boncz ◽  
Ferenc Tóth ◽  
Márta Péntek ◽  
József Nyárády ◽  
...  
Keyword(s):  
Risk Factors ◽  
Femoral Neck ◽  
Elderly Patients ◽  
Femoral Neck Fracture ◽  
Neck Fracture

A csípőtáji törésekhez idős korban magas halálozás társul. A szakirodalomban kevés a nagy beteganyagot feldolgozó, országos kiterjedésű ellátórendszer adatain alapuló feldolgozás. Célkitűzés: A tanulmány célja a 60 év feletti akut, monotraumás combnyaktöröttek primer ellátását követő halálozások vizsgálata havonta és évente ötéves utánkövetéssel, valamint a különböző rizikófaktoraik halálozásra gyakorolt hatásainak értékelése az egyes időperiódusokban. Módszer: Az adatok az Országos Egészségbiztosítási Pénztár adatbázisából származnak. Az értékelés bázisát a fekvőbeteg-ellátást végző intézményekből combnyaktörés primer műtéti ellátását követően 2000. évben emittált betegek képezik. Bemutatjuk az átlagos évenkénti, havonkénti és heti halálozási arányokat, valamint rizikótényezők szerinti alakulásukat havonként és évenként. A rizikótényezők és a halálozás kapcsolatának értékelése logisztikus és Cox-regressziós analízissel történik. Eredmények: A tanulmányban 3783 fő került elemzésre. Átlagéletkoruk 77,97 (SD 8,52) év. A halálozás az első héten 1,71%, 30 napon belül 8,99%, az első évben 30,74%, öt év alatt 61,88% volt. A halálozás havi szinten az első 5 hónapig mutat csökkenést, éves szinten az első év után stagnál. A rizikófaktorok közül a férfinem és a magasabb életkor öt évig, a kísérőbetegségek hatásai a negyedik évig, a laterális combnyaktöréstípus és a 12 órán túli ellátás két évig, a korai lokális szövődmények egy évig, a hétvégi ellátások az első hónapban eredményeznek magasabb halálozási kockázatot. Az országos és egyetemi ellátásokat követően az első évben alacsonyabb a halálozási kockázat. Következtetések: A csípőtáji törések managementjében a halálozások csökkentése érdekében hangsúlyozzuk a 12 órán belüli ellátás, a törési típusnak megfelelő módszerválasztás, a hét minden napján történő azonos ellátási feltételek biztosítása, az ellátások centrumokba történő szervezése, a beteg általános állapotának és kísérőbetegségeinek megfelelő akut ellátás és az utókezelések fontosságát.

Sign in / Sign up

Export Citation Format

Share Document