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Weekly use of fluconazole as prophylaxis in haematological patients at risk for invasive candidiasis.

Vuichard D, Weisser M, Orasch C, Frei R, Heim D, Passweg JR, Widmer AF - BMC Infect. Dis. (2014)

Bottom Line: Overall, Candida glabrata was the predominant species with 29% followed by C. albicans and C. krusei (14% each).No significant increment of non-albicans Candida species with decreased fluconazole susceptibility was perceived over this decade.Once weekly administration of 400 mg of fluconazole to prevent candidaemia appears to have no negative impact on the efficacy as a prophylaxis when compared to standard of care (400 mg of fluconazole daily).

View Article: PubMed Central - PubMed

ABSTRACT

Background: The goal was to determine whether one medical centres' unique antifungal prophylactic regimen for patients at high risk for invasive candidiasis because of their haematological malignancies, haematopoietic stem cell transplants, or high-dose chemotherapy might lead ultimately to a higher incidence of infection, to increasing fluconazole resistance, or to a shift in the predominant strain of Candida in invasive fungal episodes.

Methods: Data were collected retrospectively, for a ten-year period from ONKO-KISS surveillance records, and from hospital, medical, and pharmacy records and then evaluated with respect to incidence of fungal infection episodes, emergence of antifungal drug resistance, and predominance of specific Candida strains in isolate cultures. Fisher's exact test and linear regression were used to compare minimum inhibitory concentrations and to compare the incidence of different Candida isolates, respectively.

Results: The incidence of infection remained quite stable over 10 years with a median of 0.67 episodes/1000 bed days. Overall, Candida glabrata was the predominant species with 29% followed by C. albicans and C. krusei (14% each). No significant increment of non-albicans Candida species with decreased fluconazole susceptibility was perceived over this decade.

Conclusions: Once weekly administration of 400 mg of fluconazole to prevent candidaemia appears to have no negative impact on the efficacy as a prophylaxis when compared to standard of care (400 mg of fluconazole daily).

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Related in: MedlinePlus

Susceptibility* of invasiveCandidaisolates to fluconazole from 2003–2012. Light grey bars = percentage of susceptible Candida species. *Susceptibility is defined as a minimum inhibitory concentration (MIC) of < or equal to 8 mg/L (CLSI definition, 2008). CLSI = Clinical and Laboratory Standards Institute, formerly known as the National Committee for Clinical Laboratory Standards (NCCLS).
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Fig2: Susceptibility* of invasiveCandidaisolates to fluconazole from 2003–2012. Light grey bars = percentage of susceptible Candida species. *Susceptibility is defined as a minimum inhibitory concentration (MIC) of < or equal to 8 mg/L (CLSI definition, 2008). CLSI = Clinical and Laboratory Standards Institute, formerly known as the National Committee for Clinical Laboratory Standards (NCCLS).

Mentions: No trend toward reduced fluconazole susceptibility among invasive Candida isolates was found over the 10 years (Figure 2), with susceptibility being defined according to 2008 CLSI breakpoint definitions that consider isolates with a MIC of ≥8 mg/L to be non-susceptible (p = 0.162, 95% CI 0.8651- 3.67). The median MIC of the most common invasive strains was as follows (IQR): 0.19 mg/L (0.12 – 0.16 mg/L) for C. albicans, 12 mg/L (8 – 208 mg/L) for C. glabrata and 128 mg/L (44–128 mg/L) for C. krusei. A trend analysis did not show a significant increase in MIC. However, the number of data points precludes a meaningful interpretation of this analysis.Figure 2


Weekly use of fluconazole as prophylaxis in haematological patients at risk for invasive candidiasis.

Vuichard D, Weisser M, Orasch C, Frei R, Heim D, Passweg JR, Widmer AF - BMC Infect. Dis. (2014)

Susceptibility* of invasiveCandidaisolates to fluconazole from 2003–2012. Light grey bars = percentage of susceptible Candida species. *Susceptibility is defined as a minimum inhibitory concentration (MIC) of < or equal to 8 mg/L (CLSI definition, 2008). CLSI = Clinical and Laboratory Standards Institute, formerly known as the National Committee for Clinical Laboratory Standards (NCCLS).
© Copyright Policy - open-access
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC4233028&req=5

Fig2: Susceptibility* of invasiveCandidaisolates to fluconazole from 2003–2012. Light grey bars = percentage of susceptible Candida species. *Susceptibility is defined as a minimum inhibitory concentration (MIC) of < or equal to 8 mg/L (CLSI definition, 2008). CLSI = Clinical and Laboratory Standards Institute, formerly known as the National Committee for Clinical Laboratory Standards (NCCLS).
Mentions: No trend toward reduced fluconazole susceptibility among invasive Candida isolates was found over the 10 years (Figure 2), with susceptibility being defined according to 2008 CLSI breakpoint definitions that consider isolates with a MIC of ≥8 mg/L to be non-susceptible (p = 0.162, 95% CI 0.8651- 3.67). The median MIC of the most common invasive strains was as follows (IQR): 0.19 mg/L (0.12 – 0.16 mg/L) for C. albicans, 12 mg/L (8 – 208 mg/L) for C. glabrata and 128 mg/L (44–128 mg/L) for C. krusei. A trend analysis did not show a significant increase in MIC. However, the number of data points precludes a meaningful interpretation of this analysis.Figure 2

Bottom Line: Overall, Candida glabrata was the predominant species with 29% followed by C. albicans and C. krusei (14% each).No significant increment of non-albicans Candida species with decreased fluconazole susceptibility was perceived over this decade.Once weekly administration of 400 mg of fluconazole to prevent candidaemia appears to have no negative impact on the efficacy as a prophylaxis when compared to standard of care (400 mg of fluconazole daily).

View Article: PubMed Central - PubMed

ABSTRACT

Background: The goal was to determine whether one medical centres' unique antifungal prophylactic regimen for patients at high risk for invasive candidiasis because of their haematological malignancies, haematopoietic stem cell transplants, or high-dose chemotherapy might lead ultimately to a higher incidence of infection, to increasing fluconazole resistance, or to a shift in the predominant strain of Candida in invasive fungal episodes.

Methods: Data were collected retrospectively, for a ten-year period from ONKO-KISS surveillance records, and from hospital, medical, and pharmacy records and then evaluated with respect to incidence of fungal infection episodes, emergence of antifungal drug resistance, and predominance of specific Candida strains in isolate cultures. Fisher's exact test and linear regression were used to compare minimum inhibitory concentrations and to compare the incidence of different Candida isolates, respectively.

Results: The incidence of infection remained quite stable over 10 years with a median of 0.67 episodes/1000 bed days. Overall, Candida glabrata was the predominant species with 29% followed by C. albicans and C. krusei (14% each). No significant increment of non-albicans Candida species with decreased fluconazole susceptibility was perceived over this decade.

Conclusions: Once weekly administration of 400 mg of fluconazole to prevent candidaemia appears to have no negative impact on the efficacy as a prophylaxis when compared to standard of care (400 mg of fluconazole daily).

Show MeSH
Related in: MedlinePlus