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He Wang, Ying-Chun Xu, Po-Ren Hsueh
In the Asia-Pacific region, Candida albicans is the predominant Candida species causing invasive candidiasis/candidemia in Australia, Japan, Korea, Hong Kong, Malaysia, Singapore and Thailand whereas C. tropicalis is the most frequently encountered Candida species in Pakistan and India. Invasive isolates of C. albicans, C. parapsilosis complex and C. tropicalis remain highly susceptible to fluconazole (>90% susceptible). Fluconazole resistance (6.8-15%), isolates with the non-wild-type phenotype for itraconazole susceptibility (3...
October 18, 2016: Future Microbiology
Elena M Marín Martínez, Ana Isabel Aller García, Estrella Martín-Mazuelos
BACKGROUND: Invasive fungal infection (IFI) has increased in recent years due to there being a greater number of risk factors. IFI caused by Candida is the most frequent, and although Candida albicans is the most isolated species, there is currently a decrease of C. albicans and an increase of other species of the genus. AIMS: To analyse the epidemiology, risk factors, and antifungal susceptibility of blood culture isolates of non-C.albicans Candida species in our hospital in the last 12years...
October 13, 2016: Revista Iberoamericana de Micología
João Paulo Zen Siqueira, Deanna A Sutton, Dania García, Josepa Gené, Pamela Thomson, Nathan Wiederhold, Josep Guarro
Aspergillus section Versicolores includes species of clinical relevance and many others that have been poorly studied but are occasionally found in clinical samples. The aim of this study was to investigate, using a multilocus phylogenetic approach, the spectrum of species of the section Versicolores and to determine their in vitro antifungal susceptibility. The study was based on a set of 77 clinical isolates from different USA medical centres, which had been previously identified as belonging to this section...
November 2016: Fungal Biology
Jean-Francois Timsit, Elie Azoulay, Carole Schwebel, Pierre Emmanuel Charles, Muriel Cornet, Bertrand Souweine, Kada Klouche, Samir Jaber, Jean-Louis Trouillet, Fabrice Bruneel, Laurent Argaud, Joel Cousson, Ferhat Meziani, Didier Gruson, Adeline Paris, Michael Darmon, Maité Garrouste-Orgeas, Jean-Christophe Navellou, Arnaud Foucrier, Bernard Allaouchiche, Vincent Das, Jean-Pierre Gangneux, Stéphane Ruckly, Daniele Maubon, Vincent Jullien, Michel Wolff
Importance: Although frequently used in treating intensive care unit (ICU) patients with sepsis, empirical antifungal therapy, initiated for suspected fungal infection, has not been shown to improve outcome. Objective: To determine whether empirical micafungin reduces invasive fungal infection (IFI)-free survival at day 28. Design, Setting, and Participants: Multicenter double-blind placebo-controlled study of 260 nonneutropenic, nontransplanted, critically ill patients with ICU-acquired sepsis, multiple Candida colonization, multiple organ failure, exposed to broad-spectrum antibacterial agents, and enrolled between July 2012 and February 2015 in 19 French ICUs...
October 5, 2016: JAMA: the Journal of the American Medical Association
Cinzia Auriti, Marco Falcone, Maria Paola Ronchetti, Bianca Maria Goffredo, Sara Cairoli, Rosamaria Crisafulli, Fiammetta Piersigilli, Tiziana Corsetti, Andrea Dotta, Manjunath P Pai
High doses of micafungin are advocated in neonates with systemic candidiasis but limited pharmacokinetic (PK) and safety data are available to support their use. Eighteen preterm neonates and infants with systemic candidiasis, 3 with meningitis, were treated for at least 14 days with 8 to 15 mg/kg/day of intravenous micafungin. Plasma concentrations (4 measurements) were determined after the third dose and cerebrospinal-fluid (CSF) concentrations were also obtained in three patients. Population PK analyses were used to identify the optimal model and further validated using external data (n=5)...
October 3, 2016: Antimicrobial Agents and Chemotherapy
Duhita G Sant, Santosh G Tupe, Chepuri V Ramana, Mukund V Deshpande
Increase in invasive fungal infections over past few years especially in immunocompromised patients prompted the search for new antifungal agents with improved efficacy. Current antifungal armory includes very few effective drugs like Amphotericin B, new generation azoles including voriconazole and posaconazole, echinocandins like caspofungin, micafungin, to name a few. Azole class of antifungals which target fungal cell membrane are first choice of treatment for many years because of their effectiveness. As fungal cell membrane is predominantly made up of sterols, glycerophospholipids and sphingolipids, the role of lipids in pathogenesis and target identification for improved therapeutics were largely pursued by researchers during last few years...
September 26, 2016: Journal of Applied Microbiology
Alexandra Mpakosi, Maria Siopi, Vasiliki Falaina, Nikolaos Siafakas, Emmanuel Roilides, Maria Kimouli, Martha Theodoraki, Paraskevi Karle, Joseph Meletiadis
New Candida species may cause bloodstream infections challenging current therapeutic approaches because of unpredictable susceptibility and virulence. In the present report, we describe a fungemia case due to Candida pulcherrima in a premature neonate. After full in vitro diagnostic workup, the neonate was successfully treated with liposomal amphotericin B and micafungin achieving rapid fungal eradication from blood.
June 2016: Medical Mycology Case Reports
Patrick J van der Geest, Nicole G M Hunfeld, Sophie E Ladage, A B Johan Groeneveld
BACKGROUND: In critically ill patients the incidence of invasive fungal infections caused by Candida spp. has increased remarkably. Echinocandins are recommended as initial treatment for invasive fungal infections. The safety and efficacy of micafungin compared to caspofungin is similar, but no comparison is made between anidulafungin and micafungin concerning safety and efficacy. We therefore performed a retrospective study to assess these aspects in critically ill patients with invasive candidiasis...
2016: BMC Infectious Diseases
Vincent Jullien, Elie Azoulay, Carole Schwebel, Thomas Le Saux, Pierre Emmanuel Charles, Muriel Cornet, Bertrand Souweine, Kadda Klouche, Samir Jaber, Jean-Louis Trouillet, Fabrice Bruneel, Martin Cour, Joel Cousson, Ferhat Meziani, Didier Gruson, Adeline Paris, Michael Darmon, Maité Garrouste-Orgeas, Jean-Christophe Navellou, Arnaud Foucrier, Bernard Allaouchiche, Vincent Das, Jean-Pierre Gangneux, Stéphane Ruckly, Michel Wolff, Jean-François Timsit
OBJECTIVES: To identify the factors associated with the interindividual pharmacokinetic (PK) variability of micafungin and to evaluate the probability of reaching the previously determined PK/pharmacodynamic efficacy thresholds (AUC/MIC >5000 for non-parapsilosis Candida sp. and ≥285 for Candida parapsilosis) with the recommended 100 mg daily dose in ICU patients with sepsis and mechanical ventilation. METHODS: One hundred patients were included and 436 concentrations were available for PK analysis performed with NONMEM software...
September 8, 2016: Journal of Antimicrobial Chemotherapy
Steven Gabardi, Spencer Martin, Mihir Sura, Anisa Mohammed, Yoav Golan
PURPOSE: In high-risk patients, candiduria may be associated with the development of urinary tract infections (UTI) and invasive candidiasis. The triazole antifungals achieve good urine concentrations, but their use is limited by the emergence of non-albicans Candida spp. with low-triazole susceptibility. The echinocandins remain fungicidal against many azole-resistant Candida spp., but low urine concentrations limit their use. We examined the rates of candiduria elimination in micafungin-treated patients...
November 2016: International Urology and Nephrology
T Yan, S L Li, D X Wang
OBJECTIVE: To compare the efficacy and safety of micafungin with caspofungin for the empirical treatment of severe intra-abdominal infections in surgical intensive care patients. METHOD: This was a retrospective cohort study.From May 1 st 2012 to April 30 2015, 47 patients with severe intra-abdominal infection complicated with specific risk of Intra-abdominal invasive candidiasis (IAC) receiving empirical treatment of echinocandins were enrolled in Department of Critical Care Medicine, Peking University First Hospital...
August 2, 2016: Zhonghua Yi Xue za Zhi [Chinese medical journal]
Nobuyuki Ashizawa, Shigeki Nakamura, Shotaro Ide, Masato Tashiro, Takahiro Takazono, Yoshifumi Imamura, Taiga Miyazaki, Koichi Izumikawa, Yoshihiro Yamamoto, Katsunori Yanagihara, Yoshitsugu Miyazaki, Shigeru Kohno
A 76-year-old woman received long-term immunosuppressive treatment for collagen vascular disease-associated interstitial pneumonia. The patient developed a cavitary mass lesion in the right lower lung field, and both nontuberculous mycobacteria and Aspergillus spp. were isolated after bronchial washing. The patient underwent a right lower lobectomy but developed Aspergillus empyema. Empyema due to Aspergillus spp. is a rare and life-threatening condition; however, the standard therapeutic strategies for treating Aspergillus empyema are not clear...
2016: Internal Medicine
A García-de-Lorenzo, S Luque, S Grau, A Agrifoglio, L Cachafeiro, E Herrero, M J Asensio, S M Sánchez, J A Roberts
Severely burned patients have altered drug pharmacokinetics (PKs), but it is unclear how different they are from those in other critically ill patient groups. The aim of the present study was to compare the population pharmacokinetics of micafungin in the plasma and burn eschar of severely burned patients with those of micafungin in the plasma and peritoneal fluid of postsurgical critically ill patients with intra-abdominal infection. Fifteen burn patients were compared with 10 patients with intra-abdominal infection; all patients were treated with 100 to 150 mg/day of micafungin...
October 2016: Antimicrobial Agents and Chemotherapy
Jamie L Wagner, Allison M Bell
Amphotericin B deoxycholate (AmBd) is rarely used due to its adverse effect profile, which includes nephrotoxicity, infusion-related reactions, and hepatotoxicity. The incidence of hepatotoxicity related to AmBd is 18-23%, but the reports of this adverse effect are mainly in immunocompromised patients receiving chemotherapy. We report a case of AmBd-related acute hepatic injury in an immunocompetent male with multiple medical problems. The patient initially had acute hepatic injury likely caused by poor nutritional status and a diagnosis of failure to thrive, but was recovering...
April 2016: Journal of Pharmacology & Pharmacotherapeutics
Livia Lown, Brian M Peters, Carla J Walraven, Mairi C Noverr, Samuel A Lee
Candida albicans is a major cause of catheter-related bloodstream infections and is associated with high morbidity and mortality. Due to the propensity of C. albicans to form drug-resistant biofilms, the current standard of care includes catheter removal; however, reinsertion may be technically challenging or risky. Prolonged exposure of an antifungal lock solution within the catheter in conjunction with systemic therapy has been experimentally attempted for catheter salvage. Previously, we demonstrated excellent in vitro activity of micafungin, ethanol, and high-dose doxycycline as single agents for prevention and treatment of C...
2016: PloS One
S Grau, S Luque, D Echeverría-Esnal, L Sorlí, N Campillo, M Montero, F Álvarez Lerma, V Plasencia, J P Horcajada
Six cases of patients diagnosed with urinary tract infection (UTI) successfully treated with micafungin are reported. Four were infected with fluconazole-resistant Candida spp. and two (with hepatic injury) were infected with fluconazole-sensitive Candida spp. Traditionally, echinocandins have not been considered for the treatment of UTIs. However, despite its low urinary excretion rate, therapeutic drug monitoring of micafungin urinary levels could be helpful in order to achieve optimal pharmacokinetic/pharmacodynamic (PK/PD) indices for treating UTIs caused by Candida spp...
August 2016: International Journal of Antimicrobial Agents
Sebastian Schneeweiss, Peggy L Carver, Kausik Datta, Alicia Galar, Melissa D Johnson, Matthew G Johnson, Francisco M Marty, Jerod Nagel, Maryann Najdzinowicz, Melissa Saul, Shmuel Shoham, Fernanda P Silveira, Christy A Varughese, Marissa Wilck, Lisa Weatherby, Tim Auton, Alexander M Walker
BACKGROUND: Although echinocandins are generally well tolerated, there is little information on the frequency with which renal and hepatic adverse effects occur during use of micafungin or other parenteral antifungal (PAF) agents in clinical practice. METHODS: MYCOS is a multicentre cohort study of adult and paediatric patients who received micafungin or other PAFs between 2005 and 2012 at seven tertiary care hospitals from six centres in the USA. PAF cohort controls were selected through propensity score (PS) matching to micafungin recipients using clinical characteristics, other treatments, procedures and hospital service where PAF treatment was initiated...
October 2016: Journal of Antimicrobial Chemotherapy
José Ramón Azanza Perea
The echinocandins share pharmacodynamic properties, although there are some interesting differences in their pharmacokinetic behaviour in the clinical practice. They are not absorbed by the oral route. They have a somewhat special distribution in the organism, as some of them can reach high intracellular concentrations while, with some others, the concentration is reduced. They are highly bound to plasma proteins, thus it is recommended to administer a loading dose for anidulafungin and caspofungin, although this procedure is not yet clear with micafungin...
July 2016: Revista Iberoamericana de Micología
Silvia Park, Kihyun Kim, Jun Ho Jang, Seok Jin Kim, Won Seog Kim, Doo Ryeon Chung, Cheol-In Kang, Kyong Ran Peck, Chul Won Jung
OBJECTIVES: Invasive fungal infections (IFIs) cause significant morbidity and mortality among recipients of hematopoietic stem cell transplantation (HSCT). Although fluconazole is used widely as an antifungal prophylactic agent in these patients, it is not reliably effective against mold infection including invasive aspergillosis. Micafungin provides antifungal activity against Candida and Aspergillus species, and previous studies have demonstrated its efficacy when used as a prophylactic agent for fungal infection in neutropenic patients...
July 6, 2016: Journal of Infection
Thomas Peter, Rosi Bissinger, Elena Signoretto, Andreas F Mack, Florian Lang
BACKGROUND/AIMS: The antifungal drug Micafungin is used for the treatment of diverse fungal infections including candidiasis and aspergillosis. Side effects of Micafungin treatment include microangiopathic hemolytic anemia and thrombocytopenia with microvascular thrombosis. The development of thrombosis may be fostered by stimulation of eryptosis, the suicidal death of erythrocytes characterized by cell shrinkage and cell membrane scrambling with phosphatidylserine translocation to the erythrocyte surface...
2016: Cellular Physiology and Biochemistry
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