Risk Of Invasive Infections Research Articles

Evaluation of Panfungal Marker (1,3)-⃞-D-Glucanin Diagnosis of Invasive Infections with Candida Species

Abstract Introduction. Although blood culture is considered a gold standard in diagnosis of invasive infections, it is still not reliable and fast enough for diagnosis of candidemia. Determination of serum (1,3)-⃞-D-glucan is a highly sensitive and specific test for invasive mycosis, and could probably be of benefit to patients with high risk for invasive infections with Candida species. Aim. The aim of this study was to prospectively evaluate the diagnostic performance of serum (1.3)-⃞-Dglucan BDG (Fungitell) assay, in comparison with blood culture, for diagnosis of invasive infections with Candida species. Methods. Blood and sera from 120 patients divided in 4 groups, hospitalized at the University clinics in Skopje, during a 2-year period, were investigated for invasive Candida infections. Blood was examined with conventional methods (automated BacT/Alert system, Gram stain and culture on fungal media). Identification of Candida species was performed with VITEK-2 system. Serum (1,3)-⃞-D-glucan was determined by means of Fungitell assay. Results. Positive blood culture was registered in 23.33%, 43.33%, 23.8% and in 3.33% of samples only in groups I, II, III and IV, respectively. Positive findings with (1,3)-⃞-D-glucan Fungitell assay at the same time with blood culture were detected in 83.33%, 76.67%, 30% and 26.67% in groups I, II, III and IV, respectively. The average concentration of BDG was highest in group I, followed by group II, group IV and group III. Conclusion. Our results suggest that a positive (1,3)-⃞-D-glucan assay could be a superior test in addition to the blood culture for diagnosis of candidemia and highlights the value of this test as a diagnostic adjunct in the serodiagnosis of an invasive candidiasis.

Experience with Proctectomy to Manage Combat Casualties Sustaining Catastrophic Perineal Blast Injury Complicated by Invasive Mucor Soft-Tissue Infections

Catastrophic pelviperineal injuries have become more commonplace on the modern battlefield as a result of dismounted blast mechanism and the survival benefits afforded by far-forward resuscitation and surgery. Inherent in the survival of casualties with such devastating injuries is both the risk for invasive infections and the need for complex reconstruction. We report a series of two combat casualties sustaining the constellation of catastrophic pelviperineal blast injury, anal sphincter complex destruction, complicated by invasive fungal infection managed with completion proctectomy. Our experience, although lacking numbers to qualify as high-level evidence to guide care, will assist future surgeons' care for similar patients.

Fungemia por Trichosporon asahii en un paciente con neoplasia hematológica

BackgroundTrichosporonosis is an opportunistic infection caused by the genus Trichosporon. The majority of cases of invasive trichosporonosis occurs in immunocompromised individuals. Case reportWe describe a case of disseminated infection by Trichosporon asahii in a hematology patient. A 52-year-old man diagnosed with acute lymphoblastic leukemia developed a febrile episode during the third cycle of the induction chemotherapy. The blood cultures were positive after 24h incubation, showing elongated structures compatible with fungal elements in the Gram stain. The identification of the fungus as Trichosporon asahii was carried out by the assimilation of compounds of carbon and the amplification and sequencing of the D1/D2 domain and the internal transcribed spacer of the ribosomal DNA. The fungus was also isolated from the pustular lesions that the patient had in the chest. After treatment with amphotericin B, the patient progressed satisfactorily. ConclusionsTrichosporon asahii is an emergent pathogen in immunosupressed patients and its presence should not be considered as colonization, as there is risk of invasive infection.

Splenic Abscess Due to Salmonella enteritidis

Splenic abscess is a very rare complication of non-typhoidal Salmonella infections. We report a case of splenic abscess caused by Salmonella enteritidis. The patient is a 63-year-old woman with diabetes mellitus and underwent splenectomy. This case suggests that the patients with comorbities are at increased risk for invasive infections in non-typhoidal Salmonella infections.

Clinical spectrum of serious bacterial infections among splenectomized patients with hemoglobinopathies in Israel: a 37-year follow-up study

Patients with hemoglobinopathies who undergo splenectomy are at risk for invasive infections. The aim of this investigation was to present the clinical spectrum of infections in splenectomized patients. The study cohort comprised 54 splenectomized patients with beta-thalassemia (β-thalassemic) and sickle cell disease. The incidence of serious invasive bacterial infections was recorded. All patients received pneumococcal vaccine and all received oral prophylactic penicillin. A total of 22 episodes of serious bacterial infections were identified in 19 patients among the study cohort of 54 splenectomized patients (35%). The clinical spectrum included sepsis (10 patients), bacteremia (8), liver abscess (1), forearm abscess (1), and urinary tract infection (2). The most frequent pathogens were Escherichia coli (8 cases), Steptococcus pneumoniae (5), and Campylobacter (2). 22 patients with β thalassemia died during the study period: 6 due to bacterial infection and 18 due to cardiomyopathy. The time elapsed between splenectomy and S. pneumoniae infection was significantly shorter than that between splenectomy and infections caused by other pathogens (18 ± 14 vs. 115 ± 93 months, respectively; p = 0.035). Splenectomized patients with β thalassemia and sickle cell disease are predisposed to severe infections, with the majority of these infections being caused by Gram-negative microorganisms. The attending physician(s) should take these findings into consideration when deciding upon an empiric antibiotic treatment for splenectomized patients who present with fever or sepsis.

Candidoses invasives en réanimation néonatale

In the USA, the incidence of invasive candidiasis in neonates is respectively 0.3% of infants over 2500 g and up to 20% of infants less than 1000 g. Their incidence is increasing. Two populations of newborn infants are particularly vulnerable: the premature infants and newborn infants with severe neonatal digestive diseases. Fifty percent of infants hospitalized in NICU are colonized with Candida at the end of the first week of hospitalization; a direct relationship exists between the importance of colonization and the invasive infection risk. C. albicans is the species most often responsible for invasive candidiasis in the newborn. These infections represent the third cause of related-catheter infection in the USA. Mortality rate in neonates linked to this disease is 20 to 50%; morbidity primarily concerns brain and lungs. Neonatal invasive candidiasis risk factors are known and a primary prevention is possible. The diagnosis of neonatal invasive candidiasis is difficult and often delayed because of a polymorphic clinical expression. Empiric and preemptive treatment are based on the use of amphotericin B. Prophylactic treatment using fluconazole of newborns with birth weight ≤ 1000 grams and/or gestational age ≤ 27 weeks gestation is recommended by the American Academy of Paediatrics and the Infectious Diseases Society of America. A better knowledge of French epidemiological data in this area would improve both the diagnosis and therapeutic management of this disease.

Multicenter, Prospective Surveillance Study of Staphylococcus aureus Nasal Colonization in 28 Italian Intensive Care Units: The ISABEL Study

The role of methicillin-resistant Staphylococcus aureus (MRSA) colonization as a predictor of invasive disease in intensive care unit (ICU) patients was established many years ago. The role of mefhicillin-susceptible Staphylococcus aureus (MSSA) colonization is more debated, although in a recent report patients who were carriers of MRSA or MSSA at ICU admission were found to be at increased risk. Whether carriage at ICU admission involves a higher risk of invasive infection than carriage acquired during an ICU stay has not been established. We report the results of a study aimed at estimating the frequency of S. aureus (MRSA and MSSA) colonization at admission and at discharge in patients admitted to several ICUs in Italy and at estimating the relationship between colonization status and infection by S. aureus.

Recent Developments in Drug Delivery to Prolong Allograft Survival in Lung Transplant Patients

Since the discovery of cyclosporine in 1971, calcineurin inhibitors have played a critical role in the therapeutic suppression of the immune response. Patients receiving solid organ transplants rely heavily on these medications to prevent the acute and chronic rejection of allografted tissue. These therapies can prove difficult because of potential toxicity, heightened risk of invasive infection, and erratic oral bioavailability, requiring frequent blood samples for monitoring of systemic levels. Added challenges are presented in immunosuppression of lung transplant patients owing to the increased susceptibility to invasive infection and extensive immune mechanisms inherent in lung tissue. With the introduction of tacrolimus, a more potent calcineurin inhibitor, clinical outcomes of transplants have continued to improve; however, little improvement has been noted in lung transplantation. While very effective upon arrival at the site of action, tacrolimus and cyclosporine present a variety of formulation challenges such as poor solubility, potential systemic toxicity, and extensive first pass metabolism. Initial attempts to improve solubility in both oral and intravenous formulations have resulted in variable drug absorption and increased systemic toxicity, respectfully, creating a need for formulation improvement. Through alternative routes of delivery and novel formulation techniques, researchers have addressed these issues and, in some cases, demonstrated improved clinical outcomes. Through enhanced solubilization, reduction in absorption variability, and more effective drug targeting with reduced systemic levels, improvements in outcomes and overall patient survival in lung and other solid organ transplantation can be expected.

Preterm Neonates’ Risk for Invasive Fungal Infections

Fungi, predominantly candida species, are important causes of infection in the neonatal intensive care unit (NICU). Invasive fungal infections (IFIs) are usually preceded by colonization with the same species. In a case-control chart-review study, researchers in Italy examined the variables that increase IFI risk in fungus-colonized neonates. The researchers identified 201 very-low-birth-weight (<1500 g) infants who were admitted …

Risk factors associated to invasive infection in children and adolescents with cancer during febrile neutropenia episodes

9046 Background: Febrile neutropenia (FN) after chemotherapy requires prompt introduction of empiric antimicrobial therapy. It has been demonstrated that FN patients do not represent a homogeneous group, and the stratification of infectious risk leads to changes in therapy. Our objectives were to evaluated the efficacy of the antimicrobial regimens used according to the FN institutional protocol and to identify risk factors related to invasive infection in children and adolescents during episodes of FN. Methods: We conducted a prospective study in the Pediatric Oncology Institute (IOP-GRAACC-UNIFESP/SP-Brazil) from March/2003 to June/2004. We analyzed 448 FN episodes in 200 patients, they were classified in high and low risk of invasive infection according to the underling disease and comorbities. Low risk patients (solid tumors, ALL and lymphomas in remission, without comorbities) were treated with oral gatifloxacin as outpatient; whereas high risk (AML, solid tumors, Lymphomas and ALL with comorbities or activity) were treated with cefepime as inpatient. Invasive infection was considered when a culture obtained from a sterile site resulted positive for bacterial and/or fungus or there were clinical and laboratory findings that strongly suggest sepsis. Results: Of 204 (45.5%) episodes treated with gatifloxacin, 72.1% obtained success without modification. Of 206 (46.0%) episodes treated with cefepime, 34.5% obtained success without modification, 38 (8.5%) patients were treated with distinct antibiotic regimen. Invasive infection was observed in 133 episodes (29.6%); 16 (3.6%) deaths occurred, all of them in the high risk group and the overall success was 84.3%. In the logistic regression analysis remained as independent risk factors: age ≤3 ys (OR: 2.3), temperature ≥38.5ºC (OR:1.6), central venous catheter (OR:1.7), underlying active disease (OR:1.6), mucositis (OR:2.4) and diarrhea (OR:2.4). Conclusions: Applying a institutional protocol, it is possible to predict the infectious risk and treat the patients individually .The observed overall success (84.3%), confirms that the therapy based in the protocol was adequate. There was no toxicity associated with gatifloxacin in this study, and no deaths in the low risk group. No significant financial relationships to disclose.

Extracorporeal life support after staged palliation of a functional single ventricle: Subsequent morbidity and survival

We sought to review the outcome of infants with a functional single ventricle receiving postoperative extracorporeal life support. We reviewed all patients with a functional single ventricle receiving postoperative extracorporeal life support between January 1997 and May 2003. We supported 25 infants (age range, 2-139 days; median age, 15 days; weight range, 1.9-5.9 kg; median weight, 3.4 kg) with extracorporeal life support. Operative procedures were Norwood stage 1 procedure in 18 patients, modified Blalock-Taussig shunt in 4 patients, bidirectional superior cavopulmonary shunt in 2 patients, and pulmonary vein repair in 1 patient. Indications for extracorporeal life support included cardiac arrest (14/25) and low cardiac output state (11/25). Extracorporeal membrane oxygenation was initiated in 19 patients, with conversion to a ventricular assist device in 7 patients. Ventricular assist device alone was initiated in 6 patients. Survival to decannulation was 76%, with 5 late deaths from multiorgan failure and 56% intensive care unit survival. Survival to hospital discharge was 44%. On univariate analysis, the presence of arrhythmia before extracorporeal life support (P = .005), renal failure (P = .0007), Candida species-induced sepsis (P = .026), and multiorgan failure (P = .0009) were significant risk factors in the nonsurvivors. Median hospital stay was 43.5 days (range, 6-181 days) for the whole group and 93 days (range, 36-181 days) for survivors. Eight patients completed next stage palliation. Twenty percent of patients were supported with a ventricular assist device alone, with 50% conversion to a ventricular assist device from extracorporeal membrane oxygenation. Survival to decannulation was encouraging. Multiorgan failure and risk of invasive infection in the post-extracorporeal membrane oxygenation period mitigate against survival to hospital discharge. Use of extracorporeal life support before cardiac arrest might reduce attrition between decannulation and hospital discharge.

Invasive fungal infection in children with persistent febrile neutropenia.

Children with persistent febrile neutropenia (fever > 96 hours) refractory to antibacterial therapy carry a high risk of invasive fungal infection (IFI). However, epidemiologic data in such patient populations is lacking in Taiwan. A retrospective study was conducted to identify risk factors and outcome of IFI in children with persistent febrile neutropenia (> 96 hours) hospitalized at National Taiwan University Hospital from January 1, 1999 through December 31, 1999. They were categorized into proven, probable, possible, or no IFI according to host, microbiologic and clinical criteria. A total of 29 episodes (35.4%) of IFI occurred in 82 episodes of persistent febrile neutropenia and included 1 proven, 12 probable and 16 possible cases. Pneumonia was most common (69.0%), followed by disseminated infection (17.2%), paranasal sinusitis (6.9%), and hepatosplenic abscess (6.9%). Multivariate analysis revealed 4 risk factors independently associated with IFI: prolonged neutropenia (> 30 days; odds ratio [OR], 10.4; 95% confidence interval [CI], 1.8-60.5), prolonged steroid therapy (OR 2.0, 95% CI 1.0-10.8), allogeneic bone marrow transplantation (OR 5.3, 95% CI 1.0-28.0), and relapsed malignancy (OR 3.5, 95% CI 1.1-11.1). Patients with IFI carried higher in-hospital mortality than those without (51.7% vs 3.8%, p < 0.001). Among those with IFI, delayed antifungal therapy (persistent fever > 7 days) was associated with higher mortality rate than earlier treatment (73.3% vs 28.6%, p = 0.024) and was an independent adverse prognostic factor. IFI was common in patients with persistent febrile neutropenia and delayed antifungal therapy was an independent adverse prognostic factor.

The effects of interferon-γ and transforming growth factor-β on adherence and survival of group B Streptococcus type III strains in ECV304 cells

Group B streptococci (GBS) are an important cause of neonatal sepsis, pneumonia and meningitis. In some newborns, GBS sepsis may have a severe course, including septic shock with high mortality rate, whereas other newborns are colonized with GBS on their surfaces without any clinical signs of bacterial infections. Interferon (IFN)-gamma is produced in neonatal GBS sepsis, and transforming growth factor (TGF)-beta is also found in the uterus. The involvement of IFN-gamma and TGF-beta in the earliest phase of infection might be a determinant of susceptibility and/or progression of infection in vivo. The aim of this study was to assess the effect of IFN-gamma and TGF-beta on adherence and intracellular viability in ECV304 cells of GBS serotype III isolated from cerebrospinal fluid (CSF) and vagina (strains 90356 and 80340, respectively). Interaction of GBS-ECV304 cells showed that the CSF isolate exhibited a more efficient adherence mechanism than the vagina isolate (P<0.001). Intracellular viability was observed for the CSF 90356 isolate within 2 h incubation. Results suggest the expression of additional bacterial virulence factors that favor some GBS type III strains to cause invasive disease. Detection of genotypic virulence marker (162-kb) in the CSF 90356 isolate by PFGE emphasizes the high risk of invasive infection by some GBS-III strains. Treatment of ECV304 cells with IFN-gamma and/or TGF-beta increased adherence of both GBS strains (P<0.001). Intracellular survival of the CSF 90356 isolate was observed after 24 h incubation following treatment of ECV304 cells with IFN-gamma and TGF-beta. Our data suggest that both IFN-gamma and TGF-beta may favor virulence of GBS strains. Variation of IFN-gamma and TGF-beta producing capacity of host cells of different individuals may influence development of invasive disease by GBS-III.

Pneumococcal Colonization and Antibiotic Resistance

Patients with HIV infection have about a 100-fold increased risk of invasive pneumococcal infection. Because the development of clinical disease depends in part on the frequency of carriage of invasive serotypes, these Houston researchers determined pneumococcal colonization rates of adults with HIV at a variety of different CD4-cell counts and compared this rate with noninfected controls. Researchers recruited 103 HIV-infected patients and …

Human neonatal monocyte-derived macrophages and neutrophils exhibit normal nonopsonic and opsonic receptor-mediated phagocytosis and superoxide anion production.

Human neonates are at risk for invasive infections with fungi and gram-negative bacteria, microorganisms which are often susceptible to phagocytosis in either the presence or the absence of opsonins. Although opsonic phagocytosis has been investigated, to date there have been no systematic studies of nonopsonic phagocytosis in neonates. We investigated receptor-mediated phagocytosis by neonatal neutrophils and monocyte-derived macrophages in order to determine if a functional defect exists in any of the classes of nonopsonic or opsonic receptors. Ingestion or binding by mannosyl/fucosyl, Fc and complement receptors and the receptor(s) for unopsonized Pseudomonas aeruginosa were normal in neutrophils and macrophages from the cord blood of 26 healthy full-term neonates as compared to simultaneous normal adult controls. Superoxide anion production by neonatal neutrophils in response to both soluble and particulate stimuli was also normal. We conclude that neonatal nonopsonic and opsonic receptor-mediated phagocytosis are normal.