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Query: UMLS:C0243026 (sepsis)
 52,417 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

The number of patients undergoing BMT is rising steadily. The increase is due to a broadening of the indications for transplantation and an increase in the donor pool. There has been a progressive improvement in outcome particularly due to a fall in transplant-related mortality. Methotrexate and cyclosporin are the mainstay of graft versus host disease (GVHD) prophylaxis, but acute GVHD remains a major problem in the unrelated donor recipient. Infections remain an important cause of death and emphasise the crucial role of antimicrobial prophylaxis; death from Gram-negative sepsis has been significantly reduced by the use of prophylactic antibiotics. Fungal infections carry a high mortality, especially in allogenic transplant recipients. Fluconazole is used to protect patients in the neutropenic period and beyond in higher risk individuals. Viral infections, which may occur late, are emerging as a significant cause of morbidity and mortality in the allogeneic, particularly unrelated transplantation setting. A long term susceptibility to encapsulated bacteria suggests delayed immune reconstitution; revaccination policies are standard in most units. The longer term effects of transplantation are increasingly important with improving survival and include chronic GVHD, endocrine, cardiorespiratory and other systemic abnormalities. The increased risk of secondary malignancies is also of concern.
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PMID:Bone marrow transplantation: current situation, complications and prevention. 860 39

Imidazole compounds have been shown to be beneficial in systemic sepsis and inflammation. The purpose of this study was to delineate the effects of fluconazole on systemic hemodynamics and on microanatomy of the heart, lung, liver, and kidney parenchyma of swine during graded bacteremia. Eighteen adult swine were studied in three groups: 1), anesthesia control; 2), septic control (Aeromonas hydrophila, 10(9)/mL, infused i.v. for 4 h); 3) fluconazole (fluconazole, 30 mg/kg i.v., followed by A. hydrophila infusion). After 4 h of graded bacteremia, autopsy was performed. Compared with the septic control group, cardiac index, oxygen delivery, and oxygen consumption were reduced significantly after fluconazole pretreatment, and mixed venous hemoglobin oxygen saturation (SVO2) and oxygen extraction were increased. Plasma thromboxane A2 and leukotriene levels were not affected by fluconazole. Computerized digital image analysis of the liver, heart, and kidney specimens revealed no statistically significant differences between the septic control group and fluconazole-pretreated animals. In the lung specimens, preinfusion of fluconazole decreased alveolar wall thickness in septic swine (anesthesia control group: 8.15 x 10(-3) +/- 1.3 x 10(-3)mm versus septic control group: 9.9 x 10(-3) +/- 1.3 x 10(-4) versus fluconazole group: 6.8 x 10(-3) +/- 1.6 x 10(-3); p < or = .05). Fluconazole pretreatment before graded bacteremia has no beneficial effect on cardiopulmonary performance or septic tissue edema of the heart, kidney, or liver. Tissue oxygen metabolism might be down-regulated by fluconazole. However, preinfusion of fluconazole appears to normalize the sepsis-induced increase in pulmonary alveolar wall thickness. The net significance of these changes on clinical outcome is not clear from these data.
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PMID:The cardiopulmonary, eicosanoid, and tissue microanatomic effects of fluconazole during graded bacteremia. 888 87

In this prospective, randomized study fluconazole and amphotericin B/5-flucytosine were compared in the treatment of systemic candidiasis. Seventy-two non-neutropenic intensive care patients with systemic Candida infections were enrolled. Thirty-six patients were randomly assigned to receive fluconazole (400 mg on the first day then 200 mg) and 36 were randomized to amphotericin B/5-flucytosine (1.0-1.5 mg/kg body weight every other day and 3 x 2.5 g flucytosine/day) for 14 days following the diagnosis. There was no statistically significant difference in clinical outcome in regard to the treatment of pneumonia and sepsis: 18/28 of the patients were treated successfully with fluconazole and 17/27 with amphotericin B/5-flucytosine. For the treatment of peritonitis, however, amphotericin B/5-flucytosine was more effective than fluconazole (55% vs. 25%). Furthermore, amphotericin B/5-flucytosine was found to be superior to fluconazole with regard to pathogen eradication (86% vs. 50%). Fluconazole was associated with less toxicity than amphotericin B/5-flucytosine.
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PMID:A randomized study comparing fluconazole with amphotericin B/5-flucytosine for the treatment of systemic Candida infections in intensive care patients. 900 89

Eight preterm infants with mean gestational age of 31.6 +/- 1.16 weeks and a mean birth weight of 1310 +/- 201.7 g presented at a mean postnatal age of 26 +/- 11.4 days with knee joint swellings and pedal oedema. There was no other clinical, haematological or microbiological evidence of bacterial sepsis. Fungal cultures yielded growth of Candida spp. from blood in five, from urine in four, from cerebrospinal fluid in one, and from all the three babies in whom the joints were aspirated. Radiographic changes of metaphysitis of the involved joints were noted in all. All infants had received prior antibiotic therapy. No infant had received total parenteral nutrition or had central lines inserted. All infants were treated with fluconazole in doses of 7.5 mg/kg/day for 6 weeks. Six of eight were thriving well at 3 months of age without any evidence of residual joint disease. One infant succumbed to disseminated disease and one was lost to follow-up. Candidial arthritis is an uncommon presentation of neonatal candidiasis. Fluconazole therapy proved effective.
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PMID:Nursery outbreak of neonatal fungal arthritis treated with fluconazole. 914 82

We performed a retrospective review of patient case records to identify risk factors for candidaemia and to assess incidence, management and outcome of candidaemia in an Australian teaching hospital. Between January 1994 and June 1996, 38 cases of candidaemia were identified. The incidence was 0.74 per 1000 admissions of 24 h duration, and 1.54 per 1000 admissions of 5 days or more. The mortality rate was 34%, with eight of 13 (62%) of these deaths attributable to candidaemia. Risk factors included underlying gastrointestinal disease (66%) and recent abdominal surgery (61%), while recent broad spectrum antibiotic use was a contributing factor in 95%. Twenty-nine patients (76%) had a vascular access device in situ at time of detection. This was the apparent source of candidaemia in 28 (97%). Twenty-six (90%) were being used for TPN administration. Of patients receiving TPN, 5.2% developed candidaemia. Standard central venous catheters (CVC) were present in 21 patients (55%), having been in situ for an average of 12.7 days. Eighteen (86%) had been in situ for 7 days or more. Management involved removal of any implicated intravascular device. Thirty of 33 early survivors received antifungal chemotherapy. Therapy with amphotericin B, fluconazole alone or amphotericin B followed by fluconazole was equally effective. Concurrent corticosteroid use and neutropaenia contributed to increased mortality. Candidaemia is not benign. Policies regarding regular changing of central lines, especially in the setting of TPN administration and control of broad spectrum antibiotic use are appropriate measures aimed to reduce incidence. Management involves removal of implicated lines and antifungal chemotherapy. Pre-emptive therapy for candida infection should be considered in selected patients with the likelihood of TPN-related central line sepsis. Fluconazole is an effective alternative to amphotericin B in non-neutropenic patients.
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PMID:Candidaemia in an Australian teaching hospital: relationship to central line and TPN use. 957 Jun 55

Fluconazole has been used as prophylaxis against systemic fungal infections in preterm neonates. We conducted a study to determine whether cessation of a policy of prophylactic fluconazole results in a resurgence of fungal infections in a unit. Neonates born in the 3 epoches: A 36-month pre-Fluconazole prophylaxis epoch (Group 1), a 21-month Fluconazole prophylaxis epoch (Group 2) and a 39-month post Fluconazole prophylaxis epoch (Group 3) were compared for incidence and onset of fungal sepsis and resistance patterns. There was a decline in the incidence of fungal sepsis from Group 1 to Group 2, and it remained stable from Group 2 to Group 3. There was no significant difference in resistance to Fluconazole and to any of the azoles in Groups 1, 2 and 3 respectively.
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PMID:Effects of cessation of a policy of neonatal fluconazole prophylaxis on fungal resurgence. 1642 60

A 45-year-old homosexual man with pneumocystis pneumonia and esophageal candidiasis tested positive in ELISA and Western blot analysis for HIV-1. His CD4+ T cell count was 43/microL and his HIV-RNA load was 250,000 copies/mL. He was treated with Trimetoprim-Sulfamethoxazole, Prednisolone and Fluconazole. Valganciclovir was added to treat CMV retinitis. During the clinical course, 21 days after admission, the patient presented with a temperature of 39 degrees C and blood analysis showed neutropenia. Cefepime and G-CSF were initiated, but new consolidation was observed in the upper left lobe in chest radiography. He underwent bronchoscopy and lavage culture was positive for Aspergillus fumigatus. Serum testing of galactomannan was also positive and pulmonary aspergillosis was diagnosed. The patient was initially treated with Micafungin but switched to Voriconazole when clinical symptoms worsened. An eventual clinical response was observed and pulmonary aspergillosis was controlled. Unfortunately, he died of sepsis due to MRSA 2 months later. Pulmonary aspergillosis is a devastating complication with poor prognosis in patients with HIV infection. Amphotericin-B has been the mainstay of pulmonary aspergillosis treatment, but reports indicate mortality exceeding 80%. Use of Voriconazole, a relatively new antifungal agent, may lower mortality with fewer adverse effects than conventional antifungal therapy.
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PMID:[Voriconazole as an effective therapy against pulmonary aspergillosis in a man with immunodeficiency virus-infection: a case report]. 1744 80

This manuscript reports on two very low birth weight premature infants with respiratory distress, receiving parenteral nutrition and broad-spectrum antibiotics for about 3 weeks, who developed Candida albicans sepsis associated with fungal mycoses and endocarditis, despite treatment with Amphotericin B and Caspofungin. On days 40 and 47, respectively, antifungal therapy was modified to liposomal Amphotericin B combined with Fluconazole 6 mg/kg/day for 4 weeks, resulting in complete resolution of the mycetomas. Our observations suggest that the combination of liposomal Amphotericin B with Fluconazole is able to result in complete resolution of cardiac mycetomas in preterm infants.
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PMID:Successful resolution of cardiac mycetomas by combined liposomal Amphotericin B with Fluconazole treatment in premature neonates. 1820 13

Vulvovaginal infection is the most common cause of gynecological problems in sexually active women. Few years ago it was not considered as serious disease which may cause major health implications. Currently we are aware that it implies life worsening, temporal indisposition, postoperative complications and even life threatening sepsis in patients hospitalized in Intensive Care Units. Knowledge about pharmacological properties of drugs used in treatment vulvovaginal candidiasis allows for tailoring therapy to each patient. Fluconazole is modern and up to date option for treatment of VVC/rVVC. Short- and long-term therapeutic efficacy of fluconazole was confirmed in numerous high reliability clinical trials. Good tolerance, wide range of single therapeutic dose and high level of patient's acceptance gives the specialist powerful and efficient tool for management of VVC/rVVC.
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PMID:[Treatment of acute and recurrent vulvovaginal candidiasis (VVC/rVVC)--state of art in 2008. Expert Board of Polish Gynecological Society]. 1893 17

Sepsis is a leading cause of death in the intensive care unit (ICU), with Candida spp. in the forefront among the important pathogens. As recent studies have shown, survival outcome is strongly influenced by adequate antifungal therapy at an early stage that is often delayed by the time lag associated with microbiological diagnosis. Risk factor-based prediction models have a high negative predictive value, but positive prediction of candidaemia in the individual patient remains elusive. New antigen- or DNA-based methods for early diagnosis still await clinical validation. Their routine use is hampered by methodological issues. Species distribution of invasive Candida isolates in the ICU appears to be influenced primarily by age, previous hospitalisation and colonising species. In the context of the importance of adequate first-line treatment, recent guidelines favour the use of echinocandins in critically ill patients with symptoms evoking high suspicion of invasive candidiasis. This is supported by robust clinical trial data, a few interactions and low toxicity. Fluconazole is characterised by reduced activity against some important Candida species, elevated rates of persistent infection seen in comparative trials. Amphotericin B deoxycholate should be considered obsolete in ICU patients because of its high toxicity. Invasive aspergillosis (IA) is a rare devastating infection in the general ICU population, but some centres have reported elevated incidences and underdiagnosis as determined in autopsy-controlled studies. Treatment with mould-active agents such as voriconazole must be initiated early in patients with suspected IA.
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PMID:Current aspects of invasive candidiasis and aspergillosis in adult intensive care patients. 2049 30


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