Risks Involved in Selective Decontamination in Immunocompromised Patients.

Summary: Selective oral and systemic decontamination are widely discussed when it comes to the prophylaxis of bacterial and fungal infections in immunocompromised patients. The number of such patients is clearly rising due to the aggressiveness of modern medicine. Host defence is based on a variety of factors including the barrier function of mucosal surfaces as well as the phagocytic system provided by the blood. It seems helpful to distinguish between three different stages of immunodeficiency: "Minor immunodeficiency", "immunodeficiency" (in a stricter sense), "major immunodeficiency". When it comes to the choice of measures to be taken to protect the host, it is not only needed to consider the microbes already present but also the present state of defence mechanisms. When invasive fungal infections in particular have to be prevented, several drugs have to be discussed, As conventional antifun-gals have not met all expectations there is clear need for new drugs such as itraconazole.     

Antifungal Activity of Propolis Against Yeasts Isolated From Blood Culture: In Vitro Evaluation

Background: Due to the failure of available antifungal agents in the treatment of candidemia and the toxic activities of these drugs, a lot of researches are being conducted to develop new nontoxic and effective antifungal agents for optimal control of fungal pathogens. The aim of this study is to evaluate the in vitro antifungal activity of propolis against yeasts isolated from the blood cultures of intensive care unit patients. Methods: Seventy‐six strains were included in this study. The in vitro antifungal activity of propolis, fluconazole (FLU), and itraconazole (ITR) was investigated by the microdilution broth methods (CLSI guidelines M27‐A3 for yeast). The propolis sample was collected from Kayseri, Turkey. Results: Of the 76 isolates, 33 were identified as Candida albicans while 37 were C. parapsilosis, three were C. tropicalis, and three were identified as C. glabrata. The geometric mean range for MIC (μg/ml) with regard to all isolates was 0.077 to 3 μg/ml for FLU and ITR, and 0.375 to 0.70 μg/ml for propolis. It was shown that propolis had significant antifungal activity against all Candida strains and the MIC range of propolis was determined as 0185 to 3 μg/ml. Conclusion: This study demonstrated that propolis had significant antifungal activity against yeasts isolated from blood culture compared with FLU and ITR. The propolis MIC in azole‐resistant strains such as C. glabrata was found lower than the FLU MIC.     

In vitro activity of voriconazole against Mexican oral yeast isolates

Oral candidiasis is the most prevalent complication in HIV‐infected and AIDS patients. Topical antifungal treatment is useful for the initial episodes of oral candidiasis, but most patients suffer more than one episode and fluconazole or itraconazole can help in the management, and voriconazole may represent a useful alternative agent for the treatment of recalcitrant oral and oesophageal candidiasis. The aim of this research was to study the in vitro activity of voriconazole and fluconazole against Mexican oral isolates of clinically relevant yeast. The in vitro susceptibility of 187 oral yeast isolates from HIV‐infected and healthy Mexicans was determined for fluconazole and voriconazole by the M44‐A disc diffusion method. At 24 h, fluconazole was active against 179 of 187 isolates (95.7 %). Moreover, a 100% susceptibility to voriconazole was observed. Voriconazole and fluconazole are highly active in vitro against oral yeast isolates. This study provides baseline data on susceptibilities to both antifungal agents in Mexico.     

老年肺癌患者呼吸道深部真菌感染因素分析

目的：探讨老年肺癌患者呼吸道深部真菌感染的危险因素及预防措施。方法：对58例老年肺癌患者呼吸道深部真菌感染的临床资料进行回顾性分析。结果：老年肺癌患者呼吸道深部真菌感染的病原菌以白色念珠菌为主，占72，4％（42／58）。肺癌的分期晚、白细胞减少、长期应用多种抗生素、放化疗及各种侵入性诊疗等为真菌感染的危险因素。应用以氟康唑为主的综合治疗后，52例（89．7％）治愈，6例死亡。结论：老年肺癌患者呼吸道深部真菌感染有多种危险因素，应早期预防，早期诊断，确诊后及时应用高效低毒的氟康唑治疗有较好的疗效，同时应加强免疫与支持疗法。     

Fluconazole and itraconazole susceptibilities of Candida spp. isolated from oropharyngeal specimens and blood cultures of paediatric haematology/oncology patients

This study examined the in vitro susceptibilities to fluconazole and itraconazole of isolates of Candida spp. from surveillance oropharyngeal specimens and blood cultures from paediatric patients with malignancy. The species distribution of 100 isolates from oropharyngeal specimens was C. albicans 86%, C. glabrata 7%, C. lusitaniae 4%, C. parapsilosis 2% and C. tropicalis 1%. From a total of nine isolates from blood cultures the species distribution was C. albicans 33.3%, C. parapsilosis 33.3 % and C. guilliermondii 33.3%. Only three of the oropharyngeal isolates were resistant to fluconazole (MIC > or = 64 mg l(-1)) and only two were resistant to itraconazole (MIC > or = 1 mg l(-1)). None of the blood culture isolates was resistant to either agent. At this centre, C. albicans is the predominant species from oropharyngeal specimens, but non-albicans Candida species predominate in blood cultures. Although resistance to fluconazole and itraconazole is rare at present, continued surveillance is warranted to monitor trends in species distribution and antifungal susceptibility.     

华法林与氟康唑联合应用致国际标准化比值升高

1例72岁女性患者因可疑肺栓塞给予华法林及那屈肝素钙联合治疗,国际标准化比值(INR)稳定在1.23～2.81。联合用药8 d后,停用那屈肝素钙,单用华法林3 mg/d口服2 d后,检查INR为3.31。因行痰培养检查示白色念珠菌阳性,遂加用氟康唑0.4 g,1次/d静脉滴注,且华法林剂量调整为1.5 mg/d。氟康唑与华法林联用后第1、6天INR分别为3.91,7.31。立即停用华法林,氟康唑继续按原剂量应用,并给予维生素K1 40 mg肌内注射。停药后第1、2、3天INR分别为4.91,2.01,1.30。停药后第5天再次应用华法林1.5 mg/d,同时氟康唑调整至0.2 g/d。两药联用后第4天INR为1.68。     

Candida glabrata – unique features and challenges in the clinical management of invasive infections

Candida glabrata is a pathogenic yeast with several unique biological features. This article provides an up‐to‐date review on current data and reasoning aspects of this clinically problematic organism. Haploidy, absence of pseudohyphae, facultative anaerobe growth of C. glabrata, as well as its intrinsically low susceptibility to azole antifungals require specific consideration in diagnosis and treatment approaches. As C. glabrata today represents a sizeable percentage of pathogens in candidaemia, the use of azole antifungals in upfront therapy of invasive yeast infections is discouraged by recent guidelines. While the selection of C. glabrata mutants with impaired susceptibility to echinocandins has been described, analyses of several clinical studies indicate an association of improved outcomes with the use of echinocandins as the primary treatment for invasive yeast infections with potential or documented involvement of C. glabrata.     

高效液相色谱法测定注射用氟康唑的含量

目的建立注射用氟康唑含量的高效液相色谱测定法。方法采用C18柱（150mm×4.6mm，5μm），以磷酸盐缓冲液（pH=7.0）-甲醇（55：45）N流动相，检测波长为260nm。结果氟康唑进样量在0、21～2．13μg范围内与峰面积呈良好的线性关系，r=0．9998，平均回收率为99．74％，RSD为0．90％。结论采用方法精密可靠，可控制注射用氟康唑质量。