Fungal infections in ICU. Tang Swee Fong Department of Paediatrics Universiti Kebangsaan Malaysia

Size: px
Start display at page:

Download "Fungal infections in ICU. Tang Swee Fong Department of Paediatrics Universiti Kebangsaan Malaysia"

Transcription

1 Fungal infections in ICU Tang Swee Fong Department of Paediatrics Universiti Kebangsaan Malaysia

2 Epidemiology of invasive fungal infections - US +300% Martin GS, et al. N Engl J Med 2003;348:

3 Fungal players Opportunistic Normal flora Candida spp. Ubiquitous in our environment Aspergillus spp. Cryptococcus spp. Mucor spp. Newly emerging fungi Fusarium spp. Scedosporidium spp. Trichosporin spp. Penicillium spp. Zygomycetes Endemic geographically restricted Blastomyces sp. Coccidiodes sp. Histoplasmosis sp.

4 Percent Species distribution Pappas, 2003 Zaoulis, 2005 Abelson, C. albicans C. parapsilopsis C. glabrata Pappas PG, et al. Clin Infect Dis 2003; 37: Zaoulis TE, et al. Microbiol Infect Dis 2005;52:295-8 Abelson JA, et al. Pediatrics 2005; 116:61-7

5 Candidaemia in a paediatric intensive care unit 4.3% had candidaemia Overall mortality 28.1% Predictors of mortality Severity of illness Isolation of C. tropicalis Singhi SC, et al. Pediatr Crit Care Med 2004;5:369-74

6 Trends in mortality by type of blood stream infection Crude in-hospital mortality: candidaemia, 28.3% vs bacterial bloodstream infection, 15.0% (p<0.0001) Shorr AF, et al. Crit Care Med 2009;37:

7 Adjusted length of stay and total costs by type of blood stream infection Candida Grampositive Gramnegative Anaerobe Mixed bacteria LOS, days (95% CI) 4.8* (4.1, 5.5) 2.4 (2.3, 2.6) Reference group 3.3 (2.8, 3.8) 1.8 (1.5, 2.2) Total cost, $ (95% CI) 12,617* (10755, 14479) 4,473 (4,062, 4,885) Reference group 6,871 (5,472, 8,269) 3,693 (2,629, 4,758) *p<0.0001) Shorr AF, et al. Crit Care Med 2009;37:

8 Outcomes attributable to candidaemia, US Paediatric Adult Variable With candidaemia Without candidaemia Attributable increase With candidaemia Without candidaemia Attributable increase (n=1118) (n=2062) (95% CI) (95% CI) Mortality, % ( ) ( ) Length of stay, mean no. of days per patient ( ) ( ) Total charges, mean USD per patient 183,645 91,379 92, 266 (65, ,474) 66,154 26,823 39,331 (3,360-45,602) Zaoutis TE, et al. Clin Infect Dis 2005;41:1232-9

9 Risk factors for invasive candidiasis in the intensive care setting Environmental factors Endotracheal intubation Central venous v and arterial lines Urinary catheterisation Parenteral nutrition Prolonged ICU stay Broad-spectrum antibiotics Bacterial infections Immunosuppressive drugs Cancer and chemotherapy Blood transfusions Dialysis Recent surgery (especially GIT) Transplantation Host factors Immunodeficiency Neutropaenia Malignancies Bone marrow transplantation Critical illness Preterm birth Low Apgar score Congenital abnormalities Prior colonisation with Candida spp.

10 Risk factors for invasive candidiasis in the intensive care setting Environmental factors Endotracheal intubation Central venous and arterial lines Urinary catheterisation Parenteral nutrition Prolonged ICU stay Broad-spectrum antibiotics Bacterial infections Immunosuppressive drugs Cancer and chemotherapy Blood transfusions Dialysis Recent surgery (especially GIT) Transplantation Host factors Immunodeficiency Neutropaenia Malignancies Bone marrow transplantation Critical illness Preterm birth Congenital abnormalities Prior colonisation with Candida spp.

11 Risk factors for invasive candidiasis in the intensive care setting Environmental factors Host factors Endotracheal intubation Central venous and arterial lines Urinary catheterisation Parenteral nutrition Prolonged ICU stay Broad-spectrum antibiotics Bacterial infections Immunosuppressive drugs Cancer and chemotherapy Blood transfusions Dialysis Transplantation Immunodeficiency Neutropaenia Malignancies Bone marrow transplantation Critical illness Preterm birth Congenital abnormalities Prior colonisation with Candida spp. incidence of colonisation and invasive candidiasis after 8 days Recent surgery (especially GIT) Peak incidence around day 10 of ICU stay

12 Corrected colonisation index Candida colonisation index (CCI) CCI = number of distinct body sites positive for Candida spp. total sites tested * CCI > 0.5: identified infected patients Corrected Colonisation Index = CCI x number of sites with heavy candida growth Eggimann P, 2006 Snydman DR, 2003

13 Pathophysiology of invasive candidiasis Adhesion Colonisation Exogenous Diabetes Neutropenia Burns Antibiotics Invasion Antibiotics Vascular access Parenteral nutrition ICU stay > 7 days Candida colonisation Renal failure Major abdominal surgery Endogenous Candidaemia 0.5-1/1000 admissions (10% of bacteraemia) 35% survival Dissemination 35% die from candidaemia 35% die from underlying disease Modified from Eggimann P, et al. Lancet Infect Dis 2003;3:

14 Diagnosis Difficult to diagnose 20% have no fever 20-30% diagnosed at postmortem autopsy

15 Diagnosis Positive blood culture from a normally sterile site Positive only in 50-60% cases (even with disseminated infection) Histologically positive biopsy specimen Not routinely carried out

16 Surface colonisation vs invasive disease Positive endotracheal tube secretions Immune status? Lung opacities? Candiduria Immune status? Remove urinary catheter Repeat urine culture Ultrasound kidneys Blood culture

17 Diagnosis Candida Fungal wall elements (β-d glucan, mannan, β 1-3 glucan) PCR assays Aspergillus High resolution CT scan Serological and molecular techniques Jones BL, et al. Curr Opin Infect Dis 2003;16:521-6

18 Diagnosis

19 When to treat? Septic patients Profound immunosuppression Specimens positive for Candida Asymptomatic Non-neutropaenic

20 Time to starting antifungal therapy and mortality Morrell M, et al. Antimicrob Agents Chemother 2005;49: Garey KW, et al. Clin Infect Dis 2006;43:25-31

21 Antifungal therapies in critical care settings Prophylactic Pre-emptive Empirical Curative Targeted prophylaxis Targeted empirical No colonisation data needed Proof of infection Sign of sepsis Candida colonisation Risk factors

22 Prophylaxis Administration of antifungals to patients at high risk Organ-transplanted patients Immunocompromised with expected long-term neutropaenia Non-immunocompromised patients High risk of invasive candidiasis (frequency of candidiasis >10%) Expected long ICU stay Prolonged mechanical ventilation Eggimann P, et al. Lancet Infect Dis 2003;3: Pappas PG, et al. Clin Infect Dis 2009;38:161-89

23 Antifungal agents for preventing fungal infections in non-neutropenic critically ill patients Reduce fungal infections by one-half Reduce mortality by one-quarter Playford GE, et al. J Antimicrob Chemother 2006;57:628-38

24 Antifungal therapies in critical care settings Prophylactic Pre-emptive Empirical Curative Targeted prophylaxis Targeted empirical No colonisation data needed Proof of infection Sign of sepsis Candida colonisation Risk factors

25 Pre-emptive therapy Early administration of antifungal treatment Evidence of substantial colonisation Presence of multiple risk factors Eggimann P, et al. Lancet Infect Dis 2003;3: Pappas PG, et al. Clin Infect Dis 2009;38:161-89

26 Candida score bedside scoring system Predictors of proven Candida infection Multifocal Candida colonisation (1 pt) Total parenteral nutrition (1 pt) Surgery upon ICU admission (1pt) Severe sepsis (2 points) Sensitivity 81% Specificity 76% Cut-off score > fold increased likelihood of IC (95% CI, ) Leon C, et al. Crit Care Med 2006;34:730-7 Hollenbach E. Mycoses 2008;51:25-45

27 Pre-emptive therapy Early administration of antifungal treatment Evidence of substantial colonisation Presence of multiple risk factors Risk of severe candidiasis outweighs potential side-effects and emergence of resistant strains Eggimann P, et al. Lancet Infect Dis 2003;3: Pappas PG, et al. Clin Infect Dis 2009;38:161-89

28 Antifungal therapies in critical care settings Prophylactic Pre-emptive Empirical Curative Targeted prophylaxis Targeted empirical No colonisation data needed Proof of infection Sign of sepsis Candida colonisation Risk factors

29 Empiric therapy Treatment of high risk patients who exhibit signs and symptoms of disease even in the absence of positive cultures or evidence of disease For critically ill patients with risk factors for invasive candidiasis persistent fever with no other known cause found multiple organ dysfunction Eggimann P, et al. Lancet Infect Dis 2003;3: Pappas PG, et al. Clin Infect Dis 2009;38:161-89

30 Empiric therapy Should be based on clinical assessment of risk factors serologic markers for invasive candidiasis culture data from nonsterile sites Eggimann P, et al. Lancet Infect Dis 2003;3: Pappas PG, et al. Clin Infect Dis 2009;38:161-89

31 Empiric therapy Fluconazole Echinocandins Moderate to severe disease Recent exposure to azole At high risk of infection with C. glabrata or C. krusei Amphotericin B Intolerance to or limited availability of other antifungals Eggimann P, et al. Lancet Infect Dis 2003;3: Pappas PG, et al. Clin Infect Dis 2009;38:161-89

32 Treatment of candidaemia in non-neutropaenic patients Selection of agents History of recent azole exposure History of intolerance to an antifungal agent Dominant Candida species Current susceptibility data in clinical location Severity of illness Relevant comorbidities Evidence of CNS, cardiac valves and/or visceral involvement Pappas PG, et al. Clin Infect Dis 2009;48:503-35

33 Antifungal choices Polyenes Amphotericin B ABLC, ABCD, AmBisome Liposomal nystatin Echinocandins Caspofungin Micafungin Anidulafungin Aminocandin Azoles Fluconazole Itraconazole Voriconazole Posaconazole Ravuconazole

34 Fluconazole First line therapy mild to moderate illness (ie haemodynamically stable) no previous exposure to azoles do not belong in a group at high risk of C. glabrata Not for patients with candidaemia and suspected concomitant endocardial or CNS involvement Step-down therapy for infections with organisms likely to be susceptible Pappas PG, et al. Clin Infect Dis 2009;48:503-35

35 Echinocandins Significant fungicidal activity Favourable safety profile Few drug interactions Initial therapy recent exposure to an azole moderately severe to severe disease allergy or intolerance to azoles or AmB high risk of infection with C. krusei and C. glabrata Pappas PG, et al. Clin Infect Dis 2009;48:503-35

36 Amphotericin Initial therapy alternative therapy unavailable or unaffordable history of intolerance to echinocandins or azoles infection refractory to other therapy organism is resistant to other agents suspected infection with non-candida yeast eg Cryptococcus neoformans Pappas PG, et al. Clin Infect Dis 2009;48:503-35

37 Treatment of Non-Candida albicans candidaemia C. parasilopsis Fluconazole? Less responsive to echinocandin C. glabrata Echinocandin Pappas PG, et al. Clin Infect Dis 2009;48:503-35

38 Other measures Removal of vascular lines Dilated fundoscopic examination

39 Duration of therapy 14 days after resolution of symptoms clearance of Candida species from bloodstream pertains to all systemic antifungal therapy (including sequential therapy with AmB or echinocandin followed by an azole) Pappas PG, et al. Clin Infect Dis 2009;48:503-35

40 Prevention Optimal placement of central venous catheter and care Hand washing Strict control of antimicrobial use

41 Summary invasive candidiasis Cause of substantial morbidity and mortality Trend towards increasing numbers of infections caused by non-albicans Candida species Prophylaxis vs preemptive vs empirical therapy Choice of antifungal agent depends on local epidemiologic and patient factors

42 Conclusion Past Fungal infections rare Difficult to diagnose Limited treatment options Present Fungal infections more common Still difficult to diagnose More treatments available Future Diagnostics Risk identification Assessment of management strategies

43 Thank you

An Update in the Management of Candidiasis

An Update in the Management of Candidiasis An Update in the Management of Candidiasis Daniel B. Chastain, Pharm.D., AAHIVP Infectious Diseases Pharmacy Specialist Phoebe Putney Memorial Hospital Adjunct Clinical Assistant Professor UGA College

More information

WHICH ANTIFUNGAL AGENT IS THE CHOICE FOR SUSPECTED FUNGAL INFECTIONS?

WHICH ANTIFUNGAL AGENT IS THE CHOICE FOR SUSPECTED FUNGAL INFECTIONS? WHICH ANTIFUNGAL AGENT IS THE CHOICE FOR SUSPECTED FUNGAL INFECTIONS? Assoc. Prof. Dr. Serkan SENER Acibadem University Medical School Department of Emergency Medicine, Istanbul Acibadem Ankara Hospital,

More information

Title: Author: Speciality / Division: Directorate:

Title: Author: Speciality / Division: Directorate: Antifungal guidelines for CANDIDIASIS INFECTIONS (Adults) Proven infection: Targeted antifungal therapy should be prescribed for: o Positive cultures from a sterile site with clinical or radiological abnormality

More information

Antifungal Stewardship. Önder Ergönül, MD, MPH Koç University, School of Medicine, Istanbul 6 October 2017, ESGAP course, Istanbul

Antifungal Stewardship. Önder Ergönül, MD, MPH Koç University, School of Medicine, Istanbul 6 October 2017, ESGAP course, Istanbul Antifungal Stewardship Önder Ergönül, MD, MPH Koç University, School of Medicine, Istanbul 6 October 2017, ESGAP course, Istanbul 1 2 Objectives What do we know? Invasive Candida and Aspergillosis Impact

More information

MANAGEMENT OF HOSPITAL-ACQUIRED FUNGAL INFECTIONS

MANAGEMENT OF HOSPITAL-ACQUIRED FUNGAL INFECTIONS MANAGEMENT OF HOSPITAL-ACQUIRED FUNGAL INFECTIONS Paul D. Holtom, MD Associate Professor of Medicine and Orthopaedics USC Keck School of Medicine Numbers of Cases of Sepsis in the United States, According

More information

CURRENT AND NEWER ANTI-FUNGAL THERAPIES- MECHANISMS, INDICATIONS, LIMITATIONS AND PROBLEMS. Dr AMIT RAODEO DM SEMINAR

CURRENT AND NEWER ANTI-FUNGAL THERAPIES- MECHANISMS, INDICATIONS, LIMITATIONS AND PROBLEMS. Dr AMIT RAODEO DM SEMINAR CURRENT AND NEWER ANTI-FUNGAL THERAPIES- MECHANISMS, INDICATIONS, LIMITATIONS AND PROBLEMS Dr AMIT RAODEO DM SEMINAR Introduction The incidence of invasive fungal infections in critically ill intensive

More information

Antifungals and current treatment guidelines in pediatrics and neonatology

Antifungals and current treatment guidelines in pediatrics and neonatology Dragana Janic Antifungals and current treatment guidelines in pediatrics and neonatology Dragana Janic. University Children`s Hospital, Belgrade, Serbia 10/10/17 Hotel Crowne Plaza, Belgrade, Serbia; www.dtfd.org

More information

Objec&ves. Clinical Presenta&on

Objec&ves. Clinical Presenta&on Michelle A. Barron, MD Associate Professor of Medicine Division of Infectious Diseases University of Colorado Denver Objec&ves Determine who is at risk for invasive candidiasis. Understand whether prophylaxis

More information

Fungal Infection in the ICU: Current Controversies

Fungal Infection in the ICU: Current Controversies Fungal Infection in the ICU: Current Controversies Andrew F. Shorr, MD, MPH, FCCP, FACP Washington Hospital Center Georgetown University, Washington, DC Disclosures I have served as a consultant to, researcher/investigator

More information

Current options of antifungal therapy in invasive candidiasis

Current options of antifungal therapy in invasive candidiasis Current options of antifungal therapy in invasive candidiasis Saloua Ladeb Bone Marrow Transplant Center Tunis HAMMAMET 24 th April 2012 DEFINITION One or more positive results on blood culture for Candida

More information

WHAT IS THE ROLE OF EMPIRIC TREATMENT FOR SUSPECTED INVASIVE CANDIDIASIS IN NONNEUTROPENIC PATIENTS IN THE ICU?

WHAT IS THE ROLE OF EMPIRIC TREATMENT FOR SUSPECTED INVASIVE CANDIDIASIS IN NONNEUTROPENIC PATIENTS IN THE ICU? WHAT IS THE ROLE OF EMPIRIC TREATMENT FOR SUSPECTED INVASIVE CANDIDIASIS IN NONNEUTROPENIC PATIENTS IN THE ICU? Empiric antifungal therapy should be considered in critically ill patients with risk factors

More information

ADEQUATE ANTIFUNGAL USE FOR BLOODSTREAM INFECTIONS

ADEQUATE ANTIFUNGAL USE FOR BLOODSTREAM INFECTIONS ADEQUATE ANTIFUNGAL USE FOR BLOODSTREAM INFECTIONS COMMERCIAL RELATIONS DISCLOSURE 2500 9000 15000 Astellas Gilead Sciences Pfizer Inc Expert advice Speaker s bureau Speaker s bureau OUTLINE OF THE PRESENTATION

More information

1. Pre-emptive therapy. colonization, colonization, pre-emptive therapy. , ICU colonization. colonization. 2, C. albicans

1. Pre-emptive therapy. colonization, colonization, pre-emptive therapy. , ICU colonization. colonization. 2, C. albicans Jpn. J. Med. Mycol. Vol. 45, 217 221, 2004 ISSN 0916 4804,.,, colonization, pre-emptive therapy. 2, non-albicans Candida., fluconazole.,. Key words: postoperative infection, non-albicans Candida, pre-emptive

More information

Antifungal Update. Candida: In Vitro Antifungal Susceptibility Testing

Antifungal Update. Candida: In Vitro Antifungal Susceptibility Testing Antifungal Update B. Joseph Guglielmo, Pharm.D. Professor and Chair Department of Clinical Pharmacy School of Pharmacy University of California San Francisco The patient spikes a new fever and 3/3 blood

More information

Fungi GUIDE TO INFECTION CONTROL IN THE HOSPITAL CHAPTER NUMBER 53: Author Moi Lin Ling, MBBS, FRCPA, CPHQ, MBA

Fungi GUIDE TO INFECTION CONTROL IN THE HOSPITAL CHAPTER NUMBER 53: Author Moi Lin Ling, MBBS, FRCPA, CPHQ, MBA GUIDE TO INFECTION CONTROL IN THE HOSPITAL CHAPTER NUMBER 53: Fungi Author Moi Lin Ling, MBBS, FRCPA, CPHQ, MBA Chapter Editor Ziad A. Memish, MD, FRCPC, FACP Cover heading - Topic Outline Topic outline

More information

Case Studies in Fungal Infections and Antifungal Therapy

Case Studies in Fungal Infections and Antifungal Therapy Case Studies in Fungal Infections and Antifungal Therapy Wayne L. Gold MD, FRCPC Annual Meeting of the Canadian Society of Internal Medicine November 4, 2017 Disclosures No financial disclosures or industry

More information

Antifungals in Invasive Fungal Infections: Antifungals in neutropenic patients

Antifungals in Invasive Fungal Infections: Antifungals in neutropenic patients BVIKM-SBIMC La Hulpe, 6 November 2008 Antifungals in Invasive Fungal Infections: Antifungals in neutropenic patients Johan Maertens, MD Acute Leukemia and SCT Unit University Hospital Gasthuisberg Catholic

More information

Antifungal Update 2/22/12. Which is the most appropriate initial empirical therapy in a candidemic patient?

Antifungal Update 2/22/12. Which is the most appropriate initial empirical therapy in a candidemic patient? Antifungal Update B. Joseph Guglielmo, Pharm.D. Professor and Chair Department of Clinical Pharmacy School of Pharmacy University of California San Francisco 3/3 blood cultures are positive for an unidentified

More information

Prophylaxis versus Diagnostics-driven approaches to treatment of Invasive fungal diseases. Y.L. Kwong Department of Medicine University of Hong Kong

Prophylaxis versus Diagnostics-driven approaches to treatment of Invasive fungal diseases. Y.L. Kwong Department of Medicine University of Hong Kong Prophylaxis versus Diagnostics-driven approaches to treatment of Invasive fungal diseases Y.L. Kwong Department of Medicine University of Hong Kong Pathogenic yeast Candida Cryptococcus Trichosporon Pathogenic

More information

INFEZIONI FUNGINE E PERCORSI TERAPEUTICI IN ICU. Claudio Viscoli Professor of Infectious Disease University of Genoa

INFEZIONI FUNGINE E PERCORSI TERAPEUTICI IN ICU. Claudio Viscoli Professor of Infectious Disease University of Genoa INFEZIONI FUNGINE E PERCORSI TERAPEUTICI IN ICU Claudio Viscoli Professor of Infectious Disease University of Genoa What I would like to discuss with you today When to start an antifungal therapy (before

More information

ESCMID Online Lecture Library. by author

ESCMID Online Lecture Library. by author What is the best antifungal strategy for severe intra-abdominal infections? Philippe Montravers MD, PhD Anaesthesia and Surgical ICU Bichat Claude Bernard Hospital Assistance Publique Hopitaux de Paris

More information

Use of Antifungals in the Year 2008

Use of Antifungals in the Year 2008 Use of Antifungals in the Year 2008 Jose G. Montoya, MD Associate Professor of Medicine Associate Chief for Clinical Affairs Division of Infectious Diseases Stanford University School of Medicine Diagnosis

More information

Use of Antifungal Drugs in the Year 2006"

Use of Antifungal Drugs in the Year 2006 Use of Antifungal Drugs in the Year 2006" Jose G. Montoya, MD Associate Professor of Medicine Associate Chief for Clinical Affairs Division of Infectious Diseases Stanford University School of Medicine

More information

Antifungal Update 2/24/11. Which is the most appropriate initial empirical therapy in a candidemic patient?

Antifungal Update 2/24/11. Which is the most appropriate initial empirical therapy in a candidemic patient? Antifungal Update B. Joseph Guglielmo, Pharm.D. Professor and Chair Department of Clinical Pharmacy School of Pharmacy University of California San Francisco The patient spikes a new fever and 3/3 blood

More information

Systemic Candidiasis for the clinicians: between guidelines and daily clinical practice

Systemic Candidiasis for the clinicians: between guidelines and daily clinical practice Systemic Candidiasis for the clinicians: between guidelines and daily clinical practice Anastasia Antoniadou Assoc. Professor Internal Medicine and Infectious Diseases National and Kapodistrian University

More information

Voriconazole October 2015 Risk Management Plan. Voriconazole

Voriconazole October 2015 Risk Management Plan. Voriconazole Voriconazole October 2015 VI.2 VI.2.1 Elements for a Public Summary Overview of disease epidemiology Invasive aspergillosis (IA) is the most devastating of Aspergillus related diseases, targeting severely

More information

TOWARDS PRE-EMPTIVE? TRADITIONAL DIAGNOSIS. GALACTOMANNAN Sensitivity 61% Specificity 93% Neg Predict Value >95% β-d-glucan Neg Predict Value 100% PCR

TOWARDS PRE-EMPTIVE? TRADITIONAL DIAGNOSIS. GALACTOMANNAN Sensitivity 61% Specificity 93% Neg Predict Value >95% β-d-glucan Neg Predict Value 100% PCR TOWARDS PRE-EMPTIVE? GALACTOMANNAN Sensitivity 61% Specificity 93% Neg Predict Value >95% TRADITIONAL DIAGNOSIS β-d-glucan Neg Predict Value 100% PCR diagnostics FUNGAL BURDEN FIRST TEST POSITIVE FOR ASPERGILLOSIS

More information

Itraconazole vs. fluconazole for antifungal prophylaxis in allogeneic stem-cell transplant patients D. J. Winston

Itraconazole vs. fluconazole for antifungal prophylaxis in allogeneic stem-cell transplant patients D. J. Winston REVIEW Itraconazole vs. fluconazole for antifungal prophylaxis in allogeneic stem-cell transplant patients D. J. Winston Division of Hematology-Oncology, Department of Medicine, UCLA Medical Center, Los

More information

Early Diagnosis and Therapy for Fungal Infections

Early Diagnosis and Therapy for Fungal Infections Early Diagnosis and Therapy for Fungal Infections Debra Goff PharmD, FCCP Clinical Associate Professor Infectious Disease Specialist The Ohio State University Medical Center Columbus Ohio, USA The Ohio

More information

9/7/2018. Faculty. Overcoming Challenges in the Management of Invasive Fungal Infections. Learning Objectives. Faculty Disclosure

9/7/2018. Faculty. Overcoming Challenges in the Management of Invasive Fungal Infections. Learning Objectives. Faculty Disclosure Faculty Overcoming Challenges in the Management of Invasive Fungal James S. Lewis II, PharmD, FIDSA ID Clinical Pharmacy Coordinator Oregon Health and Science University Departments of Pharmacy and Infectious

More information

Terapia della candidiasi addomaniale

Terapia della candidiasi addomaniale Verona 16 marzo 2018 Terapia della candidiasi addomaniale Pierluigi Viale Infectious Disease Unit Teaching Hospital S. Orsola Malpighi Bologna INTRA ABDOMINAL CANDIDIASIS open questions a single definition

More information

Candiduria in ICU : when and how to treat? Dr. Debashis Dhar Dept of Critical Care and Emergency Medicine Sir Ganga Ram Hospital

Candiduria in ICU : when and how to treat? Dr. Debashis Dhar Dept of Critical Care and Emergency Medicine Sir Ganga Ram Hospital Candiduria in ICU : when and how to treat? Dr. Debashis Dhar Dept of Critical Care and Emergency Medicine Sir Ganga Ram Hospital Introduction Nosocomial bacteriuria or candiduria develops in up to 25%

More information

Dr Eggimann collaborated in several industrysponsored. clinical trials since Talk ID: year old BMI 41 Transferred for septic shock

Dr Eggimann collaborated in several industrysponsored. clinical trials since Talk ID: year old BMI 41 Transferred for septic shock Suggestions to prevent Candida infections Dr Philippe Eggimann, PD&MER Service de Médecine Intensive Adulte www.soins-intensifs.chuv.ch Anything I say can be highly biased Dr Eggimann collaborated in several

More information

Antifungal Resistance in Asia: Mechanisms, Epidemiology, and Consequences

Antifungal Resistance in Asia: Mechanisms, Epidemiology, and Consequences 5th MMTN Conference 5-6 November 2016 Bangkok, Thailand 10:20-10:45, 6 Nov, 2016 Antifungal Resistance in Asia: Mechanisms, Epidemiology, and Consequences Yee-Chun Chen, M.D., PhD. Department of Medicine,

More information

Condition First line Alternative Comments Candidemia Nonneutropenic adults

Condition First line Alternative Comments Candidemia Nonneutropenic adults Recommendations for the treatment of candidiasis. Clinical Practice Guidelines for the Management of Candidiasis: 2009 Update by the Infectious Diseases Society of America. Condition First line Alternative

More information

Cigna Drug and Biologic Coverage Policy

Cigna Drug and Biologic Coverage Policy Cigna Drug and Biologic Coverage Policy Subject Voriconazole Effective Date... 3/15/2018 Next Review Date... 3/15/2019 Coverage Policy Number... 4004 Table of Contents Coverage Policy... 1 General Background...

More information

EMERGING FUNGAL INFECTIONS IN IMMUNOCOMPROMISED PATIENTS

EMERGING FUNGAL INFECTIONS IN IMMUNOCOMPROMISED PATIENTS EMERGING FUNGAL INFECTIONS IN IMMUNOCOMPROMISED PATIENTS DR LOW CHIAN YONG MBBS, MRCP(UK), MMed(Int Med), FAMS Consultant, Dept of Infectious Diseases, SGH Introduction The incidence of invasive fungal

More information

Invasive Fungal Infections in Solid Organ Transplant Recipients

Invasive Fungal Infections in Solid Organ Transplant Recipients Outlines Epidemiology Candidiasis Aspergillosis Invasive Fungal Infections in Solid Organ Transplant Recipients Hsin-Yun Sun, M.D. Division of Infectious Diseases Department of Internal Medicine National

More information

Micafungin and Candida spp. Rationale for the EUCAST clinical breakpoints. Version February 2013

Micafungin and Candida spp. Rationale for the EUCAST clinical breakpoints. Version February 2013 Micafungin and Candida spp. Rationale for the EUCAST clinical breakpoints. Version 1.0 5 February 2013 Foreword EUCAST The European Committee on Antimicrobial Susceptibility Testing (EUCAST) is organised

More information

Nationwide survey of treatment for pediatric patients with invasive fungal infections in Japan

Nationwide survey of treatment for pediatric patients with invasive fungal infections in Japan J Infect Chemother (2013) 19:946 950 DOI 10.1007/s10156-013-0624-7 ORIGINAL ARTICLE Nationwide survey of treatment for pediatric patients with invasive fungal infections in Japan Masaaki Mori Received:

More information

ESCMID Online Lecture Library. by author

ESCMID Online Lecture Library. by author How To Best Use Antifungal Agents Cornelia Lass-Flörl Division of Hygiene and Medical Microbiology Innsbruck Medical University ESCMID SUMMER SCHOOL 2012 Epidemiology Diagnosis Roadmap Antifungal drugs

More information

Candida auris: an Emerging Hospital Infection

Candida auris: an Emerging Hospital Infection National Center for Emerging and Zoonotic Infectious Diseases Candida auris: an Emerging Hospital Infection Paige Armstrong MD MHS Epidemic Intelligence Service Officer Mycotic Diseases Branch Association

More information

Improving Clinical Outcomes in Fungal Infection Control and Management

Improving Clinical Outcomes in Fungal Infection Control and Management Improving Clinical Outcomes in Fungal Infection Control and Management DISCLAIMER The information within this CME/CE activity is for continuing education purposes only, and is not intended to substitute

More information

Antifungal Treatment in Neonates

Antifungal Treatment in Neonates Antifungal Treatment in Neonates Irja Lutsar University of Tartu, Estonia Lisbon, 12. October 2015 Prevalence of invasive fungal infections in NeoINN database 2005-2014 UK; 2012-2014 Estonia & Greece 1

More information

Micafungin, a new Echinocandin: Pediatric Development

Micafungin, a new Echinocandin: Pediatric Development Micafungin, a new Echinocandin: Pediatric Development Andreas H. Groll, M.D. Infectious Disease Research Program Center for Bone Marrow Transplantation and Department of Pediatric Hematology/Oncology University

More information

Dr Kaniz Fatema. FCPS (Medicine), MD (Critical Care Medicine) Associate Professor Dept of Critical Care Medicine BIRDEM General Hospital

Dr Kaniz Fatema. FCPS (Medicine), MD (Critical Care Medicine) Associate Professor Dept of Critical Care Medicine BIRDEM General Hospital Dr Kaniz Fatema FCPS (Medicine), MD (Critical Care Medicine) Associate Professor Dept of Critical Care Medicine BIRDEM General Hospital 65-years old lady HTN (15 yrs) Adult Still s Disease (2 mon)

More information

Antifungal drugs Dr. Raz Muhammed

Antifungal drugs Dr. Raz Muhammed Antifungal drugs 13. 12. 2018 Dr. Raz Muhammed 2. Flucytosine (5-FC) Is fungistatic Is a synthetic pyrimidine antimetabolite Is often used in combination with amphotericin B in the treatment of systemic

More information

The EMPIRICUS trial the final nail in the coffin of empirical antifungal therapy in the intensive care unit?

The EMPIRICUS trial the final nail in the coffin of empirical antifungal therapy in the intensive care unit? Editorial The EMPIRICUS trial the final nail in the coffin of empirical antifungal therapy in the intensive care unit? Michael Osthoff 1,2, Nina Khanna 1,2, Martin Siegemund 3 1 Division of Infectious

More information

How Can We Prevent Invasive Fungal Disease?

How Can We Prevent Invasive Fungal Disease? How Can We Prevent Invasive Fungal Disease? Chris Kibbler Professor of Medical Microbiology University College London And Royal Free Hospital, London, UK Invasive Aspergillosis 2 - Acquisition Preventive

More information

Voriconazole. Voriconazole VRCZ ITCZ

Voriconazole. Voriconazole VRCZ ITCZ 7 7 8 7 8 fluconazole itraconazole in vitro in vivo Candida spp. C. glabrata C. krusei Cryptococcus neoformans in vitro Aspergillus spp. in vitro in vivo Aspergillus fumigatus Candida albicans C. krusei

More information

PROGRESSI NELLA TERAPIA ANTIFUNGINA. A tribute to Piero Martino

PROGRESSI NELLA TERAPIA ANTIFUNGINA. A tribute to Piero Martino PROGRESSI NELLA TERAPIA ANTIFUNGINA A tribute to Piero Martino 1946-2007 ITALIAN ICONS IERI, OGGI, E DOMANI IERI, OGGI, E DOMANI IERI, OGGI, E DOMANI 1961 CAUSES OF DEATH IN PATIENTS WITH MALIGNANCIES

More information

Evidence-Based Approaches to the Safe and Effective Management of Invasive Fungal Infections. Presenter. Disclosures

Evidence-Based Approaches to the Safe and Effective Management of Invasive Fungal Infections. Presenter. Disclosures Evidence-Based Approaches to the Safe and Effective Management of Invasive Fungal Infections Presenter James S. Lewis II, PharmD, FIDSA ID Clinical Pharmacy Coordinator Oregon Health and Science University

More information

Current Options in Antifungal Pharmacotherapy

Current Options in Antifungal Pharmacotherapy Current Options in Antifungal Pharmacotherapy John Mohr, Pharm.D., Melissa Johnson, Pharm.D., Travis Cooper, Pharm.D., James S. Lewis, II, Pharm.D., and Luis Ostrosky-Zeichner, M.D. Infections caused by

More information

ECMM Excellence Centers Quality Audit

ECMM Excellence Centers Quality Audit ECMM Excellence Centers Quality Audit Person in charge: Department: Head of Department: Laboratory is accredited according to ISO 15189 (Medical Laboratories Requirements for quality and competence) Inspected

More information

Management Strategies For Invasive Mycoses: An MD Anderson Perspective

Management Strategies For Invasive Mycoses: An MD Anderson Perspective Management Strategies For Invasive Mycoses: An MD Anderson Perspective Dimitrios P. Kontoyiannis, MD, ScD, FACP, FIDSA Professor of Medicine Director of Mycology Research Program M. D. Anderson Cancer

More information

What have we learned about systemic antifungals currently available on the market?

What have we learned about systemic antifungals currently available on the market? 2nd ECMM/CEMM Workshop Milano, September 25, 2010 What have we learned about systemic antifungals currently available on the market? Prof. Dr. Georg Maschmeyer Dept. of Hematology, Oncology & Palliative

More information

Fungal Infection Pre-Infusion Data

Fungal Infection Pre-Infusion Data Fungal Infection Pre-Infusion Data Registry Use Only Sequence Number: Date Received: CIBMTR Center Number: Event date: / / CIBMTR Form 2046 revision 5 (page 1 of 5). Last Updated May, 2018. Infection Episode

More information

Received 4 August 2010/Returned for modification 23 October 2010/Accepted 19 November 2010

Received 4 August 2010/Returned for modification 23 October 2010/Accepted 19 November 2010 ANTIMICROBIAL AGENTS AND CHEMOTHERAPY, Feb. 2011, p. 561 566 Vol. 55, No. 2 0066-4804/11/$12.00 doi:10.1128/aac.01079-10 Copyright 2011, American Society for Microbiology. All Rights Reserved. Candida

More information

Prophylaxis, Empirical, Pre-emptive Therapy of Aspergillosis in Hematological Patients: Which Strategy?

Prophylaxis, Empirical, Pre-emptive Therapy of Aspergillosis in Hematological Patients: Which Strategy? TIMM-4 18-21 October 2009 Athens, Greece Prophylaxis, Empirical, Pre-emptive Therapy of Aspergillosis in Hematological Patients: Which Strategy? www.ichs.org Georg Maschmeyer Dept. of Hematology, Oncology

More information

amphotericin B empiric therapy; preemptive therapy presumptive therapy Preemptive therapy Presumptive therapy ET targeted therapy ET

amphotericin B empiric therapy; preemptive therapy presumptive therapy Preemptive therapy Presumptive therapy ET targeted therapy ET 4 17 9 27 17 1 7 amphotericin B 34 empiric therapy; ET preemptive therapy presumptive therapy Preemptive therapy Presumptive therapy ET targeted therapy ET Key words: antifungal therapyempiric therapypreemptive

More information

Fungal update. Liise-anne Pirofski, M.D. Albert Einstein College of Medicine

Fungal update. Liise-anne Pirofski, M.D. Albert Einstein College of Medicine Liise-anne Pirofski, M.D. Albert Einstein College of Medicine Fungal update http://clicks.robertgenn.com/miss-potter.php http://letterfromhere.blogspot.com/2007/06/beatrix-potters-jog-trot-through.html

More information

The incidence of invasive fungal infections

The incidence of invasive fungal infections AN EPIDEMIOLOGIC UPDATE ON INVASIVE FUNGAL INFECTIONS * Michael A. Pfaller, MD ABSTRACT *Based on a presentation given by Dr Pfaller at a symposium held in conjunction with the 43rd Interscience Conference

More information

ESCMID Online Lecture Library. by author. Salvage Therapy of Invasive Aspergillosis Refractory to Primary Treatment with Voriconazole

ESCMID Online Lecture Library. by author. Salvage Therapy of Invasive Aspergillosis Refractory to Primary Treatment with Voriconazole Salvage Therapy of Invasive Aspergillosis Refractory to Primary Treatment with Voriconazole J.A. Maertens, hematologist, MD, PhD University Hospital Gasthuisberg Leuven, Belgium Current guidelines: first-line

More information

1 Guidelines for the Management of Candidaemia

1 Guidelines for the Management of Candidaemia 1 Guidelines for the Management of Candidaemia LIVERPOOL CLINICAL LABORATORIES GUIDELINE FOR THE MANAGEMENT OF CANDIDAEMIA IN NON-NEUTROPENIC ADULT PATIENTS AND PROPHYLAXIS/PRE-EMPTIVE TREATMENT IN HIGH

More information

Invasive Fungal Infections in Critically Ill Patients. Dr Ravinder Kaur Director Professor&HOD Department of Microbiology,LHMC

Invasive Fungal Infections in Critically Ill Patients. Dr Ravinder Kaur Director Professor&HOD Department of Microbiology,LHMC Invasive Fungal Infections in Critically Ill Patients Dr Ravinder Kaur Director Professor&HOD Department of Microbiology,LHMC Invasive fungal infections(ifis) Major causes of morbidity and mortality in

More information

When is failure failure?

When is failure failure? When is failure failure? Bart-Jan Kullberg, M.D. Radboud University Nijmegen The Netherlands The ICU patient with candidemia!! Female, 39 years old!! Multiple abdominal surgeries for Crohn's disease!!

More information

New Directions in Invasive Fungal Disease: Therapeutic Considerations

New Directions in Invasive Fungal Disease: Therapeutic Considerations New Directions in Invasive Fungal Disease: Therapeutic Considerations Coleman Rotstein, MD, FRCPC, FACP University of Toronto University Health Network Toronto, Ontario Disclosure Statement for Coleman

More information

Update zu EUCAST 2012 Cornelia Lass-Flörl

Update zu EUCAST 2012 Cornelia Lass-Flörl Update zu EUCAST 2012 Cornelia Lass-Flörl Frühjahrstagung 2012 Paul-Ehrlich-Gesellschaft Sektion Antimykotische Chemotherapie Bonn, 4./5. Mai 2012 Agenda 1. Breakpoints 2. Rationale documents and technical

More information

Reducing the antifungal drugs consumption in the ICU

Reducing the antifungal drugs consumption in the ICU Reducing the antifungal drugs consumption in the ICU Philippe Montravers Département d Anesthésie et Réanimation Chirurgicale CHU Bichat Claude Bernard Pole TCAUR, HUPNVS Assistance Publique-Hôpitaux de

More information

Top 5 papers in clinical mycology

Top 5 papers in clinical mycology Top 5 papers in clinical mycology Dirk Vogelaers Department of General Internal Medicine University Hospital Ghent Joint symposium BVIKM/BSIMC and SBMHA/BVMDM Influenza-associated aspergillosis in critically

More information

Antifungal Pharmacotherapy

Antifungal Pharmacotherapy Interpreting Antifungal Susceptibility Testing: Science or Smoke and Mirrors A. W. F O T H E R G I L L, M A, M B A U N I V E R S I T Y O F T E X A S H E A L T H S C I E N C E C E N T E R S A N A N T O

More information

DAYTON CHILDREN S HOSPITAL CLINICAL PRACTICE GUIDELINES

DAYTON CHILDREN S HOSPITAL CLINICAL PRACTICE GUIDELINES DAYTON CHILDREN S HOSPITAL CLINICAL PRACTICE GUIDELINES DISCLAIMER: This Clinical Practice Guideline (CPG) generally describes a recommended course of treatment for patients with the identified health

More information

Updated Guidelines for Management of Candidiasis. Vidya Sankar, DMD, MHS April 6, 2017

Updated Guidelines for Management of Candidiasis. Vidya Sankar, DMD, MHS April 6, 2017 Updated Guidelines for Management of Candidiasis Vidya Sankar, DMD, MHS April 6, 2017 Statement of Disclosure I have no actual or potential conflict of interest in relation to this presentation Outline

More information

Clinical Practice Guidelines for the Management of Candidiasis: 2009 Update by the Infectious Diseases Society of America

Clinical Practice Guidelines for the Management of Candidiasis: 2009 Update by the Infectious Diseases Society of America IDSA GUIDELINES Clinical Practice Guidelines for the Management of Candidiasis: 2009 Update by the Infectious Diseases Society of America Peter G. Pappas, 1 Carol A. Kauffman, 2 David Andes, 4 Daniel K.

More information

We are IntechOpen, the world s leading publisher of Open Access books Built by scientists, for scientists. International authors and editors

We are IntechOpen, the world s leading publisher of Open Access books Built by scientists, for scientists. International authors and editors We are IntechOpen, the world s leading publisher of Open Access books Built by scientists, for scientists 3,800 116,000 120M Open access books available International authors and editors Downloads Our

More information

Candidemia: New Sentinel Surveillance in the 7-County Metro

Candidemia: New Sentinel Surveillance in the 7-County Metro Candidemia: New Sentinel Surveillance in the 7-County Metro Brittany VonBank, MPH Paula Vagnone, MT (ASCP) 651-201-5414 www.health.state.mn.us Health Care-associated Infections & Antimicrobial Resistance

More information

Common Fungi. Catherine Diamond MD MPH

Common Fungi. Catherine Diamond MD MPH Common Fungi Catherine Diamond MD MPH Birth Month and Day & Last Four Digits of Your Cell Phone # BEFORE: http://tinyurl.com/kvfy3ts AFTER: http://tinyurl.com/lc4dzwr Clinically Common Fungi Yeast Mold

More information

Supplementary Materials to the Manuscript: Polymorphisms in TNF-α Increase Susceptibility to

Supplementary Materials to the Manuscript: Polymorphisms in TNF-α Increase Susceptibility to Supplementary Materials to the Manuscript: Polymorphisms in TNF-α Increase Susceptibility to Intra-abdominal Candida Infection in High Risk Surgical ICU Patients A. Wójtowicz, Ph.D. 1, F. Tissot, M.D.

More information

Antifungal Pharmacodynamics A Strategy to Optimize Efficacy

Antifungal Pharmacodynamics A Strategy to Optimize Efficacy Antifungal Pharmacodynamics A Strategy to Optimize Efficacy David Andes, MD Associate Professor, Department of Medicine Division of Infectious Diseases Medical Microbiology and Immunology University of

More information

ESCMID Online Lecture Library. by author. CASE PRESENTATION ECCMID clinical grand round May Anat Stern, MD Rambam medical center Haifa, Israel

ESCMID Online Lecture Library. by author. CASE PRESENTATION ECCMID clinical grand round May Anat Stern, MD Rambam medical center Haifa, Israel CASE PRESENTATION ECCMID clinical grand round May 2014 Anat Stern, MD Rambam medical center Haifa, Israel An 18 years old Female, from Ukraine, diagnosed with acute lymphoblastic leukemia (ALL) in 2003.

More information

Treatment and Prophylaxis

Treatment and Prophylaxis Treatment and Prophylaxis Andreas H. Groll, M.D. Infectious Disease Research Program Center for Bone Marrow Transplantation and Department of Pediatric Hematology/Oncology University Children s Hospital

More information

Fungal infection in the immunocompromised patient. Dr Kirsty Dodgson

Fungal infection in the immunocompromised patient. Dr Kirsty Dodgson Fungal infection in the immunocompromised patient Dr Kirsty Dodgson Aims Discuss different types of fungi Overview of types of clinical infections Clinical Manifestations Fungus Includes Moulds Aspergillus

More information

Fungal Infections in Neutropenic Hematological Disorders

Fungal Infections in Neutropenic Hematological Disorders Fungal Infections in Neutropenic Hematological Disorders 23 Dr Farah Jijina 24 Fungal Infections in Neutropenic Hematological Disorders 25 Dr Farah Jijina 26 Fungal Infections in Neutropenic Hematological

More information

Candida colonization index and subsequent infection in critically ill surgical patients: 20 years later

Candida colonization index and subsequent infection in critically ill surgical patients: 20 years later Intensive Care Med DOI 10.1007/s00134-014-3355-z MY PAPER 20 YEARS LATER Philippe Eggimann Didier Pittet Candida colonization index and subsequent infection in critically ill surgical patients: 20 years

More information

DAYTON CHILDREN S HOSPITAL CLINICAL PRACTICE GUIDELINES

DAYTON CHILDREN S HOSPITAL CLINICAL PRACTICE GUIDELINES DAYTON CHILDREN S HOSPITAL CLINICAL PRACTICE GUIDELINES DISCLAIMER: This Clinical Practice Guideline (CPG) generally describes a recommended course of treatment for patients with the identified health

More information

Candida sake candidaemia in non-neutropenic critically ill patients: a case series

Candida sake candidaemia in non-neutropenic critically ill patients: a case series Candida sake candidaemia in non-neutropenic critically ill patients: a case series Deven Juneja, Apurba K Borah, Prashant Nasa, Omender Singh, Yash Javeri and Rohit Dang Candidaemia has been shown to be

More information

Neutropenic Sepsis Guideline

Neutropenic Sepsis Guideline Neutropenic Sepsis Guideline Neutropenic Sepsis Guideline - definitions Suspected or proven infection in a neutropenic patient is a MEDICAL EMERGENCY and is an indication for immediate assessment and prompt

More information

Antifungal prophylaxis in haematology patients: the role of voriconazole

Antifungal prophylaxis in haematology patients: the role of voriconazole REVIEW 10.1111/j.1469-0691.2012.03772.x Antifungal prophylaxis in haematology patients: the role of voriconazole Y. Hicheri 1, G. Cook 2 and C. Cordonnier 1 1) Service d Hématologie Clinique, Assistance

More information

I am against to TDM in critically ill patient

I am against to TDM in critically ill patient TDM I am against to TDM in critically ill patient TDM of antifungals: where are we? Dr. Rafael Zaragoza Antifungal therapy in ICU; prophylaxis, pre-emptive and targeted Conflicts of interest: Pfizer Astellas

More information

Optimizing antifungal dosing regimens. Joseph Meletiadis, PhD, FECMM Assistant Professor of Microbiology

Optimizing antifungal dosing regimens. Joseph Meletiadis, PhD, FECMM Assistant Professor of Microbiology ATHENA 2017 International Conference November 28 30, 2017 Optimizing antifungal dosing regimens Joseph Meletiadis, PhD, FECMM Assistant Professor of Microbiology Clinical Microbiology Laboratory, «Attikon»

More information

Outcomes with micafungin in patients with candidaemia or invasive candidiasis due to Candida glabrata and Candida krusei

Outcomes with micafungin in patients with candidaemia or invasive candidiasis due to Candida glabrata and Candida krusei J Antimicrob Chemother 211; 66: 375 3 doi:1.193/jac/dkq446 Advance Access publication 8 December 21 Outcomes with micafungin in patients with candidaemia or invasive candidiasis due to Candida glabrata

More information

Is pre-emptive therapy a realistic approach?

Is pre-emptive therapy a realistic approach? Is pre-emptive therapy a realistic approach? J Peter Donnelly PhD, FRCPath Department of Haematology Radboud University Nijmegen Medical Centre Nijmegen, The Netherlands Is pre-emptive therapy a realistic

More information

TREATMENT STRATEGIES FOR INVASIVE FUNGAL INFECTIONS. Part I: EMPIRICAL THERAPY

TREATMENT STRATEGIES FOR INVASIVE FUNGAL INFECTIONS. Part I: EMPIRICAL THERAPY TREATMENT STRATEGIES FOR INVASIVE FUNGAL INFECTIONS Part I: EMPIRICAL THERAPY CAUSES OF DEATH IN PATIENTS WITH MALIGNANCIES NIJMEGEN, THE NETHERLANDS n = 328 BACTERIAL INFECTION FUNGAL INFECTION 7% 36%

More information

NEW ANTI-INFECTIVE AGENTS IN 2003 : SPECTRUM AND INDICATIONS. 20th Symposium (spring 2003) Thursday May 22nd 2003

NEW ANTI-INFECTIVE AGENTS IN 2003 : SPECTRUM AND INDICATIONS. 20th Symposium (spring 2003) Thursday May 22nd 2003 NEW ANTI-INFECTIVE AGENTS IN 2003 : SPECTRUM AND INDICATINS 20th Symposium (spring 2003) Thursday May 22nd 2003 The slides presented at this meeting are available on this site as "Web slide shows" and

More information

High risk neutropenic patient (anticipated duration > 10 days) Send blood twice weekly for Beta -D Glucan Galactomanan Aspergillus PCR

High risk neutropenic patient (anticipated duration > 10 days) Send blood twice weekly for Beta -D Glucan Galactomanan Aspergillus PCR DERBY TEACHING HOSPITALS NHS FOUNDATION TRUST Prophylaxis, diagnosis and treatment of invasive fungal infections in oncology/haematology patients with prolonged neutropenia. High risk neutropenic patient

More information

HAEMATOLOGY ANTIFUNGAL POLICY

HAEMATOLOGY ANTIFUNGAL POLICY HAEMATOLOGY ANTIFUNGAL POLICY PROPHYLAXIS Primary Prophylaxis Patient Group Patients receiving intensive remissioninduction chemotherapy for Acute Leukaemia (excluding patients receiving vinca alkaloids)

More information

EMPIRICAL PRESCRIBING GUIDELINES FOR SYSTEMIC FUNGAL INFECTIONS IN ADULTS - HH (1)/CL(G)/651/13

EMPIRICAL PRESCRIBING GUIDELINES FOR SYSTEMIC FUNGAL INFECTIONS IN ADULTS - HH (1)/CL(G)/651/13 Hampshire Hospitals NHS Foundation Trust Empirical Antifungal Prescribing Guidelines [INSERT UNIQUE POLICY IDENTIFIER] Due for latest review on January 2015. CHECK THE INTRANET FOR LATEST VERSION EMPIRICAL

More information

National Center for Emerging and Zoonotic Infectious Diseases AR Lab Network Candida Testing

National Center for Emerging and Zoonotic Infectious Diseases AR Lab Network Candida Testing National Center for Emerging and Zoonotic Infectious Diseases AR Lab Network Candida Testing Snigdha Vallabhaneni, MD, MPH Medical Epidemiologist Centers for Disease Control and Prevention Invasive Candidiasis

More information

FKS Mutant Candida glabrata: Risk Factors and Outcomes in Patients With Candidemia

FKS Mutant Candida glabrata: Risk Factors and Outcomes in Patients With Candidemia Clinical Infectious Diseases Advance Access published July 9, 2014 MAJOR ARTICLE FKS Mutant Candida glabrata: Risk Factors and Outcomes in Patients With Candidemia Nicholas D. Beyda, 1 Julie John, 1 Abdullah

More information

9/18/2018. Invasive Candidiasis. AR Lab Network Candida Testing. Most Common Healthcare Associated Bloodstream Infection in the United States?

9/18/2018. Invasive Candidiasis. AR Lab Network Candida Testing. Most Common Healthcare Associated Bloodstream Infection in the United States? National Center for Emerging and Zoonotic Infectious Diseases AR Lab Network Candida Testing Invasive Candidiasis Snigdha Vallabhaneni, MD, MPH Medical Epidemiologist Centers for Disease Control and Prevention

More information