Subject(s)
Anti-Infective Agents/therapeutic use , Bone Marrow Transplantation , Hematologic Neoplasms/drug therapy , Immunosuppressive Agents/therapeutic use , Infection Control/methods , Neutropenia/drug therapy , Bone Marrow Transplantation/immunology , Fever/drug therapy , Fever/etiology , Hematologic Neoplasms/complications , Hematologic Neoplasms/immunology , Humans , Immunocompromised Host , Immunosuppressive Agents/adverse effects , Neutropenia/complications , Neutropenia/immunology , Treatment OutcomeSubject(s)
Anti-Infective Agents/therapeutic use , Bacterial Infections/prevention & control , Mycoses/prevention & control , Transplantation/adverse effects , Virus Diseases/prevention & control , Anti-Infective Agents/administration & dosage , Bacterial Infections/drug therapy , Humans , Mycoses/drug therapy , Risk Factors , Virus Diseases/drug therapySubject(s)
Infections , Opportunistic Infections , Organ Transplantation/adverse effects , Anti-Infective Agents/therapeutic use , Antibiotic Prophylaxis , Humans , Infections/diagnosis , Infections/drug therapy , Infections/etiology , Opportunistic Infections/diagnosis , Opportunistic Infections/drug therapy , Opportunistic Infections/etiology , Opportunistic Infections/prevention & controlSubject(s)
Immunosuppression Therapy , Organ Transplantation , West Nile Fever/transmission , Animals , Chickens , Humans , MetaphorSubject(s)
Bacterial Infections , Cytomegalovirus Infections , Hematopoietic Stem Cell Transplantation/adverse effects , Organ Transplantation/adverse effects , Bacterial Infections/drug therapy , Bacterial Infections/prevention & control , Cytomegalovirus Infections/drug therapy , Cytomegalovirus Infections/prevention & control , Humans , Time FactorsABSTRACT
BACKGROUND: The efficacy of trimethoprim-sulfamethoxazole (TMP/SMX) in the prevention of toxoplasmosis after orthotopic cardiac transplantation has been the subject of some controversy, with many transplant groups preferring to use the combination of pyrimethamine and sulfadiazine. Although effective, this latter regimen does not offer equal protection against other pathogens, such as or. To assess the value of TMP/SMX, we reviewed the experience in our heart transplant patients, all of whom received TMP/SMX (160/800 mg) three times weekly for approximately 8 months after transplantation. METHODS: We report on 417 orthotopic cardiac transplants during a 17-year period. We have 100% one-year patient follow-up after transplantation. Data was collected on pretransplantation donor and recipient anti- serology, immunosuppression, allograft rejection, survival, yearly posttransplantation anti- serology, development of acute toxoplasmosis, and the occurrence of other infections. RESULTS: In this cohort, acute toxoplasmosis developed after transplantation in one case (0.2%). Among the highest risk patients (D+R-) who were treated for at least one episode of rejection, the risk of acute toxoplasmosis was 5% (1 of 22 patients). No change in survival was found between the different anti- IgG serogroups (D-R-, D-R+, D+R-, or D+R+). Anti- IgG seroconversion occurred in eight -seronegative recipients after transplantation; all patients, except the case already noted, were asymptomatic and required no specific anti- therapy. No cases of, or infections were identified. Five proven and two suspected cases of pneumonia were found (only 2 of these 7 patients were receiving TMP/SMX at the time of pneumonia diagnosis). CONCLUSIONS: These data demonstrate that TMP/SMX prophylaxis (160/800 mg) three times per week is effective prophylaxis after orthotopic cardiac transplantation and has prophylactic benefits against other posttransplantation opportunistic pathogens.
Subject(s)
Anti-Infective Agents/administration & dosage , Heart Transplantation , Toxoplasmosis/prevention & control , Trimethoprim, Sulfamethoxazole Drug Combination/administration & dosage , Female , Follow-Up Studies , Humans , Male , Postoperative Complications/drug therapy , Postoperative Complications/mortality , Postoperative Complications/parasitology , Prevalence , Retrospective Studies , Risk Factors , Survival Analysis , Toxoplasmosis/mortalityABSTRACT
BACKGROUND: Invasive fungal infections (IFI), particularly those caused by Aspergillus and other angioinvasive molds, are associated with an excessive mortality despite therapy. METHODS: Voriconazole was prescribed on a compassionate basis to patients with IFI who were intolerant to or who had progressed despite standard therapy. Outcome was determined by protocol-based criteria as established by the consensus definitions (complete response [CR], partial response [PR], stable disease, failure, and intolerance). RESULTS: Forty-five patients were enrolled in a compassionate release program (29 [64%] because of failure of response to standard therapy), between 1998 and 2002. Of the 45 patients enrolled, 35 (78%) had invasive Aspergillus, 3 (7%) had Fusarium, and 2 (4%) had Scedosporium infections. Underlying illnesses were as follows: 13 (29%) solid-organ transplant (SOT), 11 (24%) BMT, and 7 (13%) hematologic malignancy. Site of infection was as follows: 26 (58%) pulmonary, 9 (20%) disseminated, 5 (11%) central nervous system (CNS), and 3 (7%) sinus. Overall response rates were as follows: 9 (20%) CR, 17 (38%) PR, 15 (33%) failure, and 4 (9%) intolerant. Seven of the eight (88%) patients with sinus or CNS disease demonstrated stabilization of the IFI. The median duration of voriconazole therapy was 79 days with 9 (20%) patients receiving over 1 year of therapy. Nine thousand one hundred twenty-eight days of therapy were given with only four serious adverse events in two cases considered possibly or probably drug related. CONCLUSIONS: In this population of severely immunocompromised patients with life-threatening IFI who have failed or were intolerant to standard antifungal therapy, voriconazole demonstrated substantial efficacy and an acceptable level of toxicity.