Candida albicans Germ-Tube Antibody: Evaluation of a New Automatic Assay for Diagnosing Invasive Candidiasis in ICU Patients.

Testing for Candida albicans germ-tube antibody IFA IgG assay (CAGTA) is used to detect invasive candidiasis infection. However, most suitable assays lack automation and rapid single-sample testing. The CAGTA assay was adapted in an automatic monotest system (invasive candidiasis [CAGTA] VirClia® IgG monotest (VirClia®), a chemiluminescence assay with ready-to-use reagents that provides a rapid objective result. CAGTA assay was compared with the monotest automatic VirClia® assay in order to establish the diagnostic reliability, accuracy, and usefulness of this method. A prospective study with 361 samples from 179 non-neutropenic critically ill adults patients was conducted, including 21 patients with candidemia, 18 with intra-abdominal candidiasis, 84 with Candida spp. colonization, and 56 with culture-negative samples, as well as samples from ten healthy subjects. Overall agreement between the two assays (CAGTA and VirCLIA) was 85.3%. These assays were compared with the gold-standard method to determine the sensitivity, specificity as well as positive and negative predictive values. In patients with candidemia, values for CAGTA and VirCLIA assays were 76.2 versus 85.7%, 80.3 versus 75.8%, 55.2 versus 52.9%, and 91.4 versus 94.3%, respectively. The corresponding values in patients with intra-abdominal candidiasis were 61.1 versus 66.7%, 80.3 versus 75.8%, 45.8 versus 42.9%, and 88.3 versus 89.3%, respectively. No differences were found according to the species of Candida isolated in culture, except for Candida albicans and C. parapsilosis, for which VirClia® was better than CAGTA. According to these results, the automated VirClia® assay was a reliable, rapid, and very easy to perform technique as tool for the diagnosis invasive candidiasis.

Efficacy and safety of caspofungin in critically ill patients. ProCAS Study

Introducción. Caspofungina es una equinocandina con eficacia probada en candidiasis invasiva (CI) y aspergilosis invasiva (AI). ProCAS es un estudio patrocinado por el Grupo de Trabajo de Enfermedades Infecciosas de la Sociedad Española de Medicina Intensiva Critica Y Unidades Coronarias (Semicyuc), que trata de analizar su efectividad y seguridad en condiciones de práctica clínica habitual en el paciente grave ingresado en UCI. Material y métodos. Estudio observacional, prospectivo y multicéntrico que tiene como objetivo estimar la efectividad clínica y la seguridad del acetato de caspofungina en el tratamiento de CI y de AI en pacientes críticos refractarios o intolerantes al tratamiento antifúngico convencional. La valoración de la efectividad tanto clínica como la microbiológica se realizó al final del tratamiento con caspofungina. Resultados. Se incluyeron 98 pacientes; 62 CI probadas, 25 CI probables y 11 AI probables, procedentes de 24 centros, durante los años 2005 y 2006. El tratamiento con caspofungina se realizó en monoterapia en el 89.8% de los casos y como primera línea en el 54.1%. La respuesta clínica favorable obtenida para CI, CI probable y AI probable fue de 91,9%, 84% y 81.8%, respectivamente. La respuesta microbiológica fue favorable en el 74,6%, 68% y 54.6%, para los casos de CI probada, CI probable y AI probable, respectivamente. No se objetivaron efectos adversos graves. Conclusiones. En condiciones de práctica clínica habitual, caspofungina es eficaz y segura para el tratamiento de infecciones fúngicas invasoras (CI/AI). El perfil de eficacia y seguridad fue similar al observado en los ensayos clínicos publicados(AU)

Introduction. Caspofungin is an echinocandin with proven efficacy in invasive candidiasis (IC) and invasive aspergillosis (IA). ProCAS is a study sponsored by the Working Group of the Infectious Diseases of the Spanish Society of Intensive Care Medicine, which analyzes the effectiveness and safety of caspofungin in routine clinical practice conditions in the critically ill. Methods. A prospective, multicenter, observational study designed to estimate the clinical effectiveness and safety of caspofungin acetate in the treatment of IC and IA in patients refractory to or intolerant of conventional antifungal therapy. The assessment of effectiveness both clinic and the microbiological was carried out at the end of the treatment with caspofungin. Results. We included 98 patients, 62 IC proven, 25 probable and 11 IA probable, from 24 centers during 2005 and 2006. Treatment with caspofungin monotherapy was performed in 89.8% of cases and as first line therapy in 54.1%. The favorable clinical response obtained for IC, probable IC, and probable IA was 91.9, 84, and 81.8%, respectively. The microbiological response was favorable in 74.6, 68, and 54.6% for proven cases of IC, probable IC, and probable IA, respectively. No serious adverse effects were observed. Conclusions. In routine clinical practice conditions, caspofungin is effective and safe for the treatment of invasive fungal infections (IC/IA). The efficacy and safety profile was similar to that observed in published clinical trials(AU)

Efficacy and safety of caspofungin in critically ill patients. ProCAS Study.

INTRODUCTION: Caspofungin is an echinocandin with proven efficacy in invasive candidiasis (IC) and invasive aspergillosis (IA). ProCAS is a study sponsored by the Working Group of the Infectious Diseases of the Spanish Society of Intensive Care Medicine, which analyzes the effectiveness and safety of caspofungin in routine clinical practice conditions in the critically ill. METHODS: A prospective, multicenter, observational study designed to estimate the clinical effectiveness and safety of caspofungin acetate in the treatment of IC and IA in patients refractory to or intolerant of conventional antifungal therapy. The assessment of effectiveness both clinic and the microbiological was carried out at the end of the treatment with caspofungin. RESULTS: We included 98 patients, 62 IC proven, 25 probable and 11 IA probable, from 24 centers during 2005 and 2006. Treatment with caspofungin monotherapy was performed in 89.8% of cases and as first line therapy in 54.1%. The favorable clinical response obtained for IC, probable IC, and probable IA was 91.9, 84, and 81.8%, respectively. The microbiological response was favorable in 74.6, 68, and 54.6% for proven cases of IC, probable IC, and probable IA, respectively. No serious adverse effects were observed. CONCLUSIONS: In routine clinical practice conditions, caspofungin is effective and safe for the treatment of invasive fungal infections (IC/IA). The efficacy and safety profile was similar to that observed in published clinical trials.

Peritonitis candidiásica / Candida peritonitis

Debido a que Candida spp. es un componente de la flora endógena del tubo digestivo, puede formar parte de la etiología de prácticamente cualquier tipo de infección abdominal. Es frecuente, por ello, aislar Candida spp. en las peritonitis secundarias polimicrobianas por dehiscencia de suturas intestinales. En estos casos no hay acuerdo claro acerca de cuando el aislamiento de Candida spp. en drenajes peritoneales representa infección y no colonización. La recomendación general es interpretar que hay infección cuando la muestra en la que se identifica el germen es intraoperatoria o se ha obtenido mediante punción directa de la colección intraabdominal. Cuando se cultiva Candida spp. en las muestras de drenajes tomadas posteriormente es posible que se trate de una simple colonización. Sin embargo, cuando estos cultivos se acompañan de signos de sepsis, el paciente reúne criterios de gravedad o bien se aísla Candida spp. repetidamente, la mayoría de los intensivistas deciden iniciar tratamiento antifúngico. Este tratamiento es similar para candidemias, candidiasis invasivas diseminada y peritonitis candidiásica

Candida spp. is a component of the endogenous flora of the digestive tract and can consequently form part of the etiology of almost any type of abdominal infection. Candida spp. is therefore frequently isolated in polymicrobial secondary peritonitis due to intestinal suture dehiscence. In these cases, there is no clear consensus on when Candida spp. isolation in peritoneal drainage fluid represents infection rather than colonization. The general recommendation is to interpret that there is infection when the sample containing the pathogen is intraoperative or has been obtained directly from the intraabdominal collection. When Candida spp. is cultured in samples from subsequently obtained drainage fluid, colonization is a possibility. However, when these cultures are accompanied by signs of sepsis, the patient shows severity criteria or Candida spp. is repeatedly isolated, most intensivists decide to begin antifungal therapy. This treatment is similar for candidemias, disseminated invasive candidiasis and Candida peritonitis

Consenso para la elaboración del informe de alta hospitalaria en especialidades médicas / Consensus for hospital discharge reports in medical specialities

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Intensive care adult patients with severe respiratory failure caused by Influenza A (H1N1)v in Spain.

INTRODUCTION: Patients with influenza A (H1N1)v infection have developed rapidly progressive lower respiratory tract disease resulting in respiratory failure. We describe the clinical and epidemiologic characteristics of the first 32 persons reported to be admitted to the intensive care unit (ICU) due to influenza A (H1N1)v infection in Spain. METHODS: We used medical chart reviews to collect data on ICU adult patients reported in a standardized form. Influenza A (H1N1)v infection was confirmed in specimens using real-time reverse transcriptase-polymerase-chain-reaction (RT PCR) assay. RESULTS: Illness onset of the 32 patients occurred between 23 June and 31 July, 2009. The median age was 36 years (IQR = 31 - 52). Ten (31.2%) were obese, 2 (6.3%) pregnant and 16 (50%) had pre-existing medical complications. Twenty-nine (90.6%) had primary viral pneumonitis, 2 (6.3%) exacerbation of structural respiratory disease and 1 (3.1%) secondary bacterial pneumonia. Twenty-four patients (75.0%) developed multiorgan dysfunction, 7 (21.9%) received renal replacement techniques and 24 (75.0%) required mechanical ventilation. Six patients died within 28 days, with two additional late deaths. Oseltamivir administration delay ranged from 2 to 8 days after illness onset, 31.2% received high-dose (300 mg/day), and treatment duration ranged from 5 to 10 days (mean 8.0 +/- 3.3). CONCLUSIONS: Over a 5-week period, influenza A (H1N1)v infection led to ICU admission in 32 adult patients, with frequently observed severe hypoxemia and a relatively high case-fatality rate. Clinicians should be aware of pulmonary complications of influenza A (H1N1)v infection, particularly in pregnant and young obese but previously healthy persons.

Uso de los glucocorticoides en el tratamiento del paciente con sepsis grave: ¿otro ejemplo de la ley del péndulo? / Corticosteroids in the treatment of severe sepsis: another example of the swing of the pendulum?

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[Therapeutic efficacy of anidulafungin for the treatment of oesophageal candidiasis, candidemia and invasive candidiasis]. / Utilidad clínica de la anidulafungina en el tratamiento de las candidiasis esofágicas, candidemias y candidiasis invasoras.

Anidulafungin is a new echinocandin that appears to have several advantages over existing antifungals. It is unique because it slowly degrades in humans, undergoing a process of biotransformation rather than being metabolized. It exhibits high in vitro and in vivo activities against Candida spp. and Aspergillus spp. In several clinical studies investigating Candida esophagitis; candidemia and invasive candidiasis, the clinical efficacy of this echinocandin was similar, or even superior, to that of established antifungals in candidemia. Antifungal activity against strains no longer susceptible to conventional antifungal agents, such as fluconazole and amphotericin B suggests that anidulafungin can be used as salvage therapy in life-threatening fungal infections. The limited toxicity profile, minimal drug-drug interactions and the fact that does not require dosage adjustment in subjects with hepatic or renal impairment, establishes this echinocandin as an attractive new option for the treatment of invasive fungal infections.

Utilidad clínica de la anidulafungina en el tratamiento de las candidiasis esofágicas, candidemias y candidiasis invasoras / Therapeutic efficacy of anidulafungin for the treatment of oesophageal candidiasis, candidemia and invasive candidiasis

La anidulafungina es una nueva equinocandina que tiene ventajas respectoa otros antifúngicos. Es la única de su grupo con un metabolismoautobiodegradable. Exhibe una elevada actividad in vitro e in vivo frentea Candida spp. y Aspergillus spp. En diferentes ensayos clínicos se haapreciado que la eficacia de la anidulafungina es similar a la de otrosantifúngicos, e incluso en candidemias es el único superior al comparador alfinal del tratamiento y dos semanas después. La actividad de laanidulafungina frente a cepas resistentes a antifúngicos convencionales leconvierte en un fármaco de primera línea para el tratamiento “de rescate” enestas situaciones. El excelente perfil de seguridad, las limitadas interaccionesque presenta con otros fármacos y el hecho de no requerir ajustes dedosificación en pacientes con fracaso renal o hepático, son factores quehacen de esta equinocandina una nueva y atractiva opción terapéutica eninfecciones fúngicas invasoras(AU)

Anidulafungin is a new echinocandin that appears to have several advantagesover existing antifungals. It is unique because it slowly degrades in humans,undergoing a process of biotransformation rather than being metabolized.It exhibits high in vitro and in vivo activities against Candida spp. andAspergillus spp. In several clinical studies investigating Candida esophagitis;candidemia and invasive candidiasis, the clinical efficacy of this echinocandinwas similar, or even superior, to that of established antifungals in candidemia.Antifungal activity against strains no longer susceptible to conventionalantifungal agents, such as fluconazole and amphotericin B suggests thatanidulafungin can be used as salvage therapy in life-threatening fungalinfections. The limited toxicity profile, minimal drug–drug interactions and thefact that does not require dosage adjustment in subjects with hepatic or renalimpairment, establishes this echinocandin as an attractive new option for thetreatment of invasive fungal infections(AU)