Synergistic effect of nikkomycin Z with caspofungin and micafungin against Candida albicans and Candida parapsilosis biofilms.

Antifungal lock therapy has received significant interest in the last few years because the frequently usage of intravascular devices is associated with an increasing number of catheter-related bloodstream infections caused by Candida species. Antifungal combinations with synergistic interaction can be a good choice for antifungal lock therapy; therefore, interactions were examined between two echinocandins (caspofungin and micafungin) and the chitin synthesis inhibitor nikkomycin Z against Candida albicans and C. parapsilosis biofilms. Susceptibility was evaluated using the XTT-based checkerboard microdilution method, while the nature of interactions was assessed by calculating fractional inhibitory concentration indices and using the Bliss independence model. Mathematic-based evaluations were supplemented with fluorescent LIVE/DEAD viability assay. The results obtained by statistical interaction analyses correlated well with the viability assay. The tested echinocandins with nikkomycin Z caused an extended cell death and the structure of the biofilm was sparse compared to the control, especially for C. albicans. The findings support the simultaneous usage of nikkomycin Z and caspofungin or micafungin in alternative therapies such as the antifungal lock therapy. SIGNIFICANCE AND IMPACT OF THE STUDY: Antifungal lock therapy can be a potential therapeutic approach to eradicate the intraluminal Candida biofilms; however, there is no approved lock strategy against fungal species so far. The results of this study provide valuable evidence that nikkomycin Z acts synergistically in combination with caspofungin or micafungin against biofilms. In addition, this synergy was more pronounced for micafungin combined with nikkomycin Z. Therefore, nikkomycin Z can be considered as a potential agent in antifungal lock therapy especially with micafungin against C. albicans or C. parapsilosis biofilms.

Activity of exogenous tyrosol in combination with caspofungin and micafungin against Candida parapsilosis sessile cells.

AIMS: Fungal quorum-sensing molecules may have an inhibitory effect as adjuvant against Candida biofilms. Therefore, in vitro activity of caspofungin and micafungin was evaluated against Candida parapsilosis biofilms in the presence of tyrosol. METHODS AND RESULTS: Interactions were assessed using fractional inhibitory concentration index (FICI) determination, metabolic activity-based time-kill experiments and scanning electron microscopy (SEM). Tyrosol caused 1-16-fold and 2-32-fold decrease in median caspofungin and micafungin MICs respectively. Based on FICI, synergy was observed in isolates 27001 and 17820 with caspofungin and 27001 with micafungin. In time-kill experiments, the metabolic activity reduction was higher for micafungin compared to caspofungin at 24 h especially when used in 64 and 256 mg l-1 concentrations. In the case of micafungin, the 256 mg l-1  + 1 mmol l-1 combination caused significantly higher decrease in metabolic activity compared to the corresponding concentration alone (256 mg l-1 ) at 24 h (P < 0·05). SEM confirmed the higher killing effect of tested echinocandins with tyrosol. CONCLUSIONS: Considerable metabolic activity reduction and cell damage was detected for combinations especially in the case of micafungin. SIGNIFICANCE AND IMPACT OF THE STUDY: Our findings support the development of new alternative therapeutic strategies against C. parapsilosis biofilms.

[Acute venous liver circulatory disorder caused by blunt abdominal trauma: is it a compartment syndrome?]. / Akut venöse Leberkreislaufstörung verursacht von stumpfem Bauchtrauma: handelt es sich um ein Kompartmentsyndrom?

Authors describe the case of a 37-year-old female patient who had been operated on for a subcapsular haematoma of the liver that had developed following a blunt abdominal trauma. This manifested as a Budd-Chiari syndrome-like phenomenon that was not recognized until an exploratory operation was performed, when we found that the liver was hard and dark purple in colour and there was considerable ascites in the abdominal cavity. After aspiration of the haematoma, which contained about 1 l of a mixture of fluid and clotted blood, the circulation of the liver rapidly improved. On the basis of the findings, a posttraumatic Budd-Chiari syndrome seems unlikely, since the symptoms caused by the rise in intracapsular pressure are similar to those of a compartment syndrome. No literature data can be found to define such a posttraumatic failure of the liver circulation. Subcapsular and intrahepatic haematomata can be successfully monitored by ultrasonography and managed conservatively if they are asymptomatic. Operation is restricted to lesions with worsening symptoms or increasing danger of haemorrhage.

[Ruptured retroperitoneal bile duct cyst. An extremely rare injury after blunt abdominal trauma]. / Rupturierte retroperitoneale Gallengangszyste. Eine extrem seltene Verletzung nach stumpfem Bauchtrauma.

Management of a retroperitoneal extrahepatic bile duct cystenteric tear at a cystenteric malformation of the intra- and extrahepatic ducts (Todani IV-A) discovered during an emergency surgical procedure following an accident is presented and the problems associated with bile duct cysts are discussed. It is pointed out that acute treatment with a simple and safe method (external Kehr-T drainage) can be successful when injuries are present, although most trauma surgeon are seldom, and many never, directly confronted with injuries attributable to these extremely rare malformations.