A prospective survey of Aspergillus spp. in respiratory tract samples: Species identification and susceptibility patterns.

We analyzed the species distribution and susceptibility patterns of 433 strains of Aspergillus spp. isolated from respiratory samples of 419 in-patients included in multicenter prospective study (FUNGAE-IFI) between July 2014 and October 2015. Identification was carried out by conventional methods at each participating center and by molecular sequencing of a portion of the ß-tubulin gene at one of the centers. In vitro susceptibility was evaluated by broth microdilution methods and using the E-test (for cryptic species). Species identified included 249 A. fumigatus sensu stricto, 60 A. terreus sensu stricto, 47 A. flavus sensu stricto, 44 A. tubingensis, 18 A. niger sensu stricto , five A. nidulans sensu stricto, three A. tamarii, two A. calidoustus, two A. carneus, one A. acuelatus, one A. carbonarius, and one A. sydowii. Cryptic species were found in 12.5% of isolates (n = 54). The frequency of non-wild-type isolates for amphotericin B was 3.4% (n = 15) of the isolates tested and for azoles 3% (n = 10). None of the Aspergillus spp. were non-wild type to echinocandins. Of the 54 cryptic species only two strains were non-wild-type strains by microdilution method (3.7%) (two A. tubingensis, one to amphotericin B and another one to voriconazole) and by E-test method five strains of A. tubingensis showed high minimal inhibitory concentration (MIC) to amphotericin B (11.4%) and five to azoles (12.1%), one A. calidoustus strain showed high MICs for three azoles (50%), A. carneus to itraconazole (100%) and A. sydowii to amphotericin B and itraconazole (100%). These results provide relevant information on susceptibility patterns, frequency, and epidemiology of species involved in respiratory tract samples and of the incidence of recently described cryptic species.

A new design for the review and appraisal of semi-solid dosage forms: Semi-solid Control Diagram (SSCD).

The Semi-solid Control Diagram (SSCD) is a new tool designed for the study of different excipients and different semi-solid dosage forms. It can be used to review and evaluate different formulations and/or batches and facilitate the selection of one of them that will present the most suitable galenic characteristics for topical application. It is also useful to track stability studies by comparing the diagrams, which allows to measure the impact of subjecting the formulation to different conditions and times to be examined. In this study, the Semi-solid Control Diagram (SSCD) is used as an instrument for studying and evaluating semi-solid pharmaceutical dosage forms, by comparing several different semisolid preparations (lipogels). With these results, the tool is validated and the best formulation has been discriminated from the others.

Factores clínicos asociados a aspergilosis pulmonar invasiva en pacientes con neumopatías crónicas y aislamiento respiratorio de Aspergillus spp / Clinical factors associated with invasive pulmonary aspergillosis in patients with chronic pneumopathies and respiratory isolation of Aspergillus spp

Fundamento y objetivo: Determinar variables clínicas para distinguir colonización de aspergilosis pulmonar invasiva (API) en pacientes con neumopatías crónicas y aislamiento respiratorio de Aspergillus spp. Pacientes y método: Estudio retrospectivo de cohortes donde se incluyeron pacientes con aislamiento respiratorio de Aspergillus spp. durante un período de 10 años. La API se definió mediante los criterios de Bulpa. Para determinar los factores de riesgo de API se recogieron variables clínicas y se realizó un análisis de regresión logística múltiple. Resultados: Se incluyeron 83 pacientes con aislamiento de Aspergillus spp. El 68,7% (n=57) de los pacientes presentaba enfermedad pulmonar respiratoria crónica, el 18% (n=15) fibrosis pulmonar y el 13,3% (n=11) asma bronquial. Veintidós pacientes (26,6%) reunieron criterios de API. El fluconazol (OR 4,49; IC 95% 1,5-13,4; p=0,007), la insuficiencia respiratoria grave (OR 4,64; IC 95% 1,46-14,72; p=0,009) y el tiempo de hospitalización (OR 1,05; IC 95% 1,01-1,1 p=0,006) se asociaron con mayor riesgo de API. Conclusiones: En los pacientes con neumopatías crónicas con aislamiento respiratorio de Aspergillus spp., el uso de fluconazol, la insuficiencia respiratoria grave y el tiempo de hospitalización se asocian con mayor riesgo de que el aislamiento se corresponda con API(AU)

Background and objective: To determine clinical variables to distinguish invasive pulmonary aspergillosis (IPA) from colonization in patients with chronic pneumopathies with positive culture of Aspergillus spp. in respiratory samples. Patients and methods: Retrospective cohort study including patients with respiratory isolations of Aspergillus spp. during a period of 10 years. IPA was evaluated according to the Bulpa criteria. Clinical variables were collected and a multiple logistic regression analysis was carried out. Results: Eighty-three patients with isolation of Aspergillus spp. from respiratory samples were included; 68.7% (n=57) of the patients had chronic obstructive pulmonary disease, 18% (n=15) pulmonary fibrosis and 13.3% (n=11) bronchial asthma. Twenty-two patients (26.6%) had IPA. The use of fluconazole (OR 4.49; CI 95% 1.5-13.4; P=0.007), severe respiratory failure (OR 4.64; CI 95% 1.46-14.72; P=0.009) and hospitalization time (OR 1.05; CI 95% 1.01-1.1; P=0.006) were associated with IPA. Conclusions: Prior use of fluconazole, severe respiratory failure and hospitalization time are associated with IPA in patients with chronic pneumopathies with respiratory isolation of Aspergillus spp(AU)

[Clinical factors associated with invasive pulmonary aspergillosis in patients with chronic pneumopathies and respiratory isolation of Aspergillus spp]. / Factores clínicos asociados a aspergilosis pulmonar invasiva en pacientes con neumopatías crónicas y aislamiento respiratorio de Aspergillus spp.

BACKGROUND AND OBJETIVE: To determine clinical variables to distinguish invasive pulmonary aspergillosis (IPA) from colonization in patients with chronic pneumopathies with positive culture of Aspergillus spp. in respiratory samples. PATIENTS AND METHODS: Retrospective cohort study including patients with respiratory isolations of Aspergillus spp. during a period of 10 years. IPA was evaluated according to the Bulpa criteria. Clinical variables were collected and a multiple logistic regression analysis was carried out. RESULTS: Eighty-three patients with isolation of Aspergillus spp. from respiratory samples were included; 68.7% (n=57) of the patients had chronic obstructive pulmonary disease, 18% (n=15) pulmonary fibrosis and 13.3% (n=11) bronchial asthma. Twenty-two patients (26.6%) had IPA. The use of fluconazole (OR 4.49; CI 95% 1.5-13.4; P=.007), severe respiratory failure (OR 4.64; CI 95% 1.46-14.72; P=.009) and hospitalization time (OR 1.05; CI 95% 1.01-1.1; P=.006) were associated with IPA. CONCLUSIONS: Prior use of fluconazole, severe respiratory failure and hospitalization time are associated with IPA in patients with chronic pneumopathies with respiratory isolation of Aspergillus spp.

Risk factors for pulmonary Aspergillus terreus infection in patients with positive culture for filamentous fungi.

BACKGROUND: Invasive aspergillosis (IA) is a common fungal infection in immunocompromised patients and has a high mortality rate. Among patients with IA, Aspergillus terreus infections have become a growing concern in the past few years. OBJECTIVE: To determine the clinical risk factors for isolation of and respiratory infection by A terreus in patients with culture findings positive for filamentous fungi. METHODS: Cohort study of 505 consecutive isolates of filamentous fungi in 332 patients from one center. A terreus was present in 46 isolates from 40 patients (9.1%). Clinical histories were reviewed to identify the risk factors related to isolation of and infection by A terreus, which were grouped into three categories (ie, host factors, factors related to immunosuppression, and factors related to hospitalization), and were analyzed using a multiple logistic regression model. RESULTS: A total of 192 of 505 isolates studied (38%) were due to invasive respiratory infection. A total of 27 of 46 cultures (58.7%) that were positive for A terreus were due to invasive infection (odds ratio [OR], 2.53; 95% confidence interval [CI], 1.37 to 4.69; p = 0.034). The factors associated with invasive A terreus infection were prophylactic use of amphotericin B aerosols (OR, 27.8; 95% CI, 6.7 to 109.7; p = 0.001) and mechanical ventilation (OR, 3.3; 95% CI, 1.02 to 10.9; p = 0.04). Transplantation was associated with a lower risk of A terreus infection (OR, 0.2; 95% CI, 0.046 to 0.789; p = 0.02). CONCLUSIONS: In patients with culture findings positive for filamentous fungi, the prophylactic use of amphotericin B aerosols and mechanical ventilation are associated with a higher risk of A terreus infections. In these patients, transplantation is associated with a lower risk of isolation and respiratory infection by A terreus.

[Ambulatory anesthesia in Catalonia, Spain]. / Anestesia ambulatoria en Cataluña.

BACKGROUND AND OBJECTIVE: The aim of this arm of the ANESCAT study was to describe the characteristics of ambulatory anesthesia in Catalonia, Spain. PATIENTS AND METHOD: Relevant data was extracted from a survey of anesthetic procedures in 131 public, publicly contracted, and private hospitals on 14 representative days in 2003. RESULTS: Of the estimated 603,189 anesthesias performed, 206,992 (34.32%; 95% confidence interval, 33.3%-35.4%) were on outpatients. The median (10th to 90th percentile) age of patients was 59 (22-80) years and 56.6% were women. The physical status of patients according to the American Society of Anesthesiologists (ASA) classification was ASA I or II for 75.1% of the patient sample. The most common approach to anesthesia was sedation/monitoring (47.7%), followed by regional anesthesia (28.9%). The types of regional anesthesia reported most often were peri- or retrobulbar blocks (50.8% of the regional blocks), followed by spinal anesthesia (22.2%). Anesthesia was required for surgery in 76.5% of the cases and for diagnostic or other nonsurgical procedures in 22%. The individual surgical specialties creating the greatest demand for anesthetic procedures were ophthalmology (39%) and orthopedic and trauma surgery (10.9%). The specific interventions accounting for the largest percentages of anesthetic procedures were cataract extraction (32.3%) and digestive tract endoscopy (16.7%). In 8.2% of the cases, patients did not require a stay in the postanesthetic recovery unit. Private hospitals, facilities with fewer than 250 beds, and those not accredited to provide medical resident training had higher rates of ambulatory anesthesia. CONCLUSIONS: Ambulatory procedures account for approximately a third of the anesthesia workload in Catalonia. Sedation/monitoring and regional anesthesia are the approaches that predominate in this category. Ambulatory anesthesia is applied mainly in ophthalmology and the rate of endoscopic procedures requiring outpatient anesthesia is also high.

Anestesia ambulatoria en Cataluña / Ambulatory anesthesia in Catalonia, Spain

Fundamento y objetivo: Describir las características de la anestesia ambulatoria en Cataluña (España) en 2003. Pacientes y método: Datos referentes a anestesia de la encuesta epidemiológica ANESCAT 2003, basada en los actos anestésicos realizados en 131 hospitales públicos, concertados y privados de Cataluña durante 14 días representativos del año 2003. Resultados: De la estimación de 603.189 anestesias realizadas, 206.992 (34,32%; intervalo de confianza del 95%, 33,3-35,4%) fueron ambulatorias. La edad mediana (percentiles 10-90) de los pacientes fue de 59 (22-80) años y el 56,6% eran mujeres. El 75,1% correspondió a pacientes con clase 1 o 2 de la clasificación de la American Society of Anesthesiologists (ASA). La sedación/vigilancia fue la forma de anestesia más frecuente (47,7%), seguida de la anestesia regional (28,9%); de esta última, las técnicas más utilizadas fueron los bloqueos peri/retrobulbares (un 50,8% de las anestesias regionales), seguidos de la anestesia subaracnoidea (22,2%). El 76,5% de las anestesias se aplicaron para intervenciones quirúrgicas y el 22% para exploraciones o procedimientos no quirúrgicos. Las especialidades quirúrgicas más implicadas fueron la oftalmología (39%) y la cirugía ortopédica y traumatología (10,9%). Los procedimientos más frecuentes fueron la cirugía de cataratas (32,3%) y las endoscopias digestivas (16,7%). El 8,2% de los pacientes no requirió recuperación postanestésica. El índice de anestesias ambulatorias fue superior en hospitales privados, de tamaño inferior a 250 camas y sin docencia de programa de residencia. Conclusiones: La anestesia ambulatoria en Cataluña supone aproximadamente la tercera parte de todas las anestesias, con predominio de la sedación/vigilancia y anestesia regional. Se aplica principalmente a cirugía oftalmológica y tiene una importante tasa de procedimientos endoscópicos

Background and objective: The aim of this arm of the ANESCAT study was to describe the characteristics of ambulatory anesthesia in Catalonia, Spain. Patients and method: Relevant was extracted from a survey of anesthetic procedures in 131 public, publicly contracted, and private hospitals on 14 representative days in 2003. Results: Of the estimated 603,189 anesthesias performed, 206,992 (34.32%; 95% confidence interval, 33.3%-35.4%) were on outpatients. The median (10th to 90th percentile) age of patients was 59 (22-80) years and 56.6% were women. The physical status of patients according to the American Society of Anesthesiologists (ASA) classification was ASA I or II for 75.1% of the patient sample. The most common approach to anesthesia was sedation/monitoring (47.7%), followed by regional anesthesia (28.9%). The types of regional anesthesia reported most often were peri- or retrobulbar blocks (50.8% of the regional blocks), followed by spinal anesthesia (22.2%). Anesthesia was required for surgery in 76.5% of the cases and for diagnostic or other nonsurgical procedures in 22%. The individual surgical specialties creating the greatest demand for anesthetic procedures were ophthalmology (39%) and orthopedic and trauma surgery (10.9%). The specific interventions accounting for the largest percentages of anesthetic procedures were cataract extraction (32.3%) and digestive tract endoscopy (16.7%). In 8.2% of the cases, patients did not require a stay in the postanesthetic recovery unit. Private hospitals, facilities with fewer than 250 beds, and those not accredited to provide medical resident training had higher rates of ambulatory anesthesia. Conclusions: Ambulatory procedures account for approximately a third of the anesthesia workload in Catalonia. Sedation/monitoring and regional anesthesia are the approaches that predominate in this category. Ambulatory anesthesia is applied mainly in ophthalmology and the rate of endoscopic procedures requiring outpatient anesthesia is also high

In vitro activity of voriconazole against Prototheca wickerhamii: comparative evaluation of sensititre and NCCLS M27-A2 methods of detection.

A total of 104 Prototheca wickerhamii isolates and two control strains were tested for susceptibility to voriconazole using the Sensititre YeastOne colorimetric antifungal plate and NCCLS reference method. Voriconazole was highly active against all isolates, with an MIC at which 90% of isolates were inhibited of < or = 0.5 microg/ml. Comparison of MICs obtained with the Sensititre product and the NCCLS method demonstrated agreement (100% +/- 2 log2 dilutions) between the two methods. Voriconazole may offer an option for the treatment of Prototheca sp. infections, and its efficacy should be established through clinical experience.

Susceptibility of filamentous fungi to voriconazole tested by two microdilution methods.

The growing number of fungal infections, coupled with emerging resistance to classical antifungal agents, has led to the development of new agents, among them voriconazole. Susceptibility to voriconazole was tested by two microdilution techniques: the National Committee for Clinical Laboratory Standards reference method M38-A and a colorimetric method, Sensititre YeastOne. The study tested a total of 244 isolates: 223 Aspergillus (136 Aspergillus fumigatus, 37 A. niger, 26 A. terreus, 16 A. flavus, 7 A. nidulans, and 1 A. ustus), 14 Fusarium (8 Fusarium moniliformis, and 6 F. oxysporum), 6 Scedosporium apiospermum, and 1 Rhizomucor pusillus strain and four control strains (Candida parapsilosis ATCC 22019, C. krusei ATCC 6258, A. fumigatus ATCC 204305, and A. flavus ATCC 204304). For all tested species except one F. moniliforme strain and R. pusillus, the MIC, the MIC at which 50% of the isolates are inhibited (MIC(50)), and MIC(90) ranges of

Comparison of two microdilution methods for testing susceptibility of Candida spp. to voriconazole.

The growing number of fungal infections, coupled with emerging resistance to classical antifungal agents, has led to the development of new agents, among them voriconazole. Susceptibility to voriconazole was tested by using two microdilution techniques: the reference method described in National Committee for Clinical Laboratory Standards document M27-A2 and a colorimetric method, Sensititre YeastOne. A total of 272 Candida isolates (132 of Candida albicans, 62 of C. parapsilosis, 33 of Candida glabrata, 21 of C. krusei, 15 of C. tropicalis, and 9 of C. lusitaniae) and two control strains (C. parapsilosis ATCC 22019 and C. krusei ATCC 6258) were tested. There was a high rate of agreement between the two methods used (97 to 100%).

[CHROMAgar Candida with fluconazole: comparison with microdilution techniques]. / CHROMAgar Candida más fluconazol: comparación con técnicas de microdilución.

INTRODUCTION: The increasing incidence of fungal infections and the reported emergence of resistance to antifungal agents call for the development of techniques for in vitro measurement of antifungal susceptibility that will enable prediction of clinical outcome in patients suffering from these infections. METHODS. Susceptibility to fluconazole was tested in 156 clinical yeast isolates (109, Candida albicans; 19, C. parapsilosis; 12, C. glabrata; 11, C. tropicalis; 2, C. krusei; 1, C. pelliculosa; 1, C. lambica, and 1, Saccharomyces cerevisiae) and two control strains (C. krusei ATCC 6258 and C. parapsilosis ATCC 22019) using a simple screening method, CHROMAgar Candida with fluconazole (8 micro g/ml). This method was compared with two broth microdilution techniques: the reference method (NCCLS, document M27-A) and Sensititre(TM) YeastOne. RESULTS: Sensititre(TM) YeastOne showed close agreement with NCCLS M27-A results for all species (C. albicans and non albicans). CHROMAgar Candida with fluconazole (8 micro g/ml) yielded results matching those of the two broth microdilution methods for sensitive strains and strains highly resistant to fluconazole (C. krusei and C. glabrata), but performed less well with strains displaying dose-dependent susceptibility. CONCLUSION: These data suggest that CHROMAgar Candida with fluconazole (8 micro g/ml), appears to be a rapid, simple and sensitive screening method for detection and identification of fluconazole-susceptible and -highly resistant yeasts. However, additional methods should be used to determine whether positive growth in this medium is due to resistant strains (MIC > or = 64 micro g/ml) or to strains displaying dose-dependent susceptibility (MIC 16-32 micro g/ml). The usefulness of CHROMAgar Candida with fluconazole depends on the sample source and the species under study.