RESUMO
Between February 1994 and November 1998, 56 oncology patients infected with vancomycin-resistant enterococci (VRE) were treated with quinopristin-dalfopristin (Q-D) plus minocycline (MIN). Infections included bacteremia, urinary tract infection, pneumonia, and wound infection. The response rate was 68%, and the most frequent adverse event was arthralgia or myalgia (36%). Q-D-MIN is effective for VRE infection in cancer patients but is associated with a substantial frequency of arthralgia or myalgia.
Assuntos
Antibacterianos/uso terapêutico , Enterococcus/efeitos dos fármacos , Infecções por Bactérias Gram-Positivas/tratamento farmacológico , Imunidade/efeitos dos fármacos , Minociclina/uso terapêutico , Resistência a Vancomicina , Virginiamicina/análogos & derivados , Virginiamicina/uso terapêutico , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Antibacterianos/efeitos adversos , Antineoplásicos/efeitos adversos , Criança , Quimioterapia Combinada , Enterococcus faecalis , Enterococcus faecium , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Minociclina/efeitos adversos , Neoplasias/complicações , Dor/induzido quimicamente , Virginiamicina/efeitos adversosRESUMO
BACKGROUND: Candida krusei is inherently resistant to fluconazole and is emerging as a frequent cause of fungemia in patients with hematologic malignant neoplasms. OBJECTIVE: To determine the risk and prognostic factors associated with C krusei fungemia in comparison with Candida albicans fungemia in patients with cancer. METHODS: Retrospective study of 57 cases of C krusei fungemia occurring at the M. D. Anderson Cancer Center, Houston, Tex, from 1989 to 1996. The C krusei cases were compared with 57 cases of C albicans fungemia with respect to demographics, underlying cancer, Acute Physiology and Chronic Health Evaluation II score, immunosuppression status, chemotherapy, and the use of central venous catheters, as well as fluconazole prophylaxis. RESULTS: At our institution, C krusei accounted for 5% of fungemias during 1989 through 1992 and for 10% during 1993 through 1996. Patients with C krusei fungemia more often had leukemia than patients with C albicans (77% vs 11%; P =.02), whereas catheter-related infections were more common among patients with C albicans fungemia (42% vs 0%; P<.001). Patients with C krusei fungemia had a lower response rate (51% vs 69%; P =.05), largely because they more frequently were neutropenic and had disseminated infection. Mortality related to fungemia was 49% in the cases with C krusei vs 28% in C albicans. Multiple logistic regression analysis showed that persistent neutropenia (P =.02) and septic shock (P =.002) were predictors of poor prognosis. CONCLUSION: In neutropenic patients, C krusei fungemia is associated with high mortality. It should be suspected in patients with leukemia who are receiving fluconazole prophylaxis and should be treated aggressively with an amphotericin B regimen.
Assuntos
Antifúngicos/uso terapêutico , Fungemia/tratamento farmacológico , Fungemia/microbiologia , Neoplasias Hematológicas , Hospedeiro Imunocomprometido , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Anfotericina B/uso terapêutico , Antineoplásicos/efeitos adversos , Candida albicans/efeitos dos fármacos , Estudos de Casos e Controles , Cateterismo Venoso Central/efeitos adversos , Cateteres de Demora/efeitos adversos , Criança , Pré-Escolar , Resistência Microbiana a Medicamentos , Feminino , Fluconazol/uso terapêutico , Fungemia/etiologia , Neoplasias Hematológicas/terapia , Humanos , Imunossupressores/efeitos adversos , Lactente , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Neutropenia/etiologia , Prognóstico , Estudos Retrospectivos , Fatores de Risco , Choque Séptico/etiologia , Resultado do TratamentoRESUMO
From 1988 to 1998, we identified nine patients with Candida guilliermondii fungemia. Four of the five patients with nosocomial infection died, while all of the non-nosocomial cases survived, even though one half of them (2/4) did not receive any treatment Nosocomial C guilliermondii fungemia is often associated with poor outcome despite aggressive antifungal therapy.