Voriconazole and fluconazole susceptibility of Candida isolates.

An adapted NCCLS M27-A method was used to evaluate the activity of voriconazole (VRC) and fluconazole (FLC) against 295 Candida isolates collected from 189 patients (including isolates from deep sites). Isolates included 186 C. albicans, 54 C. glabrata, 27 C. tropicalis, 14 C. parapsilosis, 6 C. krusei, 6 C. lusitaniae, 1 C. lypolytica and 1 C. sake. Forty-two isolates had reduced susceptibility to FLC (MIC >8 mg/L); 83.3% of these had VRC MICs < or =2 mg/L (9 of 11 C. albicans, 18 of 19 C glabrata, 6 of 6 C. krusei, 2 of 2 C. lusitaniae and 0 of 4 C. tropicalis), including 60% of isolates collected from deep-seated infections. These results suggested that in the era of azole resistance, VRC has a promising antifungal activity for serious infections with Candida spp., including most species with low susceptibility to FLC and uncommonly isolated species.

A comparison of bacteremic pneumococcal pneumonia with nonbacteremic community-acquired pneumonia of any etiology--results from a Canadian multicentre study.

BACKGROUND: Bacteremic pneumococcal pneumonia has not been the subject of a multicentre Canadian Study. OBJECTIVES: To compare bacteremic community-acquired Streptococcus pneumoniae pneumonia with nonbacteremic community-acquired pneumonia of any etiology. METHODS: A prospective cohort study was conducted at 15 centres in eight Canadian provinces from January 1996 to January 1998. RESULTS: Fifty-six of the 450 patients (12.4%) had one or more blood cultures positive for S pneumoniae. Compared with the 394 blood culture-negative patients, the bacteremic patients were younger (55.6 years versus 63.4 years; P=0.002). At presentation, bacteremic patients had a higher mean oral temperature (38.1+/-1.2 degrees C versus 37.7+/-1.2 degrees C; P=0.026), a higher pulse rate (108.4+/-22.1 beats/min versus 102.1+/-20.6 beats/min; P=0.033), a lower diastolic blood pressure reading (66.8+/-12.7 mmHg versus 73.8+/-15.8 mmHg; P=0.001) and a higher percentage of white blood cells that were band forms (22.1% versus 14.2%; P=0.0007). The time from onset of symptoms until admission to hospital was shorter among the bacteremic patients (4.6+/-3.7 days versus 7.0+/-13.9 days; P=0.005). Three capsular polysaccharide types accounted for 53.4% of the isolates: type 14, 29.2%; type 4, 12.1%; and type 22 F, 12.1%. Two of 44 isolates were resistant to penicillin. CONCLUSIONS: While some differences in patient characteristics and presentation occur when patients with bacteremic pneumococcal pneumonia are compared with nonbacteremic patients with community-acquired pneumonia, there is considerable overlap, and clinical presentation does not allow one to distinguish the bacteremic patients from the nonbacteremic patients.

Seroepidemiology of Coxiella burnetii infection and its frequency as a cause of community-acquired pneumonia in Canada.

The present study tested acute and convalescent serum samples from 788 patients hospitalized for community-acquired pneumonia in seven Canadian provinces for antibodies to Coxiella burnetii. One hundred nine patients (13.8%) had antibodies to this microorganism, and seven patients had acute Q fever. Serological evidence of infection with C burnetii was present in patients from all seven provinces. Three of the seven cases of acute Q fever were from Manitoba, suggesting that there may be unrecognized cases of Q fever in this province. In addition, a case of acute Q fever in Newfoundland, where there had previously been no reported cases, was noted, although subsequently, an outbreak of Q fever on goat farms has been reported.

Legionnaires' disease - Results of a multicentre Canadian study.

BACKGROUND: There has never been a cross-Canada surveillance project to determine the rate of Legionella species as a cause of community-acquired pneumonia requiring hospitalization and to determine whether there are any regional differences in the rates of Legionnaires' disease in Canada. Anecdotally, Legionnaires' disease is thought to be uncommon in Western Canada. METHODS: From January, 1996 through to October 31, 1997, a prospective study of the etiology of community acquired pneumonia requiring admission to 15 tertiary care hospitals in eight Canadian provinces was conducted. A urine sample from each patient was tested for Legionella pneumophila serogroup 1 antigen using a commercially available ELISA assay. A culture of sputum or other respiratory specimens for Legionellaceae was carried out at the discretion of the attending physician. Two hundred thirty-four patients had acute and 6-week convalescent serum samples tested for antibodies to L pneumophila serogroups 1 through 6 using an ELISA method. RESULTS: 28 of the 850 patients (3.2%) had Legionnaires' disease; 18 of 823 (2.1%) were positive for L pneumophila serogroup 1 by urinary antigen testing. The rate of Legionnaires' disease, based on urinary antigen, at the Halifax site was higher than that at the other sites (seven of 163 patients versus 11 of 660 [P=0.04]). Of the 28 cases of Legionnaires' disease identified using all methods, 11 of 277 patients (3.9%) were enrolled from Western provinces versus 17 of 573 patients (2.9%) from Eastern provinces (P=nonsignificant). CONCLUSIONS: Legionnaires' disease is just as common in Western as in Eastern Canada. L pneumophila serogroup 1 may be more common in Halifax than at the other sites studied.

A Randomized Trial Assessing the Effectiveness of Ezetimibe in South Asian Canadians with Coronary Artery Disease or Diabetes: The INFINITY Study.

Background. There is a paucity of data regarding the effectiveness and safety of lipid-lowering treatments among South-Asian patients. Methods. Sixty-four South-Asian Canadians with coronary artery disease or diabetes and persistent hypercholesterolemia on statin therapy, were randomized to ezetimibe 10 mg/day co-administered with statin therapy (EZE + Statin) or doubling their current statin dose (STAT(2)). Primary outcome was the proportion of patients achieving target LDL-C (<2.0 mmol/L) after 6 weeks. Secondary outcomes included the change in lipid profile and the incidence of treatment-emergent adverse events through 12 weeks. Exploratory markers for vascular inflammation were assessed at baseline and 12 weeks. Results. At 6 weeks, the primary outcome was significantly higher among the EZE + Statin patients (68% versus 36%; P = 0.031) with an OR (95% CI) of 3.97 (1.19, 13.18) upon accounting for baseline LDL-C and adjusting for age. At 12 weeks, 76% of EZE + Statin patients achieved target LDL-C compared to 48% (P = 0.047) of the STAT(2) patients (adjusted OR (95% CI) = 3.31 (1.01,10.89)). No significant between-group differences in exploratory markers were observed with the exception of CRP. Conclusions. Patients receiving ezetimibe and statin were more likely to achieve target LDL-C after 6 and 12 weeks compared to patients doubling their statin dose. Ezetimibe/statin combination therapy was well tolerated among this cohort of South-Asian Canadians, without safety concerns.