Medical mycology最新文献_第5页

Insights into Pneumocystis jirovecii pneumonia in South Africa (2018-2022). 南非乙氏肺囊虫肺炎（2018-2022）。

IF 2.7 3区医学

Medical mycology Pub Date : 2025-01-25 DOI: 10.1093/mmy/myaf001

Mbali Precious Nkosi, Keegan John Hoog, Michelle Lowe

{"title":"Insights into Pneumocystis jirovecii pneumonia in South Africa (2018-2022).","authors":"Mbali Precious Nkosi, Keegan John Hoog, Michelle Lowe","doi":"10.1093/mmy/myaf001","DOIUrl":"10.1093/mmy/myaf001","url":null,"abstract":"Pneumocystis jirovecii causes P. jirovecii pneumonia (PJP)-a leading opportunistic infection among persons with advanced human immunodeficiency virus. Furthermore, individuals with underlying conditions such as cancer and transplant recipients are susceptible to PJP. Most data on PJP come from other countries, with limited knowledge about its prevalence in Africa. The aim was to describe changes in the proportion of positive PJP tests in South Africa from 2018 to 2022. A 5-year retrospective study was conducted on patients with suspected P. jirovecii, detected by polymerase chain reaction. Data were obtained from the National Health Laboratory Service, where laboratory diagnostics were done as part of routine patient care. Mann-Whitney test and Χ2 tests were used to compare the age, sex, and wards with both the negative and positive results of PJP. From 2018 to 2022, a total of 8110 patients' results were retrieved, and 8059 met the inclusion criteria. The positive test proportions of PJP in South Africa were 32.66%, 29.93%, 34.02%, 24.98%, and 25.78%, respectively. The median age was 35 years, with interquartile range of 24-43 years (P = .002). Female patients had a higher positive test proportion than males (59.39% vs. 38.74%, P < .001). The proportion of positive PJP tests was higher in general wards (48.54%) and intensive care units (18.99%) (P = .012). The epidemiology of PJP in South Africa is similar to that of other countries in some respects but is influenced by unique factors specific to the country. These findings are crucial for public health planning, emphasising the need for targeted PJP prevention strategies considering sex- and age-specific vulnerabilities in South Africa.","PeriodicalId":18586,"journal":{"name":"Medical mycology","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-01-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11761960/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143029117","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Evaluating predictors of ocular complications and mortality in candidemia: Are repeat blood cultures key? 评价念珠菌病眼部并发症和死亡率的预测因素：重复血培养是关键吗？

IF 2.7 3区医学

Medical mycology Pub Date : 2025-01-25 DOI: 10.1093/mmy/myaf010

Hamail Iqbal, Dejan Nikolic, Carlo Foppiano Palacios

{"title":"Evaluating predictors of ocular complications and mortality in candidemia: Are repeat blood cultures key?","authors":"Hamail Iqbal, Dejan Nikolic, Carlo Foppiano Palacios","doi":"10.1093/mmy/myaf010","DOIUrl":"10.1093/mmy/myaf010","url":null,"abstract":"Candidemia can lead to ocular complications, including endophthalmitis and chorioretinitis. Management of candidemia traditionally included ophthalmic exams. However, due to concerns regarding the utility of performing ophthalmic exams in all patients, there is a need for prognostic factors suggestive of ocular complications. We sought to evaluate if positive follow-up blood cultures (FUBC) are associated with ocular involvement in candidemia. We conducted a single-center, retrospective review of candidemia cases at an academic medical center (2017-2022). Data on demographics, risk factors, ophthalmic exams, eye infection, and mortality outcomes were collected. Data was analyzed using descriptive statistics, χ2 tests, and multivariate logistic regression. A total of 238 episodes of candidemia among 199 patients were included. FUBC were obtained for 97% of cases and were positive in 35%. Ophthalmic exams were performed in 82% of cases and identified 10 endophthalmitis and 11 chorioretinitis cases. There was no significant association between positive FUBC and endophthalmitis or chorioretinitis. Ocular infections were associated with presence of any visual symptom (P < .001), Candida albicans (P = .02), C. dubliniensis (P = .003), and length of antifungal regimen (P = .007). Hospital mortality was associated with age (P < .001), C. lusitaniae (P = .056), acquisition of FUBC (P = .03), completion of an ophthalmic exam (P = .046), vasopressor use (P < .001), and length of antifungal regimen (P = .009). While positive FUBC did not correlate with ocular candidiasis, specific Candida species were associated with endophthalmitis and chorioretinitis. C. lusitaniae infections, acquisition of FUBC, and ophthalmic exam were predictors of hospital mortality. Other indications for ophthalmic evaluations and further identification of mortality risk factors need to be investigated.","PeriodicalId":18586,"journal":{"name":"Medical mycology","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-01-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143189904","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Effective detection of azole resistance in Aspergillus fumigatus sensu stricto using a gradient diffusion plastic strip: A comparison of filtered-adjusted vs. unfiltered-unadjusted inocula. 梯度扩散塑料条法检测严格感烟曲霉对唑的抗性：过滤调整与未过滤调整接种物的比较

IF 2.7 3区医学

Medical mycology Pub Date : 2025-01-25 DOI: 10.1093/mmy/myaf011

Julia Serrano-Lobo, Elena Reigadas, Patricia Muñoz, Pilar Escribano, Jesús Guinea

{"title":"Effective detection of azole resistance in Aspergillus fumigatus sensu stricto using a gradient diffusion plastic strip: A comparison of filtered-adjusted vs. unfiltered-unadjusted inocula.","authors":"Julia Serrano-Lobo, Elena Reigadas, Patricia Muñoz, Pilar Escribano, Jesús Guinea","doi":"10.1093/mmy/myaf011","DOIUrl":"10.1093/mmy/myaf011","url":null,"abstract":"Gradient diffusion plastic strips are utilized for azole susceptibility testing against Aspergillus fumigatus in some clinical microbiology laboratories; however, they lack proper validation. We evaluated the performance of this method for detecting azole resistance in A. fumigatus sensu stricto, and we assessed whether skipping filtration and inoculum adjustment of conidial suspensions negatively influenced its performance. A total of 98 A. fumigatus sensu stricto isolates, previously classified as azole-susceptible or resistant, were studied. Azole-resistant isolates had specific cyp51A gene mutations, including TR34-L98H ± S297T-F495I, G54R, TR46-Y121F-T289A, and G448S. Conidial suspensions were prepared following the principles of the E.Def 9.4 method or left unfiltered and unadjusted. Based on minimum inhibitory concentration (MIC) distributions obtained with the gradient diffusion plastic strip using both types of inoculum preparations, cutoff values were proposed to classify isolates as resistant: >1 mg/l for itraconazole and voriconazole and >0.25 mg/l for posaconazole. These cutoffs coincided with EUCAST breakpoints and correctly classified all except one (TR46-Y121F-T289A) isolate. High essential agreement values (95.9%-98%) were obtained, regardless of inoculum preparation. Overall, sensitivity/specificity values of the gradient diffusion plastic strip using the proposed cutoff values for itraconazole (100%/98%), voriconazole (100%/100%), and posaconazole (100%/98%) to screen for azole resistance were not impacted by the inoculum preparation method. Thus, the gradient diffusion plastic strip is a reliable method for screening azole resistance in A. fumigatus isolates using the proposed MIC cutoffs, and inoculum preparation without filtration and adjustment of conidial suspensions did not negatively influence the performance of the method.","PeriodicalId":18586,"journal":{"name":"Medical mycology","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-01-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143256239","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Invasive aspergillosis caused by cryptic species in transplant recipients: A review. 移植受者中隐种引起的侵袭性曲霉病：综述。

IF 2.7 3区医学

Medical mycology Pub Date : 2025-01-25 DOI: 10.1093/mmy/myaf015

Muneyoshi Kimura, Shahid Husain

{"title":"Invasive aspergillosis caused by cryptic species in transplant recipients: A review.","authors":"Muneyoshi Kimura, Shahid Husain","doi":"10.1093/mmy/myaf015","DOIUrl":"10.1093/mmy/myaf015","url":null,"abstract":"The clinical and microbiological characteristics of invasive aspergillosis (IA) caused by cryptic Aspergillus species have not been well-defined in transplant settings. However, IA is among the most common mould infections in solid organ and hematopoietic stem cell transplant recipients. Among 55 causative isolates in the 53 reported cases, Aspergillus calidoustus, A. lentulus, A. tubingensis, and A. udagawae were the four most common causative cryptic Aspergillus species. Newer diagnostic modalities, such as matrix-assisted laser desorption ionization-time of flight mass spectrometry, may help diagnose these cryptic species. Of the 24 cases with detailed clinical information, 13 had antifungal breakthrough infections. The 12-week mortality rates of all 24 cases, 7 cases of A. calidoustus, and 7 cases of A. lentulus were 46%, 43%, and 43%, respectively. Based on antifungal susceptibility profiles obtained from previous studies, an empiric antifungal regimen such as liposomal amphotericin B with or without echinocandin is recommended for A. calidoustus. A combination of an anti-mould azole and liposomal amphotericin B with or without an echinocandin is suggested for A. lentulus and A. udagawae. Additionally, any one of voriconazole, isavuconazole, or posaconazole with or without liposomal amphotericin B with or without an echinocandin is indicated for A. tubingensis. Newer antifungal agents may have more significant activity against Aspergillus cryptic species.","PeriodicalId":18586,"journal":{"name":"Medical mycology","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-01-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143399476","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Drug-resistance genes and antifungal susceptibility of Trichophyton verrucosum variants isolated from bovine skin lesions and farm environments. 牛皮损和农场环境分离的疣状毛癣菌变异的耐药基因和抗真菌敏感性。

IF 2.7 3区医学

Medical mycology Pub Date : 2025-01-25 DOI: 10.1093/mmy/myae124

Han Gyu Lee, Young-Hun Jung, Ara Cho, Yoon Jung Do, Eun-Young Bok, Jae Ku Oem, Tai-Young Hur

{"title":"Drug-resistance genes and antifungal susceptibility of Trichophyton verrucosum variants isolated from bovine skin lesions and farm environments.","authors":"Han Gyu Lee, Young-Hun Jung, Ara Cho, Yoon Jung Do, Eun-Young Bok, Jae Ku Oem, Tai-Young Hur","doi":"10.1093/mmy/myae124","DOIUrl":"10.1093/mmy/myae124","url":null,"abstract":"Trichophyton verrucosum causes a highly contagious disease in bovines and is occasionally transmitted to humans. Azoles are widely used as antifungal drugs in bovines, and act by targeting the ergosterol biosynthesis pathway. However, cases of treatment failure and recurrence of dermatophyte infections have been associated with mutations at the drug target site. Currently, information on T. verrucosum variants is lacking. This study aimed to classify T. verrucosum variants isolated from animals exhibiting clinical symptoms and cattle environments in the Republic of Korea based on their antifungal susceptibility and the presence or absence of ergosterol biosynthesis (ERG) and subtilisin genes. Of 139 clinical and 39 environmental samples, 86 and 21 were found to be infected, respectively. The positivity rate of calves aged 1-6 months was 73.1%, which was significantly higher than that of calves aged >6 months (55.2%). Twenty-seven T. verrucosum strains were identified as T. album (n = 9), T. ochraceum (n = 6), and T. discoides (n = 12). Antifungal susceptibility testing showed that enilconazole had the lowest geometric mean antifungal activity of 1.08, 1, and 0.94 µg/ml against T. album, T. ochraceum, and T. discoides, respectively. The detection ratios of ERG3 and ERG6 differed significantly among the three variants. In conclusion, our study suggests conducting sample cultures and antifungal susceptibility tests on isolates before administering antifungal drugs. Moreover, the expression profile of ERG appears to have a potential link to drug susceptibility. This information may contribute to the prevention and management of dermatophytosis in cattle.","PeriodicalId":18586,"journal":{"name":"Medical mycology","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-01-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143123370","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Genomic investigation of an antifungal-resistant Aspergillus fumigatus outbreak in a French hospital. 法国一家医院抗真菌耐药烟曲霉爆发的基因组调查。

IF 2.7 3区医学

Medical mycology Pub Date : 2025-01-25 DOI: 10.1093/mmy/myaf012

Valentin Joste, Maëlys Delouis, Abdelmounaim Mouhajir, Stuti Gera Denis-Petit, Pierre Moënne-Locoz, Solen Kernéis, Sandrine Houzé, Christine Bonnal, Romain Coppée

{"title":"Genomic investigation of an antifungal-resistant Aspergillus fumigatus outbreak in a French hospital.","authors":"Valentin Joste, Maëlys Delouis, Abdelmounaim Mouhajir, Stuti Gera Denis-Petit, Pierre Moënne-Locoz, Solen Kernéis, Sandrine Houzé, Christine Bonnal, Romain Coppée","doi":"10.1093/mmy/myaf012","DOIUrl":"10.1093/mmy/myaf012","url":null,"abstract":"Aspergillus fumigatus is associated with various invasive, chronic, and allergic fungal diseases. The emergence of environmental azole-resistant strains complicates the treatment of these infections. The use of whole-genome sequencing (WGS), which is widely used to study bacterial and viral outbreaks, could be beneficial for characterizing azole-resistant A. fumigatus outbreaks. Here, nine azole-resistant cyp51A TR34/L98H A. fumigatus strains isolated during an outbreak in a French hospital between November 2021 and October 2022 were studied. The genetic relatedness of these strains was assessed using microsatellites, high-quality single-nucleotide polymorphisms (SNPs) from WGS data, phylogenetic reconstruction, and principal component analysis. Multiple sequenced but independently cultured A. fumigatus strains were used as identical strain controls. Among the nine unrelated patients infected by TR34/L98H A. fumigatus, five had previously isolated A. fumigatus strains without the cyp51A TR34/L98H mutation. Both microsatellites and WGS confirmed that the initial cyp51A wild-type strains for these five patients were genetically different from the new mutant strains. Eight of the nine TR34/L98H strains were genetically close, with a number of SNPs similar to the controls. These resistant strains were not related to four environmental strains isolated in the hospital. Altogether, the results suggest that at least eight patients were exposed to a common source, although its exact origin could not be determined. The presence of antifungal-resistant strains in healthcare settings underscores the need for active research into resistant strains and that both microsatellites and WGS techniques have their place in the management of A. fumigatus epidemics.","PeriodicalId":18586,"journal":{"name":"Medical mycology","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-01-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143382882","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Aspergillus spp., aspergillosis and azole usage in animal species in Europe: Results from a multisectoral survey and review of recent literature. 曲霉，曲霉病和唑在欧洲动物物种中的使用：来自多部门调查和最近文献综述的结果。

IF 2.7 3区医学

Medical mycology Pub Date : 2025-01-25 DOI: 10.1093/mmy/myaf009

Judith E de Jong, Annet E Heuvelink, Lucía Dieste Pérez, Manon M C Holstege

{"title":"Aspergillus spp., aspergillosis and azole usage in animal species in Europe: Results from a multisectoral survey and review of recent literature.","authors":"Judith E de Jong, Annet E Heuvelink, Lucía Dieste Pérez, Manon M C Holstege","doi":"10.1093/mmy/myaf009","DOIUrl":"10.1093/mmy/myaf009","url":null,"abstract":"Aspergillosis in humans and animals is caused by certain Aspergillus spp. and can be treated with fungicide azoles. Treatment in animals is often long and complicated by the lack of registered products, species-specific pharmacodynamics, side effects, and withdrawal periods for animal products. The emergence of azole resistance in Aspergillus spp. isolates from human, environmental, and avian samples is alarming, requiring multisectoral attention and a One Health approach. Recent information on the prevalence and impact of aspergillosis in animals, and the use of fungicide azoles in their treatment is however lacking. In this study, we collected and analysed data on the occurrence of aspergillosis and/or presence of Aspergillus spp., and the use of fungicide azoles in animal categories in Europe over the last decade, by means of an international survey and literature review. Thirty-three survey responses were included, from respondents with various professional backgrounds. Fifty-eight articles were included for literature review, of which 90% contained information on the presence of Aspergillus spp. in diseased or healthy animals and 38% on the veterinary use of azoles. Results were consistent: the presence of Aspergillus spp. and related disease, and the use of fungicide azoles were most frequently reported in 'companion animals' and 'zoo animals and wildlife'. Considering the limitations in interpreting the obtained results and the lack of available data, more consistent data collection is necessary to accurately estimate the importance of Aspergillus spp. and related diseases, the use of azoles in veterinary medicine, and its relevance in public health.","PeriodicalId":18586,"journal":{"name":"Medical mycology","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-01-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11835019/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143075162","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

The profound effect of diabetes mellitus control on outcomes of coccidioidomycosis. 糖尿病控制对球孢子菌病预后的深远影响。

IF 2.7 3区医学

Medical mycology Pub Date : 2025-01-25 DOI: 10.1093/mmy/myaf004

Rawan El Kurdi, Alyssa McGary, Matthew R Buras, Patricia M Verona, Curtiss B Cook, Janis E Blair

{"title":"The profound effect of diabetes mellitus control on outcomes of coccidioidomycosis.","authors":"Rawan El Kurdi, Alyssa McGary, Matthew R Buras, Patricia M Verona, Curtiss B Cook, Janis E Blair","doi":"10.1093/mmy/myaf004","DOIUrl":"10.1093/mmy/myaf004","url":null,"abstract":"Coccidioidomycosis is an endemic fungal infection caused by the soil-dwelling Coccidioides. One prior study showed that persons with diabetes mellitus (DM) with elevated glucose at the time of coccidioidomycosis had poorer coccidioidal outcomes compared to persons without DM. We aimed to assess the association between hemoglobin A1C (A1C) and outcomes among persons with coccidioidomycosis and coexisting DM. We conducted a retrospective case-control study of patients with DM (cases) and without DM (controls) with coccidioidomycosis to assess the effect of glycemic control on outcomes in patients with DM. From January 1, 2017, to October 13, 2022, we identified 138 DM patients with coccidioidomycosis and compared them with 283 non-DM control patients with coccidioidomycosis. Compared with controls, cases were more likely to require hospitalization (OR 1.20, P < .001), have a lung cavity (OR 1.36, P < .001) and cavitary complications (OR 1.09, P = .001), require surgical management (OR 1.07, P = .016), and experience relapsed infection (OR 1.09, P = .041). Among the cases, when baseline A1C was assessed as a continuous variable, each 1-unit increase of A1C had a significant effect on coccidioidomycosis-related hospitalizations (A1C OR 1.59, P = .005) and the presence of cavities (OR 1.42, P = .01). Controlling for Charlson Comorbidity Index did not change the significance of A1C influence on outcomes of hospitalization and lung cavities. DM patients with A1C levels ≤8.0 at presentation did not have increased adverse coccidioidomycosis outcomes. In summary, glycemic control profoundly impacts the outcomes of diabetic patients with coccidioidomycosis.","PeriodicalId":18586,"journal":{"name":"Medical mycology","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-01-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143052865","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Impact of an institutional antifungal stewardship program on antifungal usage and outcomes in patients with invasive fungal infections. 机构抗真菌管理计划对侵袭性真菌感染患者抗真菌使用和预后的影响。

IF 2.7 3区医学

Medical mycology Pub Date : 2025-01-25 DOI: 10.1093/mmy/myaf003

Janya Sachdev, Sudesh Gourav, Immaculata Xess, Manish Soneja, Sryla Punjadath, Vijaydeep Siddharth, Mragnayani Pandey, Sonakshi Gupta, Aish Manhas, Bhaskar Rana, Kavi Priya Appasami, Gagandeep Singh

{"title":"Impact of an institutional antifungal stewardship program on antifungal usage and outcomes in patients with invasive fungal infections.","authors":"Janya Sachdev, Sudesh Gourav, Immaculata Xess, Manish Soneja, Sryla Punjadath, Vijaydeep Siddharth, Mragnayani Pandey, Sonakshi Gupta, Aish Manhas, Bhaskar Rana, Kavi Priya Appasami, Gagandeep Singh","doi":"10.1093/mmy/myaf003","DOIUrl":"10.1093/mmy/myaf003","url":null,"abstract":"Therapeutic and prophylactic use of antifungals is rising continuously. However, inadequate awareness of diagnostic and treatment guidelines and limited laboratory modalities lead to inappropriate use. This study assessed the impact of an institutional antifungal stewardship program on antifungal use practices and patient outcomes. In the pre-intervention phase, data was collected regarding antifungal therapy among patients with invasive fungal infections. Appropriateness of antifungal prescription was assessed. In the intervention phase, simple algorithms for diagnosis and management of fungal infections were prepared from international guidelines and incorporated into a booklet for distribution. Monthly training sessions were conducted. New serological and molecular tests and therapeutic drug monitoring were introduced. In the post-intervention phase, an antifungal stewardship team was constituted for clinical advisory on demand and ongoing training. Data regarding antifungal therapy was collected and compared with pre-intervention data. Untreated patients decreased from 25% to 18.9% post-intervention (P = .28). Appropriate antifungal use increased from 72.6% to 77.9% (P = .4) among patients with a single fungal infection, and from 57.1% to 88.5% (P = .04) for at least one infection among those with dual fungal infections. 49 incidents of inappropriate use in various categories were seen among 75 patients receiving antifungals pre-intervention, decreasing to 42 incidents among 94 patients post-intervention (P = .06), particularly evident among patients with dual infections (P = .002). Mortality increased from 51% to 75.86% post-intervention (P = .0001). Overall, the small improvement noticed in antifungal usage pattern can still be considered significant, given the limited study period.","PeriodicalId":18586,"journal":{"name":"Medical mycology","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-01-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143029167","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

A practical approach to investigating nosocomial acquisition of Aspergillus. 一种研究曲霉院内感染的实用方法。

IF 2.7 3区医学

Medical mycology Pub Date : 2025-01-25 DOI: 10.1093/mmy/myaf007

Eelco F J Meijer, Aleksandra Marek, Gordon Ramage, Anuradha Chowdhary, Linda Bagrade, Andreas Voss, Abhijit M Bal

{"title":"A practical approach to investigating nosocomial acquisition of Aspergillus.","authors":"Eelco F J Meijer, Aleksandra Marek, Gordon Ramage, Anuradha Chowdhary, Linda Bagrade, Andreas Voss, Abhijit M Bal","doi":"10.1093/mmy/myaf007","DOIUrl":"10.1093/mmy/myaf007","url":null,"abstract":"Invasive mould disease (IMD) has a high mortality in immunosuppressed patients. Invasive aspergillosis (IA) is the most common IMD. A guideline for preventing IA has been published jointly by the Centers for Disease Control and Prevention, the Infectious Disease Society of America, and the American Society of Blood and Marrow Transplantation. Use of high-efficiency particulate air filters, adequate air exchange rates, sealing of patient rooms, and preventing exposure to moulds by nursing patients in areas away from construction sites are recommended by the guideline. However, there is limited information in relation to the actions to be undertaken by infection prevention and control teams in the event of one or more cases of nosocomial aspergillosis. In this review, we describe a systematic approach to aspergillosis by defining possible and probable nosocomial acquisition based on the number of days since hospital admission. We advocate an incremental response to the investigation of nosocomial aspergillosis in patients in protective isolation taking into account the number of cases and the likelihood of nosocomial origin. For single cases of nosocomial IA, we suggest that infection control investigations should focus on case surveillance and walk-through inspection escalating in a stepwise manner to enhanced case surveillance, verification of environmental controls, environmental monitoring, genotyping of clinical and environmental isolates, and review of antifungal prophylaxis for multiple cases and outbreaks. Where applicable, the construction site should be inspected with the aim to reduce the dispersal of conidia. Surveillance systems need to be strengthened to better understand the epidemiology of IA.","PeriodicalId":18586,"journal":{"name":"Medical mycology","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-01-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143059785","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0