Background: The epidemiology of IFI in patients with hematologic malignancies may vary according ... more Background: The epidemiology of IFI in patients with hematologic malignancies may vary according to geographic region. Methods: In this 18-month survey, all HSCT recipients and patients with acute myeloid leukemia (AML) or myelodyaplasia (MDS) undergoing induction remission from May 2007 have been followed for 1 year (HSCT) or until the end treatment (AML/MDS). Data on demographics, risk factors and clinical features are collected. If an IFI is diagnosed, information is collected regarding diagnosis, treatment and outcome. Radiologic and histopathological material and fungal isolates are sent to the coordinating center, and cases are classified blindly by a data review committee according to the modified EORTC/MSG criteria. Results: Until April 2008 , there are 460 patients in the cohort: 142 AML/MDS and 318 HSCT (autologous 135, allogeneic 183). Fluconazole prophylaxis was given to 87% HSCT and 60% AML/MDS. A total of 52 IFI were diagnosed so far (11%), 48% proven, 12% probable and...
This is part of the series of practice guidelines commissioned by the Brazilian Society for Infec... more This is part of the series of practice guidelines commissioned by the Brazilian Society for Infectious Diseases through its Practice Guidelines Committee. The purpose of these guidelines is to provide assistance to clinicians in the antimicrobial treatment of community-acquired pneumonia (CAP) in immunocompetent adults. Panel members and consultants are experts in adult infectious diseases. The guidelines are evidence based where possible. The recommendations included in this document were elaborated based on the most frequently isolated pathogens and their antimicrobial susceptibilities. The etiology was based mainly on international studies, since there are very few regional data. On the other hand, the antimicrobial susceptibilities of main bacterial causes of CAP were based on the results of several antimicrobial resistance surveillance studies recently performed in Brazil. Other reference guidelines for the treatment of CAP, such as those elaborated by the Infectious Diseases Society of America and by the Canadian Infectious Diseases Society, were also discussed by the group during the elaboration of this document.
A infecção em receptores de transplante de células-tronco hematopoéticas (TCTH) está relacionada ... more A infecção em receptores de transplante de células-tronco hematopoéticas (TCTH) está relacionada a altas taxas de morbidade e mortalidade. O tipo de transplante, a fonte de célula-tronco hematopoética, a utilização de doadores alternativos e outras medidas relacionadas ao ...
Invasive candidosis is increasingly prevalent in seriously ill patients. Our aim was to compare m... more Invasive candidosis is increasingly prevalent in seriously ill patients. Our aim was to compare micafungin with liposomal amphotericin B for the treatment of adult patients with candidaemia or invasive candidosis. We did a double-blind, randomised, multinational non-inferiority study to compare micafungin (100 mg/day) with liposomal amphotericin B (3 mg/kg per day) as first-line treatment of candidaemia and invasive candidosis. The primary endpoint was treatment success, defined as both a clinical and a mycological response at the end of treatment. Primary analyses were done on a per-protocol basis. This trial is registered with ClinicalTrials.gov, number NCT00106288. 264 individuals were randomly assigned to treatment with micafungin; 267 were randomly assigned to receive liposomal amphotericin B. 202 individuals in the micafungin group and 190 in the liposomal amphotericin B group were included in the per-protocol analyses. Treatment success was observed for 181 (89.6%) patients treated with micafungin and 170 (89.5%) patients treated with liposomal amphotericin B. The difference in proportions, after stratification by neutropenic status at baseline, was 0.7% (95% CI -5.3 to 6.7). Efficacy was independent of the Candida spp and primary site of infection, as well as neutropenic status, APACHE II score, and whether a catheter was removed or replaced during the study. There were fewer treatment-related adverse events--including those that were serious or led to treatment discontinuation--with micafungin than there were with liposomal amphotericin B. Micafungin was as effective as--and caused fewer adverse events than--liposomal amphotericin B as first-line treatment of candidaemia and invasive candidosis.
The Brazilian journal of infectious diseases : an official publication of the Brazilian Society of Infectious Diseases, 2008
Community-Acquired Pneumonia (CAP) is a major public health problem. In Brazil it has been estima... more Community-Acquired Pneumonia (CAP) is a major public health problem. In Brazil it has been estimated that 2,000,000 people are affected by CAP every year. Of those, 780,000 are admitted to hospital, and 30,000 have death as the outcome. This is an open-label, non-comparative study with the purpose of evaluating efficacy, safety, and tolerability levels of IV azithromycin (IVA) and IV ceftriaxone (IVC), followed by oral azithromycin (OA) for the treatment of inpatients with mild to severe CAP. Eighty-six patients (mean age 56.6 +/- 19.8) were administered IVA (500 mg/day) and IVC (1g/day) for 2 to 5 days, followed by AO (500 mg/day) to complete a total of 10 days. At the end of treatment (EOT) and after 30 days (End of Study--EOS) the medication was evaluated clinically, microbiologically and for tolerability levels. Out of the total 86-patient population, 62 (72.1%) completed the study. At the end of treatment, 95.2% (CI95: 88.9% - 100%) reported cure or clinical improvement; at the...
Background: The epidemiology of IFI in patients with hematologic malignancies may vary according ... more Background: The epidemiology of IFI in patients with hematologic malignancies may vary according to geographic region. Methods: In this 18-month survey, all HSCT recipients and patients with acute myeloid leukemia (AML) or myelodyaplasia (MDS) undergoing induction remission from May 2007 have been followed for 1 year (HSCT) or until the end treatment (AML/MDS). Data on demographics, risk factors and clinical features are collected. If an IFI is diagnosed, information is collected regarding diagnosis, treatment and outcome. Radiologic and histopathological material and fungal isolates are sent to the coordinating center, and cases are classified blindly by a data review committee according to the modified EORTC/MSG criteria. Results: Until April 2008 , there are 460 patients in the cohort: 142 AML/MDS and 318 HSCT (autologous 135, allogeneic 183). Fluconazole prophylaxis was given to 87% HSCT and 60% AML/MDS. A total of 52 IFI were diagnosed so far (11%), 48% proven, 12% probable and...
This is part of the series of practice guidelines commissioned by the Brazilian Society for Infec... more This is part of the series of practice guidelines commissioned by the Brazilian Society for Infectious Diseases through its Practice Guidelines Committee. The purpose of these guidelines is to provide assistance to clinicians in the antimicrobial treatment of community-acquired pneumonia (CAP) in immunocompetent adults. Panel members and consultants are experts in adult infectious diseases. The guidelines are evidence based where possible. The recommendations included in this document were elaborated based on the most frequently isolated pathogens and their antimicrobial susceptibilities. The etiology was based mainly on international studies, since there are very few regional data. On the other hand, the antimicrobial susceptibilities of main bacterial causes of CAP were based on the results of several antimicrobial resistance surveillance studies recently performed in Brazil. Other reference guidelines for the treatment of CAP, such as those elaborated by the Infectious Diseases Society of America and by the Canadian Infectious Diseases Society, were also discussed by the group during the elaboration of this document.
A infecção em receptores de transplante de células-tronco hematopoéticas (TCTH) está relacionada ... more A infecção em receptores de transplante de células-tronco hematopoéticas (TCTH) está relacionada a altas taxas de morbidade e mortalidade. O tipo de transplante, a fonte de célula-tronco hematopoética, a utilização de doadores alternativos e outras medidas relacionadas ao ...
Invasive candidosis is increasingly prevalent in seriously ill patients. Our aim was to compare m... more Invasive candidosis is increasingly prevalent in seriously ill patients. Our aim was to compare micafungin with liposomal amphotericin B for the treatment of adult patients with candidaemia or invasive candidosis. We did a double-blind, randomised, multinational non-inferiority study to compare micafungin (100 mg/day) with liposomal amphotericin B (3 mg/kg per day) as first-line treatment of candidaemia and invasive candidosis. The primary endpoint was treatment success, defined as both a clinical and a mycological response at the end of treatment. Primary analyses were done on a per-protocol basis. This trial is registered with ClinicalTrials.gov, number NCT00106288. 264 individuals were randomly assigned to treatment with micafungin; 267 were randomly assigned to receive liposomal amphotericin B. 202 individuals in the micafungin group and 190 in the liposomal amphotericin B group were included in the per-protocol analyses. Treatment success was observed for 181 (89.6%) patients treated with micafungin and 170 (89.5%) patients treated with liposomal amphotericin B. The difference in proportions, after stratification by neutropenic status at baseline, was 0.7% (95% CI -5.3 to 6.7). Efficacy was independent of the Candida spp and primary site of infection, as well as neutropenic status, APACHE II score, and whether a catheter was removed or replaced during the study. There were fewer treatment-related adverse events--including those that were serious or led to treatment discontinuation--with micafungin than there were with liposomal amphotericin B. Micafungin was as effective as--and caused fewer adverse events than--liposomal amphotericin B as first-line treatment of candidaemia and invasive candidosis.
The Brazilian journal of infectious diseases : an official publication of the Brazilian Society of Infectious Diseases, 2008
Community-Acquired Pneumonia (CAP) is a major public health problem. In Brazil it has been estima... more Community-Acquired Pneumonia (CAP) is a major public health problem. In Brazil it has been estimated that 2,000,000 people are affected by CAP every year. Of those, 780,000 are admitted to hospital, and 30,000 have death as the outcome. This is an open-label, non-comparative study with the purpose of evaluating efficacy, safety, and tolerability levels of IV azithromycin (IVA) and IV ceftriaxone (IVC), followed by oral azithromycin (OA) for the treatment of inpatients with mild to severe CAP. Eighty-six patients (mean age 56.6 +/- 19.8) were administered IVA (500 mg/day) and IVC (1g/day) for 2 to 5 days, followed by AO (500 mg/day) to complete a total of 10 days. At the end of treatment (EOT) and after 30 days (End of Study--EOS) the medication was evaluated clinically, microbiologically and for tolerability levels. Out of the total 86-patient population, 62 (72.1%) completed the study. At the end of treatment, 95.2% (CI95: 88.9% - 100%) reported cure or clinical improvement; at the...
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