Ruhnke M.,Charite - Medical University of Berlin |
Rickerts V.,Goethe University Frankfurt |
Cornely O.A.,University of Cologne |
Buchheidt D.,University of Heidelberg |
And 13 more authors.
Mycoses | Year: 2011
Invasive Candida infections are important causes of morbidity and mortality in immunocompromised and hospitalised patients. This article provides the joint recommendations of the German-speaking Mycological Society (Deutschsprachige Mykologische Gesellschaft, DMyKG) and the Paul-Ehrlich-Society for Chemotherapy (PEG) for diagnosis and treatment of invasive and superficial Candida infections. The recommendations are based on published results of clinical trials, case-series and expert opinion using the evidence criteria set forth by the Infectious Diseases Society of America (IDSA). Key recommendations are summarised here: The cornerstone of diagnosis remains the detection of the organism by culture with identification of the isolate at the species level; in vitro susceptibility testing is mandatory for invasive isolates. Options for initial therapy of candidaemia and other invasive Candida infections in non-granulocytopenic patients include fluconazole or one of the three approved echinocandin compounds; liposomal amphotericin B and voriconazole are secondary alternatives because of their less favourable pharmacological properties. In granulocytopenic patients, an echinocandin or liposomal amphotericin B is recommended as initial therapy based on the fungicidal mode of action. Indwelling central venous catheters serve as a main source of infection independent of the pathogenesis of candidaemia in the individual patients and should be removed whenever feasible. Pre-existing immunosuppressive treatment, particularly by glucocorticosteroids, ought to be discontinued, if feasible, or reduced. The duration of treatment for uncomplicated candidaemia is 14days following the first negative blood culture and resolution of all associated symptoms and findings. Ophthalmoscopy is recommended prior to the discontinuation of antifungal chemotherapy to rule out endophthalmitis or chorioretinitis. Beyond these key recommendations, this article provides detailed recommendations for specific disease entities, for antifungal treatment in paediatric patients as well as a comprehensive discussion of epidemiology, clinical presentation and emerging diagnostic options of invasive and superficial Candida infections. © 2011 Blackwell Verlag GmbH.
Linzenmeier G.,Institute For Med Mikrobiologie |
Neussel H.,Institute For Med Mikrobiologie
Chemotherapie Journal | Year: 2012
217 bacterial strains isolated from pathological material were examined by the agar dilution test for their sensitivity to Trimethoprim, Sulfamethoxazole and a combination of both drugs in the proportion 1:20. 114 of these strains were examined at the same time by the agar diffusion method, using individual and combination discs. The medium was DST agar (Oxoid). In E. coli, Klebsiella-Enterobacter and Proteus a very clearcut synergism of Trimethoprim with Sulfamethoxazole could be demonstrated. By contrast, only a small additive effect was found for P. pyocyanea, Staphylococcus aureus and Enterococci. The values for the minimal inhibitory concentration obtained in the two-dimensional serial dilution test gave a good correlation (r=-0.92) with the size of inhibition zones produced by combination discs containing 1,25 mcg Trimethoprim + 23,75 mcg Sulfamethoxazole. From the calculated regression line and in consideration of a mean serum level of 1,56 mcg/ml Trimethoprim and 31,2 mcg/ml Sulfamethoxazole, it can be stated that strains with inhibition zones of more than 20 mm are "sensitive", those with inhibition zones of 10-20 mm "moderately sensitive". Strains which give smaller inhibition zones or show none should be considered "resistant".