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Houston, TX, United States

Beyda N.D.,University of Houston | Chuang S.H.,National University of Singapore | Jahangir Alam M.,University of Houston | Shah D.N.,University of Houston | And 3 more authors.
Journal of Antimicrobial Chemotherapy | Year: 2013

Objectives: Candida famata (also known as Debaryomyces hansenii and Torulopsis candida) is a commensal yeast found in cheese, dairy products and the environment. C. famata accounts for 0.2%-2% of invasive candidiasis. The purpose of this study was to provide an overview of the treatment of C. famata bloodstream infections. Methods: The clinical course of two hospitalized patients who developed C. famata fungaemia within 2 weeks of each other was summarized along with available data regarding in vitro susceptibility patterns, genotyping and clinical outcomes of these cases compared with the published literature. Results and conclusions: C. famata appears to exhibit reduced susceptibility to echinocandins and azoles, particularly in the setting of prior antifungal exposure. The removal of indwelling central venous catheters and prompt initiation of therapy with liposomal amphotericin B is recommended for successful treatment of C. famata fungaemia, particularly in immunocompromised patients. These cases also help provide justification for routine antifungal susceptibility testing in patients with candidaemia to guide optimal antifungal therapy. © The Author 2012. Published by Oxford University Press on behalf of the British Society for Antimicrobial Chemotherapy. All rights reserved. Source

Jiang Z.-D.,University of Houston | Ke S.,Baylor College of Medicine | DuPont H.L.,St. Lukes Episcopal Hospital
International Journal of Antimicrobial Agents | Year: 2010

Rifaximin shortens the duration of travellers' diarrhoea without important alteration of colonic flora. This study investigated the expression of virulence factors [heat-stable (ST) and heat-labile (LT) enterotoxins, surface adhesion factors (CS2/CS3, CS6) and matrix metalloproteinase-9 (MMP-9)] as well as the interleukin (IL)-8 induction potential of diarrhoeagenic Escherichia coli and Shigella sonnei strains exposed to rifaximin (8, 32 and 64 mg/L) for 4, 8, 18 and 24 h. Following exposure to rifaximin, enterotoxigenic E. coli (ETEC) isolates did not express ST/LT, CS2/CS3 or CS6, whereas enteroaggregative E. coli (EAEC) and S. sonnei isolates did not produce detectable amounts of MMP-9. Moreover, induction of IL-8 was undetectable. At subinhibitory concentrations, rifaximin alters the virulence of ETEC, EAEC and S. sonnei isolates. These findings help explain the efficacy of rifaximin despite minimal alteration of colonic flora. © 2009 Elsevier B.V. and the International Society of Chemotherapy. Source

Huang J.S.,University of Houston | Jiang Z.-D.,University of Houston | Garey K.W.,University of Houston | Lasco T.,St. Lukes Episcopal Hospital | And 2 more authors.
Antimicrobial Agents and Chemotherapy | Year: 2013

The relationship between rifamycin drug use and the development of resistant strains of Clostridium difficile was studied at a large university hospital in Houston, TX, between May 2007 and September 2011. In 49 of 283 (17.3%) patients with C. difficile infection (CDI), a rifamycin-resistant strain of C. difficile was identified that compares to a rate of 8% using the same definitions in 2006-2007 (P±0.59). The 49 patients infected by a resistant organism were matched by date of admission to 98 control patients with CDI from whom a rifamycin-susceptible C. difficile strain was isolated. Cases and controls did not differ according to demographic and clinical characteristics and showed similar but low rates of prior rifamycin use. Similar rates of rifamycin resistance were seen in cases of hospital-acquired CDI (38/112 [34%]) versus community-acquired CDI (7/20 [35%]). At a university hospital in which rifaximin was commonly used, infection by rifamycin-resistant strains of C. difficile was not shown to relate to prior use of a rifamycin drug or to acquiring the infection in the hospital, although the rate of overall resistance appeared to be rising. Copyright © 2013, American Society for Microbiology. All Rights Reserved. Source

Alpert J.N.,St. Lukes Episcopal Hospital
Southern Medical Journal | Year: 2010

A 60-year-old man complained of 20-25 second episodes of bilateral arm paralysis. Neuroimaging disclosed spinal cord compression at the C3-4 level caused by a herniated disc and retrolisthesis. Spinal cord ischemia due to impingement of a vertebral artery or its spinal branch was suspected but could not be substantiated by neuroimaging. Discectomy and fusion eliminated these attacks. © 2010 by The Southern Medical Association. Source

Galler G.,St. Lukes Episcopal Hospital | Garcia-Torres F.,Kelsey Seybold Clinic | DuPont A.W.,University of Texas Medical Branch | Greisinger A.,Kelsey Research Foundation
American Journal of Tropical Medicine and Hygiene | Year: 2010

This study evaluated occurrence of travel and travelers' diarrhea in patients with irritable bowel syndrome (IBS). A survey was mailed to 591 patients of a clinical practice who had IBS. Based on survey responses, patients were categorized as having IBS, post-infectious IBS (PI-IBS), unclassified functional bowel disorder (UFBD), or post-infectious UFBD (PI-UFBD). Of 201 persons who returned questionnaires meeting inclusion criteria, 57.7%, 11.4%, 24.9%, and 6.0% had IBS, UFBD, PI-IBS, and PI-UFBD, respectively. Travel during six months before illness onset was more common in patients with PI-IBS or PI-UFBD than in persons with idiopathic IBS or UFBD (P = 0.006). Survey results demonstrated that 16.1% of post-infectious bowel disorder cases and 7.5% of overall IBS cases in a general medical population developed chronic disease within six months of an international trip. Symptoms of established functional bowel disorder in each clinical category were shown to worsen after travel-related acute diarrhea. Copyright © 2010 by The American Society of Tropical Medicine and Hygiene. Source

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