Pneumocystis pneumonia guidelines – in haematology patients
May 23 2016
Pneumocystis pneumonia (PCP) remains a rather enigmatic condition outwith AIDS. Uncommon, acute, non-specific and often fatal, it represents a real challenge to those caring for immunocompromised patients. In a series of 4 articles just published in the Journal of Antimicrobial Chemotherapy, multiple authors from Europe have reviewed the burden, diagnosis, therapy and prevention of PCP in haematology patients, including those undergoing allogeneic stem cell transplantation. It is a generally increasing problem, despite effective prophylaxis.
O’Neill final report on AMR has specific recommendations about antifungal resistance
May 19 2016
Lord Jim O’Neill’s global Review on AMR will set out its final recommendations, providing a comprehensive action plan for the world to prevent drug-resistant infections and defeat the rising threat of superbugs – something that could kill 10 million people a year by 2050, the equivalent of 1 person every 3 seconds, and more than cancer kills today. Building on eight interim papers, this is the final report from Lord O’Neill’s Review, established by the UK Prime Minister David Cameron in 2014 to avoid the world being “cast back into the dark ages of medicine”.
There are 4 general recommendations and 5 ideas about how to pay for it:
1. A global public awareness campaign to educate all of us about the problem of drug resistance.
2. The supply of new antibiotics needs to be improved so they can replace existing ones as they become ineffective.
3. We need to use antibiotics more selectively through the use of rapid diagnostics, to reduce unnecessary use, which speeds the incidence and spread of drug resistance.
4. We must reduce the global unnecessary use of antibiotics in agriculture.
With respect to fungal diseases and antifungals, similar priority areas were identified by O’Neill (Report p64):
Invasive aspergillosis in Bahrain
May 16 2016
The true epidemiology of invasive aspergillosis (IA) remains uncertain in many areas. In a retrospective study, Alsalman et al. (2016) studied the epidemiology of IA in 60 patients with Aspergillus-positive cultures over 5 years in a major hospital in Bahrain. Patients were classified according to two different systems 1. The European Organization for the Research and Treatment of Cancer/Mycoses Study Group (MSG) criteria and 2. validated criteria to distinguish Aspergillus colonization from IA (putative or proven IA). They also investigated the risk factors, clinical presentation, underlying conditions and outcomes.
Spontaneous abortion linked to oral fluconazole
May 06 2016
Oral fluconazole is used in severe or recurrent cases of vaginal candidiasis during pregnancy, despite concern regarding its safety. Previous data has demonstrated an association between fluconazole exposure and heart defects (see LIFE news item) and case reports have linked long-term, high-dose treatment to a distinct pattern of craniofacial and skeletal birth defects (e.g. Lopez-Rangel & Van Allen, 2005). Though two previous studies have shown no increased risk of spontaneous abortion or still births with oral fluconazole, small sample sizes indicate a lack of power to detect even a moderate increase in risk. From a cohort of nearly 1.5 million pregnancies, the group from the Staten Serum Institute in Copenhagen, led by Ditte Molgaard-Neilsen therefore investigated the relationship between exposure to oral fluconazole, and risk of spontaneous abortion and still births.
Multiple origins of azole resistance in Aspergillus fumigatus in India
April 29 2016
Resistance to triazoles in A. fumigatus increases the probability that treatment will fail. Howard Chang et al. from McMaster University and colleagues from Delhi (2016) have found multiple origins for multi-triazole resistance in India. They analysed a total of 89 A. fumigatus isolates from India (51 multi-triazole resistant isolates, 38 azole-susceptible isolates). The study attempted to understand the origin, dispersal and long-term evolution of drug resistance in A. fumigatus. A combined analysis using multilocus sequence typing (MLST), Straf microsatellites and PCR fingerprinting found much more genetic variability than previously found in India. The development of resistance in environmental isolate 497/Ei/12/3, for example, was likely driven by agricultural fungicides, as it showed cross-resistance to those commonly used, including bromuconazole, tebuconazole and hexaconazole.