Infection is still the major cause of death in severe burn patients, thus the optimization of antibiotic therapy is an important approach to the annihilation of pathogenic bacteria and the decrease of drug-resistance bacteria. It is urgent for burn surgeons to face the selection pressure of antibiotics and the fungous infections following the incorrect use of antibiotics. Regardless of its complexity, the treatment of sepsis associated with post-burn bacterial infections should be systematical. Besides the effective anti-shock therapy, early enteral feeding, excision of necrotic tissues, and effective anti-infection treatment, the immunological regulation and the prevention and cure of coagulation disorders are necessary in the treatment of severely burned patients.
Burns ; microbiology ; Cross Infection ; Humans ; Infection Control ; Mycoses ; prevention & control

Humans ; Infant, Newborn ; Infant, Premature ; Infant, Premature, Diseases ; microbiology ; prevention & control ; Mycoses ; prevention & control

Humans ; Infant, Newborn ; Infant, Premature ; Infant, Premature, Diseases ; diagnosis ; microbiology ; prevention & control ; Mycoses ; diagnosis ; prevention & control

Objective: To Evaluate the efficacy and safety of posaconazole as primary prevention of invasive fungal disease (IFD) in patients with severe aplastic anemia (SAA) treated with anti-thymus/lymphocyte immunoglobulin (ATG/ALG) combined with cyclosporine intensive immunosuppressive therapy (IST). Methods: A retrospective analysis of clinical data of 58 SAA patients who received IST of anti-thymocyte immunoglobulin combining cyclosporine and antifungal prophylaxis during April 2013 to May 2017 in Peking Union Medical College Hospital was performed. The patients were divided into posaconazole prophylaxis group and the control group (itraconazole or fluconazole). The disease characteristics, IFD prevention effect and adverse drug reaction, curative effect and prognosis of the two groups were compared. Results: Posaconazole was used to prevent fungal infection in 20 patients. The other 38 patients were used as the control group. Retrospective analysis showed comparable characteristics (gender, age, disease severity, etiology, interval between the onset of disease to treatment, ATG/ALG type) of both groups. The incidence of IFD were 0 and 15.8% in posaconazole prophylaxis group and the control group, respectively (P=0.084). In the control group, there were 6 cases diagnosed as IFD. Of them, 2 were confirmed, 2 suspected and 2 not identified. Five of the 6 cases were pulmonary infection, 1 bloodstream infections. Of the 6 IFD cases, 5 were very severe aplastic anemia (VSAA). There was no obvious adverse reaction in posaconazole prophylaxis group. Conclusion: Posaconazole is safe and effective for primary prevention of fungal infection of SAA patients receiving IST, especially for the VSAA.
Anemia, Aplastic ; Cyclosporine ; Humans ; Immunosuppressive Agents ; Mycoses/prevention & control* ; Primary Prevention ; Retrospective Studies ; Treatment Outcome ; Triazoles/therapeutic use*

OBJECTIVEWith the widespread application of peripherally inserted central catheters (PICC) in neonatal intensive care unit (NICU), the incidence of invasive fungal infections increased significantly than ever. The present study aimed to explore the clinical significance of oral fluconazole in premature infants with gestational age ≤ 32 weeks and/or birth weight ≤ 1500 grams who had catheter insertions.

METHODThis study enrolled 118 infants admitted between January 2006 and December 2007 who did not receive fluconazole prophylaxis (control group) and 106 infants admitted between January 2008 and June 2009 who received oral fluconazole prophylaxis (prophylaxis group). Statistical analyses were performed by using SPSS 11.5 software. The clinical characteristics and the risk factors for invasive fungal infection between the two groups were compared. Liver functions (alanine transaminase, ALT and direct bilirubin) were monitored to evaluate the safety of fluconazole prophylaxis.

RESULTExcept for the proportion of infants born via vaginal delivery in the control group (56/118, 47.5%) was significantly lower than that in prophylaxis group (69/106, 65.1%, P = 0.007), there were no significant significant differences in the demographics and other baseline clinical characteristics between the two groups. There were no significant differences in the risk factors for invasive fungal infection between the two groups either. Nine infants developed invasive fungal infection in control group (7.6%), while no invasive fungal infection was found in prophylaxis group (0%, P = 0.01). Compared to infants in control group, those in prophylaxis group showed no significant changes in alanine transaminase ALT and direct bilirubin levels at 2 weeks and 4 weeks after fluconazole prophylaxis: the incidences of abnormal ALT and direct bilirubin levels were 8.5% (10/118) and 6.8% (8/118) in control group compared to 11.3% (12/106) and 8.5% (9/106) in prophylaxis group after 2 weeks (P = 0.47 and 0.63); the incidences of abnormal ALT and direct bilirubin levels were 3.4% (4/118) and 3.4% (4/118) in control group compared to 5.7% (6/106) and 8.5% (9/106) in prophylaxis group after 4 weeks (P = 0.62 and 0.15).

CONCLUSIONFor infants with PICC insertions and gestational ages at birth ≤ 32 weeks and/or low birth weight ≤ 1500 grams, oral fluconazole is effective to prevent invasive fungal infection. Oral fluconazole in premature infants neither affected the liver function, nor increased the incidence of cholestasis.

Antifungal Agents ; therapeutic use ; Catheterization ; Fluconazole ; therapeutic use ; Humans ; Infant, Newborn ; Infant, Premature ; Mycoses ; prevention & control ; Retrospective Studies

Birth Weight ; Catheterization, Central Venous ; adverse effects ; Cross Infection ; etiology ; prevention & control ; Humans ; Infant, Newborn ; Intensive Care Units, Neonatal ; Mycoses ; prevention & control ; Risk Factors

OBJECTIVETo describe the constituent ratio of different kinds of antifungal agents as first choice in empirical or preemptive antifungal therapy for patients with hematological malignancies received chemotherapy or hematopoietic stem cell transplantation (HSCT).

METHODSBetween 2008 January and 2009 December, 367 patients received chemotherapy or HSCT from 15 medical centers in China were collected. The strategies of antifungal therapy and the first-choice antifungal agents were analyzed.

RESULTSOf them, 282(76.8%) patients received empirical antifungal therapy, 85(23.2%) preemptive therapy. The number of first choice antifungal agents were 55(15.0%) of fluconazole, 174(47.4%) of itraconazole, 39(10.6%) of voriconazole, 57(15.5%) of traditional/lipid formulation amphotericin B, 26(7.1%) of caspofungin, 7(1.9%) of micafungin, and 9(2.5%) of combination antifungal therapy respectively. Moreover, voriconazole and combination antifungal agents were more often selected for preemptive antifungal therapy, while the probabilities of itraconazole were the highest in both empirical and preemptive strategies. More patients undergoing HSCT were first given itraconazole or caspofungin for antifungal therapy, while amphotericin B, fluconazole and voriconazole were more administered in patients received chemotherapy. Caspofungin and combined antifungal agents were more often used for patients with secondary antifungal prophylaxis, while itraconazole was usually used for patients with no prophylaxis or primary antifungal prophylaxis.

CONCLUSIONEmpirical antifungal therapy was more administered in hematological malignancies patients received chemotherapy or HSCT. Itraconazole was the most commonly used agent for antifungal therapy followed by amphotericin, fluconazole, voriconazole and echinocandin agents.

Adult ; Antibiotic Prophylaxis ; Antifungal Agents ; therapeutic use ; Antineoplastic Agents ; therapeutic use ; China ; epidemiology ; Female ; Hematologic Neoplasms ; drug therapy ; microbiology ; Humans ; Male ; Middle Aged ; Mycoses ; prevention & control ; Young Adult

OBJECTIVETo evaluate the efficacy and safety of itraconazole for secondary prophylaxis of previous proven or probable invasive fungal infection (IFI) in patients undergoing chemotherapy or allogeneic hematopoietic stem cell transplantation (HSCT) in agranulocytosis state.

METHODSA phase IV prospective, open-label, multicenter trial was conducted to evaluate itraconazole (200 mg q12h intravenously d1-2, 200 mg/d) as secondary antifungal prophylaxis in patients (18-65 years old) undergoing chemotherapy or HSCT with previous proven or probable IFI. Itraconazole was started when patients' neutrophils＜1.5 × 10⁹/L, and stopped when chemotherapy patients' neutrophils ＞0.5 × 10⁹/L and stem cell transplant recipients' neutrophils＞1.0 × 10⁹/L. The primary end-point of the study was the incidence of proven, probable or possible IFI.

RESULTSSeventy one patients from November 2008 to September 2010 were enrolled in the trial. The median duration of itraconazole prophylaxis was 14 (4-35) days. No patients died of drug-related toxicity within trial. Five cases occurred IFI during the trial. The cumulative incidence of invasive fungal disease was 7.0%. One patient was withdrawn from the study due to treatment-related adverse events (liver malfunction and severe phlebitis).

CONCLUSIONItraconazole appears to be safe and effective for secondary prophylaxis of systemic fungal infection after chemotherapy and allogeneic HSCT. The observed incidence of 7.0% is considerably lower than the relapse rate reported in historical controls, suggesting that itraconazole is a promising prophylactic agent in this population.

Adolescent ; Adult ; Aged ; Antifungal Agents ; therapeutic use ; Female ; Hematopoietic Stem Cell Transplantation ; Humans ; Itraconazole ; therapeutic use ; Male ; Middle Aged ; Mycoses ; prevention & control ; Prospective Studies ; Treatment Outcome ; Young Adult

OBJECTIVETo evaluate the effect of fluconazole in prophylaxis of fungal infection in very low birth weight infants.

METHODSPubMed, EMBASE, Ovid, China National Knowledge Infrastructure, Vip Chinese Periodical Database, Wanfang Chinese Periodical Database and Chinese Bio-medicine Database were searched for the case-control study on the effect of fluconazole in prophylaxis of fungal infection in very low birth weight infants from Jan. 1994 to Jan. 2009. Articles were evaluated according to inclusion criteria. Poor-quality studies were excluded, and RevMan 4.22 software was applied for investigating the heterogeneity among individual studies and calculating the pooled risk ratio (RR) and 95% confidence interval (CI).

RESULTSFive eligible randomized clinical trials were included. Four studies were graded as "A" and one study was graded "B". Meta-analysis based on the included studies showed that the prophylactic fluconazole could significantly reduce the fungal colonization (RR: 0.32 and 95% CI: 0.23 to 0.44, P < 0.00001); and infections (RR: 0.44 and 95% CI: 0.29 to 0.65, P < 0.0001) in very low birth weight neonates. However, there was no statistically significant difference between the infants treated and not treated with prophylactic fluconazole in the neonatal mortality (RR: 0.68 and 95% CI: 0.43 to 1.07, P = 0.09) and the prophylactic use of fluconazole did not show any side-effects on the liver and bilirubin. None of the studies found any significant changes in the minimal inhibitory concentration of fluconazole in fungal isolates during the study period. There were different results about the emergence of resistance to fluconazole.

CONCLUSIONSMeta-analysis of five randomized controlled trials suggest that prophylactic fluconazole reduces the incidence of fungal colonization and invasive fungal infection in very low birth weight infants. Further trials are needed to provide more precise evaluation on efficacy, and to assess the effect on mortality, neurodevelopment and the emergence of resistance to antifungal agents. Different NICU should have different policy on prophylactic fluconazole and also adjust the policy at different time according to the incidence of fungal infection and antifungal drug resistance.

Antifungal Agents ; adverse effects ; therapeutic use ; Fluconazole ; adverse effects ; therapeutic use ; Humans ; Infant, Newborn ; Infant, Very Low Birth Weight ; Mycoses ; prevention & control ; Randomized Controlled Trials as Topic ; Safety

OBJECTIVE: To explore the effect of posaconazole in the primary prevention of invasive fungal disease (IFD) in the induction therapy of childhood acute lymphoblastic leukemia (ALL). METHODS: From August 2018 to November 2020, 144 pediatric patients with ALL treated in Department of Pediatrics, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University were selected, 88 cases received fluconazole as IFD prophylaxis (fluconazole prophylaxis group), 56 cases received posaconazole as IFD prophylaxis (posaconazole prophylaxis group). The incidence of IFD and treatment-related adverse reactions between the two groups were compared, and the safety of posaconazole was evaluated. RESULTS: The incidence of IFD in the fluconazole prophylaxis group was 20.4% (18/88), and in the posaconazole prophylaxis group was 7.1% (4/56). The incidence of IFD between the two groups was statistically significant different(P=0.030). There was no serious adverse reactions in the two groups. The incidence of mild adverse reactions in the posaconazole prophylaxis group (23.2%) was lower than that in the fluconazole prophylaxis group(39.8%), and the difference was statistically significant (P=0.039). There were 12 cases died in the fluconazole prophylaxis group and 4 in the posaconazole prophylaxis group, while no significant difference in the overall survival rate between the two groups (P=0.281). CONCLUSION The effect of posaconazole in the primary prophylaxis of IFD is better and incidence of adverse reactions is lower than fluconazole. Posaconazole can be tolerated, and expected to become the first-line primary prophylaxis drug for IFD during the induction remission therapy of childhood ALL.
Antifungal Agents/therapeutic use* ; Child ; Humans ; Induction Chemotherapy ; Mycoses/drug therapy* ; Precursor Cell Lymphoblastic Leukemia-Lymphoma/drug therapy* ; Primary Prevention ; Triazoles