1.Selection of resistant fungi in liver transplant recipients during use of newer antifungal agents -- a report of two cases.
Pushpalatha B LINGEGOWDA ; Chee Kiat TAN ; Ai Ling TAN ; Ban Hock TAN
Annals of the Academy of Medicine, Singapore 2011;40(6):287-290
INTRODUCTIONBecause invasive fungal infections cause significant morbidity and mortality in liver transplant recipients, the use of antifungal prophylaxis, and the early empirical use of antifungal agents, is widespread on liver transplant units. The new-generation azoles such as voriconazole and the echinocandins have been welcome additions to the antifungal armamentarium. These agents have become the leading options for prophylaxis in liver transplant units, despite the absence of strong data for their efficacy in this setting.
CLINICAL PICTUREWe report two recipients of living-donor liver transplants who became infected/colonised with fungi resistant to an echinocandin and the azoles after exposure to these agents. One patient developed trichosporonosis while on caspofungin and the other became infected/ colonised with Candida glabrata that was resistant to voriconazole and posaconazole.
CONCLUSIONWe report these to highlight some of the consequences of using the newer antifungal agents.
Adult ; Antifungal Agents ; therapeutic use ; Drug Resistance, Fungal ; Echinocandins ; therapeutic use ; Fatal Outcome ; Female ; Fluconazole ; therapeutic use ; Humans ; Lipopeptides ; Liver Transplantation ; adverse effects ; immunology ; Male ; Middle Aged ; Mycoses ; drug therapy ; prevention & control ; Pyrimidines ; therapeutic use ; Triazoles ; therapeutic use ; Trichosporonosis ; drug therapy ; prevention & control ; Voriconazole ; Young Adult
2.National surgical antibiotic prophylaxis guideline in Singapore.
Wei Teng Gladys CHUNG ; Humaira SHAFI ; Jonathan SEAH ; Parthasarathy PURNIMA ; Taweechai PATUN ; Kai Qian KAM ; Valerie Xue Fen SEAH ; Rina Yue Ling ONG ; Li LIN ; Robin Sing Meng CHOO ; Pushpalatha LINGEGOWDA ; Cheryl Li Ling LIM ; Jasmine Shimin CHUNG ; Nathalie Grace S Y CHUA ; Tau Hong LEE ; Min Yi YAP ; Tat Ming NG ; Jyoti SOMANI
Annals of the Academy of Medicine, Singapore 2022;51(11):695-711
INTRODUCTION:
Institutional surgical antibiotic prophylaxis (SAP) guidelines are in place at all public hospitals in Singapore, but variations exist and adherence to guidelines is not tracked consistently. A national point prevalence survey carried out in 2020 showed that about 60% of surgical prophylactic antibiotics were administered for more than 24 hours. This guideline aims to align best practices nationally and provides a framework for audit and surveillance.
METHOD:
This guideline was developed by the National Antimicrobial Stewardship Expert Panel's National Surgical Antibiotic Prophylaxis Guideline Development Workgroup Panel, which comprises infectious diseases physicians, pharmacists, surgeons and anaesthesiologists. The Workgroup adopted the ADAPTE methodology framework with modifications for the development of the guideline. The recommended duration of antibiotic prophylaxis was graded according to the strength of consolidated evidence based on the scoring system of the Singapore Ministry of Health Clinical Practice Guidelines.
RESULTS:
This National SAP Guideline provides evidence-based recommendations for the rational use of antibiotic prophylaxis. These include recommended agents, dose, timing and duration for patients undergoing common surgeries based on surgical disciplines. The Workgroup also provides antibiotic recommendations for special patient population groups (such as patients with β-lactam allergy and patients colonised with methicillin-resistant Staphylococcus aureus), as well as for monitoring and surveillance of SAP.
CONCLUSION
This evidence-based National SAP Guideline for hospitals in Singapore aims to align practices and optimise the use of antibiotics for surgical prophylaxis for the prevention of surgical site infections while reducing adverse events from prolonged durations of SAP.
Humans
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Antibiotic Prophylaxis
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Anti-Bacterial Agents/therapeutic use*
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Methicillin-Resistant Staphylococcus aureus
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Singapore
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Surgeons
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Hospitals, Public