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J Pemán

Publications and source records attributed to J Pemán.

At least 19 recordsLinked to original sources
PubMed2006

In vitro antifungal susceptibility testing of filamentous fungi with Sensititre Yeast One.

Sensititre is a colorimetric microdilution method for in vitro antifungal susceptibility testing based on the M27-A document (National Committee for Clinical Laboratory Standards) for yeasts. Difference between both methods is the presence of Alamar-blue and RPMI 1640 (glucose 2%) as culture medium. Antifungal susceptibility to amphotericin B, fluconazole, itraconazole, ketoconazole and flucytosine, 100 opportunistic filamentous fungi (Aspergillus spp., Fusarium spp., Scedosporium spp.) obtained from pathological samples was determined by the Sensititre method. Induction to conidium and sporangiospore formation at 35 degrees C was used to get inoculum and plates were covered by 1 ml of saline and suspensions were made by gently probing by a sterile loop. Optical densities of the conidial suspensions were adjusted to 80-82% transmittance for Aspergillus spp. and 68-70% for the rest of strains tested. Final inoculum concentration size was 0.4 x 10(4)-5 x 10(4) CFU ml(-1). Readings were made at 72 h of incubation at 35 degrees C; amphotericin B and itraconazole was active against Aspergillus fumigatus with CMI90 1 and 0.5 microg ml(-1), respectively, opposite to Scedosporium prolificans and Scedosporium apiospermum. As it was expected, a CMI90 of 256 microg ml(-1) for fluconazole and CMI90 for flucytosine amounting to 64 g ml(-1) were obtained. Sensititre Yeast One is a useful method and an alternative to reference methods to determine antifungal susceptibility of filamentous fungi for clinical laboratory routine. Correlation with microdilution results is studied. New triazole derivatives should be included as soon as their clinical use will be feasible.

Amphotericin B↗
PubMed2006

[In vitro activity of voriconazole against yeast and algae isolates according to new resistance pattern cut-off points].

Voriconazole is a second-generation triazole derived from fluconazole but with greater potency and spectrum of activity, showing good in vitro activity against Candida, Cryptococcus and Aspergillus species, and other filamentous and dimorphic fungi. It can be administered orally or intravenously. It was initially approved in 2002 by the U.S. Food and Drug Administration as a treatment option for invasive aspergillosis and Fusarium and S. apiospermum infections showing resistance or intolerance to other antifungals; later on, it also received approval in the United States and Europe as a treatment option for esophageal candidiasis; candida infection in non-neutropenic patients; disseminated candidiasis of skin, abdomen, kidney and bladder; and injuries. Recently, the Clinical Laboratory Standard Institute established some provisional break points for voriconazole, classifying isolates with an MIC or=4 mg/l as resistant. In line with these new data, we performed a systematic review of literature on in vitro activity of voriconazole against yeast and algae isolates, and compared it to that of fluconazole and itraconazole. The review included a total of 27,340 yeast isolates, 24,177 of Candida species, 2,726 of Cryptococcus species, 453 of other species, and 104 Prototheca. The yeast isolates resistant to voriconazole is approximately 1%, and 71% of fluconazole-resistant isolates are susceptible to voriconazole.

Antifungal Agents↗
PubMed2006

[Evaluation and utility of the E-test and Neo-Sensitabs methods in studying fluconazole yeast susceptibility].

Standardized broth dilution methods are cumbersome for routine use in a clinical laboratory to study antifungal yeast susceptibility. Recently, the CLSI has standardized a disk diffusion method faster and more suitable to study fluconazole and voriconazole susceptibility. The objectives of the present study were to determine: a) the suitability of the Neo-Sensitabs tablets to study fluconazole susceptibility; b) whether Mueller-Hinton agar with methylene blue (MHAG-AM) could be used in the E-test method; and c) the interaction of the methylene blue with RPMI medium. A total of 84 blood stream yeast isolates were used (25 C. albicans, 7 C. parapsilosis, 10 C. tropicalis, 12 C. glabrata, 7 C. krusei, 4 C. lusitaniae and 19 C. neoformans). The methylene blue makes sharper inhibition zones both in MHAG-AM and RPMI media. With fluconazole Neo-Sensitabs tablets, the lowest percentage of very major errors was found in MHAG-AM and the greatest in RPMIG. In both diffusion methods and culture media, the very major errors were found in C. albicans, C. tropicalis (only with Neo-Sensitabs) and C. glabrata. The percentage of fluconazole-resistant strains was lower in the media that contained glucose (2%). Neo-Sensitabs tablets are a reliable alternative to the dilution methods to detect fluconazole susceptibility. In the case of resistance, more studies are required; nevertheless, inhibition zone > or =17 mm should be applied to define fluconazole resistance.

Antifungal Agents↗
PubMed2005

Epidemiology and antifungal susceptibility of Candida species isolated from blood: results of a 2-year multicentre study in Spain.

This study, included in the prospective survey of candidaemia in Europe supported by the European Confederation of Medical Mycology, presents the epidemiological and antifungal susceptibility results of 290 cases of candidaemia (80 in children <15 years old) reported from September 1997 to August 1999 by 19 Spanish hospitals. Presence of an intravenous catheter and previous antibiotic therapy were the most frequent risk factors. The percentages of the four most common species isolated (adults/children) were as follows: Candida albicans (46/36.2), C. parapsilosis (21.9/50), C. tropicalis (12.8/3.75), and C. glabrata (10.1/5). As initial therapy, fluconazole was preferred in adults (54%) and liposomal amphotericin B in children (58%). The 30-day mortality rate was 40.6%, and the species most frequently associated with a fatal outcome was C. krusei (60%). The rates of susceptibility to antifungal agents were as follows: amphotericin B, 91%; flucytosine, 99%; fluconazole, 93.6%; itraconazole, 87.4%; and voriconazole, 92%. These results provide baseline data for future epidemiological and susceptibility studies and for evaluating the impact of new antifungal agents on the distribution of species and the mortality rates associated with candidaemia in Spain.

Adolescent↗
PubMed2005

Aspergillus infections in lung transplant recipients: risk factors and outcome.

This retrospective study of 251 lung transplant patients aimed to determine the prevalence, clinical presentation and mortality of Aspergillus infection in order to define specific risk factors and to compare survival in patients with and without infection. Aspergillus was isolated from 86 (33%) cases, which involved colonisation (n = 50), tracheobronchial lesions (n = 17) or invasive aspergillosis (n = 19). Overall, aspergillosis had an impact on survival (p < 0.05); in fact the 5-year mortality rate was substantially higher in single lung transplant recipients with bronchial anastomotic infection, and in those with late-onset infections and chronic rejection. A significant association (p < 0.05) was found between acute rejection and the time at which fungal infection was diagnosed. Aspergillus infection was not related to cytomegalovirus infection or treatment with corticosteroids. The mortality rate for invasive infections was 78% and was related to survival (p < 0.0001); invasive aspergillosis was also associated with chronic rejection (p < 0.05), but not with high corticosteroid doses (p 0.49) or use of tacrolimus (p 0.73). In conclusion, Aspergillus infection was associated with a reduction in the 5-year survival rate of lung transplant recipients, and this was particularly true for patients infected with the invasive forms and for patients with single lung transplants, bronchial anastomotic infection and chronic rejection. Isolation of Aspergillus spp. from respiratory samples preceded acute rejection, and may be a marker of graft dysfunction and/or airway inflammation. Close monitoring, or even pre-emptive antifungal therapy, is recommended for patients with chronic rejection or bronchial airway mechanical abnormalities and persistent Aspergillus colonisation.

Aspergillosis↗
PubMed2005

[Activity of voriconazole against yeasts isolated from blood culture determined by two methods].

The in vitro activity of voriconazole has been determined by two methods: the reference M27-A2 and the marketed Sensititre YeastOne microdilution colorimetric method. The agreement (+/-2 dilutions) and correlation between methods as well as the percentage of errors has been determined. A total of 144 yeasts (47 Candida albicans, 52 C. parapsilosis, 13 C. tropicalis, 10 C. krusei, 9 C. glabrata, 2 C. guilliermondii, 1 C. colliculosa, 1 C. dubliniensis, 2 Trichosporum asahii, 1 T. mucoide, 1 Trichosporum spp., 1 Kloakera apis, 2 Pichia ohmeri, and 2 Rhodotorula glutinis) isolated from blood culture between October 2002 and May 2005 were assayed. Voriconazole has shown good in vitro activity. The rate of voriconazole-susceptible (MIC < or =1 mg/l) strains was 97% and the MIC90 0.25 mg/l by the two methods. The overall percentage of agreement between methods was 86% (range 44.23-100%) and the Pearson's coefficient of correlation was 0.961. Categorical agreement was strain dependent and ranged from 84.6% for emergent yeasts to 100% for the other species tested except for C. glabrata (66.6%). No major or very major errors were found, the percentage of minor errors being 1.38%. Only one C. tropicalis and one C. glabrata strain were resistant (MIC > or =4 mg/l) to voriconazole (1.38%) by the reference method. The colorimetric method identified the voriconazole-resistant C. tropicalis strain, and classified the C. glabrata as susceptible-dose dependent. The colorimetric method is a potential alternative method for testing the susceptibility of yeast in a clinical laboratory and identifies the susceptible strains (100% agreement) very well. Nevertheless, further studies including more voriconazole-resistant strains are required to determine the ability of the method to identify resistance, which is the goal of susceptibility tests.

Antifungal Agents↗
PubMed2004

[Usefulness of the E-test and its assay conditions in the study of the interaction of antifungal agents. A pilot study].

Preliminary data from a pilot study to assess the usefulness of the E-test in the study of antimycoctics are presented, evaluating assay and reproduction conditions. Results are compared with those obtained using the checkerboard method and mortality-time curves. Trials were carried out with a strain of Candida albicans (ATCC 90028). The E-test strips were combined in direct proportion, MIC-MIC, and in inverse proportion. The results showed that the method can be reproduced, is easy to carry out and may be suitable for the study of the in vitro interaction of antimycotics on yeast. The directly and inversely proportionate strip combination appeared to be the most suitable. At the prediffusion stage, the most highly water-soluble antimycotic should be used. The recommended time for prediffusion is one hour for water-soluble antimycotics, and two hours for non-water-soluble ones. The E-test showed good correlation with mortality-time curves. Nonetheless, in vivo correlation studies are required to determine the usefulness of the results in vitro and the most suitable method of measurement

Amphotericin B↗
PubMed2004

[Study of in vitro activity of caspofungin on non-Candida albicans yeast strains determined by two methods: M27-A2 and EUCAST].

The in vitro activity of caspofungin against 147 non-Candida albicans yeasts isolated from blood culture was studied using two broth microdilution methods: M27-A2 and EUCAST. The minimum concentrations that produced a growth inhibition of > or = 50% and of 100% (MIC2 and MIC0, respectively) and a reduction in the number of viable colonies > or = 99% versus the initial inoculum (MFC) were determined for all strains. Caspofungin demonstrated good activity (MIC2 and MIC0 < or = 2 mg/l for 90% of the strains) against the species studied, including those that are normally resistant or have a high percentage of azole resistance (Candida krusei, Candida glabrata, Candida tropicalis). Nevertheless, the antifungal activity is lower (MFC < or = 2 mg/l in 73.47% of the strains with the M27-A2 method versus 62.59% with EUCAST), particularly for Candida guilliermondii and Candida parapsilosis. The two methods tested demonstrated good correlation for the MIC and lower correlation for the MFC. Essential agreement and concordance (+/- 2 log) between both methods for all strains tested were: 73.47% and 93.20% for MIC2; 74.8% and 91.84% for MIC0; and 57.1% and 74.15% for MFC, respectively. MICs determined by the EUCAST method are one- to three-fold dilutions lower, while the MFC are higher than those obtained by the M27-A2 method.

Antifungal Agents↗
PubMed2003

Visceral leishmaniasis in lung transplantation.

Infection by intracellular microorganisms with a special geographic distribution, such as Leishmania spp, has been reported in a limited number of patients undergoing solid-organ transplant (SOT). No cases of Leishmania spp infection in lung transplant patients were found in a review of the literature. In our series of 222 lung or heart and lung transplantations performed from February 1990 to October 2002, two cases of visceral leishmaniasis (VL) were diagnosed and treated with liposomal amphotericin B. All cases reported to date in transplant patients, including the ones discussed here, occurred in people living in or traveling to countries in the Mediterranean area. We therefore consider it advisable to include serological testing for latent infection due to Leishmania spp in pretransplantation screening for our geographical setting, despite the limited return of this strategy.

Adult↗
PubMed2003

Performance of Bacticard Candida compared with the germ tube test for the presumptive identification of Candida albicans.

Bacticard Candida was compared with the germ tube test for the rapid, presumptive identification of Candida albicans. This test kit detects the enzymatic activities l-proline aminopeptidase and beta-galactosaminidase in yeast colonies grown on culture media. Candida albicans produces both enzymes whereas other yeasts produce only one or neither of the enzymes. We evaluated 536 isolates including eight genera and 33 species of medically important yeasts, including 228 C. albicans and 36 C. dubliniensis. Both tests did not discriminate between C. albicans and C. dubliniensis isolates. The sensitivity and specificity for the Bacticard Candida test were 97.8 and 96.5%, respectively. Bacticard Candida and germ tube tests detected 246 (93.2%), and 256 (97%) C. albicans plus C. dubliniensis isolates. There were eight false-positive results with BactiCard Candida kit and four false-positive results with the germ tube test. Positive and negative predictive values for Bacticard Candida enzymatic test were 95.3 and 98.4%, respectively, while 97.4 and 98.1% for the germ tube test, its specificity being 98.1% and efficiency 97% (97.7% for germ tube). We have observed slightly lower values of sensitivity and specificity than those reported by others using the BactiCard test kit. Bacticard Candida provides a rapid and accurate alternative to the germ tube test for the presumptive identification of C. albicans.

Aminopeptidases↗
PubMed2002

Candidemia at a tertiary-care hospital: epidemiology, treatment, clinical outcome and risk factors for death.

The demographic, clinical and microbiological data of patients with candidemia at the "Hopital Universitario La Fe", a tertiary-care hospital in Valencia, Spain, from 1995 to 1997 was analyzed retrospectively. Candida spp. were isolated in blood cultures from 145 patients, 32% of whom were children (25% of these were neonates). The most common species isolated was Candida albicans, followed by Candida parapsilosis, Candida krusei and Candida tropicalis. Risk factors for candidemia included underlying disease, therapy with broad-spectrum antibiotics and the presence of a central venous catheter. The majority of children were treated with amphotericin B, whereas 52% of adults received fluconazole. Overall mortality was 44% (30% in children and 50% in adults), and attributable mortality was 30% (24% in children and 33% in adults). Multivariate analysis indicated that neutropenia, corticosteroid therapy, lack of antifungal treatment, and failure to replace the central venous catheter were factors associated with candidemia-related death. Among the adult population, an APACHE II score greater than 15 predicted candidemia-related death.

Adolescent↗
PubMed2002

Two cases of fungemia due to Candida lusitaniae and a literature review.

Reported here are two cases of candidemia caused by Candida lusitaniae that occurred in two immunocompromised patients at Hospital Universitario "La Fe" in Valencia, Spain. Case 1 involved a low-birth-weight premature infant with congenital nephrotic syndrome who was successfully treated with amphotericin B, and case 2 involved a 50-year old woman with a high-grade malignancy lymphoma who succumbed to the infection. Antifungal susceptibility testing of the Candida lusitaniae isolates recovered from both patients revealed sensitivity to amphotericin, 5-flucytosine and fluconazole. Results are presented and discussed together with a comprehensive review of the literature, covering all previously reported cases of fungemia caused by this emerging pathogen.

Amphotericin B↗
PubMed2002

Infectious complications in patients undergoing unrelated donor bone marrow transplantation: experience from a single institution.

OBJECTIVE: To analyze the incidence and characteristics of documented infections in patients with hematologic malignancies undergoing unrelated donor bone marrow transplantation (UD-BMT). METHODS: We studied the occurrence of infections in 22 patients with hematologic malignancies or severe aplastic anemia who underwent UD-BMT from April 1990 to December 2000. The median age was 26 years (range 13-46). Acyclovir-ganciclovir, co-trimoxazole, fluconazole-nystatin and ciprofloxacin were administered for anti-infectious prophylaxis. RESULTS: We registered 61 infectious episodes. During the early post-transplant period, there were eight clinically documented infections (CDIs), four cases of fever of unknown origin (FUO), seven cases of bacteremia, two cases of cytomegalovirus (CMV) antigenemia, and one case of CMV disease. In the intermediate period (days 30-100 after BMT), there were nine cases of CMV antigenemia, three bacterial infections, two fungal infections, one case of disseminated toxoplasmosis, and one case of FUO. In the late period (day 100 and later), we documented 13 viral infections, eight bacterial infections, one CDI, and one case of invasive aspergillosis. Infections contributed to death in 10 of 17 patients. Citrobacter bacteremia and sepsis of unknown origin were the main causes of infectious mortality in the early period. Infection was the main cause of death in six of seven patients in the late period. CONCLUSION: A high incidence of life-threatening infections and infection-related mortality was observed. A high rate of CMV infection in the early period, and death caused by multiresistant Gram-negative microorganisms in the late period, were the main findings in this series.

Adolescent↗
PubMed2002

[Correlation between in vitro susceptibility to antifungal drugs and the clinical evolution of patients with candidiasis and cryptococcosis].

The increase in the incidence of fungal infections and the emergence of resistance call for the development of techniques for measuring in vitro antifungal susceptibility that are useful for predicting clinical outcome in patients suffering from these infections. In the past, the lack of standardized testing techniques led to poor intra- and interlaboratory reproducibility. Recently, the National Committee for Clinical Laboratory Standards (NCCLS) has developed a reference method for antifungal susceptibility testing, document M27A. This document is a necessary and important step towards the standardization of antifungal susceptibility testing, which has important implications in the analysis of clinical and microbiological data. This article provides a comprehensive review of studies correlating in vitro antifungal susceptibility testing and clinical outcome. In general, it is possible to predict the therapeutic outcome, especially in HIV infected patients with oropharyngeal candidiasis treated with fluconazole. However, in other more heterogeneous groups of patients it is more difficult to correlate the in vitro and in vivo data.

Amphotericin B↗