Healthcare burden of probable and proven invasive mucormycosis: a multi-centre cost-of-illness analysis of patients treated in tertiary care hospitals between 2003 and 2016

Publication date: Available online 10 November 2018Source: Journal of Hospital InfectionAuthor(s): S.M. Heimann, M.J.G.T. Vehreschild, O.A. Cornely, W.J. Heinz, B. Grüner, G. Silling, J. Kessel, D. Seidel, J.J. VehreschildSummaryBackgroundInvasive mucormycosis (IM) is a rare invasive fungal infection with a high mortality rate. However, data concerning the clinical and economic burden of IM are scarce.AimTo evaluate the direct treatment costs and additional expenditures of patients with IM.MethodsA retrospective cost-of-illness analysis of cases with IM extracted from FungiScope – Global Registry for Emerging Fungal Infections, accessible through the epidemiological research platform www.ClinicalSurveys.net, was undertaken. Results of patients with IM were compared with those of matched patients with similar underlying conditions based on the German Diagnosis Related Group (G-DRG) coding.FindingsOut of 46 patients with probable/proven IM, 31 (67%) patients were male and the median age was 53 years (range 11–88 years). Forty-two patients (92%) had haematological diseases as the most common risk factor. Analysis of cost factors identified antifungal treatment due to IM as the primary cost driver [€22,816, 95% confidence interval (CI) €15,036–32,346], with mean overall direct treatment costs of €53,261 (95% CI €39,660–68,825). Compared with matched patients, patients with IM were treated in hospital for 26.5 additional days (stand...
Source: Journal of Hospital Infection - Category: Infectious Diseases Source Type: research

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Case: A 71-year-old male with acute myeloid leukemia (AML) on posaconazole for invasive fungal disease prophylaxis was found to have necrotic, escharred skin lesions on his bilateral forearms that developed while awaiting resolution of chemotherapy-induced neutropenia. 4-mm punch biopsies were performed through the necrotic center of each lesion and frozen sections were sent for investigation. Right forearm skin biopsy and frozen section were positive for angioinvasive fungal infection within the dermis and subcutis, which demonstrated vascular occlusion by numerous fungal hyphae.
Source: Journal of the American Academy of Dermatology - Category: Dermatology Source Type: research
Hematopoietic cell transplantation is an essential and often the sole treatment strategy for relapsed and refractory hematological malignancies. Patients and health care professionals expect to achieve long-term survival with intensive chemotherapy, total body irradiation, and allogeneic immune reactions caused by graft versus leukemia effect [1]. Controlling treatment-related mortality is also a key to successful hematopoietic cell transplantation. Adverse events after hematopoietic cell transplantation include the immune reaction called graft versus host disease (GVHD), bacterial, viral, and fungal infections, and hepati...
Source: Biology of Blood and Marrow Transplantation - Category: Hematology Authors: Source Type: research
AbstractPatients with hematological malignancies are severely immunocompromised and are at high risk of invasive fungal infection (IFI), particularly those undergoing remission-induction chemotherapy for acute myeloid leukemia (AML). IFIs are a major cause of morbidity and mortality in such patients. We planned to study the incidence of IFI in patients with AML undergoing intensive chemotherapy and receiving antifungal prophylaxis. We retrospectively reviewed consecutive 46 patients with non-M3 AML, who received induction chemotherapy and systemic antifungal prophylaxis. None of the patients had IFI at the time of initiati...
Source: Indian Journal of Hematology and Blood Transfusion - Category: Hematology Source Type: research
Conclusion: The results indicate that oral candidiasis is a prevalent fungal infection in the patients with hematologic malignancies with C. albicans being the main etiological agent. However, other species of Candida cause similar infections in these patients. PMID: 31341565 [PubMed]
Source: Iranian Journal of Microbiology - Category: Microbiology Tags: Iran J Microbiol Source Type: research
Conclusions: Ciclopirox did not show any potential to induce resistance in T. rubrum and appears endowed of a more complete activity than efinaconazole in the management of onychomycosis, as the nail keratin is a substrate for the growth of fungal cells and the availability in large concentration just in the nail bed may not be sufficient to guarantee the complete eradication of pathogens. PMID: 31332076 [PubMed - as supplied by publisher]
Source: Antimicrobial Agents and Chemotherapy - Category: Microbiology Authors: Tags: Antimicrob Agents Chemother Source Type: research
This study aimed to investigate the effectiveness of oral VRCZ compared to that of first-generation azoles prescribed within 7  days after the onset of chemotherapy in adult patients with AML/MDS using the Japanese administrative database.MethodsThis nationwide retrospective cohort study was conducted using the Diagnosis Procedure Combination/Per-Diem Payment System. The primary outcome was the proportion of patients who switched to intravenous antifungal agents. Analyses using the instrumental variable method were performed to address unmeasured confounding.ResultsIn total, data on 5517 inpatients from 142 hospitals ...
Source: International Journal of Clinical Oncology - Category: Cancer & Oncology Source Type: research
Abstract Over-expression of the human P-glycoprotein (P-gp) in tumor cells is a classic example of an ABC protein serving as a hindrance to effective chemotherapy. The existence of proteins homologous to P-gp in organisms encompassing the entire living kingdom highlights extrusion of drugs as a general mechanism of multidrug resistance. Infections caused by opportunistic human fungal pathogens such as Candida species are very common and has intensified in recent years. The typical hosts, who possess suppressed immune systems due to conditions such as HIV and transplantation surgery etc., are prone to fungal infect...
Source: Fungal Genetics and Biology - Category: Biology Authors: Tags: Fungal Genet Biol Source Type: research
Abstract Antifungal resistance is one of the major causes of the increasing mortality rates in fungal infections, especially for those caused by Aspergillus spp. A surveillance program was established in 2014 in the Spanish National Center for Microbiology for tracking resistance on the most prevalent Aspergillus species. 273 samples were included in the study and were initially classified as susceptible or resistant according to EUCAST breakpoints. Several Aspergillus cryptic species were found within the molecularly identified isolates. Cyp51 mutations were characterized for A. fumigatus, A. terreus and A. flavu...
Source: Antimicrobial Agents and Chemotherapy - Category: Microbiology Authors: Tags: Antimicrob Agents Chemother Source Type: research
In this study, we performed a high copy genomic DNA (gDNA) library screening to find and characterize genes that reduce susceptibility to amphotericin B, caspofungin and voriconazole in Saccharomyces cerevisiae We identified PDR16 and PMP3 genes for amphotericin B, RMD9 and SWH1 genes for caspofungin, and MRS3 and TRI1 genes for voriconazole. The deletion mutants for PDR16 and PMP3 were drug susceptible, but the other mutants had no apparent susceptibility. Quantitative PCR analyses suggested that the corresponding drugs up-regulated the expression of PDR16, PMP3, SWH1 and MRS3 genes. To further characterize these genes, w...
Source: Antimicrobial Agents and Chemotherapy - Category: Microbiology Authors: Tags: Antimicrob Agents Chemother Source Type: research
In this study we investigated the use of compounds that target C. albicans polymorphism, such as 1-dodecanol, isoamyl alcohol and farnesol, to attempt to improve β-peptide efficacy for preventing C. albicans biofilms. Isoamyl alcohol, which prevents hyphal formation, reduced the minimum biofilm prevention concentrations (MBPCs) of β-peptides by up to 128-fold. Combinations of isoamyl alcohol and antifungal β-peptides resulted in less than 10% hemolysis at the antifungal MBPCs. Overall, our results suggest potential benefits of combination therapies comprised of morphogenesis modulators and antifungal AMP pep...
Source: Antimicrobial Agents and Chemotherapy - Category: Microbiology Authors: Tags: Antimicrob Agents Chemother Source Type: research
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