amphotericin-b and Urinary-Tract-Infections

To assess the efficacy and safety of bladder irrigation with amphotericin B for treatment of fungal infection in the urinary tract.. All the available randomized controlled trials (published before March, 2018) examining bladder irrigation with amphotericin B for treatment of urinary tract fungal infection were searched in the Cochrane Central Register of Controlled Trials (Issue 12, 2017), PubMed, EMBase, Web of Knowledge Database, CNKI, CBM, Wanfang DATA and VIP information. Data were extracted from the selected trials for meta-analysis using RevMan 5.3 software.. A total of 96 studies were retrieved from the databases, and 9 trials involving 853 patients were included in the analysis. Meta-analysis results showed that compared with oral administration of fluconazole, bladder irrigation with amphotericin B was more effective in the treatment of fungal infection in the urinary tract (OR=1.66, 95%CI: 1.2-2.3, P=0.002) and was associated with less adverse reactions.. Bladder irrigation with amphotericin B can improve the curative effect of fungal infection in the urinary tract, but due to the small sample size of the included studies, this conclusion needs to be further validated by high-quality studies.

Topics: Amphotericin B; Antifungal Agents; Fluconazole; Humans; Mycoses; Randomized Controlled Trials as Topic; Therapeutic Irrigation; Urinary Bladder; Urinary Tract Infections

The urinary tract is a common source for life-threatening infections. Most patients with sepsis or septic shock from a urinary source have complicated urinary tract infection. This article explains the epidemiology, risk factors, and treatment. Effective management, appropriate collection of microbiology specimens, prompt initiation of antimicrobial therapy, source control, and supportive therapy are described.

Topics: Acute Disease; Aminoglycosides; Amphotericin B; Anti-Infective Agents; Antifungal Agents; Catheters, Indwelling; Community-Acquired Infections; Cross Infection; Deoxycholic Acid; Drug Combinations; Female; Fluconazole; Humans; Male; Prognosis; Risk Factors; Shock, Septic; Urinary Tract; Urinary Tract Infections

Candiduria is a hospital-associated infection and a daily problem in the intensive care unit. The treatment of asymptomatic candiduria is not well established and the use of amphotericin B bladder irrigation (ABBI) is controversial. The aim of this systematic review was to determine the best place for this therapy in practice.. The databases searched in this study included MEDLINE, EMBASE, Web of Science, and LILACS (January 1960-June 2007). We included manuscripts with data on the treatment of candiduria using ABBI. The studies were classified as comparative, dose-finding, or non-comparative.. From 213 studies, nine articles (377 patients) met our inclusion criteria. ABBI showed a higher clearance of the candiduria 24 hours after the end of therapy than fluconazole (odds ratio (OR) 0.57, 95% confidence interval (CI) 0.32-1.00). Fungal culture 5 days after the end of both therapies showed a similar response (OR 1.51, 95% CI 0.81-2.80). The evaluation of ABBI using an intermittent or continuous system of delivery showed an early candiduria clearance (24 hours after therapy) of 80% and 82%, respectively (OR 0.87, 95% CI 0.52-1.36). Candiduria clearance at >5 days after the therapy showed a superior response using continuous bladder irrigation with amphotericin B (OR 0.52, 95% CI 0.29-0.94). The use of continuous ABBI for more than 5 days showed a better result (88% vs. 78%) than ABBI for less than 5 days, but without significance (OR 0.55, 95% CI 0.34-1.04).. Although the strength of the results in the underlying literature is not sufficient to allow the drawing of definitive conclusions, ABBI appears to be as effective as fluconazole, but it does not offer systemic antifungal therapy and should only be used for asymptomatic candiduria.

Topics: Adult; Amphotericin B; Antifungal Agents; Candida; Candidiasis; Fluconazole; Humans; Randomized Controlled Trials as Topic; Therapeutic Irrigation; Urinary Bladder; Urinary Tract Infections; Urine

Fungal urinary tract infections (funguria) are rare in community medicine, but common in hospitals where 10 to 30% of urine cultures isolate Candida species. Clinical features vary from asymptomatic urinary tract colonization (the most common situation) to cystitis, pyelonephritis, or even severe sepsis with fungemia. The pathologic nature of funguria is closely related to host factors, and management depends mainly on the patient's underlying health status. Microbiological diagnosis of funguria is usually based on a fungal concentration of more than 10(3)/mm(3) in urine. No cutoff point has been defined for leukocyte concentration in urine. Candida albicans is the most commonly isolated species, but previous antifungal treatment and previous hospitalization affect both species and susceptibility to antifungal agents. Treatment is recommended only when funguria is symptomatic or in cases of fungal colonization when host factors increase the risk of fungemia. The antifungal agents used for funguria are mainly fluconazole and amphotericin B deoxycholate, because other drugs have extremely low concentrations in urine. Primary and secondary preventions are essential. The reduction of risk factors requires removing urinary catheters, limiting antibiotic treatment, and optimizing diabetes mellitus treatment.

Topics: Aged; Amphotericin B; Antifungal Agents; Candida albicans; Candidiasis; Cross Infection; Cystitis; Deoxycholic Acid; Drug Combinations; Female; Fluconazole; Fungemia; Fungi; Health Status; Hospital Mortality; Humans; Male; Mycoses; Primary Prevention; Pyelonephritis; Risk Factors; Urinary Catheterization; Urinary Tract Infections; Urine

In this article, we review the issues surrounding funguria and its management. With this background, the value of bladder irrigation with amphotericin B for the management of funguria is directly examined. Amphotericin B bladder irrigation is used frequently in clinical practice. Although its use is not standardized, there are multiple studies that attempt to show the impact on funguria management. These bladder irrigations have been used either for treatment of funguria or (less commonly) as a diagnostic test in attempts to identify upper urinary tract disease. Despite their widespread therapeutic use and relative safety, it is not clear from our experience and a review of the literature that amphotericin B bladder irrigations have any diagnostic or therapeutic value. The patient may be best served by removal of the urinary catheter, if possible, rather than by instillation of bladder irrigation with amphotericin B.

Topics: Amphotericin B; Antifungal Agents; Humans; Mycoses; Urinary Catheterization; Urinary Tract Infections

Systemic infection with Aspergillus fumigatus is an opportunistic disease that affects mainly immunocompromised hosts and is associated with a high mortality rate. We report a case of A. fumigatus endocarditis after an episode of thrombotic thrombocytopenic purpura. Diagnosis was established after sudden rupture of posterior papillary muscle of the normal native mitral valve. Soon after mitral valve replacement, Aspergillus endocarditis recurred, associated with multiple peripheral emboli, which necessitated a second operation.

Topics: Amphotericin B; Anti-Infective Agents; Aspergillosis; Aspergillus fumigatus; Candidiasis; Drug Resistance, Fungal; Embolism; Endocarditis; Fatal Outcome; Female; Heart Valve Prosthesis Implantation; Humans; Immunocompromised Host; Immunosuppressive Agents; Itraconazole; Lung Diseases, Fungal; Middle Aged; Mitral Valve Insufficiency; Opportunistic Infections; Papillary Muscles; Postoperative Complications; Prednisolone; Pseudomonas Infections; Purpura, Thrombotic Thrombocytopenic; Recurrence; Rupture, Spontaneous; Shock, Septic; Sputum; Ultrasonography; Urinary Tract Infections

Candida species are a common cause of urinary tract infection in newborns requiring intensive care. Renal candidiasis is frequently associated with these urinary tract infections and is manifest by "fungus balls" or renal parenchymal infiltration. Candidal urinary tract infections in high-risk newborns are often associated with candidemia, thereby warranting systemic antifungal therapy. Sonography is useful in diagnosing renal candidiasis, obstruction from "fungus balls," and abscesses. The sonographic appearance of "fungus balls" may persist long after clinical resolution of Candida infection in neonates and should not affect duration of antifungal therapy. Amphotericin B is currently the drug of choice for neonates with renal candidiasis and candidal urinary tract infection. Surgical management should be reserved for decompression of obstructive candidiasis and drainage of abscesses.

Topics: Amphotericin B; Antifungal Agents; Candidiasis; Cross Infection; Drainage; Humans; Infant, Newborn; Intensive Care Units, Neonatal; Kidney Diseases; Urinary Tract Infections

Recent findings on the epidemiology and treatment of funguria are reviewed. Funguria, or candiduria, is a common nosocomial condition and may develop as early as the first two weeks of hospitalization. Risk factors include antibacterial therapy, an indwelling urinary catheter, urologic procedures, female sex, diabetes, and immunosuppressive therapy. Candida albicans is the species most commonly isolated from the urine of infected patients. Spontaneous resolution of funguria is relatively infrequent. Furthermore, although nonpharmacologic measures, such as removing unnecessary antibacterials and changing or removing indwelling urinary catheters, may be beneficial, they are often inadequate without additional, pharmacologic therapy. The most serious complication of untreated asymptomatic funguria is candidemia. Bladder irrigations with amphotericin B have been the standard of therapy for many years; recently, the optimal concentration and method of irrigation (continuous versus intermittent) have been debated. Studies indicate that intravesical amphotericin B and oral fluconazole therapy are each effective in clearing funguria. Intravesical amphotericin B appears to act more rapidly; however, the effect of systemic fluconazole therapy often persists longer than that of amphotericin B irrigation, and oral therapy is more convenient and less expensive. Oral fluconazole appears to have a more delayed but more lasting effect on funguria than amphotericin B bladder irrigation. Studies are needed to determine whether intravesical amphotericin B still has a role in the treatment of funguria and to refine strategies involving fluconazole.

Topics: Amphotericin B; Antifungal Agents; Candidiasis; Cross Infection; Female; Fluconazole; Humans; Male; Sex Factors; Urinary Catheterization; Urinary Tract Infections

The antimicrobial management of patients in the critical care unit is complex. Not only must the clinician be familiar with a number of clinical, microbiological, pharmacological, and epidemiological observations but also fundamental pharmacodynamic concepts. It is an understanding of these concepts that forms the basis for the design of dosing strategies that maximize clinical efficacy and minimize toxicity. Antimicrobial selection is further complicated by the plethora of new antimicrobial agents available with varying clinical utility. Nowhere is this more evident than in the quinolone class of antibiotics. To aid the clinician in differentiating between quinolones it now seems reasonable to create a classification system akin to the generation grouping applied to the cephalosporins. Our classification is based upon the pharmacodynamic principles discussed within this article.

Topics: Aminoglycosides; Amphotericin B; Anti-Bacterial Agents; Anti-Infective Agents; Antifungal Agents; Community-Acquired Infections; Cross Infection; Fluoroquinolones; Humans; Intensive Care Units; Mycoses; Pneumonia, Bacterial; Skin Diseases, Bacterial; Soft Tissue Infections; United States; Urinary Tract Infections

Genitourinary fungal infections have become increasingly common in clinical practice. We review the literature on such infections, emphasizing recognition of fungal disease, predisposing factors, pathogenesis, and approaches to therapy.

Topics: Amphotericin B; Aspergillosis; Blastomycosis; Candidiasis; Coccidioidomycosis; Cryptococcosis; Female; Genital Diseases, Female; Genital Diseases, Male; Histoplasmosis; Humans; Infant, Newborn; Male; Mycoses; Urinary Tract Infections

The literature on the clinical use of rifampicin in combination for the treatment of non-mycobacterial diseases is reviewed. From the published evidence, the most promising associations are, for staphylococcal infections, gentamicin, erythromycin, kanamycin and fusidic acid. In the field of Gram-negative infections, Psuedomonas-induced sepsis in particular, data are not so impressive but promising results have been obtained with the associated use of rifampicin and gentamicin or colistin. Some systemic fungal diseases may be successfully treated with rifampicin in combination with amphotericin-B. Although only few reports are available on this subject, the importance of such an application is stressed in view of the severity of these diseases and of the lack of appropriate treatments.

Topics: Amphotericin B; Cephalosporins; Chloramphenicol; Colistin; Drug Therapy, Combination; Endocarditis, Bacterial; Erythromycin; Gentamicins; Humans; Kanamycin; Lincomycin; Mycoses; Nalidixic Acid; Penicillins; Pseudomonas Infections; Respiratory Tract Infections; Rifampin; Staphylococcal Infections; Sulfamethoxazole; Tetracyclines; Trimethoprim; Urinary Tract Infections; Vancomycin

Although fungal urinary tract infections occur less frequently than bacterial urinary tract infections their incidence has increased during the last several decades and their clinical importance to the urologist should not be underestimated. Herein the pertinent literature on fungal urinary tract infections is reviewed, with emphasis on the predisposing factors, pathogenesis, host defense mechanisms and the clinical spectrum of the disease. An approach to the evaluation of positive cultures and therapy is presented.

Topics: Amphotericin B; Animals; Candida; Candidiasis; Female; Flucytosine; Genital Diseases, Female; Genital Diseases, Male; Humans; Male; Mice; Mycoses; Urinary Tract Infections

Topics: Actinomycosis; Amphotericin B; Aspergillosis; Biopsy; Blastomycosis; Candidiasis; Cystoscopy; Humans; Mycoses; Penicillins; Penicillium; Sporothrix; Surgical Procedures, Operative; United States; Urinary Tract Infections; Urography

Studies in experimental animals and humans have shown that Amphotericin B (AmB) persists in urine for days to weeks after a single IV dose in levels that should inhibit candidal organisms and thereby obviate the need for frequent dosing. Including data from four previously described patients, we have now treated a total of 11 patients (12 episodes) with Candida urinary tract infections with single-dose AmB (six, Candida albicans; two, C. tropicalis; four, other nonalbicans Candida). The duration of candiduria prior to entry ranged from 18 to 180 days. Predisposing conditions included renal transplantation (1), diabetes mellitus (8), genitourinary stones (1) or anomalies (4), catheterization (2), and antibacterial therapy (11). A single patient was intolerant of AmB. Out of 11 evaluable candiduric episodes, eight resolved. Failure occurred in one patient with a chronic indwelling bladder catheter and in the allograft recipient. The data suggest that the sustained urinary excretion of AmB may permit successful single- or paucidose therapy of Candida urinary tract infections in some patients with a minimum of toxicity.

Topics: Adult; Aged; Aged, 80 and over; Amphotericin B; Antifungal Agents; Candida; Candidiasis; Female; Humans; Injections, Intravenous; Male; Middle Aged; Urinary Tract Infections

Fungal urinary tract infections are increasingly prevalent in the elderly in acute and chronic care settings. This randomized trial compares the efficacy and safety of oral fluconazole with the efficacy and safety of bladder irrigation with amphotericin B for treatment of funguria (> or = 10,000 cfu/mL of urine) in 109 hospitalized elderly patients. A second treatment course was given for persistent funguria. Indwelling bladder catheters were present in 69% of the patients. While Candida albicans was the predominant isolate from catheterized patients, C. albicans, Candida tropicalis, and Torulopsis glabrata were recovered from noncatheterized patients. Two days after completion of treatment, funguria was eradicated in 96% of the patients treated with amphotericin B and 73% of those treated with fluconazole (P < .05). At 1 month after study enrollment, the mortality rate associated with all causes was greater among patients who were treated with amphotericin B bladder irrigation than among those who received oral fluconazole therapy (41% vs. 22%, respectively; P < .05); this finding suggests that local therapy may be associated with poorer survival. The proportion of patients without funguria at 1 month after study enrollment was similar in the two treatment groups (84%, amphotericin B group; 80%, fluconazole group). A few minor and mild adverse events occurred.

Topics: Administration, Oral; Aged; Aged, 80 and over; Amphotericin B; Candidiasis; Combined Modality Therapy; Female; Fluconazole; Follow-Up Studies; Humans; Male; Therapeutic Irrigation; Treatment Outcome; Urinary Bladder; Urinary Tract Infections

The efficacy of continuous versus intermittent bladder irrigation with amphotericin B in the treatment of candiduria was compared.. A prospective, randomized and comparative pilot study was done on 20 patients. Continuous bladder irrigation with 50 mg./l. amphotericin B infused during 24 hours for 2 days was compared to 3 intermittent bladder irrigations of 10 mg./100 ml. amphotericin B in 1 day. Urine cultures were obtained 72 hours after treatment.. The organism was eradicated in 8 patients (80%) who received continuous irrigation and 3 (30%) who received intermittent irrigation (p = 0.035).. Continuous amphotericin B bladder irrigation was superior in terms of efficacy, ease of administration and patient comfort.

Topics: Aged; Aged, 80 and over; Amphotericin B; Antifungal Agents; Candida; Humans; Male; Middle Aged; Pilot Projects; Prospective Studies; Therapeutic Irrigation; Urinary Bladder; Urinary Tract Infections; Urine

Fungal urinary tract infection has become a frequent clinical entity. Despite limited evaluation of its efficacy, bladder irrigation with amphotericin B has become the usual means of therapy for such infections. The outcome of treatment with amphotericin B bladder irrigation for an average of 5 days for 95 hospitalized patients with funguria (mean age, 75 years) during a 14-month period is presented. All patients who received treatment were identified from pharmacy records; those for whom urine culture results were obtained after treatment were studied. Fever and/or pyuria was identified in the majority of cases. Funguria was eradicated in 80% (confidence interval, 72%-88%). Concomitant diabetes mellitus or the previous use of indwelling bladder catheters did not alter response to treatment. The mortality rate following treatment of funguria was 39%, compared to 30.5% for a similar population during the same period. Amphotericin B bladder irrigation may not prove to be ideal therapy despite the fact that it initially eradicated funguria in the majority of subjects in this study.

Topics: Administration, Intravesical; Aged; Amphotericin B; Diabetes Complications; Female; Humans; Male; Middle Aged; Mycoses; Retrospective Studies; Risk Factors; Urinary Catheterization; Urinary Tract Infections

The significance of candiduria in critically ill patients remains unclear. It may represent harmless colonization or a potentially life-threatening infection. We analyzed 47 patients in the surgical intensive care unit (SICU) (trauma: 20, general surgery: 15, neurosurgery: 12) who had candiduria, defined by a colony count greater than 100,000/mL. Twenty-seven of these patients were studied retrospectively. Twenty were evaluated prospectively. All patients were receiving broad-spectrum antibiotics for bacterial infections. Retrospective group: ten patients (group A) did not develop disseminated candidiasis, whereas 17 patients (group B) did. Group B had higher APACHE II scores on admission (13.4 +/- 7.8) and at the time of candiduria (13.7 +/- 4.4) when compared with group A [admission: 5.0 +/- 4.6; candiduria: 6.7 +/- 3.6 (p < 0.02)]. In group B, disseminated candidiasis was not diagnosed and treated until 9.9 +/- 4.4 days after development of candiduria. Prospective group: twenty patients with candiduria were treated with systemic fluconazole (group C) at the time of candiduria. The APACHE II scores of group C on admission (12.8 +/- 3.9) and at the time of candiduria (10.5 +/- 4.0) were comparable with those of group B. No patient in Group C developed disseminated candidiasis. The septic mortality rates of groups A, B, and C were 0%, 53%, and 5%, respectively (p < 0.05-0.0001). In patients exhibiting ongoing sepsis and organ failure (high APACHE scores), candiduria may be an early indicator of systemic infection. Diagnosis of disseminated infection and its treatment may be delayed if conventional criteria for candidiasis (positive blood cultures, multiple site isolation) are awaited.(ABSTRACT TRUNCATED AT 250 WORDS)

Topics: Adult; Aged; Amphotericin B; Bacterial Infections; Candidiasis; Cause of Death; Colony Count, Microbial; Critical Illness; Cross Infection; Fluconazole; Fungemia; Hospital Mortality; Humans; Infection Control; Infusions, Intravenous; Middle Aged; Prospective Studies; Retrospective Studies; Risk Factors; Severity of Illness Index; Superinfection; Therapeutic Irrigation; Urinary Tract Infections; Urine

To study the effect of enterally administered polymyxin E, tobramycin, and amphotericin B (selective flora suppression) on bacterial colonization, infection, resistance, and mortality rate.. Prospective, consecutive crossover controlled study.. Two surgical ICUs in a university hospital; ICU I with ten beds, ICU II with eight beds.. Two hundred patients entered the 1-yr trial. Fifty of 111 patients received selective flora suppression during the first 6 months in ICU I (test group), while 61 of 111 patients served as the control group in the following 6 months. In ICU II, 49 of 89 patients received no selective flora suppression in the first 6 months (control group), followed by 40 of 89 patients receiving selective flora suppression during the second 6-month period (test group).. The test group got a mixture of nonabsorbable antibiotics (paste and suspension) in the digestive tract. The control group received paste and suspension without antimicrobial agents. All 200 patients received cefotaxime during the first 4 days.. With the use of selective flora suppression, colonization with aerobic Gram-negative bacilli was significantly (p less than .01) reduced. There was also a significant reduction in nosocomial bronchopulmonary (ICU I and II; p less than .001) and urinary tract (ICU II; p less than .001) infections. The difference in mortality was not significant. There was no development of resistance against the antibiotics used during the limited period evaluated.. Selective flora suppression is effective in reducing secondary colonization by aerobic Gram-negative bacilli. Reduction of bronchopulmonary and urinary tract infections most likely occurs with colonization prevention.

Topics: Administration, Oral; Adult; Aged; Amphotericin B; Bacterial Infections; Bronchopneumonia; Colistin; Critical Care; Cross Infection; Female; Gram-Negative Aerobic Bacteria; Humans; Intensive Care Units; Male; Middle Aged; Mortality; Mouth; Ointments; Prospective Studies; Sepsis; Suspensions; Tobramycin; Urinary Tract Infections

The question to be answered in this study was: Is prophylactic selective florasuppression advantageous compared to conventional antibiotic policy as far as microbial colonisation, infection, mortality and development of resistance are concerned? A prospective, consecutive, placebo-controlled study in two ICU's was carried out during four 6-months periods. 200 patients who were intubated for at least 3 days, required intensive care for a minimum of 5 days, and belonged to either class III or IV according to the "Therapeutic Intervention Scoring System" were included in the study. They received either placebo or the prophylaxis regimen described by Stoutenbeek et al., consisting of polymyxin E, tobramycin and amphotericin B. Oropharyngeal, tracheobronchial and rectal colonisation with aerobic gram-negative bacilli markedly decreased in the test groups. The rates of nosocomial bronchopulmonary infections (ICU I and II) and urinary tract infections (ICU II) were significantly reduced. There was no significant reduction in wound infection, septicaemia and mortality rates. No development of resistance and no increase of multi-resistant strains occurred. Selective florasuppression is effective in reducing infection rates in critically ill patients without development of resistant strains.

Topics: Adult; Aged; Amphotericin B; Bacterial Infections; Bronchopneumonia; Clinical Trials as Topic; Colistin; Cross Infection; Drug Therapy, Combination; Female; Humans; Intensive Care Units; Male; Prospective Studies; Risk Factors; Sepsis; Surgical Wound Infection; Tobramycin; Urinary Tract Infections

Topics: Adolescent; Adult; Amphotericin B; Ampicillin; Cadaver; Cephalosporins; Cephradine; Clinical Trials as Topic; Colistin; Drug Therapy, Combination; Humans; Kidney Transplantation; Middle Aged; Postoperative Complications; Urinary Tract Infections

To determine the incidence of hematogenous candida endophthalmitis in seriously ill patients given parenteral hyperalimentation fluids, 131 hyperalimented postoperative patients were prospectively evaluated. All patients were screened weekly for the development of chorioretinal lesions, blood cultures positive for Candida albicans, and signs and symptoms of candida infection. Thirteen (9.9%) of 131 patients developed chorioretinal lesions compatible with hematogenous candida endophthalmitis. Seven of the 13 patients with eye lesions had blood cultures positive for yeast, whereas only two of 118 without eye lesions had blood cultures positive for yeast (P less than 0.0005). Thus, the occurrence of eye lesions consistent with hematogenous candida endophthalmitis correlated with positive blood cultures for yeast and strongly suggested invasive candidiasis.

Topics: Amphotericin B; Candidiasis; Candidiasis, Oral; Chorioretinitis; Culture Media; Endophthalmitis; Gastrointestinal Hemorrhage; Humans; Intertrigo; Parenteral Nutrition; Parenteral Nutrition, Total; Urinary Tract Infections; Wound Infection

Mucormycosis is a rare fungal infection often seen in immunocompromised hosts. Isolated renal mucormycosis may however present in immunocompetent children as renal failure and has a uniformly poor prognosis if not detected and treated early into the course of illness. We present a 3-year-old boy with unrelenting pyelonephritis in whom serial urine cultures done were negative. A final diagnosis of isolated renal mucormycosis was made by magnetic resonance imaging and renal biopsy.

Topics: Abdominal Pain; Amphotericin B; Antifungal Agents; Child, Preschool; Dialysis; Fever; Humans; Kidney; Kidney Failure, Chronic; Magnetic Resonance Imaging; Male; Mucorales; Mucormycosis; Pyelonephritis; Treatment Outcome; Triazoles; Urinary Tract Infections; Vomiting

Amphotericin B (AmB) is one of the most used drugs for the treatment of systemic fungal infections; however, the treatment causes several toxic manifestations, including nephrotoxicity and hemolytic anemia. Chitosan-coated poly(lactide-co-glycolide) (PLGA) nanoparticles containing AmB were developed with the aim to decrease AmB toxicity and propose the oral route for AmB delivery. In this work, the antifungal efficacy of chitosan-coated PLGA nanoparticles containing AmB was evaluated in 20 strains of fungus isolates from patients with vulvovaginal candidiasis (01 Candida glabrata and 03 Candida albicans), bloodstream infections (04 C. albicans and 01 C. tropicalis) and patients with urinary tract infection (04 Candida albicans, 02 Trichosporon asahii, 01 C. guilhermondii, 03 C. glabrata) and 01 Candida albicans ATCC 90028. Moreover, the cytotoxicity over erythrocytes was evaluated. The single-emulsion solvent evaporation method was suitable for obtaining chitosan-coated PGLA nanoparticles containing AmB. Nanoparticles were spherical in shape, presented mean particle size about 460 nm, positive zeta potential and encapsulation efficiency of 42%. Moreover, nanoparticles prolonged the AmB release. All the strains were susceptible to plain AmB and nanostructured AmB, according to EUCAST breakpoint version 8.1 (resistant > 1 μg/mL), using broth microdilution method. In C. albicans (urine, blood, and vulvovaginal secretion isolates, and 1 ATCC), the MIC value of AmB-loaded nanoparticles varied from 0.25 to 0.5 μg/mL and EUCAST varied from 0.03 to 0.5 μg/mL. In urine and vulvovaginal secretion isolates of C. glabrata, the MIC value of AmB-loaded nanoparticles varied from 0.25 to 0.5 μg/mL and EUCAST varied from 0.03 to 0.015 μg/mL. In urine isolates of C. guilhermondii, the MIC value of AmB-loaded nanoparticles was 0.12 μg/mL and EUCAST was 0.06 μg/mL. In blood isolates of C. tropicalis, the MIC value of AmB-loaded nanoparticles was 0.5 μg/mL and EUCAST was 0.25 μg/mL. Finally, in urine isolates of T asahii, the MIC value of AmB-loaded nanoparticles was 1 μg/mL and EUCAST varied from 0.5 to 1 μg/mL. In the cytotoxicity assay, plain AmB was highly hemolytic (100% in 24 h) while AmB-loaded chitosan/PLGA nanoparticles presented negligible hemolysis.

Topics: Amphotericin B; Animals; Antifungal Agents; Candida; Candidemia; Candidiasis, Vulvovaginal; Chitosan; Drug Carriers; Female; Humans; Lactic Acid; Microbial Sensitivity Tests; Nanoparticles; Polyglycolic Acid; Polylactic Acid-Polyglycolic Acid Copolymer; Trichosporon; Urinary Tract Infections

To determine the prevalence and antifungal susceptibility pattern of Candida species.. This prospective, cross-sectional study was conducted at the Quaid-e-Azam International Hospital, Islamabad, Pakistan, from January 2014 to February 2015, and comprised different clinical samples which were analysed for various types of microbial infections. Species differentiation was confirmed by biochemical and molecular methods. Antifungal susceptibility against amphotericin B, fluconazole and voriconazole was determined by Clinical and Laboratory Standards Institute M44-A disk diffusion method.. Of the 219 Candida isolates, majority of them were isolated from urine 78(35.6%) and vaginal swabs 59(26.9%). Moreover, 144(65.8%) samples were of females and 75(34.2%) were of males. Candida albicans 128(58.45%) was the most predominant species followed by Candida glabrata 30(13.69%), Candida tropicalis 26(11.87%), Candida krusei 17(7.76%), Candida parapsilosis 12(5.47%), Candida dubliniensis 3(1.37%) and Candida lusitaniae 3(1.37). All isolates were least susceptible to amphotericin B with a susceptibility rate of 213(97.26%). The highest resistance was found for voriconazole 40(18.26%) compared to fluconazole 32(14.61%).. Candida species possessed high resistance rate against various antifungal agents.

Topics: Adolescent; Adult; Amphotericin B; Antifungal Agents; Candida; Candida albicans; Candida glabrata; Candida parapsilosis; Candida tropicalis; Candidiasis; Candidiasis, Vulvovaginal; Child; Child, Preschool; Cross-Sectional Studies; Drug Resistance, Fungal; Female; Fluconazole; Humans; Infant; Infant, Newborn; Inpatients; Male; Microbial Sensitivity Tests; Middle Aged; Molecular Epidemiology; Outpatients; Pakistan; Prevalence; Prospective Studies; Respiratory Tract Infections; Tertiary Care Centers; Urinary Tract Infections; Voriconazole; Young Adult

The aim of this study was to identify Candida spp. isolated from candiduria episodes at a tertiary hospital in the Midwest region of Brazil, and to determine their susceptibility profiles to antifungal compounds. From May 2011 to April 2012, Candida spp. isolated from 106 adult patients with candiduria admitted to the University Hospital of the Federal University of Mato Grosso do Sul were evaluated. Both, species identification and susceptibility testing with fluconazole-FLC, voriconazole-VRC, and amphotericin B-AmB were carried out using the Vitek 2. To discriminate species of the C. parapsilosis complex, a RAPD-PCR technique using the RPO2 primer was performed. From the total of 106 isolates, 42 (39.6%) C. albicans and 64 (60.4%) Candida non-albicans (CNA) - 33 C. tropicalis, 18 C. glabrata, 5 C. krusei, 4 C. parapsilosis sensu stricto, 2 C. kefyr, 1 C. lusitaniae, and 1 C. guilliermondii were identified. All isolates were susceptible to AmB and VRC, whereas all C. glabrata isolates presented either resistance (5.6%) or dose-dependent susceptibility (94.4%) to FLC. The study of Candida spp. and their resistance profiles may help in tailoring more efficient therapeutic strategies for candiduria.

Topics: Adult; Aged; Aged, 80 and over; Amphotericin B; Antifungal Agents; Brazil; Candida; Candidiasis; Drug Resistance, Fungal; Electrophoresis, Agar Gel; Female; Fluconazole; Hospitals, University; Humans; Male; Microbial Sensitivity Tests; Middle Aged; Random Amplified Polymorphic DNA Technique; Treatment Outcome; Urinary Tract Infections; Voriconazole; Young Adult

Funguria occurs often in hospitalized patients and is most commonly caused by Candida species. Fluconazole is the agent of choice for most Candida urinary tract infections. Amphotericin B bladder irrigations (ABBI) are an alternative treatment option.. The purpose of this study is to assess the efficacy of ABBI compared to fluconazole for the treatment of candiduria in the intensive care unit (ICU) setting.. We conducted a retrospective chart review of patients admitted to ICUs at our institution with a positive urine culture for Candida species between 2005 and 2012. All patients receiving ABBI were included; patients receiving fluconazole for treatment of candiduria were matched by year. The primary endpoint was achievement of cure.. There was no difference in cure between the ABBI and fluconazole groups (59.6% vs. 52.8%, p = 0.55). Clearance was higher in patients receiving ABBI (92.3% vs. 67.9%, p < 0.001). Logistic regression found that renal dysfunction predicted greater cure with ABBI therapy compared to fluconazole (OR 7.63, 95% CI 1.81-32.1).. ABBI was equally efficacious in achieving overall cure, and resulted in greater clearance of candiduria compared to fluconazole. ABBI may be considered an alternative to fluconazole for the treatment of candiduria and may be preferred over fluconazole in patients with renal dysfunction.

Topics: Adult; Aged; Amphotericin B; Anti-Bacterial Agents; Antifungal Agents; Candidiasis; Cross Infection; Female; Fluconazole; Humans; Intensive Care Units; Male; Middle Aged; Retrospective Studies; Therapeutic Irrigation; Treatment Outcome; Urinary Bladder; Urinary Tract Infections

Recent publications suggest the distribution of Candida species causing candiduria may vary geographically, which has implications for the continued efficacy of antifungal therapy and emerging resistance.. To investigate the incidence of Candiduria at a university hospital in the UK. Further, to assess the distribution of species and the accompanying antifungal susceptibility profile, in order to monitor the clinical utility of current antifungal treatment guidelines for candiduria so that patients receive the best possible outcomes from the most up to date care.. Retrospective audit.. From 1st January 2005 to 31st October 2014, we retrospectively reviewed 37 538 positive urine cultures recorded in a computerized laboratory results database. Identification and susceptibility testing was performed using the VITEK® 2 fungal susceptibility card (bioMérieux, Marcy d'Etoile, France).. In total, 96 cultures were positive for Candida species, of which 69 (72%) were C.albicans, which translates to a prevalence of 2.6 per 1000 positive urine cultures. Candiduria was more common in younger patients, males and catheterized females. We report 94 and 73% of isolates of C.albicans and other non-C.albicans Candida species were susceptible to fluconazole. All isolates were susceptible to amphotericin B.. Our results add weight to the evidence supporting current European and North American guidelines recommending fluconazole or amphotericin B for treatment of candiduria, if antifungal treatment is clinically indicated.

Topics: Adult; Amphotericin B; Antifungal Agents; Candida; Candidiasis; Drug Resistance, Fungal; Fluconazole; Flucytosine; Humans; Microbial Sensitivity Tests; Species Specificity; United Kingdom; Urinary Tract Infections

Candida spp. are the most common opportunistic mycosis worldwide. Although Candida albicans is the most common cause of urinary tract infections, the frequency of non-albicans Candida species is increasing with common use of antifungal in the prophylaxis and treatment. This may lead to difficulties in treatment. Antifungal tests should be applied with identification of species for effective treatment. In this study, identification of Candida species isolated from urine culture and investigation of susceptibility of these strains to amphotericin B, flucytosine, fluconazole, voriconazole was aimed. In this study, 58 Candida strains isolated from urine cultures at Osmaniye State Hospital between January 2012 and April 2013 were included. Urine culture and antifungal susceptibility tests were applied. Incidence rate of Candida spp. was determined as C. albicans (56.9%), Candida glabrata (20.6%), Candida tropicalis (10.3%), Candida parapsilosis (7%), Candida krusei (3.4%), Candida kefyr (1.8%). Most of the isolates were susceptible to amphotericin B, flucytosine, fluconazole, voriconazole. Twenty three (39.7%) Candida strains were isolated from internal medical branches and Intensive Care Unit and 12 (20.6%) from the Surgical Medical Branches. C. albicans and C. glabrata species were isolated most frequently as a candiduria factor in this hospital between January 2012 and April 2013. The analysis of antifungal susceptibility profile shows no significant resistance to antifungals.

Topics: Adult; Amphotericin B; Antifungal Agents; Candida; Candidiasis; Drug Resistance, Fungal; Female; Fluconazole; Humans; Male; Middle Aged; Urinary Tract Infections; Young Adult

Phaeohyphomycosis is a heterogeneous group of opportunistic infections caused by dematiaceous molds, which are distributed worldwide as plant pathogens but rarely cause human diseases. However, due to the growing populations of immunocompromised patients, these fungi are frequently recognized as important human pathogens. We are reporting this very rare, unique case for the first time from Islamabad, Pakistan, describing the association of visceral Phaeohyphomycosis caused by the opportunistic fungus Alternaria alternata, affecting the left kidney, with the immunocompromised state in a young incidentally detected patient with insulin-dependent type I diabetes. The case was diagnosed on the basis of a high index of clinical suspicion, microbial cultures, microscopy, imaging studies and endourological procedures. The patient did not respond well to the highly sensitive Amphotericin B, resulting in loss of the kidney. Therefore, we suggest that clinicians involved in treating immunocompromised patients should have a high degree of clinical suspicion for such opportunistic pathogens to allow timely initiation of the correct diagnostic and therapeutic work-up.

Topics: Alternaria; Amphotericin B; Antifungal Agents; Diabetes Mellitus, Type 1; Humans; Hydronephrosis; Hypoglycemic Agents; Immunocompromised Host; Insulin; Male; Nephrectomy; Opportunistic Infections; Phaeohyphomycosis; Predictive Value of Tests; Risk Factors; Treatment Outcome; Urinary Tract Infections; Young Adult

Trichosporon asahii is a basidiomycete yeast responsible for white piedra and onychomycosis in the immunocompetent host. In the immunocompromised patients, invasive infections are reported; their diagnosis is difficult and they are associated with high mortality rate. Urinary infection due to Trichosporon Asahi is rare but its incidence increasing. We report the case of a 58 year old diabetic patient. The yeast was isolated from urine samples of three consecutive crops in pure form. The patient improved after antifungal therapy.

Topics: Acute Kidney Injury; Amphotericin B; Antifungal Agents; Diabetes Mellitus, Type 1; Humans; Immunocompromised Host; Male; Middle Aged; Opportunistic Infections; Trichosporon; Trichosporonosis; Urinary Tract Infections; Urine; Virulence

To determine the proportion of albicans and non-albicans candiduria in a hospital setting and to ascertain if fluconazole is still suitable as empirical antifungal therapy based on antifungal susceptibility patterns of Candida species.. The cross-sectional study was conducted between December 2010 and December 2011 at UKM Medical Centre, Kuala Lumpur, Malaysia and comprised 64 urine samples from patients who were either suspected or confirmed to have urinary tract infections. Yeasts were speciated using ID 32 C and subjected to antifungal susceptibility testing using Sensititre® YeastOne YO8.. Candida albicans accounted for 38(59.4%) of the isolates, Candida tropicalis 18(28.1%), Candida glabrata 6(9.4%) and Candida parapsilosis 2(3.1%). Overall, the isolates were susceptible to both amphotericin B (MIC90 1 μg/ml) and to 5-flucytosine (MIC90 0.25 μg/ml), but susceptible-dose dependent towards fluconazole (MIC90 16 μg/ml). Individually, Candida albicans was susceptible to fluconazole (MIC90 2 μg/ml), amphotericin B (MIC90 0.5 μg/ml) and 5-flucytosine (MIC90 0.25 μg/ml). Candida tropicalis was also susceptible to fluconazole (MIC90 4 μg/ml), amphotericin B (MIC90 1 μg/ml) and 5-flucytosine (MIC90 0.125 μg/ml). Candida glabrata was resistant to fluconazole (MIC90 64 μg/ml), but susceptible to amphotericin B (MIC90 1 μg/ml) and 5-flucytosine (MIC90 0.125 μg/ml). Lastly, Candida parapsilosis was resistant to fluconazole (MIC90 256 μg/ml), but susceptible to amphotericin B (MIC90 0.5 μg/ml) and 5-flucytosine (MIC90 0.5 μg/ml).. The commonest yeast associated with candiduria at the study site was Candida albicans, and fluconazole can still be used for empirical therapy of candiduria.

Topics: Amphotericin B; Antifungal Agents; Candida albicans; Candidiasis; Cross-Sectional Studies; Dose-Response Relationship, Drug; Fluconazole; Humans; Malaysia; Microbial Sensitivity Tests; Urinary Tract Infections

Urinary tract infection (UTI) caused by Candida spp. is an increasing problem in clinical practice. Risk factors include diabetes mellitus, extremes of age, urinary tract abnormalities and indwelling catheters. Here, we determined the applicability of isothermal microcalorimetry (IMC) for the detection and antifungal drug susceptibility testing of Candida albicans in artificial urine.. Isothermal microcalorimetry was used to monitor the metabolic heat production rates of C. albicans at 37 °C (μW = μJ s(-1) ). The influence of increasing concentrations of glucose and antifungal drugs on the growth of C. albicans was investigated. The growth rate increased linearly from 0.024 ± 0.010 to 0.203 ± 0.006 h(-1) with increasing concentration of glucose from 20 to 1640 mg l(-1) . The minimum inhibitory concentrations (MIC) against C. albicans were determined at a fixed glucose concentration of 560 mg l(-1) . These MIC were 0.5 μg ml(-1) for amphotericin B, 5 μg ml(-1) for flucytosine, 0.8 μg ml(-1) for fluconazole and 0.5 μg ml(-1) for tioconazole, respectively.. IMC is able to detect and quantify growth of C. albicans in artificial urine and to determine the MIC of antifungal drugs against C. albicans. This study demonstrated that IMC can be used for basic research on Candida-UTI and opens promising avenue for the use of IMC as rapid drug resistance screening tool and diagnostic tool.. Little is known on the growth of C. albicans in urine. Our study provides measurements of the growth rate of this yeast in urine with various glucose concentrations. Thus, important insights are gathered for risk group such as patients with diabetes or patients with prolonged parenteral nutrition resulting in higher urinary glucose concentration.

Topics: Amphotericin B; Antifungal Agents; Calorimetry; Candida albicans; Fluconazole; Flucytosine; Glucose; Humans; Imidazoles; Microbial Sensitivity Tests; Urinary Tract Infections; Urine

The purpose of this investigation was to assess the prevalence of upper urinary tract involvement in patients with candiduria by means of (111)indium-oxine-labeled leukocyte scintigraphy. An observational cohort study of patients with confirmed candiduria was conducted in an acute-care teaching hospital in Spain from March 2006 through February 2009. An (111)In-labeled leukocyte scan was performed in order to assess the upper urinary tract involvement. A series of non-matched patients without candiduria nor bacteriuria undergoing scintigraphy to exclude infections in other sites than the urinary tract was also studied. Demographics, baseline illness, and clinical data were recorded. Candiduria was detected in 428 patients, and scintigraphy was performed in 35 of these patients. Twenty-nine patients without candiduria nor bacteriuria were also studied. Positive renal scintigraphy was documented in 24 (68%) patients with confirmed candiduria and in 3 (10%) patients without candiduria (p < 0.005). Renal uptake was not associated with a higher mortality nor with re-admissions. Subclinical pyelonephritis could be more frequent in patients with candiduria than it has been previously considered.

Topics: Aged; Aged, 80 and over; Amphotericin B; Candida; Candidiasis; Cohort Studies; Female; Humans; Indium; Male; Middle Aged; Prevalence; Pyelonephritis; Radionuclide Imaging; Spain; Urinary Tract; Urinary Tract Infections

A 67-year-old man developed dysuria and position-dependent obstructive voiding symptoms after undergoing holmium laser ablation of the prostate (HOLAP) for benign prostatic hypertrophy. A large fungal (candidal) ball adherent to the bladder wall was removed by loop excision, but the bezoar recurred in 2 weeks despite systemic fluconazole and intravesical amphotericin B. A second attempt at endoscopic removal with ultrasonic lithotripsy, endoscopic graspers, and fulguration was also unsuccessful. The patient underwent open partial cystectomy to remove his invasive fungal bezoar. Convalescence was unremarkable. Urinalysis, culture, and follow-up cystoscopy after partial cystectomy demonstrated successful definitive treatment of the fungal ball.

Topics: Aged; Amphotericin B; Antifungal Agents; Bezoars; Candidiasis; Combined Modality Therapy; Cystectomy; Cystoscopy; Dysuria; Electrocoagulation; Fluconazole; Humans; Laser Therapy; Lasers, Solid-State; Lithotripsy; Male; Postoperative Complications; Prostatic Hyperplasia; Recurrence; Urinary Bladder; Urinary Tract Infections

Systemic Candidia infections are of major concern in neonates, especially in those with risk factors such as longer use of broad spectrum antibiotics. Recent studies showed that also term babies with underlying gastrointestinal or urinary tract abnormalities are much more prone to systemic Candida infection. We report a very rare case of candidiasis caused by Candida kefyr in a term neonate.. Renal agenesis on the left side was diagnosed antenatally and anal atresia postnatally. Moreover, a vesico-ureteral-reflux (VUR) grade V was detected by cystography. The first surgical procedure, creating a protective colostoma, was uneventful. Afterwards our patient developed urosepsis caused by Enterococcus faecalis and was treated with piperacillin. The child improved initially, but deteriorated again. A further urine analysis revealed Candida kefyr in a significant number. As antibiotic resistance data about this non-albicans Candida species are limited, we started liposomal amphotericin B (AMB), but later changed to fluconazole after receiving the antibiogram. Candiduria persisted and abdominal imaging showed a Candida pyelonephritis. Since high grade reflux was prevalent we instilled AMB into the child's bladder as a therapeutic approach. While undergoing surgery (creating a neo-rectum) a recto-vesical fistula could be shown and subsequently was resected. The child recovered completely under systemic fluconazole therapy over 3 months.. Candidiasis is still of major concern in neonates with accompanying risk factors. As clinicians are confronted with an increasing number of non-albicans Candida species, knowledge about these pathogens and their sensitivities is of major importance.

Topics: Amphotericin B; Antifungal Agents; Anus, Imperforate; Candida; Candidiasis; Congenital Abnormalities; Enterococcus faecalis; Fluconazole; Gram-Positive Bacterial Infections; Humans; Infant, Newborn; Kidney; Kidney Diseases; Sepsis; Treatment Outcome; Urinary Tract Infections; Urine; Vesico-Ureteral Reflux

Trichosporon asahii is the causative agent of both superficial and deep-seated infections of increasing morbidity and mortality. Urinary tract infections (UTIs) due to T. asahii, frequently associated with indwelling medical devices, have been reported over the years. However, few studies have specifically focused on the genotypic diversity of T. asahii isolates from urine specimens from intensive care units (ICUs), let alone potential virulence factors and antifungal susceptibility testing. In the present study, 23 T. asahii isolates were collected from UTI patients in ICUs between January 2008 and January 2012. Three genotypes (I, III, IV) were determined based on the combination of internal transcribed spacer and intergenic spacer locus PCR. Protease, phospholipase and haemolysin production was assessed by halo formation on corresponding agar plates. Only haemolytic activity was observed to varying degrees. Neither protease nor phospholipase was detectable. Biofilm formation on polystyrene surfaces was detected through a formazan salt reduction assay. All clinical isolates had the ability to form biofilm. In contrast to the susceptibility of planktonic T. asahii cells to clinically used amphotericin B, 5-flucytosine, fluconazole, itraconazole and voriconazole, a remarkable rise in the MICs of these for biofilm T. asahii cells was observed. Our results suggested that genotype IV was the most prevalent genotype among T. asahii isolates from ICUs in China. Haemolysin and biofilm might contribute to the pathogenicity and recurrence of T. asahii-related UTIs. Although triazoles, especially voriconazole, were effective against planktonic T. asahii cells, they failed to treat preformed biofilms.

Topics: Aged; Aged, 80 and over; Amphotericin B; Antifungal Agents; Cross Infection; DNA, Fungal; DNA, Intergenic; Drug Resistance, Multiple, Fungal; Female; Flucytosine; Genetic Variation; Genotype; Hemolysin Proteins; Humans; Intensive Care Units; Male; Microbial Sensitivity Tests; Peptide Hydrolases; Phospholipases; Pyrimidines; Triazoles; Trichosporon; Trichosporonosis; Urinary Tract Infections; Virulence Factors; Voriconazole

The aims of this study were to analyse the amphotericin B and fluconazole susceptibility and molecular epidemiology of Candida strains (Candida albicans, Candida tropicalis and Candida glabrata) isolated from the urine samples of patients hospitalized in the intensive care unit. Identification of the isolates was done according to microscopic morphology (chlamydospor, blastospor, pseudohyphae and true hyphae) on cornmeal agar, germ tube formation and carbohydrate assimilation patterns (API ID 32C bioMérieux, France). Antifungal susceptibilities of the isolates were determined by in vitro broth microdilution method recommended by Clinical and Laboratory Standards Institute (CLSI). To investigate the clonal relationship of the isolates, randomly amplified polymorphic DNA (RAPD) analysis was performed by using Cnd3 primer. Of the 56 Candida isolates minimum inhibitory concentration (MIC) ranges, MIC50 and MIC90 values for amphotericin B were 0.125-1 µg/ml, 0.125 and 0.5 µg/ml for C.albicans, 0.125-1 µg/ml, 0.25 and 1 µg/ml for C.tropicalis and 0.125-1 µg/ml, 0.25 and 1 µg/ml for C.glabrata, respectively. Fluconazole MIC ranges, MIC50 and MIC90 values were 0.25-4 µg/ml, 0.25 and 0.5 µg/ml for C.albicans, 0.25-16 µg/ml, 0.5 and 1 µg/ml for C.tropicalis and 0.5-64 µg/ml, 8 and 16 µg/ml for C.glabrata, respectively. For amphotericin B, none of the isolates had high MIC values (MIC > 1 µg/ml). While one of the C.glabrata isolates was resistant to fluconazole (MIC ≥ 64 µg/ml), one C.tropicalis and two C.glabrata isolates were dose-dependent susceptible (MIC: 16-32 µg/ml). The results of RAPD analysis indicated an exogenous spread from two clones for C.albicans, one clone for C.glabrata and one clone for C.tropicalis. This study underlines the importance of molecular epidemiological analysis of clinical samples together with hospital environmental samples in terms of Candida spp. To determine the exogenous origin for the related strains and to prevent nosocomial Candida infections.

Topics: Amphotericin B; Antifungal Agents; Candida; Candidiasis; DNA, Fungal; Female; Fluconazole; Humans; Intensive Care Units; Male; Microbial Sensitivity Tests; Molecular Epidemiology; Random Amplified Polymorphic DNA Technique; Turkey; Urinary Tract Infections; Urine

In many instances a report from the clinical laboratory indicating candiduria represents colonization or procurement contamination of the specimen and not invasive candidiasis. Even if infection of the urinary tract by Candida species can be confirmed, antifungal therapy is not always warranted. Further investigation may reveal predisposing factors, which if corrected or treated, result in the resolution of the infection. For those with symptomatic urinary tract infections (UTIs), the choice of antifungal agent will depend upon the clinical status of the patient, the site of infection, and the pharmacokinetics and pharmacodynamics of the agent. Because of its safety, achievement of high concentrations in the urine, and availability in both an oral and intravenous formulation, fluconazole is preferred for the treatment of Candida UTIs. Flucytosine is concentrated in urine and has broad activity against Candida spp, but its use requires caution because of toxicity. Low-dose amphotericin B may be useful for Candida UTIs in selected patients. The role of echinocandins and azoles that do not achieve measurable concentrations in the urine is not clear. Small case series note some success, but failures have also occurred. Irrigation of the bladder with antifungal agents has limited utility. However, with fungus balls, irrigation of the renal pelvis through a nephrostomy tube can be useful in combination with systemic antifungal agents.

Topics: Algorithms; Amphotericin B; Antifungal Agents; Azoles; Candida; Candidiasis; Candidiasis, Invasive; Causality; Echinocandins; Fluconazole; Flucytosine; Humans; Urinary Tract Infections

Candida krusei is an uncommon cause of vaginitis and cystitis but is unique because of the management challenge it poses due to intrinsic resistance to fluconazole and flucytosine. We report a case of C. krusei vaginitis and cystitis successfully managed with topical vaginal and intravesical amphotericin B. The challenges in managing C. krusei cystitis and the role of amphotericin B bladder irrigation in the management of fungal urinary tract infections are discussed.

Topics: Administration, Topical; Amphotericin B; Antifungal Agents; Candida; Candidiasis, Vulvovaginal; Drug Resistance, Fungal; Female; Humans; Middle Aged; Treatment Outcome; Urinary Tract Infections

Long-term dialysis in children with multiple handicaps has become easier with the advent of continuous ambulatory peritoneal dialysis (PD). Due to the widespread use of PD and the long survival of patients with spina bifida, an increasing number of patients with spina bifida are on PD. The viability and safety of PD in spina bifida patients with a ventriculoperitoneal shunt (VPS) have been a matter of concern. Some authors consider the presence of a VPS a relative contraindication for PD, but more recent reports suggest that PD under close monitoring is not contraindicated. We report a 17-year-old girl born with meningomyelocele, hydrocephalus and neurogenic bladder who was maintained on VPS. She reached end-stage renal failure 17 years later and was put on PD based on family and patient preference. She had an uneventful course in the initial 9 months, but later developed fungal peritonitis which was successfully managed with catheter withdrawal and an intravenous antifungal agent (amphotercin 0.75 mg/kg). Simultaneous ventricle-aspirated cerebrospinal fluid was sterile. To our knowledge, this is the first report of fungal infection in such a patient. Although we share the view that PD is not an absolute contraindication in patients with a functioning VPS, its likely complications, especially infectious complications in developing countries, should be kept in mind before initiating PD in such patients.

Topics: Adolescent; Amphotericin B; Antifungal Agents; Candida glabrata; Candidiasis; Female; Growth Disorders; Humans; Hydrocephalus; Kidney Failure, Chronic; Meningomyelocele; Peritoneal Dialysis, Continuous Ambulatory; Peritonitis; Recurrence; Spina Bifida Cystica; Urinary Bladder, Neurogenic; Urinary Catheterization; Urinary Tract Infections; Ventriculoperitoneal Shunt

Primary renal aspergillosis is rare in diabetic patients. Diagnosis of localized primary renal Aspergillus infection in diabetic patients requires careful investigations due to its benign presentation and lack of associated systemic clinical features. There is also paucity of information on the role of conservative treatment of such localized infection with antifungal agents only. Here, we describe a case of localized renal aspergillosis in a type 2 diabetic patient with a brief review of literature.. We describe a case of unilateral renal aspergillosis following intracorporeal pneumatic lithotripsy (ICPL) in a type 2 diabetic man. The patient presented with mild pain in the left lumbar region and periodic expulsion of whitish soft masses per urethra, which yielded growth of Aspergillus fumigatus. He was treated initially with amphotericin B; however, it was stopped after 2 weeks, as he could not tolerate the drug. Subsequently, he was successfully treated with oral itraconazole.. Localized renal aspergillosis may be suspected in diabetic patients having history of urinary tract instrumentation, mild lumbar pain, passage of suspicious masses in urine and persistent pyuria. Examination of the suspicious substances expelled per urethra is essential for diagnosis as routine multiple urine analysis may yield negative results. Conservative treatment with oral itraconazole alone is effective in cases with incomplete obstruction.

Topics: Amphotericin B; Antifungal Agents; Aspergillosis; Aspergillus fumigatus; Diabetes Complications; Humans; Itraconazole; Kidney Calculi; Lithotripsy; Male; Middle Aged; Stents; Urinary Tract Infections

Topics: Amphotericin B; Antifungal Agents; Candidiasis; Humans; Infant; Leukocyte Count; Male; Recurrence; Ultrasonography; Urinalysis; Urinary Tract; Urinary Tract Infections

The exposure to Aspergillus organisms/spores is likely common, but disease caused by tissue invasion with these fungi is uncommon and occurs primarily in the setting of immunosuppression. We report a case of rapidly advancing invasive endomyocardial aspergillosis secondary to prolonged usage of multiple broad-spectrum antibiotics in a nonimmunocompromised host. A 36-year-old cotton textile worker presented to our institution with a 3-month history of weight loss and fatigue. He reported receiving prolonged use of multiple broad-spectrum antibiotic treatment. The echocardiogram demonstrated multiple endomyocardial vegetations and a mass in the left atrium. Myocardial biopsy specimen revealed an invasive endomyocardial aspergillosis. The patient was investigated for immune deficiency including HIV, and this workup was negative. Treatment was started with amphotericin B and heparin for presumed left atrial thrombus. The patient died because of a rupture of mycotic aneurysm that resulted in cerebral hemorrhage. This case illustrates the risk of an invasive fungal infection in a nonimmunocompromised host who is a prolonged user of antibiotics in the setting of environmental exposure of opportunistic invasive fungal infections.

Topics: Adult; Amphotericin B; Anti-Bacterial Agents; Antifungal Agents; Aspergillosis; Aspergillus fumigatus; Cardiomyopathies; Cerebral Hemorrhage; Fatal Outcome; Humans; Intracranial Aneurysm; Male; Opportunistic Infections; Rupture; Ultrasonography; Urinary Tract Infections

To present a series of neonates with renal fungus balls diagnosed by ultrasonography, urine culture and/or by the detection of Candida pseudomycelium in urine.. We revised the clinical records of neonates for whom the diagnosis of renal fungus ball was established by ultrasound and laboratory studies; these patients had been hospitalized at the National Institute of Pediatrics in Mexico between January 1st, 1999 and December 31st, 2002.. During the study period, 9 neonates were diagnosed with renal fungus ball. In 7 cases, the ethiologic agent was Candida albicans; whereas it was C. tropicalis in one case and C. parapsilosisin the other. Urine culture was positive (> or =10,000 UFC/ml) in 8 cases, whereas the fungal density was only 2400 UFC/ml in the last sample. Pseudohyphae were present in all cases and ultrasonography showed fungus ball in every case. All patients received a single antifungal drug, either amphotericin B or fluconazole. All the patients recovered and none of them required surgical treatment. Control postreatment by ultrasound studies showed that the fungus balls had disappeared in every case.. The diagnosis of Candida renal fungus balls based on the ultrasound study and urine culture is also substantiated by the detection of pseudomycelium in the centrifugation pellet of urine samples, which is a fast diagnostic method. This approach permitted an early diagnosis and treatment of Candida renal fungus balls.

Topics: Amphotericin B; Antifungal Agents; Candida; Candidiasis; Female; Fluconazole; Humans; Infant, Newborn; Male; Microbial Sensitivity Tests; Mycelium; Ultrasonography; Urinary Bladder; Urinary Tract Infections; Urine

Topics: Amphotericin B; Antifungal Agents; Humans; Mycoses; Therapeutic Irrigation; Urinary Catheterization; Urinary Tract Infections

Fungal urinary tract infections are commonly encountered in the hospitalized neonate. Although these infections most commonly take the form of cystitis, the infection may be complicated by the formation of fungal bezoars, with subsequent urinary tract obstruction. In certain cases, endosurgical debulking or extraction of the fungal bezoar may be necessary. This is particularly challenging in neonates due to their often-compromised physiologic state and small size. We report a case of a premature infant with bilateral obstructing renal fungal bezoars in whom a percutaneous catheter-based thrombectomy system was used successfully to debulk the fungal burden.

Topics: Amphotericin B; Antifungal Agents; Bezoars; Candida albicans; Candidiasis; Catheterization; Humans; Hydronephrosis; Infant, Newborn; Infant, Premature; Kidney; Nephrostomy, Percutaneous; Thrombectomy; Ultrasonography; Urinary Tract Infections

Two consensus conferences taking place in the United States and Spain were organized to optimize diagnosis and treatment of Candida spp. infections. Among other results, clinical scenarios in which early prescription of antifungal agents is indicated were identified.. To determine the criteria followed by physicians for prescribing antifungal agents in critically ill patients in our country and to investigate adherence to the guidelines proposed by the consensus conferences.. A questionnaire was designed and directed to 4th- and 5th-year residents in intensive care medicine and to specialists in intensive care with training in infectious diseases or other medical areas. Four case reports for which expert consensus indicates early antifungal treatment were included in the questionnaire; 1) recurrent peritonitis secondary to perforation of the digestive tract, with mixed flora including fungi; 2) persistent febrile syndrome in a patient with multiple mucosal fungal colonizations treated with broad-spectrum antibiotics; 3) candiduria and pyuria in a febrile patient; and 4) candidemia.. A total of 135 questionnaires from 45 different ICUs were returned (60% response rate). In the candidemia and fungal peritonitis examples, early treatment with antifungal agents was indicated in 100% and 85.9% of responses, respectively, whereas for sepsis with multifocal candidiasis and candiduria associated with pyuria and fever, early treatment was prescribed in only 41.5% and 55.6% of responses, respectively. There were no significant differences in response with regard to degree of training of the physicians surveyed. Fluconazole prescription predominated, mainly at doses of 400 mg/day, in mixed peritonitis, disseminated candidiasis and candiduria, whereas amphotericin B lipid formulations were preferentially indicated in cases of candidemia. Antifungal treatment (early or late) was prescribed in all responses for candidemia, in 95.5% for mixed peritonitis (fungi and bacteria), in 79.5% for multifocal candidiasis in patients with persistent sepsis, and in 77.9% for candiduria with fever and pyuria.. Adherence to recommendations from the consensus conferences was high among intensive medicine specialists, with no differences according to level of training in infectious diseases.

Topics: Amphotericin B; Antifungal Agents; Candidiasis; Case Management; Consensus Development Conferences as Topic; Critical Care; Data Collection; Drug Utilization; Fever; Fluconazole; Fungemia; Guideline Adherence; Humans; Internship and Residency; Intestinal Perforation; Mycoses; Peritonitis; Practice Guidelines as Topic; Practice Patterns, Physicians'; Spain; Surveys and Questionnaires; Urinary Tract Infections

We present two cases of nosocomial urinary tract infection due to Trichosporon asahii in intensive care unit patients with bladder catheter from two hospitals in Santiago, Chile. Both patients had an several catheters and bacterial infections that required the use of antibiotic therapy. One strain showed in vitro resistance to amphotericin B. Both strains were susceptible to fluconazole, but presented MIC with dose-dependent susceptibility to ketoconazole and itraconazole. This is the first report showing T. asahii as urinary tract infection agent in Chile.

Topics: Amphotericin B; Antifungal Agents; Chile; Communicable Diseases, Emerging; Cross Infection; Drug Resistance, Fungal; Fatal Outcome; Fluconazole; Humans; Immunocompromised Host; Intensive Care Units; Itraconazole; Ketoconazole; Male; Microbial Sensitivity Tests; Middle Aged; Multiple Myeloma; Mycoses; Opportunistic Infections; Parkinson Disease; Postoperative Complications; Trichosporon; Urinary Catheterization; Urinary Tract Infections; Ventriculoperitoneal Shunt

We report a case of Candida glabrata perinephric abscess in a patient with diabetes mellitus who recently underwent ureteropelvic surgery for lithiasic urinary tract obstruction. Surgical drainage and amphotericin B treatment led to resolution of the infection. C. glabrata urinary infection has become more prevalent over the last decade in immunocompromised patients. Drainage is indicated for development of a fungal abscess in the perinephric area. Most authors recommend administration of an antifungal adjuvant treatment.

Topics: Abscess; Aged; Amphotericin B; Anti-Bacterial Agents; Antifungal Agents; Candida; Candidiasis; Combined Modality Therapy; Diabetes Mellitus, Type 1; Drainage; Escherichia coli Infections; Female; Humans; Hypertension; Immunocompromised Host; Kidney Diseases; Postoperative Complications; Risk Factors; Serotyping; Urinary Calculi; Urinary Tract Infections

Candiduria is a common nosocomial infection, occurring predominantly in elderly debilitated subjects with frequent co-morbid pathology, especially diabetes mellitus. The majority of candiduric patients are catheterized or have been recently catheterized or instrumented. Physician surveys indicate considerable variation in attitude towards treatment of asymptomatic candiduria. Management of candiduria is seriously limited by lack of understanding of the natural history of this infection as well as reliable data of treatment efficacy based upon controlled studies. The recent availability of oral antifungal agents has strongly influenced physicians in adopting a more interventional role. Most therapeutic studies quoted in the literature compare active intervention with a variety of systemic or local measures. Reference is made to a recent placebo-controlled prospective study, in which fluconazole was significantly more effective than placebo in short-term eradication of asymptomatic candiduria. Nevertheless, follow-up of these asymptomatic patients revealed identical candiduria rates within 1 month of cessation of therapy. In most studies, evidence of clinical benefit in asymptomatic patients by the eradication of candiduria has not been evident. In conclusion, the majority of hospitalized patients, particularly those with continued catheterization, do not require local or systemic antifungal therapy for asymptomatic candiduria.

Topics: Amphotericin B; Antifungal Agents; Candidiasis; Clinical Trials as Topic; Cross Infection; Fluconazole; Humans; Urinary Catheterization; Urinary Tract Infections

Clinicians' reaction to isolating Candida organisms in urine culture (> or = 10(4) CFU ml-1) was assessed in a retrospective review of 133 consecutive in-patients (> or = 15 years-of-age) over a 5 month period. The average age was 68.8 years and male/female ratio was 0.36 (35/98). Most (78.2%) patients had an indwelling catheter, and many (35.3%) were in the intensive care unit (ICU). In response to culture-result, clinicians initiated antifungal therapy in 80 instances (60.2%). Treatment was often based on a single culture without documenting the infection (n = 53/80, 66.3%) in the absence of risk for invasive disease. Removing the indwelling-catheter was never attempted and antibiotics were rarely discontinued or modified (1.3%). Fluconazole was most frequently utilized (n = 42, 52.5%), followed by amphotericin-B bladder-irrigation (n = 26, 32.5%), and combined fluconazole/amphotericin-B bladder-irrigation (n = 12, 15%). Therapy was more frequently initiated in ICU-cases (76.6 versus 55.6%; P = 0.023) and less often in non-catheterized individuals (40.7 versus 69%; P = 0.012) and patients with 10(4) CFU ml-1 (25.9 versus 72.7%; P < 0.0001). These findings show that clinicians nowadays do not follow current guidelines for the management of candiduria. Efforts to increase clinicians' awareness of these guidelines, which are intended to confirm the diagnosis and stratify treatment according to patient risk factors, appear to be necessary.

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Amphotericin B; Antifungal Agents; Attitude of Health Personnel; Candida; Candidiasis; Catheters, Indwelling; Colony Count, Microbial; Female; Fluconazole; Humans; Intensive Care Units; Male; Middle Aged; Retrospective Studies; Urinary Tract Infections

To describe the renewed interest in Candida infections in general and urinary tract infections in particular, due to a recrudescence of immunodepressed patients and a better knowledge of their clinical and radiological manifestations.. The authors report 2 cases of Candida bezoars diagnosed by IVU, ultrasonography and CT scan in two insulin-dependent diabetics.. The first case presented with right renal involvement, in the form of delayed renal secretion on IVU with the presence of a pelvic filling defect, dilatation of the upper tract cavities on ultrasonography with a dilated renal pelvis occupied by an echogenic formation with no posterior acoustic shadow. CT showed a slightly heterogeneous low-density lesion with no contrast enhancement. The second case presented with right pelvic and vesical involvement. The diagnosis of urinary candidiasis was confirmed, in the first case, by the presence of whitish lumps on catheterization, for which analysis and culture were in favour of candidiasis and, in the second case, by direct examination and urine culture. Treatment with amphotericin B led to improvement followed by disappearance of the signs in both cases.. In addition to laboratory examinations, noninvasive imaging techniques, mainly ultrasonography and CT, but also percutaneous aspiration, constitute a decisive element in the diagnostic and therapeutic management of urinary candidiasis.

Topics: Adult; Amphotericin B; Antifungal Agents; Bezoars; Candidiasis; Female; Humans; Tomography, X-Ray Computed; Ultrasonography; Urinary Tract Infections; Urography

Topics: Amphotericin B; Antifungal Agents; Aspergillosis; Humans; Itraconazole; Kidney Transplantation; Male; Middle Aged; Urinary Tract Infections

Topics: Administration, Intravesical; Amphotericin B; Antifungal Agents; Candidiasis; Humans; Therapeutic Irrigation; Urinary Tract Infections

Topics: Aged; Amphotericin B; Antifungal Agents; Candida; Candidiasis; Drug Resistance, Microbial; Female; Humans; Immunocompetence; Microbial Sensitivity Tests; Time Factors; Urinary Tract Infections

Topics: Administration, Oral; Amphotericin B; Azoles; Candidiasis; Humans; Therapeutic Irrigation; Urinary Bladder; Urinary Tract Infections

To examine the range of disease caused by invasive Candida infection in neonates and infants and to discuss the available treatment options, particularly surgery and drug therapy.. Five consecutive infants with invasive urinary tract Candida infection presenting over an 18-month period were reviewed. Treatment protocols included a combination of surgery and treatment with amphotericin, flucytosine and fluconazole.. The range of disease severity from simple Candida urinary tract infection to overwhelming multi-organ sepsis was demonstrated. Urinary tract obstruction was identified as a predisposing factor in three of the five cases. In all cases, infection was cleared by the treatment protocol. Two cases with bilateral renal pelvic fungal balls showed resolution with no surgery in three kidneys and showed no advantage of pyelotomy and perfusion.. The results question the role of surgery, which may be limited to the relief of primary urological obstruction. We advocate the use of oral fluconazole to prevent or treat early systemic infection and, for severe systemic infections, a prolonged course of fluconazole in combination with flucytosine should be considered as an alternative to amphotericin, which is toxic and can only be given intravenously.

Topics: Amphotericin B; Candidiasis; Female; Fluconazole; Flucytosine; Humans; Infant; Infant, Newborn; Male; Urinary Tract Infections

Topics: Amphotericin B; Candidiasis; Child; Child, Preschool; Drug Carriers; Humans; Liposomes; Urinary Tract Infections

Topics: Amphotericin B; Cross Infection; Humans; Mycoses; Urinary Catheterization; Urinary Tract Infections

Twenty-six cases of candidemia associated with a well-defined urinary tract source were retrospectively identified and reviewed. Urinary tract abnormalities were present in 23 of 26 patients (88%), 19 (73%) of whom had urinary tract obstruction. Nineteen patients had undergone urinary tract procedures before the onset of candidemia. Episodes of candidemia were brief and low-grade in intensity (median duration, 1 day; median colony count, 1.5 cfu/10 mL of blood). Only eight patients (31%) received > or = 500 mg of amphotericin B. There were five in-hospital deaths (19%); two of these deaths were attributed to candidiasis. No late complications of candidemia were documented for the surviving patients. Patients with urologic pathology and candiduria who undergo surgery or manipulation of the urinary tract are at significant risk for candidemia, and further studies should examine the issue of administration of prophylaxis to this group.

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Amphotericin B; Candidiasis; Female; Fungemia; Humans; Male; Middle Aged; Postoperative Complications; Retrospective Studies; Treatment Outcome; Urinary Tract; Urinary Tract Infections; Urine; Urography; Urologic Diseases

Topics: Amphotericin B; Candida; Candidiasis; Humans; Therapeutic Irrigation; Urinary Bladder; Urinary Tract Infections

Topics: Amphotericin B; Candidiasis; Female; Fluconazole; Humans; Therapeutic Irrigation; Urinary Bladder; Urinary Catheterization; Urinary Tract Infections

Candiduria has emerged as a common, vexing diagnostic and therapeutic problem over the past 40 years. Treatment by means of bladder irrigation with a solution of amphotericin B has become widely used in clinical practice. However, the specifics of the procedure--concentration of amphotericin B, use of continuous washing vs. instillation with cross-clamping to allow "dwell-times," and duration of treatment--are based entirely on anecdotal experiences. The published reports and evolution of recommendations are reviewed. A prospective randomized double-blind study is needed to provide answers. In the meantime, administration of 200-300 mL of amphotericin B solution by triple-lumen urethral catheter with cross-clamping for 60-90 minutes seems most appropriate. Irrigation for no longer than 2 days should suffice if the procedure is to be effective. The optimal concentration of amphotericin B has not been defined; however, 5-10 mg/L appears adequate.

Topics: Amphotericin B; Candidiasis; Humans; Therapeutic Irrigation; Urinary Bladder; Urinary Tract Infections; Urine

Topics: Amphotericin B; Azoles; Candidiasis; Flucytosine; Humans; Urinary Tract Infections

Topics: Adult; Amphotericin B; Hospitalization; Humans; Mycoses; Risk Factors; Therapeutic Irrigation; Urinary Bladder; Urinary Tract Infections

Liposomal amphotericin B without prior administration of Fungizone was found to be an effective treatment in 4 patients with urinary tract infections caused by Candida albicans. Urine typically became culture negative after 1-4 days of dosing at 50 mg/day, demonstrating that therapeutic levels of amphotericin B were reached in the urine at conventional doses given in liposomal form. The low incidence of toxicity with this preparation was particularly useful in patients with impaired renal function, including renal transplant patients on cyclosporine immunosuppression.

Topics: Adult; Aged; Amphotericin B; Candidiasis; Drug Carriers; Female; Humans; Immunosuppression Therapy; Kidney Transplantation; Liposomes; Male; Middle Aged; Urinary Tract Infections

Systemic candidiasis is uncommon. We reviewed our experience with this disease from the infectious disease unit, Auckland Hospital, between 1982 and 1988, because many of these patients are referred to us. We then selected 11 of them to highlight particular presentations, diagnostic or management issues. We included both compromised and noncompromised patients from medical and surgical services. Candida albicans was the most common cause, but we also saw patients infected with C glabrata, C parapsilosis, and C tropicalis and present them to exemplify their different clinical presentations. Demonstrable fungaemia is uncommon in patients with systemic candidiasis, serological techniques are both insensitive and nonspecific and patients are often too ill from underlying disease to allow for invasive diagnostic procedures. Thus diagnosis is often difficult. Parenteral amphotericin B with or without 5-fluorocytosine is still the main antifungal treatment. Triazole antifungals may change that in the future. Systemic candidiasis retains a high mortality: careful individualised management of patients may improve mortality and morbidity.

Topics: Adult; Aged; Amphotericin B; Candida; Candidiasis; Drug Administration Schedule; Female; Hospitals, Municipal; Humans; Male; Middle Aged; New Zealand; Osteomyelitis; Referral and Consultation; Retrospective Studies; Urinary Tract Infections

We report on 5 neonates with obstructive urinary tract candidiasis in whom percutaneous nephrostomy had a major role in management. The advantages of percutaneous nephrostomy in this setting include prompt drainage of the obstructed renal pelvis or ureter, direct access to obtain specimens from the renal pelvis to confirm the diagnosis, direct irrigation of the fungus balls with amphotericin B and an access route for fragmentation of fungus balls by guide wire manipulation. In 3 cases percutaneous placement of the nephrostomy tube was successful in obtaining and maintaining access to the renal pelvis, while in 2 surgical intervention was required because of problems maintaining placement of the percutaneous catheters. Percutaneous nephrostomy with antegrade amphotericin B irrigation, coupled with systemic antifungal therapy, is the mainstay of treatment. The usefulness of ultrasonography in the early diagnosis of renal candidiasis also is emphasized.

Topics: Amphotericin B; Candidiasis; Combined Modality Therapy; Drug Therapy, Combination; Female; Flucytosine; Humans; Infant; Infant, Newborn; Infant, Premature, Diseases; Male; Nephrostomy, Percutaneous; Urinary Tract Infections

Miconazole was used as a fungistatic genitourinary irrigant in the management of 10 patients with persistent candiduria. All patients were in the older age group, with a mean age of 77.6 years, and they were debilitated by a variety of medical problems, including major surgery, neoplasia, recurrent bacterial infection, diabetes or other metabolic dysfunction. Miconazole at a concentration of 50 mcg. per ml. was administered continuously during 24 hours for 5 consecutive days via a urethral catheter. Candiduria resolved in 8 of the 10 patients, with 1 requiring a second course of miconazole at a concentration of 100 mcg. per ml. Two patients manifested other foci of infection, necessitating intravenous and intravesical amphotericin B. Stability studies showed that the miconazole irrigation solutions maintain their antifungal activity for 11 days at room temperature. The 5-day cost (drug and materials) of the miconazole irrigation at 50 mcg. per ml. was $17.75 versus $76.75 for an equal course of therapy with amphotericin B. In addition, compared to amphotericin B as an antifungal genitourinary irrigant, miconazole is prepared more easily, requires less labor and preparation time, and does not require refrigeration or protection from light. These clinical observations indicate that miconazole is a cost-effective antifungal genitourinary irrigant.

Topics: Aged; Aged, 80 and over; Amphotericin B; Candidiasis; Catheters, Indwelling; Cost-Benefit Analysis; Drug Evaluation; Humans; Miconazole; Middle Aged; Therapeutic Irrigation; Time Factors; Urinary Bladder; Urinary Tract Infections

Topics: Amphotericin B; Candidiasis; Humans; Urinary Tract Infections

Topics: Adult; Aged; Amphotericin B; Chromatography, High Pressure Liquid; Diabetes Mellitus; Humans; Methanol; Middle Aged; Mycoses; Urinary Tract Infections

Topics: Amphotericin B; Candidiasis; Child; Child, Preschool; Drug Therapy, Combination; Female; Flucytosine; Humans; Immune Tolerance; Opportunistic Infections; Urinary Tract Infections

Topics: Adult; Amphotericin B; Candida; Candidiasis; Female; Humans; Kidney Transplantation; Male; Middle Aged; Mycoses; Postoperative Complications; Urinary Tract Infections

Persistent Candiduria may represent significant urinary infection which has the potential for inducing obstructive uropathy and/or renal abscesses. Urine candidal colony counts, serological and radiographic studies will differentiate colonization from infection. Initial treatment may involve correction of iatrogenic factors such as removal of catheters, stopping antibacterial antibiotics and improvement of the patient's nutritional status. Persistence of funguria will require irrigations of the urinary system with antifungal agents and/or the use of systemic antifungal therapy.

Topics: Administration, Topical; Amphotericin B; Antifungal Agents; Candidiasis; Flucytosine; Humans; Imidazoles; Nystatin; Transfer Factor; Urinary Tract Infections; Urography

A 78-year-old man with mild diabetes presented with dysuria and frequency of urination of 15 months' duration subsequent to urinary catheterization for cataract surgery. Multiple urine specimens revealed the presence of considerable quantities of yeast that were later identified as Candida lusitaniae. The patient responded well to irrigation of the bladder with amphotericin B.

Topics: Aged; Amphotericin B; Candida; Candidiasis; Humans; Male; Urinary Tract Infections

We analyzed 20 cases of urinary fungal infection experienced at our Department, during the last 2 years. Candida albicans was the most prevalent of the fungi affecting the urinary tract. Torulopsis glabrata and Candida tropicalis were also prevalent. Antibiotics, indwelling catheter and obstructive uropathy were the most prevalent predisposing factors of the fungal infection. Of 20 cases of fungal infection, 5 cases were cured only by elimination of the predisposing factors, and 15 cases were treated and resolved by administration of sodium bicarbonate, 5-fluorocytosine and or irrigation with amphotericin B. But one case of bilateral renal torulopsiosis developed into renal failure, and 4 cases died of the primary disease.

Topics: Adolescent; Adult; Aged; Amphotericin B; Anti-Bacterial Agents; Bicarbonates; Candida; Candidiasis; Child; Child, Preschool; Female; Flucytosine; Humans; Infant; Male; Middle Aged; Mycoses; Sodium; Sodium Bicarbonate; Urinary Catheterization; Urinary Tract Infections

A case report of extensive and severe urinary tract infection caused by Torulopsis glabrata is presented. In this multiple antibiotic therapy, multiple surgical procedures, and urinary obstruction due to urolithiasis are believed to be factors predisposing to an opportunistic fungal infection.

Topics: Amphotericin B; Biopsy; Candida; Flucytosine; Humans; Male; Middle Aged; Mycoses; Therapeutic Irrigation; Urinary Bladder; Urinary Tract Infections

High urinary colony counts of Candida may develop in patients with prolonged indwelling bladder catheters, multiple antibiotic usage and compromised host resistance. Serum candidal antibody titers may differentiate candidal colonization or early infection from invasive or disseminated infection. The persistence of marked candiduria in the absence of elevated antibody titers or other manifestations of disseminated infection presents a therapeutic dilemma to the urologist. Should the patient be treated with systemic therapy, that is flucytosine or intravenous amphotericin B, or should he be observed until the signs of systemic or renal infection develop? Amphotericin B may be used as a urological irrigant in the management of noninvasive urinary fungal infection. Of 40 patients with persistent candiduria treated with daily irrigations of amphotericin B via a 3-way indwelling urethral catheter or urethral catheter and suprapubic tube for an average of 6 days 37 (92.5 per cent) demonstrated marked reduction or elimination of the candiduria. None of the patients had an adverse reaction. Amphotericin B also has been used as a urological adjuvant to surgical treatment of candidal infection of the kidney and upper tract. It also has a role in the treatment in candidal urethritis. We believe that the timely use of amphotericin B irrigations may prevent the development of disseminated candidal infection.

Topics: Adult; Aged; Amphotericin B; Candidiasis; Female; Humans; Male; Middle Aged; Therapeutic Irrigation; Urethra; Urinary Catheterization; Urinary Tract Infections

Aspergillosis limited to the urinary tract is a rare disease, seen most often in patients with altered immunity, especially diabetics. The disease has 3 patterns, 2 of which have been described previously. We report the first case documenting the ascending route of infection. Multiple urine cultures may be required for proper identification. Histopathology and culture of sloughed tissue and fungus balls shed per urethram are the essential means of reliable diagnosis. successful treatment of this disease localized to the urinary tract require a high index of suspicion in certain clinical settings, prompt diagnosis, a combination of systemic and local antifungal chemotherapy, and surgical drainage when necessary.

Topics: Amphotericin B; Aspergillosis; Aspergillus flavus; Drainage; Humans; Male; Middle Aged; Urinary Tract Infections

Topics: Amphotericin B; Female; Flucytosine; Humans; Male; Urinary Tract Infections; Yeasts

Candidiasis often is the final insult to the critically ill patient. Flucytosine, an orally administered antifungal agent, was used in the treatment of 225 patients with genitourinary candidiasis. Criteria for treatment included clinical manifestations, high urine colony counts of Candida, serologic findings and in vitro sensitivity of Candida to flucytosine. Infection was eradicated in 212 patients (94 per cent), as determined by clinical and laboratory criteria. The only significant adverse drug effect was reversible agranulocytosis, which ccurred in 2 patients. Thirteen patients (6 per cent) required supplemental therapy with systemic or bladder irrigations of amphotericin B.

Topics: Agranulocytosis; Amphotericin B; Candidiasis; Cytosine; Female; Flucytosine; Genital Diseases, Female; Genital Diseases, Male; Humans; Male; Urinary Tract Infections

Fungus balls of the urinary tract are rare and usually associated with infection by Candid albicans. Since 1968 five patients seen at the Medical College of Virginia Hospitals presented with this peculiar manifestation of candidiasis. Summaries of their epidemiologic clinical, pathologic, and mycologic data are presented. All Candida fungus balls involved the upper collecting system and were detected by radiography and confirmed by culture and/or pathologic section. Two of the five patients completely recovered. Three patients were treated with flucytosine and/or local irrigation with a polyene antifungal agent. Two recovered and the third died of probable bacterial sepsis. One patient was treated successfully with surgical removal of the fungus ball and a brief period of local irrigation with amphotericin B (AMB). The fifth patient recovered after 28 days of parenteral AMB. Predisposing factors and pathogenetic mechanisms are discussed, and a rational approach to therapy is outlined.

Topics: Adult; Aged; Amphotericin B; Candidiasis; Diabetes Complications; Female; Flucytosine; Humans; Male; Middle Aged; Urinary Tract Infections

The new therapeutic methods based on antibiotics, corticosteroids and immunosuppressors and the new medicosurgical techniques (catheters, monitoring in intensive-care units, open-heart surgery) modify the host, favorise the adaptation and introduction f endogenous and exogenous yeast-like fungi and thus create a new pathology characterized by deep visceral or septicemic infections due to yeasts belonging to the genera Candida, Torulopsis, Cryptococcus, Trichosporon, Rhodotorula, and Saccharomyces. The pathological aspects are analyzed and therapy is suggested in the light of new findings on polyenes (nystatine, amphotericine B), 5-fluorocytosine, imidazole, derivatives (miconazole, econazole) considering their association in function of synergy or antagonism possibilities.

Topics: Amphotericin B; Candida; Candidiasis; Cryptococcosis; Dermatomycoses; Endocarditis; Flucytosine; Humans; Iatrogenic Disease; Imidazoles; Lung Diseases, Fungal; Mycoses; Nystatin; Osteitis; Sepsis; Urinary Tract Infections

Urinary tract infections result mostly from ascending infection by micro-organisms introduced by way of the urethra. Bacteria are the usual causative agents. Occasionally, yeasts notably Candida albicans, are involved. Females are more prone to acute infections than males because of shorter urethra and the higher risks of contamination in the females.

Topics: Adult; Aged; Amphotericin B; Candida; Diabetes Complications; Female; Flucytosine; Humans; Middle Aged; Mycoses; Urinary Tract Infections

Topics: Amphotericin B; Candidiasis; Cytosine; Drug Resistance, Microbial; Flucytosine; Humans; Rifampin; Urinary Tract Infections

Candida in the urine or surgical wound is a potentially lethal pathogen. Management of 82 patients has provided a rationale for the treatment of these infections. Urine colony counts, serologic findings and clinical observations determine therapy. Amphotericin B irrigants are effective for local infections. Disseminated infections require flucytosine and/or intravenous amphotericin B.

Topics: Amphotericin B; Candida; Candidiasis; Flucytosine; Humans; Nystatin; Radiography; Ureter; Ureteral Obstruction; Urinary Tract Infections; Urine

Reports in the literature of patients surviving mucormycosis involving the craniofacial structures are exceedingly rare. The necessity for early diagnosis by recognition of any of the six key signs and symptoms is emphasized. The futility of standard diagnostic tools, other than biopsy, is noted. An underlying debilitating condition such as diabetic ketoacidosis can predispose the patient to an acute infection by this usually nonpathogenic organism. The requirement for prompt treatment of the debilitating condition together with treatment to eradicate the fungus is stressed.

Topics: Abscess; Adult; Amphotericin B; Cavernous Sinus; Cranial Nerves; Dental Caries; Diabetes Complications; Diabetic Coma; Diabetic Neuropathies; Diagnosis, Differential; Face; Humans; Insulin; Lung Diseases; Male; Mucormycosis; Ophthalmoplegia; Pneumonia; Sinus Thrombosis, Intracranial; Skull; Tooth Diseases; Urinary Tract Infections

Topics: Amphotericin B; Candida albicans; Candidiasis; Cystitis; Female; Flucytosine; Humans; Kidney Diseases; Male; Prostatitis; Urinary Catheterization; Urinary Tract Infections

Topics: Adult; Aged; Agglutination Tests; Amphotericin B; Candida albicans; Candidiasis; Cytosine; Female; Humans; Infant; Male; Precipitin Tests; Serologic Tests; Urinary Tract Infections

Topics: Amphotericin B; Candida albicans; Candidiasis; Candidiasis, Oral; Central Nervous System Diseases; Culture Media; Digestive System; Female; Gastroenteritis; Gentian Violet; Humans; Infant, Newborn; Mustard Compounds; Nystatin; Urinary Tract Infections

Topics: Adult; Amphotericin B; Antilymphocyte Serum; Azathioprine; Dactinomycin; Female; Heart Transplantation; Humans; Infections; Male; Middle Aged; Mycoses; Nystatin; Prednisone; Propylene Glycols; Protozoan Infections; Respiratory Tract Infections; Sepsis; Staphylococcal Infections; Transplantation Immunology; Transplantation, Homologous; Urinary Tract Infections; Virus Diseases

Topics: Aged; Amphotericin B; Ampicillin; Anti-Bacterial Agents; Cephalothin; Chloramphenicol; Humans; Kanamycin; Kidney Diseases; Male; Methicillin; Middle Aged; Streptomycin; Urinary Tract Infections; Urography

Topics: Amphotericin B; Candidiasis; Humans; Male; Middle Aged; Urinary Tract Infections

Topics: Adrenal Cortex Hormones; Adult; Aged; Amphotericin B; Arthritis, Rheumatoid; Aspirin; Cryptococcosis; Cryptococcus; Female; Hematuria; Humans; Kidney Papillary Necrosis; Male; Meningitis; Middle Aged; Proteinuria; Pyelonephritis; Pyuria; Urea; Urinary Tract Infections

Topics: Adult; Aged; Amphotericin B; Cryptococcosis; Cryptococcus; Female; Humans; Male; Pregnancy; Pregnancy Complications, Infectious; Sepsis; Urinary Tract Infections

Topics: Amphotericin B; Ampicillin; Candida; Chloramphenicol; Cortisone; Female; Histoplasmosis; Humans; Liver; Lupus Erythematosus, Systemic; Middle Aged; Prednisone; Salmonella paratyphi A; Urinary Tract Infections

Topics: Adult; Amphotericin B; Blood Urea Nitrogen; Candida; Candidiasis; Female; Humans; Injections, Intravenous; Middle Aged; Urinary Tract Infections; Urine

Topics: Amphotericin B; Anti-Bacterial Agents; Anti-Infective Agents; Azo Compounds; Bacitracin; Chlormerodrin; Diuretics; Drug Therapy; Erythromycin; Humans; Kanamycin; Mandelic Acids; Methenamine; Metronidazole; Nalidixic Acid; Naphthyridines; Neomycin; Nitrofurans; Nitrofurantoin; Nystatin; Organomercury Compounds; Penicillins; Polymyxins; Sulfonamides; Tetracycline; Toxicology; Urinary Tract Infections

Topics: Amphotericin B; Blastomycosis; Humans; Tuberculosis; Tuberculosis, Urogenital; Urinary Tract Infections; Urogenital System

Topics: Amphotericin B; Antifungal Agents; Fungicides, Industrial; Humans; Phosphates; Tetracycline; Urinary Tract Infections