Antibacterials/antifungals/antineoplastics

Abstract

Buchta V, et al. Saprochaete clavata Invasive InfectionsA New Threat to antineoplastics Hematological-Oncological Patients. Frontiers in Microbiology 10: 2196, 2019. Available from: URL: http://doi.org/10.3389/fmicb.2019.02196 Czech Saprochaete clavata infection, drug resistance and Republic 803438265 lack of drug effect: 6 case reports In a retrospective study of patients diagnosed with Saprochaete clavata infection between March 2005 and December 2017, six patients (1 man and 5 women) aged 45–66 years were described, who developed Saprochaete clavata infection or Saprochaete clavata pneumonia during treatment with anticancer drugs or prophylactic antibiotic therapy. The patients also developed drug resistance to prophylactic antifungal therapy with fluconazole or voriconazole. Four of these six patients died of septic shock and multiple organ dysfunction syndrome despite treatment with amphotericin B [amphotericin B deoxycholate], amphotericin B liposomal [Abelcet], micafungin or voriconazole [not all routes, dosages and outcomes stated; durations of treatments to reactions onsets not stated]. The patients had diffuse large B-cell lymphoma or new, late or early relapse of acute myeloid leukaemia (AML). Five of the 6 patients received chemotherapy with Ida-HiDAraC regimen consisting of idarubicin and high dose cytarabine [cytosine arabinoside] (1 patient), FLAG-Ida regimen consisting of fludarabine and idarubicin (2 patients), HiDAC regimen consisting of high dose cytarabine (1 patient) and methylprednisolone sodium succinate, R-CHOP regimen consisting of rituximab, cyclophosphamide, doxorubicin, vincristine and prednisone and intrathecal hydrocortisone, methotrexate and cytarabine (1 patient). All the patients had various previous diseases or risk factor including administration of cytarabine. Additionally, all the patients were receiving prophylactic antibiotic therapy with ciprofloxacin, meropenem, vancomycin, teicoplanin, imipenem, cefoperazone, piperacillin/tazobactam, amikacin, ciprofloxacin, metronidazole, linezolid, levofloxacin, cefepime or linezolid or prophylactic anti-fungal therapy with fluconazole or voriconazole. The blood culture test for all the patients was positive for Saprochaete clavata (Geotrichum clavatum). The clinical form of Saprochaete clavata was bloodstream infection (BSI, n=4) including one BSI disseminated and BSI with pneumonia (n=2). Additionally, neutropenia was noted in all the patients. The fungal infection was considered secondary to anticancer drugs and prophylactic antibiotic. A relatively high MIC of fluconazole in strains isolated from the patients, which suggested that the prophylactic treatment with the triazole drug could represent a selective pressure for S.clavata overgrowth leading to drug resistance of fluconazole in five patients and voriconazole in one patient. Following the diagnosis of Saprochaete clavata infection, two of these six patients were treated with amphotericin B, amphotericin B liposomal or voriconazole. The remaining four patients were treated with IV amphotericin B 75mg once a day and oral voriconazole 200mg twice a day (1 patient), IV amphotericin B 50mg once a day, IV amphotericin B liposomal 400mg once a day and oral voriconazole 200mg twice a day (1 patient), IV amphotericin B 50mg once a day (1 patient) and IV micafungin 100mg once a day and oral voriconazole 200mg every 12 hours (1 patient). Three of these 6 patients were also placed on pulmonary ventilator. Despite treatment with antifungal drugs, four of these 6 patients died of septic shock and multiple organ dysfunction syndrome. Of the remaining two patients, one patient died of early relapse AML and irreversible brain damage and one patient survived. In two of these 6 patients, autopsy was performed and it was positive for Saprochaete clavata. Author comment: Six new cases. . .of blood-stream S. clavata infections Four patients died of multiorgan failure and sepsis despite treatment with lipid-based amphotericin B and/or voriconazole. [T]he result of antibiotic therapy or cholecystectomy that can alter composition of transformation microbiota and indirectly interfere with the production of 1