Tiene Bauters

Prevalence of vulvovaginal candidiasis and susceptibility to fluconazole in women

In this study a new method of membrane filtration using a panel of florigenic enzyme substrates to identify and differentiate four major Candida species within 9 to 12 hours was tested for its ability to diagnose vulvovaginal candidiasis. The study subjects were 612 women who were recruited from consecutive patients who attended a gynecological clinic at Ghent University Hospital during a 14-week period. Some subjects had symptoms of vaginitis, but others did not. Each subject underwent a clinical examination including a wet vaginal smear and a vaginal swab, which was placed in transport gel for delivery to the laboratory. The florigenic process involves the formation of a microcolony on a membrane filter over a 9- to 11-hour incubation period. The membrane is cut into five segments, which are impregnated with a buffered solution of a florigenic 4-methylumbilliferyl substrate. After a further incubation period of 30 minutes, during which cleavage of enzyme substrates takes place, the microcolonies are examined under long-wavelength ultraviolet light resulting in blue or orange fluorescence. A positive yeast culture was obtained from the vaginal swabs of 123 of the 612 women (20.1%). Sixty-five of the patients had symptoms of vaginitis (vulvar pruritus and vaginal discharge), and 547 were asymptomatic. Of the 65 symptomatic women, 60% (39 of 65) had a positive KOH wet smear, and 40% (26/65) had a negative KOH result. More than two thirds of the isolated species were C. albicans (68.3%); C. glabrata was found in 16.3%, C. parapsilosis was isolated in 8.9%, and C. humicola, C. krusei, and C. lusitaniae were found in 1.6%, 0.8%, and 0.8%, respectively. The florigenic technique agreed 100% of the time with chromogenic analysis performed as a comparative standard. The highest number of isolated yeasts was found in women with clinical symptoms of candidiasis and a positive KOH test (29 of 35 >1000 CFU/ml). Conversely, women with clinical symptoms and negative KOH test had low numbers of isolated yeasts. When the subjects were divided into subgroups, pregnant women were the most likely, and postmenopausal women with no hormonal replacement therapy were the least likely, to have a positive yeast culture (33 of 103, 32%, P =.045; 15 of 119, 12.6%, P =.003, respectively). Yeast was found in 26.9% of postmenopausal women not taking oral contraceptives (22 of 114), and 14.4% and 14.0% of premenopausal women taking oral contraceptives (16 of 111) or with an intrauterine device (8 of 57), respectively. The rate of yeast colonization was significantly related to the amount of estrogen in oral contraceptives, with the higher concentrations more likely to have positive yeast growth (P =.05). Similarly, yeast colonization in pregnant women grew significantly as pregnancy progressed (P =.05). Twenty-six of the 123 yeast isolates were resistant to fluconazole when subjected to in vitro sensitivity testing.

Colonization of voice prostheses by albicans and non-albicans Candida species.

Objectives The purposes of the study were to assess the colonization of tracheoesophageal voice prostheses by albicans and non‐albicans Candida species and to determine their susceptibility for three antimycotics that are frequently used for prophylaxis or treatment of oral candidiasis (i.e., miconazole, fluconazole, and nystatin).

Infection risk related to the use of medicinal leeches

ObjectiveTo assess the incidence of postoperative wound infections related to treatment with medicinal leeches at Ghent University Hospital.MethodA 2-year retrospective analysis of bacteriologic culture results of soft tissue infections in patients treated with medicinal leeches.ResultsCultures of suspected wound infections were taken and susceptibility testing of isolates was performed on 17 of 47 patients (36.2%). Aeromonas was frequently isolated (18.5%).ConclusionsA high incidence of infection during and after application of medicinal leeches, despite their external decontamination, necessitates an antibiotic prophylaxis. In particular Aeromonas must be covered, as soft tissue infections with these bacteria can give serious complications. The prophylactic antibiotic should cover the most frequent isolated species taking into account the importance of Aeromonas and the susceptibility pattern. Based on the results, fluoroquinolones seem to be a good choice. The authors believe that practical recommendations to hospital pharmacists on prophylaxis during Hirudo medicinalis treatment, might enhance the safety of it’s use by reducing the number of infections.

The Mucosal Toxicity of Different Benzalkonium Chloride Analogues Evaluated with an Alternative Test Using Slugs

AbstractPurpose. The objective of this study was to evaluate the mucosal toxicity of different benzalkonium chloride (BAC) analogues using slugs as the alternative test organism. Methods. The effect of different BAC analogues on the mucosal tissue of slugs was determined from the protein, lactate dehydrogenase, and alkaline phosphatase released from the foot mucosa after treatment. Additionally, mucus production and reduction in body weight of the slugs were measured. The eye irritation potency of the molecules was evaluated with the Bovine Corneal Opacity and Permeability (BCOP) assay. The antimicrobial activity of the different BAC analogues was also assessed. Results. All BAC analogues induced severe damage to the mucosal epithelium of the slugs, and the irritation increased with decreasing alkyl chain length: BAC-C16 < BAC-C14 < BAC-C12 ∼ BAC-mix. A similar ranking was obtained with the BCOP assay for eye irritation. The relative order of activities among the three BAC analogues was the same, i.e., BAC-C14 ≥ BAC-C16 > BAC-C12. The BAC-C14 exhibited higher activity than the BAC-mix. Conclusions. The toxicity and activity of BAC analogues depend on the alkyl chain length. The use of BAC-C14 as a conservative agent in pharmaceutical preparations instead of the BAC-mix should be considered.

Interaction between methotrexate and omeprazole in an adolescent with leukemia: a case report

We present a case of severe mucositis due to a drug–drug interaction between methotrexate (MTX) and omeprazole in an adolescent with Acute Lymphatic Leukemia (ALL). In view of the prevalence of MTX in many cytotoxic protocols, and the frequent use of omeprazole in the (ambulatory) oncology setting, we believe that this case-report is worth mentioning.

Chemotherapy drug shortages in paediatric oncology: A 14-year single-centre experience in Belgium

Shortages of chemotherapy are a growing challenge for the healthcare system. We present the burden of drug shortages of chemotherapeutics in the paediatric hemato-oncology unit of a tertiary care hospital and solutions that were used to manage them. Between January 2001 and December 2014, 54 individual shortages were detected, affecting a total number of 21 different drugs. In total, 4127 shortage days were registered with a mean duration of 196.5 SD ± 144.0 days per individual drug shortage. Methotrexate, doxorubicin and carboplatin had the longest supply disruptions. Solutions to address the problems were purchase of a generic alternative, a change of individual treatment plans, cohorting of patients and import from abroad.

Antifungal drugs and rational use of antifungals in treating invasive aspergillosis: the role of the hospital pharmacist

AbstractAim:This review discusses the most common used antifungal agents in the treatment of invasive fungal infections. In addition, guidelines for the treatment of invasive aspergillosis, as used in the Ghent University Hospital, are described. Moreover, the importance of determining the effectiveness of antifungal therapy as well as the potential role of the hospital pharmacist in the management of this infection is highlighted. Methods:A review of the English-language literature was conducted using the MEDLINE database and scientific websites. Search terms including antimycotics, antifungal therapy and invasive aspergillosis were used to refine the search, and preference was given to studies published after 1992. This was completed with recent treatment guidelines. Results:An overview of the most recent advances in antifungal therapy is described. In addition, a flowchart for treatment of invasive aspergillosis (proven, probable or possible) has been developed. Conclusion:Invasive fungal infections will remain a frequent and important complication of modern medicine. Considering the clinical and financial outcome of invasive fungal infections, the role of the hospital pharmacist can be a paramount to the treatment.

Stability of extemporaneously prepared cytarabine, methotrexate sodium, and methylprednisolone sodium succinate

PURPOSE The short-term stability of extemporaneously prepared triple intrathecal therapy, containing cytarabine, methotrexate sodium, and methylprednisolone sodium succinate, was evaluated. METHODS Three batches of triple intrathecal solution were prepared using commercially available products and stored in three different packaging materials (plastic syringe system, brown glass vials, and brown glass vials filled with metal needles). The solutions were protected from light and stored at 5 °C, 25 °C, and 40 °C or exposed to ultraviolet and visible light at 25 °C, compliant with the International Conference on Harmonisation. Samples were taken immediately before and after 4, 8, 24, 32, and 48 hours of storage. Simultaneous high-performance liquid chromatography- ultraviolet light/diode array detector assay of cytarabine, methotrexate sodium, and methylprednisolone sodium succinate was performed using a fused-core stationary phase and an acetonitrile-based gradient. First-order kinetic degradation values were calculated, and temperature dependence was evaluated using the Arrhenius equation. RESULTS Cytarabine was stable under all storage conditions. Methotrexate sodium displayed significant degradation after light exposure but remained stable under the other storage conditions. Methylprednisolone sodium succinate was found to be the most labile component in the triple intrathecal solution. Temperature-dependent degradation was observed, resulting in 46% degradation after 48 hours at 40 °C. Two degradants were formed: methylprednisolone and methylprednisolone hydrogen succinate. Packaging material and batch-to-batch variability did not significantly influence the stability of the triple intrathecal solution. CONCLUSION Triple intrathecal solution of cytarabine, methotrexate sodium, and methylprednisolone sodium succinate was stable for up to 12 hours when stored at 5 °C and protected from light.

Practical implications for the administration of 13-cis retinoic acid in pediatric oncology

Children with high-risk neuroblastoma are treated with polychemotherapy, surgery, radiotherapy and even autologous stem-cell transplantation. On top of this complex treatment, most children also receive 13-cis retinoic acid as differentiation agent. As no suitable pharmaceutical formulation is available so far, there are often problems with the administration of the product in children. The present report describes some practical recommendations for the administration of isotretinoin in children treated for high-risk neuroblastoma.

Successful use of eculizumab in a pediatric patient treated for paroxysmal nocturnal hemoglobinuria

Paroxysmal nocturnal hemoglobinuria (PNH) is a rare, debilitating life-threatening clonal hematopoietic stem cell disease. The clinical manifestations of PNH are usually seen in adulthood and are very rarely reported in children. Eculizumab, a humanized monoclonal antibody targeting and preventing cleavage of the terminal complement protein C5, has become the “gold standard” of treatment for hemolysis or significant disease-related complications in patients with PNH. Although eculizumab is not licensed for use in pediatrics, we report a young PNH patient with bone marrow failure and severe episodes of hemolytic anemia who was treated successfully with eculizumab for >18 months.