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      Colombian consensus on the diagnosis, treatment, and prevention of Candida Spp. disease in children and adults, Translated title: Consenso Colombiano Para el Diagnóstico, Tratamiento y Prevención de la Enfermedad por Candida Spp. en Niños y Adultos

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      Infectio
      Asociación Colombiana de Infectología.
      invasive candidiasis, candidemia, fungal diagnostics, consensus guidelines, antifungal treatment, adult patient, pediatric patient, neonatal patient, nonneutropenic patient, neutropenic patient, critical patient, candidiasis invasora, candidemia, guías de consenso, diagnóstico fúngico, tratamiento antifúngico, paciente adulto, paciente pediátrico, paciente neonato, paciente no neutropénico, paciente neutropénico, paciente crítico.

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          Abstract

          Abstract Invasive Candidiasis (IC) and candidemia (as its most frequent manifestation) have become the main cause of opportunistic mycosis at hospital settings. This study, made by members of the Colombian Association of Infectious Diseases (ACIN), was aimed at providing a set of recommendations for the management, follow-up and prevention of IC / candidemia and mucous membrane candida infection in adult, pediatric and neonatal patients in a hospital setting, including the hemato-oncological and critical care units. All the data obtained through an exhaustive search were reviewed and analyzed in a comprehensive manner by all the members of the group, and the recommendations issued are being made after a careful review of the scientific literature available and the consensus of all specialists involved; the emergence of Candida Spp. problem is highlighted and a correct orientation to health professionals regarding the management of patients with candidiasis is provided in a rational and practical way, emphasizing patient evaluation, diagnostic strategies, prophylaxis, empirical treatment, directed treatment and preventative therapy.

          Translated abstract

          Resumen La Candidiasis Invasora (CI) y la candidemia, como su manifestación más frecuente, se ha convertido en la principal causa de micosis oportunista a nivel hospitalario. Este manuscrito realizado por miembros de la Asociación Colombiana de Infectología (ACIN), tuvo como objetivo proporcionar un conjunto de recomendaciones para manejo, seguimiento y prevención de la CI/candidemia y de la infección candidiásica de mucosas, en población adulta, pediátrica y neonatal, en un entorno hospitalario, incluyendo las unidades hemato-oncológicas y unidades de cuidado crítico. Todos los datos obtenidos mediante una búsqueda exhaustiva, fueron revisados y analizados de manera amplia por todos los miembros del grupo, y las recomendaciones emitidas se elaboraron luego de la evaluación de la literatura científica disponible, y el consenso de todos los especialistas involucrados, reconociendo el problema de la emergencia de las infecciones por Candida Spp. y brindando una correcta orientación a los profesionales de la salud sobre el manejo de pacientes con enfermedad candidiásica, de una forma racional y práctica, enfatizando en la evaluación del paciente, estrategias de diagnóstico, profilaxis, tratamiento empírico, tratamiento dirigido y terapia preventiva.

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          Prospective surveillance for invasive fungal infections in hematopoietic stem cell transplant recipients, 2001-2006: overview of the Transplant-Associated Infection Surveillance Network (TRANSNET) Database.

          The incidence and epidemiology of invasive fungal infections (IFIs), a leading cause of death among hematopoeitic stem cell transplant (HSCT) recipients, are derived mainly from single-institution retrospective studies. The Transplant Associated Infections Surveillance Network, a network of 23 US transplant centers, prospectively enrolled HSCT recipients with proven and probable IFIs occurring between March 2001 and March 2006. We collected denominator data on all HSCTs preformed at each site and clinical, diagnostic, and outcome information for each IFI case. To estimate trends in IFI, we calculated the 12-month cumulative incidence among 9 sequential subcohorts. We identified 983 IFIs among 875 HSCT recipients. The median age of the patients was 49 years; 60% were male. Invasive aspergillosis (43%), invasive candidiasis (28%), and zygomycosis (8%) were the most common IFIs. Fifty-nine percent and 61% of IFIs were recognized within 60 days of neutropenia and graft-versus-host disease, respectively. Median onset of candidiasis and aspergillosis after HSCT was 61 days and 99 days, respectively. Within a cohort of 16,200 HSCT recipients who received their first transplants between March 2001 and September 2005 and were followed up through March 2006, we identified 718 IFIs in 639 persons. Twelve-month cumulative incidences, based on the first IFI, were 7.7 cases per 100 transplants for matched unrelated allogeneic, 8.1 cases per 100 transplants for mismatched-related allogeneic, 5.8 cases per 100 transplants for matched-related allogeneic, and 1.2 cases per 100 transplants for autologous HSCT. In this national prospective surveillance study of IFIs in HSCT recipients, the cumulative incidence was highest for aspergillosis, followed by candidiasis. Understanding the epidemiologic trends and burden of IFIs may lead to improved management strategies and study design.
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            Initiation of inappropriate antimicrobial therapy results in a fivefold reduction of survival in human septic shock.

            Our goal was to determine the impact of the initiation of inappropriate antimicrobial therapy on survival to hospital discharge of patients with septic shock. The appropriateness of initial antimicrobial therapy, the clinical infection site, and relevant pathogens were retrospectively determined for 5,715 patients with septic shock in three countries. Therapy with appropriate antimicrobial agents was initiated in 80.1% of cases. Overall, the survival rate was 43.7%. There were marked differences in the distribution of comorbidities, clinical infections, and pathogens in patients who received appropriate and inappropriate initial antimicrobial therapy (p < 0.0001 for each). The survival rates after appropriate and inappropriate initial therapy were 52.0% and 10.3%, respectively (odds ratio [OR], 9.45; 95% CI, 7.74 to 11.54; p < 0.0001). Similar differences in survival were seen in all major epidemiologic, clinical, and organism subgroups. The decrease in survival with inappropriate initial therapy ranged from 2.3-fold for pneumococcal infection to 17.6-fold with primary bacteremia. After adjustment for acute physiology and chronic health evaluation II score, comorbidities, hospital site, and other potential risk factors, the inappropriateness of initial antimicrobial therapy remained most highly associated with risk of death (OR, 8.99; 95% CI, 6.60 to 12.23). Inappropriate initial antimicrobial therapy for septic shock occurs in about 20% of patients and is associated with a fivefold reduction in survival. Efforts to increase the frequency of the appropriateness of initial antimicrobial therapy must be central to efforts to reduce the mortality of patients with septic shock.
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              Executive Summary: Clinical Practice Guideline for the Management of Candidiasis: 2016 Update by the Infectious Diseases Society of America.

              It is important to realize that guidelines cannot always account for individual variation among patients. They are not intended to supplant physician judgment with respect to particular patients or special clinical situations. IDSA considers adherence to these guidelines to be voluntary, with the ultimate determination regarding their application to be made by the physician in the light of each patient's individual circumstances.
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                Author and article information

                Contributors
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                Journal
                inf
                Infectio
                Infect.
                Asociación Colombiana de Infectología. (Bogotá, Distrito Capital, Colombia )
                0123-9392
                September 2019
                : 23
                : 3
                : 271-304
                Affiliations
                [16] Cali Valle del Cauca orgnameUniversidad del Valle Colombia
                [3] Bogotá Bogotá orgnameUniversidad El Bosque orgdiv1Centro Médico Imbanaco Colombia
                [9] Bogotá orgnameUniversidad Nacional de Colombia orgdiv1Facultad de Medicina orgdiv2Internal Medicine Department Colombia
                [7] Cali Valle del Cauca orgnameUniversidad del Valle orgdiv1Centro Médico Imbanaco Colombia
                [11] Cali orgnameCentro Médico Imbanaco Colombia
                [13] Bogotá orgnameUniversidad Nacional de Colombia orgdiv1Facultad de Medicina Colombia
                [12] Cali orgnameFundación Clínica Valle del Lili Colombia
                [5] Cali Valle del Cauca orgnameUniversidad del Valle Colombia
                [4] Bogotá orgnameUniversidad Nacional de Colombia orgdiv1Facultad de Medicina Colombia
                [1] Cali Valle del Cauca orgnameUniversidad del Valle orgdiv1Clínica de Occidente de Cali orgdiv2Centro Médico Imbanaco Colombia
                [8] Medellín orgnameCorporación para Investigaciones Biológicas Colombia
                [14] Bogotá Bogotá orgnamePontificia Universidad Javeriana orgdiv1Facultad de Ciencias Colombia
                [18] Bogotá orgnameUniversidad Nacional de Colombia orgdiv1Facultad de Medicina Colombia
                [10] Medellín orgnameClínica Cardiovascular Colombia
                [15] Cali Valle del Cauca orgnameUniversidad del Valle Colombia
                [6] Cartagena Bolívar orgnameUniversidad de Cartagena Colombia
                [17] Barranquilla orgnameUniversidad Libre de Barranquilla Colombia
                [2] Bogotá orgnameUniversidad Nacional de Colombia orgdiv1Facultad de Medicina orgdiv2Departamento de Microbiología Colombia
                Article
                S0123-93922019000300271
                10.22354/in.v23i3.792
                45d1dc0f-774b-4d5d-9d5f-1ec2f685ae44

                This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.

                History
                : 26 September 2017
                : 02 February 2018
                Page count
                Figures: 0, Tables: 0, Equations: 0, References: 392, Pages: 34
                Product

                SciELO Colombia

                Categories
                Original articles

                neonatal patient,nonneutropenic patient,neutropenic patient,critical patient,candidiasis invasora,candidemia,guías de consenso,diagnóstico fúngico,tratamiento antifúngico,paciente adulto,paciente pediátrico,paciente neonato,paciente no neutropénico, paciente neutropénico,invasive candidiasis,fungal diagnostics,consensus guidelines,antifungal treatment,adult patient,pediatric patient,paciente crítico.

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