Efficacy Study of Early Presumptive Therapy (EPT) for Deep Fungal Infection
We retrospectively studied the efficacy of early presumptive therapy (EPT). Subjects and Method: Of the critically ill patients admitted from January 1998 to the end of December 2000 to Kyorin University Trauma Burn and Intensive Care Center, 77 cases were diagnosed with suspected deep fungal infect...
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| Published in | Nihon Ishinkin Gakkai zasshi Vol. 45; no. 4; pp. 203 - 208 |
|---|---|
| Main Authors | , , , , , |
| Format | Journal Article |
| Language | English Japanese |
| Published |
Japan
The Japanese Society for Medical Mycology
2004
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| Subjects | |
| Online Access | Get full text |
| ISSN | 0916-4804 1882-0476 |
| DOI | 10.3314/jjmm.45.203 |
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| Abstract | We retrospectively studied the efficacy of early presumptive therapy (EPT). Subjects and Method: Of the critically ill patients admitted from January 1998 to the end of December 2000 to Kyorin University Trauma Burn and Intensive Care Center, 77 cases were diagnosed with suspected deep fungal infection, and EPT was administered. The diagnosis of suspected deep fungal infection was made by definition. EPT (FLCZ 200 to 400mg/day×14 days) was started as soon as the diagnosis was made and continued for two weeks. Its efficacy was retrospectively studied by analyzing the clinical findings, changes in local organisms, and hematological tests. Results: After treatment, 62% of the patients showed improvement in clinical signs of infection, elimination of locally detected fungus, and improvement in the serum diagnosis test. Post-EPT detection levels of the fungus had decreased to 21%. The mean pre-EPT body temperature was 38.7°C±0.6°C, but the mean post-EPT temperature was 36.7°C±0.6°C. The mean level of blood 1, 3-β-D-glucan was 35±13pg/ml at the time the diagnosis was made, but returned to normal levels after treatment had concluded. No patients died as a direct result of the fungal infection. Conclusion: This study of early presumptive therapy in critically ill patients in the emergency and intensive care medicine fields showed the therapy in these, and in high risk patients to be efficacious. |
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| AbstractList | We retrospectively studied the efficacy of early presumptive therapy (EPT).
Of the critically ill patients admitted from January 1998 to the end of December 2000 to Kyorin University Trauma Burn and Intensive Care Center, 77 cases were diagnosed with suspected deep fungal infection, and EPT was administered. The diagnosis of suspected deep fungal infection was made by definition. EPT (FLCZ 200 to 400 mg/day x 14 days) was started as soon as the diagnosis was made and continued for two weeks. Its efficacy was retrospectively studied by analyzing the clinical findings, changes in local organisms, and hematological tests.
After treatment, 62% of the patients showed improvement in clinical signs of infection, elimination of locally detected fungus, and improvement in the serum diagnosis test. Post-EPT detection levels of the fungus had decreased to 21%. The mean pre-EPT body temperature was 38.7 degrees C +/- 0.6 degrees C, but the mean post-EPT temperature was 36.7 degrees C +/- 0.6 degrees C. The mean level of blood 1,3-beta-D-glucan was 35 plus minus 13 pg/ml at the time the diagnosis was made, but returned to normal levels after treatment had concluded. No patients died as a direct result of the fungal infection.
This study of early presumptive therapy in critically ill patients in the emergency and intensive care medicine fields showed the therapy in these, and in high risk patients to be efficacious. We retrospectively studied the efficacy of early presumptive therapy (EPT).UNLABELLEDWe retrospectively studied the efficacy of early presumptive therapy (EPT).Of the critically ill patients admitted from January 1998 to the end of December 2000 to Kyorin University Trauma Burn and Intensive Care Center, 77 cases were diagnosed with suspected deep fungal infection, and EPT was administered. The diagnosis of suspected deep fungal infection was made by definition. EPT (FLCZ 200 to 400 mg/day x 14 days) was started as soon as the diagnosis was made and continued for two weeks. Its efficacy was retrospectively studied by analyzing the clinical findings, changes in local organisms, and hematological tests.SUBJECTS AND METHODOf the critically ill patients admitted from January 1998 to the end of December 2000 to Kyorin University Trauma Burn and Intensive Care Center, 77 cases were diagnosed with suspected deep fungal infection, and EPT was administered. The diagnosis of suspected deep fungal infection was made by definition. EPT (FLCZ 200 to 400 mg/day x 14 days) was started as soon as the diagnosis was made and continued for two weeks. Its efficacy was retrospectively studied by analyzing the clinical findings, changes in local organisms, and hematological tests.After treatment, 62% of the patients showed improvement in clinical signs of infection, elimination of locally detected fungus, and improvement in the serum diagnosis test. Post-EPT detection levels of the fungus had decreased to 21%. The mean pre-EPT body temperature was 38.7 degrees C +/- 0.6 degrees C, but the mean post-EPT temperature was 36.7 degrees C +/- 0.6 degrees C. The mean level of blood 1,3-beta-D-glucan was 35 plus minus 13 pg/ml at the time the diagnosis was made, but returned to normal levels after treatment had concluded. No patients died as a direct result of the fungal infection.RESULTSAfter treatment, 62% of the patients showed improvement in clinical signs of infection, elimination of locally detected fungus, and improvement in the serum diagnosis test. Post-EPT detection levels of the fungus had decreased to 21%. The mean pre-EPT body temperature was 38.7 degrees C +/- 0.6 degrees C, but the mean post-EPT temperature was 36.7 degrees C +/- 0.6 degrees C. The mean level of blood 1,3-beta-D-glucan was 35 plus minus 13 pg/ml at the time the diagnosis was made, but returned to normal levels after treatment had concluded. No patients died as a direct result of the fungal infection.This study of early presumptive therapy in critically ill patients in the emergency and intensive care medicine fields showed the therapy in these, and in high risk patients to be efficacious.CONCLUSIONThis study of early presumptive therapy in critically ill patients in the emergency and intensive care medicine fields showed the therapy in these, and in high risk patients to be efficacious. We retrospectively studied the efficacy of early presumptive therapy (EPT). Subjects and Method: Of the critically ill patients admitted from January 1998 to the end of December 2000 to Kyorin University Trauma Burn and Intensive Care Center, 77 cases were diagnosed with suspected deep fungal infection, and EPT was administered. The diagnosis of suspected deep fungal infection was made by definition. EPT (FLCZ 200 to 400mg/day×14 days) was started as soon as the diagnosis was made and continued for two weeks. Its efficacy was retrospectively studied by analyzing the clinical findings, changes in local organisms, and hematological tests. Results: After treatment, 62% of the patients showed improvement in clinical signs of infection, elimination of locally detected fungus, and improvement in the serum diagnosis test. Post-EPT detection levels of the fungus had decreased to 21%. The mean pre-EPT body temperature was 38.7°C±0.6°C, but the mean post-EPT temperature was 36.7°C±0.6°C. The mean level of blood 1, 3-β-D-glucan was 35±13pg/ml at the time the diagnosis was made, but returned to normal levels after treatment had concluded. No patients died as a direct result of the fungal infection. Conclusion: This study of early presumptive therapy in critically ill patients in the emergency and intensive care medicine fields showed the therapy in these, and in high risk patients to be efficacious. |
| Author | Yoshizawa, Mie Shimazaki, Syuji Goto, Hideaki Tanaka, Hideharu Sakaki, Seiki Yoshinari, Kiyoshi |
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| BackLink | https://www.ncbi.nlm.nih.gov/pubmed/15550916$$D View this record in MEDLINE/PubMed |
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| References | 7) 田中秀治, 後藤英昭, 櫻井勝, 島崎修次:重症鈍的外傷患者における深在性真菌症発生のリスクと外傷重症度の検討. 日本外傷学会雑誌 13:216-222, 1999. 10) Solomkin JS, Flohr A, Simmons RL: Indications for therapy fungemia in postoperative patients. Arch Surg 117: 1272-1275, 1982. 2) Border JR: Trauma and sepsis, in Worth MH (eds): Principles and Practice of Trauma Care. Baltimore Williams & Wilkins, pp. 330-387, 1982. 5) 田中秀治, 古畑敏子, 後藤英昭, 櫻井勝, 島崎修次:救命救急センターにおける深在性真菌症の発生頻度の検討-真菌感染のリスクと疾病形態, 患者重症度との関係-. 真菌誌 40:135-142, 1999. 20) Obayashi T, Yoshida M, Mori T, et al.: Plasma (1-3)-β-D-glucan measurement in diagnosis of invasive deep mycosis and fungal febrile episords. Lancet 345: 17-20, 1995. 4) 田中秀治:重症患者において耐性菌を発生させないためのアプローチ. 平松啓一編. 耐性菌感染症の理論と実際. 医薬ジャーナル社, 東京 pp. 162-168, 1998. 9) Alexander JW, Boice ST, Babcock GF, et al.: The process or microbial translocation. Ann Surg 212: 496-512, 1990. 18) Aikawa N, Sumiyama Y, Kusachi S, et al.: Use of antifungal agents in febrile patients nonresponsive to antibacterial treatment: the current status in surgical and critical care patients in Japan. J Infect Chemother 8: 237-241, 2002. 3) Vincent JL, Bihari DJ, Suter PM, et al.: The prevalence of nosocomial infection in intensive care units in Europe: Results of the European prevalence of infection in intensive care (EPIC) study. JAMA 274: 639-644, 1995. 19) Dube MP, Heseltine PNR, Rinaldi MG, et al.: Fungemia and colonization with nystain-resistant Candida rugosa in a burn unit. Clin Infec Dis 18: 77-82, 1994. 13) Maejima K, Deitch EA, Berg R: Promotion by burn stress of the translocation of bacteria from the gastrointestinal tracts of mice. Arch Surg 119: 166-172, 1984. 11) Wey SB, Mori M, Pfaller MA, et al.: Risk factors for hospital-acquired candidemia. A matched case-control study. Arch Intern Med. 149: 2349-2353, 1989. 15) Demajo WA, JG Guimond F, Rotstein C, et al.: Guideline for the management of nosocomial Candida infections in non-neutropenic intensive care patients. Canadian J Inf Dis 8 (Suppl. B): 3B-9B, 1997. 6) Dean DA, Burchard KW: Fungal Infection in surgical patients. Am J Surg 171: 374-382, 1996. 12) Berg RD, Garlington AW: Translocation of certain indigenous bacteria from the gastrointestinal tract to the mesenteric lymph nodes and other organs in a gnotobiotic mouse model. Infect Immun 23: 403-411, 1979. 1) Chitkara YK, Feierabend TC: Endogenous and exogenous infections with Pseudomonas aeruginosa in a bum unit. Int Surg 66: 237-240, 1981. 17) Wey SB, Motomi M, Pfaller MA, et al.: Hospitalacquired candidemia; The attributable mortality and excess length of stay. Arch Intern Med 148: 2642-2645, 1988. 14) British Society for Antimicrobial Chemotherapy Working Party: Management of deep Candida infection in surgical and intensive care unit patients. Intens Care Med 20: 522-528, 1994. 16) Pittet D, Monod M, Suter PM, et al.: Candida colonization and subsequent infections on critically ill surgical patients. Ann Surg 220: 751-758, 1994. 8) Maejima K, Deitch EA, Burg RD: Bacterial translocation from the gastrointestinal tract of rats receiving thermal injury. Infect Immun 43: 6-10, 1984. |
| References_xml | – reference: 16) Pittet D, Monod M, Suter PM, et al.: Candida colonization and subsequent infections on critically ill surgical patients. Ann Surg 220: 751-758, 1994. – reference: 17) Wey SB, Motomi M, Pfaller MA, et al.: Hospitalacquired candidemia; The attributable mortality and excess length of stay. Arch Intern Med 148: 2642-2645, 1988. – reference: 20) Obayashi T, Yoshida M, Mori T, et al.: Plasma (1-3)-β-D-glucan measurement in diagnosis of invasive deep mycosis and fungal febrile episords. Lancet 345: 17-20, 1995. – reference: 6) Dean DA, Burchard KW: Fungal Infection in surgical patients. Am J Surg 171: 374-382, 1996. – reference: 9) Alexander JW, Boice ST, Babcock GF, et al.: The process or microbial translocation. Ann Surg 212: 496-512, 1990. – reference: 12) Berg RD, Garlington AW: Translocation of certain indigenous bacteria from the gastrointestinal tract to the mesenteric lymph nodes and other organs in a gnotobiotic mouse model. Infect Immun 23: 403-411, 1979. – reference: 18) Aikawa N, Sumiyama Y, Kusachi S, et al.: Use of antifungal agents in febrile patients nonresponsive to antibacterial treatment: the current status in surgical and critical care patients in Japan. J Infect Chemother 8: 237-241, 2002. – reference: 2) Border JR: Trauma and sepsis, in Worth MH (eds): Principles and Practice of Trauma Care. Baltimore Williams & Wilkins, pp. 330-387, 1982. – reference: 19) Dube MP, Heseltine PNR, Rinaldi MG, et al.: Fungemia and colonization with nystain-resistant Candida rugosa in a burn unit. Clin Infec Dis 18: 77-82, 1994. – reference: 1) Chitkara YK, Feierabend TC: Endogenous and exogenous infections with Pseudomonas aeruginosa in a bum unit. Int Surg 66: 237-240, 1981. – reference: 4) 田中秀治:重症患者において耐性菌を発生させないためのアプローチ. 平松啓一編. 耐性菌感染症の理論と実際. 医薬ジャーナル社, 東京 pp. 162-168, 1998. – reference: 7) 田中秀治, 後藤英昭, 櫻井勝, 島崎修次:重症鈍的外傷患者における深在性真菌症発生のリスクと外傷重症度の検討. 日本外傷学会雑誌 13:216-222, 1999. – reference: 10) Solomkin JS, Flohr A, Simmons RL: Indications for therapy fungemia in postoperative patients. Arch Surg 117: 1272-1275, 1982. – reference: 14) British Society for Antimicrobial Chemotherapy Working Party: Management of deep Candida infection in surgical and intensive care unit patients. Intens Care Med 20: 522-528, 1994. – reference: 5) 田中秀治, 古畑敏子, 後藤英昭, 櫻井勝, 島崎修次:救命救急センターにおける深在性真菌症の発生頻度の検討-真菌感染のリスクと疾病形態, 患者重症度との関係-. 真菌誌 40:135-142, 1999. – reference: 15) Demajo WA, JG Guimond F, Rotstein C, et al.: Guideline for the management of nosocomial Candida infections in non-neutropenic intensive care patients. Canadian J Inf Dis 8 (Suppl. B): 3B-9B, 1997. – reference: 3) Vincent JL, Bihari DJ, Suter PM, et al.: The prevalence of nosocomial infection in intensive care units in Europe: Results of the European prevalence of infection in intensive care (EPIC) study. JAMA 274: 639-644, 1995. – reference: 13) Maejima K, Deitch EA, Berg R: Promotion by burn stress of the translocation of bacteria from the gastrointestinal tracts of mice. Arch Surg 119: 166-172, 1984. – reference: 11) Wey SB, Mori M, Pfaller MA, et al.: Risk factors for hospital-acquired candidemia. A matched case-control study. Arch Intern Med. 149: 2349-2353, 1989. – reference: 8) Maejima K, Deitch EA, Burg RD: Bacterial translocation from the gastrointestinal tract of rats receiving thermal injury. Infect Immun 43: 6-10, 1984. |
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| SubjectTerms | Antifungal Agents - administration & dosage critical care medicine deep fungal infection Drug Administration Schedule EPT Female Humans Male Mycoses - prevention & control Retrospective Studies |
| Title | Efficacy Study of Early Presumptive Therapy (EPT) for Deep Fungal Infection |
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