Consensus statement on the management of invasive candidiasis in Indian scenario

Invasive fungal infections in critically ill patients are associated with increased morbidity and mortality. Candida species are among the most common causes of nosocomial bloodstream infections and of invasive infections in intensive care units (ICUs). The high mortality mandates early identification of invasive candidiasis which is vital to initiate appropriate and timely treatment and improve outcomes. Delaying the initiation of treatment could result in an increase in mortality which can be avoided by usage of more rapid diagnostic techniques. There are multiple diagnostic tests including culture and non-culture tests like 1,3-β-D-glucan and newer techniques like MALDI-TOF which are available to diagnose candidemia but each with their drawbacks. Additionally, there are various guidelines like IDSA and ESCMID on treatment which aim to minimize death, late complications from deep-seated candidiasis and rise of drug- resistant Candida strains. Through this consensus statement prepared by a panel of experts, all of whom are senior intensivists, infectious disease specialists and microbiologists, we aim to address the major aspects of management of invasive candidiasis in the Indian population as per the authors opinions, backed by published evidence and supported by the latest clinical guidelines.

Safety and Efficacy Profile of CSE-1034 as a Prolonged De-escalation Therapy in Prosthetic Joint Infection: A Case Report

Background: Although rare, infection is considered to be most dreadful of the prosthetic related complications resulting in repeated surgical intervention, extended hospitalization or sometimes in loss of implant or permanent disability if not treated promptly. Poor treatment outcome associated with prosthetic joint infections (PJIs) could be partly attributed to rise in anti-microbial resistance among the causative agents. Case Presentation: This is a first reported case of ceftriaxone + sulbactam + ethylenediaminetetraacetic acid (CSE 1034) being used as an de-escalation therapy for more than 24 days with good safety and efficacy outcome in a 78 year male patient with PJI associated with hip replacement surgery, treated initially with meropenem and colistin followed by prolonged de-escalation therapy (24 days).Conclusions: In clinically complicated cases of deep infections where prolonged use of last resort antibiotics is used, CSE-1034 can be considered as a safe, efficacious and economical de-escalating antibiotic to complete the treatment course and prevent recurrence of infection, especially in PJI