Assessment of high-priced systemic antifungal prescriptions.

OBJECTIVES: To assess compliance with international guidelines for costly antifungal prescriptions and to compare these results with a first study performed in 2007. METHODS: Retrospective study including all costly antifungal prescriptions made in surgical and medical intensive care units and in a hepatobiliary, pancreatic, and digestive surgery unit. Prescriptions were assessed in terms of indication, dosage, and antifungal de-escalation. RESULTS: Seventy-four treatments were analyzed. Treatments were prescribed for prophylactic (1%), empirical (22%), pre-emptive (16%), or targeted therapy (61%). Caspofungin accounted for 68% of prescriptions, followed by voriconazole (20%) and liposomal amphotericin B (12%). Indication was appropriate in 91%, debatable in 1%, and inappropriate in 8%. Dosage was appropriate in 69%, debatable in 8%, and inappropriate in 23%. Prescriptions were inappropriate for the following reasons: lack of dosage adjustment in light of the hepatic function (10 cases), underdosage or excessive dosage by>25% of the recommended dose in seven cases. De-escalation to fluconazole was implemented in 40% of patients presenting with a fluconazole-susceptible candidiasis. CONCLUSION: The overall incidence of appropriate use was higher in 2012 compared with 2007 (62% and 37% respectively, P=0.004). Nevertheless, costly antifungal prescriptions need to be optimized in particular for empirical therapy, dosage adjustment, and potential de-escalation to fluconazole.

Aetiologies and contributing factors of vulvovaginal candidiasis in Abidjan (Cote d'Ivoire).

AIM OF THE STUDY: In order to update the data and contribute to optimizing the management of vulvovaginal candidiasis, we conducted this study to determine their etiology (and hence the sensitivity of the isolated fungal organisms) and the factors contributing to their occurrence in Abidjan (Cote d'Ivoire). PATIENTS AND METHODS: This cross-sectional survey involving 400 women with clinically vulvovaginitis was conducted from May to July 2011. It was carried out at the health centre for venereal diseases located at the National Institute of Public Hygiene in Abidjan. After a swab collecting, direct examination and culture on Sabouraud Chloramphenicol and Sabouraud Chloramphenicol Actidione media were implemented to research yeasts. After identifying yeast species through blastesis tests and auxanogram, its in vitro susceptibility to amphotericin B, 5-fluorocytosine, clotrimazole, miconazole, econazole and ketoconazole was assessed. RESULTS: As a whole, 172 patients suffered from vulvovaginal candidiasis i.e. an overall prevalence of 43%. Candida albicans was most frequently isolated (82.5%) followed by C. glabrata (10.5%). C. albicans and C. tropicalis were resistant to the 5-fluorocytosine (respectively 24.65 and 33.33%). Other molecules have shown excellent activity on all yeasts isolated. Type of housing, type of underwear and patients personal history were statistically associated with the presence of vulvovaginal candidiasis (respectively P=0.003; 0.010; 0.022). CONCLUSION: Vulvovaginal candidiasis is relatively frequent in Abidjan and antifungal compounds are in general still effective for treatment. Being knowledgeable of risk factors for this vulvovaginitis will ensure better prevention of their occurrence.

Quantificação e identificação de Candida na cavidade oral de crianças / Quantification and identification of Candida in the oral cavity children

A identificação correta e precisa do agente causal de uma candidose é importante para a caracterização epidemiológica do tipo de infecção, como também para a escolha do tratamento. Os objetivos deste trabalho foram isolar, quantificar e identificar asleveduras do gênero Candida, presentes na cavidade oral de crianças de 2 a 4 anos de idade. Para a realização deste trabalho foram feitas coletas semanais em um grupo formado por dez crianças de 2 a 4 anos de idade, com o auxílio de swabs estéreis, friccionados na região periodental. O material coletado foi inoculado em meio cromogênico, utilizando-se a técnica de esgotamento e incubado a 36oC. A quantificação e identificação seguiram a metodologia descrita por Gwendolyn. Os resultados mostraram que, em 2.256 colônias isoladas, a C. albicans foi a mais frequente com 70,00; 70,44 e 95,15%, seguido pela C. tropicalis, com 16,99; 13,85 e 4,65%, C. glabrata com 11,77; 4,98 e 0,20%, respectivamente para 2, 3 e 4 anos de idade. A espécie que apresentou menor frequência foi a C. krusei com 1,24 e 10,73%, para 2 e 3 anos. Em crianças de 4 anos, não se verificou a presença dessa espécie .

The correct and precise identification of the causative agent of thrush is important for epidemiological characterization of the type of infection, but also for the choice of treatment. The objectives of this work was to isolate and quantify identify yeasts of the genus Candida in the oral cavity of children 2 to 4 years of age. For this work, samples were collected weekly in a group of ten children from 2 to 4 years old, and the samples were taken with sterile swabs, which were rubbed on the periodontal region. The collected material was inoculated on chromogenic medium, using the technique of exhaustion and incubated to 36 C. The quantification and identification followed the methodology described by Gwendolyn, (2005).The results showed that in 2256 isolated colonies, C.albicans was the most frequent with 70.00, 70.44 and 95.15%, followed by C. tropicalis, with 16.99, 13.85 and 4.65%, C. glabrata with 11.77, 4.98 and 0.20% respectively for 2, 3 and 4 years of age. The species that showed a lower frequency was C. krusei with 1.24and 10.73% for 2 and 3 years. In children aged 4 years, there was the presence of this species .