Assuntos
Infecções Bacterianas , COVID-19 , Coinfecção , Bactérias , Infecções Bacterianas/complicações , Humanos , SARS-CoV-2RESUMO
The management of invasive fungal disease (IFD) in the haemato-oncology setting remains a challenge. This article reviews recent guidelines relating to IFD for their similarities and differences, as well as applying the Appraisal of Guidelines Research and Evaluation (AGREE) criteria. The guidelines' recommendations on antifungal prophylaxis, empirical and definitive treatment of candidiasis and aspergillosis are summarized; also, minimum standards for diagnosis and follow-up are discussed. This critique of the reviewed guidelines is a practical guide to physicians and commissioners in making local policies for IFD management.
Assuntos
Antifúngicos/uso terapêutico , Candidíase Invasiva/tratamento farmacológico , Neoplasias Hematológicas/complicações , Aspergilose Pulmonar Invasiva/tratamento farmacológico , Candidíase Invasiva/diagnóstico , Candidíase Invasiva/prevenção & controle , Quimioprevenção/métodos , Neoplasias Hematológicas/tratamento farmacológico , Humanos , Hospedeiro Imunocomprometido , Aspergilose Pulmonar Invasiva/diagnóstico , Aspergilose Pulmonar Invasiva/prevenção & controle , Guias de Prática Clínica como AssuntoRESUMO
OBJECTIVES: Conventional detection of extended-spectrum beta-lactamase (ESBL) producers in blood cultures usually requires overnight incubation. This could delay the prescribing of appropriate therapy. We evaluated whether the chromogenic cephalosporin HMRZ-86, which is hydrolysed by ESBLs, could be used for the rapid detection of ESBL producers directly in blood culture broths. METHODS: The HMRZ-86 test was first applied to broth cultures of isolates producing known beta-lactamases. A colour change indicating hydrolysis, which was inhibited by clavulanic acid, was taken as an indication of ESBL production. A similar method was used for testing blood culture supernatants and broth subcultures of blood cultures. RESULTS: The HMRZ-86 test detected all the ESBL producers among 83 clinical isolates and control strains. Only one false positive was seen. The usefulness of HMRZ-86 for the direct testing of blood culture broths was limited by the presence of lysed blood. However, by using a 2 h broth subculture of the blood culture broths, the HMRZ-86 test was able to detect all those blood cultures containing an ESBL producer. No false positive or negative tests occurred according to the results of our standard phenotypic tests. CONCLUSIONS: The HMRZ-86 test is a simple and rapid method that can be used for detecting ESBL producers in blood cultures.
