scholarly journals Reasons for Failure of Antifungal-lock Therapy with Caspofungin: Need for Higher Concentrations

2017 ◽  
Vol 4 (1) ◽  
pp. 30-32 ◽  
Author(s):  
Rana İşgüder ◽  
Gökhan Ceylan ◽  
Özlem Sandal ◽  
Ferhat Sarı ◽  
Gamze Gülfidan ◽  
...  
Keyword(s):  
Lock Therapy ◽  
Antifungal Lock Therapy

scholarly journals Rabbit Model of Candida albicans Biofilm Infection: Liposomal Amphotericin B Antifungal Lock Therapy

2004 ◽  
Vol 48 (5) ◽  
pp. 1727-1732 ◽  
Author(s):  
Matthew K. Schinabeck ◽  
Lisa A. Long ◽  
Mohammad A. Hossain ◽  
Jyotsna Chandra ◽  
Pranab K. Mukherjee ◽  
...  
Keyword(s):  
Candida Albicans ◽  
Amphotericin B ◽  
Treatment Strategy ◽  
Liposomal Amphotericin ◽  
Rabbit Model ◽  
Liposomal Amphotericin B ◽  
Electron Microscopic ◽  
Lock Therapy ◽  
Antifungal Lock Therapy ◽  
Scanning Electron

ABSTRACT Catheter-related infections due to Candida albicans biofilms are a leading cause of fungal nosocomial bloodstream infection. In this paper, we describe the development of a model of catheter-associated infection with C. albicans biofilms and show that antifungal lock therapy with liposomal amphotericin B is an effective treatment strategy for these infections. Silicone catheters surgically placed in New Zealand White rabbits were infected with C. albicans, and the rabbits were randomized into three groups: (i) untreated controls, (ii) liposomal amphotericin B lock, and (iii) fluconazole lock. Upon completion of therapy, blood cultures were obtained and the catheters were removed for quantitative culture and scanning electron microscopic analyses. Quantitative cultures revealed that catheters treated with liposomal amphotericin B yielded 0 CFU, which was significant compared to the untreated controls (P < 0.001) and the fluconazole-treated group (P = 0.0079). Although fluconazole treatment tended to have lower CFU compared to untreated controls, there was no difference in mean colony counts between these two groups (1.128 ± 0.764 and 1.841 ± 1.141 log10 CFU/catheter segment, respectively; P = 0.297). Scanning electron microscopy revealed abundant biofilm in the control and fluconazole groups, while the liposomal amphotericin B group was virtually cleared. These findings suggest a possible treatment strategy for the successful salvage of catheters infected with C. albicans biofilms and describe an animal model that may play an important role in the further study of C. albicans biofilm pathogenesis and evaluation of potential antibiofilm agents.

scholarly journals 2856. Salvaging High-Value Catheters: Antifungal Lock Therapy for Candidal Central Catheter Infections in a Pediatric Cohort

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S75-S76
Author(s):  
Lorne W Walker ◽  
Andrew J Nowalk
Keyword(s):  
Blood Culture ◽  
Retrospective Analysis ◽  
Candida Species ◽  
Pediatric Population ◽  
Bloodstream Infections ◽  
Outcome Data ◽  
Recurrence Rates ◽  
Early Removal ◽  
Lock Therapy ◽  
Antifungal Lock Therapy

Abstract Background By IDSA guidelines, therapy for central line-associated bloodstream infections (CLABSI) due to Candida species requires catheter removal and administration of systemic antifungals. Despite this, in selected cases catheter salvage is desirable. The addition of antifungal lock therapy (ALT) has been proposed in these cases, but evidence for efficacy of this approach is limited. Here we report a retrospective analysis of ALT use for CLABSI due to Candida species at a single pediatric center. Methods All events of candidal CLABSI with ALT use were identified by retrospective record review between January 1, 2008 and December 31, 2018. CLABSI was defined by the growth of Candida from at least one central blood culture. Clearance was defined as a period of 48 hours with no positive cultures. Recurrence was defined as a subsequent positive blood culture with the same fungal organism either before or after line removal. Events were classified as “early removal” vs. “retained 7 days” depending on whether the line remained in place on day 7 after the first positive culture. Results Overall, 122 qualifying CLABSI were identified, 64 (52%) were retained 7 days or more (Table 1). Overall, 59% of CLABSI met criteria for clearance prior to line removal. Lines retained 7 days were likely to also remain in place at 28 days (72%) and had a low rate of relapse (8%) within 28 days. Lines in the early removal group had lower recurrence rates within 1 year (17% vs. 42%, P = 0.005), but this difference narrowed when considering recurrence at any time (31% vs. 47%, P = 0.1) or by Kaplan–Meier analysis (Figure 1) Additional microbiological and outcome data can be found in Tables 2 and 3. Conclusion This retrospective analysis is the largest described cohort of antifungal locks for line salvage in a pediatric population to our knowledge. These findings highlight the advantages of line removal, with lower recurrence at 1 year. However, when line salvage with antifungal locks is attempted, retention and recurrence rates in the first month are favorable, and recurrence rates converge in the long-term, presumably because the underlying risk factors remain. While line removal remains the standard therapy for candidal CLABSI, we find that ALT-based line salvage may be a viable alternative. Disclosures All Authors: No reported Disclosures.

scholarly journals Antifungal Lock Therapy

2012 ◽  
Vol 57 (1) ◽  
pp. 1-8 ◽  
Author(s):  
Carla J. Walraven ◽  
Samuel A. Lee
Keyword(s):  
Antifungal Agents ◽  
Bloodstream Infections ◽  
Central Venous ◽  
Content Type ◽  
The Past ◽  
Significant Interest ◽  
Lock Therapy ◽  
Antifungal Lock Therapy ◽  
Intravascular Devices

ABSTRACTThe widespread use of intravascular devices, such as central venous and hemodialysis catheters, in the past 2 decades has paralleled the increasing incidence of catheter-related bloodstream infections (CR-BSIs).Candida albicansis the fourth leading cause of hospital-associated BSIs. The propensity ofC. albicansto form biofilms on these catheters has made these infections difficult to treat due to multiple factors, including increased resistance to antifungal agents. Thus, curing CR-BSIs caused byCandidaspecies usually requires catheter removal in addition to systemic antifungal therapy. Alternatively, antimicrobial lock therapy has received significant interest and shown promise as a strategy to treat CR-BSIs due toCandidaspecies. The existingin vitro, animal, and patient data for treatment ofCandida-related CR-BSIs are reviewed. The most promising antifungal lock therapy (AfLT) strategies include use of amphotericin, ethanol, or echinocandins. Clinical trials are needed to further define the safety and efficacy of AfLT.

scholarly journals Antifungal Lock Therapy With Liposomal Amphotericin B: A Prospective Trial

2014 ◽  
Vol 5 (1) ◽  
pp. 80-84 ◽  
Author(s):  
William McGhee ◽  
Marian G. Michaels ◽  
Judith M. Martin ◽  
George V. Mazariegos ◽  
Michael Green
Keyword(s):  
Amphotericin B ◽  
Liposomal Amphotericin ◽  
Prospective Trial ◽  
Liposomal Amphotericin B ◽  
Lock Therapy ◽  
Antifungal Lock Therapy

Antifungal Lock Therapy With Combined 70% Ethanol and Micafungin in a Critically Ill Infant

2014 ◽  
Vol 33 (4) ◽  
pp. 419-420 ◽  
Author(s):  
Fiammetta Piersigilli ◽  
Cinzia Auriti ◽  
Iliana Bersani ◽  
Bianca Goffredo ◽  
Giuseppe Bianco ◽  
...  
Keyword(s):  
Critically Ill ◽  
Lock Therapy ◽  
Antifungal Lock Therapy

Use of Antimicrobial Lock Therapy for the Treatment of Central Line-Related Blood-Stream Infections: A Case Series

2018 ◽  
Author(s):  
F. Piersigilli ◽  
C. Auriti ◽  
I. Bersani ◽  
F. Campi ◽  
I. Savarese ◽  
...  
Keyword(s):  
Case Series ◽  
Blood Stream ◽  
Central Line ◽  
Blood Stream Infections ◽  
Lock Therapy

scholarly journals Approaches for Mitigating Microbial Biofilm-Related Drug Resistance: A Focus on Micro- and Nanotechnologies

Molecules ◽  
2021 ◽  
Vol 26 (7) ◽  
pp. 1870
Author(s):  
Harinash Rao ◽  
Sulin Choo ◽  
Sri Raja Rajeswari Mahalingam ◽  
Diajeng Sekar Adisuri ◽  
Priya Madhavan ◽  
...  
Keyword(s):  
Antimicrobial Resistance ◽  
Physiological State ◽  
Persister Cells ◽  
Microbial Biofilm ◽  
Antimicrobial Coatings ◽  
Drug Efflux Pumps ◽  
Lock Therapy ◽  
Related Drug ◽  
Healthcare Associated ◽  
Potential Therapeutics

Biofilms play an essential role in chronic and healthcare-associated infections and are more resistant to antimicrobials compared to their planktonic counterparts due to their (1) physiological state, (2) cell density, (3) quorum sensing abilities, (4) presence of extracellular matrix, (5) upregulation of drug efflux pumps, (6) point mutation and overexpression of resistance genes, and (7) presence of persister cells. The genes involved and their implications in antimicrobial resistance are well defined for bacterial biofilms but are understudied in fungal biofilms. Potential therapeutics for biofilm mitigation that have been reported include (1) antimicrobial photodynamic therapy, (2) antimicrobial lock therapy, (3) antimicrobial peptides, (4) electrical methods, and (5) antimicrobial coatings. These approaches exhibit promising characteristics for addressing the impending crisis of antimicrobial resistance (AMR). Recently, advances in the micro- and nanotechnology field have propelled the development of novel biomaterials and approaches to combat biofilms either independently, in combination or as antimicrobial delivery systems. In this review, we will summarize the general principles of clinically important microbial biofilm formation with a focus on fungal biofilms. We will delve into the details of some novel micro- and nanotechnology approaches that have been developed to combat biofilms and the possibility of utilizing them in a clinical setting.

scholarly journals β-Lactam antibiotics and vancomycin inhibit the growth of planktonic and biofilm Candida spp.: An additional benefit of antibiotic-lock therapy?

2015 ◽  
Vol 45 (4) ◽  
pp. 420-423 ◽  
Author(s):  
José J.C. Sidrim ◽  
Carlos E.C. Teixeira ◽  
Rossana A. Cordeiro ◽  
Raimunda S.N. Brilhante ◽  
Débora S.C.M. Castelo-Branco ◽  
...  
Keyword(s):  
Additional Benefit ◽  
Candida Spp ◽  
Lock Therapy ◽  
Antibiotic Lock

211 Ethanol Lock Therapy in Reducing Catheter Related Blood Stream Infections (CRBSI) in Home Parenteral Nutrition Patients

2010 ◽  
Vol 138 (5) ◽  
pp. S-39 ◽  
Author(s):  
Bijo K. John ◽  
Maqsood A. Khan ◽  
Rex Speerhas ◽  
Kristen Rhoda ◽  
Cindy Hamilton ◽  
...  
Keyword(s):  
Parenteral Nutrition ◽  
Blood Stream ◽  
Home Parenteral Nutrition ◽  
Blood Stream Infections ◽  
Lock Therapy ◽  
Ethanol Lock
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