Acute bacterial endocarditis during granulocytopenia in an allogenic marrow transplant recipient.

Safdar A, Childs BH, Keefe D, Sepkowitz KA.

Am J Med. 2000 Oct 15;109(6):514-5.

Treatment for coccidioidomycosis in pregnancy?

Busowski JD, Safdar A.

Postgrad Med. 2001 Mar;109(3):76-7.

Prospective study of Candida species in patients at a comprehensive cancer center.

Safdar A, Chaturvedi V, Cross EW, Park S, Bernard EM, Armstrong D, Perlin DS.

Antimicrob Agents Chemother. 2001 Jul;45(7):2129-33.

Abstract

Since most nosocomial systemic yeast infections arise from the endogenous flora of the patient, we prospectively evaluated the species stratification and antifungal susceptibility profile of Candida spp. associated with heavy colonization and systemic infection in patients at Memorial Sloan-Kettering Cancer Center in New York. A total of 349 Candida isolates were obtained from 223 patients during the later half of 1998. Cancer was the most common underlying disease, occurring in 91% of the patients, including 61.8% with organ and 23.7% with hematological malignancies; 4.4% of the patients had AIDS. Candida albicans was the predominant species (67.3%); among 114 non-albicans Candida spp., C. glabrata (45.6%) was the most frequent, followed by C. tropicalis (18.4%), C. parapsilosis (16.6%), and C. krusei (9.6%). The overall resistance to triazole-based agents among all yeast isolates was 9.4 and 10.8% for fluconazole and itraconazole, respectively. A total of 5% of C. albicans strains were resistant to triazole antifungals, whereas 30.8 and 46.2% of C. glabrata strains were resistant to fluconazole (MIC > or = 64 microg/ml) and itraconazole (MIC > or = 1 microg/ml), respectively. A significant association was observed between prior treatment with triazole and isolation of fluconazole-resistant C. albicans (P = 0.005, OR 36), although this relationship was not seen in C. glabrata isolates (P = 0.4). This study reinforces the importance of periodic, prospective surveillance of clinical fungal isolates to determine appropriate prophylactic, empiric, and preemptive antifungal therapy for the highly susceptible patient population.

Infectious morbidity in critically ill patients with cancer.

Safdar A, Armstrong D.

Crit Care Clin. 2001 Jul;17(3):531-70, vii-viii. Review.

Abstract

Infection frequently complicates the course of cancer treatment and often adversely affects the outcome. Patients have a greater tendency for acquiring infections caused by opportunistic microorganisms. Agents with low virulence potential may lead to invasive and often life-threatening infections because of altered host immune function. The immune dysfunction may be caused by the underlying malignancy, by antineoplastic chemotherapy, or by invasive procedures during supportive care.

Acute febrile myelodysplasia and pneumonitis due to human herpesvirus 6 after accelerated chemotherapy.

Safdar A, Brown AE, Malkin M.

Am J Med. 2001 Sep;111(4):329-30.

 

 

Clinical microbiological case: refractory chest wall infection following reconstructive surgery in a patient with relapsed lung cancer.

Safdar A, Bains M, Polsky B.

Clin Microbiol Infect. 2001 Oct;7(10):563-4, 577-9.

Candida glabrata and Candida krusei fungemia after high-risk allogeneic marrow transplantation: no adverse effect of low-dose fluconazole prophylaxis on incidence and outcome.

Safdar A, van Rhee F, Henslee-Downey JP, Singhal S, Mehta J.

Bone Marrow Transplant. 2001 Nov;28(9):873-8.

Abstract

Candidemia is a serious complication in patients following allogeneic blood, marrow, and organ transplantation. Fourteen patients developed nosocomial fungemia among 204 allogeneic marrow transplants performed during 1997-1999. Incidence of hematogenous candidiasis was 6.8 per 100 allogeneic BMT. All 14 had an indwelling central venous catheter (CVC) and fluconazole (100-200 mg daily) was given prophylactically. In 11 (78.5%) neutropenic patients, duration between agranulocytosis and diagnosis of fungemia was (median, +/- s.d.) 10 +/- 8 days. Candida glabrata (53.3%) was the most common yeast species, followed by C. krusei (33.3%), and C. parapsilosis (13.3%). Candida albicans was conspicuously absent. Ten patients (71.4%) had primary transplant-related complication (>2 days) including hemolytic uremic syndrome/thrombotic thrombocytopenic purpura (HUS/TTP) (n = 5), severe hemorrhagic cystitis (n = 3), and bacteremia (n = 2). Seven (50.0%) patients expired and in three (21.4%) deaths were attributed to fungemia. The impact of a primary transplant-related complication on short-term survival in this setting was not significant (P = 0.07) (HUS/TTP (P > 0.5); neutropenia (P > 0.5); GVHD (P = 0.35)). Removal of CVC did not alter outcome in our group (P > or = 0.5) although in patients with persistent fungemia (>72 h), and those with preceding bacteremia, mortality was significantly higher (P = 0.002). Conventional prognosticators of poor outcome did not adversely effect short-term survival in our transplant recipients with hematogenous candidiasis. The predominance of C. glabrata and C. krusei breakthrough infections was similar to what is seen with high-dose fluconazole (400 mg) prophylaxis, and no adverse effects of low-dose fluconazole in terms of increased incidence of non-susceptible Candida species was seen.

Progressive cutaneous hyalohyphomycosis due to Paecilomyces lilacinus: rapid response to treatment with caspofungin and itraconazole.

Safdar A.

Clin Infect Dis. 2002 May 15;34(10):1415-7. Epub 2002 Apr 23.

Abstract

A case of rapidly progressive cutaneous infection due to Paecilomyces lilacinus developed in a woman with advanced pancreatic cancer who did not have granulocytopenia. The infection responded favorably to caspofungin and itraconazole combination therapy.

Prosthetic valve endocarditis due to vancomycin-resistant Enterococcus faecium: treatment with chloramphenicol plus minocycline.

Safdar A, Bryan CS, Stinson S, Saunders DE.

Clin Infect Dis. 2002 Jun 1;34(11):E61-3. Epub 2002 May 9.

Abstract

We report a case of prosthetic valve endocarditis and persistent bacteremia due to vancomycin-resistant Enterococcus faecium. The combination of parenteral chloramphenicol plus minocycline therapy was administered for 8 weeks and resulted in cure after treatment with quinupristin-dalfopristin had failed.

Clinical microbiological case: cardiac tamponade due to hemorrhagic pericarditis in a non-immunocompromised woman from south-eastern United States.

Safdar A, Humphery SH, Harding SA, Close TP.

Clin Microbiol Infect. 2002 Apr;8(4):243-4, 248-51.