SIGNIFICANCE STATEMENT: Although cytomegalovirus (CMV) infection is an important factor in the pathogenesis of kidney allograft rejection, previous studies have not determined the optimal CMV prevention strategy to avoid indirect effects of the virus. In this randomized trial involving 140 kidney transplant recipients, incidence of acute rejection at 12 months was not lower with valganciclovir prophylaxis (for at least 3 months) compared with preemptive therapy initiated after detection of CMV DNA in whole blood. However, prophylaxis was associated with a lower risk of subclinical rejection at 3 months. Although both regimens were effective in preventing CMV disease, the incidence of CMV DNAemia (including episodes with higher viral loads) was significantly higher with preemptive therapy. Further research with long-term follow-up is warranted to better compare the two approaches. BACKGROUND: The optimal regimen for preventing cytomegalovirus (CMV) infection in kidney transplant recipients, primarily in reducing indirect CMV effects, has not been defined. METHODS: This open-label, single-center, randomized clinical trial of valganciclovir prophylaxis versus preemptive therapy included kidney transplant recipients recruited between June 2013 and May 2018. After excluding CMV-seronegative recipients with transplants from seronegative donors, we randomized 140 participants 1:1 to receive valganciclovir prophylaxis (900 mg, daily for 3 or 6 months for CMV-seronegative recipients who received a kidney from a CMV-seropositive donor) or preemptive therapy (valganciclovir, 900 mg, twice daily) that was initiated after detection of CMV DNA in whole blood (≥1000 IU/ml) and stopped after two consecutive negative tests (preemptive therapy patients received weekly CMV PCR tests for 4 months). The primary outcome was the incidence of biopsy-confirmed acute rejection at 12 months. Key secondary outcomes included subclinical rejection, CMV disease and DNAemia, and neutropenia. RESULTS: The incidence of acute rejection was lower with valganciclovir prophylaxis than with preemptive therapy (13%, 9/70 versus 23%, 16/70), but the difference was not statistically significant. Subclinical rejection at 3 months was lower in the prophylaxis group (13% versus 29%, P = 0.027). Both regimens prevented CMV disease (in 4% of patients in both groups). Compared with prophylaxis, preemptive therapy resulted in significantly higher rates of CMV DNAemia (44% versus 75%, P < 0.001) and a higher proportion of patients experiencing episodes with higher viral load (≥2000 IU/ml), but significantly lower valganciclovir exposure and neutropenia. CONCLUSION: Among kidney transplant recipients, the use of valganciclovir prophylaxis did not result in a significantly lower incidence of acute rejection compared with the use of preemptive therapy. CLINICAL TRIAL REGISTRY NAME AND REGISTRATION NUMBER: Optimizing Valganciclovir Efficacy in Renal Transplantation (OVERT Study), ACTRN12613000554763 .

• MeSH
• antivirové látky škodlivé účinky   MeSH
• cytomegalovirové infekce * epidemiologie   MeSH
• Cytomegalovirus genetika   MeSH
• lidé MeSH
• neutropenie * chemicky indukované   komplikace   MeSH
• příjemce transplantátu MeSH
• transplantace ledvin * škodlivé účinky   MeSH
• valganciklovir škodlivé účinky   MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH
• práce podpořená grantem MeSH
• randomizované kontrolované studie MeSH
• Názvy látek
• antivirové látky MeSH
• valganciklovir MeSH

OBJECTIVES: Fluoroquinolone (FQ) prophylaxis was recommended in 2005 by European Conference on Infections in Leukemia (ECIL) for patients with prolonged neutropenia. In consideration of a worldwide increase in antibiotic resistance, the issue of FQ prophylaxis during neutropenia was re-evaluated. METHODS: Literature review of randomised controlled trials (RCT) and observational studies published in years 2006-2014 was performed. Their results were analysed in meta-analysis. Meta-regression model was applied to evaluate whether the rates of FQ resistance in community and hospital settings influenced the efficacy of FQ prophylaxis. The impact of FQ prophylaxis on colonisation and infection with resistant bacteria was reviewed. RESULTS: Two RCTs and 12 observational studies were identified. FQ prophylaxis did not have effect on mortality (pooled OR 1.01, 95%CI 0.73-1.41), but was associated with lower rate of bloodstream infections (BSI) (pooled OR 0.57, 95%CI 0.43-0.74) and episodes of fever during neutropenia (pooled OR 0.32, 95%CI 0.20-0.50). No effect of the background rate of FQ resistance on the efficacy of FQ prophylaxis was observed. In few studies, FQ prophylaxis resulted in an increased colonisation or infection with FQ- or multi-drug resistant strains. CONCLUSIONS: The possible benefits of FQ prophylaxis on BSI rate, but not on overall mortality, should be weighed against its impact in terms of toxicity and changes in local ecology in single centres.

• Klíčová slova
• Ciprofloxacin, Febrile neutropenia, Infection, Levofloxacin, Multidrug resistance (MDR), Neutropenic, Prevention, Quinolone,
• MeSH
• antibakteriální látky terapeutické užití   MeSH
• antibiotická profylaxe * MeSH
• fluorochinolony terapeutické užití   MeSH
• hematologické nádory komplikace   mortalita   MeSH
• infekce komplikace   mortalita   MeSH
• kontrola infekce * MeSH
• lidé MeSH
• neutropenie komplikace   prevence a kontrola   MeSH
• směrnice jako téma * MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH
• metaanalýza MeSH
• práce podpořená grantem MeSH
• systematický přehled MeSH
• Názvy látek
• antibakteriální látky MeSH
• fluorochinolony MeSH

Saprochaete and Geotrichum spp. are rare emerging fungi causing invasive fungal diseases in immunosuppressed patients and scarce evidence is available for treatment decisions. Among 505 cases of rare IFD from the FungiScope™ registry, we identified 23 cases of invasive infections caused by these fungi reported from 10 countries over a 12-year period. All cases were adults and previous chemotherapy with associated neutropenia was the most common co-morbidity. Fungaemia was confirmed in 14 (61%) cases and deep organ involvement included lungs, liver, spleen, central nervous system and kidneys. Fungi were S. capitata (n=14), S. clavata (n=5), G. candidum (n=2) and Geotrichum spp. (n=2). Susceptibility was tested in 16 (70%) isolates. All S. capitata and S. clavata isolates with the exception of one S. capitata (MIC 4 mg/L) isolate had MICs>32 mg/L for caspofungin. For micafungin and anidulafungin, MICs varied between 0.25 and >32 mg/L. One case was diagnosed postmortem, 22 patients received targeted treatment, with voriconazole as the most frequent first line drug. Overall mortality was 65% (n=15). Initial echinocandin treatment was associated with worse outcome at day 30 when compared to treatment with other antifungals (amphotericin B ± flucytosine, voriconazole, fluconazole and itraconazole) (P=.036). Echinocandins are not an option for these infections.

• Klíčová slova
• Geotrichum, Saprochaete, invasive fungal diseases,
• MeSH
• amfotericin B farmakologie   terapeutické užití   MeSH
• antifungální látky farmakologie   terapeutické užití   MeSH
• dospělí MeSH
• echinokandiny farmakologie   terapeutické užití   MeSH
• flukonazol farmakologie   terapeutické užití   MeSH
• fungemie diagnóza   farmakoterapie   mikrobiologie   MeSH
• geotrichóza farmakoterapie   mikrobiologie   mortalita   MeSH
• Geotrichum klasifikace   účinky léků   genetika   izolace a purifikace   MeSH
• hostitel s imunodeficiencí MeSH
• invazivní mykotické infekce farmakoterapie   mikrobiologie   mortalita   MeSH
• lidé středního věku MeSH
• lidé MeSH
• lipopeptidy farmakologie   terapeutické užití   MeSH
• micafungin MeSH
• mikrobiální testy citlivosti MeSH
• mladiství MeSH
• mladý dospělý MeSH
• neutropenie komplikace   farmakoterapie   mikrobiologie   MeSH
• registrace * MeSH
• Saccharomycetales klasifikace   účinky léků   genetika   izolace a purifikace   MeSH
• senioři MeSH
• vorikonazol farmakologie   terapeutické užití   MeSH
• Check Tag
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• mladiství MeSH
• mladý dospělý MeSH
• mužské pohlaví MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• kazuistiky MeSH
• Názvy látek
• amfotericin B MeSH
• antifungální látky MeSH
• echinokandiny MeSH
• flukonazol MeSH
• lipopeptidy MeSH
• micafungin MeSH
• vorikonazol MeSH

BACKGROUND: We evaluated the performance of a galactomannan (GM) assay in bronchoalveolar lavage (BAL) fluid compared to serum samples for the diagnosis of invasive pulmonary aspergillosis (IPA) in patients with hematological diseases. METHODS: Two hundred and fifty-five bronchoscopies were performed on 230 patients. Bronchial and alveolar samples from BAL fluid as well as serum samples were analyzed in the GM assay. RESULTS: Twenty-eight cases of IPA (11%) were diagnosed. The sensitivity, specificity, positive predictive value, and negative predictive value of the GM assay using a cut-off of 0.5 were 57.1%, 99.3%, 94.1%, and 92.5%, respectively, for the alveolar sample; 44.0%, 99.3%, 91.7%, and 91.4%, respectively, for the bronchial sample; and 60.7%, 100%, 100%, and 92.9%, respectively, for serum. The highest sensitivity (78.6%) with good specificity (98.6%) was obtained with a 'triple detection' of GM in bronchial, alveolar, and serum samples. Neutropenia and antifungal therapy for only 24h increased the sensitivity, while antifungal treatment for ≥ 2 days decreased assay performance. Moreover, a trend towards a higher volume of aspirated fluid in GM-negative BAL (p=0.092) was observed. CONCLUSIONS: In contrast to recently published data, we found only moderate sensitivity, but high specificity and high positive predictive value of the detection of GM in BAL fluid. In addition, neutropenia, antifungal therapy, and BAL standardization affected GM assay performance.

• MeSH
• antifungální látky škodlivé účinky   terapeutické užití   MeSH
• Aspergillus chemie   izolace a purifikace   MeSH
• bronchoalveolární lavážní tekutina chemie   MeSH
• bronchoskopie MeSH
• dospělí MeSH
• galaktosa analogy a deriváty   MeSH
• hematologické nádory komplikace   MeSH
• invazivní plicní aspergilóza diagnóza   farmakoterapie   mikrobiologie   MeSH
• kohortové studie MeSH
• krevní nemoci komplikace   MeSH
• lidé středního věku MeSH
• lidé MeSH
• mannany analýza   krev   MeSH
• mladiství MeSH
• mladý dospělý MeSH
• neutropenie komplikace   MeSH
• prediktivní hodnota testů MeSH
• retrospektivní studie MeSH
• senioři MeSH
• senzitivita a specificita MeSH
• Check Tag
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• mladiství MeSH
• mladý dospělý MeSH
• mužské pohlaví MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• práce podpořená grantem MeSH
• Názvy látek
• antifungální látky MeSH
• galactomannan MeSH Prohlížeč
• galaktosa MeSH
• mannany MeSH

Aplastic anaemia (AA) of the chronic type with severe cytopenia is very frequently a difficult therapeutic problem. Patients with granulocyte values below 0.5 G/l are threatened by infections, incl. sepsis possibly with a fatal outcome. If the pool of stem cells for granulocytes is not completely exhausted and can respond to growth factors, these patients can be treated either chronically and/or in risk situations (e.g. injury, surgery) with preparations of the type of a recombinant, granulocyte colony stimulating factor (rhG-CSF), or granulocyte and monocyte colony stimulating factor (rhGM-CSF). The authors present a review of diagnostic and therapeutic algorithms in patients with the AA syndrome and summarize their own experience with the preparation Neupogen Roche (rhG-CSF).

• MeSH
• aplastická anemie komplikace   terapie   MeSH
• faktor stimulující kolonie granulocytů terapeutické užití   MeSH
• filgrastim MeSH
• lidé MeSH
• neutropenie komplikace   terapie   MeSH
• rekombinantní proteiny terapeutické užití   MeSH
• Check Tag
• lidé MeSH
• mužské pohlaví MeSH
• ženské pohlaví MeSH
• Publikační typ
• anglický abstrakt MeSH
• časopisecké články MeSH
• Názvy látek
• faktor stimulující kolonie granulocytů MeSH
• filgrastim MeSH
• rekombinantní proteiny MeSH

During the 3 years from 1989 to 1991, we evaluated the etiology of septic shock cases and infection-associated mortality. A total number of 38 patients was included in the study, according to the criteria for septic shock (SS), (Intensive Care Medicine Society, 1989). In 1989, P. aeruginosa and Enterobacteriaceae among the pathogens prevailed. In 1990 and 1991, S. aureus, enterococci and fungi were most frequent. From 8 patients with SS in 1990, the shock was due to Candida albicans in 1 and to mucoraceae in 3 patients. In 10 patients examined in 1991, 8 cases of SS were due to Candida albicans, Aspergillus niger, Fusarium solani and Acremonium strictum. The decrease of the incidence of shocks and increase of fungal etiology were found to be associated with the use of quinolones in prophylaxis and cephalosporines, aminoglycosides and vancomycine in empiric therapy in febrile neutropenic patients.

• MeSH
• houby izolace a purifikace   MeSH
• lidé MeSH
• mykózy komplikace   mikrobiologie   MeSH
• nádory komplikace   MeSH
• neutropenie komplikace   MeSH
• retrospektivní studie MeSH
• septický šok etiologie   MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH

Aggressive chemotherapy used at present for the treatment of malignant haematological diseases leads to prolonged aplasia of the bone marrow with the possible development of fulminant infectious complications. Treatment of these complications must be started immediately when they are detected, i.e. as a rule without knowing the bacteriological finding at the time. The objective of the present work was to assess by analysis of 376 positive bacteriological findings from hospitalized patients with neutropenia and 141 findings of immunocompromised patients in their homes a combination of antibiotics for empirical treatment of infectious complications which developed during hospitalization or treatment at home.

• MeSH
• antibakteriální látky terapeutické užití   MeSH
• antitumorózní látky škodlivé účinky   MeSH
• bakteriální infekce farmakoterapie   imunologie   MeSH
• časové faktory MeSH
• dospělí MeSH
• hostitel s imunodeficiencí * MeSH
• lidé středního věku MeSH
• lidé MeSH
• neutropenie chemicky indukované   komplikace   MeSH
• Check Tag
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• ženské pohlaví MeSH
• Publikační typ
• anglický abstrakt MeSH
• časopisecké články MeSH
• Názvy látek
• antibakteriální látky MeSH
• antitumorózní látky MeSH

In 42 patients with induction treatment of acute myeloblastic and lymphoblastic leukaemia the authors compared efficacy of selective decontamination of the gastrointestinal tract in prevention of infections during neutropenia less than 0.5.10(9)/l in two comparable groups. Twenty-two patients were treated with Ofloxacin (Tarivid, Hoechst Co.), 20 patients with Trimetroprim-Sulfamethoxazol (Biseptol, Polfa Co.). Both groups had concurrently also Ketoconazol in prevention of mycotic infection. The investigation revealed that Tarivid is a suitable alternative drug for selective decontamination, because it delays the onset of acquired infection, as compared with Biseptol, it reduced more efficiently the frequency of Gram-negative colonization and life-threatening Gram-negative sepsis, caused by resistent strains; its tolerance is significantly better. There was no significant difference in the occurrence of febrile days, febrile episodes, the duration of antibiotic treatment, the number of sepsis in two groups. The effect of Tarivid and Biseptol on the Gram-positive microbial flora is inadequate. Subclavian catheter increases in particularly the risk of Gram-positive sepsis in both groups.

• MeSH
• akutní lymfatická leukemie komplikace   MeSH
• akutní myeloidní leukemie komplikace   MeSH
• bakteriální infekce komplikace   prevence a kontrola   MeSH
• kombinace léků trimethoprim a sulfamethoxazol terapeutické užití   MeSH
• lidé MeSH
• neutropenie komplikace   MeSH
• ofloxacin terapeutické užití   MeSH
• Check Tag
• lidé MeSH
• mužské pohlaví MeSH
• ženské pohlaví MeSH
• Publikační typ
• anglický abstrakt MeSH
• časopisecké články MeSH
• srovnávací studie MeSH
• Názvy látek
• kombinace léků trimethoprim a sulfamethoxazol MeSH
• ofloxacin MeSH

A group of 55 hematological patients treated for the last 2.5 years by the method of selective decontamination was evaluated. Though both institutes (Bad Saarow, Hradec Králové) worked on the problem in the same conditions (indications for the treatment, characteristics of patients, basic drugs), many differences in details were found. However, the important clinical results were the same: A statistically significant decrease in infections and duration of fever in treated patients. A survey of therapy complications, surveillance of infections and incidence of microbes are presented. The evaluation showed that future research including microbiological and immunological investigation based on a standard protocol will be useful.

• MeSH
• aerobní bakterie účinky léků   MeSH
• agranulocytóza MeSH
• dospělí MeSH
• feces mikrobiologie   MeSH
• horečka komplikace   MeSH
• kyselina nalidixová škodlivé účinky   terapeutické užití   MeSH
• leukemie komplikace   farmakoterapie   MeSH
• lidé MeSH
• lymfom komplikace   farmakoterapie   MeSH
• neutropenie komplikace   farmakoterapie   mikrobiologie   MeSH
• polymyxiny škodlivé účinky   terapeutické užití   MeSH
• střeva účinky léků   mikrobiologie   MeSH
• ústní sliznice mikrobiologie   MeSH
• Check Tag
• dospělí MeSH
• lidé MeSH
• mužské pohlaví MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• Názvy látek
• kyselina nalidixová MeSH
• polymyxiny MeSH

• MeSH
• aplastická anemie komplikace   MeSH
• bakteriální infekce epidemiologie   etiologie   prevence a kontrola   MeSH
• dospělí MeSH
• Hodgkinova nemoc komplikace   MeSH
• imunologická tolerance MeSH
• krevní nemoci komplikace   MeSH
• leukemie komplikace   MeSH
• lidé středního věku MeSH
• lidé MeSH
• mladiství MeSH
• mykózy epidemiologie   etiologie   prevence a kontrola   MeSH
• neutropenie komplikace   MeSH
• senioři nad 80 let MeSH
• senioři MeSH
• Check Tag
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• mladiství MeSH
• mužské pohlaví MeSH
• senioři nad 80 let MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• anglický abstrakt MeSH
• časopisecké články MeSH