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P268 Trends in species distribution and antifungal susceptibilities of Candida species isolated from urine at the University Hospital
Posters / International Journal of Antimicrobial Agents 42S2 (2013) S41–S159
P268 Trends in species distribution and antifungal susceptibilities of Candida species isolated from urine at the University Hospital T. Sho1 *, R. Hamasuna1 , M. Honda2 , T. Muratani3 , N. Fujimoto1 , H. Mukae2 , T. Matsumoto1 . 1 Department of Urology, 2 Department of Infection Control and Prevention, University of Occupational and Environmental Health, 3 Kyurin co., Kitakyushu, Japan E-mail address : [email protected] Objectives: The aim of this study was to investigate the trends in species distribution and antifungal susceptibilities of Candida species isolated from urine of patients with urinary tract infections (UTIs) in our hospital. Methods: The antifungal susceptibilities were investigated in Candida species isolated from urine obtained in University of Occupational and Environmental Health Hospital between January 2004 and December 2012. Minimal inhibitory concentrations (MICs) of fluconazole (FLCZ), itraconazole (ITCZ), voriconazole (VRCZ), micafungin (MCFG), amphotericin-B (AMPH-B) were determined by the microdilution method in accordance with CLSI. Results: During the study period, a total of 103 Candida were isolated from urine (one isolate per patient). C. albicans was the most common isolate (54.4%), followed by C. glabrata (33.0%), C. tropicalis (6.8%), C. krusei (1.9%), C. parapsilosis (1.9%), C. guilliermondii (1.0%), Candida spp. (1.0%). The resistance rates of FLCZ against C. albicans and C. glabrata were 0.0% and 28.6%, respectively. MIC90 of MCFG at 48 hr against C. albicans and C. glabrata were 0.06 mg/mL and 0.06 mg/mL, respectively. No strain resistant to MCFG or AMPH-B was detected. Conclusion: No fluconazole-resistant C. albicans was found. In contrast to findings for C. albicans , 28.6% of C. glabrata were resistant to fluconazole. No strain resistant to MCFG or AMPH-B was detected. AIDS and HIV infection P269 Anal cancer in HIV infected patients A. Alahari Dhir1 *, S. Sawant1 , A. Daddi1 , R. Engineer2 , K. Deodhar3 . 1 Department of general medicine, 2 Department of radiation oncology, 3 Department of pathology, Tata memorial centre, Mumbai, India E-mail address : [email protected] Objectives: Anal cancer is emerging as a common non-AIDS defining cancer in HIV-positive people. Anal cancer is caused by infection with high-risk types of human papillomavirus (HPV). The rate of anal cancer appears to be increasing in the era of antiretroviral therapy. We studied the clinical profile and outcome of HIV infected patients with anal cancer seen at a tertiary referral cancer centre. Methods: This is a retrospective observational study. All HIV positive patients with anal cancer patients seen in 1999–2012 at a tertiary referral cancer centre were included in the study. Data of their demographic profiles, immune status, cancer stage, treatment received, response and outcomes were recorded and analyzed using PASW software version 18. Descriptive analysis of categorical variables and survival analysis using Kaplan Meir curve is done. Survival is compared with stage matched HIV negative anal cancer patients using log rank test. Results: There were 18 HIV infected anal cancer patients in the study period (males 12, 66.7%, females 4, 22.2% and others 2, 11.1%). The median age was 40 years (range 26–58 years) in HIV positive patients and 50 years (range 30–75 years) in HIV negative patients with anal cancer. The sexual preferences were heterosexual (15), homosexual (2) and bisexual (1). 7 (38.88%) were detected to be HIV positive at the time of anal cancer diagnosis. 5.6% were HBsAg positive and HCV positive each. 40% (4/10) had CD4 counts less than 200 cells/mm3 . Eight patients were on antiretroviral therapy (stavudine, lamivudine and nevirapine). All patients had squamous cell carcinoma. Three patients tested positive for HPV by hydrid capture. 81.2% had advanced stage of anal cancer at presentation. Three patients did not receive cancer directed treatment. Six patients received only radiotherapy (RT), 4 received RT and chemotherapy (CT), 3 RT and surgery and 2 received all. The median survival in HIV positive patients was 10.6 months and in HIV negative patients 31.4
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months. HIV positive patients had poor survival as compared to stage matched HIV negative patients with anal cancer (p = 0.00). The one year survival was 43% in HIV positive patients as against 79.9% in HIV negative patients. Conclusion: Anal cancer among HIV infected patients presents at a younger age and with advanced stage of disease. Significant immune suppression is not present. HIV positive patients with anal cancer have poor survival as compared to stage matched HIV negative patients with anal cancer. There is a need to increase awareness of need for screening for precancerous anal lesions in high risk HIV infected individuals. Role of HPV vaccination in prevention of anal cancer needs to be studied. P270 Long term antiretroviral therapy outcome among HIV-1 vertically-infected Kenyan children H. Ichimura1 *, R.M. Lihana2 , X. Bi3 , A. Ishizaki3 , W. Ochieng2 , R.M. Lwembe2 , A. Panikulam4 , T. Palakudy4 , M. Owens4 , E.M. Songok5 . 1 Department of Viral Infection and International Health, Graduate School of Medical Sciences, Kanazawa University, Kanazawa, Japan , 2 Centre of Viral Research, Kenya Medical Research Institute, Nairobi, Kenya, 3 Department of Viral Infection and International Health, Kanazawa University, Kanazawa, Japan, 4 Nyumbani Children Home, 5 Kenya Medical Research Institute, Nairobi, Kenya E-mail address : [email protected] Introduction: Antiretroviral therapy (ART) has mitigated the impact of HIV-1/AIDS among infected individuals in resource-limited settings. However, ART failure due to treatment interruption, bad adherence and emergence of drug resistance mutations has been a negative consequence. According to revised world health organization treatment guidelines in 2010, once a patient is found to be failing ART, change of regimen should be considered. Objectives: The aim of this study was to determine response to ART and evaluate the outcome among HIV-1 vertically-infected children in Kenya. Methods: At the Nyumbani Children Home in Kenya, 103 children were longitudinally followed up. CD4+ T-cell count, plasma HIV-1 RNA load (VL), and drug-resistance mutations were monitored biannually Results: After an average of 4.2±2.0 years, 43 (41.7%) children failed first-line ART (VL> 5000 copies/ml) and changed to second-line regimen. One child (2.3%) was in ART failure after 3.7±1.1 years of second-line ART. The remaining 60 children were on first-line ART for an average of 6.5±2.4 years, though four had detectable viral load with emergence of drug resistance mutations. Even though the children failed first-line ART, second-line regimen was effective enough (97.7% treatment success in 3.7 years). Conclusion: With proper monitoring, ART among children is feasible and comparable to adults even in resource-limited settings. P271 Risk factors for 1st line HAART failure and mutations associated with switch to 2nd line in children with AIDS from orphanages in Cambodia V. Krcmery1 *, J. Sokolova1,2 , N. Kulkova1,2 , A. Shahum3 , V. Sladeckova1 , M. Kolibab1 , A. Kalavska1 , J. Vujcikova1 , G. Benca1 . 1 Slovak Tropical Institute, St. Elizabeth University of Health and Social Sciences, Bratislava, 2 Department of Laboratory Medicine, School of Health Care and Social Work, Trnava University, Trnava, 3 St. Elizabeth University of Health and Social Sciences, Bratislava, Slovakia E-mail address : [email protected] Introduction: Only immunological criteria (CD4 cell) are not good predictors of virologic failure. Therefore all three criteria (immunological, virological, clinical) should be interpreted where decision has to be done, when to switch 1st line HAART to 2nd line treatment, especially when not enough experience in children is available concerning ARV change. Objectives: The aim of this study was to determine the frequency and risk factors for 1st line treatment failure during 8 years follow up in children with AIDS.
P268 Trends in species distribution and antifungal susceptibilities of Candida species isolated from urine at the University Hospital T. Sho1 *, R. Hamasuna1 , M. Honda2 , T. Muratani3 , N. Fujimoto1 , H. Mukae2 , T. Matsumoto1 . 1 Department of Urology, 2 Department of Infection Control and Prevention, University of Occupational and Environmental Health, 3 Kyurin co., Kitakyushu, Japan E-mail address : [email protected] Objectives: The aim of this study was to investigate the trends in species distribution and antifungal susceptibilities of Candida species isolated from urine of patients with urinary tract infections (UTIs) in our hospital. Methods: The antifungal susceptibilities were investigated in Candida species isolated from urine obtained in University of Occupational and Environmental Health Hospital between January 2004 and December 2012. Minimal inhibitory concentrations (MICs) of fluconazole (FLCZ), itraconazole (ITCZ), voriconazole (VRCZ), micafungin (MCFG), amphotericin-B (AMPH-B) were determined by the microdilution method in accordance with CLSI. Results: During the study period, a total of 103 Candida were isolated from urine (one isolate per patient). C. albicans was the most common isolate (54.4%), followed by C. glabrata (33.0%), C. tropicalis (6.8%), C. krusei (1.9%), C. parapsilosis (1.9%), C. guilliermondii (1.0%), Candida spp. (1.0%). The resistance rates of FLCZ against C. albicans and C. glabrata were 0.0% and 28.6%, respectively. MIC90 of MCFG at 48 hr against C. albicans and C. glabrata were 0.06 mg/mL and 0.06 mg/mL, respectively. No strain resistant to MCFG or AMPH-B was detected. Conclusion: No fluconazole-resistant C. albicans was found. In contrast to findings for C. albicans , 28.6% of C. glabrata were resistant to fluconazole. No strain resistant to MCFG or AMPH-B was detected. AIDS and HIV infection P269 Anal cancer in HIV infected patients A. Alahari Dhir1 *, S. Sawant1 , A. Daddi1 , R. Engineer2 , K. Deodhar3 . 1 Department of general medicine, 2 Department of radiation oncology, 3 Department of pathology, Tata memorial centre, Mumbai, India E-mail address : [email protected] Objectives: Anal cancer is emerging as a common non-AIDS defining cancer in HIV-positive people. Anal cancer is caused by infection with high-risk types of human papillomavirus (HPV). The rate of anal cancer appears to be increasing in the era of antiretroviral therapy. We studied the clinical profile and outcome of HIV infected patients with anal cancer seen at a tertiary referral cancer centre. Methods: This is a retrospective observational study. All HIV positive patients with anal cancer patients seen in 1999–2012 at a tertiary referral cancer centre were included in the study. Data of their demographic profiles, immune status, cancer stage, treatment received, response and outcomes were recorded and analyzed using PASW software version 18. Descriptive analysis of categorical variables and survival analysis using Kaplan Meir curve is done. Survival is compared with stage matched HIV negative anal cancer patients using log rank test. Results: There were 18 HIV infected anal cancer patients in the study period (males 12, 66.7%, females 4, 22.2% and others 2, 11.1%). The median age was 40 years (range 26–58 years) in HIV positive patients and 50 years (range 30–75 years) in HIV negative patients with anal cancer. The sexual preferences were heterosexual (15), homosexual (2) and bisexual (1). 7 (38.88%) were detected to be HIV positive at the time of anal cancer diagnosis. 5.6% were HBsAg positive and HCV positive each. 40% (4/10) had CD4 counts less than 200 cells/mm3 . Eight patients were on antiretroviral therapy (stavudine, lamivudine and nevirapine). All patients had squamous cell carcinoma. Three patients tested positive for HPV by hydrid capture. 81.2% had advanced stage of anal cancer at presentation. Three patients did not receive cancer directed treatment. Six patients received only radiotherapy (RT), 4 received RT and chemotherapy (CT), 3 RT and surgery and 2 received all. The median survival in HIV positive patients was 10.6 months and in HIV negative patients 31.4
S127
months. HIV positive patients had poor survival as compared to stage matched HIV negative patients with anal cancer (p = 0.00). The one year survival was 43% in HIV positive patients as against 79.9% in HIV negative patients. Conclusion: Anal cancer among HIV infected patients presents at a younger age and with advanced stage of disease. Significant immune suppression is not present. HIV positive patients with anal cancer have poor survival as compared to stage matched HIV negative patients with anal cancer. There is a need to increase awareness of need for screening for precancerous anal lesions in high risk HIV infected individuals. Role of HPV vaccination in prevention of anal cancer needs to be studied. P270 Long term antiretroviral therapy outcome among HIV-1 vertically-infected Kenyan children H. Ichimura1 *, R.M. Lihana2 , X. Bi3 , A. Ishizaki3 , W. Ochieng2 , R.M. Lwembe2 , A. Panikulam4 , T. Palakudy4 , M. Owens4 , E.M. Songok5 . 1 Department of Viral Infection and International Health, Graduate School of Medical Sciences, Kanazawa University, Kanazawa, Japan , 2 Centre of Viral Research, Kenya Medical Research Institute, Nairobi, Kenya, 3 Department of Viral Infection and International Health, Kanazawa University, Kanazawa, Japan, 4 Nyumbani Children Home, 5 Kenya Medical Research Institute, Nairobi, Kenya E-mail address : [email protected] Introduction: Antiretroviral therapy (ART) has mitigated the impact of HIV-1/AIDS among infected individuals in resource-limited settings. However, ART failure due to treatment interruption, bad adherence and emergence of drug resistance mutations has been a negative consequence. According to revised world health organization treatment guidelines in 2010, once a patient is found to be failing ART, change of regimen should be considered. Objectives: The aim of this study was to determine response to ART and evaluate the outcome among HIV-1 vertically-infected children in Kenya. Methods: At the Nyumbani Children Home in Kenya, 103 children were longitudinally followed up. CD4+ T-cell count, plasma HIV-1 RNA load (VL), and drug-resistance mutations were monitored biannually Results: After an average of 4.2±2.0 years, 43 (41.7%) children failed first-line ART (VL> 5000 copies/ml) and changed to second-line regimen. One child (2.3%) was in ART failure after 3.7±1.1 years of second-line ART. The remaining 60 children were on first-line ART for an average of 6.5±2.4 years, though four had detectable viral load with emergence of drug resistance mutations. Even though the children failed first-line ART, second-line regimen was effective enough (97.7% treatment success in 3.7 years). Conclusion: With proper monitoring, ART among children is feasible and comparable to adults even in resource-limited settings. P271 Risk factors for 1st line HAART failure and mutations associated with switch to 2nd line in children with AIDS from orphanages in Cambodia V. Krcmery1 *, J. Sokolova1,2 , N. Kulkova1,2 , A. Shahum3 , V. Sladeckova1 , M. Kolibab1 , A. Kalavska1 , J. Vujcikova1 , G. Benca1 . 1 Slovak Tropical Institute, St. Elizabeth University of Health and Social Sciences, Bratislava, 2 Department of Laboratory Medicine, School of Health Care and Social Work, Trnava University, Trnava, 3 St. Elizabeth University of Health and Social Sciences, Bratislava, Slovakia E-mail address : [email protected] Introduction: Only immunological criteria (CD4 cell) are not good predictors of virologic failure. Therefore all three criteria (immunological, virological, clinical) should be interpreted where decision has to be done, when to switch 1st line HAART to 2nd line treatment, especially when not enough experience in children is available concerning ARV change. Objectives: The aim of this study was to determine the frequency and risk factors for 1st line treatment failure during 8 years follow up in children with AIDS.