المؤلفون: Bailly, Sébastien, Leroy, Olivier, Montravers, Philippe, Constantin, Jean-Michel, Dupont, Hervé, Guillemot, Didier, Lortholary, Olivier, Mira, Jean-Paul, Perrigault, Pierre-François, Gangneux, Jean-Pierre, Azoulay, Elie, Timsit, Jean-François

المصدر: Intensive Care Medicine; Nov2015, Vol. 41 Issue 11, p1931-1940, 10p, 1 Diagram, 4 Charts

مصطلحات موضوعية: ANTIFUNGAL agents, CATASTROPHIC illness, INTENSIVE care units, LONGITUDINAL method, MEDICAL care, EVALUATION of medical care, MEDICAL cooperation, SCIENTIFIC observation, PATIENTS, PEPTIDES, RESEARCH, SURVIVAL analysis (Biometry), COMORBIDITY, LOGISTIC regression analysis, SEVERITY of illness index, DISEASE progression, HOSPITAL mortality, FLUCONAZOLE, INVASIVE candidiasis, PREVENTION, DIAGNOSIS, THERAPEUTICS

مصطلحات جغرافية: FRANCE

مستخلص: Purpose: Systemic antifungal therapy (SAT) of invasive candidiasis needs to be initiated immediately upon clinical suspicion. Controversies exist about adequate time and potential harm of antifungal de-escalation (DE) in documented and suspected candidiasis in ICU patients. Our objective was to investigate whether de-escalation within 5 days of antifungal initiation is associated with an increase of the 28-day mortality in SAT-treated non-neutropenic adult ICU patients.Methods: From the 835 non-neutropenic adults recruited in the multicenter prospective observational AmarCAND2 study, we selected the patients receiving systemic antifungal therapy for a documented or suspected invasive candidiasis in the ICU and who were still alive 5 days after SAT initiation. They were included into two groups according to the occurrence of observed SAT de-escalation before day 6. The average causal SAT de-escalation effect on 28-day mortality was evaluated by using a double robust estimation.Results: Among the 647 included patients, early de-escalation at day 5 after antifungal initiation occurred in 142 patients (22%), including 48 (34%) patients whose SAT was stopped before day 6. After adjustment for the baseline confounders, early SAT de-escalation was the solely factor not associated with increased 28-day mortality (RR 1.12, 95% CI 0.76-1.66).Conclusion: In non-neutropenic critically ill adult patients with documented or suspected invasive candidiasis, SAT de-escalation within 5 days was not related to increased day-28 mortality but it was associated with decreased SAT consumption. These results suggest for the first time that SAT de-escalation may be safe in these patients. [ABSTRACT FROM AUTHOR]

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المؤلفون: Grignano, Eric¹, Mekinian, Arsene¹ arsene.mekinian@sat.aphp.fr, Braun, Thorsten², Liozon, Eric³, Hamidou, Mohamed⁴, Decaux, Olivier⁵, Puéchal, Xavier⁶, Kahn, Jean Emmanuel⁷, Schoindre, Yoland⁷, Rossignol, Julien⁸, Lortholary, Olivier⁹, Lioger, Bertrand¹⁰, Hermine, Olivier⁸, Park, Sophie¹¹, Ades, Lionel¹², Montestruc, François¹³, Ricard, Laure¹, Gardin, Claude², Fenaux, Pierre¹², Fain, Olivier¹

المصدر: Leukemia Research. Aug2016, Vol. 47, p136-141. 6p.

مصطلحات موضوعية: *AUTOIMMUNE diseases, *RETROSPECTIVE studies, *INFLAMMATION treatment, *CHRONIC myeloid leukemia, *STEROID drugs, *DIAGNOSIS, *THERAPEUTICS, MEDICAL literature reviews

مصطلحات جغرافية: FRANCE

مستخلص: We wanted to describe the characteristics, treatment and outcome of autoimmune and inflammatory diseases (SAIDs) associated with chronic myelomonocytic leukemia (CMML), and conducted a French multicenter retrospective study and a literature review. We included 26 cases of CMML (median age 75 years, 54% female), 80% with CMML-1. CPSS score was low (0 or 1) in 75% of cases. SAIDS was systemic vasculitis in 54%. Diagnosis of the 2 diseases was concomitant in 31% cases, and CMML was diagnosed before SAIDs in 12 cases (46%). First line treatment for SAIDs consisted mostly of steroid, with 85% of response. Second-line treatment was needed in 40% cases. Six patients received hypomethylating agents, with 66% response on SAIDs. A literature review found 49 cases of CMML-associated SAIDs, in whom SAIDs was systemic vasculitis in 29% cases. Hence, vasculitis is the most frequent SAIDs associated with CMML. After initial response to steroids, recurrence and steroid-dependence were frequent. Hypomethylating agents may be interesting in this context. [ABSTRACT FROM AUTHOR]