Nguyen MH, Peacock Jr. JE, Morris AJ, et al. The changing face of candidemia: Emergence of non-Candida albicans species and antifungal resistance. Am J Med. 1996; 100:617-623.

The door is opening on a new era of candidemia in which non-Candida albicans species are assuming an increasing role in nosocomial infections, the authors warn.

The finding has major clinical implications given the high mortality associated with C. krusei, the high complication rate with Torulopsis glabrata, and the potential for antifungal resistance with C. lusitaniae.

In the study, non-C. Albicans species — especially T. glabrata — emerged as important and frequent pathogens causing fungemia. The change in the pattern of candidemia might be partly attributed to the increase in number of immunocompromised hosts and the widespread use of prophylactic or empiric antifungal therapy.

Within the last decade, the increased use of broad spectrum antibacterial agents has led to the selection of multiple antibiotic-resistant bacteria and Candida. Given the increasing incidence of Candida infection, many investigators are using and even advocating antifungal prophylaxis.

The result may be increasing episodes of candidemia due to the non-C. Albicans species with the attendant risk of increased antifungal resistance.

’This study suggests that our sobering experience with antibacterial resistance will soon be reincarnated with antifungal resistance,” the authors note.

Sharifi R, Geckler R, Childs S. Treatment of urinary tract infections: Selecting an appropriate broad-spectrum antibiotic for nosocomial infections. Am J Med. 1996; 100(suppl 6A):76S-82S.

Cefepime, a fourth-generation cephalosporin, was used successfully to treat both complicated and uncomplicated nosocomial infection of the urinary tract, including cases associated with concurrent bacteremia, the authors report.

In the study, hospitalized patients with complicated and uncomplicated urinary tract infection (UTI), for which parenteral therapy was appropriate, were enrolled in a randomized trial comparing the efficacy and safety of cefepime and ceftazidime. A total of 180 patients, including six with concurrent bacteremia, were evaluated for their response to cefepime (118) or ceftazidime (62), both of which were administered by intravenous infusion or intramuscular infection in doses of 500 mg every 12 hours. In cases of complicated UTI, cefepime produced a satisfactory clinical response in 83 (89%) of 93 patients and eradicated 83 (85%) of 98 pathogens. A satisfactory clinical response to ceftazidime was experienced by 43 (86%) of 50 patients; and in 39 (78%) of 50 cases pathogens were eradicated.

The most common adverse events in both groups were headache, diarrhea, and vomiting; most events were unrelated to therapy. Adverse events forced only a 2% withdrawal of patients.