Antibiotics/antifungals

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Candida auris infection: 7 case reports In a single-centre study, 7 patients (6 men and 1 woman) aged 34–82 years were described, who developed Candida auris infection during treatment with avibactam/ceftazidime, aztreonam, caspofungin, cefepime, ceftazidime, colistin, cotrimoxazole, fluconazole, linezolid, meropenem, piperacillin/tazobactam, tigecycline, vancomycin or voriconazole [routes, dosages and times to reactions onsets not stated; not all outcomes stated]. Case 1: A 53-year-old woman, whose medical history was notable for systemic lupus erythematosus, was admitted in June 2017 due to worsening renal function. She was found to have lupus nephritis stage III and V. In July 2017, she was diagnosed with pleural effusion. She subsequently started receiving piperacillin/tazobactam for 2 weeks, for possible hospital-acquired pneumonia. After 3 days, her fever increased to 38°C. She also developed atrial fibrillation and rapid ventricular response. She was admitted to the ICU. Pleural fluid on aspiration was performed and piperacillin/tazobactam was switched to cefepime for 2 weeks, vancomycin for 8 weeks and meropenem. Then, she showed extensive septation, hydropneumothorax and signs of loculated fluid. Loculated pleural effusion was treated with chest tube insertion and streptokinase. Loculated fluid culture showed methicillin-resistant Staphylococcus aureus (MRSA) and antibiotics were switched to linezolid for treating MRSA empyema. Her ICU stay was further complicated by ventilator-acquired pneumonia due to Cytomegalovirus (CMV) and Stenotrophomonas maltophilia viraemia with possible CMV colitis. In August 2017, she was found to have C. tropicalis and traction bronchiectasis. She then started receiving voriconazole for probable pulmonary aspergillosis. After 2 weeks, her liver enzymes were found to be elevated and voriconazole was switched to caspofungin for 6 weeks. CT scan showed thickened left pleural with pleural effusion and pockets of gas and radiological evidence of trapped left lung. Significant interval improvement of the right upper lobe infiltrate was also observed. Further, decortication was performed. Surgical cultures grew yeast and anidulafungin was started. The yeast was then identified as Candida auris. She was then treated with anidulafungin and her condition improved. After 6 months, she was discharged home. Case 2: A 56-year-old man, whose medical history was notable for amyotrophic lateral sclerosis with home-administered mechanical lung ventilation, was hospitalised in April 2018 for possible ventilator-associated pneumonia and fever. Upon admission, a sepsis screen showed E. coli in blood. Therefore, he started receiving meropenem. However, Candida auris was isolated from a bedsore ulcer. Antifungal therapy was started because the ulcer did not appear to be infected. Mycobacterium abscessus was isolated from the respiratory culture and he started receiving unspecified triple antibiotic therapy. In September 2018, he was discharged home but was again admitted after 6 weeks with sepsi

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