Efficacy and safety of micafungin for invasive candida infections：a meta-analysis of randomized controlled trials

Background Invasive fungal infections such as candidiasis and mold infections cause significant morbidity and mortality in seriously ill patients.Micafungin is an echinocandin antifungal agent with potent activity against most species of Candida and Aspergillus.We did this meta-analysis to clarify whether micafungin offers superior efficacy and safety compared with other antifungal agent for treating infections associated with invasive candidiasis.Methods We did a meta-analysis of randomized controlled trials to examine whether micafungin has superior efficacy and safety compared with other antifungal agents recommended by the treatment guidelines for fungal infection.Seven trials involving 2913 patients were included in this analysis.Odds ratios （OR） and 95% confidence intervals （CI） were calculated.Results Micafungin was associated with significantly better treatment success compared with the comparator antifungal agents （modified intention to treat,2851 patients; random-effects model,OR 1.20,95% CI 1.00-1.45,P=0.0487）.In addition,micafungin was more effective than the comparators for antifungal prophylaxis of neutropenic patients undergoing hematopoietic stem cell transplantation （OR 1.47,95% CI 1.08-2.00,P=0.01）.Although there was no significant difference between the compared regimens in terms of the incidence of adverse drug effects （OR 0.94,95% CI 0.77-1.11）,fewer patients treated with micafungin withdrew from the studies because of adverse events （OR 0.64,95% CI 0.44-0.94）.Conclusions Micafungin has a good safety and tolerability profile,with an efficacy at least comparable to the other antifungal agents.Micafungin offers advantages over other agents for antifungal prophylaxis.Micafungin offers an appropriate alternative for antifungal prophylaxis rather than the treatment of invasive candida infections.

Epidemiology of opportunistic invasive fungal infections in China： review of literature

Objective To summarize the recent findings on the epidemiology of medically important, opportunistic invasive fungal infections （IFIs） in China and discuss the relevant social, economical reasons and medical factors. Data sources We performed a comprehensive search of both English and Chinese literatures of opportunistic IFIs from China up to April 2012. Study selection Relevant literatures involving researches and cases/case sedes were identified, retrieved and reviewed. Results The incidence of opportunistic IFIs in China was steadily increasing. The incidence and mortality of IFIs were different in patients with various underlying conditions/diseases, from 4.12% to 41.18% and 9.8% to 60.0%, respectively. Candida species, Aspergillus species and Cryptococcus neoformans species complex were the most frequent isolated pathogens. Other uncommon opportunistic IFIs were also been reported, including trichosporonosis, mucormycosis, hyalohyphomycosis （hyaline hyphomycetes） and phaeohyphomycosis （dematiaceous hyphomycetes）. Reports of Chinese patients differed from those of many other countries as there were a higher number of patients without identifiable underlying diseases/conditions. Conclusions Because of the rapid economic development, changing population structure and a growing number of immunocompromised hosts with risk factors, today opportunistic IFIs in China have a significant impact on public health, associated with high morbidity/mortality and higher care costs. Now information related to the epidemiology of opportunistic IFIs in China is still sparse, so we need more organized groups of clinical scientists performing related researches to help the clinicians to obtain more accurate epidemiological characteristics.

Gynecologic infections seen in ThinPrep cytological test in Wuhan, China

This study aimed to analyze the prevalence of bacterial, Candida, Trichomonas, and human papillomavirus （HPV） infections in ThinPrep cytological test （TCT） performed on women of Wuhan, China. ThinPrep smears were screened by two independent experienced pathologists and reported from 2008 to 2010. A total of 46 866 ThinPrep smears were studied, and smears with inflammation were analyzed. Of the 44 162 enrolled patients, inflammation changes were observed in 21 935 （49.7%） and specific infections in 6884 （31.4%）. The infections detected were as follows： bacteria, 5663 （82.3%）; Candida, 825 （12.0%）; Trichomonas, 273 （4.0%）; and HPV, 148 （2.1%）. Significant changes were found in the prevalence of bacteria and Candida among women who underwent TCT before and after 2010. Z2 revealed an increasing proportion of specific infections found in smears after 2010 （P = 0.000）. In conclusion, bacterial infection was the most detectable in the ThinPrep smears, followed by Candida and Trichomonas. The prevalence of infection identified by TCT was found to be similar in previous literature in China.

Genetic susceptibility to Candida infection： a new look at an old entity

The identification of the first molecular defect leading to Mendelian Susceptibility to Mycobacterial Disease ;MD）,1 a rare syndrome conferring predisposition to（MSMD）,1 a rare syndrome conferring predisposition to disease caused by weakly virulent mycobacteria （such as Mycobacterium bovis, Bacille Calmette Gu6rin vaccines and environmental mycobacteria）, has led to a paradigm shift in the field of primary immunodeficiencies in the last two decades. The ＂classic＂ patient with multiple immunologic abnormalities, conferring a broad susceptibility to multiple and recurrent infectious diseases caused by both weakly pathogenic and more virulent microorganisms, was the main Primary Immunodeficiency （PID） phenotype identified. Since 1996, mutations causing MSMD have been found in at least 6 genes related to interferon （IFN）-7-mediated immunity.2

Hepatic safety of caspofungin during treatment of fungal diseases in neonates

The use of caspofungin in neonates is beyond the instructions. Therefore, a retrospective analysis was performed to investigate the hepatic safety of caspofungin during the treatment of fungal diseases in neonates. A retrospective analysis was conducted on 23 neonates with Candida infection who were treated or prevented with caspofungin. Among the 23 neonates treated with caspofungin, 13 cases were cured(57%), and 10 cases showed improvements(43%). In addition, there were no adverse reactions associated with drug use, such as gastrointestinal tract, thrombocytopenia, and liver function damage. In summary, caspofungin achieved good results in the treatment or prevention of Candida infection in neonates, and no severe adverse reactions closely related to its use were found. However, the economy and safety of antifungal drugs should be considered in clinical practice for reasonable use.