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  • Online Resource  (14)
  • Hindawi Limited  (14)
  • 1
    Online Resource
    Online Resource
    Economic Evaluation of Voriconazole for the Treatment of Candidemia in Canadian Adults
    Hindawi Limited ; 2008
    In:  Canadian Journal of Infectious Diseases and Medical Microbiology Vol. 19, No. 3 ( 2008), p. 219-226
    Details
    In: Canadian Journal of Infectious Diseases and Medical Microbiology, Hindawi Limited, Vol. 19, No. 3 ( 2008), p. 219-226
    Abstract: BACKGROUND: Candidemia is a common cause of nosocomial bloodstream infection. When selecting therapeutic treatments for candidemia, cost-effectiveness is an important consideration. The present study assessed the cost-effectiveness of voriconazole for the treatment of candidemia. METHODS: A decision-analytical model was used for evaluating the cost-effectiveness of voriconazole compared with a regimen of conventional amphotericin B (CAB) followed by fluconazole (FLU) in the treatment of non-neutropenic patients diagnosed with candidemia in the Canadian setting, based on the Global Candidemia Study. The time frame of the model was 98 days (14 weeks). Model parameters were based primarily on clinical outcome, and resource use data collected from the clinical trial were used. Supplemental data were obtained from an independent panel of 12 Canadian experts for parameters not available from the clinical trial. Unit costs were collected from Canadian sources. The outcome variables selected in the study were the number of patients cured within 98 days, the number of patients surviving at 98 days and the number of patients avoiding toxicity. Incremental costs per outcome were calculated to compare the cost-effectiveness analyses (both probabilistic and one-way sensitivity analyses were performed). RESULTS: The cost-effectiveness analysis demonstrated a difference of $1,121 in the total average cost of treatment with voriconazole ($70,489) versus CAB/FLU ($69,368). While the costs of voriconazole exceeded the costs of CAB/FLU, these costs were almost completely offset by lower hospitalization costs. While patients in both treatment arms experienced cure rates of 41%, both the percentage of patients surviving at day 98 (64.5% versus 58.2%) and the percentage of patients avoiding toxicity (64.5% versus 52.5%) were higher in the voriconazole arm. Accounting for differences in total costs and clinical outcomes, this analysis estimated an incremental cost per patient surviving at day 98 of $17,739, and an incremental cost per patient avoiding toxicity of $9,298. In the case of cost per patient cured, voriconazole had a higher cost ($1,121) than CAB/FLU. The results of the deterministic and probabilistic sensitivity analyses indicated that the model was robust. CONCLUSIONS: Results of the decision-analytical model provided evidence to support the cost-effectiveness of voriconazole relative to a regimen of CAB/FLU in the treatment of non-neutropenic patients diagnosed with candidemia in the Canadian setting.
    Type of Medium: Online Resource
    ISSN: 1712-9532
    URL: Article
    DOI: 10.1155/2008/161835
    Language: English
    Publisher: Hindawi Limited
    Publication Date: 2008
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  • 2
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    Online Resource
    A Single-Centre 10-Year Experience with Candida Bloodstream Infections
    Hindawi Limited ; 2009
    In:  Canadian Journal of Infectious Diseases and Medical Microbiology Vol. 20, No. 2 ( 2009), p. 45-50
    Details
    In: Canadian Journal of Infectious Diseases and Medical Microbiology, Hindawi Limited, Vol. 20, No. 2 ( 2009), p. 45-50
    Abstract: OBJECTIVE: To describe the clinical and microbiological features associated with Candida bloodstream infections observed at Hôpital Maisonneuve-Rosemont (Montreal, Quebec) between August 1996 and July 2006. METHODS: Episodes were retrieved from the microbiology laboratory. Different patient episodes and different isolate episodes in the same patient were selected. Antifungal susceptibility was determined by the Clinical and Laboratory Standards Institute’s (USA) M27A2 method. RESULTS: A total of 190 different episodes of candidemia in 185 patients were identified. Eleven (6%) episodes occurred in outpatients. Candida albicans was identified in the majority of episodes (57%). Its frequency remained stable over the years. The proportion of Candida krusei candidemia episodes increased between 2003 and 2006, but this was not statistically significant. A central venous indwelling catheter or a peripherally inserted central catheter line was present in the majority of patients (167 [88%]). Of the indwelling catheters removed at the time of diagnosis, 39% were positive for Candida species on culture. Overall, voriconazole was the most active agent (the minimum inhibitory concentration required to inhibit the growth of 90% of organisms was 0.5 mg/L). Resistance to fluconazole was observed in 26 (14%) isolates ( C albicans, 4%; versus non- albicans Candida species, 27%; P 〈 0.001). Being on the hematology-oncology unit at the time of diagnosis (adjusted OR 7.8; 95% CI 2.3 to 27.1; P=0.001) and having received fluconazole or itraconazole within the past three months (adjusted OR 8.3; 95% CI 2.8 to 24.4; P 〈 0.001) were significantly associated with resistance to fluconazole in multivariate analysis. CONCLUSIONS: At Hôpital Maisonneuve-Rosemont, the frequency and species distribution of blood isolates of Candida remained stable over the past decade. In vitro resistance of C albicans to fluconazole and itraconazole remained minimal; resistance of non- albicans Candida species to fluconazole did not increase significantly. The new antifungal agents all had high in vitro activity against the bloodstream Candida isolates.
    Type of Medium: Online Resource
    ISSN: 1712-9532
    URL: Article
    DOI: 10.1155/2009/731070
    Language: English
    Publisher: Hindawi Limited
    Publication Date: 2009
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  • 3
    Online Resource
    Online Resource
    An Economic Evaluation of Voriconazole versus Amphotericin B for the Treatment of Invasive Aspergillosis in Canada
    Hindawi Limited ; 2004
    In:  Canadian Journal of Infectious Diseases and Medical Microbiology Vol. 15, No. 5 ( 2004), p. 277-284
    Details
    In: Canadian Journal of Infectious Diseases and Medical Microbiology, Hindawi Limited, Vol. 15, No. 5 ( 2004), p. 277-284
    Abstract: BACKGROUND: Invasive aspergillosis (IA) is a serious fungal infection that affects immunocompromised patients. The Global Comparative Aspergillosis study demonstrated that voriconazole, a new broad-spectrum triazole, had better responses and improved survival compared with conventional amphotericin B deoxycholate (CAB) and other licensed antifungal therapy (OLAT) for the treatment of definite or probable aspergillosis. OBJECTIVES: To compare costs and outcomes of voriconazole and CAB for the treatment of definite or probable aspergillosis in Canada. METHODS: A cost-consequence decision tree model was designed to reflect the treatment pathways used in clinical practice when using voriconazole or CAB as primary therapy for IA. Therapy included initial treatment with either voriconazole or CAB and then switched to an OLAT in the event of an inadequate response, severe toxicity or intolerance. The principal data source used was the Global Comparative Aspergillosis study. RESULTS: The total cost of voriconazole when compared with CAB as initial therapy for IA was $38,319 versus $42,495 per patient, respectively, representing a 9.8% cost reduction for each patient treated with voriconazole. The higher mean cost in the CAB arm was primarily due to the high proportion of patients (73.7%) who were switched to an OLAT due to severe side effects or an inadequate response. Treating with voriconazole was a dominant strategy. The number of patients that had to be treated with voriconazole instead of CAB to save one additional life was eight. CONCLUSIONS: Voriconazole as primary treatment for IA increased the chances of successful treatment, improved survival and may represent a potential cost saving strategy in Canada.
    Type of Medium: Online Resource
    ISSN: 1712-9532
    URL: Article
    DOI: 10.1155/2004/183087
    Language: English
    Publisher: Hindawi Limited
    Publication Date: 2004
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  • 4
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    Online Resource
    Systemic Antifungal Drugs: Are We Making Any Progress?
    Hindawi Limited ; 1994
    In:  Canadian Journal of Infectious Diseases Vol. 5, No. 2 ( 1994), p. 59-61
    Details
    In: Canadian Journal of Infectious Diseases, Hindawi Limited, Vol. 5, No. 2 ( 1994), p. 59-61
    Type of Medium: Online Resource
    ISSN: 1180-2332
    URL: Article
    DOI: 10.1155/1994/828061
    Language: English
    Publisher: Hindawi Limited
    Publication Date: 1994
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  • 5
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    Online Resource
    Antimicrobial Regimens Prescribed by Canadian Physicians for Chemotherapy-Induced Febrile Neutropenic Episodes
    Hindawi Limited ; 1999
    In:  Canadian Journal of Infectious Diseases Vol. 10, No. 5 ( 1999), p. 353-357
    Details
    In: Canadian Journal of Infectious Diseases, Hindawi Limited, Vol. 10, No. 5 ( 1999), p. 353-357
    Abstract: OBJECTIVE: To study the antimicrobial management of cancer patients with chemotherapy-induced neutropenia by Canadian physicians. SETTING: A cohort of 274 cancer patients with severe neutropenia (ie, less than 0.5×10 9 neutrophils/L) who participated in a prospective double-blind, placebo controlled study on antifungal prophylaxis conducted in 14 Canadian university-affiliated centres. Antifungal prophylaxis (oral fluconazole 400 mg daily) was administered to 153 of 274 (56%) patients. RESULTS: Antibacterial prophylaxis with a quinolone was given to 87 patients (32%) at the onset of chemotherapy whereas trimethoprim/sulphamethoxazole was given to 56 (20%) patients. Fever (ie, 38°C or over) occurred in 216 (79%) patients after a median duration of neutropenia of four days (range one to 31 days). Empirical antibacterial antibiotics were administered in 214 febrile patients. In 164 (77%) patients antibiotics were started during the first 24 h of fever. Monotherapy with a third generation cephalosporin and duotherapy with a antipseudomonal beta-lactam and an aminoglycoside were prescribed in 69 (32%) and 61 (28%) of the febrile patients, respectively. Inclusion of vancomycin in the initial empirical regimen was noted in 32 (15%) patients. Modifications of the initial regimen occurred in 187 (87%) patients after a median of five days (range one to 28 days). Empirical systemic amphotericin B was added after a median duration of nine days (range one to 34 days) of the empirical antibacterial regimen. CONCLUSIONS: Overall, the antimicrobial management of cancer patients with chemotherapy-induced neutropenia by Canadian physicians follows the current guidelines promulgated by the Infectious Diseases Society of America.
    Type of Medium: Online Resource
    ISSN: 1180-2332
    URL: Article
    DOI: 10.1155/1999/721790
    Language: English
    Publisher: Hindawi Limited
    Publication Date: 1999
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  • 6
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    Online Resource
    Hepatitis E: A Newcomer to the Hepatitis Alphabet – Case Report and Review of the Literature
    Hindawi Limited ; 1995
    In:  Canadian Journal of Infectious Diseases Vol. 6, No. 1 ( 1995), p. 34-37
    Details
    In: Canadian Journal of Infectious Diseases, Hindawi Limited, Vol. 6, No. 1 ( 1995), p. 34-37
    Abstract: The first Canadian case of hepatitis E is described in a patient who travelled to Asia for a six-month period and spent most of his time in India. Hepatitis E shares some similarities with hepatitis A, notably the mode of transmission and the absence of chronic course. However, a few important differences have been noted, including a higher mortality rate and a high fatality rate in pregnant women. Hepatitis E is very common in developing countries and should be suspected more often in individuals with gastrointestinal complaints returning from endemic areas.
    Type of Medium: Online Resource
    ISSN: 1180-2332
    URL: Article
    DOI: 10.1155/1995/370423
    Language: English
    Publisher: Hindawi Limited
    Publication Date: 1995
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  • 7
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    Online Resource
    Epidemiology and Antifungal Susceptibility of Bloodstream Candida Isolates in Quebec: Report on 453 Cases between 2003 and 2005
    Hindawi Limited ; 2008
    In:  Canadian Journal of Infectious Diseases and Medical Microbiology Vol. 19, No. 1 ( 2008), p. 55-62
    Details
    In: Canadian Journal of Infectious Diseases and Medical Microbiology, Hindawi Limited, Vol. 19, No. 1 ( 2008), p. 55-62
    Abstract: BACKGROUND: Between May 2003 and April 2005, a population-based surveillance of Candida bloodstream infections was conducted in Quebec. A total of 453 episodes of candidemia (464 yeast isolates) from 54 participating hospitals were studied. RESULTS: The annual incidence rate was three per 100,000 population. Global hospital mortality was 38%. The most common predisposing factors were the presence of an intravascular catheter (80%), use of antibacterial therapy (67%), stay in an intensive care unit (49%), use of parenteral nutrition (32%) and intra-abdominal surgery (31%). Fluconazole alone or in association with other antifungals was used for treatment in over 80% of cases. Candida albicans comprised 62% of isolates, followed by Candida glabrata (17%), Candida parapsilosis (9%), Candida tropicalis (5%), Candida lusitaniae (3%) and Candida krusei (3%). Of the 288 C albicans isolates, seven (2%) were resistant to flucytosine, one to fluconazole and none to itraconazole or voriconazole. Of the 75 non- C albicans species isolates with reduced susceptibility to fluconazole (minimum inhibitory concentration [MIC] 16 μg/mL or greater), none were susceptible to itraconazole (MIC 0.12 mg/L or lower), whereas 71 (95%) were susceptible to voriconazole (MIC 1 μg/mL or lower). However, only five of 12 (42%) fluconazole-resistant isolates were susceptible to voriconazole. Posaconazole, ravuconazole and caspofungin displayed a broad spectrum of activity against these isolates, with MICs of 1 mg/L or lower in 56%, 92% and 100% of is olates, respectively. Overall, a correlation (r 2 〉 0.87) was observed among increasing fluconazole MICs and the geometric mean MICs of itraconazole, voriconazole, posaconazole and ravuconazole. CONCLUSIONS: These surveillance results when compared with those of the 1993 to 1995 survey confirm little variation in the distribution of species causing invasive Candida infection over a 10-year period in Quebec, as well as the continuous excellent overall in vitro activity of fluconazole.
    Type of Medium: Online Resource
    ISSN: 1712-9532
    URL: Article
    DOI: 10.1155/2008/634046
    Language: English
    Publisher: Hindawi Limited
    Publication Date: 2008
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  • 8
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    The Use of Antiviral Drugs for Influenza: A Foundation Document for Practitioners
    Hindawi Limited ; 2013
    In:  Canadian Journal of Infectious Diseases and Medical Microbiology Vol. 24, No. suppl c ( 2013), p. 1C-15C
    Details
    In: Canadian Journal of Infectious Diseases and Medical Microbiology, Hindawi Limited, Vol. 24, No. suppl c ( 2013), p. 1C-15C
    Type of Medium: Online Resource
    ISSN: 1712-9532
    URL: Article
    DOI: 10.1155/2013/130913
    Language: English
    Publisher: Hindawi Limited
    Publication Date: 2013
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  • 9
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    Online Resource
    Study of the Comparative Activity of Piperacillin/Tazobactam with Currently Available Antibiotics against 8206 Aerobic Isolates
    Hindawi Limited ; 1997
    In:  Canadian Journal of Infectious Diseases Vol. 8, No. 3 ( 1997), p. 147-153
    Details
    In: Canadian Journal of Infectious Diseases, Hindawi Limited, Vol. 8, No. 3 ( 1997), p. 147-153
    Abstract: OBJECTIVES: To compare the activity of piperacillin-tazobactam with piperacillin and other parenterally administered antibiotics against aerobic Gram-negative bacilli and Gram-positive cocci isolated from across Canada, and to determine the prevalence of resistance mediated by extended-spectrum cephalosporinases. METHODS: Sixty-one laboratories participated. Disk diffusion testing was performed in accordance with methods outlined by the National Committee for Clinical Laboratory Standards. Susceptibilities were performed on 8206 strains. Escherichia coli and Klebsiella pneumoniae with reduced susceptibilities to third-generation cephalosporins were screened for extended-spectrum beta-lactamases (ESBLs). RESULTS: Piperacillin-tazobactam was active against 92% of the strains, piperacillin against 81% and ticarcillin-clavulanic acid against 88%. Few differences were observed in the relative susceptibility of strains from teaching or community hospitals, from different anatomic sites or from different regions of the country. Aerobic Gram-negative bacilli tested tended to be more susceptible to all the agents than was recently reported in a similar American study. Only 43% of Enterococcus faecium were susceptible to ampicillin and 42% to piperacillin piperacillin with and without tazobactam. Only two enterococcal strains were resistant to vancomycin, and 19 had intermediate zone sizes. Of the 10 strains of E coli and eight strains of K pneumoniae with reduced susceptibility to extended spectrum cephalosporins, only one demonstrated typical ESBL activity. CONCLUSIONS: Canadian aerobic Gram-positive cocci and Gram-negative bacilli remain highly susceptible to many currently available antibiotics. The findings confirm a broad spectrum of activity of piperacillin-tazobactam and indicate that the pattern of susceptibility is quite uniform from different body sites, in both teaching and community hospitals, and across the country.
    Type of Medium: Online Resource
    ISSN: 1180-2332
    URL: Article
    DOI: 10.1155/1997/632673
    Language: English
    Publisher: Hindawi Limited
    Publication Date: 1997
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  • 10
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    Guidance on The Use of Antiviral Drugs for Influenza in Acute Care Facilities in Canada, 2014-2015
    Hindawi Limited ; 2015
    In:  Canadian Journal of Infectious Diseases and Medical Microbiology Vol. 26, No. 1 ( 2015), p. e5-e8
    Details
    In: Canadian Journal of Infectious Diseases and Medical Microbiology, Hindawi Limited, Vol. 26, No. 1 ( 2015), p. e5-e8
    Type of Medium: Online Resource
    ISSN: 1712-9532
    URL: Article
    DOI: 10.1155/2015/371840
    Language: English
    Publisher: Hindawi Limited
    Publication Date: 2015
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