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Background: Candida spp. are a frequent cause of nosocomial bloodstream infections worldwide.
Objective: To evaluate the use patterns and outcomes associated with intravenous (IV) fluconazole therapy in intensive care units in Spain and Germany.
Patients and methods: The research reported here was a prospective multicenter longitudinal observational study in adult intensive care unit patients receiving IV fluconazole. Demographic, microbiologic, therapy success, length of hospital stay, adverse event, and all-cause mortality data were collected at 14 sites in Spain and five in Germany, from February 2004 to November 2005.
Results: Patients (n = 303) received prophylaxis (n = 29), empiric therapy (n = 140), preemptive therapy (n = 85), or definitive therapy (n = 49). A total of 298 patients (98.4%) were treated with IV fluconazole as first-line therapy. The treating physicians judged therapy successful in 66% of prophylactic, 55% of empiric, 45% of preemptive, and 43% of definitive group patients. In the subgroup of 152 patients with proven and specified Candida infection only, 32% suffered from Candida specified as potentially resistant to IV fluconazole. The overall mortality rate was 42%.
Conclusion: Our study informs treatment decision makers that approximately 32% of the patients with microbiological results available suffered from Candida specified as potentially resistant to IV fluconazole, highlighting the importance of appropriate therapy.
The taxonomic status of the nominal taxon Dryophis prasinus flavescens Wall, 1910 is reevaluated herein. Based on molecular data generated from fresh collections of Ahaetulla prasina (H. Boie in F. Boie, 1827) auctorum from Northeast India and, additionally, morphological data from museum specimens originating from the same areas, we resurrect this taxon as Ahaetulla flavescens (Wall, 1910) comb. nov. We clarify the status, identity and locations of its type specimens, rediscover, redescribe and illustrate those specimens and also designate a lectotype in order to effect a proper taxonomic redefinition of this nominal taxon. We provide further details on the morphology and diagnosis of this species and elucidate its phylogenetic position. We also provide a summary of the natural history and distribution of this species. Adding to the known cryptic diversity and genetic divergence within Southeast Asian populations, this work also hints at the need for a taxonomic revision of the A. prasina complex. This work complements a previous study on the A. prasina complex focusing on populations in Indonesia. Taken together, these two studies represent phylogenetic reconstructions from different populations of the A. prasina complex across its distribution range, on the Asian mainland and the surrounding islands.
Bipolar disorder (BD) is a genetically complex mental illness characterized by severe oscillations of mood and behavior. Genome-wide association studies (GWAS) have identified several risk loci that together account for a small portion of the heritability. To identify additional risk loci, we performed a two-stage meta-analysis of >9 million genetic variants in 9,784 bipolar disorder patients and 30,471 controls, the largest GWAS of BD to date. In this study, to increase power we used ~2,000 lithium-treated cases with a long-term diagnosis of BD from the Consortium on Lithium Genetics, excess controls, and analytic methods optimized for markers on the Xchromosome. In addition to four known loci, results revealed genome-wide significant associations at two novel loci: an intergenic region on 9p21.3 (rs12553324, p = 5.87×10-9; odds ratio = 1.12) and markers within ERBB2 (rs2517959, p = 4.53×10-9; odds ratio = 1.13). No significant X-chromosome associations were detected and X-linked markers explained very little BD heritability. The results add to a growing list of common autosomal variants involved in BD and illustrate the power of comparing well-characterized cases to an excess of controls in GWAS.