Kristina Mankes

University of Maryland, Baltimore, Baltimore, MD, United States

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Publications (4)15.43 Total impact

  • G N Forrest, K Mankes
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    ABSTRACT: Zygomycosis is an infrequent and difficult-to-treat fungal infection that is found in patients with underlying immunocompromised states. The advent of the lipid amphotericin B products has allowed for treatment with higher doses of therapy and less systemic toxicity. We reviewed the outcomes of 6 renal transplant recipients diagnosed with biopsy-proven invasive zygomycosis who received amphotericin B lipid complex (ABLC) in doses greater than 5 mg/kg between 2000 and 2004. All 6 patients had baseline diabetes mellitus, were receiving immunosuppressive agents, and subsequently underwent concomitant surgery. Three of the 6 patients that survived had undergone significant surgical debridement, reduction of their immunosuppression to minimal prednisone, and received prolonged course of ABLC at 10 mg/kg/day. All survivors lost graft function during the course of their therapy. The 3 patients who died all had delays in diagnosis of their disease and subsequent surgical and appropriate medical therapy. Therefore, in renal transplant recipients the early diagnosis of invasive zygomycosis is imperative along with early therapy with surgical debridement, reduced immunosuppression, and the use of high doses of ABLC.
    Transplant Infectious Disease 07/2007; 9(2):161-4. · 1.98 Impact Factor
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    ABSTRACT: The impact of rapid identification of Candida albicans blood isolates by peptide nucleic acid fluorescence in situ hybridization (PNA FISH) on the selection and expenditure of antifungal therapy was evaluated. PNA FISH was 100% sensitive and specific in the rapid identification of 31 out of 72 candidemias as C. albicans and resulted in a significant reduction of caspofungin usage, with an overall cost savings of 1,729 US dollars per patient.
    Journal of Clinical Microbiology 10/2006; 44(9):3381-3. · 4.07 Impact Factor
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    ABSTRACT: Six cases of Candida dubliniensis fungemia were identified during an 8-month period in hospitalized patients with various conditions, including human immunodeficiency virus infection. Peptide nucleic acid fluorescent in situ hybridization analysis was used as a rapid and reliable test for differentiating C. dubliniensis from Candida albicans, making it feasible to determine the prevalence of C. dubliniensis fungemia.
    Clinical Infectious Diseases 11/2005; 41(7):1064-7. · 9.37 Impact Factor
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    ABSTRACT: Background:The increasing incidence of non-Candida albicans (NCA) candidemia often leads to empiric treatment with caspofungin until final culture results, which leads to an increase in hospital pharmacy costs. Peptide nucleic acid fluorescence in situ hybridization (PNA-FISH) can identify C. albicans in positive blood cultures within 3 hours. We report the outcomes since we introduced PNA-FISH at our institution. Methods: This is a retrospective review of blood cultures positive with yeasts identified with PNA-FISH or standard culture methods at the University of Maryland Medical Center (UMMC). We assessed the accuracy of PNA- FISH and final fungal culture results, initial antifungal agent selected, the cost of antifungal therapy, and patient outcomes. Results: Of 82 yeast blood cultures, 31 were accurately call C. albicans with PNA-FISH, and 51 were NCA. Standard culture methods misreported 6 isolates as C. albicans, which were later found to be C. dubliniensis. Breakdown of Yeast species tested and Initial therapy PNA-FISH Positive PNA-FISH Negative Species C. albicans C. glabrata C. parapsilosis C. dubliniensis Cryptococcus Neoformans C. tropicalis Number 31 16 15 6 10 4 fluconazole 27 9 10 5 9 3 caspofungin 2 4 5 1 1 1 amphotericin b (lipid) 2 3 0 0 0 0 mortality 11 4 3 1 0 1 Fluconazole was initial therapy in 87% of the C. albicans group and 68% of the NCA group. The average inpatient antifungal cost per patient between the C. albicans and NCA groups of $1990 and $3484, respectively. (p<0.05, CI -5-+2 ). Both groups demonstrated similar overall mortality of 26% and 28% respectively. (NS) A secondary observation was 3 treatment failures of caspofungin with C. parapsilosis infections and its initial use for a patient with C. neoformans. The 4 treatment failures of fluconazole were all due to endocarditis. Conclusion: The rapid PNA-FISH test for C. albicans was more accurate than standard culture methods at our institution and resulted in significant cost savings for the pharmacy. PNA-FISH also helped identify C. dubliniensis as an underreported cause of candidemia. Greater savings could be achieved if there were a probe targeting the NCA species such that we could target therapy more specifically and improve outcomes.
    Infectious Diseases Society of America 2005 Annual Meeting; 10/2005