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Oral Session #5 (Sat am, 10:45-11:45) Scientific Oral Presentation Session 5 Moderator: Dr. Brenna Anderson
High Resolution Profiling of the Vaginal Microbiome of
Healthy, Reproductive Aged Canadian Women
A Multicenter, Randomized, Placebo controlled, Parallel‐
Group, Double Blinded Study to Compare the Therapeutic
of 3 Single Vaginal Doses of Arasertaconazole Nitrate Pessaries in the Treatment of the Vulvovaginal Candidiasis
Fluconazole Resistant Candida Albicans Vulvovaginitis (VVC)?
Wayne State University School of
Antifungal Susceptibility and Therapy Outcome in
Vulvovaginal Candidiasis Caused by Candida Glabrata
Peking University Shenzhen Hospital Shenzhen,Guangdong, PR China HIGH RESOLUTION PROFILING OF THE VAGINAL MICROBIOME OF HEALTHY, REPRODUCTIVE AGED CANADIAN WOMEN
J.E. Hill1,*; M.G. Links1,2; B. Chaban1; T. Paramel Jayaprakash1; C. Fernando1; S.M.
Hemmingsen3; G. Reid4; J. van Schalkwyk5; D.M. Money5
1Department of Veterinary Microbiology, University of Saskatchewan, Saskatoon, SK, Canada;
2Saskatoon Research Centre, Agriculture and AgriFood Canada, Saskatoon, SK, Canada; 3NRC Plant
Biotechnology Institute, Saskatoon, SK, Canada; 4Lawson Health Research Institute and University of
Western Ontario, London, ON, Canada; 5Women's Health Research Institute and University of British
BACKGROUND: Next-generation sequencing studies of the vaginal microbiome to date are almost exclusively based on the 16S rRNA gene. The cpn60 gene has been established as an alternative metagenomic target that offers advantages including superior species resolution and improved representation of some bacterial taxa in complex communities. METHODS: 32 reproductive-aged women who were asymptomatic for BV, reported regular menstrual cycles, no use of hormonal birth control or IUD, and no recent use of antimicrobial medication were recruited. Vaginal swabs were self-collected weekly for 1 month. Universal cpn60 PCR product libraries and a mollicutes-specific library containing pooled PCR products from 12 samples (12 women) were subjected to pyrosequencing on the 454 platform using Titanium chemistry. A subset of samples was also examined by species-specific qPCR for Gardnerella vaginalis. RESULTS: Nugent scores for all samples ranged from 1 to 8 (mean 3.6, median 3). cpn60 profiles of 78 samples from 28 women were generated. Species prevalent in >50% of samples and >90% of women included Lactobacillus crispatus, iners and jensenii, G. vaginalis and Bifidobacterium breve. G. vaginalis observations were supported by qPCR results. Nine distinct species of Bacteroides and Prevotella were also identified. CONCLUSIONS: Our data suggest that G. vaginalis and Bifidobacteirumbreve are more prevalent in women without BV than previously reported. The cpn60 universal target simplifies species-level resolution of the vaginal microbiome. A MULTICENTER, RANDOMIZED, PLACEBO CONTROLLED, PARALLEL-GROUP, DOUBLE BLINDED STUDY TO COMPARE THE THERAPEUTIC EFFICACY, SAFETY, AND TOLERABILITY OF 3 SINGLE VAGINAL DOSES OF ARASERTACONAZOLE NITRATE PESSARIES IN THE TREATMENT OF VULVOVAGINAL CANDIDIASIS
T. Baleeiro1; S. Gropper1; N. Marti1; A. Guglietta1 and the Arasertaconazole Phase II
1 R&D Center, Ferrer Internacional , Barcelona, Spain
BACKGROUND: Arasertaconazole nitrate is a new topical antimycotic which has shown a wide spectrum of activity against yeasts, dermatophytes and molds. It has shown to have in vitro activity against C.albicans and all organisms involved in VVC, as C.glabrata, C.krusei, described as resistant to other treatments. METHODS: A multicenter, randomized, placebo controlled, parallel-group,double blinded study to compare the therapeutic efficacy, safety, and tolerability of 3 single vaginal doses of arasertaconazole nitrate pessaries (150, 300 and 600 mg). RESULTS: Multicenter study, including 24 sites from France, CZRepublic, Ukraine, Hungary, Russia, Lithuania, where 229 patients, mean age 31±8 years were randomized. Clinical, mycological and global cure were assessed at Day 8±2 (visit 2) and Day 26±4 (visit 3). Preliminar analysis FAS show global therapeutic cure at visit 2: 17.5% for placebo, 36.1% Arasertaconazole 150 mg, 46.3% Arasertaconazole 300 mg, 61% Arasertaconazole 600 mg, p < 0.0001(CI 95%). Preliminar analysis PPS show global therapeutic cure at visit 2: 17.6% for placebo, 31% Arasertaconazole 150 mg, 48.3% Arasertaconazole 300 mg, 58.8% Arasertaconazole 600 mg, p=0.0003(CI 95%). Mycological response at visit 2: 30.6% for placebo, 77.4 % Arasertaconazole 150 mg, 71.8 % arasertaconazole 300 mg, 78% Arasertaconazole 600 mg, p< 0.05(CI 95%). No SAE was notified. CONCLUSION: A single administration of Arasertaconazole nitrate pessary shows a clear dose- response. All doses were found safe and well tolerated. Further analysis are being provided. FLUCONAZOLE RESISTANT CANDIDA ALBICANS VULVOVAGINITIS (VVC) – AN EMERGING PROBLEM
Division of Infectious Diseases, Wayne State University School of Medicine, Detroit, MI
BACKGROUND: Fluconazole oral therapy has become established as the dominant therapy for VVC worldwide. Regimens include single and multiple dose regimens for acute VVC and low dose long term weekly maintenance regimens for recurrent VVC. Previously short term (1 year) follow up, failed to reveal emergence of fluconazole resistance. METHODS: Retrospective review of charts of patients referred to Vaginitis Clinic at WSU between 2000 and 2010 revealed 25 patients with clinically refractory fluconazole-resistant VVC with confirmed in vitro resistance, MIC > 2 µg/mL. After chart review, patients completed a questionnaire pertaining to demographic, co-morbidities, behavioral characteristics and antimicrobial/antifungal exposure and finally therapeutic intervention of refractory VVC. RESULTS: Study cohort (n=25) consists of married, insured, Caucasian women, with > 12 years of formal education, above average socioeconomic status. Risk factors for refractory VVC included multiple (>10) lifetime sexual partners (p = 0.03), recent use of antibiotics (p=0.04) and for mycological failure included increased fluconazole exposure (p=0.03) and older age of VVC onset (p=0.04). Strain typing using Rep PCR revealed polyclonality. CONCLUSION: Refractory fluconazole-resistant C. albicans VVC was previously considered rare. We report 25 cases over a 10 year period indicating an emerging problem. All patients had significant fluconazole consumption in previous six months. Management options of fluconazole refractory disease are extremely limited and new therapeutic modalities are needed.
Sobel JD, Wiesenfeld HC, Martens M, Danna P, Hooton TM, Rompalo A, Sperling M, Livengood C 3rd, Horowitz B, Von Thron J, Edwards L, Panzer H, Chu TC. Maintenance fluconazole therapy for recurrent vulvovaginal candidiasis. N Engl J Med. 2004 351:876-83. Richter SS, Galask RP, Messer SA, Hollis RJ, Diekema DJ, Pfaller MA. Antifungal susceptibilities of Candida species causing vulvovaginitis and epidemiology of recurrent cases. J Clin Microbiol. 2005 43:2155-62. Sobel JD, Zervos M, Reed BD, Hooton T, Soper D, Nyirjesy P, Heine MW, Willems J, Panzer H. Fluconazole susceptibility of vaginal isolates obtained from women with complicated Candida vaginitis: clinical implications. Antimicrob Agents Chemother. 2003 47:34-8.
ANTIFUNGAL SUSCEPTIBILITY AND THERAPY OF VULVOVAGINAL CANDIDIASIS CAUSED BY CANDIDA GLABRATA
1 Department of Obstetrics and Gynecology and 2 Department of Laboratory Science, Peking University
Shenzhen Hospital, Shenzhen, 518036 China
BACKGROUND: To study antifungal susceptibility and therapy outcome for vulvovaginal candidiasis (VVC) caused by Candida glabrata. METHODS: The study involved a prospective, sequential, non-randomized clinical trial of antifungal therapies and in vitro susceptibility study. All strains were identified using the API Candida. In vitro susceptibility was tested using a Rosco agar diffusion method. The patients were treated with Nystatin vaginal tablets (20 MU/day for 7 days), Miconazole Nitrate vaginal suppository(two 1200mg doses 72 hours apart), oral Fluconazole (two 150 mg doses 72 hours apart) or oral Itraconazole（200mg ,b.i.d, for one day）from separate clinical trials. Mycological cure or failure was defined according to a positive or negative Candida culture at follow-up. RESULTS: In vitro susceptible rate of Candida glabrata on Miconazole, Nystatin, Fluconazole, and Itraconazole were 89.5% (51/57), 100% (57/57), 58.0% (40/69), and 86.6% (58/67); Susceptible-dose-dependent rate were 10.5% (6/57) , 0(0/57) , 39.1% ( 27/69), and 11.9% (8/67). Mycological cure rate of therapy with Miconazole, Nystatin, Fluconazole, and Itraconazole were 42.1% (8/19), 93.7% (15/16), 55.6% (5/9) and 46.7% (7/15) at day 7-14 fowllw up. Mycological cure rate of therapy with above antifungal agents were 31.6% (6/19), 93.7% (15/16), 55.6% (5/9) and 40.0% (6/15) at day 30-35 follow up. CONCLUSIONS: Nystatin vaginal suppository should be a therapy choice for VVC caused by Candida glabrata
PERTUSSIS FACT SHEET LOS ANGELES COUNTY IMMUNIZATION PROGRAM Revised 04/2005, Page 1 of 2 BACKGROUND INFORMATION • Agent: Bordetella pertussis , a gram negative pleomorphic bacillus. • Transmission: Via contact with respiratory tract secretions or droplets of infected persons. • Incubation Period: Commonly 7-10 days (range 4-21 days). • Communicability: Grea