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Background: Invasive fungal infections (IFI) are associated with high mortality in liver transplant recipients. Prevention remains an elusive goal, especially for IFI caused by moulds. Patients and methods: From January 1998, patients who fulfilled four or more variables identified as risk factors for IFI received a cumulative dose of 1-1.5 g of lipid formulations of amphotericin B (L-AmpB; AmBisome or Abelcet). The development of IFI in these patients was compared with historical patients. Results: Two hundred and eighty liver transplant recipients were analysed over a period of 8 years. In the historical group, IFI were observed in 22 of 131 patients (17%) and invasive aspergillosis in 13 of them (10%). After January 1998, IFI were observed in nine of 149 (6%) (P < 0.01) and invasive aspergillosis in six patients (4%) (P = 0.08). In patients with four or more risk factors (high risk) for IFI, the administration of L-AmpB reduced the risk from 36% to 14% (P = 0.07), and the risk of aspergillosis from 23% to 5% (P = 0.08). Notably, prophylaxis reduced the risk of aspergillosis from 32% to 0% in dialysed patients (P = 0.03). Variables independently associated with IFI in high-risk patients were dialysis [odds ratio (OR) 3.9; 95% confidence interval (CI) 1-16.7] and surgical reintervention (OR 5.4; 95% CI 1.2-24.6), while L-AmpB was a protective factor in this multivariate analysis (OR 0.1; 95% CI 0.02-0.8). The analysis in these high-risk patients was not able to demonstrate an association between the administration of L-AmpB and higher survival. Conclusions: Selected risk factors are good predictors of IFI in liver transplant recipients. The administration of L-AmpB in high-risk patients is independently associated with a reduction of IFI. [ABSTRACT FROM AUTHOR]

Background Limited data are available to predict the length of time required for a patient to achieve sputum culture conversion after starting therapy for pulmonary tuberculosis. Methods Rates of sputum smear and culture conversion were determined at weeks 2, 4, 8 and 16 after initiating therapy in patients admitted to our Respiratory Isolation Unit from January 1997 to December 2003. Results For the 184 patients included in the analysis, the mean time from the initiation of appropriate therapy to sputum culture and smear conversion were 34 ± 26 and 38 ± 32 days (mean ± SD) respectively. Only 53% of patients obtained negative sputum cultures within the first 4 weeks of therapy. Multivariate analysis showed that the persistence of positive cultures during the first 4 weeks of therapy was associated with high bacillary counts in sputum smears at diagnosis [OR: 2.86; 95% confidence interval (95% CI): 1.20–6.66], lung cavitations (OR: 4.0; 95% CI: 1.63–9.09) and a prolonged period of symptoms (OR: 3.57; 95% CI: 1.43–3.57). The only factor associated with the persistence of positive cultures after more than 16 weeks of therapy was infection with a multidrug-resistant strain. Conclusions High initial sputum bacillary counts and drug resistance result in delayed culture conversion. This should be taken into account when decisions regarding the potential discontinuation of isolation are made. The early identification of drug resistance is important for effective infection control in hospitals. [ABSTRACT FROM AUTHOR]