51
|
Initial antifungal strategy does not correlate with mortality in patients with candidemia. Eur J Clin Microbiol Infect Dis 2015; 35:187-93. [PMID: 26634352 DOI: 10.1007/s10096-015-2527-2] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2015] [Accepted: 11/08/2015] [Indexed: 02/04/2023]
Abstract
The incidence of Candida bloodstream infections (BSIs) has increased over time, especially in medical wards. The objective of this study was to evaluate the impact of different antifungal treatment strategies on 30-day mortality in patients with Candida BSI not admitted to intensive care units (ICUs) at disease onset. This prospective, monocentric, cohort study was conducted at an 1100-bed university hospital in Rome, Italy, where an infectious disease consultation team was implemented. All cases of Candida BSIs observed in adult patients from November 2012 to April 2014 were included. Patients were grouped according to the initial antifungal strategy: fluconazole, echinocandin, or liposomal amphotericin B. Cox regression analysis was used to identify risk factors significantly associated with 15-day and 30-day mortality. During the study period, 130 patients with candidemia were observed (58 % with C. albicans, 7 % with C. glabrata, and 23 % with C. parapsilosis). The first antifungal drug was fluconazole for 40 % of patients, echinocandin for 57.0 %, and liposomal amphotericin B for 4 %. During follow-up, 33 % of patients died. The cumulative mortality 30 days after the candidemia episode was 30.8 % and was similar among groups. In the Cox regression analysis, clinical presentation was the only independent factor associated with 15-day mortality, and Acute Physiology and Chronic Health Evaluation (APACHE) II score and clinical presentation were the independent factors associated with 30-day mortality. No differences in 15-day and 30-day mortality were observed between patients with and without C. albicans candidemia. In patients with candidemia admitted to medical or surgical wards, clinical severity but not the initial antifungal strategy were significantly correlated with mortality.
Collapse
|
52
|
|
53
|
Colombo RE, Vazquez J. Echinocandins for Primary Therapy of Candidemia: Time for a Paradigm Shift? CURRENT FUNGAL INFECTION REPORTS 2015. [DOI: 10.1007/s12281-014-0215-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
|
54
|
|
55
|
Falcone M, Concia E, Iori I, Lo Cascio G, Mazzone A, Pea F, Violi F, Venditti M. Identification and management of invasive mycoses in internal medicine: a road-map for physicians. Intern Emerg Med 2014; 9:501-11. [PMID: 24871636 DOI: 10.1007/s11739-014-1077-4] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2014] [Accepted: 04/21/2014] [Indexed: 01/30/2023]
Abstract
Invasive mycoses are a rising problem, not only in traditional categories of patients like hematologic or neutropenic ones, but also in elderly non-neutropenic patients admitted to internal medicine wards. Patients being admitted to medical wards are usually older, have multiple comorbidities, e.g., liver cirrhosis or chronic obstructive respiratory disease, may be malnourished or receive peripheral or total parenteral nutrition, and frequently are undergoing chronic corticosteroid therapy, chemotherapy for cancer or monoclonal antibodies for autoimmune diseases. Such risk factors may be contemporarily present in a single patient increasing the risk for the development of invasive mycoses. Diagnosis of candidemia and invasive aspergillosis is particularly difficult in patients hospitalized on medical wards, since symptoms and signs have low specificity, and most diagnostic tests have been only validated in neutropenic hematologic patients, but not in those without neutropenia. Both candidemia and invasive aspergillosis carry significant morbidity and mortality. The aim of this paper is to provide a simple guide to physicians for a prompt identification and treatment of patients with possible or suspected invasive mycoses.
Collapse
Affiliation(s)
- Marco Falcone
- Department of Public Health and Infectious Diseases, Policlinico Umberto I, Sapienza University of Rome, Rome, Italy,
| | | | | | | | | | | | | | | |
Collapse
|
56
|
Bassetti M, Righi E, Ansaldi F, Merelli M, Trucchi C, Cecilia T, De Pascale G, Diaz-Martin A, Luzzati R, Rosin C, Lagunes L, Trecarichi EM, Sanguinetti M, Posteraro B, Garnacho-Montero J, Sartor A, Rello J, Rocca GD, Antonelli M, Tumbarello M. A multicenter study of septic shock due to candidemia: outcomes and predictors of mortality. Intensive Care Med 2014; 40:839-45. [PMID: 24807083 DOI: 10.1007/s00134-014-3310-z] [Citation(s) in RCA: 184] [Impact Index Per Article: 18.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2014] [Accepted: 04/15/2014] [Indexed: 12/14/2022]
Abstract
PURPOSE Candida is the most common cause of severe yeast infections worldwide, especially in critically ill patients. In this setting, septic shock attributable to Candida is characterized by high mortality rates. The aim of this multicenter study was to investigate the determinants of outcome in critically ill patients with septic shock due to candidemia. METHODS This was a retrospective study in which patients with septic shock attributable to Candida who were treated during the 3-year study period at one or more of the five participating teaching hospitals in Italy and Spain were eligible for enrolment. Patient characteristics, infection-related variables, and therapy-related features were reviewed. Multiple logistic regression analysis was performed to identify the risk factors significantly associated with 30-day mortality. RESULTS A total of 216 patients (mean age 63.4 ± 18.5 years; 58.3 % males) were included in the study. Of these, 163 (75 %) were admitted to the intensive care unit. Overall 30-day mortality was 54 %. Significantly higher Acute Physiology and Chronic Health Evaluation (APACHE) II scores, dysfunctional organs, and inadequate antifungal therapy were compared in nonsurvivors and survivors. No differences in survivors versus nonsurvivors were found in terms of the time from positive blood culture to initiation of adequate antifungal therapy. Multivariate logistic regression identified inadequate source control, inadequate antifungal therapy, and 1-point increments in the APACHE II score as independent variables associated with a higher 30-day mortality rate.
Collapse
Affiliation(s)
- Matteo Bassetti
- Infectious Diseases Division, Santa Maria Misericordia University Hospital, Udine, Italy,
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
57
|
Scudeller L, Viscoli C, Menichetti F, del Bono V, Cristini F, Tascini C, Bassetti M, Viale P. An Italian consensus for invasive candidiasis management (ITALIC). Infection 2013; 42:263-79. [PMID: 24272916 DOI: 10.1007/s15010-013-0558-0] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2013] [Accepted: 11/04/2013] [Indexed: 12/16/2022]
Abstract
INTRODUCTION Invasive candidiasis (IC) has primarily been studied in intensive care unit (ICU) patients, although, in reality, a vast majority of these infections occur outside of the ICU. The recent publication of the European Society of Clinical Microbiology and Infectious Diseases (ESCMID) guidelines also deal with the non-ICU population, but many uncertainties remain on the management of IC, particularly in non-critically ill patients. METHODS The Italian Society of Antimicrobial Therapy, Società Italiana di Terapia Antimicrobica (SITA), produced practical, hospital-wide recommendations on the management of Candida infection in non-immunocompromised patients in the hospital ward. RESULTS AND DISCUSSION Our focus is on patient stratification in terms of risk factors for IC and of clinical severity, emphasising a high index of suspicion to ensure early diagnosis, early treatment and de-escalation when a patient is clinically stable, in order to optimise resource allocation.
Collapse
Affiliation(s)
- L Scudeller
- Clinical Epidemiology Unit, Scientific Direction, IRCCS Policlinico San Matteo Foundation, P.le Golgi 2, 27100, Pavia, Italy,
| | | | | | | | | | | | | | | | | |
Collapse
|
58
|
Deshpande A, Gaur S, Bal A. Candidaemia in the non-neutropenic patient: A critique of the guidelines. Int J Antimicrob Agents 2013; 42:294-300. [DOI: 10.1016/j.ijantimicag.2013.06.005] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2013] [Accepted: 06/11/2013] [Indexed: 10/26/2022]
|
59
|
Cost-effectiveness of anidulafungin in confirmed candidaemia and other invasive Candida infections in Spain. J Mycol Med 2013; 23:155-63. [DOI: 10.1016/j.mycmed.2013.05.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2012] [Revised: 04/19/2013] [Accepted: 05/15/2013] [Indexed: 11/16/2022]
|
60
|
Abstract
Invasive fungal infections, especially in the critical care setting, have become an excellent target for prophylactic, empiric, and pre-emptive therapy interventions due to their associated high morbidity, mortality rate, increased incidence, and healthcare costs. For these reasons, new studies and laboratory tests have been developed over the last few years in order to formulate an early therapeutic intervention strategy in an attempt to reduce the high mortality rate associated with these infections. In recent years, evidence-based studies have shown the roles that the new antifungal drugs play in the treatment of invasive mycosis in seriously ill and complex patients, although data from critically ill patients are more limited. New antifungal agents have been analyzed in different clinical situations in critical care units, and the increasing number of non-Candida albicans species suggest that the application of early echinocandin therapy in critically ill patients with invasive candidiasis is a good option. Voriconazole should be recommended for invasive aspergillosis as a first line option.
Collapse
|
61
|
Simon J, Sun HY, Leong HN, Barez MYC, Huang PY, Talwar D, Wang JH, Mansor M, Wahjuprajitno B, Patel A, Wittayachanyapong S, Sany BSM, Lin SF, Dimopoulos G. Echinocandins in invasive candidiasis. Mycoses 2013; 56:601-9. [PMID: 23647521 DOI: 10.1111/myc.12085] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2012] [Revised: 04/04/2013] [Accepted: 04/06/2013] [Indexed: 12/29/2022]
Affiliation(s)
- John Simon
- University of Hong Kong; Pokfulam Hong Kong China
| | - Hsin-Yun Sun
- National Taiwan University Hospital; Taipei Taiwan
| | | | | | | | - Deepak Talwar
- Metro Group of Hospitals and Heart Institute; Delhi India
| | | | | | | | - Atul Patel
- Vedanta Institute of Medical Sciences; Ahmedabad India
| | | | | | | | - George Dimopoulos
- National and Kapodistrian University of Athens and Department of Critical Care; University Hospital “Attikon”; Athens Greece
| |
Collapse
|
62
|
[Susceptibility of Candida albicans blood isolates to 3 antifungal drugs: retrospective study in Rio Grande do Sul, Brazil, 1999-2009]. Rev Iberoam Micol 2013; 30:243-7. [PMID: 23500157 DOI: 10.1016/j.riam.2013.02.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2012] [Revised: 02/06/2013] [Accepted: 02/08/2013] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Candidiasis is one of the most important among recurrent invasive yeast infections in patients, thus antifungal treatment becomes a challenge. AIMS The aim of this study was to evaluate the in vitro activity of clinical Candida albicans isolates from blood cultures to fluconazole, amphotericin B and anidulafungin, in a hospital from Rio Grande do Sul, Brazil. METHODS The susceptibility of 153 isolates to the 3 drugs mentioned was tested according to Clinical and Laboratory Standars Institute. Minimal inhibitory and fungicidal concentrations (MIC, MFC, respectively) of each drug were determined, as well as the epidemiological cutoff value (ECV). RESULTS All of the isolates were susceptible to anidulafungin, MIC and MFC ≤ 1 μg/ml; however, when compared with ECV, 3% of the isolates exhibited higher values against fluconazole, 96% were susceptible, 3% susceptible dose-dependent, and 1% resistant. Also, it was observed that 21% of the isolates exhibited higher values than ECV. One isolate was resistant to amphotericin B; the other ones, susceptible, based on the MFC; furthermore, 1.5% of the isolates exhibited higher values. CONCLUSIONS C. albicans isolates exhibited more susceptibility to anidulafungin, and 90% of them (MIC90) exhibited the lowest values against amphotericin B. Based on ECV and Pfaller classification, isolates could be resistant to fluconazole, demonstrating the importance of the combination of these parameters.
Collapse
|
63
|
De Rosa FG, Trecarichi EM, Montrucchio C, Losito AR, Raviolo S, Posteraro B, Corcione S, Di Giambenedetto S, Fossati L, Sanguinetti M, Serra R, Cauda R, Di Perri G, Tumbarello M. Mortality in patients with early- or late-onset candidaemia. J Antimicrob Chemother 2012; 68:927-35. [PMID: 23236102 PMCID: PMC3594494 DOI: 10.1093/jac/dks480] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVES Although candidaemia is a well-known complication of hospital stay and has a crude mortality of ∼40%, few data are available for episodes diagnosed within 10 days after hospital admission. In this paper, we compared the risk factors for mortality according to the onset of candidaemia. METHODS This was a retrospective study of hospitalized patients with early-onset candidaemia (EOC; ≤ 10 days) or late-onset candidaemia (LOC; >10 days) to identify any distinct clinical characteristics and risk factors for 30 day mortality in two Italian academic centres. RESULTS A total of 779 patients were included in the study: 183 EOC and 596 LOC. Mortality was significantly lower in EOC (71/183, 38.8% versus 283/596, 47.5%, P=0.03). In EOC, multivariate analysis showed that inadequate initial antifungal therapy (IIAT) (P=0.005, OR 3.02, 95% CI 1.40-6.51), Candida albicans aetiology (P=0.02, OR 2.17, 95% CI 1.11-4.26) and older age (P<0.001, OR 1.05, 95% CI 1.02-1.07) were independent risk factors for mortality. In LOC, liver disease (P=0.003, OR 2.46, 95% CI 1.36-4.43), IIAT (P=0.002, OR 2.01, 95% CI 1.28-3.15) and older age (P<0.001, OR 1.03, 95% CI 1.02-1.04) were independently associated with a fatal outcome, while treatment with caspofungin was associated with survival (P<0.001, OR 0.42, 95% CI 0.26-0.67). CONCLUSIONS EOC has different clinical characteristics and risk factors for mortality compared with LOC. Although EOC mortality is significantly lower, the rate of inappropriate antifungal treatment is higher. Treatment with caspofungin is significantly associated with survival in patients with LOC. Efforts are needed to improve the diagnosis and treatment of EOC.
Collapse
Affiliation(s)
- Francesco Giuseppe De Rosa
- Department of Medical Sciences, Infectious Diseases at Amedeo di Savoia Hospital, University of Turin, Turin, Italy.
| | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
64
|
Revankar SG, Sobel JD. Are Echinocandins Better Than Azoles for Invasive Candidiasis? CURRENT FUNGAL INFECTION REPORTS 2012. [DOI: 10.1007/s12281-012-0124-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
|
65
|
Kabir MA, Ahmad Z. Candida infections and their prevention. ISRN PREVENTIVE MEDICINE 2012; 2013:763628. [PMID: 24977092 PMCID: PMC4062852 DOI: 10.5402/2013/763628] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/13/2012] [Accepted: 10/04/2012] [Indexed: 12/15/2022]
Abstract
Infections caused by Candida species have been increased dramatically worldwide due to the increase in immunocompromised patients. For the prevention and cure of candidiasis, several strategies have been adopted at clinical level. Candida infected patients are commonly treated with a variety of antifungal drugs such as fluconazole, amphotericin B, nystatin, and flucytosine. Moreover, early detection and speciation of the fungal agents will play a crucial role for administering appropriate drugs for antifungal therapy. Many modern technologies like MALDI-TOF-MS, real-time PCR, and DNA microarray are being applied for accurate and fast detection of the strains. However, during prolonged use of these drugs, many fungal pathogens become resistant and antifungal therapy suffers. In this regard, combination of two or more antifungal drugs is thought to be an alternative to counter the rising drug resistance. Also, many inhibitors of efflux pumps have been designed and tested in different models to effectively treat candidiasis. However, most of the synthetic drugs have side effects and biomedicines like antibodies and polysaccharide-peptide conjugates could be better alternatives and safe options to prevent and cure the diseases. Furthermore, availability of genome sequences of Candida
albicans and other non-albicans strains has made it feasible to analyze the genes for their roles in adherence, penetration, and establishment of diseases. Understanding the biology of Candida species by applying different modern and advanced technology will definitely help us in preventing and curing the diseases caused by fungal pathogens.
Collapse
Affiliation(s)
- M Anaul Kabir
- Molecular Genetics Laboratory, School of Biotechnology, National Institute of Technology Calicut, Calicut 673601, India
| | - Zulfiqar Ahmad
- Department of Biological and Environmental Sciences, Alabama A&M University, Normal, AL 35762, USA
| |
Collapse
|
66
|
Clancy CJ, Nguyen MH. The End of an Era in Defining the Optimal Treatment of Invasive Candidiasis. Clin Infect Dis 2012; 54:1123-5. [DOI: 10.1093/cid/cis023] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Affiliation(s)
- Cornelius J. Clancy
- Department of Medicine, Division of Infectious Diseases, University of Pittsburgh, Pennsylvania
| | - M. Hong Nguyen
- Department of Medicine, Division of Infectious Diseases, University of Pittsburgh, Pennsylvania
| |
Collapse
|