151
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Bapat PS, Nobile CJ. Photodynamic Therapy Is Effective Against Candida auris Biofilms. Front Cell Infect Microbiol 2021; 11:713092. [PMID: 34540717 PMCID: PMC8446617 DOI: 10.3389/fcimb.2021.713092] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2021] [Accepted: 08/13/2021] [Indexed: 12/23/2022] Open
Abstract
Fungal infections are increasing in prevalence worldwide. The paucity of available antifungal drug classes, combined with the increased occurrence of multidrug resistance in fungi, has led to new clinical challenges in the treatment of fungal infections. Candida auris is a recently emerged multidrug resistant human fungal pathogen that has become a worldwide public health threat. C. auris clinical isolates are often resistant to one or more antifungal drug classes, and thus, there is a high unmet medical need for the development of new therapeutic strategies effective against C. auris. Additionally, C. auris possesses several virulence traits, including the ability to form biofilms, further contributing to its drug resistance, and complicating the treatment of C. auris infections. Here we assessed red, green, and blue visible lights alone and in combination with photosensitizing compounds for their efficacies against C. auris biofilms. We found that (1) blue light inhibited and disrupted C. auris biofilms on its own and that the addition of photosensitizing compounds improved its antibiofilm potential; (2) red light inhibited and disrupted C. auris biofilms, but only in combination with photosensitizing compounds; and (3) green light inhibited C. auris biofilms in combination with photosensitizing compounds, but had no effects on disrupting C. auris biofilms. Taken together, our findings suggest that photodynamic therapy could be an effective non-drug therapeutic strategy against multidrug resistant C. auris biofilm infections.
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Affiliation(s)
- Priyanka S Bapat
- Department of Molecular and Cell Biology, School of Natural Sciences, University of California Merced, Merced, CA, United States.,Quantitative and Systems Biology Graduate Program, University of California Merced, Merced, CA, United States
| | - Clarissa J Nobile
- Department of Molecular and Cell Biology, School of Natural Sciences, University of California Merced, Merced, CA, United States.,Health Sciences Research Institute, University of California Merced, Merced, CA, United States
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152
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Janniger EJ, Kapila R. Public health issues with Candida auris in COVID-19 patients. WORLD MEDICAL & HEALTH POLICY 2021; 13:766-772. [PMID: 34909239 PMCID: PMC8661744 DOI: 10.1002/wmh3.472] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Revised: 07/14/2021] [Accepted: 08/26/2021] [Indexed: 01/07/2023]
Abstract
The ongoing pandemic of coronavirus disease 2019 (COVID‐19) has overwhelmed a number of medical facilities as well as a few entire health‐care systems. A novel issue co‐incident with the expeditious deployment of specialty care units for COVID‐19 inpatients is the worldwide epidemic of Candida auris infections. Since its first identification and classification in Japan in 2009, it has spread globally. This threat was predicted as C. auris has a high mortality rate, cryptic fomite spread, frequent misidentification since conventional methods do not detect it, and multidrug‐resistance. Since the April 2020 warning at the start of the COVID‐19 pandemic in the United States, C. auris has been delineated as an increasingly consequential source of significant nosocomial infections, emphasizing the added hazard of C. auris to COVID‐19 inpatients, particularly those in intensive care units. Candida auris was a worldwide nosocomial epidemic prior to COVID‐19; it remains so! This 21st century worldwide fungal epidemic complicates the COVID‐19 pandemic to jointly menace mankind C. auris is multi‐drug resistant, requires expensive mass spectrometry equipment to diagnose, and has a high mortality rate in intensive care units This nosocomial infection may persist on dry linen, sheets, floors, cell phones, and medical equipment for weeks We propose a policy that documents the presence or absence of this invasive Candidal species in intensive care units during this COVID‐19 pandemic to aggressively eliminate it.
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Affiliation(s)
| | - Rajendra Kapila
- Medicine, Rutgers New Jersey Medical School Rutgers New Jersey Medical School Newark New Jersey USA
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153
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Zia M, Goli M. Predisposing factors of important invasive fungal coinfections in COVID-19 patients: a review article. J Int Med Res 2021; 49:3000605211043413. [PMID: 34494475 PMCID: PMC8436309 DOI: 10.1177/03000605211043413] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
Severe acute respiratory syndrome coronavirus-2 has caused a devastating pandemic lasting for more than a year. To date, 47 million individuals have been infected and 1.2 million individuals have died worldwide. Some of the most important coinfections in patients with coronavirus disease 2019 (COVID-19) are opportunistic invasive fungal infections (OIFIs), which are sometimes not rapidly diagnosed and are often diagnosed after death. Aspergillosis and candidiasis are the most prevalent OIFIs in patients with COVID-19. Mycormycosis, cryptococcosis, and other fungal diseases have also been documented more rarely. This review aimed to summarize factors affecting COVID-19 transmission, prevalence, morbidity, and mortality in Iran as well as to review common OIFIs in patients with COVID-19. Immunological factors, underlying diseases, and social, cultural, and environmental factors can affect COVID-19 transmission. There is a need to improve diagnostic and therapeutic criteria for OIFIs and to optimize management procedures so that patients with OIFIs can receive treatment as rapidly as possible. Screening of patients with confirmed COVID-19 for OIFIs at the treating physician’s discretion could enable early OIFI diagnosis, treatment, and mortality reduction.
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Affiliation(s)
- Mohammadali Zia
- Department of Medical Basic Sciences, Isfahan (Khorasgan) Branch, Islamic Azad University, Isfahan, Iran
| | - Mohammad Goli
- Department of Food Sciences and Technology, Isfahan (Khorasgan) Branch, Islamic Azad University, Isfahan, Iran.,Laser and Biophotonics in Biotechnologies Research Center, Isfahan (Khorasgan) Branch, Islamic Azad University, Isfahan, Iran
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154
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Naik B, Ahmed SMQ, Laha S, Das SP. Genetic Susceptibility to Fungal Infections and Links to Human Ancestry. Front Genet 2021; 12:709315. [PMID: 34490039 PMCID: PMC8417537 DOI: 10.3389/fgene.2021.709315] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2021] [Accepted: 07/13/2021] [Indexed: 12/25/2022] Open
Abstract
Over the ages, fungi have associated with different parts of the human body and established symbiotic associations with their host. They are mostly commensal unless there are certain not so well-defined factors that trigger the conversion to a pathogenic state. Some of the factors that induce such transition can be dependent on the fungal species, environment, immunological status of the individual, and most importantly host genetics. In this review, we discuss the different aspects of how host genetics play a role in fungal infection since mutations in several genes make hosts susceptible to such infections. We evaluate how mutations modulate the key recognition between the pathogen associated molecular patterns (PAMP) and the host pattern recognition receptor (PRR) molecules. We discuss the polymorphisms in the genes of the immune system, the way it contributes toward some common fungal infections, and highlight how the immunological status of the host determines fungal recognition and cross-reactivity of some fungal antigens against human proteins that mimic them. We highlight the importance of single nucleotide polymorphisms (SNPs) that are associated with several of the receptor coding genes and discuss how it affects the signaling cascade post-infection, immune evasion, and autoimmune disorders. As part of personalized medicine, we need the application of next-generation techniques as a feasible option to incorporate an individual’s susceptibility toward invasive fungal infections based on predisposing factors. Finally, we discuss the importance of studying genomic ancestry and reveal how genetic differences between the human race are linked to variation in fungal disease susceptibility.
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Affiliation(s)
- Bharati Naik
- Yenepoya Research Centre, Yenepoya (Deemed to be University), Mangalore, India
| | - Sumayyah M Q Ahmed
- Yenepoya Research Centre, Yenepoya (Deemed to be University), Mangalore, India
| | - Suparna Laha
- Yenepoya Research Centre, Yenepoya (Deemed to be University), Mangalore, India
| | - Shankar Prasad Das
- Yenepoya Research Centre, Yenepoya (Deemed to be University), Mangalore, India
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155
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Roudbary M, Kumar S, Kumar A, Černáková L, Nikoomanesh F, Rodrigues CF. Overview on the Prevalence of Fungal Infections, Immune Response, and Microbiome Role in COVID-19 Patients. J Fungi (Basel) 2021; 7:720. [PMID: 34575758 PMCID: PMC8466761 DOI: 10.3390/jof7090720] [Citation(s) in RCA: 44] [Impact Index Per Article: 14.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2021] [Revised: 08/20/2021] [Accepted: 08/30/2021] [Indexed: 01/08/2023] Open
Abstract
Patients with severe COVID-19, such as individuals in intensive care units (ICU), are exceptionally susceptible to bacterial and fungal infections. The most prevalent fungal infections are aspergillosis and candidemia. Nonetheless, other fungal species (for instance, Histoplasma spp., Rhizopus spp., Mucor spp., Cryptococcus spp.) have recently been increasingly linked to opportunistic fungal diseases in COVID-19 patients. These fungal co-infections are described with rising incidence, severe illness, and death that is associated with host immune response. Awareness of the high risks of the occurrence of fungal co-infections is crucial to downgrade any arrear in diagnosis and treatment to support the prevention of severe illness and death directly related to these infections. This review analyses the fungal infections, treatments, outcome, and immune response, considering the possible role of the microbiome in these patients. The search was performed in Medline (PubMed), using the words "fungal infections COVID-19", between 2020-2021.
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Affiliation(s)
- Maryam Roudbary
- Department of Parasitology and Mycology, School of Medicine, Iran University of Medical Sciences, Tehran 1449614535, Iran;
| | - Sunil Kumar
- Faculty of Biosciences, Institute of Biosciences and Technology, Shri Ramswaroop Memorial University, Barabanki 225003, Uttar Pradesh, India;
| | - Awanish Kumar
- Department of Biotechnology, National Institute of Technology, Raipur 492010, Chhattisgarh, India
| | - Lucia Černáková
- Department of Microbiology and Virology, Faculty of Natural Sciences, Comenius University in Bratislava, Ilkovičova 6, 842 15 Bratislava, Slovakia;
| | - Fatemeh Nikoomanesh
- Infectious Disease Research Center, Birjand University of Medical Sciences, Birjand 9717853577, Iran;
| | - Célia F. Rodrigues
- LEPABE—Laboratory for Process Engineering, Environment, Biotechnology and Energy, Faculty of Engineering, University of Porto, Rua Dr. Roberto Frias, 4200-465 Porto, Portugal
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156
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Goravey W, Ali GA, Ali M, Ibrahim EB, Al Maslamani M, Abdel Hadi H. Ominous combination: COVID-19 disease and Candida auris fungemia-Case report and review of the literature. Clin Case Rep 2021; 9:e04827. [PMID: 34532055 PMCID: PMC8435228 DOI: 10.1002/ccr3.4827] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2020] [Revised: 03/24/2021] [Accepted: 08/28/2021] [Indexed: 12/29/2022] Open
Abstract
The identification of Candida auris fungemia in critically ill COVID-19 patients is detrimental, with huge implications on patient mortality and infectious control measures.
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Affiliation(s)
- Wael Goravey
- Department of Infectious DiseasesCommunicable Diseases CentreHamad Medical CorporationDohaQatar
| | - Gawahir A. Ali
- Department of Infectious DiseasesCommunicable Diseases CentreHamad Medical CorporationDohaQatar
| | - Masia Ali
- Department of Infectious DiseasesCommunicable Diseases CentreHamad Medical CorporationDohaQatar
| | - Emad B. Ibrahim
- Department of Laboratory Medicine and PathologyHamad Medical CorporationDohaQatar
- Biomedical Research CentreQatar universityDohaQatar
| | - Muna Al Maslamani
- Department of Infectious DiseasesCommunicable Diseases CentreHamad Medical CorporationDohaQatar
| | - Hamad Abdel Hadi
- Department of Infectious DiseasesCommunicable Diseases CentreHamad Medical CorporationDohaQatar
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157
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Caballero U, Eraso E, Quindós G, Jauregizar N. In Vitro Interaction and Killing-Kinetics of Amphotericin B Combined with Anidulafungin or Caspofungin against Candida auris. Pharmaceutics 2021; 13:pharmaceutics13091333. [PMID: 34575409 PMCID: PMC8468219 DOI: 10.3390/pharmaceutics13091333] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2021] [Revised: 08/20/2021] [Accepted: 08/23/2021] [Indexed: 12/22/2022] Open
Abstract
Treatment of invasive infections caused by Candida auris is challenging due to the limited therapeutic options. The combination of antifungal drugs may be an interesting and feasible approach to be investigated. The aim of this study was to examine the in vitro activity of amphotericin B in combination with anidulafungin or caspofungin against C. auris. In vitro static time–kill curve experiments were conducted for 48 h with different combinations of amphotericin B with anidulafungin or caspofungin against six blood isolates of C. auris. The antifungal activity of 0.5 mg/L of amphotericin B was limited against the six isolates of C. auris. Similarly, echinocandins alone had a negligible effect, even at the highest tested concentrations. By contrast, 1 mg/L of amphotericin B showed fungistatic activity. Synergy was rapidly achieved (8 h) with 0.5 mg/L of amphotericin B plus 2 mg/L of anidulafungin or caspofungin. These combinations lead to a sustained fungistatic effect, and the fungicidal endpoint was reached against some C. auris isolates. Additionally, ≥0.5 mg/L of either of the two echinocandins with 1 mg/L of amphotericin B resulted in fungicidal effect against all C. auris isolates. In conclusion, combinations of amphotericin B with anidulafungin or caspofungin provided greater killing with a lower dose requirement for amphotericin B compared to monotherapy, with synergistic and/or fungicidal outcomes.
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Affiliation(s)
- Unai Caballero
- Department of Pharmacology, Faculty of Medicine and Nursing, University of the Basque Country (UPV/EHU), 48940 Leioa, Spain;
| | - Elena Eraso
- Department of Immunology, Microbiology and Parasitology, Faculty of Medicine and Nursing, University of the Basque Country (UPV/EHU), 48940 Leioa, Spain; (E.E.); (G.Q.)
| | - Guillermo Quindós
- Department of Immunology, Microbiology and Parasitology, Faculty of Medicine and Nursing, University of the Basque Country (UPV/EHU), 48940 Leioa, Spain; (E.E.); (G.Q.)
| | - Nerea Jauregizar
- Department of Pharmacology, Faculty of Medicine and Nursing, University of the Basque Country (UPV/EHU), 48940 Leioa, Spain;
- Correspondence:
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158
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Zolin GVS, da Fonseca FH, Zambom CR, Garrido SS. Histatin 5 Metallopeptides and Their Potential against Candida albicans Pathogenicity and Drug Resistance. Biomolecules 2021; 11:biom11081209. [PMID: 34439875 PMCID: PMC8391865 DOI: 10.3390/biom11081209] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Revised: 08/09/2021] [Accepted: 08/11/2021] [Indexed: 12/16/2022] Open
Abstract
Usually caused by Candida albicans, buccal candidiasis begins with the morphological transition between yeast and hyphal cells. Over time and without the correct treatment, it can be disseminated through the bloodstream becoming a systemic infection with high mortality rates. C. albicans already shows resistance against antifungals commonly used in treatments. Therefore, the search for new drugs capable of overcoming antifungal resistance is essential. Histatin 5 (Hst5) is an antimicrobial peptide of the Histatin family, that can be found naturally in human saliva. This peptide presents high antifungal activity against C. albicans. However, Hst5 action can be decreased for interaction with enzymes and metal ions present in the oral cavity. The current work aims to bring a brief review of relevant aspects of the pathogenesis and resistance mechanisms already reported for C. albicans. In addition, are also reported here the main immune responses of the human body and the most common antifungal drugs. Finally, the most important aspects regarding Histatin 5 and the benefits of its interaction with metals are highlighted. The intention of this review is to show the promising use of Hst5 metallopeptides in the development of effective drugs.
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159
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Papp Z, Borman AM, Forgács L, Kovács R, Tóth Z, Chun-Ju C, Kardos G, Juhász B, Szilvássy J, Majoros L. Unpredictable In Vitro Killing Activity of Amphotericin B against Four Candida auris Clades. Pathogens 2021; 10:pathogens10080990. [PMID: 34451454 PMCID: PMC8398933 DOI: 10.3390/pathogens10080990] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2021] [Revised: 08/01/2021] [Accepted: 08/04/2021] [Indexed: 01/12/2023] Open
Abstract
Candida auris is an emerging multiresistant yeast against which amphotericin B (AMB) is still the first therapeutic choice in certain clinical situations (i.e., meningitis, endophthalmitis, and urinary tract infections). As data about the in vitro killing activity of AMB against C. auris clades are lacking, we determined MICs, minimum fungicidal concentrations (MFCs), and killing activity of AMB against 22 isolates representing the 4 major C. auris clades (South Asian n = 6; East Asian n = 4; South African n = 6, and South American n = 6). MIC values were ≤1 mg/L regardless of clades; MFC ranges were, 1–4 mg/L, 2–4 mg/L, 2 mg/L, and 2–8 mg/L for South Asian, East Asian, South African, and South American clades, respectively. AMB showed concentration-, clade-, and isolate-dependent killing activity. AMB was fungicidal at 1 mg/L against two of six, two of four, three of six, and one of six isolates from the South Asian, East Asian, South African, and South American clades, respectively. Widefield fluorescence microscopy showed cell number decreases at 1 mg/L AMB in cases of the South Asian, East Asian, and South African clades. These data draw attention to the weak killing activity of AMB against C. auris regardless of clades, even when MICs are low (≤1 mg/L). Thus, AMB efficacy is unpredictable in treatment of invasive C. auris infections.
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Affiliation(s)
- Zoltán Papp
- Department of Otorhinolaryngology and Head and Neck Surgery, University of Debrecen, 4032 Debrecen, Hungary; (Z.P.); (J.S.)
| | - Andrew M. Borman
- UK National Mycology Reference Laboratory, Public Health England, Science Quarter, Southmead Hospital, Bristol BS10 5NB, UK;
- Medical Research Council Centre for Medical Mycology (MRC CMM), University of Exeter, Exeter EX4 4QD, UK
| | - Lajos Forgács
- Department of Medical Microbiology, Faculty of Medicine, University of Debrecen, 4032 Debrecen, Hungary; (L.F.); (R.K.); (Z.T.); (C.C.-J.); (G.K.)
- Doctoral School of Pharmaceutical Sciences, University of Debrecen, 4032 Debrecen, Hungary
| | - Renátó Kovács
- Department of Medical Microbiology, Faculty of Medicine, University of Debrecen, 4032 Debrecen, Hungary; (L.F.); (R.K.); (Z.T.); (C.C.-J.); (G.K.)
- Faculty of Pharmacy, University of Debrecen, 4032 Debrecen, Hungary
| | - Zoltán Tóth
- Department of Medical Microbiology, Faculty of Medicine, University of Debrecen, 4032 Debrecen, Hungary; (L.F.); (R.K.); (Z.T.); (C.C.-J.); (G.K.)
- Doctoral School of Pharmaceutical Sciences, University of Debrecen, 4032 Debrecen, Hungary
| | - Chiu Chun-Ju
- Department of Medical Microbiology, Faculty of Medicine, University of Debrecen, 4032 Debrecen, Hungary; (L.F.); (R.K.); (Z.T.); (C.C.-J.); (G.K.)
| | - Gábor Kardos
- Department of Medical Microbiology, Faculty of Medicine, University of Debrecen, 4032 Debrecen, Hungary; (L.F.); (R.K.); (Z.T.); (C.C.-J.); (G.K.)
- Department of Metagenomics, University of Debrecen, 4032 Debrecen, Hungary
| | - Béla Juhász
- Department of Pharmacology and Pharmacotherapy, Faculty of Medicine, University of Debrecen, 4032 Debrecen, Hungary;
| | - Judit Szilvássy
- Department of Otorhinolaryngology and Head and Neck Surgery, University of Debrecen, 4032 Debrecen, Hungary; (Z.P.); (J.S.)
| | - László Majoros
- Department of Medical Microbiology, Faculty of Medicine, University of Debrecen, 4032 Debrecen, Hungary; (L.F.); (R.K.); (Z.T.); (C.C.-J.); (G.K.)
- Correspondence: ; Tel.: +36-52-255-425; Fax: +36-52-255-424
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160
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Abstract
Candida auris is a human fungal pathogen classified as an urgent threat to the delivery of health care due to its extensive antimicrobial resistance and the high mortality rates associated with invasive infections. Global outbreaks have occurred in health care facilities, particularly, long-term care hospitals and nursing homes. Skin is the primary site of colonization for C. auris. To accelerate research studies, we developed microbiome sequencing protocols, including amplicon and metagenomic sequencing, directly from patient samples at health care facilities with ongoing C. auris outbreaks. We characterized the skin mycobiome with a database optimized to classify Candida species and C. auris to the clade level. While Malassezia species were the predominant skin-associated fungi, nursing home residents also harbored Candida species, including C. albicans, and C. parapsilosis. Amplicon sequencing was concordant with culturing studies to identify C. auris-colonized patients and provided further resolution that distinct clades of C. auris are colonizing facilities in New York and Illinois. Shotgun metagenomic sequencing from a clinical sample with a high fungal bioburden generated a skin-associated profile of the C. auris genome. Future larger scale clinical studies are warranted to more systematically investigate the effects of commensal microbes and patient risk factors on the colonization and transmission of C. auris. IMPORTANCECandida auris is a human pathogen of high concern due to its extensive antifungal drug resistance and high mortality rates associated with invasive infections. Candida auris skin colonization and persistence on environmental surfaces make this pathogen difficult to control once it enters a health care facility. Residents in long-term care hospitals and nursing homes are especially vulnerable. In this study, we developed microbiome sequencing protocols directly from surveillance samples, including amplicon and metagenomic sequencing, demonstrating concordance between sequencing results and culturing.
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161
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Abstract
PURPOSE OF REVIEW The coronavirus disease (COVID-19) pandemic has resulted in necessary modifications of infection control policies and practices in acute healthcare facilities globally. This is often accompanied by infrastructure modifications, ward redesignations, as well as healthcare staff redeployments and changes to infection prevention and control (IPC) practices. We review the potential for both negative and positive impacts these major changes can have on nosocomial transmission of multidrug-resistant organisms (MDROs). RECENT FINDINGS Healthcare facilities around the world have reported outbreaks of MDROs during the COVID-19 pandemic. In contrast some centres have reported a decrease in baseline rates due to a number of possible factors. SUMMARY While implementing crucial preventive measures for COVID-19, is it important to consider any collateral effects of changes in IPC and antimicrobial stewardship program (ASP) practices. The disruption caused to IPC and ASP practices during the pandemic are likely to see a counter intuitive increase in transmission of MDROs.
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162
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Predisposition of COVID-19 patients to secondary infections: set in stone or subject to change? Curr Opin Infect Dis 2021; 34:357-364. [PMID: 34039879 DOI: 10.1097/qco.0000000000000736] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
PURPOSE OF REVIEW There likely are several predisposing factors to secondary infections in patients with Coronavirus disease 2019 (COVID-19), some of which may be preventable. The aim of this review is to explore the literature, summarize potential predisposing factors to secondary infections and their incidence. It also summarizes a variety of healthcare scenarios in which different kinds of secondary infections occur. RECENT FINDINGS Apart from immune dysregulation, severe resource limitations in healthcare settings have made COVID-19 units conducive to a variety of secondary infections. Long-term effect of excess antibiotic use in COVID-19 patients is yet to be studied. Very few studies have assessed secondary infections as the primary outcome measure making it difficult to know the true incidence. Mortality attributable to secondary infections in COVID-19 patients is also unclear. SUMMARY Incidence of secondary infections in COVID-19 patients is likely higher than what is reported in the literature. Well designed studies are needed to understand the incidence and impact of secondary infections in this patient population. Many of these may be preventable especially now, as personal protective equipment and other healthcare resources are recovering. Infection prevention and control (IPC) and antimicrobial stewardship programmes (ASP) must reassess current situation to correct any breaches that could potentially cause more harm in these already vulnerable patients as we brace for a future surge with another pandemic wave.
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163
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Hamad A, Chen Y, Khan MA, Jamshidi S, Saeed N, Clifford M, Hind C, Sutton JM, Rahman KM. Schiff bases of sulphonamides as a new class of antifungal agent against multidrug-resistant Candida auris. Microbiologyopen 2021; 10:e1218. [PMID: 34459551 PMCID: PMC8301596 DOI: 10.1002/mbo3.1218] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Revised: 06/10/2021] [Accepted: 06/24/2021] [Indexed: 11/11/2022] Open
Abstract
Invasive Candida infections in hospitalized and immunocompromised or critically ill patients have become an important cause of morbidity and mortality. There are increasing reports of multidrug resistance in several Candida species that cause Candidemia, including C. glabrata and C. auris, with limited numbers of antifungal agents available to treat patients with invasive Candida infections. Therefore, there is an urgent need to discover new antifungal agents that work against multidrug-resistant Candida species, particularly C. auris, which has been identified as an emerging global pathogen. In this article, we report a new class of antifungal agents, the Schiff bases of sulphonamides, that show activity against all Candida species tested, with an MIC range of 4-32 µg/ml. Compound 2b showed activity against C. glabrata and a panel of fluconazole-resistant C. auris strains, with MICs of 4-16 µg/ml. The drug-like nature of these Schiff bases offers opportunities to optimize these compounds with medicinal chemistry techniques to obtain more potent analogs that can be progressed toward pre-clinical evaluation.
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Affiliation(s)
- Asad Hamad
- Department of PharmacyThe Islamia University of BahawalpurBahawalpurPakistan
- Institute of Pharmaceutical ScienceKing's College LondonLondonUK
| | - Yiyuan Chen
- Institute of Pharmaceutical ScienceKing's College LondonLondonUK
| | - Mohsin A. Khan
- Department of PharmacyThe Islamia University of BahawalpurBahawalpurPakistan
| | - Shirin Jamshidi
- Institute of Pharmaceutical ScienceKing's College LondonLondonUK
| | - Naima Saeed
- Institute of Pharmaceutical ScienceKing's College LondonLondonUK
| | | | - Charlotte Hind
- Public Health EnglandNational Infections ServiceSalisburyUK
| | - J. Mark Sutton
- Public Health EnglandNational Infections ServiceSalisburyUK
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Kumari A, Rao NP, Patnaik U, Malik V, Tevatia MS, Thakur S, Jaydevan J, Saxena P. Management outcomes of mucormycosis in COVID-19 patients: A preliminary report from a tertiary care hospital. Med J Armed Forces India 2021; 77:S289-S295. [PMID: 34334896 PMCID: PMC8313063 DOI: 10.1016/j.mjafi.2021.06.009] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Accepted: 06/05/2021] [Indexed: 12/13/2022] Open
Abstract
Background Coronavirus disease 2019 (COVID-19) continues to be a significant health problem worldwide. The unprecedented surge of mucormycosis in patients with COVID-19 is a new emerging challenge. Although a few studies documenting high incidence of mucormycosis in COVID -19 patients have recently emerged in literature, data pertaining to treatment outcomes in such cohorts is lacking. Here, we report our experience in management of mucormycosis in COVID-19 patients at our tertiary care centre. Method The clinical, imaging, histopathological and treatment data of 20 patients with mucormycosis (in setting of COVID-19) was analysed. Results 35% and 65 % of cases developed mucormycosis in setting of active and recovered COVID-19 infections respectively. Diabetes mellitus was documented in 80% cases, with 55% demonstrating HbA1c >10%. Steroid was administered in 80% during COVID-19 illness. Imaging demonstrated paranasal sinus (PNS), orbital and intracranial extension in 100%, 55% and 20% patients respectively. All received amphotericin and underwent endoscopic debridement, 20% underwent orbital decompression and 5% maxillectomy with orbital exenteration. 6/20(30%) patients died (4 with rhino-orbito-cerebral disease, 1 with extensive orbito-maxillary involvement and 1 sino-nasal disease). All 6 patients received steroids and documented poor glycaemic control. Conclusion The strong association of hyperglycemia and steroid intake with mucormycosis in COVID-19 cases warrants judicious use of corticosteroids and optimal glycaemic control. Our study highlights that good clinical outcome can be achieved in invasive mucormycosis provided prompt treatment is instituted with aggressive surgical debridement and antifungal medication.
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Affiliation(s)
- Abha Kumari
- Classified Specialist (ENT), Command Hospital (Southern Command), Pune, India
| | | | - Uma Patnaik
- Senior Advisor & Head (ENT), Command Hospital (Southern Command), Pune, India
| | - Virender Malik
- Classified Specialist (Imaging & Intervention Radiology), Army Institute of Cardio Thoraicic Sciences, Pune, India
| | | | - Shivali Thakur
- Graded Specialist (ENT), Command Hospital (Southern Command), Pune, India
| | - Jijesh Jaydevan
- Resident (ENT), Command Hospital (Southern Command), Pune, India
| | - Pavitra Saxena
- Resident (ENT), Command Hospital (Southern Command), Pune, India
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165
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Frías-De-León MG, Pinto-Almazán R, Hernández-Castro R, García-Salazar E, Meza-Meneses P, Rodríguez-Cerdeira C, Arenas R, Conde-Cuevas E, Acosta-Altamirano G, Martínez-Herrera E. Epidemiology of Systemic Mycoses in the COVID-19 Pandemic. J Fungi (Basel) 2021; 7:jof7070556. [PMID: 34356935 PMCID: PMC8307417 DOI: 10.3390/jof7070556] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2021] [Revised: 06/29/2021] [Accepted: 07/07/2021] [Indexed: 02/06/2023] Open
Abstract
The physiopathologic characteristics of COVID-19 (high levels of inflammatory cytokines and T-cell reduction) promote fungal colonization and infection, which can go unnoticed because the symptoms in both diseases are very similar. The objective of this work was to study the current epidemiology of systemic mycosis in COVID-19 times. A literature search on the subject (January 2020–February 2021) was performed in PubMed, Embase, Cochrane Library, and LILACS without language restrictions. Demographic data, etiological agent, risk factors, diagnostic methods, antifungal treatment, and fatality rate were considered. Eighty nine publications were found on co-infection by COVID-19 and pneumocystosis, candidiasis, aspergillosis, mucormycosis, coccidioidomycosis, or histoplasmosis. In general, the co-infections occurred in males over the age of 40 with immunosuppression caused by various conditions. Several species were identified in candidiasis and aspergillosis co-infections. For diagnosis, diverse methods were used, from microbiological to molecular. Most patients received antifungals; however, the fatality rates were 11–100%. The latter may result because the clinical picture is usually attributed exclusively to SARS-CoV-2, preventing a clinical suspicion for mycosis. Diagnostic tests also have limitations beginning with sampling. Therefore, in the remainder of the pandemic, these diagnostic limitations must be overcome to achieve a better patient prognosis.
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Affiliation(s)
- María Guadalupe Frías-De-León
- Unidad de Investigación, Hospital Regional de Alta Especialidad de Ixtapaluca, Ciudad de México PC 56530, Estado de México, Mexico; (M.G.F.-D.-L.); (R.P.-A.); (E.G.-S.); (G.A.-A.)
| | - Rodolfo Pinto-Almazán
- Unidad de Investigación, Hospital Regional de Alta Especialidad de Ixtapaluca, Ciudad de México PC 56530, Estado de México, Mexico; (M.G.F.-D.-L.); (R.P.-A.); (E.G.-S.); (G.A.-A.)
- Sección de Estudios de Posgrado e Investigación, Escuela Superior de Medicina, Instituto Politécnico Nacional, Plan de San Luis y Díaz Mirón s/n, Col. Casco de Santo Tomas, Alcaldía Miguel Hidalgo, Ciudad de México PC 11340, Estado de México, Mexico
| | - Rigoberto Hernández-Castro
- Departamento de Ecología de Agentes Patógenos, Hospital General “Dr. Manuel Gea González”, Ciudad de México PC 14080, Estado de México, Mexico;
| | - Eduardo García-Salazar
- Unidad de Investigación, Hospital Regional de Alta Especialidad de Ixtapaluca, Ciudad de México PC 56530, Estado de México, Mexico; (M.G.F.-D.-L.); (R.P.-A.); (E.G.-S.); (G.A.-A.)
- Maestría en Ciencias de la Salud, Escuela Superior de Medicina, Instituto Politécnico Nacional, Plan de San Luis y Díaz Mirón s/n, Col. Casco de Santo Tomas, Alcaldía Miguel Hidalgo, Ciudad de México PC 11340, Estado de México, Mexico; (P.M.-M.); (E.C.-C.)
| | - Patricia Meza-Meneses
- Maestría en Ciencias de la Salud, Escuela Superior de Medicina, Instituto Politécnico Nacional, Plan de San Luis y Díaz Mirón s/n, Col. Casco de Santo Tomas, Alcaldía Miguel Hidalgo, Ciudad de México PC 11340, Estado de México, Mexico; (P.M.-M.); (E.C.-C.)
- Servicio de Infectología, Hospital Regional de Alta Especialidad de Ixtapaluca, Ciudad de México PC 56530, Estado de México, Mexico
| | - Carmen Rodríguez-Cerdeira
- Efficiency, Quality, and Costs in Health Services Research Group (EFISALUD), Galicia Sur Health Research Institute (IIS Galicia Sur), SERGAS-UVIGO, PC 36213 Vigo, Spain; (C.R.-C.); (R.A.)
- Dermatology Department, Hospital Vithas Ntra. Sra. de Fátima and University of Vigo, PC 36206 Vigo, Spain
- Campus Universitario, University of Vigo, PC 36310 Vigo, Spain
| | - Roberto Arenas
- Efficiency, Quality, and Costs in Health Services Research Group (EFISALUD), Galicia Sur Health Research Institute (IIS Galicia Sur), SERGAS-UVIGO, PC 36213 Vigo, Spain; (C.R.-C.); (R.A.)
- Sección de Micología, Hospital General “Dr. Manuel Gea González”, Ciudad de México PC 14080, Estado de México, Mexico
| | - Esther Conde-Cuevas
- Maestría en Ciencias de la Salud, Escuela Superior de Medicina, Instituto Politécnico Nacional, Plan de San Luis y Díaz Mirón s/n, Col. Casco de Santo Tomas, Alcaldía Miguel Hidalgo, Ciudad de México PC 11340, Estado de México, Mexico; (P.M.-M.); (E.C.-C.)
| | - Gustavo Acosta-Altamirano
- Unidad de Investigación, Hospital Regional de Alta Especialidad de Ixtapaluca, Ciudad de México PC 56530, Estado de México, Mexico; (M.G.F.-D.-L.); (R.P.-A.); (E.G.-S.); (G.A.-A.)
| | - Erick Martínez-Herrera
- Unidad de Investigación, Hospital Regional de Alta Especialidad de Ixtapaluca, Ciudad de México PC 56530, Estado de México, Mexico; (M.G.F.-D.-L.); (R.P.-A.); (E.G.-S.); (G.A.-A.)
- Sección de Estudios de Posgrado e Investigación, Escuela Superior de Medicina, Instituto Politécnico Nacional, Plan de San Luis y Díaz Mirón s/n, Col. Casco de Santo Tomas, Alcaldía Miguel Hidalgo, Ciudad de México PC 11340, Estado de México, Mexico
- Efficiency, Quality, and Costs in Health Services Research Group (EFISALUD), Galicia Sur Health Research Institute (IIS Galicia Sur), SERGAS-UVIGO, PC 36213 Vigo, Spain; (C.R.-C.); (R.A.)
- Correspondence: ; Tel.: +52-555-972-9800
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Evaluation of the Synergistic Activity of Antibacterial and Antifungal Drugs against Candida auris using an Inkjet Printer-Assisted Method. Antimicrob Agents Chemother 2021; 65:e0026821. [PMID: 34252295 DOI: 10.1128/aac.00268-21] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Candida auris is an emerging multidrug-resistant fungal pathogen that spreads readily in healthcare settings and has caused numerous hospital outbreaks. Very few treatment options exist for C. auris infections. We evaluated the activity of all two-drug combinations of three antifungal agents (amphotericin B, caspofungin, and voriconazole) and two antibacterial agents (minocycline and rifampin) against a collection of 10 C. auris isolates using an automated, inkjet printer-assisted checkerboard array method. Three antibacterial-antifungal combinations (amphotericin B plus rifampin, amphotericin B plus minocycline, and caspofungin plus minocycline) demonstrated synergistic activity by checkerboard array against ≥90% of strains with fractional inhibitory concentration index (FICI) values of 0.094 to 0.5. The two amphotericin B-containing combinations were also synergistic using the time-kill synergy testing method, with up to a 4.99 log10 decrease in surviving yeast compared to either agent alone. Our results suggest that combinations of antifungal and antibacterial agents may provide a promising avenue for treatment of this multidrug-resistant pathogen.
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167
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Antifungal Drug Susceptibility and Genetic Characterization of Fungi Recovered from COVID-19 Patients. J Fungi (Basel) 2021; 7:jof7070552. [PMID: 34356931 PMCID: PMC8306261 DOI: 10.3390/jof7070552] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2021] [Revised: 07/09/2021] [Accepted: 07/10/2021] [Indexed: 01/08/2023] Open
Abstract
Fungal infections are common complications of respiratory viral infections and are associated with the increased need for intensive care and elevated mortality. Data regarding microbiological and molecular characteristics of such infections in COVID-19 patients are scarce. Here, we performed a comprehensive analysis, including species identification, antifungal susceptibility testing, molecular resistance determinants analysis, typing, and retrospective clinical data review, of fungal isolates recovered from 19 COVID-19 patients, who were hospitalized at the Hackensack University Medical Center (HUMC) in Hackensack, New Jersey, USA, in the initial phase of the pandemic from April–May 2020. In total, 17 Candida albicans, two C. parapsilosis, and two Aspergillus fumigatus were analyzed. All Candida spp. isolates were susceptible to micafungin and azole drugs (fluconazole, voriconazole, posaconazole, itraconazole, isavuconazole). A. fumigatus isolates were susceptible to micafungin and all triazole drugs except fluconazole (intrinsic resistance). Multilocus sequence typing (MLST) of C. albicans isolates revealed 15 different sequence types (STs), which clustered below the clade-defining limit of p-distance < 0.04. Pulsed-field gel electrophoresis (PFGE) karyotyping revealed no chromosomal rearrangements in these isolates. A. fumigatus isolates were of different, non-related genotypes. We speculate that virus- and drug-induced immunosuppression (94.7% of the patients received corticosteroids), together with prolonged hospital stay (median duration of 29 days) and mechanical ventilation (median duration of 24 days) likely increased the susceptibility to secondary respiratory and bloodstream infections in the studied patient population. The presence of fungi in blood or respiratory tract fluid was a prognosticator for poor clinical outcome, which presented as an 89.5% 30-day mortality in our patient cohort.
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168
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Ezeokoli OT, Gcilitshana O, Pohl CH. Risk Factors for Fungal Co-Infections in Critically Ill COVID-19 Patients, with a Focus on Immunosuppressants. J Fungi (Basel) 2021; 7:545. [PMID: 34356924 PMCID: PMC8304654 DOI: 10.3390/jof7070545] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Revised: 06/28/2021] [Accepted: 06/29/2021] [Indexed: 12/15/2022] Open
Abstract
Severe cases of coronavirus disease 2019 (COVID-19) managed in the intensive care unit are prone to complications, including secondary infections with opportunistic fungal pathogens. Systemic fungal co-infections in hospitalized COVID-19 patients may exacerbate COVID-19 disease severity, hamper treatment effectiveness and increase mortality. Here, we reiterate the role of fungal co-infections in exacerbating COVID-19 disease severity as well as highlight emerging trends related to fungal disease burden in COVID-19 patients. Furthermore, we provide perspectives on the risk factors for fungal co-infections in hospitalized COVID-19 patients and highlight the potential role of prolonged immunomodulatory treatments in driving fungal co-infections, including COVID-19-associated pulmonary aspergillosis (CAPA), COVID-19-associated candidiasis (CAC) and mucormycosis. We reiterate the need for early diagnosis of suspected COVID-19-associated systemic mycoses in the hospital setting.
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Affiliation(s)
| | | | - Carolina H. Pohl
- Yeast Research Group, Department of Microbiology and Biochemistry, University of the Free State, Bloemfontein 9300, South Africa or (O.T.E.); (O.G.)
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169
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Price TK, Mirasol R, Ward KW, Dayo AJ, Hilt EE, Chandrasekaran S, Garner OB, de St Maurice A, Yang S. Genomic Characterizations of Clade III Lineage of Candida auris, California, USA. Emerg Infect Dis 2021; 27:1223-1227. [PMID: 33755003 PMCID: PMC8007294 DOI: 10.3201/eid2704.204361] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Candida auris is an emerging multidrug-resistant yeast. We describe an ongoing C. auris outbreak that began in October 2019 in Los Angeles, California, USA. We used genomic analysis to determine that isolates from 5 of 6 patients belonged to clade III; 4 isolates were closely related.
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170
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Senok A, Alfaresi M, Khansaheb H, Nassar R, Hachim M, Al Suwaidi H, Almansoori M, Alqaydi F, Afaneh Z, Mohamed A, Qureshi S, Ali A, Alkhajeh A, Alsheikh-Ali A. Coinfections in Patients Hospitalized with COVID-19: A Descriptive Study from the United Arab Emirates. Infect Drug Resist 2021; 14:2289-2296. [PMID: 34188495 PMCID: PMC8232897 DOI: 10.2147/idr.s314029] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2021] [Accepted: 05/19/2021] [Indexed: 12/15/2022] Open
Abstract
Purpose Microbial coinfections in COVID-19 patients carry a risk of poor outcomes. This study aimed to characterize the clinical and microbiological profiles of coinfections in patients with COVID-19. Methods A retrospective review of the clinical and laboratory records of COVID-19 patients with laboratory-confirmed infections with bacteria, fungi, and viruses was conducted. Only adult COVID-19 patients hospitalized at participating health-care facilities between February 1 and July 31, 2020 were included. Data were collected from the centralized electronic system of Dubai Health Authority hospitals and Sheikh Khalifa General Hospital Umm Al Quwain. Results Of 29,802 patients hospitalized with COVID-19, 392 (1.3%) had laboratory-confirmed coinfections. The mean age of patients with coinfections was 49.3±12.5 years, and a majority were male (n=330 of 392, 84.2%). Mean interval to commencement of empirical antibiotics was 1.2±3.6) days postadmission, with ceftriaxone, azithromycin, and piperacillin-tazobactam the most commonly used. Median interval between admission and first positive culture (mostly from blood, endotracheal aspirates, and urine specimens) was 15 (IQR 8-25) days. Pseudomonas aeruginosa, Klebsiella pneumoniae, and Escherichia coli were predominant in first positive cultures, with increased occurrence of Stenotrophomonas maltophilia, methicillin-resistant Staphylococcus aureus, Acinetobacter baumannii, Candida auris, and Candida parapsilosis in subsequent cultures. The top three Gram-positive organisms were Staphylococcus epidermidis, Enterococcus faecalis, and Staphylococcus aureus. There was variability in levels of sensitivity to antibiotics and isolates harboring mecA, ESBL, AmpC, and carbapenemase-resistance genes were prevalent. A total of 130 (33.2%) patients died, predominantly those in the intensive-care unit undergoing mechanical ventilation or extracorporeal membrane oxygenation. Conclusion Despite the low occurrence of coinfections among patients with COVID-19 in our setting, clinical outcomes remained poor. Predominance of Gram-negative pathogens, emergence of Candida species, and prevalence of isolates harboring drug-resistance genes are of concern.
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Affiliation(s)
- Abiola Senok
- College of Medicine, Mohammed Bin Rashid University of Medicine and Health Sciences, Dubai, United Arab Emirates
| | - Mubarak Alfaresi
- Sheikh Khalifa General Hospital, Umm Al Quwain, United Arab Emirates
| | | | - Rania Nassar
- College of Medicine, Mohammed Bin Rashid University of Medicine and Health Sciences, Dubai, United Arab Emirates.,Oral and Biomedical Sciences, School of Dentistry, Cardiff University, Cardiff, UK
| | - Mahmood Hachim
- College of Medicine, Mohammed Bin Rashid University of Medicine and Health Sciences, Dubai, United Arab Emirates
| | - Hanan Al Suwaidi
- College of Medicine, Mohammed Bin Rashid University of Medicine and Health Sciences, Dubai, United Arab Emirates
| | - Majed Almansoori
- Sheikh Khalifa General Hospital, Umm Al Quwain, United Arab Emirates
| | - Fatma Alqaydi
- Sheikh Khalifa General Hospital, Umm Al Quwain, United Arab Emirates
| | - Zuhair Afaneh
- Sheikh Khalifa General Hospital, Umm Al Quwain, United Arab Emirates
| | - Aalya Mohamed
- Sheikh Khalifa General Hospital, Umm Al Quwain, United Arab Emirates
| | - Shahab Qureshi
- Sheikh Khalifa General Hospital, Umm Al Quwain, United Arab Emirates
| | - Ayman Ali
- Sheikh Khalifa General Hospital, Umm Al Quwain, United Arab Emirates
| | | | - Alawi Alsheikh-Ali
- College of Medicine, Mohammed Bin Rashid University of Medicine and Health Sciences, Dubai, United Arab Emirates.,Dubai Health Authority, Dubai, United Arab Emirates
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171
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Drug repurposing strategies in the development of potential antifungal agents. Appl Microbiol Biotechnol 2021; 105:5259-5279. [PMID: 34151414 PMCID: PMC8214983 DOI: 10.1007/s00253-021-11407-7] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Revised: 06/01/2021] [Accepted: 06/08/2021] [Indexed: 12/15/2022]
Abstract
Abstract The morbidity and mortality caused by invasive fungal infections are increasing across the globe due to developments in transplant surgery, the use of immunosuppressive agents, and the emergence of drug-resistant fungal strains, which has led to a challenge in terms of treatment due to the limitations of three classes of drugs. Hence, it is imperative to establish effective strategies to identify and design new antifungal drugs. Drug repurposing is a potential way of expanding the application of existing drugs. Recently, various existing drugs have been shown to be useful in the prevention and treatment of invasive fungi. In this review, we summarize the currently used antifungal agents. In addition, the most up-to-date information on the effectiveness of existing drugs with antifungal activity is discussed. Moreover, the antifungal mechanisms of existing drugs are highlighted. These data will provide valuable knowledge to stimulate further investigation and clinical application in this field. Key points • Conventional antifungal agents have limitations due to the occurrence of drug-resistant strains. • Non-antifungal drugs act as antifungal agents in various ways toward different targets. • Non-antifungal drugs with antifungal activity are demonstrated as effective antifungal strategies.
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172
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Awada B, Alam W, Chalfoun M, Araj G, Bizri AR. COVID-19 and Candida duobushaemulonii superinfection: A case report. J Mycol Med 2021; 31:101168. [PMID: 34186378 PMCID: PMC8206624 DOI: 10.1016/j.mycmed.2021.101168] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Revised: 06/11/2021] [Accepted: 06/11/2021] [Indexed: 12/27/2022]
Abstract
Introduction Critically ill COVID-19 patients are at high risk for nosocomial bacterial and fungal infections due to several predisposing factors such as intensive care unit stay, mechanical ventilation, and broad-spectrum antibiotics. Data regarding multidrug resistant (MDR) Candida species in COVID-19 patients is scarce, and nonexistent regarding Candida duobushaemulonii superinfections. Case description A 34-year-old male presented to our institution with acute respiratory distress syndrome (ARDS) due to COVID-19 infection and developed Candida duobushaemulonii fungemia after multiple courses of antibiotics and prolonged mechanical ventilation. He died after recurrent pneumothorax led to respiratory failure and cardiac arrest. Discussion Bacterial and fungal infections are common complications of viral pneumonia in critically ill patients. Data regarding these infections in COVID-19 patients has been poorly studied with only a few cases reporting secondary infection, mostly without identifying specific pathogens. Prolonged hospital stays, invasive interventions (central venous catheter, mechanical ventilation), and the use of broad-spectrum antibiotics in COVID-19 infections could carry a high risk of bacterial and/or fungal superinfections. Conclusion Strategies to improve outcome in COVID-19 ICU patients should include early recognition of candidemia and appropriate antifungal therapy.
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Affiliation(s)
- Bassem Awada
- Department of Internal Medicine, Division of Infectious Diseases, American University of Beirut Medical Center, Beirut, Lebanon
| | - Walid Alam
- Department of Internal Medicine, American University of Beirut Medical Center, Beirut, Lebanon.
| | - Maria Chalfoun
- Faculty of Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - George Araj
- Department of Laboratory Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Abdul Rahman Bizri
- Department of Internal Medicine, Division of Infectious Diseases, American University of Beirut Medical Center, Beirut, Lebanon
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173
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Nobrega de Almeida J, Brandão IB, Francisco EC, de Almeida SLR, de Oliveira Dias P, Pereira FM, Santos Ferreira F, de Andrade TS, de Miranda Costa MM, de Souza Jordão RT, Meis JF, Colombo AL. Axillary Digital Thermometers uplifted a multidrug-susceptible Candida auris outbreak among COVID-19 patients in Brazil. Mycoses 2021; 64:1062-1072. [PMID: 34009677 PMCID: PMC8242760 DOI: 10.1111/myc.13320] [Citation(s) in RCA: 38] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2021] [Revised: 05/10/2021] [Accepted: 05/11/2021] [Indexed: 12/14/2022]
Abstract
Objectives To describe the first outbreak of Candidaauris in Brazil, including epidemiological, clinical and microbiological data. Methods After the first Candidaauris‐colonised patient was diagnosed in a COVID‐19 ICU at a hospital in Salvador, Brazil, a multidisciplinary team conducted a local C. auris prevalence investigation. Screening cultures for C. auris were collected from patients, healthcare workers and inanimate surfaces. Risk factors for C. auris colonisation were evaluated, and the fungemia episodes that occurred after the investigation were also analysed and described. Antifungal susceptibility of the C. auris isolates was determined, and they were genotyped with microsatellite analysis. Results Among body swabs collected from 47 patients, eight (n = 8/47, 17%) samples from the axillae were positive for C. auris. Among samples collected from inanimate surfaces, digital thermometers had the highest rate of positive cultures (n = 8/47, 17%). Antifungal susceptibility testing showed MICs of 0.5 to 1 mg/L for AMB, 0.03 to 0.06 mg/L for voriconazole, 2 to 4 mg/L for fluconazole and 0.03 to 0.06 mg/L for anidulafungin. Microsatellite analysis revealed that all C. auris isolates belong to the South Asian clade (Clade I) and had different genotypes. In multivariate analysis, having a colonised digital thermometer was the only independent risk factor associated with C. auris colonisation. Three episodes of C. auris fungemia occurred after the investigation, with 30‐day attributable mortality of 33.3%. Conclusions Emergence of C. auris in Salvador, Brazil, may be related to local C. auris clade I closely related genotypes. Contaminated axillary monitoring thermometers may facilitate the dissemination of C. auris reinforcing the concept that these reusable devices should be carefully cleaned with an effective disinfectant or replaced by other temperature monitoring methods.
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Affiliation(s)
- João Nobrega de Almeida
- Disciplina de Infectologia, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, Brazil.,Central Laboratory Division, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Igor B Brandão
- Comissão de Controle de Infecção Hospitalar, Hospital de Bahia, Salvador, Brazil
| | - Elaine C Francisco
- Disciplina de Infectologia, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, Brazil
| | | | | | | | | | - Thaisse Souza de Andrade
- Superintendência de Vigilância e Proteção da Saúde, Secretaria de Saúde do Estado da Bahia, Salvador, Brazil
| | | | | | - Jacques F Meis
- Department of Medical Microbiology and Infectious Diseases, ECMM Center of Excellence for Medical Mycology, Nijmegen, The Netherlands.,Center of Expertise in Mycology, Radboud University Medical Center/Canisius Wilhelmina Hospital, Nijmegen, The Netherlands
| | - Arnaldo L Colombo
- Disciplina de Infectologia, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, Brazil
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Ansari S, Hays JP, Kemp A, Okechukwu R, Murugaiyan J, Ekwanzala MD, Ruiz Alvarez MJ, Paul-Satyaseela M, Iwu CD, Balleste-Delpierre C, Septimus E, Mugisha L, Fadare J, Chaudhuri S, Chibabhai V, Wadanamby JMRWW, Daoud Z, Xiao Y, Parkunan T, Khalaf Y, M’Ikanatha NM, van Dongen MBM. The potential impact of the COVID-19 pandemic on global antimicrobial and biocide resistance: an AMR Insights global perspective. JAC Antimicrob Resist 2021; 3:dlab038. [PMID: 34192258 PMCID: PMC8083476 DOI: 10.1093/jacamr/dlab038] [Citation(s) in RCA: 39] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
The COVID-19 pandemic presents a serious public health challenge in all countries. However, repercussions of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infections on future global health are still being investigated, including the pandemic's potential effect on the emergence and spread of global antimicrobial resistance (AMR). Critically ill COVID-19 patients may develop severe complications, which may predispose patients to infection with nosocomial bacterial and/or fungal pathogens, requiring the extensive use of antibiotics. However, antibiotics may also be inappropriately used in milder cases of COVID-19 infection. Further, concerns such as increased biocide use, antimicrobial stewardship/infection control, AMR awareness, the need for diagnostics (including rapid and point-of-care diagnostics) and the usefulness of vaccination could all be components shaping the influence of the COVID-19 pandemic. In this publication, the authors present a brief overview of the COVID-19 pandemic and associated issues that could influence the pandemic's effect on global AMR.
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Affiliation(s)
- Shamshul Ansari
- Department of Microbiology, Chitwan Medical College and Teaching Hospital, Bharatpur, 44200 Chitwan, Nepal
| | - John P Hays
- Department of Medical Microbiology & Infectious Diseases, Erasmus University Medical Centre Rotterdam (Erasmus MC), Rotterdam, The Netherlands
| | - Andrew Kemp
- Scientific Advisory Board of the British Institute of Cleaning Sciences, Northampton, UK
| | - Raymond Okechukwu
- Department of Clinical Pharmacy and Pharmacy Management, Faculty of Pharmaceutical Sciences, Nnamdi Azikiwe University, Agulu Campus, Nigeria
| | | | - Mutshiene Deogratias Ekwanzala
- Department of Environmental, Water and Earth Sciences, Tshwane University of Technology, Pretoria, South Africa
- Environmental Engineering, Department of Civil Engineering, Kyung Hee University, Yongin-si, Gyeonggi-do, Republic of Korea
| | | | | | - Chidozie Declan Iwu
- School of Health Systems and Public Health, Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa
| | | | - Ed Septimus
- Department of Population Medicine, Harvard Medical School & Harvard Pilgrim Health Care Institute, Boston, MA, 02215, Texas A&M College of Medicine, Houston, TX 77030, USA
| | - Lawrence Mugisha
- College of Veterinary Medicine, Animal Resources & Biosecurity (COVAB), Makerere University, Kampala, Uganda
| | - Joseph Fadare
- Department of Pharmacology and Therapeutics, College of Medicine, Ekiti State University, Ado-Ekiti, Nigeria
| | - Susmita Chaudhuri
- Translational Health Science and Technology Institute, Faridabad 121001, India
| | - Vindana Chibabhai
- Department of Clinical Microbiology and Infectious Diseases, University of the Witwatersrand, and Clinical Microbiology Laboratory, Charlotte Maxeke Johannesburg Academic Hospital, National Health Laboratory Service, Johannesburg, South Africa
| | - J M Rohini W W Wadanamby
- Department of Microbiology, Lanka Hospital Diagnostics, Lanka Hospital 578, Elvitigala Mw, Colombo 05, Sri Lanka
| | - Ziad Daoud
- Department of Clinical Microbiology & Infection Prevention, Michigan Health Clinics-Saginaw, MI, USA and Department of Foundational Sciences, CMED-CMU, Mount Pleasant, MI, USA
| | - Yonghong Xiao
- State Key Laboratory for Diagnosis & Treatment of Infectious Diseases, the First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou 300013, China
| | - Thulasiraman Parkunan
- Department of Veterinary Physiology and Biochemistry, Faculty of Veterinary and Animal Sciences, Institute of Agricultural Sciences, Rajiv Gandhi South Campus, Banaras Hindu University, Mirzapur, Uttar Pradesh, India
| | - Yara Khalaf
- Department of Epidemiology, High Institute of Public Health, Alexandria University, Alexandria, Egypt
| | - Nkuchia M M’Ikanatha
- Division of Infectious Disease Epidemiology, Pennsylvania Department of Health, Harrisburg, PA, USA
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175
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O’Kelly B, Cronin C, Connellan D, Griffin S, Connolly SP, McGrath J, Cotter AG, McGinty T, Muldoon EG, Sheehan G, Cullen W, Doran P, McHugh T, Vidal L, Avramovic G, Lambert JS. Antibiotic prescribing patterns in patients hospitalized with COVID-19: lessons from the first wave. JAC Antimicrob Resist 2021; 3:dlab085. [PMID: 34223144 PMCID: PMC8242139 DOI: 10.1093/jacamr/dlab085] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Accepted: 05/25/2021] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND A high proportion of hospitalized patients with COVID-19 receive antibiotics despite evidence to show low levels of true bacterial coinfection. METHODS A retrospective cohort study examining antibiotic prescribing patterns of 300 patients sequentially diagnosed with COVID-19. Patients were grouped into 3 sub-cohorts: Group 1 received no antibiotics, Group 2 received antibiotics for microbiologically confirmed infections and Group 3 was empirically treated with antibiotics for pneumonia. The primary aim was to identify factors that influenced prescription and continuation of antibiotics in Group 3. Secondary aims were to examine differences in outcomes between groups. RESULTS In total, 292 patients were included (63 Group 1, 35 Group 2, 194 Group 3), median age was 60 years (IQR 44-76) and the majority were ethnically Irish (62%). The median duration of antibiotics was 7 days (IQR 5-10). In Group 3, factors associated with prescription IV antibiotics on admission were raised C-reactive protein (CRP) (P = 0.024), increased age (P = 0.023), higher quick SOFA (P = 0.016) score and fever >37.5 °C (P = 0.011). Factors associated with duration of antibiotic course were duration of hypoxia (P < 0.001) and maximum respiratory support requirement (P = 0.013). Twenty-one patients in Group 3 had one or more antibiotic escalation events, most (n = 139) had no escalation or de-escalation of therapy. CONCLUSIONS Duration of hypoxia and need for respiratory support may have acted as surrogate measures of improvement where usual response measures (CRP, neutrophilia, culture clearance) were absent. Continuous review of antibiotic prescriptions should be at the forefront of clinical management of hospitalized patients with COVID-19.
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Affiliation(s)
- Brendan O’Kelly
- Infectious Diseases Department, Mater Misericordiae University Hospital, Dublin 7, Ireland
- Centre for Experimental Pathogen Host Research, University College Dublin, Dublin 4, Ireland
| | - Colm Cronin
- Infectious Diseases Department, Mater Misericordiae University Hospital, Dublin 7, Ireland
| | - David Connellan
- Infectious Diseases Department, Mater Misericordiae University Hospital, Dublin 7, Ireland
| | - Sean Griffin
- Infectious Diseases Department, Mater Misericordiae University Hospital, Dublin 7, Ireland
| | - Stephen Peter Connolly
- Infectious Diseases Department, Mater Misericordiae University Hospital, Dublin 7, Ireland
- Centre for Experimental Pathogen Host Research, University College Dublin, Dublin 4, Ireland
| | - Jonathan McGrath
- Infectious Diseases Department, Mater Misericordiae University Hospital, Dublin 7, Ireland
| | - Aoife G Cotter
- Infectious Diseases Department, Mater Misericordiae University Hospital, Dublin 7, Ireland
- Centre for Experimental Pathogen Host Research, University College Dublin, Dublin 4, Ireland
- School of Medicine, University College Dublin, Dublin 4, Ireland
| | - Tara McGinty
- Infectious Diseases Department, Mater Misericordiae University Hospital, Dublin 7, Ireland
- Centre for Experimental Pathogen Host Research, University College Dublin, Dublin 4, Ireland
- School of Medicine, University College Dublin, Dublin 4, Ireland
| | - Eavan G Muldoon
- Infectious Diseases Department, Mater Misericordiae University Hospital, Dublin 7, Ireland
- School of Medicine, University College Dublin, Dublin 4, Ireland
| | - Gerard Sheehan
- Infectious Diseases Department, Mater Misericordiae University Hospital, Dublin 7, Ireland
| | - Walter Cullen
- School of Medicine, University College Dublin, Dublin 4, Ireland
| | - Peter Doran
- School of Medicine, University College Dublin, Dublin 4, Ireland
| | - Tina McHugh
- School of Medicine, University College Dublin, Dublin 4, Ireland
| | - Louise Vidal
- School of Medicine, University College Dublin, Dublin 4, Ireland
| | | | - John S Lambert
- Infectious Diseases Department, Mater Misericordiae University Hospital, Dublin 7, Ireland
- School of Medicine, University College Dublin, Dublin 4, Ireland
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176
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Mulet Bayona JV, Tormo Palop N, Salvador García C, Fuster Escrivá B, Chanzá Aviñó M, Ortega García P, Gimeno Cardona C. Impact of the SARS-CoV-2 Pandemic in Candidaemia, Invasive Aspergillosis and Antifungal Consumption in a Tertiary Hospital. J Fungi (Basel) 2021; 7:jof7060440. [PMID: 34072876 PMCID: PMC8228091 DOI: 10.3390/jof7060440] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Revised: 05/24/2021] [Accepted: 05/28/2021] [Indexed: 01/07/2023] Open
Abstract
In addition to the increase in fungal infections that has been observed in the last few decades, it has been reported that severe clinical COVID-19 can increase the risk of invasive fungal infections. The main objective of this study was to evaluate if there had been an increase in candidaemia and invasive pulmonary aspergillosis (IPA) cases since the onset of the SARS-CoV-2 pandemic. Data were retrospectively collected from April 2019 to March 2021, from patients admitted to Consorcio Hospital General Universitario de Valencia (Spain). A total of 152 candidaemia cases (56 of which were due to Candida auris) and 108 possible IPA cases were detected. A great increase in candidaemia cases was produced during the first and the third epidemic waves of the SARS-CoV-2 pandemic (June 2020, and January 2021, respectively), while an increase in IPA cases was produced during the third wave. The 28-day mortality rates in patients affected by candidaemia and IPA increased in 2020 and 2021. C. auris has displaced the other Candida species, becoming the most isolated Candida species in blood cultures since the onset of the SARS-CoV-2 pandemic. Antifungal consumption increased in 2020 when compared to 2019, especially echinocandins, voriconazole and isavuconazole.
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Affiliation(s)
- Juan Vicente Mulet Bayona
- Department of Microbiology and Parasitology, Consorcio Hospital General Universitario de Valencia, 46014 Valencia, Spain; (N.T.P.); (C.S.G.); (B.F.E.); (M.C.A.); (C.G.C.)
- Correspondence:
| | - Nuria Tormo Palop
- Department of Microbiology and Parasitology, Consorcio Hospital General Universitario de Valencia, 46014 Valencia, Spain; (N.T.P.); (C.S.G.); (B.F.E.); (M.C.A.); (C.G.C.)
| | - Carme Salvador García
- Department of Microbiology and Parasitology, Consorcio Hospital General Universitario de Valencia, 46014 Valencia, Spain; (N.T.P.); (C.S.G.); (B.F.E.); (M.C.A.); (C.G.C.)
| | - Begoña Fuster Escrivá
- Department of Microbiology and Parasitology, Consorcio Hospital General Universitario de Valencia, 46014 Valencia, Spain; (N.T.P.); (C.S.G.); (B.F.E.); (M.C.A.); (C.G.C.)
| | - Mercedes Chanzá Aviñó
- Department of Microbiology and Parasitology, Consorcio Hospital General Universitario de Valencia, 46014 Valencia, Spain; (N.T.P.); (C.S.G.); (B.F.E.); (M.C.A.); (C.G.C.)
| | - Pilar Ortega García
- Department of Hospital Pharmacy, Consorcio Hospital General Universitario de Valencia, 46014 Valencia, Spain;
| | - Concepción Gimeno Cardona
- Department of Microbiology and Parasitology, Consorcio Hospital General Universitario de Valencia, 46014 Valencia, Spain; (N.T.P.); (C.S.G.); (B.F.E.); (M.C.A.); (C.G.C.)
- Department of Microbiology and Ecology, University of Valencia, 46010 Valencia, Spain
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177
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Černáková L, Roudbary M, Brás S, Tafaj S, Rodrigues CF. Candida auris: A Quick Review on Identification, Current Treatments, and Challenges. Int J Mol Sci 2021; 22:4470. [PMID: 33922907 PMCID: PMC8123192 DOI: 10.3390/ijms22094470] [Citation(s) in RCA: 36] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Revised: 04/21/2021] [Accepted: 04/21/2021] [Indexed: 02/07/2023] Open
Abstract
Candida auris is a novel and major fungal pathogen that has triggered several outbreaks in the last decade. The few drugs available to treat fungal diseases, the fact that this yeast has a high rate of multidrug resistance and the occurrence of misleading identifications, and the ability of forming biofilms (naturally more resistant to drugs) has made treatments of C. auris infections highly difficult. This review intends to quickly illustrate the main issues in C. auris identification, available treatments and the associated mechanisms of resistance, and the novel and alternative treatment and drugs (natural and synthetic) that have been recently reported.
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Affiliation(s)
- Lucia Černáková
- Department of Microbiology and Virology, Faculty of Natural Sciences, Comenius University in Bratislava, Ilkovičova 6, 842 15 Bratislava, Slovakia;
| | - Maryam Roudbary
- Department of Parasitology and Mycology, School of Medicine, Iran University of Medical Sciences, Tehran 1449614535, Iran;
| | - Susana Brás
- Centre of Biological Engineering, LIBRO—‘Laboratório de Investigação em Biofilmes Rosário Oliveira’, University of Minho, 4710-057 Braga, Portugal;
| | - Silva Tafaj
- Microbiology Department, University Hospital “Shefqet Ndroqi”, 1044 Tirana, Albania;
| | - Célia F. Rodrigues
- LEPABE—Laboratory for Process Engineering, Environment, Biotechnology and Energy, Faculty of Engineering, University of Porto, 4200-465 Porto, Portugal
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Kovács R, Tóth Z, Locke JB, Forgács L, Kardos G, Nagy F, Borman AM, Majoros L. Comparison of In Vitro Killing Activity of Rezafungin, Anidulafungin, Caspofungin, and Micafungin against Four Candida auris Clades in RPMI-1640 in the Absence and Presence of Human Serum. Microorganisms 2021; 9:863. [PMID: 33923783 PMCID: PMC8073555 DOI: 10.3390/microorganisms9040863] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Revised: 04/14/2021] [Accepted: 04/15/2021] [Indexed: 02/07/2023] Open
Abstract
Candida auris is an emerging and frequently multidrug-resistant pathogen against which the echinocandins are the preferred therapeutic option. We compared killing activities of anidulafungin, caspofungin, micafungin, and rezafungin against 13 isolates representing four C. auris clades (South Asian n = 3; East Asian n = 3; South African n = 3; South American n = 4, of which two were of environmental origin). Minimum inhibitory concentration MICs and killing kinetics in RPMI-1640 and RPMI-1640 plus 50% serum (50% serum) were determined. The four echinocandins were never fungicidal and induced large aggregates in RPMI-1640 and, less markedly, in 50% serum. Colony forming unit CFU decreases were found more consistently in 50% serum than in RPMI-1640. Isolates from the East Asian clade were killed at ≥1-≥ 4 mg/L with all echinocandins regardless of media. Anidulafungin and micafungin produced killing at peak drug serum concentration (8 mg/L) against environmental but not clinical isolates from the South American and the South African clades. Micafungin at ≥8 mg/L but not anidulafungin produced CFU decreases against the South Asian clade as well. In 50% serum, rezafungin at ≥1-≥ 8 mg/L produced killing against all four clades. The next generation echinocandin, rezafungin, showed the same or better activity at clinically attainable trough concentration regardless of media, compared with anidulafungin, caspofungin, and micafungin against all four tested C. auris clades.
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Affiliation(s)
- Renátó Kovács
- Department of Medical Microbiology, Faculty of Medicine, University of Debrecen, 4032 Debrecen, Hungary; (R.K.); (Z.T.); (L.F.); (G.K.); (F.N.)
| | - Zoltán Tóth
- Department of Medical Microbiology, Faculty of Medicine, University of Debrecen, 4032 Debrecen, Hungary; (R.K.); (Z.T.); (L.F.); (G.K.); (F.N.)
- Doctoral School of Pharmaceutical Sciences, University of Debrecen, 4032 Debrecen, Hungary
| | - Jeffrey B. Locke
- Cidara Therapeutics, Inc., 6310 Nancy Ridge Dr., Suite 101, San Diego, CA 92121, USA;
| | - Lajos Forgács
- Department of Medical Microbiology, Faculty of Medicine, University of Debrecen, 4032 Debrecen, Hungary; (R.K.); (Z.T.); (L.F.); (G.K.); (F.N.)
- Doctoral School of Pharmaceutical Sciences, University of Debrecen, 4032 Debrecen, Hungary
| | - Gábor Kardos
- Department of Medical Microbiology, Faculty of Medicine, University of Debrecen, 4032 Debrecen, Hungary; (R.K.); (Z.T.); (L.F.); (G.K.); (F.N.)
| | - Fruzsina Nagy
- Department of Medical Microbiology, Faculty of Medicine, University of Debrecen, 4032 Debrecen, Hungary; (R.K.); (Z.T.); (L.F.); (G.K.); (F.N.)
- Doctoral School of Pharmaceutical Sciences, University of Debrecen, 4032 Debrecen, Hungary
| | - Andrew M. Borman
- UK National Mycology Reference Laboratory, Public Health England, Science Quarter, Southmead Hospital, Bristol BS10 5NB, UK;
- Medical Research Council Centre for Medical Mycology (MRC CMM), University of Exeter, Exeter EX4 4QD, UK
| | - László Majoros
- Department of Medical Microbiology, Faculty of Medicine, University of Debrecen, 4032 Debrecen, Hungary; (R.K.); (Z.T.); (L.F.); (G.K.); (F.N.)
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179
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Candidemia among Iranian Patients with Severe COVID-19 Admitted to ICUs. J Fungi (Basel) 2021; 7:jof7040280. [PMID: 33917967 PMCID: PMC8068363 DOI: 10.3390/jof7040280] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Revised: 04/05/2021] [Accepted: 04/06/2021] [Indexed: 12/14/2022] Open
Abstract
As a novel risk factor, COVID-19 has led to an increase in the incidence of candidemia and an elevated mortality rate. Despite being of clinical importance, there is a lack of data regarding COVID-19-associated candidemia (CAC) among Iranian patients. Therefore, in this retrospective study, we assessed CAC epidemiology in the intensive care units (ICUs) of two COVID-19 centers in Mashhad, Iran, from early November 2020 to late January 2021. Yeast isolates from patients’ blood were identified by 21-plex polymerase chain reaction (PCR) and sequencing, then subjected to antifungal susceptibility testing according to the CLSI M27-A3 protocol. Among 1988 patients with COVID-19 admitted to ICUs, seven had fungemia (7/1988; 0.03%), among whom six had CAC. The mortality of the limited CAC cases was high and greatly exceeded that of patients with COVID-19 but without candidemia (100% (6/6) vs. 22.7% (452/1988)). In total, nine yeast isolates were collected from patients with fungemia: five Candida albicans, three C. glabrata, and one Rhodotorula mucilaginosa. Half of the patients infected with C. albicans (2/4) were refractory to both azoles and echinocandins. The high mortality of patients with CAC, despite antifungal therapy, reflects the severity of the disease in these patients and underscores the importance of rapid diagnosis and timely initiation of antifungal treatment.
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180
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Affiliation(s)
- Sandip Sarkar
- Department of Ophthalmology, Jawaharlal Institute of Post Graduate Medical Education and Research, Puducherry, India
| | - Tanmay Gokhale
- Department of Ophthalmology, Jawaharlal Institute of Post Graduate Medical Education and Research, Puducherry, India
| | - Sushmita Sana Choudhury
- Department of Microbiology, Jawaharlal Institute of Post Graduate Medical Education and Research, Karaikal, India
| | - Amit Kumar Deb
- Department of Ophthalmology, Jawaharlal Institute of Post Graduate Medical Education and Research, Puducherry, India
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181
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Increased antimicrobial resistance during the COVID-19 pandemic. Int J Antimicrob Agents 2021; 57:106324. [PMID: 33746045 PMCID: PMC7972869 DOI: 10.1016/j.ijantimicag.2021.106324] [Citation(s) in RCA: 221] [Impact Index Per Article: 73.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2020] [Revised: 02/09/2021] [Accepted: 03/13/2021] [Indexed: 01/08/2023]
Abstract
In addition to SARS-CoV-2 (severe acute respiratory syndrome coronavirus 2) infection itself, an increase in the incidence of antimicrobial resistance poses collateral damage to the current status of the COVID-19 (coronavirus disease 2019) pandemic. There has been a rapid increase in multidrug-resistant organisms (MDROs), including extended-spectrum β-lactamase (ESBL)-producing Klebsiella pneumoniae, carbapenem-resistant New Delhi metallo-β-lactamase (NDM)-producing Enterobacterales, Acinetobacter baumannii, methicillin-resistant Staphylococcus aureus (MRSA), pan-echinocandin-resistant Candida glabrata and multi-triazole-resistant Aspergillus fumigatus. The cause is multifactorial and is particularly related to high rates of antimicrobial agent utilisation in COVID-19 patients with a relatively low rate of co- or secondary infection. Appropriate prescription and optimised use of antimicrobials according to the principles of antimicrobial stewardship as well as quality diagnosis and aggressive infection control measures may help prevent the occurrence of MDROs during this pandemic.
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182
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Emergence of Candida auris in Brazil in a COVID-19 Intensive Care Unit. J Fungi (Basel) 2021; 7:jof7030220. [PMID: 33803060 PMCID: PMC8002986 DOI: 10.3390/jof7030220] [Citation(s) in RCA: 48] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Revised: 03/09/2021] [Accepted: 03/13/2021] [Indexed: 01/17/2023] Open
Abstract
In December 2020, Candida auris emerged in Brazil in the city of Salvador. The first two C. auris colonized patients were in the same COVID-19 intensive care unit. Antifungal susceptibility testing showed low minimal inhibitory concentrations of 1 µg/mL, 2 µg/mL, 0.03 µg/L, and 0.06 µg/mL for amphotericin B, fluconazole, voriconazole, and anidulafungin, respectively. Microsatellite typing revealed that the strains are clonal and belong to the South Asian clade C. auris. The travel restrictions during the COVID-19 pandemic and the absence of travel history among the colonized patients lead to the hypothesis that this species was introduced several months before the recognition of the first case and/or emerged locally in the coastline Salvador area.
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183
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Rusic D, Vilovic M, Bukic J, Leskur D, Seselja Perisin A, Kumric M, Martinovic D, Petric A, Modun D, Bozic J. Implications of COVID-19 Pandemic on the Emergence of Antimicrobial Resistance: Adjusting the Response to Future Outbreaks. Life (Basel) 2021; 11:life11030220. [PMID: 33801799 PMCID: PMC8000815 DOI: 10.3390/life11030220] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Revised: 03/06/2021] [Accepted: 03/07/2021] [Indexed: 12/23/2022] Open
Abstract
The net effect of the coronavirus disease 2019 (COVID-19) pandemic and the response to it on the emergence of antimicrobial resistance is yet unknown. Positive impacts on the spread of multiresistant pathogens and infections in general may be observed with the implementation of general preventative measures for the spread of infectious disease such as social distancing, reduced travel and increased personal hygiene. This pandemic has accelerated the development of novel technologies, such as mRNA vaccines, that may be used to fight other diseases. These should be capitalized upon to manage the ongoing antimicrobial resistance pandemic in the background. However, it is likely that the COVID-19 pandemic is fueling the emergence of antimicrobial resistance due to high rates of inappropriate antimicrobial prescribing, the high use of biocides and the interruption of treatment for other conditions. Clinical uncertainty driven by the lack of effective diagnostics and practice of telemedicine may have driven the inappropriate use of antimicrobials. As pathogens know no borders, increased focus is needed for infectious diseases still threatening low- and middle-income countries such as tuberculosis. Stewardship measures for future outbreaks should stress the importance of social distancing and hand washing but discourage the overuse of disinfectants and antimicrobials that are not proven effective.
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Affiliation(s)
- Doris Rusic
- Department of Pharmacy, University of Split School of Medicine, Soltanska 2, 21 000 Split, Croatia; (D.R.); (J.B.); (D.L.); (A.S.P.); (A.P.); (D.M.)
| | - Marino Vilovic
- Department of Pathophysiology, University of Split School of Medicine, Soltanska 2, 21 000 Split, Croatia; (M.V.); (M.K.); (D.M.)
| | - Josipa Bukic
- Department of Pharmacy, University of Split School of Medicine, Soltanska 2, 21 000 Split, Croatia; (D.R.); (J.B.); (D.L.); (A.S.P.); (A.P.); (D.M.)
| | - Dario Leskur
- Department of Pharmacy, University of Split School of Medicine, Soltanska 2, 21 000 Split, Croatia; (D.R.); (J.B.); (D.L.); (A.S.P.); (A.P.); (D.M.)
| | - Ana Seselja Perisin
- Department of Pharmacy, University of Split School of Medicine, Soltanska 2, 21 000 Split, Croatia; (D.R.); (J.B.); (D.L.); (A.S.P.); (A.P.); (D.M.)
| | - Marko Kumric
- Department of Pathophysiology, University of Split School of Medicine, Soltanska 2, 21 000 Split, Croatia; (M.V.); (M.K.); (D.M.)
| | - Dinko Martinovic
- Department of Pathophysiology, University of Split School of Medicine, Soltanska 2, 21 000 Split, Croatia; (M.V.); (M.K.); (D.M.)
| | - Ana Petric
- Department of Pharmacy, University of Split School of Medicine, Soltanska 2, 21 000 Split, Croatia; (D.R.); (J.B.); (D.L.); (A.S.P.); (A.P.); (D.M.)
- Split-Dalmatia County Pharmacy, Kneza Ljudevita Posavskog 12 b, 21 000 Split, Croatia
| | - Darko Modun
- Department of Pharmacy, University of Split School of Medicine, Soltanska 2, 21 000 Split, Croatia; (D.R.); (J.B.); (D.L.); (A.S.P.); (A.P.); (D.M.)
| | - Josko Bozic
- Department of Pathophysiology, University of Split School of Medicine, Soltanska 2, 21 000 Split, Croatia; (M.V.); (M.K.); (D.M.)
- Correspondence:
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Macauley P, Epelbaum O. Epidemiology and Mycology of Candidaemia in non-oncological medical intensive care unit patients in a tertiary center in the United States: Overall analysis and comparison between non-COVID-19 and COVID-19 cases. Mycoses 2021; 64:634-640. [PMID: 33608923 PMCID: PMC8013328 DOI: 10.1111/myc.13258] [Citation(s) in RCA: 48] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Revised: 02/14/2021] [Accepted: 02/17/2021] [Indexed: 01/07/2023]
Abstract
The epidemiology and mycology of invasive candidiasis in the ICU is well‐described in certain types of critically ill patients but not in others. One population that has been scarcely studied is non‐neutropenic patients admitted specifically to medical ICUs. Even less is known about the broader category of medical ICU patients without active oncological disease. This group constitutes a very large share of the patients requiring critical care across the globe, especially in the era of the SARS‐CoV‐2 pandemic. We analysed medical ICU candidaemia episodes that occurred in non‐oncological patients in our tertiary academic centre in the United States from May 2014 to October 2020 to determine the incidence and species distribution of the associated isolates. We then separately considered non‐COVID‐19 and COVID‐19 cases and compared their characteristics. In the non‐COVID‐19 group, there were 38 cases for an incidence of 1.1% and rate of 11/1000 admissions. In the COVID‐19 group, there were 12 cases for an incidence of 5.1% and rate of 51/1000 admissions. In the entire sample, as well as separately in the non‐COVID‐19 and COVID‐19 groups,Candida albicans accounted for a minority of isolates. Compared to non‐COVID‐19 patients with candidaemia, COVID‐19 patients had lower ICU admission SOFA score but longer ICU length of stay and central venous catheter dwell time at candidaemia detection. This study provides valuable insight into the incidence and species distribution of candidaemia cases occurring in non‐oncological critically ill patients and identifies informative differences between non‐COVID‐19 and COVID‐19 patients.
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Affiliation(s)
- Precious Macauley
- Division of Pulmonary, Critical Care, and Sleep Medicine, Westchester Medical Center, Valhalla, NY, USA
| | - Oleg Epelbaum
- Division of Pulmonary, Critical Care, and Sleep Medicine, Westchester Medical Center, Valhalla, NY, USA
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185
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Moser D, Biere K, Han B, Hoerl M, Schelling G, Choukér A, Woehrle T. COVID-19 Impairs Immune Response to Candida albicans. Front Immunol 2021; 12:640644. [PMID: 33717195 PMCID: PMC7953065 DOI: 10.3389/fimmu.2021.640644] [Citation(s) in RCA: 47] [Impact Index Per Article: 15.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2020] [Accepted: 01/20/2021] [Indexed: 12/11/2022] Open
Abstract
Infection with SARS-CoV-2 can lead to Coronavirus disease-2019 (COVID-19) and result in severe acute respiratory distress syndrome (ARDS). Recent reports indicate an increased rate of fungal coinfections during COVID-19. With incomplete understanding of the pathogenesis and without any causative therapy available, secondary infections may be detrimental to the prognosis. We monitored 11 COVID-19 patients with ARDS for their immune phenotype, plasma cytokines, and clinical parameters on the day of ICU admission and on day 4 and day 7 of their ICU stay. Whole blood stimulation assays with lipopolysaccharide (LPS), heat-killed Listeria monocytogenes (HKLM), Aspergillus fumigatus, and Candida albicans were used to mimic secondary infections, and changes in immune phenotype and cytokine release were assessed. COVID-19 patients displayed an immune phenotype characterized by increased HLA-DR+CD38+ and PD-1+ CD4+ and CD8+ T cells, and elevated CD8+CD244+ lymphocytes, compared to healthy controls. Monocyte activation markers and cytokines IL-6, IL-8, TNF, IL-10, and sIL2Rα were elevated, corresponding to monocyte activation syndrome, while IL-1β levels were low. LPS, HKLM and Aspergillus fumigatus antigen stimulation provoked an immune response that did not differ between COVID-19 patients and healthy controls, while COVID-19 patients showed an attenuated monocyte CD80 upregulation and abrogated release of IL-6, TNF, IL-1α, and IL-1β toward Candida albicans. This study adds further detail to the characterization of the immune response in critically ill COVID-19 patients and hints at an increased susceptibility for Candida albicans infection.
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Affiliation(s)
| | | | | | | | | | - Alexander Choukér
- Department of Anesthesiology, LMU Hospital, Ludwig-Maximilians-University, Munich, Germany
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186
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Knight GM, Glover RE, McQuaid CF, Olaru ID, Gallandat K, Leclerc QJ, Fuller NM, Willcocks SJ, Hasan R, van Kleef E, Chandler CIR. Antimicrobial resistance and COVID-19: Intersections and implications. eLife 2021; 10:e64139. [PMID: 33588991 PMCID: PMC7886324 DOI: 10.7554/elife.64139] [Citation(s) in RCA: 159] [Impact Index Per Article: 53.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2020] [Accepted: 02/02/2021] [Indexed: 01/08/2023] Open
Abstract
Before the coronavirus 2019 (COVID-19) pandemic began, antimicrobial resistance (AMR) was among the top priorities for global public health. Already a complex challenge, AMR now needs to be addressed in a changing healthcare landscape. Here, we analyse how changes due to COVID-19 in terms of antimicrobial usage, infection prevention, and health systems affect the emergence, transmission, and burden of AMR. Increased hand hygiene, decreased international travel, and decreased elective hospital procedures may reduce AMR pathogen selection and spread in the short term. However, the opposite effects may be seen if antibiotics are more widely used as standard healthcare pathways break down. Over 6 months into the COVID-19 pandemic, the dynamics of AMR remain uncertain. We call for the AMR community to keep a global perspective while designing finely tuned surveillance and research to continue to improve our preparedness and response to these intersecting public health challenges.
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Affiliation(s)
- Gwenan M Knight
- AMR Centre, London School of Hygiene and Tropical Medicine (LSHTM)LondonUnited Kingdom
- Centre for Mathematical Modelling of Infectious Diseases (CMMID), LSHTMLondonUnited Kingdom
- Department of Infectious Disease Epidemiology, Faculty of Epidemiology and Public Health, LSHTMLondonUnited Kingdom
- TB Centre, LSHTMLondonUnited Kingdom
| | - Rebecca E Glover
- AMR Centre, London School of Hygiene and Tropical Medicine (LSHTM)LondonUnited Kingdom
- Department of Health Services Research and Policy, Faculty of Public Health and Policy, LSHTMLondonUnited Kingdom
| | - C Finn McQuaid
- AMR Centre, London School of Hygiene and Tropical Medicine (LSHTM)LondonUnited Kingdom
- Centre for Mathematical Modelling of Infectious Diseases (CMMID), LSHTMLondonUnited Kingdom
- Department of Infectious Disease Epidemiology, Faculty of Epidemiology and Public Health, LSHTMLondonUnited Kingdom
- TB Centre, LSHTMLondonUnited Kingdom
| | - Ioana D Olaru
- AMR Centre, London School of Hygiene and Tropical Medicine (LSHTM)LondonUnited Kingdom
- Clinical Research Department, Faculty of Infectious and Tropical Diseases, LSHTMLondonUnited Kingdom
- Biomedical Research and Training InstituteZambezi RiverZimbabwe
| | - Karin Gallandat
- AMR Centre, London School of Hygiene and Tropical Medicine (LSHTM)LondonUnited Kingdom
- Department of Disease Control, Faculty of Infectious and Tropical Diseases, LSHTMLondonUnited Kingdom
| | - Quentin J Leclerc
- AMR Centre, London School of Hygiene and Tropical Medicine (LSHTM)LondonUnited Kingdom
- Centre for Mathematical Modelling of Infectious Diseases (CMMID), LSHTMLondonUnited Kingdom
- Department of Infectious Disease Epidemiology, Faculty of Epidemiology and Public Health, LSHTMLondonUnited Kingdom
| | - Naomi M Fuller
- AMR Centre, London School of Hygiene and Tropical Medicine (LSHTM)LondonUnited Kingdom
- Centre for Mathematical Modelling of Infectious Diseases (CMMID), LSHTMLondonUnited Kingdom
- Department of Infectious Disease Epidemiology, Faculty of Epidemiology and Public Health, LSHTMLondonUnited Kingdom
| | - Sam J Willcocks
- AMR Centre, London School of Hygiene and Tropical Medicine (LSHTM)LondonUnited Kingdom
- Department of Infection Biology, Faculty of Infectious and Tropical Diseases, LSHTMLondonUnited Kingdom
| | - Rumina Hasan
- AMR Centre, London School of Hygiene and Tropical Medicine (LSHTM)LondonUnited Kingdom
- Department of Pathology and Laboratory Medicine, Aga Khan UniversityKarachiPakistan
- Department of Immunology and Infection, Faculty of Infectious and Tropical Diseases, LSHTMLondonUnited Kingdom
| | - Esther van Kleef
- Department of Public Heath, Institute of Tropical MedicineAntwerpBelgium
| | - Clare IR Chandler
- AMR Centre, London School of Hygiene and Tropical Medicine (LSHTM)LondonUnited Kingdom
- Department of Global Health and Development, Faculty of Public Health and Policy, LSHTMLondonUnited Kingdom
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187
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Di Pilato V, Codda G, Ball L, Giacobbe DR, Willison E, Mikulska M, Magnasco L, Crea F, Vena A, Pelosi P, Bassetti M, Marchese A. Molecular Epidemiological Investigation of a Nosocomial Cluster of C. auris: Evidence of Recent Emergence in Italy and Ease of Transmission during the COVID-19 Pandemic. J Fungi (Basel) 2021; 7:140. [PMID: 33672021 PMCID: PMC7919374 DOI: 10.3390/jof7020140] [Citation(s) in RCA: 42] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Revised: 02/12/2021] [Accepted: 02/12/2021] [Indexed: 01/15/2023] Open
Abstract
Candida auris is an emerging MDR pathogen raising major concerns worldwide. In Italy, it was first and only identified in July 2019 in our hospital (San Martino Hospital, Genoa), where infection or colonization cases have been increasingly recognized during the following months. To gain insights into the introduction, transmission dynamics, and resistance traits of this fungal pathogen, consecutive C. auris isolates collected from July 2019 to May 2020 (n = 10) were subjected to whole-genome sequencing (WGS) and antifungal susceptibility testing (AST); patients' clinical and trace data were also collected. WGS resolved all isolates within the genetic clade I (South Asian) and showed that all but one were part of a cluster likely stemming from the index case. Phylogenetic molecular clock analyses predicted a recent introduction (May 2019) in the hospital setting and suggested that most transmissions were associated with a ward converted to a COVID-19-dedicated ICU during the pandemic. All isolates were resistant to amphotericin B, voriconazole, and fluconazole at high-level, owing to mutations in ERG11(K143R) and TACB1(A640V). Present data demonstrated that the introduction of MDR C. auris in Italy was a recent event and suggested that its spread could have been facilitated by the COVID-19 pandemic. Continued efforts to implement stringent infection prevention and control strategies are warranted to limit the spread of this emerging pathogen within the healthcare system.
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Affiliation(s)
- Vincenzo Di Pilato
- Department of Surgical Sciences and Integrated Diagnostics (DISC), University of Genoa, 16132 Genoa, Italy; (G.C.); (L.B.); (P.P.); (A.M.)
| | - Giulia Codda
- Department of Surgical Sciences and Integrated Diagnostics (DISC), University of Genoa, 16132 Genoa, Italy; (G.C.); (L.B.); (P.P.); (A.M.)
| | - Lorenzo Ball
- Department of Surgical Sciences and Integrated Diagnostics (DISC), University of Genoa, 16132 Genoa, Italy; (G.C.); (L.B.); (P.P.); (A.M.)
- Anesthesia and Intensive Care, San Martino Policlinico Hospital—IRCCS for Oncology and Neuroscience, 16132 Genoa, Italy
| | - Daniele Roberto Giacobbe
- Infectious Diseases Unit, San Martino Policlinico Hospital—IRCCS for Oncology and Neuroscience, 16132 Genoa, Italy; (D.R.G.); (M.M.); (L.M.); (A.V.); (M.B.)
- Department of Health Sciences (DISSAL), University of Genoa, 16132 Genoa, Italy
| | - Edward Willison
- Clinical Microbiology Unit, San Martino Policlinico Hospital—IRCCS for Oncology and Neuroscience, 16132 Genoa, Italy; (E.W.); (F.C.)
| | - Malgorzata Mikulska
- Infectious Diseases Unit, San Martino Policlinico Hospital—IRCCS for Oncology and Neuroscience, 16132 Genoa, Italy; (D.R.G.); (M.M.); (L.M.); (A.V.); (M.B.)
- Department of Health Sciences (DISSAL), University of Genoa, 16132 Genoa, Italy
| | - Laura Magnasco
- Infectious Diseases Unit, San Martino Policlinico Hospital—IRCCS for Oncology and Neuroscience, 16132 Genoa, Italy; (D.R.G.); (M.M.); (L.M.); (A.V.); (M.B.)
- Department of Health Sciences (DISSAL), University of Genoa, 16132 Genoa, Italy
| | - Francesca Crea
- Clinical Microbiology Unit, San Martino Policlinico Hospital—IRCCS for Oncology and Neuroscience, 16132 Genoa, Italy; (E.W.); (F.C.)
| | - Antonio Vena
- Infectious Diseases Unit, San Martino Policlinico Hospital—IRCCS for Oncology and Neuroscience, 16132 Genoa, Italy; (D.R.G.); (M.M.); (L.M.); (A.V.); (M.B.)
| | - Paolo Pelosi
- Department of Surgical Sciences and Integrated Diagnostics (DISC), University of Genoa, 16132 Genoa, Italy; (G.C.); (L.B.); (P.P.); (A.M.)
- Anesthesia and Intensive Care, San Martino Policlinico Hospital—IRCCS for Oncology and Neuroscience, 16132 Genoa, Italy
| | - Matteo Bassetti
- Infectious Diseases Unit, San Martino Policlinico Hospital—IRCCS for Oncology and Neuroscience, 16132 Genoa, Italy; (D.R.G.); (M.M.); (L.M.); (A.V.); (M.B.)
- Department of Health Sciences (DISSAL), University of Genoa, 16132 Genoa, Italy
| | - Anna Marchese
- Department of Surgical Sciences and Integrated Diagnostics (DISC), University of Genoa, 16132 Genoa, Italy; (G.C.); (L.B.); (P.P.); (A.M.)
- Clinical Microbiology Unit, San Martino Policlinico Hospital—IRCCS for Oncology and Neuroscience, 16132 Genoa, Italy; (E.W.); (F.C.)
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188
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Salmanton-García J, Sprute R, Stemler J, Bartoletti M, Dupont D, Valerio M, Garcia-Vidal C, Falces-Romero I, Machado M, de la Villa S, Schroeder M, Hoyo I, Hanses F, Ferreira-Paim K, Giacobbe DR, Meis JF, Gangneux JP, Rodríguez-Guardado A, Antinori S, Sal E, Malaj X, Seidel D, Cornely OA, Koehler P. COVID-19-Associated Pulmonary Aspergillosis, March-August 2020. Emerg Infect Dis 2021; 27:1077-1086. [PMID: 33539721 PMCID: PMC8007287 DOI: 10.3201/eid2704.204895] [Citation(s) in RCA: 175] [Impact Index Per Article: 58.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Pneumonia caused by severe acute respiratory syndrome coronavirus 2 emerged in China at the end of 2019. Because of the severe immunomodulation and lymphocyte depletion caused by this virus and the subsequent administration of drugs directed at the immune system, we anticipated that patients might experience fungal superinfection. We collected data from 186 patients who had coronavirus disease-associated pulmonary aspergillosis (CAPA) worldwide during March-August 2020. Overall, 182 patients were admitted to the intensive care unit (ICU), including 180 with acute respiratory distress syndrome and 175 who received mechanical ventilation. CAPA was diagnosed a median of 10 days after coronavirus disease diagnosis. Aspergillus fumigatus was identified in 80.3% of patient cultures, 4 of which were azole-resistant. Most (52.7%) patients received voriconazole. In total, 52.2% of patients died; of the deaths, 33.0% were attributed to CAPA. We found that the cumulative incidence of CAPA in the ICU ranged from 1.0% to 39.1%.
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189
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Prestel C, Anderson E, Forsberg K, Lyman M, de Perio MA, Kuhar D, Edwards K, Rivera M, Shugart A, Walters M, Dotson NQ. Candida auris Outbreak in a COVID-19 Specialty Care Unit - Florida, July-August 2020. MMWR-MORBIDITY AND MORTALITY WEEKLY REPORT 2021; 70:56-57. [PMID: 33444298 PMCID: PMC7808709 DOI: 10.15585/mmwr.mm7002e3] [Citation(s) in RCA: 127] [Impact Index Per Article: 42.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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190
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Villanueva-Lozano H, Treviño-Rangel RDJ, González GM, Ramírez-Elizondo MT, Lara-Medrano R, Aleman-Bocanegra MC, Guajardo-Lara CE, Gaona-Chávez N, Castilleja-Leal F, Torre-Amione G, Martínez-Reséndez MF. Outbreak of Candida auris infection in a COVID-19 hospital in Mexico. Clin Microbiol Infect 2021; 27:S1198-743X(20)30790-4. [PMID: 33429028 PMCID: PMC7835657 DOI: 10.1016/j.cmi.2020.12.030] [Citation(s) in RCA: 107] [Impact Index Per Article: 35.7] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2020] [Revised: 12/12/2020] [Accepted: 12/23/2020] [Indexed: 12/22/2022]
Affiliation(s)
- Hiram Villanueva-Lozano
- Universidad Autónoma de Nuevo León, School of Medicine, Department of Microbiology, Monterrey, Nuevo León, Mexico
| | - Rogelio de J Treviño-Rangel
- Universidad Autónoma de Nuevo León, School of Medicine, Department of Microbiology, Monterrey, Nuevo León, Mexico
| | - Gloria M González
- Universidad Autónoma de Nuevo León, School of Medicine, Department of Microbiology, Monterrey, Nuevo León, Mexico
| | - María Teresa Ramírez-Elizondo
- Hospital San José-Tec Salud, Epidemiological Surveillance Unit, Monterrey, Nuevo León, Mexico; Instituto Tecnológico y de Estudios Superiores de Monterrey, School of Medicine and Health Sciences, Monterrey, Nuevo León, Mexico
| | - Reynaldo Lara-Medrano
- Hospital San José-Tec Salud, Epidemiological Surveillance Unit, Monterrey, Nuevo León, Mexico
| | | | - Claudia E Guajardo-Lara
- Laboratory of Clinical Microbiology, Hospital San José-TecSalud, Monterrey, Nuevo León, Mexico
| | - Natalia Gaona-Chávez
- Hospital San José-Tec Salud, Epidemiological Surveillance Unit, Monterrey, Nuevo León, Mexico
| | - Fernando Castilleja-Leal
- Instituto Tecnológico y de Estudios Superiores de Monterrey, School of Medicine and Health Sciences, Monterrey, Nuevo León, Mexico
| | - Guillermo Torre-Amione
- Instituto Tecnológico y de Estudios Superiores de Monterrey, School of Medicine and Health Sciences, Monterrey, Nuevo León, Mexico
| | - Michel F Martínez-Reséndez
- Hospital San José-Tec Salud, Epidemiological Surveillance Unit, Monterrey, Nuevo León, Mexico; Instituto Tecnológico y de Estudios Superiores de Monterrey, School of Medicine and Health Sciences, Monterrey, Nuevo León, Mexico.
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191
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Spread of Carbapenem-Resistant Gram-Negatives and Candida auris during the COVID-19 Pandemic in Critically Ill Patients: One Step Back in Antimicrobial Stewardship? Microorganisms 2021; 9:microorganisms9010095. [PMID: 33401591 PMCID: PMC7823370 DOI: 10.3390/microorganisms9010095] [Citation(s) in RCA: 72] [Impact Index Per Article: 24.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2020] [Revised: 12/26/2020] [Accepted: 12/29/2020] [Indexed: 02/07/2023] Open
Abstract
The possible negative impact of severe adult respiratory distress caused by severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) infection (COVID-19) on antimicrobial stewardship and infection control has been postulated, but few real-life data are available. The aim of this study was to report our experience with colonization/infection of carbapenem-resistant Pseudomonas aeruginosa (CRPA), carbapenem-resistant Klebsiella pneumoniae (CR-Kp) and Candida auris among critically ill COVID-19 patients admitted to the intensive care unit (ICU). All COVID-19 patients admitted to the ICUs at San Martino Policlinico Hospital–IRCCS in Genoa, Italy, were screened from 28 February to 31 May 2020. One-hundred and eighteen patients admitted to COVID-19 ICUs were included in the study. Among them, 12 (10.2%) became colonized/infected with CRPA, 6 (5.1%) with C. auris and 2 (1.6%) with CR-Kp. All patients with CRPA received prior treatment with meropenem, and in 11 (91.7%) infection was not preceded by colonization. Four patients (66.7%) developed C. auris candidemia. A significant spread of resistant pathogens was observed among critically ill COVID-19 patients. Dedicated strategies are warranted to prevent horizontal spread and maintain effective antimicrobial stewardship programs in the setting of COVID-19 care.
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192
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Rajni E, Garg VK, Bacchani D, Sharma R, Vohra R, Mamoria V, Malhotra H. Prevalence of Bloodstream Infections and their Etiology in COVID-19 Patients Admitted in a Tertiary Care Hospital in Jaipur. Indian J Crit Care Med 2021; 25:369-373. [PMID: 34045801 PMCID: PMC8138648 DOI: 10.5005/jp-journals-10071-23781] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Background World is in grip of coronavirus disease-2019 (COVID-19) pandemic right now. Majority of studies center around its epidemiological and clinical characteristics. Information regarding secondary bacterial infections is limited. This retrospective observational study was done to determine the prevalence and characteristics of bloodstream infections in COVID-19 patients admitted in a tertiary care center in Jaipur. Materials and methods All blood cultures received from COVID-19 positive patients admitted in designated COVID care ICUs and wards were included in the study. A predesigned pretested questionnaire was used to collect relevant data. Blood cultures were done using BD BACTEC™ FX40, and identification and antimicrobial susceptibility testing of isolates were done by VITEK® 2 COMPACT. Results One thousand five hundred seventy-eight (1578) COVID-19 positive patients were admitted in center during 5-month study period from whom 158 blood cultures were received. Out of these, 15 (9.4%) were positive. Median age of patients with positive blood culture was 54 years and included 10 males and 5 females. Ten (67%) patients needed intensive care in ICU. Significant correlation of blood culture positivity was found with parameters like ICU admission, presence of an indwelling device, underlying comorbidity, raised biochemical markers, and adverse clinical outcome. Conclusions Incidence of bloodstream infections is low for COVID-19 patients. Antibiotic prophylaxis needs to be used with caution, and prompt discontinuation should be done based on clinical judgment. How to cite this article Rajni E, Garg VK, Bacchani D, Sharma R, Vohra R, Mamoria V, et al. Prevalence of Bloodstream Infections and their Etiology in COVID-19 Patients Admitted in a Tertiary Care Hospital in Jaipur. Indian J Crit Care Med 2021;25(4):369-373.
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Affiliation(s)
- Ekadashi Rajni
- Department of Microbiology, Mahatma Gandhi University of Medical Sciences, Jaipur, Rajasthan, India
| | - Vishnu K Garg
- Department of Anaesthesiology, Mahatma Gandhi University of Medical Sciences, Jaipur, Rajasthan, India
| | - Daisy Bacchani
- Department of Microbiology, Mahatma Gandhi University of Medical Sciences, Jaipur, Rajasthan, India
| | - Richa Sharma
- Department of Microbiology, Mahatma Gandhi University of Medical Sciences, Jaipur, Rajasthan, India
| | - Rajat Vohra
- Department of PSM, Mahatma Gandhi University of Medical Sciences, Jaipur, Rajasthan, India
| | - Vedprakash Mamoria
- Department of Microbiology, Mahatma Gandhi University of Medical Sciences, Jaipur, Rajasthan, India
| | - Hemant Malhotra
- Department of Medical Oncology, Mahatma Gandhi University of Medical Sciences, Jaipur, Rajasthan, India
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193
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Pulmonary Candidiasis Associated with COVID-19: Evaluation of Causative Agents and their Antifungal Susceptibility Patterns. TANAFFOS 2021; 20:29-35. [PMID: 34394367 DOI: pmid/34394367] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 10/03/2020] [Accepted: 12/26/2020] [Indexed: 11/23/2022]
Abstract
BACKGROUND The purpose of the present study was to isolate Candida species from individuals with the COVID-19 disease and evaluate the susceptibility pattern of Candida spp. to routine antifungal drugs. MATERIALS AND METHODS A total of 25 Candida spp. isolated from hospitalized patients with COVID-19, who were suspected to have pulmonary candidiasis, and 26 archived Candida spp. specimens were enrolled in this study. For the identification of Candida spp., PCR was performed to detect and amplify the ITS1 and ITS4 genes. Then the products were subjected to the Msp I restriction enzyme to precisely identify the species. The amplification of the WHP1 gene was conducted to identify Candida albicans species. The antifungal activities of routine drugs and the synthesize AuNPs against Candida spp. were assessed based on the protocols presented by the Clinical and Laboratory Standards Institute M60. RESULTS In the present study, C. albicans (24; 96%) and C. parapsilosis (1; 4%) were identified as the etiologic agents of the pulmonary candidiasis associated with the COVID-19 infection. Voriconazol and amphotericin B had superior activity against all the isolates in this study. Treatment with fluconazole and itraconazole did not significantly change the formation of colony-forming units (CFU). However, treatment with the AuNPs significantly decreased (within the range of 92-99.1%; P<0.05) the number of CFUs. CONCLUSION The azole prophylaxis has likely been associated with the development of resistant isolates; the results of the present study suggested the promising role of novel antifungal agents such as AuNPs in overcoming drug resistant fungi.
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194
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Affiliation(s)
- Dominique L Monnet
- European Centre for Disease Prevention and Control (ECDC), Stockholm, Sweden
| | - Stephan Harbarth
- Infection Control Program and Division of Infectious Diseases, University of Geneva Hospitals and Faculty of Medicine, Geneva, Switzerland
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195
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Coronavirus Disease 2019 (COVID-19) in a Patient with Disseminated Histoplasmosis and HIV-A Case Report from Argentina and Literature Review. J Fungi (Basel) 2020; 6:jof6040275. [PMID: 33182836 PMCID: PMC7711963 DOI: 10.3390/jof6040275] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2020] [Revised: 10/27/2020] [Accepted: 11/05/2020] [Indexed: 01/08/2023] Open
Abstract
The disease caused by the new SARS-CoV-2, known as Coronavirus disease 2019 (COVID-19), was first identified in China in December 2019 and rapidly spread around the world. Coinfections with fungal pathogens in patients with COVID-19 add challenges to patient care. We conducted a literature review on fungal coinfections in patients with COVID-19. We describe a report of a patient with disseminated histoplasmosis who was likely infected with SARS-CoV-2 and experienced COVID-19 during hospital care in Buenos Aires, Argentina. This patient presented with advanced HIV disease, a well-known factor for disseminated histoplasmosis; on the other hand, we suspected that COVID-19 was acquired during hospitalization but there is not enough evidence to support this hypothesis. Clinical correlation and the use of specific Histoplasma and COVID-19 rapid diagnostics assays were key to the timely diagnosis of both infections, permitting appropriate treatment and patient care.
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196
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Basso RP, Poester VR, Benelli JL, Stevens DA, Zogbi HE, Vasconcellos ICDS, Pasqualotto AC, Xavier MO. COVID-19-Associated Histoplasmosis in an AIDS Patient. Mycopathologia 2020; 186:109-112. [PMID: 33156463 PMCID: PMC7644795 DOI: 10.1007/s11046-020-00505-1] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2020] [Accepted: 10/23/2020] [Indexed: 12/30/2022]
Abstract
Most reports associating fungal infections with COVID-19 have been cases of invasive aspergillosis. Here, we report a case of severe histoplasmosis and COVID-19 infections in an HIV patient in Rio Grande, Southern Brazil. Histoplasmosis must be included as a diagnostic possibility in opportunistic fungal co-infections in COVID-19 patients with AIDS, mainly in endemic areas.
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Affiliation(s)
- Rossana Patricia Basso
- Pós-Graduação em Ciências da Saúde, Laboratório de Micologia, Faculdade de Medicina, Universidade Federal do Rio Grande (FAMED-FURG), Campus Saúde, Visconde de Paranaguá 102, Centro, Rio Grande, RS, 96201-900, Brazil.,Hospital Universitário Dr. Miguel Riet Corrêa Jr. (HU-FURG), vinculado à Empresa Brasileira de Serviços Hospitalares (EBSERH), Rio Grande, RS, Brazil
| | - Vanice Rodrigues Poester
- Pós-Graduação em Ciências da Saúde, Laboratório de Micologia, Faculdade de Medicina, Universidade Federal do Rio Grande (FAMED-FURG), Campus Saúde, Visconde de Paranaguá 102, Centro, Rio Grande, RS, 96201-900, Brazil
| | - Jéssica Louise Benelli
- Pós-Graduação em Ciências da Saúde, Laboratório de Micologia, Faculdade de Medicina, Universidade Federal do Rio Grande (FAMED-FURG), Campus Saúde, Visconde de Paranaguá 102, Centro, Rio Grande, RS, 96201-900, Brazil
| | - David A Stevens
- California Institute for Medical Research, San Jose, CA, USA.,Division of Infectious Diseases and Geographic Medicine, Stanford University Medical School, Stanford, CA, USA
| | - Heruza Einsfeld Zogbi
- Pós-Graduação em Ciências da Saúde, Laboratório de Micologia, Faculdade de Medicina, Universidade Federal do Rio Grande (FAMED-FURG), Campus Saúde, Visconde de Paranaguá 102, Centro, Rio Grande, RS, 96201-900, Brazil.,Hospital Universitário Dr. Miguel Riet Corrêa Jr. (HU-FURG), vinculado à Empresa Brasileira de Serviços Hospitalares (EBSERH), Rio Grande, RS, Brazil
| | - Izadora Clezar da S Vasconcellos
- Programa de Pós-Graduação em Patologia, Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Porto Alegre, RS, Brazil
| | - Alessandro Comarú Pasqualotto
- Programa de Pós-Graduação em Patologia, Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Porto Alegre, RS, Brazil
| | - Melissa Orzechowski Xavier
- Pós-Graduação em Ciências da Saúde, Laboratório de Micologia, Faculdade de Medicina, Universidade Federal do Rio Grande (FAMED-FURG), Campus Saúde, Visconde de Paranaguá 102, Centro, Rio Grande, RS, 96201-900, Brazil. .,California Institute for Medical Research, San Jose, CA, USA. .,Division of Infectious Diseases and Geographic Medicine, Stanford University Medical School, Stanford, CA, USA.
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Botti C, Lusetti F, Neri T, Peroni S, Castellucci A, Salsi P, Ghidini A. Comparison of percutaneous dilatational tracheotomy versus open surgical technique in severe COVID-19: Complication rates, relative risks and benefits. Auris Nasus Larynx 2020; 48:511-517. [PMID: 33143935 PMCID: PMC7598348 DOI: 10.1016/j.anl.2020.10.014] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2020] [Revised: 09/29/2020] [Accepted: 10/23/2020] [Indexed: 01/08/2023]
Abstract
Objective Patients with acute respiratory failure due to COVID-19 have a high likelihood of needing prolonged intubation and may subsequently require tracheotomy. Usually, the choice of technique (percutaneous dilatational tracheotomy [PDT] versus open surgical tracheotomy [OST]) depends on the preference of surgeons and patient-related factors. In case of COVID-19, airborne spread of viral particles and limited time of apnea must be considered in the choice of the safest technique. The aim of this study is to compare the complication rates and offer an assessment of relative risks and benefits of PDT versus OST in patients with severe COVID-19. Methods We performed a retrospective study considering 47 consecutive patients affected by severe acute respiratory distress syndrome due to SARS-CoV-2 infection, needing invasive mechanical ventilation and subsequent tracheostomy. This study was performed at the Intensive Care Unit of our tertiary referral center. Complication rates were analyzed. Results Seventeen patients underwent PDT and 30 patients were submitted to OST. Twenty-six patients (55.3%) had post-operative complications (local infection, hemorrhage, subcutaneous emphysema) with no significant difference between PDT and OST. Conclusion PDT and OST are characterized by similar postoperative complication rates in severe COVID-19 patients. These findings suggest that OST might be preferred if expert ENT surgeons are available, as PDT could result in longer apnea and exposure to generated aerosol. However, authors recommend considering either OST or PDT at the discretion of the medical staff involved, according to the personal experience of the operators performing the procedure.
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Affiliation(s)
- Cecilia Botti
- PhD Program in Clinical and Experimental Medicine, University of Modena and Reggio Emilia, Reggio Emilia, Italy; Department of Surgery, Otolaryngology Unit, Azienda USL-IRCCS di Reggio Emilia, viale Risorgimento 80, 42123 Reggio Emilia, Italy.
| | - Francesca Lusetti
- Department of Surgery, Otolaryngology Unit, Azienda USL-IRCCS di Reggio Emilia, viale Risorgimento 80, 42123 Reggio Emilia, Italy
| | - Tommaso Neri
- Intensive Care Unit, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Stefano Peroni
- Intensive Care Unit, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Andrea Castellucci
- Department of Surgery, Otolaryngology Unit, Azienda USL-IRCCS di Reggio Emilia, viale Risorgimento 80, 42123 Reggio Emilia, Italy
| | - Pierpaolo Salsi
- Intensive Care Unit, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Angelo Ghidini
- Department of Surgery, Otolaryngology Unit, Azienda USL-IRCCS di Reggio Emilia, viale Risorgimento 80, 42123 Reggio Emilia, Italy
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Arastehfar A, Carvalho A, Nguyen MH, Hedayati MT, Netea MG, Perlin DS, Hoenigl M. COVID-19-Associated Candidiasis (CAC): An Underestimated Complication in the Absence of Immunological Predispositions? J Fungi (Basel) 2020; 6:jof6040211. [PMID: 33050019 PMCID: PMC7712987 DOI: 10.3390/jof6040211] [Citation(s) in RCA: 155] [Impact Index Per Article: 38.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2020] [Revised: 10/01/2020] [Accepted: 10/06/2020] [Indexed: 12/20/2022] Open
Abstract
The recent global pandemic of COVID-19 has predisposed a relatively high number of patients to acute respiratory distress syndrome (ARDS), which carries a risk of developing super-infections. Candida species are major constituents of the human mycobiome and the main cause of invasive fungal infections, with a high mortality rate. Invasive yeast infections (IYIs) are increasingly recognized as s complication of severe COVID-19. Despite the marked immune dysregulation in COVID-19, no prominent defects have been reported in immune cells that are critically required for immunity to Candida. This suggests that relevant clinical factors, including prolonged ICU stays, central venous catheters, and broad-spectrum antibiotic use, may be key factors causing COVID-19 patients to develop IYIs. Although data on the comparative performance of diagnostic tools are often lacking in COVID-19 patients, a combination of serological and molecular techniques may present a promising option for the identification of IYIs. Clinical awareness and screening are needed, as IYIs are difficult to diagnose, particularly in the setting of severe COVID-19. Echinocandins and azoles are the primary antifungal used to treat IYIs, yet the therapeutic failures exerted by multidrug-resistant Candida spp. such as C. auris and C. glabrata call for the development of new antifungal drugs with novel mechanisms of action.
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Affiliation(s)
- Amir Arastehfar
- Center for Discovery and Innovation, Hackensack Meridian Health, Nutley, NJ 07110, USA;
- Correspondence: (A.A.); (A.C.); (M.H.); Tel./Fax: +1-201-880-3100 (A.A.); +351-253-604811 (A.C.); +1-619-543-5605 (M.H.)
| | - Agostinho Carvalho
- Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, 4710-057 Braga, Portugal
- ICVS/3B’s—PT Government Associate Laboratory, 4710-057 Guimarães/Braga, Portugal
- Correspondence: (A.A.); (A.C.); (M.H.); Tel./Fax: +1-201-880-3100 (A.A.); +351-253-604811 (A.C.); +1-619-543-5605 (M.H.)
| | - M. Hong Nguyen
- Department of Medicine, University of Pittsburgh, Pittsburgh, PA 15261, USA;
| | - Mohammad Taghi Hedayati
- Invasive Fungi Research Center, Department of Medical Mycology, School of Medicine, Mazandaran University of Medical Sciences, Sari 4815733971, Iran;
| | - Mihai G. Netea
- Department of Internal Medicine and Radboud Center for Infectious Diseases, Radboud University Medical Centre, 6500HB Nijmegen, The Netherlands;
- Department of Genomics & Immunoregulation, Life and Medical Sciences Institute, University of Bonn, 53115 Bonn, Germany
- Radboud Institute for Molecular Life Sciences, Radboud University Medical Center, 6525 GA Nijmegen, The Netherlands
| | - David S. Perlin
- Center for Discovery and Innovation, Hackensack Meridian Health, Nutley, NJ 07110, USA;
| | - Martin Hoenigl
- Clinical and Translational Fungal-Working Group, University of California San Diego, La Jolla, CA 92093, USA
- Section of Infectious Diseases and Tropical Medicine, Department of Internal Medicine, Medical University of Graz, 8036 Graz, Austria
- Division of Infectious Diseases and Global Public Health, Department of Medicine, University of California, San Diego, San Diego, CA 92093, USA
- Correspondence: (A.A.); (A.C.); (M.H.); Tel./Fax: +1-201-880-3100 (A.A.); +351-253-604811 (A.C.); +1-619-543-5605 (M.H.)
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199
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Mehta S, Pandey A. Rhino-Orbital Mucormycosis Associated With COVID-19. Cureus 2020; 12:e10726. [PMID: 33145132 PMCID: PMC7599039 DOI: 10.7759/cureus.10726] [Citation(s) in RCA: 199] [Impact Index Per Article: 49.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2020] [Accepted: 09/30/2020] [Indexed: 12/15/2022] Open
Abstract
Coronavirus disease 2019 (COVID-19) infections may be associated with a wide range of bacterial and fungal co-infections. We report the case of a patient with COVID-19 infection, which, during the course of the treatment, developed rhino-orbital mucormycosis. A 60- year-old male patient, a longstanding diabetic, with a positive reverse-transcriptase polymerase chain reaction (RT-PCR) for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), was admitted for treatment. He received parenteral meropenem and oral oseltamivir with parenteral methylprednisolone. Over the course of the admission, he developed signs of orbital cellulitis. Magnetic resonance imaging (MRI) of the brain, orbits, and paranasal sinuses, revealed soft tissue swelling in the right preseptal, malar, premaxillary and retrobulbar regions with paranasal sinusitis. A nasal biopsy revealed broad aseptate filamentous fungal hyphae suggestive of mucormycosis, which was confirmed on culture. Extensive use of steroids/monoclonal antibodies/broad-spectrum antibiotics may lead to the development/exacerbation of a preexisting fungal disease. Physicians should be aware of the possibility of secondary invasive fungal infections in patients with COVID-19 infection.
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Affiliation(s)
- Salil Mehta
- Ophthalmology, Lilavati Hospital and Research Center, Mumbai, IND
| | - Abha Pandey
- Chest Medicine, Lilavati Hospital and Research Center, Mumbai, IND
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