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de Souza ÂC, Pereira DC, Barth PO, Roesch EW, Lutz L, Aquino VR, Goldani LZ. Rapid identification,fluconazole and micafungin susceptibility testing of Candida species from blood culture by a short incubation method. Diagn Microbiol Infect Dis 2024; 109:116271. [PMID: 38522370 DOI: 10.1016/j.diagmicrobio.2024.116271] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Revised: 02/18/2024] [Accepted: 03/15/2024] [Indexed: 03/26/2024]
Abstract
This study aimed to develop and validate a rapid method for identification by MALDI-TOF system and determination of the susceptibility to Fluconazole and Micafungin by broth microdilution among Candidaspecies causing bloodstream infections. Subcultures from blood culture bottles were incubated for 5 hours (+/- 1h) and used to perform the tests, so that the turnaround time of rapid identification and susceptibility profile was about 5 and 24 hours, respectively. The rapid identification showed agreement of 92.05 %. Regarding the rapid broth microdilution for Fluconazole and Micafungin, the agreement was 97.06 % (p<0.001) and 100 % (p<0.001), and the Kappa coefficient was 0.91 (p<0.001) and 1.0 (p<0.001), respectively. To conclude, both rapid methods showed to be reproducible, inexpensive, easy to perform and time-saving. Thus, these methodologies could be useful to guide and adjust empirical antifungal therapy.
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Affiliation(s)
- Ândrea Celestino de Souza
- Post-graduation Program in Medical Sciences, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, RS, Brasil.
| | - Dariane Castro Pereira
- Unidade de Microbiologia, Serviço de Diagnóstico Laboratorial - Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Brasil
| | - Patricia Orlandi Barth
- Post-graduation Program in Medical Sciences, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, RS, Brasil
| | - Eliane Würdig Roesch
- Unidade de Microbiologia, Serviço de Diagnóstico Laboratorial - Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Brasil
| | - Larissa Lutz
- Unidade de Microbiologia, Serviço de Diagnóstico Laboratorial - Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Brasil
| | - Valério Rodrigues Aquino
- Unidade de Microbiologia, Serviço de Diagnóstico Laboratorial - Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Brasil
| | - Luciano Zubaran Goldani
- Post-graduation Program in Medical Sciences, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, RS, Brasil
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Association between Following the ESCMID Guidelines for the Management of Candidemia and Mortality: A Retrospective Cohort Study. J Fungi (Basel) 2022; 8:jof8050541. [PMID: 35628796 PMCID: PMC9147446 DOI: 10.3390/jof8050541] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2022] [Revised: 05/19/2022] [Accepted: 05/20/2022] [Indexed: 12/12/2022] Open
Abstract
Objectives: The objective of this study was to evaluate the association between ESCMID adherence and 30-day mortality in candidemia. Methods: We performed a retrospective cohort study in two French tertiary-care hospitals. All patients with at least one positive blood culture (BC) for Candida spp. between January 2013 and December 2019 were included. An adherent case was defined as a candidemia case for which the treatment fulfilled a bundle of defined criteria based on the latest ESCMID recommendations. We explored factors associated with adherence to ESCMID recommendations in an unadjusted model, and we used a propensity score method to address potential channeling biases with regard to 30-day mortality. Results: During the study period, 165 cases of candidemia were included. Among the ESCMID criteria, funduscopic examination was not performed in 45% and neither was echocardiography in 31%, while the ESCMID criteria were fully implemented in 44 cases (27%). In the propensity score analysis, the all-cause 30-day mortality rate was significantly lower among adherent cases (3.4/36.6, 9%) than among nonadherent cases (42.4/119.5, 36%) (OR = 5.3 95% CI [1.6–17.1]). Conclusions: In our study, adherence to the bundle of criteria for candidemia management was associated with increased survival, supporting additional efforts to implement these recommendations.
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Evaluation of Identification and Susceptibility for Candida Spp. Isolated Directly from Positive Blood Culture Bottles. Int J Microbiol 2021; 2021:9364231. [PMID: 34824584 PMCID: PMC8610690 DOI: 10.1155/2021/9364231] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Revised: 08/30/2021] [Accepted: 10/01/2021] [Indexed: 11/17/2022] Open
Abstract
Determination of the susceptibility profile of isolates of Candida from blood culture bottles is extremely important for correctly guiding patient pharmacotherapy. The aim of this study was to compare the results of analysis of Candida isolated directly from blood culture bottles by the VITEK MS MALDI-TOF identification system and the fluconazole disk diffusion assay with those of standard identification methods. Testing directly from the bottle allowed results 24 to 48 hours quicker than the standard method. There was a categorical agreement of 51.64% (47 of 91 samples) between the results of analysis directly from the bottle and analysis by the standard method. Regarding species identification, there was 96.15% agreement for Candida parapsilosis (25 of 26 samples). Categorical agreement between the rapid and standard disk diffusion methods was 95%, and the agreement between the rapid disk diffusion method and the broth microdilution method was 97%. Only minor errors in the rapid method were observed: 3 (5%) in the standard disk diffusion method and 2 (3%) in the broth microdilution method. Our study concluded that the rapid disk diffusion method for fluconazole is a fast, easy, reproducible, and consistent method. Its timely implementation for testing antifungal agents in the clinical microbiology laboratory can help reduce profile release times, thus helping to determine the most appropriate antifungal treatment.
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Skłodowski K, Chmielewska SJ, Depciuch J, Deptuła P, Piktel E, Daniluk T, Zakrzewska M, Czarnowski M, Cieśluk M, Durnaś B, Parlińska-Wojtan M, Savage PB, Bucki R. Ceragenin-Coated Non-Spherical Gold Nanoparticles as Novel Candidacidal Agents. Pharmaceutics 2021; 13:pharmaceutics13111940. [PMID: 34834355 PMCID: PMC8619546 DOI: 10.3390/pharmaceutics13111940] [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: 09/20/2021] [Revised: 11/08/2021] [Accepted: 11/10/2021] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND Infections caused by Candida spp. have become one of the major causes of morbidity and mortality in immunocompromised patients. Therefore, new effective fungicides are urgently needed, especially due to an escalating resistance crisis. METHODS A set of nanosystems with rod- (AuR), peanut- (AuP), and star-shaped (AuS) metal cores were synthesized. These gold nanoparticles were conjugated with ceragenins CSA-13, CSA-44, and CSA-131, and their activity was evaluated against Candida strains (n = 21) through the assessment of MICs (minimum inhibitory concentrations)/MFCs (minimum fungicidal concentrations). Moreover, in order to determine the potential for resistance development, serial passages of Candida cells with tested nanosystems were performed. The principal mechanism of action of Au NPs was evaluated via ROS (reactive oxygen species) generation assessment, plasma membrane permeabilization, and release of the protein content. Finally, to evaluate the potential toxicity of Au NPs, the measurement of hemoglobin release from red blood cells (RBCs) was carried out. RESULTS All of the tested nanosystems exerted a potent candidacidal activity, regardless of the species or susceptibility to other antifungal agents. Significantly, no resistance development after 25 passages of Candida cells with AuR@CSA-13, AuR@CSA-44, and AuR@CSA-131 nanosystems was observed. Moreover, the fungicidal mechanism of action of the investigated nanosystems involved the generation of ROS, damage of the fungal cell membrane, and leakage of intracellular contents. Notably, no significant RBCs hemolysis at candidacidal doses of tested nanosystems was detected. CONCLUSIONS The results provide rationale for the development of gold nanoparticles of rod-, peanut-, and star-shaped conjugated with CSA-13, CSA-44, and CSA-131 as effective candidacidal agents.
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Affiliation(s)
- Karol Skłodowski
- Department of Medical Microbiology and Nanobiomedical Engineering, Medical University of Bialystok, 15-222 Bialystok, Poland
| | - Sylwia Joanna Chmielewska
- Department of Medical Microbiology and Nanobiomedical Engineering, Medical University of Bialystok, 15-222 Bialystok, Poland
| | - Joanna Depciuch
- Institute of Nuclear Physics, Polish Academy of Sciences, 31-342 Krakow, Poland
| | - Piotr Deptuła
- Department of Medical Microbiology and Nanobiomedical Engineering, Medical University of Bialystok, 15-222 Bialystok, Poland
| | - Ewelina Piktel
- Department of Medical Microbiology and Nanobiomedical Engineering, Medical University of Bialystok, 15-222 Bialystok, Poland
| | - Tamara Daniluk
- Department of Medical Microbiology and Nanobiomedical Engineering, Medical University of Bialystok, 15-222 Bialystok, Poland
| | - Magdalena Zakrzewska
- Department of Medical Microbiology and Nanobiomedical Engineering, Medical University of Bialystok, 15-222 Bialystok, Poland
| | - Michał Czarnowski
- Department of Medical Microbiology and Nanobiomedical Engineering, Medical University of Bialystok, 15-222 Bialystok, Poland
| | - Mateusz Cieśluk
- Department of Medical Microbiology and Nanobiomedical Engineering, Medical University of Bialystok, 15-222 Bialystok, Poland
| | - Bonita Durnaś
- The Faculty of Medicine and Health Sciences, Collegium Modicum of the Jan Kochanowski University in Kielce, 25-734 Kielce, Poland
| | | | - Paul B Savage
- Department of Chemistry and Biochemistry, Brigham Young University, Provo, UT 84602, USA
| | - Robert Bucki
- Department of Medical Microbiology and Nanobiomedical Engineering, Medical University of Bialystok, 15-222 Bialystok, Poland
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Cortés JA, Montañez AM, Carreño-Gutiérrez AM, Reyes P, Gómez CH, Pescador A, Ariza B, Rosso F. Risk Factors for Mortality in Colombian Patients with Candidemia. J Fungi (Basel) 2021; 7:jof7060442. [PMID: 34073125 PMCID: PMC8229794 DOI: 10.3390/jof7060442] [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: 04/09/2021] [Revised: 05/27/2021] [Accepted: 05/28/2021] [Indexed: 12/30/2022] Open
Abstract
The aim of the study was to describe the microbiology and susceptibility profile of candidemia and to identify the risk factors associated with mortality in Colombia. A cohort of patients was followed for 30 days during 2008 to 2010. Microbiological identification and susceptibility assessments were performed in a reference centre. Demographic, clinical and treatment variables were evaluated for their associations with mortality. A parametric survival regression analysis was used to identify the risk factors associated with mortality. A total of 109 patients with candidemia in four hospitals in Colombia were identified, with a median age of 30 years old. C. parapsilosis was the most frequently identified microorganism (38.5%); the susceptibility of all isolates was high to fluconazole and anidulafungin, except for C. glabrata isolates. The overall mortality was 35.7%, and the risk factors associated with mortality included lack of antifungal treatment (HR 5.5, 95% CI 3.6–11.4), cancer (HR 3.9, 95% CI 2.3–8.0), diabetes (HR 2.5, 95% CI 1.03–6.4), and age (HR 1.13 per every 10 years, 95% CI 1.02–1.24). Catheter removal was associated with a low mortality rate (HR 0.06, 95% CI 0.00–0.49). Prompt antifungal treatment, better glycemic control and catheter removal should be prioritized in the management of candidemia.
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Affiliation(s)
- Jorge Alberto Cortés
- Department of Internal Medicine, Facultad de Medicina, Hospital Universitario Nacional, Universidad Nacional de Colombia, Bogotá 111321, Colombia; (A.M.M.); (A.M.C.-G.)
- Correspondence: ; Tel.: +57-315-3514013
| | - Anita María Montañez
- Department of Internal Medicine, Facultad de Medicina, Hospital Universitario Nacional, Universidad Nacional de Colombia, Bogotá 111321, Colombia; (A.M.M.); (A.M.C.-G.)
| | - Ana María Carreño-Gutiérrez
- Department of Internal Medicine, Facultad de Medicina, Hospital Universitario Nacional, Universidad Nacional de Colombia, Bogotá 111321, Colombia; (A.M.M.); (A.M.C.-G.)
| | - Patricia Reyes
- Department of Infectious Diseases, Clínica Universitaria Colombia, Bogotá 111321, Colombia;
| | | | - Angela Pescador
- Hospital Militar Central, Bogotá 111321, Colombia; (C.H.G.); (A.P.)
| | - Beatriz Ariza
- Hospital Universitario San Ignacio, Bogotá 111321, Colombia;
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Schroeder M, Weber T, Denker T, Winterland S, Wichmann D, Rohde H, Ozga AK, Fischer M, Kluge S. Epidemiology, clinical characteristics, and outcome of candidemia in critically ill patients in Germany: a single-center retrospective 10-year analysis. Ann Intensive Care 2020; 10:142. [PMID: 33064220 PMCID: PMC7567770 DOI: 10.1186/s13613-020-00755-8] [Citation(s) in RCA: 38] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Accepted: 10/03/2020] [Indexed: 12/15/2022] Open
Abstract
Background Despite advances in the management of bloodstream infections (BSI) caused by Candida spp., the mortality still remains high in critically ill patients. The worldwide epidemiology of yeast-related BSI is subject to changing species distribution and resistance patterns, challenging antifungal treatment strategies. The aim of this single-center study was to identify predictors of mortality after 28 and 180 days in a cohort of mixed surgical and medical critically ill patients with candidemia. Methods Patients, who had been treated for laboratory-confirmed BSI caused by Candida spp. in one of 12 intensive care units (ICU) at a University hospital between 2008 and 2017, were retrospectively identified. We retrieved data including clinical characteristics, Candida species distribution, and antifungal management from electronic health records to identify risk factors for mortality at 28 and 180 days using a Cox regression model. Results A total of 391 patients had blood cultures positive for Candida spp. (incidence 4.8/1000 ICU admissions). The mortality rate after 28 days was 47% (n = 185) and increased to 60% (n = 234) after 180 days. Age (HR 1.02 [95% CI 1.01–1.03]), a history of liver cirrhosis (HR 1.54 [95% CI 1.07–2.20]), septic shock (HR 2.41 [95% CI 1.73–3.37]), the Sepsis-related Organ Failure Assessment score (HR 1.12 [95% CI 1.07–1.17]), Candida score (HR 1.25 [95% CI 1.11–1.40]), and the length of ICU stay at culture positivity (HR 1.01 [95% CI 1.00–1.01]) were significant risk factors for death at 180 days. Patients, who had abdominal surgery (HR 0.66 [95% CI 0.48–0.91]) and patients, who received adequate (HR 0.36 [95% CI 0.24–0.52]) or non-adequate (HR 0.31 [95% CI 0.16–0.62]) antifungal treatment, had a reduced mortality risk compared to medical admission and no antifungal treatment, respectively. Conclusions The mortality of critically ill patients with Candida BSI is high and is mainly determined by disease severity, multiorgan dysfunction, and antifungal management rather than species distribution and susceptibility. Our results underline the importance of timely treatment of candidemia. However, controversies remain on the optimal definition of adequate antifungal management.
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Affiliation(s)
- Maria Schroeder
- Department of Intensive Care Medicine, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany.
| | - Theresa Weber
- Department of Intensive Care Medicine, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany
| | - Timme Denker
- Department of Intensive Care Medicine, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany
| | - Sarah Winterland
- Department of Intensive Care Medicine, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany
| | - Dominic Wichmann
- Department of Intensive Care Medicine, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany
| | - Holger Rohde
- Department of Medical Microbiology, Virology and Hygiene, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Ann-Kathrin Ozga
- Center for Experimental Medicine, Institute of Medical Biometry and Epidemiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Marlene Fischer
- Department of Intensive Care Medicine, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany
| | - Stefan Kluge
- Department of Intensive Care Medicine, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany
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