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Chastain DB, White BP, Tu PJ, Chan S, Jackson BT, Kubbs KA, Bandali A, McDougal S, Henao-Martínez AF, Cluck DB. Candidemia in Adult Patients in the ICU: A Reappraisal of Susceptibility Testing and Antifungal Therapy. Ann Pharmacother 2024; 58:305-321. [PMID: 37272474 DOI: 10.1177/10600280231175201] [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] [Indexed: 06/06/2023] Open
Abstract
OBJECTIVE To provide updates on the epidemiology and recommendations for management of candidemia in patients with critical illness. DATA SOURCES A literature search using the PubMed database (inception to March 2023) was conducted using the search terms "invasive candidiasis," "candidemia," "critically ill," "azoles," "echinocandin," "antifungal agents," "rapid diagnostics," "antifungal susceptibility testing," "therapeutic drug monitoring," "antifungal dosing," "persistent candidemia," and "Candida biofilm." STUDY SELECTION/DATA EXTRACTION Clinical data were limited to those published in the English language. Ongoing trials were identified through ClinicalTrials.gov. DATA SYNTHESIS A total of 109 articles were reviewed including 25 pharmacokinetic/pharmacodynamic studies and 30 studies including patient data, 13 of which were randomized controlled clinical trials. The remaining 54 articles included fungal surveillance data, in vitro studies, review articles, and survey data. The current 2016 Infectious Diseases Society of America (IDSA) Clinical Practice Guideline for the Management of Candidiasis provides recommendations for selecting empiric and definitive antifungal therapies for candidemia, but data are limited regarding optimized dosing strategies in critically ill patients with dynamic pharmacokinetic changes or persistent candidemia complicated. RELEVANCE TO PATIENT CARE AND CLINICAL PRACTICE Outcomes due to candidemia remain poor despite improved diagnostic platforms, antifungal susceptibility testing, and antifungal therapy selection for candidemia in critically ill patients. Earlier detection and identification of the species causing candidemia combined with recognition of patient-specific factors leading to dosing discrepancies are crucial to improving outcomes in critically ill patients with candidemia. CONCLUSIONS Treatment of candidemia in critically ill patients must account for the incidence of non-albicans Candida species and trends in antifungal resistance as well as overcome the complex pathophysiologic changes to avoid suboptimal antifungal exposure.
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Affiliation(s)
- Daniel B Chastain
- Department of Clinical & Administrative Pharmacy, University of Georgia College of Pharmacy, Albany, GA, USA
| | - Bryan P White
- University of Oklahoma Health Medical Center, Oklahoma City, OK, USA
| | - Patrick J Tu
- Charlie Norwood VA Medical Center, Augusta, GA, USA
| | - Sophea Chan
- Department of Clinical & Administrative Pharmacy, University of Georgia College of Pharmacy, Albany, GA, USA
- Department of Pharmacy, Phoebe Putney Memorial Hospital, Albany, GA, USA
| | | | - Kara A Kubbs
- University of Oklahoma Health Medical Center, Oklahoma City, OK, USA
| | - Aiman Bandali
- Overlook Medical Center, Atlantic Health System, Summit, NJ, USA
| | | | - Andrés F Henao-Martínez
- Division of Infectious Diseases, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - David B Cluck
- Department of Pharmacy Practice, Bill Gatton College of Pharmacy, East Tennessee State University, Johnson City, TN, USA
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Rhimi W, Mendoza-Roldan J, Aneke CI, Mosca A, Otranto D, Alastruey-Izquierdo A, Cafarchia C. Role of lizards as reservoirs of pathogenic yeasts of zoonotic concern. Acta Trop 2022; 231:106472. [PMID: 35443196 DOI: 10.1016/j.actatropica.2022.106472] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Revised: 04/14/2022] [Accepted: 04/15/2022] [Indexed: 11/01/2022]
Abstract
Reptiles have become popular exotic pets and in some parts of the world, they are used as important source of food, medicines, and materials. Synanthropic lizards are recognized as reservoirs of viruses, bacteria, and parasites but their role in dissemination of zoonotic pathogenic yeasts in the environment was never investigated. Therefore, fecal samples (n=177) from Podarcis siculus (Italian wall lizard), Chalcides ocellatus (Ocellated skink) and Tarentola mauritanica (Moorish gecko) were collected and yeasts were isolated and identified biochemically and molecularly by sequencing the rDNA internal transcribed spacer region (ITS). The phylogenetical relationship of isolated yeast species and their antifungal susceptibility profiles to ten antifungal agents were also assessed. Sixty samples (n=60/177; 33.9%) scored positive for yeasts, with the highest occurrence in C. ocellatus (n=11/17; 64.7%) and the highest variety of species in P. siculus (n=11/12; 91.6%). A total of 364 isolates belonging to Candida, Trichosporon, Saccharomyces and Geotrichum genera were molecularly identified. In particular, Candida albicans (n=160; 44%) followed by Trichosporon coremiiforme (n=44; 12.1%), Pichia kudriavzevii (n=32; 8.8%) and Trichosporon asahii (n=28; 7.7%) were the most frequently isolated species. The phylogenetic tree grouped all representative sequence types within the clade including Candida spp. strains from different geographical areas and from animal species, including human. All tested strains showed high susceptibility to the assayed antifungal drugs. This study suggests the role of lizards as reservoirs and spreaders of zoonotic pathogenic yeasts in the environment. The absence of resistance phenomena in the isolated yeasts might reflect an environment free of azole antifungal pollution or chemicals, suggesting the usefulness of these animals as bio indicators of environment quality.
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Atiencia-Carrera MB, Cabezas-Mera FS, Tejera E, Machado A. Prevalence of biofilms in Candida spp. bloodstream infections: A meta-analysis. PLoS One 2022; 17:e0263522. [PMID: 35113972 PMCID: PMC8812928 DOI: 10.1371/journal.pone.0263522] [Citation(s) in RCA: 30] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Accepted: 01/20/2022] [Indexed: 01/10/2023] Open
Abstract
CONTEXT Candida-related infections are nowadays a serious Public Health Problem emerging multidrug-resistant strains. Candida biofilm also leads bloodstream infections to invasive systemic infections. OBJECTIVE The present meta-analysis aimed to analyze Candida biofilm rate, type, and antifungal resistance among hospitalized patients between 1995 and 2020. DATA SOURCES Web of Science, Scopus, PubMed, and Google Scholar databases were searched for English papers using the following medical subject heading terms (MESH): "invasive candidiasis"; "bloodstream infections"; "biofilm formation"; "biofilm-related infections"; "mortality"; and "prevalence". STUDY SELECTION The major inclusion criteria included reporting the rate of biofilm formation and the prevalence of biofilm-related to Candida species, including observational studies (more exactly, cohort, retrospective, and case-control studies). Furthermore, data regarding the mortality rate, the geographical location of the study set, and the use of anti-fungal agents in clinical isolates were also extracted from the studies. DATA EXTRACTION Independent extraction of articles by 2 authors using predefined data fields, including study quality indicators. DATA SYNTHESIS A total of 31 studies from publicly available databases met our inclusion criteria. The biofilm formation in the data set varied greatly from 16 to 100% in blood samples. Most of the studies belonged to Europe (17/31) and Asia (9/31). Forest plot showed a pooled rate of biofilm formation of 80.0% (CI: 67-90), with high heterogeneity (Q = 2567.45, I2 = 98.83, τ2 = 0.150) in random effects model (p < 0.001). The funnel plot and Egger's linear regression test failed to find publication bias (p = 0.896). The mortality rate in Candida-related bloodstream infections was 37.9% of which 70.0% were from biofilm-associated infections. Furthermore, Candida isolates were also characterized in low, intermediate, or high biofilm formers through their level of biofilm mass (crystal violet staining or XTT assays) after a 24h growth. When comparing between countries, statistical differences were obtained (p = 0.0074), showing the lower and higher biofilm prevalence values in Italy and Spain, respectively. The prevalence of low, intermediate, and high biofilms were 36.2, 18.9, and 35.0% (p < 0.0001), respectively. C. tropicalis was the prevalent species in high biofilm formation (67.5%) showing statistically significant differences when compared to other Candida species, except for C. krusei and C. glabrata. Finally, the rates of antifungal resistance to fluconazole, voriconazole, and caspofungin related to biofilm were 70.5, 67.9 and 72.8% (p < 0.001), respectively. CONCLUSIONS Early detection of biofilms and a better characterization of Candida spp. bloodstream infections should be considered, which eventually will help preserve public health resources and ultimately diminish mortality among patients.
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Affiliation(s)
- María Belén Atiencia-Carrera
- Instituto de Microbiología, Colegio de Ciencias Biológicas y Ambientales (COCIBA), Universidad San Francisco de Quito (USFQ), Diego de Robles y Vía Interoceánica, Campus Cumbayá, Quito, Pichincha, Ecuador
| | - Fausto Sebastián Cabezas-Mera
- Instituto de Microbiología, Colegio de Ciencias Biológicas y Ambientales (COCIBA), Universidad San Francisco de Quito (USFQ), Diego de Robles y Vía Interoceánica, Campus Cumbayá, Quito, Pichincha, Ecuador
| | - Eduardo Tejera
- Facultad de Ingeniería y Ciencias Agropecuarias Aplicadas, Grupo de Bioquimioinformática, Universidad de Las Américas, Quito, Pichincha, Ecuador
- * E-mail: (ET); (AM)
| | - António Machado
- Instituto de Microbiología, Colegio de Ciencias Biológicas y Ambientales (COCIBA), Universidad San Francisco de Quito (USFQ), Diego de Robles y Vía Interoceánica, Campus Cumbayá, Quito, Pichincha, Ecuador
- * E-mail: (ET); (AM)
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Barroso FD, da Silva LJ, Sá LG, da Silva CR, Neto JB, do Nascimento FB, Queiroz HA, Leitão AC, Cabral VP, Rodrigues DS, Barbosa AD, Cavalcanti BC, Morais MO, Júnior HV. Synergistic activity of dobutamine combined with azoles and its mechanism of action against strains of Candida glabrata. Future Microbiol 2022; 17:437-448. [PMID: 35285249 DOI: 10.2217/fmb-2020-0256] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Aims: To evaluate the antifungal effect of dobutamine against Candida glabrata as well as its synergism with azoles and its action on biofilm. Methods: The M27-A3 protocol and flow cytometry were used for elucidation of the possible mechanism of action. Results: The tested isolates presented MICs ranging from 2 to 32 μg/ml for dobutamine, with fungistatic effect. A total of 82% of the strains showed synergism with fluconazole, with 90% showing synergism with itraconazole. The effect on biofilm formation was nonsignificant. Cytometry tests showed that dobutamine induced mitochondrial depolarization. Conclusion: Dobutamine has an antifungal effect on strains of C. glabrata and synergistic activity with azoles. This effect is probably mediated by increased oxidative damage to the membrane.
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Affiliation(s)
- Fatima Dd Barroso
- Department of Clinical and Toxicological Analysis, School of Pharmacy, Federal University of Ceará, Fortaleza, Brazil
| | - Lisandra J da Silva
- Department of Clinical and Toxicological Analysis, School of Pharmacy, Federal University of Ceará, Fortaleza, Brazil
| | - Lívia Gav Sá
- Department of Clinical and Toxicological Analysis, School of Pharmacy, Federal University of Ceará, Fortaleza, Brazil.,Faculty of Biomedicine, Unichristus University Center, Fortaleza, Brazil
| | - Cecília R da Silva
- Department of Clinical and Toxicological Analysis, School of Pharmacy, Federal University of Ceará, Fortaleza, Brazil
| | - João Ba Neto
- Department of Clinical and Toxicological Analysis, School of Pharmacy, Federal University of Ceará, Fortaleza, Brazil.,Faculty of Biomedicine, Unichristus University Center, Fortaleza, Brazil
| | - Francisca Ba do Nascimento
- Department of Clinical and Toxicological Analysis, School of Pharmacy, Federal University of Ceará, Fortaleza, Brazil
| | - Helaine A Queiroz
- Department of Clinical and Toxicological Analysis, School of Pharmacy, Federal University of Ceará, Fortaleza, Brazil
| | - Amanda C Leitão
- Department of Clinical and Toxicological Analysis, School of Pharmacy, Federal University of Ceará, Fortaleza, Brazil
| | - Vitória Pf Cabral
- Department of Clinical and Toxicological Analysis, School of Pharmacy, Federal University of Ceará, Fortaleza, Brazil
| | - Daniel S Rodrigues
- Department of Clinical and Toxicological Analysis, School of Pharmacy, Federal University of Ceará, Fortaleza, Brazil
| | - Amanda D Barbosa
- Department of Clinical and Toxicological Analysis, School of Pharmacy, Federal University of Ceará, Fortaleza, Brazil
| | - Bruno C Cavalcanti
- Drug Research and Development Center, Federal University of Ceará, Fortaleza, CE, 60430-276, Brazil
| | - Manoel O Morais
- Drug Research and Development Center, Federal University of Ceará, Fortaleza, CE, 60430-276, Brazil
| | - Hélio Vn Júnior
- Department of Clinical and Toxicological Analysis, School of Pharmacy, Federal University of Ceará, Fortaleza, Brazil
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Surveillance of Antifungal Resistance in Candidemia Fails to Inform Antifungal Stewardship in European Countries. J Fungi (Basel) 2022; 8:jof8030249. [PMID: 35330251 PMCID: PMC8950249 DOI: 10.3390/jof8030249] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Revised: 02/24/2022] [Accepted: 02/25/2022] [Indexed: 11/17/2022] Open
Abstract
Background: The increasing burden of candidemia and the emergence of resistance, especially among non-Candida albicans strains, represent a new threat for public health. We aimed to assess the status of surveillance and to identify publicly accessible resistance data in Candida spp blood isolates from surveillance systems and epidemiological studies in 28 European and 4 European Free Trade Association member states. Methods: A systematic review of national and international surveillance networks, from 2015 to 2020, and peer-reviewed epidemiological surveillance studies, from 2005 to 2020, lasting for at least 12 consecutive months and with at least two centers involved, was completed to assess reporting of resistance to amphotericin B, azoles, and echinocandins in C. albicans, C. glabrata, C. parapsilosis, C. tropicalis, C. krusei, and C. auris. Results: Only 5 (Austria, Italy, Norway, Spain, and United Kingdom) of 32 countries provided resistance data for Candida spp blood isolates. Among 322 surveillance studies identified, 19 were included from Belgium, Denmark, Iceland, Italy, Portugal, Spain, Sweden, Switzerland, and United Kingdom. C. albicans and C. glabrata were the most monitored species, followed by C. parapsilosis and C. tropicalis. C. krusei was not included in any national surveillance system; 13 studies assessed resistance. No surveillance system or study reported resistance for C. auris. Fluconazole, voriconazole, caspofungin, and amphotericin B resistance in C. albicans, C. glabrata, and C. parapsilosis were the most common drug–species combination monitored. Quality of surveillance data was poor, with only two surveillance systems reporting microbiological methods and clinical data. High heterogeneity was observed in modalities of reporting, data collection, and definitions. Conclusion: Surveillance of antifungal resistance in Candida spp blood-isolates is fragmented and heterogeneous, delaying the application of a translational approach to the threat of antifungal resistance and the identification of proper targets for antifungal stewardship activities. International efforts are needed to implement antifungal resistance surveillance programs in order to adequately monitor antifungal resistance.
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Boonsilp S, Homkaew A, Phumisantiphong U, Nutalai D, Wongsuk T. Species Distribution, Antifungal Susceptibility, and Molecular Epidemiology of Candida Species Causing Candidemia in a Tertiary Care Hospital in Bangkok, Thailand. J Fungi (Basel) 2021; 7:jof7070577. [PMID: 34356956 PMCID: PMC8303137 DOI: 10.3390/jof7070577] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2021] [Revised: 07/15/2021] [Accepted: 07/15/2021] [Indexed: 12/29/2022] Open
Abstract
Candida species represent a common cause of bloodstream infection (BSI). Given the emergence of non-albicans Candida (NAC) associated with treatment failure, investigations into the species distribution, fungal susceptibility profile, and molecular epidemiology of pathogens are necessary to optimize the treatment of candidemia and explore the transmission of drug resistance for control management. This study evaluated the prevalence, antifungal susceptibility, and molecular characteristics of Candida species causing BSI in a tertiary-level hospital in Bangkok, Thailand. In total, 54 Candida isolates were recovered from 49 patients with candidemia. C. tropicalis was the most prevalent species (33.3%), followed by C. albicans (29.6%). Most Candida species were susceptible to various antifungal agents, excluding C. glabrata and C. tropicalis, which had increased rates of non-susceptibility to azoles. Most C. glabrata isolates were non-susceptible to echinocandins, especially caspofungin. The population structure of C. albicans was highly diverse, with clade 17 predominance. GoeBURST analysis of C. tropicalis revealed associations between genotype and fluconazole resistance in a particular clonal complex. The population structure of C. glabrata appeared to have a low level of genetic diversity in MLST loci. Collectively, these data might provide a fundamental database contributing to the development of novel antifungal agents and diagnostic tests.
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Affiliation(s)
- Siriphan Boonsilp
- Department of Clinical Pathology, Faculty of Medicine Vajira Hospital, Navamindradhiraj University, Bangkok 10300, Thailand;
- Correspondence: (S.B.); (T.W.)
| | - Anchalee Homkaew
- Division of Central Laboratory and Blood Bank, Faculty of Medicine Vajira Hospital, Navamindradhiraj University, Bangkok 10300, Thailand; (A.H.); (D.N.)
| | - Uraporn Phumisantiphong
- Department of Clinical Pathology, Faculty of Medicine Vajira Hospital, Navamindradhiraj University, Bangkok 10300, Thailand;
- Division of Central Laboratory and Blood Bank, Faculty of Medicine Vajira Hospital, Navamindradhiraj University, Bangkok 10300, Thailand; (A.H.); (D.N.)
| | - Daranee Nutalai
- Division of Central Laboratory and Blood Bank, Faculty of Medicine Vajira Hospital, Navamindradhiraj University, Bangkok 10300, Thailand; (A.H.); (D.N.)
| | - Thanwa Wongsuk
- Department of Clinical Pathology, Faculty of Medicine Vajira Hospital, Navamindradhiraj University, Bangkok 10300, Thailand;
- Correspondence: (S.B.); (T.W.)
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7
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Lotfali E, Fattahi A, Sayyahfar S, Ghasemi R, Rabiei MM, Fathi M, Vakili K, Deravi N, Soheili A, Toreyhi H, Shirvani F. A Review on Molecular Mechanisms of Antifungal Resistance in Candida glabrata: Update and Recent Advances. Microb Drug Resist 2021; 27:1371-1388. [PMID: 33956513 DOI: 10.1089/mdr.2020.0235] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
Candida glabrata is the second frequent etiologic agent of mucosal and invasive candidiasis. Based on the recent developments in molecular methods, C. glabrata has been introduced as a complex composed of C. glabrata, Candida nivariensis, and Candida bracarensis. The four main classes of antifungal drugs effective against C. glabrata are pyrimidine analogs (flucytosine), azoles, echinocandins, and polyenes. Although the use of antifungal drugs is related to the predictable development of drug resistance, it is not clear why C. glabrata is able to rapidly resist against multiple antifungals in clinics. The enhanced incidence and antifungal resistance of C. glabrata and the high mortality and morbidity need more investigation regarding the resistance mechanisms and virulence associated with C. glabrata; additional progress concerning the drug resistance of C. glabrata has to be further prevented. The present review highlights the mechanism of resistance to antifungal drugs in C. glabrata.
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Affiliation(s)
- Ensieh Lotfali
- Department of Medical Parasitology and Mycology, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Azam Fattahi
- Center for Research and Training in Skin Diseases and Leprosy, Tehran University of Medical Sciences, Tehran, Iran
| | - Shirin Sayyahfar
- Research Center of Pediatric Infectious Diseases, Institute of Immunology and Infectious Diseases, Iran University of Medical Sciences, Tehran, Iran
| | - Reza Ghasemi
- Student Research Committee, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mohammad Mahdi Rabiei
- Student Research Committee, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mobina Fathi
- Student Research Committee, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Kimia Vakili
- Student Research Committee, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Niloofar Deravi
- Student Research Committee, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Amirali Soheili
- Student Research Committee, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Hossein Toreyhi
- Student Research Committee, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Fariba Shirvani
- Pediatric Infections Research Center, Research Institute for Children Health, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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Mareković I, Pleško S, Rezo Vranješ V, Herljević Z, Kuliš T, Jandrlić M. Epidemiology of Candidemia: Three-Year Results from a Croatian Tertiary Care Hospital. J Fungi (Basel) 2021; 7:jof7040267. [PMID: 33807486 PMCID: PMC8065499 DOI: 10.3390/jof7040267] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2021] [Revised: 03/24/2021] [Accepted: 03/29/2021] [Indexed: 12/15/2022] Open
Abstract
Invasive candidosis is the most common invasive fungal infection in hospitalized patients and is associated with a high mortality rate. This is the first study from a Croatian tertiary care hospital describing epidemiology, risk factors and species distribution in patients with candidemia. A three-year retrospective observational study, from 2018 to 2020, was performed at the University Hospital Centre Zagreb, Zagreb, Croatia. A total of 160 patients with candidemia (n = 170 isolates) were enrolled. Candidemia incidence increased from 0.47 to 0.69 per 1000 admissions in 2018 and 2020, respectively. Ninety-five patients (58.38%) were in the intensive care unit. The main risk factors for candidemia were central venous catheter (CVC) (84.38%), previous surgical procedure (56.88%) and invasive mechanical ventilation (42.50%). Candida albicans was identified in 43.53% of isolates, followed by C. parapsilosis (31.76%) and C. glabrata (12.36%), C. krusei (5.29%), C. tropicalis (2.35%) and C. lusitaniae (2.35%). The study discovered a shift to non-albicansCandida species, particularly C. parapsilosis, and made it possible to determine the main tasks we should focus on to prevent candidemia in the hospital, these being mainly infection control measures directed towards prevention of catheter-related bloodstream infections, specifically comprising hand hygiene and CVC bundles of care. The potential benefit of fluconazole prophylaxis in certain populations of surgical patients could also be considered.
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Affiliation(s)
- Ivana Mareković
- Department of Clinical and Molecular Microbiology, University Hospital Centre Zagreb, School of Medicine University of Zagreb, 10000 Zagreb, Croatia; (S.P.); (V.R.V.); (Z.H.); (M.J.)
- Correspondence: ; Tel.: +385-1-2367-318
| | - Sanja Pleško
- Department of Clinical and Molecular Microbiology, University Hospital Centre Zagreb, School of Medicine University of Zagreb, 10000 Zagreb, Croatia; (S.P.); (V.R.V.); (Z.H.); (M.J.)
| | - Violeta Rezo Vranješ
- Department of Clinical and Molecular Microbiology, University Hospital Centre Zagreb, School of Medicine University of Zagreb, 10000 Zagreb, Croatia; (S.P.); (V.R.V.); (Z.H.); (M.J.)
| | - Zoran Herljević
- Department of Clinical and Molecular Microbiology, University Hospital Centre Zagreb, School of Medicine University of Zagreb, 10000 Zagreb, Croatia; (S.P.); (V.R.V.); (Z.H.); (M.J.)
| | - Tomislav Kuliš
- Department of Urology, University Hospital Centre Zagreb, School of Medicine University of Zagreb, 10000 Zagreb, Croatia;
| | - Marija Jandrlić
- Department of Clinical and Molecular Microbiology, University Hospital Centre Zagreb, School of Medicine University of Zagreb, 10000 Zagreb, Croatia; (S.P.); (V.R.V.); (Z.H.); (M.J.)
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Arastehfar A, Gabaldón T, Garcia-Rubio R, Jenks JD, Hoenigl M, Salzer HJF, Ilkit M, Lass-Flörl C, Perlin DS. Drug-Resistant Fungi: An Emerging Challenge Threatening Our Limited Antifungal Armamentarium. Antibiotics (Basel) 2020; 9:antibiotics9120877. [PMID: 33302565 PMCID: PMC7764418 DOI: 10.3390/antibiotics9120877] [Citation(s) in RCA: 91] [Impact Index Per Article: 22.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Revised: 11/02/2020] [Accepted: 12/03/2020] [Indexed: 12/14/2022] Open
Abstract
The high clinical mortality and economic burden posed by invasive fungal infections (IFIs), along with significant agricultural crop loss caused by various fungal species, has resulted in the widespread use of antifungal agents. Selective drug pressure, fungal attributes, and host- and drug-related factors have counteracted the efficacy of the limited systemic antifungal drugs and changed the epidemiological landscape of IFIs. Species belonging to Candida, Aspergillus, Cryptococcus, and Pneumocystis are among the fungal pathogens showing notable rates of antifungal resistance. Drug-resistant fungi from the environment are increasingly identified in clinical settings. Furthermore, we have a limited understanding of drug class-specific resistance mechanisms in emerging Candida species. The establishment of antifungal stewardship programs in both clinical and agricultural fields and the inclusion of species identification, antifungal susceptibility testing, and therapeutic drug monitoring practices in the clinic can minimize the emergence of drug-resistant fungi. New antifungal drugs featuring promising therapeutic profiles have great promise to treat drug-resistant fungi in the clinical setting. Mitigating antifungal tolerance, a prelude to the emergence of resistance, also requires the development of effective and fungal-specific adjuvants to be used in combination with systemic antifungals.
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Affiliation(s)
- Amir Arastehfar
- Center for Discovery and Innovation, Hackensack Meridian Health, Nutley, NJ 07110, USA; (A.A.); (R.G.-R.)
| | - Toni Gabaldón
- Life Sciences Programme, Supercomputing Center (BSC-CNS), Jordi Girona, 08034 Barcelona, Spain;
- Mechanisms of Disease Programme, Institute for Research in Biomedicine (IRB), 08024 Barcelona, Spain
- Catalan Institution for Research and Advanced Studies. Pg. Lluís Companys 23, 08010 Barcelona, Spain
| | - Rocio Garcia-Rubio
- Center for Discovery and Innovation, Hackensack Meridian Health, Nutley, NJ 07110, USA; (A.A.); (R.G.-R.)
| | - Jeffrey D. Jenks
- Department of Medicine, University of California San Diego, San Diego, CA 92103, USA;
- Clinical and Translational Fungal-Working Group, University of California San Diego, La Jolla, CA 92093, USA;
- Division of Infectious Diseases and Global Public Health, Department of Medicine, University of California San Diego, La Jolla, CA 92093, USA
| | - Martin Hoenigl
- Clinical and Translational Fungal-Working Group, University of California San Diego, La Jolla, CA 92093, USA;
- Division of Infectious Diseases and Global Public Health, Department of Medicine, 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
| | | | - Macit Ilkit
- Division of Mycology, University of Çukurova, 01330 Adana, Turkey
- Correspondence: (M.I.); (D.S.P.); Tel.: +90-532-286-0099 (M.I.); +1-201-880-3100 (D.S.P.)
| | - Cornelia Lass-Flörl
- Institute of Hygiene and Medical Microbiology, Medical University of Innsbruck, 6020 Innsbruck, Austria;
| | - David S. Perlin
- Center for Discovery and Innovation, Hackensack Meridian Health, Nutley, NJ 07110, USA; (A.A.); (R.G.-R.)
- Correspondence: (M.I.); (D.S.P.); Tel.: +90-532-286-0099 (M.I.); +1-201-880-3100 (D.S.P.)
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Tits J, Cammue BPA, Thevissen K. Combination Therapy to Treat Fungal Biofilm-Based Infections. Int J Mol Sci 2020; 21:ijms21228873. [PMID: 33238622 PMCID: PMC7700406 DOI: 10.3390/ijms21228873] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2020] [Revised: 11/19/2020] [Accepted: 11/20/2020] [Indexed: 12/21/2022] Open
Abstract
An increasing number of people is affected by fungal biofilm-based infections, which are resistant to the majority of currently-used antifungal drugs. Such infections are often caused by species from the genera Candida, Aspergillus or Cryptococcus. Only a few antifungal drugs, including echinocandins and liposomal formulations of amphotericin B, are available to treat such biofilm-based fungal infections. This review discusses combination therapy as a novel antibiofilm strategy. More specifically, in vitro methods to discover new antibiofilm combinations will be discussed. Furthermore, an overview of the main modes of action of promising antibiofilm combination treatments will be provided as this knowledge may facilitate the optimization of existing antibiofilm combinations or the development of new ones with a similar mode of action.
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11
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Risaliti L, Pini G, Ascrizzi R, Donato R, Sacco C, Bergonzi MC, Salvatici MC, Bilia AR. Artemisia annua essential oil extraction, characterization, and incorporation in nanoliposomes, smart drug delivery systems against Candida species. J Drug Deliv Sci Technol 2020. [DOI: 10.1016/j.jddst.2020.101849] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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12
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Combination of Miconazole and Domiphen Bromide Is Fungicidal against Biofilms of Resistant Candida spp. Antimicrob Agents Chemother 2020; 64:AAC.01296-20. [PMID: 32690639 DOI: 10.1128/aac.01296-20] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Accepted: 07/02/2020] [Indexed: 12/15/2022] Open
Abstract
The occurrence and recurrence of mucosal biofilm-related Candida infections, such as oral and vulvovaginal candidiasis, are serious clinical issues. Vaginal infections caused by Candida spp., for example, affect 70 to 75% of women at least once during their lives. Miconazole (MCZ) is the preferred topical treatment against these fungal infections, yet it has only moderate antibiofilm activity. Through screening of a drug-repurposing library, we identified the quaternary ammonium compound domiphen bromide (DB) as an MCZ potentiator against Candida biofilms. DB displayed synergistic anti-Candida albicans biofilm activity with MCZ, reducing the number of viable biofilm cells 1,000-fold. In addition, the MCZ-DB combination also resulted in significant killing of biofilm cells of azole-resistant C. albicans, C. glabrata, and C. auris isolates. In vivo, the MCZ-DB combination had significantly improved activity in a vulvovaginal candidiasis rat model compared to that of single-compound treatments. Data from an artificial evolution experiment indicated that the development of resistance against the combination did not occur, highlighting the potential of MCZ-DB combination therapy to treat Candida biofilm-related infections.
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Arastehfar A, Lass-Flörl C, Garcia-Rubio R, Daneshnia F, Ilkit M, Boekhout T, Gabaldon T, Perlin DS. The Quiet and Underappreciated Rise of Drug-Resistant Invasive Fungal Pathogens. J Fungi (Basel) 2020; 6:E138. [PMID: 32824785 PMCID: PMC7557958 DOI: 10.3390/jof6030138] [Citation(s) in RCA: 63] [Impact Index Per Article: 15.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2020] [Revised: 07/22/2020] [Accepted: 08/11/2020] [Indexed: 12/13/2022] Open
Abstract
Human fungal pathogens are attributable to a significant economic burden and mortality worldwide. Antifungal treatments, although limited in number, play a pivotal role in decreasing mortality and morbidities posed by invasive fungal infections (IFIs). However, the recent emergence of multidrug-resistant Candida auris and Candida glabrata and acquiring invasive infections due to azole-resistant C. parapsilosis, C. tropicalis, and Aspergillus spp. in azole-naïve patients pose a serious health threat considering the limited number of systemic antifungals available to treat IFIs. Although advancing for major fungal pathogens, the understanding of fungal attributes contributing to antifungal resistance is just emerging for several clinically important MDR fungal pathogens. Further complicating the matter are the distinct differences in antifungal resistance mechanisms among various fungal species in which one or more mechanisms may contribute to the resistance phenotype. In this review, we attempt to summarize the burden of antifungal resistance for selected non-albicansCandida and clinically important Aspergillus species together with their phylogenetic placement on the tree of life. Moreover, we highlight the different molecular mechanisms between antifungal tolerance and resistance, and comprehensively discuss the molecular mechanisms of antifungal resistance in a species level.
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Affiliation(s)
- Amir Arastehfar
- Center for Discovery and Innovation, Hackensack Meridian Health, Nutley, NJ 07110, USA;
| | - Cornelia Lass-Flörl
- Institute of Hygiene and Medical Microbiology, Medical University of Innsbruck, 6020 Innsbruck, Austria;
| | - Rocio Garcia-Rubio
- Center for Discovery and Innovation, Hackensack Meridian Health, Nutley, NJ 07110, USA;
| | - Farnaz Daneshnia
- Westerdijk Fungal Biodiversity Institute, 3584 CT Utrecht, The Netherlands; (F.D.); (T.B.)
| | - Macit Ilkit
- Division of Mycology, University of Çukurova, 01330 Adana, Turkey;
| | - Teun Boekhout
- Westerdijk Fungal Biodiversity Institute, 3584 CT Utrecht, The Netherlands; (F.D.); (T.B.)
- Institute of Biodiversity and Ecosystem Dynamics (IBED), University of Amsterdam, 1012 WX Amsterdam, The Netherlands
| | - Toni Gabaldon
- Life Sciences Programme, Barcelona, Supercomputing Center (BSC-CNS), Jordi Girona, 08034 Barcelona, Spain;
- Mechanisms of Disease Programme, Institute for Research in Biomedicine (IRB), 08024 Barcelona, Spain
- Institució Catalana de Recerca i Estudis Avançats (ICREA), 08010 Barcelona, Spain
| | - David S. Perlin
- Center for Discovery and Innovation, Hackensack Meridian Health, Nutley, NJ 07110, USA;
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14
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Arastehfar A, Daneshnia F, Salehi M, Yaşar M, Hoşbul T, Ilkit M, Pan W, Hagen F, Arslan N, Türk-Dağı H, Hilmioğlu-Polat S, Perlin DS, Lass-Flörl C. Low level of antifungal resistance of Candida glabrata blood isolates in Turkey: Fluconazole minimum inhibitory concentration and FKS mutations can predict therapeutic failure. Mycoses 2020; 63:911-920. [PMID: 32413170 PMCID: PMC7497236 DOI: 10.1111/myc.13104] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2020] [Revised: 04/25/2020] [Accepted: 05/02/2020] [Indexed: 12/26/2022]
Abstract
Background Candida glabrata is the third leading cause of candidaemia in Turkey; however, the data regarding antifungal resistance mechanisms and genotypic diversity in association with their clinical implication are limited. Objectives To assess genotypic diversity, antifungal susceptibility and mechanisms of drug resistance of Cglabrata blood isolates and their association with patients' outcome in a retrospective multicentre study. Patients/Methods Isolates from 107 patients were identified by ITS sequencing and analysed by multilocus microsatellite typing, antifungal susceptibility testing, and sequencing of PDR1 and FKS1/2 hotspots (HSs). Results Candida glabrata prevalence in Ege University Hospital was twofold higher in 2014‐2019 than in 2005‐2014. Six of the analysed isolates had fluconazole MICs ≥ 32 µg/mL; of them, five harboured unique PDR1 mutations. Although echinocandin resistance was not detected, three isolates had mutations in HS1‐Fks1 (S629T, n = 1) and HS1‐Fks2 (S663P, n = 2); one of the latter was also fluconazole‐resistant. All patients infected with isolates carrying HS‐FKS mutations and/or demonstrating fluconazole MIC ≥ 32 µg/mL (except one without clinical data) showed therapeutic failure (TF) with echinocandin and fluconazole; seven such isolates were collected in Ege (n = 4) and Gulhane (n = 3) hospitals and six detected recently. Among 34 identified genotypes, none were associated with mortality or enriched for fluconazole‐resistant isolates. Conclusion Antifungal susceptibility testing should be supplemented with HS‐FKS sequencing to predict TF for echinocandins, whereas fluconazole MIC ≥ 32 µg/mL may predict TF. Recent emergence of C glabrata isolates associated with antifungal TF warrants future comprehensive prospective studies in Turkey.
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Affiliation(s)
- Amir Arastehfar
- Shanghai Key Laboratory Molecular Medical Mycology, Shanghai, China.,Westerdijk Fungal Biodiversity Institute, Utrecht, The Netherlands
| | - Farnaz Daneshnia
- Shanghai Key Laboratory Molecular Medical Mycology, Shanghai, China
| | - Mohammadreza Salehi
- Department of Infectious Diseases and Tropical Medicine, Faculty of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Melike Yaşar
- Department of Medical Microbiology, Faculty of Medicine, Ege University, Izmir, Turkey
| | - Tuğrul Hoşbul
- Department of Medical Microbiology, Gulhane Training and Research Hospital, University of Health Sciences, Ankara, Turkey
| | - Macit Ilkit
- Division of Mycology, Faculty of Medicine, Çukurova University, Adana, Turkey
| | - Weihua Pan
- Shanghai Key Laboratory Molecular Medical Mycology, Shanghai, China
| | - Ferry Hagen
- Westerdijk Fungal Biodiversity Institute, Utrecht, The Netherlands.,University Medical Center Utrecht, Utrecht, The Netherlands.,People's Hospital, Jining, China
| | - Nazlı Arslan
- Department of Medical Microbiology, Dokuz Eylül University Faculty of Medicine, Izmir, Turkey
| | - Hatice Türk-Dağı
- Department of Microbiology, Faculty of Medicine, Selcuk University, Konya, Turkey
| | | | - David S Perlin
- Center for Discovery and Innovation, Hackensack Meridian Health, Nutley, NJ, USA
| | - Cornelia Lass-Flörl
- Division of Hygiene and Medical Microbiology, Medical University of Innsbruck, Innsbruck, Austria
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15
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Arastehfar A, Daneshnia F, Najafzadeh MJ, Hagen F, Mahmoudi S, Salehi M, Zarrinfar H, Namvar Z, Zareshahrabadi Z, Khodavaisy S, Zomorodian K, Pan W, Theelen B, Kostrzewa M, Boekhout T, Lass-Flörl C. Evaluation of Molecular Epidemiology, Clinical Characteristics, Antifungal Susceptibility Profiles, and Molecular Mechanisms of Antifungal Resistance of Iranian Candida parapsilosis Species Complex Blood Isolates. Front Cell Infect Microbiol 2020; 10:206. [PMID: 32509592 PMCID: PMC7253641 DOI: 10.3389/fcimb.2020.00206] [Citation(s) in RCA: 39] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2019] [Accepted: 04/16/2020] [Indexed: 11/13/2022] Open
Abstract
Clonal expansion of fluconazole resistant (FLZ-R) Candida parapsilosis isolates is increasingly being identified in many countries, while there is no study exploring the antifungal susceptibility pattern, genetic diversity, and clinical information for Iranian C. parapsilosis blood isolates. Candida parapsilosis species complex blood isolates (n = 98) were recovered from nine hospitals located in three major cities, identified by MALDI-TOF MS, and their genetic relatedness was examined by AFLP fingerprinting. Antifungal susceptibility testing followed CLSI-M27-A3 and ERG11, MRR1 and hotspots 1/2 (HS1/2) of FKS1 were sequenced to assess the azole and echinocandin resistance mechanisms, respectively. Ninety-four C. parapsilosis and four Candida orthopsilosis isolates were identified from 90 patients. Only 43 patients received systemic antifungal drugs with fluconazole as the main antifungal used. The overall mortality rate was 46.6% (42/90) and death mostly occurred for those receiving systemic antifungals (25/43) relative to those not treated (17/47). Although, antifungal-resistance was rare, one isolate was multidrug-resistant (FLZ = 16 μg/ml and micafungin = 8 μg/ml) and the infected patient showed therapeutic failure to FLZ prophylaxis. Mutations causing azole and echinocandin resistance were not found in the genes studied. AFLP revealed five genotypes (G) and G1 was the main one (59/94; 62.7%). Clinical outcome was significantly associated with city (P = 0.02, α <0.05) and Mashhad was significantly associated with mortality (P = 0.03, α <0.05). Overall, we found a low level of antifungal resistance for Iranian C. parapsilosis blood isolates, but the noted MDR strain can potentially become the source of future infections and challenge the antifungal therapy in antifungal-naïve patients. AFLP typing results warrants confirmation using other resolutive typing methods.
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Affiliation(s)
- Amir Arastehfar
- Yeast Biodiversity Department, Westerdijk Fungal Biodiversity Institute, Utrecht, Netherlands
| | - Farnaz Daneshnia
- Yeast Biodiversity Department, Westerdijk Fungal Biodiversity Institute, Utrecht, Netherlands
| | - Mohammad Javad Najafzadeh
- Department of Parasitology and Mycology, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Ferry Hagen
- Yeast Biodiversity Department, Westerdijk Fungal Biodiversity Institute, Utrecht, Netherlands.,Department of Medical Microbiology, University Medical Center Utrecht, Utrecht, Netherlands.,Laboratory of Medical Mycology, Jining No. 1 People's Hospital, Jining, China
| | - Shahram Mahmoudi
- Department of Medical Parasitology and Mycology, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Mohammadreza Salehi
- Department of Infectious Diseases and Tropical Medicine, Faculty of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Hossein Zarrinfar
- Allergy Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Zahra Namvar
- Department of Microbiology, School of Biological Sciences, Islamic Azad University, Tehran, Iran
| | - Zahra Zareshahrabadi
- Basic Sciences in Infectious Diseases Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Sadegh Khodavaisy
- Department of Medical Parasitology and Mycology, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Kamiar Zomorodian
- Basic Sciences in Infectious Diseases Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Weihua Pan
- Medical Mycology, Shanghai Changzheng Hospital, Second Military Medical University, Shanghai, China
| | - Bart Theelen
- Yeast Biodiversity Department, Westerdijk Fungal Biodiversity Institute, Utrecht, Netherlands
| | | | - Teun Boekhout
- Yeast Biodiversity Department, Westerdijk Fungal Biodiversity Institute, Utrecht, Netherlands.,Institute of Biodiversity and Ecosystem Dynamics, University of Amsterdam, Amsterdam, Netherlands
| | - Cornelia Lass-Flörl
- Division of Hygiene and Medical Microbiology, Medical University of Innsbruck, Innsbruck, Austria
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16
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Barber KE, Wagner JL, Miller JM, Lewis EA, Stover KR. Impact of Obesity in Patients with Candida Bloodstream Infections: A Retrospective Cohort Study. Infect Dis Ther 2020; 9:175-183. [PMID: 32062851 PMCID: PMC7054502 DOI: 10.1007/s40121-020-00285-7] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2019] [Indexed: 01/27/2023] Open
Abstract
BACKGROUND Candida species are responsible for 15% of bloodstream infections, leading to prolonged hospitalizations and increased mortality. With the rise in obesity, antifungal dosing is unclear. The purpose of this study was to determine differences in clinical outcomes between obese versus non-obese patients with Candida bloodstream infections. METHODS This retrospective cohort included adult patient's first episode of Candida bloodstream infection treated with ≥ 48 h of antifungal therapy between 1 June 2013 and 31 August 2019. Patients were excluded for: dual systemic antifungal therapy, polymicrobial infections, or chronic candidiasis. The primary outcome was infection-related length of stay. Secondary outcomes included: time to candidemia resolution, 30-day readmission rates, and in-hospital mortality. RESULTS Eighty patients were included (28 obese; 52 non-obese). Most were male (55%); median age was 54 years. Median BMI and weight were 36.3 kg/m2 and 103 kg versus 20.4 kg/m2 and 61 kg, respectively (p < 0.01). Baseline characteristics were comparable. C. albicans was isolated in 37.5% of cultures and C. glabrata in 30%. Micafungin was utilized empirically in 72.5% of patients; obese patients received definitive micafungin more frequently (57.1% vs. 21.2%; p < 0.01) and were treated longer (13 versus 10 days; p = 0.04). Infection-related length of stay was 19 days in the obese patients and 13 days in the non-obese patients (p = 0.05). Non-obese patients had a shorter duration of candidemia (5 versus 6 days; p = 0.02). In-hospital mortality was numerically higher in obese patients (21.4% versus 13.5%; p = 0.36). There were no differences in 30-day readmissions between groups. CONCLUSIONS Worse clinical outcomes were observed for obese versus non-obese patients. Further clinical research is warranted.
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Affiliation(s)
- Katie E Barber
- Department of Pharmacy Practice, University of Mississippi School of Pharmacy, Jackson, MS, USA.
| | - Jamie L Wagner
- Department of Pharmacy Practice, University of Mississippi School of Pharmacy, Jackson, MS, USA
| | - Jennifer M Miller
- Department of Pharmacy Practice, University of Mississippi School of Pharmacy, Jackson, MS, USA
| | - Emily A Lewis
- Department of Pharmacy Practice, University of Mississippi School of Pharmacy, Jackson, MS, USA
| | - Kayla R Stover
- Department of Pharmacy Practice, University of Mississippi School of Pharmacy, Jackson, MS, USA
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17
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Mesini A, Mikulska M, Giacobbe DR, Del Puente F, Gandolfo N, Codda G, Orsi A, Tassinari F, Beltramini S, Marchese A, Icardi G, Del Bono V, Viscoli C. Changing epidemiology of candidaemia: Increase in fluconazole-resistant Candida parapsilosis. Mycoses 2020; 63:361-368. [PMID: 31954083 DOI: 10.1111/myc.13050] [Citation(s) in RCA: 40] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2019] [Revised: 01/06/2020] [Accepted: 01/11/2020] [Indexed: 12/20/2022]
Abstract
AIM During the last decade a continuous increase in non-albicans species isolation has been observed with Candida parapsilosis being one of the leading species. Aim of this study was to describe the epidemiology of candidemia, particularly of C parapsilosis, its predictors and clinical outcome. MATERIALS AND METHODS Incidences of candidemia was evaluated analyzing data from both a prospective collection (2012-2016) and a retrospective one (2008-2011). Predictors and outcome were based only on the prospective phase. C parapsilosis potential clusters were analysed by randomly amplified polymorphic DNA (RAPD) technique. RESULTS 1240 episodes were identified. Incidences of candidemia increased from 1.97 episodes/10 000 patient-days in 2008 to 4.59/10 000 patient-days in 2016 (P < .001), mainly due to an increase of C parapsilosis (incidence rate ratio, IRR: 1.04, P < .001). 33.0% of C parapsilosis strains were resistant to fluconazole; no resistance to echinocandins was found. Independent predictors of C parapsilosis candidemia were time of infection (P = .007), previous use of echinocandins (P < .0001) and year in which the episode was registered (P < .0001). 30 days mortality was 32.4% for C parapsilosis, with a significant difference compared to C non-parapsilosis. Potential clonal C parapsilosis strains were detected by genetic analyses, showing RAPD profile A as the most represented (72.6% of isolates). DISCUSSION C parapsilosis candidemia is an emerging issue in our center, possibly attributed to some extent to horizontal transmission of the pathogen, as confirmed by the analysis of isolates similarities. Further microbiological and epidemiological investigations are needed in order to identify the most effective measures to reduce the rate of this infection.
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Affiliation(s)
- Alessio Mesini
- Department of Health Sciences (DiSSal), University of Genova, Genova, Italy
| | - Małgorzata Mikulska
- Department of Health Sciences (DiSSal), University of Genova, Genova, Italy.,Infectious Diseases Unit, Ospedale Policlinico San Martino IRCCS, Genova, Italy
| | | | - Filippo Del Puente
- Department of Health Sciences (DiSSal), University of Genova, Genova, Italy
| | - Nemo Gandolfo
- Department of Health Sciences (DiSSal), University of Genova, Genova, Italy
| | - Giulia Codda
- Department of Surgical and Diagnostic Sciences (DiSC), University of Genova, Genova, Italy.,Microbiology Unit, Ospedale Policlinico San Martino IRCCS, Genova, Italy
| | - Andrea Orsi
- Department of Health Sciences (DiSSal), University of Genova, Genova, Italy.,Hygiene Unit, Ospedale Policlinico San Martino IRCCS, Genova, Italy
| | - Federico Tassinari
- Department of Health Sciences (DiSSal), University of Genova, Genova, Italy
| | - Sabrina Beltramini
- Pharmacy Complex Unit, Ospedale Policlinico San Martino IRCCS, Genova, Italy
| | - Anna Marchese
- Department of Surgical and Diagnostic Sciences (DiSC), University of Genova, Genova, Italy.,Microbiology Unit, Ospedale Policlinico San Martino IRCCS, Genova, Italy
| | - Giancarlo Icardi
- Department of Health Sciences (DiSSal), University of Genova, Genova, Italy.,Hygiene Unit, Ospedale Policlinico San Martino IRCCS, Genova, Italy
| | - Valerio Del Bono
- Infectious Diseases Unit, Ospedale Policlinico San Martino IRCCS, Genova, Italy
| | - Claudio Viscoli
- Department of Health Sciences (DiSSal), University of Genova, Genova, Italy.,Infectious Diseases Unit, Ospedale Policlinico San Martino IRCCS, Genova, Italy
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18
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Prigitano A, Cavanna C, Passera M, Gelmi M, Sala E, Ossi C, Grancini A, Calabrò M, Bramati S, Tejada M, Lallitto F, Farina C, Rognoni V, Fasano MA, Pini B, Romanò L, Cogliati M, Esposto MC, Tortorano AM. Evolution of fungemia in an Italian region. J Mycol Med 2019; 30:100906. [PMID: 31708424 DOI: 10.1016/j.mycmed.2019.100906] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2019] [Revised: 09/09/2019] [Accepted: 10/09/2019] [Indexed: 11/29/2022]
Abstract
BACKGROUND Fungemia represents a public health concern. Knowing aetiology and activity of the antifungals is critical for the management of bloodstream infections. Therefore, surveillance on local/international levels is desirable for a prompt administration of appropriate therapy. METHODS Data on fungi responsible for fungemia and antifungal susceptibility profiles were collected from a laboratory-based surveillance over 2016-2017 in 12 hospitals located in Lombardia, Italy. The trend of this infection in twenty years was analysed. RESULTS A total of 1024 episodes were evaluated. Rate of candiaemia progressively increased up to 1.46/1000 admissions. C.albicans was the most common species (52%), followed by C. parapsilosis (15%) and C glabrata (13%). As in the previous surveys the antifungal resistance is rare (echinocandins<2%, fluconazole 6%, amphotericin B 0.6%). Fungi other than Candida were responsible for 18 episodes: Cryptococcus neoformans (5 cases), Fusarium spp. (4), Magnusiomyces clavatus (3), Saccharomyces cerevisiae (3), Rhodotorula spp. (2), Exophiala dermatitidis (1). All fungi, except S.cerevisiae, were intrinsically resistant to echinocandins. Some isolates showed also elevated azole MIC. CONCLUSIONS No particular changes in terms of species distribution and antifungal susceptibility patterns was noted. However, surveillance programs are needed to monitor trends in antifungal resistance, steer stewardship activities, orient empirical treatment.
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Affiliation(s)
- A Prigitano
- Department of Biomedical Science for Health, Università degli Studi di Milano, Via Pascal 36, 20133 Milano, Italy
| | - C Cavanna
- Microbiology and Virology Unit IRCCS Policlinico San Matteo, Pavia, Italy
| | - M Passera
- Microbiology Institute, ASST 'Papa G iovanni XXIII', Bergamo, Italy
| | - M Gelmi
- Microbiology Laboratory, A.O. Spedali Civili, Brescia, Italy
| | - E Sala
- Microbiology - ASST Lariana, Como, Italy
| | - C Ossi
- Laboratory of Microbiology and Virology, San Raffaele Scientific Institute, Milano, Italy
| | - A Grancini
- Microbiology Laboratory, Fondazione IRCCS C à Granda O. Maggiore Policlinico, Milano, Italy
| | - M Calabrò
- Microbiology Section, Humanitas Research Hospital, Milano, Italy
| | - S Bramati
- Microbiology Laboratory, Ospedale San Gerardo, Monza, Italy
| | - M Tejada
- Medicina di Laboratorio, IRCCS Policlinico San Donato, Milano, Italy
| | - F Lallitto
- Microbiology and Virology Unit IRCCS Policlinico San Matteo, Pavia, Italy
| | - C Farina
- Microbiology Institute, ASST 'Papa G iovanni XXIII', Bergamo, Italy
| | | | - M A Fasano
- Microbiology and Virology Unit, ASST Bergamo Ovest Treviglio, Italy
| | - B Pini
- Laboratory of Microbiology and Virology, ASST Lecco, Italy
| | - L Romanò
- Department of Biomedical Science for Health, Università degli Studi di Milano, Via Pascal 36, 20133 Milano, Italy
| | - M Cogliati
- Department of Biomedical Science for Health, Università degli Studi di Milano, Via Pascal 36, 20133 Milano, Italy
| | - M C Esposto
- Department of Biomedical Science for Health, Università degli Studi di Milano, Via Pascal 36, 20133 Milano, Italy
| | - A M Tortorano
- Department of Biomedical Science for Health, Università degli Studi di Milano, Via Pascal 36, 20133 Milano, Italy.
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19
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Morbidity and mortality of candidaemia in Europe: an epidemiologic meta-analysis. Clin Microbiol Infect 2019; 25:1200-1212. [DOI: 10.1016/j.cmi.2019.04.024] [Citation(s) in RCA: 101] [Impact Index Per Article: 20.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2019] [Revised: 04/15/2019] [Accepted: 04/18/2019] [Indexed: 01/30/2023]
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20
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Low Level of Antifungal Resistance in Iranian Isolates of Candida glabrata Recovered from Blood Samples in a Multicenter Study from 2015 to 2018 and Potential Prognostic Values of Genotyping and Sequencing of PDR1. Antimicrob Agents Chemother 2019; 63:AAC.02503-18. [PMID: 30936110 PMCID: PMC6591624 DOI: 10.1128/aac.02503-18] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2018] [Accepted: 03/18/2019] [Indexed: 11/20/2022] Open
Abstract
Establishing an effective empirical antifungal therapy requires that national surveillance studies be conducted. Herein, we report the clinical outcome of infections with and the microbiological features of Iranian isolates of Candida glabrata derived from patients suffering from candidemia. C. glabrata isolates were retrospectively collected from four major cities in Iran; identified by a 21-plex PCR, matrix-assisted laser desorption ionization-time of flight mass spectrometry, and large subunit of ribosomal DNA sequencing; and genotyped by amplified fragment length polymorphism (AFLP). Mutations in PDR1, ERG11, and hot spot 1 (HS1) of FKS1 and FKS2 were investigated, and antifungal susceptibility testing (AFST) was performed (by the CLSI M27-A3 and M27-S4 methods). Seventy isolates of C. glabrata were collected from 65 patients with a median age of 58 years. Fluconazole was the most widely used (29.23%) and least effective antifungal agent. The overall crude mortality rate was 35.4%. Only one strain was resistant to fluconazole, and 57.7% and 37.5% of the isolates were non-wild type (non-WT) for susceptibility to caspofungin and voriconazole, respectively. All isolates showed the WT phenotype for amphotericin B, posaconazole, and itraconazole. HS1 of FKS1 and FKS2 did not harbor any mutations, while numerous missense mutations were observed in PDR1 and ERG11 AFLP clustered our isolates into nine genotypes; among them, genotypes 1 and 2 were significantly associated with a higher mortality rate (P = 0.034 and P = 0.022, α < 0.05). Moreover, 83.3% of patients infected with strains harboring a single new mutation in PDR1, T745A, died despite treatment with fluconazole or caspofungin. Overall, Iranian isolates of C. glabrata were susceptible to the major antifungal drugs. Application of genotyping techniques and sequencing of a specific gene (PDR1) might have prognostic implications.
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Kothalawala M, Jayaweera JAAS, Arunan S, Jayathilake A. The emergence of non-albicans candidemia and evaluation of HiChrome Candida differential agar and VITEK2 YST® platform for differentiation of Candida bloodstream isolates in teaching hospital Kandy, Sri Lanka. BMC Microbiol 2019; 19:136. [PMID: 31226938 PMCID: PMC6588897 DOI: 10.1186/s12866-019-1518-3] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2018] [Accepted: 06/17/2019] [Indexed: 01/28/2023] Open
Abstract
Background Candidemia is an emerging hospital-acquired bloodstream infection (BSI). It is common among severely ill and immunocompromised patients. Even following appropriate therapy in candidemia, recent studies reveal relative high mortality (40%). The global incidence of candidemia shows an incline. In Sri Lanka, candida speciation often difficult where basic facilities are less available. We have compared the risk factors, epidemiology, demography, and performance of HiChrome Candida differential agar (HiCA) characteristics with the VITEK2 YST platform for differentiation of Candida albicans (CA) and non-albicans candida (NAC) from blood culture isolate. Methods This is a laboratory-based cross-sectional study. Positive aerobic BACTEC blood cultures having yeast were identified using HiCA and VITEK2® platform. Epidemiology, risk factors, and clinical outcomes were compared between CA and NAC bloodstream isolates. Results Out of 120 positive yeast samples, VITEK2® has identified 110 (92%) as Candida sp. From that CA-34 (31%) and NAC-76 (69%) were isolated. Candidemia following NCA in neonates (p = 0.02), infants (p = 0.04) and adults (p = 0.02) in ICU and immunocompromised patients were significantly higher. Compared to CA, NAC bacteremia period prevalence (0.00041%) and incidence (0.23 per 100,000-person-years) was significantly high (p = 0.03). NAC 48 (63%) isolates were resistance to azoles. Exposure to antifungals (odds ratio (OR); p = 0.03), prolonged intensive care stay > 14 days (OR-3.3; p = 0.04), having a central venous line for > 8 days (OR-4.3; p = 0.03) and on immunosuppressive treatment (OR-2.4; p = 0.04) was significantly poses risk for NAC candidemia. Sen day mortality was significant among non-albicans cases (p = 0.03) while 30-day mortality was significant among albicans cases (p = 0.04). Compared to VITEK2®, the HiCA method was 93% sensitive and 93% specific in detecting CA. Conclusion Compared to CA, candidemia following NAC was high. NAC isolates were having a high percentage of fluconazole and voriconazole resistance. VITEK2 YST® platform provides antifungal susceptibility with minimal inhibitory concentration (MIC). Impact, this would highlight the use of rapid candida identification flat form with MIC to direct appropriate antifungals for candidemia. For that implementation of novel diagnostic facilities like the VITEK2 YST platform at a tertiary care facility is demanding.
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Affiliation(s)
- Mahen Kothalawala
- Department of Microbiology, Teaching Hospital Kandy Sri Lanka, Kandy, Sri Lanka
| | - J A A S Jayaweera
- Faculty of Medicine and Allied Sciences, Rajarata University of Sri Lanka, Saliyapura, Sri Lanka.
| | - Sinnapoo Arunan
- Department of Microbiology, Teaching Hospital Kandy Sri Lanka, Kandy, Sri Lanka
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Abstract
Patients with suppressed immunity are at the highest risk for hospital-acquired infections. Among these, invasive candidiasis is the most prevalent systemic fungal nosocomial infection. Over recent decades, the combined prevalence of non-albicans Candida species outranked Candida albicans infections in several geographical regions worldwide, highlighting the need to understand their pathobiology in order to develop effective treatment and to prevent future outbreaks. Candida parapsilosis is the second or third most frequently isolated Candida species from patients. Besides being highly prevalent, its biology differs markedly from that of C. albicans, which may be associated with C. parapsilosis' increased incidence. Differences in virulence, regulatory and antifungal drug resistance mechanisms, and the patient groups at risk indicate that conclusions drawn from C. albicans pathobiology cannot be simply extrapolated to C. parapsilosis Such species-specific characteristics may also influence their recognition and elimination by the host and the efficacy of antifungal drugs. Due to the availability of high-throughput, state-of-the-art experimental tools and molecular genetic methods adapted to C. parapsilosis, genome and transcriptome studies are now available that greatly contribute to our understanding of what makes this species a threat. In this review, we summarize 10 years of findings on C. parapsilosis pathogenesis, including the species' genetic properties, transcriptome studies, host responses, and molecular mechanisms of virulence. Antifungal susceptibility studies and clinician perspectives are discussed. We also present regional incidence reports in order to provide an updated worldwide epidemiology summary.
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Hadžić D, Skokić F, Brkić S, Saračević A. Clinical and laboratory characteristics of Neonatal Candida sepsis. SANAMED 2019. [DOI: 10.24125/sanamed.v14i3.364] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
Introduction: Steady progress in intensive treatment worldwide has increased the survival of immature neonates, but with multiple invasive procedures, which has increased the risk of infection and, consequently, fungal sepsis. Candida is the dominant cause, with the rise of resistant non-albicans species. The mortality rate is high and requires timely suspicion and adequate treatment to counteract fatal outcomes. Objectives:To analyze the clinical and laboratory characteristics of Candida sepsis, compared to bacterial sepsis, in neonates treated in the neonatal intensive care unit. Methods: A retrospective cohort study conducted at the Intensive care unit of Pediatric Clinic Tuzla over a three-year period (2016-2018) analyzed the clinical and laboratory characteristics of neonates with Candida sepsis, evidenced by positive blood culture. The control group was neonates treated at the same time for proven bacterial sepsis. Statistical analysis applied standard methods, and the research was approved by the Ethics Committee of the institution. Results: Out of the total 921 neonates treated over a three-year period, culture-confirmed Candida sepsis was found in 48 (5.2%). Prematurity and low birth weight were the most significant risk factors and affected neonates had a more difficult clinical presentation, more receiving parenteral nutrition, mechanical ventilation, intravenous gamma globulin, and longer intensive treatment. Candida sepsis manifested mainly as late-onset. Laboratory abnormalities mainly included CRP elevation, anemia, leukocyte count deviations, and thrombocytopenia. There was no difference in mortality, 44 neonates recovered (91.7%), while 4 (8.3%) died. Antifungal therapy lasted 20.6 ± 6 days, and intensive treatment 38.2 ± 23.2 days, and was significantly longer compared to the control. All isolates were Candida species without in vitro resistance. In 8 neonates (16.7%) treatment complications were recorded. Conclusions: Neonatal Candida sepsis endangers life, complicates treatment, increases costs and mortality rate. Recovery depends on timely suspicion, adequate treatment, and supervision. Antifungal susceptibility is also important and requires monitoring of local epidemiological dynamics.
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24
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Ahmadi NA, Davodi L. Candidemia after cardiac surgery in Tehran, Iran: A retrospective analysis of 424 cases at two medical centers. ALEXANDRIA JOURNAL OF MEDICINE 2018. [DOI: 10.1016/j.ajme.2017.11.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Affiliation(s)
- Nayeb Ali Ahmadi
- Proteomics Research Center, Faculty of Paramedical Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Leila Davodi
- Medical Diagnostic Laboratory, Lavasani hospital, Tehran, Iran
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Ksiezopolska E, Gabaldón T. Evolutionary Emergence of Drug Resistance in Candida Opportunistic Pathogens. Genes (Basel) 2018; 9:genes9090461. [PMID: 30235884 PMCID: PMC6162425 DOI: 10.3390/genes9090461] [Citation(s) in RCA: 114] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2018] [Revised: 09/14/2018] [Accepted: 09/17/2018] [Indexed: 01/08/2023] Open
Abstract
Fungal infections, such as candidiasis caused by Candida, pose a problem of growing medical concern. In developed countries, the incidence of Candida infections is increasing due to the higher survival of susceptible populations, such as immunocompromised patients or the elderly. Existing treatment options are limited to few antifungal drug families with efficacies that vary depending on the infecting species. In this context, the emergence and spread of resistant Candida isolates are being increasingly reported. Understanding how resistance can evolve within naturally susceptible species is key to developing novel, more effective treatment strategies. However, in contrast to the situation of antibiotic resistance in bacteria, few studies have focused on the evolutionary mechanisms leading to drug resistance in fungal species. In this review, we will survey and discuss current knowledge on the genetic bases of resistance to antifungal drugs in Candida opportunistic pathogens. We will do so from an evolutionary genomics perspective, focusing on the possible evolutionary paths that may lead to the emergence and selection of the resistant phenotype. Finally, we will discuss the potential of future studies enabled by current developments in sequencing technologies, in vitro evolution approaches, and the analysis of serial clinical isolates.
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Affiliation(s)
- Ewa Ksiezopolska
- Bioinformatics and Genomics Programme, Centre for Genomic Regulation (CRG), The Barcelona Institute of Science and Technology (BIST), 08003 Barcelona, Spain.
- Universitat Pompeu Fabra (UPF), 08003 Barcelona, Spain.
| | - Toni Gabaldón
- Bioinformatics and Genomics Programme, Centre for Genomic Regulation (CRG), The Barcelona Institute of Science and Technology (BIST), 08003 Barcelona, Spain.
- Universitat Pompeu Fabra (UPF), 08003 Barcelona, Spain.
- Institució Catalana de Recerca i Estudis Avançats (ICREA), 08010 Barcelona, Spain.
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26
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Goemaere B, Lagrou K, Spriet I, Hendrickx M, Becker P. Clonal Spread of Candida glabrata Bloodstream Isolates and Fluconazole Resistance Affected by Prolonged Exposure: a 12-Year Single-Center Study in Belgium. Antimicrob Agents Chemother 2018; 62:e00591-18. [PMID: 29784839 PMCID: PMC6105788 DOI: 10.1128/aac.00591-18] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2018] [Accepted: 05/16/2018] [Indexed: 11/20/2022] Open
Abstract
Candida glabrata is a major cause of candidemia in immunocompromised patients and is characterized by a high-level of fluconazole resistance. In the present study, the acquisition of antifungal resistance and potential clonal spread of C. glabrata were explored at a single center over a 12-year period by analyzing 187 independent clinical C. glabrata bloodstream isolates. One strain was found to be micafungin resistant due to a mutation in the FKS2 gene. Fluconazole resistance remained stable throughout the period and was observed in 20 (10.7%) of the isolates. An analysis of the antifungal consumption data revealed that recent prior exposure to fluconazole increased the risk to be infected by a resistant strain. In particular, the duration of the treatment was significantly longer for patients infected by a resistant isolate, while the total and mean daily doses received did not impact the acquisition of resistance in C. glabrata No link between genotype and resistance was found. However, multilocus variable-number tandem-repeat analyses indicated a potential intrahospital spread of some isolates between patients. These isolates shared the same genetic profiles, and infected patients were hospitalized in the same unit during an overlapping period. Finally, quantitative real-time PCR analyses showed that, unlike that for other ABC efflux pumps, the expression of CgCDR1 was significantly greater in resistant strains, suggesting that it would be more involved in fluconazole (FLC) resistance. Our study provides additional evidence that the proper administration of fluconazole is required to limit resistance and that strict hand hygiene is necessary to avoid the possible spreading of C. glabrata isolates between patients.
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Affiliation(s)
- Berdieke Goemaere
- BCCM/IHEM Fungal Collection, Service of Mycology and Aerobiology, Sciensano, Brussels, Belgium
| | - Katrien Lagrou
- Department of Microbiology and Immunology, KU Leuven, Leuven, Belgium
- Clinical Department of Laboratory Medicine, National Reference Center for Mycosis, University Hospitals Leuven, Leuven, Belgium
| | - Isabel Spriet
- Department of Pharmaceutical and Pharmacological Sciences, KU Leuven, Leuven, Belgium
- Clinical Department of Pharmacology and Pharmacotherapy, University Hospitals Leuven, Leuven, Belgium
| | - Marijke Hendrickx
- BCCM/IHEM Fungal Collection, Service of Mycology and Aerobiology, Sciensano, Brussels, Belgium
| | - Pierre Becker
- BCCM/IHEM Fungal Collection, Service of Mycology and Aerobiology, Sciensano, Brussels, Belgium
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Lallitto F, Prigitano A, Mangione F, Piralla A, Tamarozzi F, Marone P, Cavanna C. Presence of L701 M mutation in the FKS1 gene of echinocandin-susceptible Candida krusei isolates. Diagn Microbiol Infect Dis 2018; 92:311-314. [PMID: 30131237 DOI: 10.1016/j.diagmicrobio.2018.07.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2018] [Revised: 06/04/2018] [Accepted: 07/05/2018] [Indexed: 11/30/2022]
Abstract
Resistance of Candida krusei isolates to echinocandins, the recommended drugs to treat candidemia, has been associated with mutations in hot spot (HS) regions of the FKS1 gene or L701 M mutation in a region between HS1 and HS3 of FKS1. However, the role of L701 M mutation alone in causing reduced echinocandins susceptibility is still unclear. We analyzed a region between HS1 and HS3 of FKS1 of 25 C. krusei isolates from clinical samples. Susceptibility to echinocandins was determined by a commercial broth microdilution assay and by the microdilution method according to the European Committee on Antimicrobial Susceptibility Testing (EUCAST). The L701 M mutation was detected in 22/25 (88%) C. krusei isolates with low MIC values in the absence of other HS mutations. The presence of isolated L701 M mutation in C. krusei clinical isolates susceptible to echinocandins suggests that this mutation may be just associated to polymorphism in the C. krusei population.
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Affiliation(s)
- Fabiola Lallitto
- Microbiology and Virology Department, Fondazione IRCCS Policlinico San Matteo, Viale C. Golgi 19, 27100, Pavia, Italy
| | - Anna Prigitano
- Department of Biomedical Sciences for Health, Università degli Studi di Milano, Via Pascal 36, 20133, Milan, Italy
| | - Francesca Mangione
- Microbiology and Virology Department, Fondazione IRCCS Policlinico San Matteo, Viale C. Golgi 19, 27100, Pavia, Italy
| | - Antonio Piralla
- Microbiology and Virology Department, Fondazione IRCCS Policlinico San Matteo, Viale C. Golgi 19, 27100, Pavia, Italy
| | - Francesca Tamarozzi
- Microbiology and Virology Department, Fondazione IRCCS Policlinico San Matteo, Viale C. Golgi 19, 27100, Pavia, Italy
| | - Piero Marone
- Microbiology and Virology Department, Fondazione IRCCS Policlinico San Matteo, Viale C. Golgi 19, 27100, Pavia, Italy
| | - Caterina Cavanna
- Microbiology and Virology Department, Fondazione IRCCS Policlinico San Matteo, Viale C. Golgi 19, 27100, Pavia, Italy.
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Sozio E, Pieralli F, Azzini AM, Tintori G, Demma F, Furneri G, Sbrana F, Bertolino G, Fortunato S, Meini S, Bragantini D, Morettini A, Nozzoli C, Menichetti F, Concia E, Tascini C. A prediction rule for early recognition of patients with candidemia in Internal Medicine: results from an Italian, multicentric, case-control study. Infection 2018; 46:625-633. [PMID: 29949088 DOI: 10.1007/s15010-018-1162-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2018] [Accepted: 06/05/2018] [Indexed: 12/27/2022]
Abstract
PURPOSE Increasing prevalence of candidemia in Internal Medicine wards (IMWs) has been reported in recent years, but risk factors for candida bloodstream infection in patients admitted to IMW may differ from those known in other settings. The aim of this study was to identify risk factors and define a prediction rule for the early recognition of the risk of candidemia in IMW inpatients. METHODS This was a multicentric, retrospective, observational case-control study on non-neutropenic patients with candidemia admitted to IMWs of four large Italian Hospitals. Each eligible patient with candidemia (case) was matched to a control with bacteremia. Stepwise logistic regression analyses were performed. RESULTS Overall, 300 patients (150 cases and 150 controls) were enrolled. The following factors were associated with an increased risk of candidemia and weighted to build a score: total parenteral nutrition (OR 2.45, p = 0.008; 1 point); central venous catheter (OR 2.19, p = 0.031; 1 point); peripherally inserted central catheter (OR 5.63, p < 0.0001; 3 points), antibiotic treatment prior (OR 2.06; p = 0.059; 1 point) and during hospitalization (OR2.38, p = 0.033; 1 point); neurological disability (OR 2.25, p = 0.01; 1 point); and previous hospitalization within 3 months (OR 1.56, p = 0.163; 1 point). At ROC curve analysis, a final score ≥ 4 showed 84% sensitivity, 76% specificity, and 80% accuracy in predicting the risk of candidemia. CONCLUSIONS The proposed scoring system showed to be a simple and highly performing tool in distinguishing bloodstream infections due to Candida and bacteria in patients admitted to IMW. The proposed rule might help to reduce delay in empirical treatment and improve appropriateness in antifungal prescription in septic patients.
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Affiliation(s)
- Emanuela Sozio
- Emergency Department, North-West District, Tuscany HealthCare, Spedali Riuniti Livorno, Viale Alfieri 36, 57100, Leghorn, Italy.
| | - Filippo Pieralli
- Intermediate Care Unit, Azienda Ospedaliera Universitaria Careggi, Florence, Italy
| | - Anna Maria Azzini
- Infectious Disease Unit, Azienda Ospedaliera Universitaria Integrata di Verona, p.Le LA Scuro, Verona, Italy
| | - Giancarlo Tintori
- Emergency Medicine Unit, Nuovo Santa Chiara University Hospital, Azienda Ospedaliera Universitaria Pisana, Pisa, Italy
| | - Federica Demma
- Health Economics and Outcome Research Department-EBMA Consulting, Milan, Italy
| | - Gianluca Furneri
- Health Economics and Outcome Research Department-EBMA Consulting, Milan, Italy
| | | | | | - Simona Fortunato
- Infectious Diseases Clinic, Nuovo Santa Chiara University Hospital, Azienda Ospedaliera Universitaria Pisana, Pisa, Italy
| | - Simone Meini
- Department of Internal Medicine, S.M. Annunziata Hospital, Florence, Italy
| | - Damiano Bragantini
- Infectious Disease Unit, Azienda Ospedaliera Universitaria Integrata di Verona, p.Le LA Scuro, Verona, Italy
| | - Alessandro Morettini
- Internal Medicine Unit, Azienda Ospedaliera Universitaria Careggi, Florence, Italy
| | - Carlo Nozzoli
- Internal Medicine Unit, Azienda Ospedaliera Universitaria Careggi, Florence, Italy
| | - Francesco Menichetti
- Infectious Diseases Clinic, Nuovo Santa Chiara University Hospital, Azienda Ospedaliera Universitaria Pisana, Pisa, Italy
| | - Ercole Concia
- Infectious Disease Unit, Azienda Ospedaliera Universitaria Integrata di Verona, p.Le LA Scuro, Verona, Italy
| | - Carlo Tascini
- First Division of Infectious Diseases, Cotugno Hospital, Azienda Ospedaliera dei Colli, Naples, Italy
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Absence of Azole or Echinocandin Resistance in Candida glabrata Isolates in India despite Background Prevalence of Strains with Defects in the DNA Mismatch Repair Pathway. Antimicrob Agents Chemother 2018; 62:AAC.00195-18. [PMID: 29610199 DOI: 10.1128/aac.00195-18] [Citation(s) in RCA: 41] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2018] [Accepted: 03/26/2018] [Indexed: 01/07/2023] Open
Abstract
Candida glabrata infections are increasing worldwide and exhibit greater rates of antifungal resistance than those with other species. DNA mismatch repair (MMR) gene deletions, such as msh2Δ, in C. glabrata resulting in a mutator phenotype have recently been reported to facilitate rapid acquisition of antifungal resistance. This study determined the antifungal susceptibility profiles of 210 C. glabrata isolates in 10 hospitals in India and investigated the impact of novel MSH2 polymorphisms on mutation potential. No echinocandin- or azole-resistant strains and no mutations in FKS hot spot regions were detected among the C. glabrata isolates, supporting our in vitro susceptibility testing results. CLSI antifungal susceptibility data showed that the MICs of anidulafungin (geometric mean [GM], 0.12 μg/ml) and micafungin (GM, 0.01 μg/ml) were lower and below the susceptibility breakpoint compared to that of caspofungin (CAS) (GM, 1.31 μg/ml). Interestingly, 69% of the C. glabrata strains sequenced contained six nonsynonymous mutations in MSH2, i.e., V239L and the novel mutations E459K, R847C, Q386K, T772S, and V239/D946E. Functional analysis of MSH2 mutations revealed that 49% of the tested strains (40/81) contained a partial loss-of-function MSH2 mutation. The novel MSH2 substitution Q386K produced higher frequencies of CAS-resistant colonies upon expression in the msh2Δ mutant. However, expression of two other novel MSH2 alleles, i.e., E459K or R847C, did not confer selection of resistant colonies, confirming that not all mutations in the MSH2 MMR pathway affect its function or generate a phenotype of resistance to antifungal drugs. The lack of drug resistance prevented any correlations from being drawn with respect to MSH2 genotype.
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30
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Rodrigues CF, Rodrigues ME, Henriques M. Susceptibility of Candida glabrata biofilms to echinocandins: alterations in the matrix composition. BIOFOULING 2018; 34:569-578. [PMID: 29798695 DOI: 10.1080/08927014.2018.1472244] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/09/2018] [Accepted: 04/28/2018] [Indexed: 06/08/2023]
Abstract
Candidiases are the most recurrent fungal infections, especially among immunosuppressed patients. Although Candida albicans is still the most widespread isolated species, non-Candida albicans Candida species have been increasing. The goal of this work was to determine the susceptibility of C. glabrata biofilms to echinocandins and to evaluate their effect on the biofilm matrix composition, comparing the results with other Candida species. Drug susceptibilities were assessed through the determination of minimum inhibitory concentration (MIC), minimum fungicidal concentration (MFC) and minimum biofilm eradication concentration (MBEC) of caspofungin (Csf) and micafugin (Mcf). The β-1,3 glucans content of the matrices was assessed after contact with the drugs. The data suggest that, generally, after contact with echinocandins, the concentration of β-1,3 glucans increased. These adjustments in the matrix composition of C. glabrata biofilms and the chemical differences between Csf and Mcf, seem responsible and may determine the effectivity of the drug responses.
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Affiliation(s)
- Célia F Rodrigues
- a CEB, Centre of Biological Engineering, LIBRO - Laboratório de Investigação em Biofilmes Rosário Oliveira , University of Minho , Braga , Portugal
| | - Maria Elisa Rodrigues
- a CEB, Centre of Biological Engineering, LIBRO - Laboratório de Investigação em Biofilmes Rosário Oliveira , University of Minho , Braga , Portugal
| | - Mariana Henriques
- a CEB, Centre of Biological Engineering, LIBRO - Laboratório de Investigação em Biofilmes Rosário Oliveira , University of Minho , Braga , Portugal
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Scordino F, Giuffrè L, Barberi G, Marino Merlo F, Orlando MG, Giosa D, Romeo O. Multilocus Sequence Typing Reveals a New Cluster of Closely Related Candida tropicalis Genotypes in Italian Patients With Neurological Disorders. Front Microbiol 2018; 9:679. [PMID: 29696003 PMCID: PMC5904457 DOI: 10.3389/fmicb.2018.00679] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2018] [Accepted: 03/22/2018] [Indexed: 01/12/2023] Open
Abstract
Candida tropicalis is a pathogenic yeast that has emerged as an important cause of candidemia especially in elderly patients with hematological malignancies. Infections caused by this species are mainly reported from Latin America and Asian-Pacific countries although recent epidemiological data revealed that C. tropicalis accounts for 6-16.4% of the Candida bloodstream infections (BSIs) in Italy by representing a relevant issue especially for patients receiving long-term hospital care. The aim of this study was to describe the genetic diversity of C. tropicalis isolates contaminating the hands of healthcare workers (HCWs) and hospital environments and/or associated with BSIs occurring in patients with different neurological disorders and without hematological disease. A total of 28 C. tropicalis isolates were genotyped using multilocus sequence typing analysis of six housekeeping (ICL1, MDR1, SAPT2, SAPT4, XYR1, and ZWF1) genes and data revealed the presence of only eight diploid sequence types (DSTs) of which 6 (75%) were completely new. Four eBURST clonal complexes (CC2, CC10, CC11, and CC33) contained all DSTs found in this study and the CC33 resulted in an exclusive, well-defined, clonal cluster from Italy. In conclusion, C. tropicalis could represent an important cause of BSIs in long-term hospitalized patients with no underlying hematological disease. The findings of this study also suggest a potential horizontal transmission of a specific C. tropicalis clone through hands of HCWs and expand our understanding of the molecular epidemiology of this pathogen whose population structure is still far from being fully elucidated as its complexity increases as different categories of patients and geographic areas are examined.
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Affiliation(s)
- Fabio Scordino
- Scientific Institute for Research, Hospitalization and Health Care (IRCCS), Centro Neurolesi "Bonino-Pulejo", Messina, Italy
| | - Letterio Giuffrè
- Department of Veterinary Sciences, Division of Animal Production, University of Messina, Messina, Italy
| | - Giuseppina Barberi
- Scientific Institute for Research, Hospitalization and Health Care (IRCCS), Centro Neurolesi "Bonino-Pulejo", Messina, Italy
| | - Francesca Marino Merlo
- Scientific Institute for Research, Hospitalization and Health Care (IRCCS), Centro Neurolesi "Bonino-Pulejo", Messina, Italy
| | - Maria Grazia Orlando
- Department of Chemical, Biological, Pharmaceutical and Environmental Sciences, University of Messina, Messina, Italy
| | - Domenico Giosa
- Scientific Institute for Research, Hospitalization and Health Care (IRCCS), Centro Neurolesi "Bonino-Pulejo", Messina, Italy
| | - Orazio Romeo
- Scientific Institute for Research, Hospitalization and Health Care (IRCCS), Centro Neurolesi "Bonino-Pulejo", Messina, Italy.,Department of Chemical, Biological, Pharmaceutical and Environmental Sciences, University of Messina, Messina, Italy
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Association between Candida biofilm-forming bloodstream isolates and the clinical evolution in patients with candidemia: An observational nine-year single center study in Mexico. Rev Iberoam Micol 2018; 35:11-16. [DOI: 10.1016/j.riam.2017.01.005] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2016] [Revised: 12/19/2016] [Accepted: 01/17/2017] [Indexed: 12/29/2022] Open
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Bassetti M, Carnelutti A, Peghin M, Aversa F, Barchiesi F, Girmenia C, Pagano L, Sanguinetti M, Tortorano AM, Montagna MT, Viale P, Viscoli C, Denning DW. Estimated burden of fungal infections in Italy. J Infect 2018; 76:103-106. [DOI: 10.1016/j.jinf.2017.07.008] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2017] [Revised: 07/24/2017] [Accepted: 07/27/2017] [Indexed: 01/13/2023]
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34
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Multicenter Identification and Antifungal Susceptibility Patterns of Candida Species Isolated from Clinical Samples. Jundishapur J Microbiol 2017. [DOI: 10.5812/jjm.56117] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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35
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Pharkjaksu S, Chongtrakool P, Suwannakarn K, Ngamskulrungroj P. Species distribution, virulence factors, and antifungal susceptibility among Candida parapsilosis complex isolates from clinical specimens at Siriraj Hospital, Thailand, from 2011 to 2015. Med Mycol 2017; 56:426-433. [DOI: 10.1093/mmy/myx058] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2016] [Accepted: 07/14/2017] [Indexed: 12/15/2022] Open
Affiliation(s)
- Sujiraphong Pharkjaksu
- Department of Microbiology, Faculty of Medicine Siriraj Hospital, Mahidol University, Thailand 10700
| | - Piriyaporn Chongtrakool
- Department of Microbiology, Faculty of Medicine Siriraj Hospital, Mahidol University, Thailand 10700
| | - Kamol Suwannakarn
- Department of Microbiology, Faculty of Medicine Siriraj Hospital, Mahidol University, Thailand 10700
| | - Popchai Ngamskulrungroj
- Department of Microbiology, Faculty of Medicine Siriraj Hospital, Mahidol University, Thailand 10700
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Candidemia in the Neonatal Intensive Care Unit: A Retrospective, Observational Survey and Analysis of Literature Data. BIOMED RESEARCH INTERNATIONAL 2017; 2017:7901763. [PMID: 28884129 PMCID: PMC5572580 DOI: 10.1155/2017/7901763] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/16/2017] [Accepted: 06/18/2017] [Indexed: 12/23/2022]
Abstract
We evaluated the epidemiology of Candida bloodstream infections in the neonatal intensive care unit (NICU) of an Italian university hospital during a 9-year period as a means of quantifying the burden of infection and identifying emerging trends. Clinical data were searched for in the microbiological laboratory database. For comparative purposes, we performed a review of NICU candidemia. Forty-one candidemia cases were reviewed (overall incidence, 3.0 per 100 admissions). Candida parapsilosis sensu stricto (58.5%) and C. albicans (34.1%) were the most common species recovered. A variable drift through years was observed; in 2015, 75% of the cases were caused by non-albicans species. The duration of NICU hospitalization of patients with non-albicans was significantly longer than in those with C. albicans (median days, 10 versus 12). Patients with non-albicans species were more likely to have parenteral nutrition than those with C. albicans (96.3% versus 71.4%). Candida albicans was the dominant species in Europe and America (median, 55% and 60%; resp.); non-albicans species predominate in Asia (75%). Significant geographic variation is evident among cases of candidemia in different parts of the world, recognizing the importance of epidemiological data to facilitate the treatment.
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Ghezzi MC, Brunetti G, Visconti V, Giordano A, Raponi G. Candidaemia in a tertiary care academic hospital in Italy. The impact of C. parapsilosis complex on the species distribution and antifungal susceptibility. J Med Microbiol 2017; 66:990-998. [PMID: 28686553 DOI: 10.1099/jmm.0.000505] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
PURPOSE To analyse the species distribution and the susceptibility profiles to the major antifungal agents of Candida isolated from bloodstream infections (BSIs) in both intensive care units (ICUs) and non-ICU wards in a tertiary care hospital in Italy from 2010 until 2015. METHODOLOGY Episodes of Candida BSI were recorded in a retrospective observational cohort study. Yeasts were isolated from both blood and intravascuIar devices (IVDs) and their susceptibility to antifungal drugs was tested using the microdilution method. RESULTS 514 Candida BSIs were evidenced and 19 % of these episodes were associated with the presence of an IVD. The trend of the general incidence increased significantly throughout the study period, ranging from 1.42 to 3.63 (mean 2.52) episodes/1000 admissions. The incidence of Candida BSIs and IVD-associated candidaemia was significantly higher in ICUs relative to the other wards. The most frequently isolated species were C. albicans and C. parapsilosis complex, with the latter presenting a significant increased trend of isolation. C. parapsilosis complex was most frequently involved in IVD-related candidaemia, coinfections and late recurrent infections. Furthermore, the MIC50s of C. parapsilosis complex were significantly enhanced for echinocandins compared to the MIC50s for the same drugs and the other yeasts, while the MIC50s of C. albicans for amphotericin B showed a significant increase during the study period, ranging from 0.1 to 0.5 µg ml-1. CONCLUSIONS A progressively enhanced incidence of Candida BSIs, a relatively high impact of C. parapsilosis complex and changes in the susceptibility profiles of the isolated yeasts were evidenced during the observation period.
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Affiliation(s)
- Maria Cristina Ghezzi
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Italy
| | - Grazia Brunetti
- Department of Molecular Medicine, Sapienza University of Rome, Italy
| | - Valeria Visconti
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Italy
| | - Alessandra Giordano
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Italy
| | - Giammarco Raponi
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Italy
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Invasive Candidiasis in Brescia, Italy: Analysis of Species Distribution and Antifungal Susceptibilities During Seven Years. Mycopathologia 2017; 182:897-905. [DOI: 10.1007/s11046-017-0155-3] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2016] [Accepted: 06/01/2017] [Indexed: 10/19/2022]
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Antibodies against a β-glucan-protein complex of Candida albicans and its potential as indicator of protective immunity in candidemic patients. Sci Rep 2017; 7:2722. [PMID: 28578431 PMCID: PMC5457410 DOI: 10.1038/s41598-017-02977-6] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2017] [Accepted: 04/20/2017] [Indexed: 01/24/2023] Open
Abstract
Sera from candidemic and non-candidemic subjects were examined for antibodies against the cell wall β1,3- and β1,6-glucans, as well as the β-glucan-associated protein MP65 of Candida species. Although antibodies against each of the above components were detected in all subjects, candidemic patients had lower antibody titers against β1,3-glucan, but higher antibody titers against β1,6-glucan and MP65, than non-candidemic subjects. The elevated levels of anti-β1,6-glucan and -MP65 antibodies found in candidemic patients were independent on the patient risk category, APACHE II score, presence of co-morbidities, β1,3-glucanemia level, Candida isolate, and antifungal treatment. Interestingly, however, the anti-MP65, but not the anti-β1,6-glucan antibodies, of candidemic patients had higher titers in survivors than in non-survivors, particularly in those subject categories with the highest mortality (>65-years old, diabetic, or septic shock patients). Thus, candidemic patients are capable of boosting anti-Candida immune responses upon infection, and some of these responses might be associated to the generation of protective immunity in patients with candidemia.
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Yeşilkaya A, Azap Ö, Aydın M, Akçil Ok M. Epidemiology, species distribution, clinical characteristics and mortality of candidaemia in a tertiary care university hospital in Turkey, 2007-2014. Mycoses 2017; 60:433-439. [PMID: 28338249 DOI: 10.1111/myc.12618] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2016] [Revised: 02/23/2017] [Accepted: 02/23/2017] [Indexed: 01/05/2023]
Abstract
Candidaemia still continues to be a serious medical concern and the epidemiology of candidaemia varies according to geographical areas. We aim to determine the incidence, local epidemiology, Candida species distribution and crude mortality rates of candidaemia. We retrospectively evaluated candidaemia episodes in between January 2007 and August 2014. We compared demographic, clinical, microbiological findings and mortality rates of episodes caused by Candida albicans and non-albicans Candida species. Overall the candidaemia incidences were 1.23 episodes/1000 admissions. A significant negative slope among candidaemia episodes and years was determined. Overall C. albicans (54.6%) was the most common species followed by Candida glabrata, Candida tropicalis and Candida parapsilosis respectively. Preinfection hospital stay and length of hospital stay were statistically longer in patients with non-albicans Candida candidaemia than in patients with C. albicans candidaemia. The source of candidaemia was unknown in 52.5% of all episodes. Central venous catheters among non-albicans Candida candidaemia episodes and urinary system among C. albicans candidaemia episodes were common source of candidaemia compared to each other. Previous antifungal therapy preceding candidaemia and concomitant bacteraemia were significantly associated with non-albicans Candida candidaemia. Continuous local surveillance will preserve its pivotal importance in formulating empirical antifungal therapy and improving management of candidaemia.
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Affiliation(s)
- Ayşegül Yeşilkaya
- Faculty of Medicine, Department of Infectious Diseases and Clinical Microbiology, Baskent University, Ankara, Turkey
| | - Özlem Azap
- Faculty of Medicine, Department of Infectious Diseases and Clinical Microbiology, Baskent University, Ankara, Turkey
| | - Mehtap Aydın
- Faculty of Medicine, Department of Infectious Diseases and Clinical Microbiology, Baskent University, Ankara, Turkey
| | - Mehtap Akçil Ok
- Faculty of Health Sciences, Department of Nutrition and Dietetic, Baskent University, Ankara, Turkey
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Enoch DA, Yang H, Aliyu SH, Micallef C. The Changing Epidemiology of Invasive Fungal Infections. Methods Mol Biol 2017; 1508:17-65. [PMID: 27837497 DOI: 10.1007/978-1-4939-6515-1_2] [Citation(s) in RCA: 228] [Impact Index Per Article: 32.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Invasive fungal infections (IFI) are an emerging problem worldwide with invasive candidiasis and candidemia responsible for the majority of cases. This is predominantly driven by the widespread adoption of aggressive immunosuppressive therapy among certain patient populations (e.g., chemotherapy, transplants) and the increasing use of invasive devices such as central venous catheters (CVCs). The use of new immune modifying drugs has also opened up an entirely new spectrum of patients at risk of IFIs. While the epidemiology of candida infections has changed in the last decade, with a gradual shift from C. albicans to non-albicans candida (NAC) strains which may be less susceptible to azoles, these changes vary between hospitals and regions depending on the type of population risk factors and antifungal use. In certain parts of the world, the incidence of IFI is strongly linked to the prevalence of other disease conditions and the ecological niche for the organism; for instance cryptococcal and pneumocystis infections are particularly common in areas with a high prevalence of HIV disease. Poorly controlled diabetes is a major risk factor for invasive mould infections. Environmental factors and trauma also play a unique role in the epidemiology of mould infections, with well-described hospital outbreaks linked to the use of contaminated instruments and devices. Blastomycosis is associated with occupational exposure (e.g., forest rangers) and recreational activities (e.g., camping and fishing).The true burden of IFI is probably an underestimate because of the absence of reliable diagnostics and lack of universal application. For example, the sensitivity of most blood culture systems for detecting candida is typically 50 %. The advent of new technology including molecular techniques such as 18S ribosomal RNA PCR and genome sequencing is leading to an improved understanding of the epidemiology of the less common mould and dimorphic fungal infections. Molecular techniques are also providing a platform for improved diagnosis and management of IFI.Many factors affect mortality in IFI, not least the underlying medical condition, choice of therapy, and the ability to achieve early source control. For instance, mortality due to pneumocystis pneumonia in HIV-seronegative individuals is now higher than in seropositive patients. Of significant concern is the progressive increase in resistance to azoles and echinocandins among candida isolates, which appears to worsen the already significant mortality associated with invasive candidiasis. Mortality with mould infections approaches 50 % in most studies and varies depending on the site, underlying disease and the use of antifungal agents such as echinocandins and voriconazole. Nevertheless, mortality for most IFIs has generally fallen with advances in medical technology, improved care of CVCs, improved diagnostics, and more effective preemptive therapy and prophylaxis.
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Affiliation(s)
- David A Enoch
- National Infection Service, Public Health England, Cambridge Microbiology and Public Health Laboratory, Addenbrooke's Hospital, Box 236, Cambridge Biomedical Campus, Hills Road, Cambridge, CB2 0QW, UK.
| | - Huina Yang
- National Infection Service, Public Health England, Cambridge Microbiology and Public Health Laboratory, Addenbrooke's Hospital, Box 236, Cambridge Biomedical Campus, Hills Road, Cambridge, CB2 0QW, UK
| | - Sani H Aliyu
- National Infection Service, Public Health England, Cambridge Microbiology and Public Health Laboratory, Addenbrooke's Hospital, Box 236, Cambridge Biomedical Campus, Hills Road, Cambridge, CB2 0QW, UK
| | - Christianne Micallef
- National Infection Service, Public Health England, Cambridge Microbiology and Public Health Laboratory, Addenbrooke's Hospital, Box 236, Cambridge Biomedical Campus, Hills Road, Cambridge, CB2 0QW, UK
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Dellière S, Healey K, Gits-Muselli M, Carrara B, Barbaro A, Guigue N, Lecefel C, Touratier S, Desnos-Ollivier M, Perlin DS, Bretagne S, Alanio A. Fluconazole and Echinocandin Resistance of Candida glabrata Correlates Better with Antifungal Drug Exposure Rather than with MSH2 Mutator Genotype in a French Cohort of Patients Harboring Low Rates of Resistance. Front Microbiol 2016; 7:2038. [PMID: 28066361 PMCID: PMC5179511 DOI: 10.3389/fmicb.2016.02038] [Citation(s) in RCA: 50] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2016] [Accepted: 12/05/2016] [Indexed: 11/21/2022] Open
Abstract
Candida glabrata is a major pathogenic yeast in humans that is known to rapidly acquire resistance to triazole and echinocandin antifungal drugs. A mutator genotype (MSH2 polymorphism) inducing a mismatch repair defect has been recently proposed to be responsible for resistance acquisition in C. glabrata clinical isolates. Our objectives were to evaluate the prevalence of antifungal resistance in a large cohort of patients in Saint-Louis hospital, Paris, France, some of whom were pre-exposed to antifungal drugs, as well as to determine whether MSH2 polymorphisms are associated with an increased rate of fluconazole or echinocandin resistance. We collected 268 isolates from 147 patients along with clinical data and previous antifungal exposure. Fluconazole and micafungin minimal inhibition concentrations (MICs) were tested, short tandem repeat genotyping was performed, and the MSH2 gene was sequenced. According to the European Committee on Antimicrobial Susceptibility breakpoints, 15.7% of isolates were resistant to fluconazole (MIC > 32 mg/L) and 0.7% were resistant to micafungin (MIC > 0.03 mg/L). A non-synonymous mutation within MSH2 occurred in 44% of the isolates, and 17% were fluconazole resistant. In comparison, fluconazole resistant isolates with no MSH2 mutation represented 15% (P = 0.65). MSH2 polymorphisms were associated with the short tandem repeat genotype. The rate of echinocandin resistance is low and correlates with prior exposure to echinocandin. The mutator genotype was not associated with enrichment in fluconazole resistance but instead corresponded to rare and specific genotypes.
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Affiliation(s)
- Sarah Dellière
- Laboratoire de Parasitologie-Mycologie, AP-HP, Groupe Hospitalier Saint-Louis-Lariboisière-Fernand-Widal Paris, France
| | - Kelley Healey
- Public Health Research Institute, New Jersey Medical School, Rutgers Biomedical and Health Sciences, Rutgers Newark, NJ, USA
| | - Maud Gits-Muselli
- Laboratoire de Parasitologie-Mycologie, AP-HP, Groupe Hospitalier Saint-Louis-Lariboisière-Fernand-WidalParis, France; Université Paris Diderot, Sorbonne Paris CitéParis, France
| | - Bastien Carrara
- Laboratoire de Parasitologie-Mycologie, AP-HP, Groupe Hospitalier Saint-Louis-Lariboisière-Fernand-Widal Paris, France
| | - Alessandro Barbaro
- Laboratoire de Parasitologie-Mycologie, AP-HP, Groupe Hospitalier Saint-Louis-Lariboisière-Fernand-Widal Paris, France
| | - Nicolas Guigue
- Laboratoire de Parasitologie-Mycologie, AP-HP, Groupe Hospitalier Saint-Louis-Lariboisière-Fernand-Widal Paris, France
| | - Christophe Lecefel
- Service de Pharmacie, AP-HP, Groupe Hospitalier Saint-Louis-Lariboisière-Fernand-Widal Paris, France
| | - Sophie Touratier
- Service de Pharmacie, AP-HP, Groupe Hospitalier Saint-Louis-Lariboisière-Fernand-Widal Paris, France
| | - Marie Desnos-Ollivier
- Unité de Mycologie Moléculaire, Institut Pasteur, Centre National de la Recherche Scientifique, Centre National de Référence Mycoses Invasives et Antifongiques, URA3012 Paris, France
| | - David S Perlin
- Public Health Research Institute, New Jersey Medical School, Rutgers Biomedical and Health Sciences, Rutgers Newark, NJ, USA
| | - Stéphane Bretagne
- Laboratoire de Parasitologie-Mycologie, AP-HP, Groupe Hospitalier Saint-Louis-Lariboisière-Fernand-WidalParis, France; Université Paris Diderot, Sorbonne Paris CitéParis, France; Unité de Mycologie Moléculaire, Institut Pasteur, Centre National de la Recherche Scientifique, Centre National de Référence Mycoses Invasives et Antifongiques, URA3012Paris, France
| | - Alexandre Alanio
- Laboratoire de Parasitologie-Mycologie, AP-HP, Groupe Hospitalier Saint-Louis-Lariboisière-Fernand-WidalParis, France; Université Paris Diderot, Sorbonne Paris CitéParis, France; Unité de Mycologie Moléculaire, Institut Pasteur, Centre National de la Recherche Scientifique, Centre National de Référence Mycoses Invasives et Antifongiques, URA3012Paris, France
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Cretella D, Barber KE, King ST, Stover KR. Comparison of susceptibility patterns using commercially available susceptibility testing methods performed on prevalent Candida spp. J Med Microbiol 2016; 65:1445-1451. [PMID: 27902377 DOI: 10.1099/jmm.0.000383] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
The rising rates of invasive fungal infections caused by non-albicans Candida and the increasing emergence of antifungal resistance complicate the management of invasive candidiasis. Accurate and timely antifungal susceptibility testing is critical to targeting antifungal therapy. The purpose of this study was to compare commercially available susceptibility testing methods using prospectively collected Candida isolates. Susceptibility testing was performed on 74 Candida isolates collected from July 2014 to March 2015 using broth microdilution according to the Clinical and Laboratory Standards Institute method, Etest, Vitek 2 (YS-05) and Sensititre. Essential agreement and categorical agreement (CA) were assessed using the reference method. Of the 34 total blood isolates collected, Candida albicans comprised only 38 % (13) of the Candida spp. with Candidaglabrata being nearly as prevalent (29 %, 10). CA using Etest was 86 % for fluconazole, 72 % for caspofungin, 98 % for micafungin and 97 % for anidulafungin. Vitek 2 CA was 90 % for fluconazole and 98 % for caspofungin. Sensititre CA was 93 % for fluconazole, 98 % for caspofungin, 98 % for micafungin and 100 % for anidulafungin. Although our study tested a small population of Candida isolates, our results were variable by method. When implementing antifungal susceptibility testing, clinicians should be aware of the strengths and limitations of each testing method.
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Affiliation(s)
- David Cretella
- Pharmacy Services, University of Mississippi Medical Center, Jackson, MS, USA
| | - Katie E Barber
- Pharmacy Practice, University of Mississippi School of Pharmacy, Jackson, MS, USA
| | - S Travis King
- Pharmacy Practice, University of Mississippi School of Pharmacy, Jackson, MS, USA.,Medicine-Infectious Diseases, University of Mississippi Medical Center, Jackson, MS, USA
| | - Kayla R Stover
- Pharmacy Practice, University of Mississippi School of Pharmacy, Jackson, MS, USA.,Medicine-Infectious Diseases, University of Mississippi Medical Center, Jackson, MS, USA
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Ishikane M, Hayakawa K, Kutsuna S, Takeshita N, Ohmagari N. Epidemiology of Blood Stream Infection due to Candida Species in a Tertiary Care Hospital in Japan over 12 Years: Importance of Peripheral Line-Associated Candidemia. PLoS One 2016; 11:e0165346. [PMID: 27798663 PMCID: PMC5087841 DOI: 10.1371/journal.pone.0165346] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2016] [Accepted: 10/10/2016] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Candidemia is an important cause of mortality in healthcare settings. Peripheral lines are a source of candidemia, yet few studies have reported on the clinico-epidemiological features of candidemia due to peripheral-line associated blood stream infection (PLABSI). METHODS We conducted a single-centre retrospective cohort study of all patients with candidemia between 2002 and 2013. PLABSI was defined as the presence of at least one of the following: the presence of phlebitis or the resolution of clinical symptoms after peripheral-line withdrawal, with careful exclusion of an alternative explanation for bacteraemia. We described the epidemiology of candidemia and assessed predictive factors of PLABSI due to Candida spp., peripheral line-associated candidemia (PLAC), compared with non-PLAC. RESULTS A total of 301 episodes of candidemia, including 37 of PLAC, were diagnosed during the study period. Central-line associated blood stream infection, intra-abdominal infection, and infection of unknown source accounted for the remaining 233, 14, and 17 cases, respectively. The overall incidence rate of candidemia was 0.11/1000 patient-days. In multivariate analysis, cephalosporin exposure (odds ratio [OR] = 2.22, 95% CI 1.04-4.77), polymicrobial bacteraemia/fungaemia (OR = 2.87, 95% CI 1.02-8.10), and ID specialist consultation (OR = 2.40, 95% CI 1.13-5.13) were identified as independent predictors of PLAC. Although non-PLAC had a higher mortality, the length of hospital stay after candidemia was similar between the two groups and candidemia duration was longer in the PLAC group. CONCLUSION PLACs are an important cause of candidemia in hospitalized patients. Appropriate identification and management of PLAC are crucial.
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Affiliation(s)
- Masahiro Ishikane
- Department of Disease Control and Prevention Center, National Center for Global Health and Medicine, Tokyo, Japan
- Division of Global infectious diseases, Department of Infection and Epidemiology, Graduate School of Medicine, Tohoku University, Miyagi, Japan
- * E-mail:
| | - Kayoko Hayakawa
- Department of Disease Control and Prevention Center, National Center for Global Health and Medicine, Tokyo, Japan
| | - Satoshi Kutsuna
- Department of Disease Control and Prevention Center, National Center for Global Health and Medicine, Tokyo, Japan
| | - Nozomi Takeshita
- Department of Disease Control and Prevention Center, National Center for Global Health and Medicine, Tokyo, Japan
| | - Norio Ohmagari
- Department of Disease Control and Prevention Center, National Center for Global Health and Medicine, Tokyo, Japan
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45
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CAND-LO 2014–15 study: changing epidemiology of candidemia in Lombardy (Italy). Infection 2016; 44:765-780. [DOI: 10.1007/s15010-016-0951-6] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2016] [Accepted: 10/05/2016] [Indexed: 12/31/2022]
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Zheng S, Ng TY, Li H, Tan AL, Tan TT, Tan BH. A dedicated fungal culture medium is useful in the diagnosis of fungemia: a retrospective cross-sectional study. PLoS One 2016; 11:e0164668. [PMID: 27736956 PMCID: PMC5063326 DOI: 10.1371/journal.pone.0164668] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2016] [Accepted: 09/29/2016] [Indexed: 01/05/2023] Open
Abstract
Background Mortality for candidemia ranges from 15% to 35%. Current guidelines recommend inoculating blood into three aerobic and three anaerobic blood culture bottles when candidemia is suspected, without mention of a fungal blood culture bottle. Objective To determine the value of the BACTEC Myco/F Lytic blood culture media in the diagnosis of fungemia. Methods A two-year retrospective cross-sectional study was performed for patients who had fungemia with submitted BACTEC Plus Aerobic/F (Aer), BACTEC Plus Anaerobic/F (Anaer) or Myco/F Lytic (Myco) blood culture bottles. Results The detection rate of fungemia was 77.4% in 93 patients with contemporaneously submitted blood culture bottles when limited to only Aer/Anaer culture results. The detection rate improved significantly with the addition of the Myco culture bottle results (p<0.0001). A logistic regression model showed that Myco culture bottle submissions were less useful for patients with appropriate anti-fungal therapy administered within 48 hours [OR = 0.18, 95% CI = (0.06, 0.49), p = 0.001] and those with fungal growth detected within 48 hours [OR = 0.33, 95% CI = (0.12, 0.89), p = 0.001]. Among a subset of patients with concordant blood culture results, those with Myco culture bottles submission allowed earlier fungal detection and speciation by at least one day in 27.5% and 25.0% of the cases respectively. Conclusion Our study highlights the importance of a dedicated fungal blood culture when fungemia is clinically suspected. Nearly a quarter of fungemias may be missed if a fungal blood culture is not performed.
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Affiliation(s)
- Shuwei Zheng
- Department Infectious Diseases, Singapore General Hospital, Singapore, Singapore
- * E-mail:
| | - Tong Yong Ng
- Department of Pathology, Singapore General Hospital, Singapore, Singapore
| | - Huihua Li
- Health Services Research & Biostatistics Unit, Division of Research, Singapore General Hospital, Singapore, Singapore
| | - Ai Ling Tan
- Department of Pathology, Singapore General Hospital, Singapore, Singapore
| | - Thuan Tong Tan
- Department Infectious Diseases, Singapore General Hospital, Singapore, Singapore
| | - Ban Hock Tan
- Department Infectious Diseases, Singapore General Hospital, Singapore, Singapore
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Scudeller L, Bassetti M, Concia E, Corrao S, Cristini F, De Rosa FG, Del Bono V, Durante-Mangoni E, Falcone M, Menichetti F, Tascini C, Tumbarello M, Venditti M, Viale P, Viscoli C, Mazzone A. MEDical wards Invasive Candidiasis ALgorithms (MEDICAL):Consensus proposal for management. Eur J Intern Med 2016; 34:45-53. [PMID: 27495949 DOI: 10.1016/j.ejim.2016.07.007] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2016] [Revised: 07/06/2016] [Accepted: 07/08/2016] [Indexed: 01/27/2023]
Abstract
INTRODUCTION A majority of invasive Candida infections occur in medical wards; however, evidence for management in this setting is scarce and based primarily on the intensive care or surgical setting. On behalf of the Italian Society for Anti-Infective Therapy (SITA) and the Italian Federation of Associations of Hospital Doctors on Internal Medicine (FADOI), the MEDICAL group produced practical management algorithms for patients in internal medicine wards. METHODS The MEDICAL group panel, composed of 30 members from internal medicine, infectious disease, clinical pharmacology, clinical microbiology and clinical epidemiology, provided expert opinion through the RAND/UCLA method. RESULTS Seven clinical scenarios were constructed based on clinical severity and probability of invasive candidiasis. For each scenario, the appropriateness of 63 different diagnostic, imaging, management, or therapeutic procedures was determined in two Delphi rounds. The necessity for performing each appropriate procedure, was then determined in a third Delphi round. Results were summarized in algorithms. DISCUSSION The proposed algorithms provide internal medicine physicians and managers with an easy to interpret tool that is exhaustive, clear and suitable for adaption to individual local settings. Attention was paid to individual patient management and resource allocation.
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Affiliation(s)
- Luigia Scudeller
- Clinical Epidemiology Unit, Scientific Direction, IRCCS, Policlinico San Matteo Foundation, Pavia, Italy.
| | - Matteo Bassetti
- Infectious Diseases Division, Santa Maria della Misericordia University Hospital, Udine, Italy
| | - Ercole Concia
- Section of Infectious Diseases, Department of Pathology and Diagnostics, Azienda Ospedaliera Universitaria Integrata, Policlinico G B Rossi, Verona, Italy
| | - Salvatore Corrao
- Department of Internal Medicine, National Relevance Hospital Trust, ARNAS Civico, Di Cristina e Benfratelli, Palermo, Di.Bi.M.I.S., University of Palermo, Italy
| | - Francesco Cristini
- Infectious Diseases Unit, Teaching Hospital Policlinico S. Orsola-Malpighi Alma Mater Studiorum, University of Bologna, Bologna, Italy
| | | | - Valerio Del Bono
- Clinic of Infectious Diseases, IRCCS San Martino-IST, University of Genova, Genova, Italy
| | - Emanuele Durante-Mangoni
- Internal Medicine Section, Department of Cardiothoracic Sciences, and Division of Infectious and Transplant Medicine, Second University of Naples at Monaldi Hospital, Napoli, Italy
| | - Marco Falcone
- Department of Public Health and Infectious Diseases, Policlinico Umberto I, "Sapienza" University of Rome, Rome, Italy
| | | | - Carlo Tascini
- Infectious Disease Department, Cisanello Hospital, Pisa, Italy
| | - Mario Tumbarello
- Infectious Diseases Institute, Policlinico Gemelli, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Mario Venditti
- Department of Public Health and Infectious Diseases, Policlinico Umberto I, "Sapienza" University of Rome, Rome, Italy
| | - Pierluigi Viale
- Infectious Diseases Unit, Teaching Hospital Policlinico S. Orsola-Malpighi Alma Mater Studiorum, University of Bologna, Bologna, Italy
| | - Claudio Viscoli
- Clinic of Infectious Diseases, IRCCS San Martino-IST, University of Genova, Genova, Italy
| | - Antonino Mazzone
- Internal Medicine Department, Hospital of Legnano, Legnano, Italy
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Abstract
Invasive fungal infections are an important infection concern for patients with underlying immunosuppression. Antifungal therapy is a critical component of patient care, but therapeutic choices are limited due to few drug classes. Antifungal resistance, especially among Candida species, aggravates the problem. The echinocandin drugs (micafungin, anidulafungin, and caspofungin) are the preferred choice to treat a range of candidiasis. They target the fungal-specific enzyme glucan synthase, which is responsible for the biosynthesis of a major cell wall polymer. Therapeutic failure involves acquisition of resistance, although it is a rare event among most Candida species. However, in some settings, higher-level resistance has been reported among Candida glabrata, which is also frequently resistant to azole drugs, resulting in difficult-to-treat multidrug-resistant strains. The mechanism of echinocandin resistance involves amino acid changes in "hot spot" regions of FKS-encoded subunits of glucan synthase, which decreases the sensitivity of enzyme to drug, resulting in higher minimum inhibitory concentration values. The cellular processes promoting the formation of resistant FKS strains involve complex stress response pathways that yield a variety of adaptive compensatory genetic responses. Standardized broth microdilution techniques can be used to distinguish FKS mutant strains from wild type, but testing C. glabrata with caspofungin should be approached cautiously. Finally, clinical factors that promote echinocandin resistance include prophylaxis, host reservoirs including biofilms in the gastrointestinal tract, and intra-abdominal infections. An understanding of clinical and molecular factors that promote echinocandin resistance is critical to develop better diagnostic tools and therapeutic strategies to overcome resistance.
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Affiliation(s)
- David S Perlin
- Public Health Research Institute, New Jersey Medical School-Rutgers Biomedical and Health Sciences, Newark
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Barchiesi F, Orsetti E, Osimani P, Catassi C, Santelli F, Manso E. Factors related to outcome of bloodstream infections due to Candida parapsilosis complex. BMC Infect Dis 2016; 16:387. [PMID: 27507170 PMCID: PMC4977692 DOI: 10.1186/s12879-016-1704-y] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2016] [Accepted: 07/11/2016] [Indexed: 11/25/2022] Open
Abstract
Background Although Candida albicans is the most common cause of fungal blood stream infections (BSIs), infections due to Candida species other than C. albicans are rising. Candida parapsilosis complex has emerged as an important fungal pathogen and became one of the main causes of fungemia in specific geographical areas. We analyzed the factors related to outcome of candidemia due to C. parapsilosis in a single tertiary referral hospital over a five-year period. Methods A retrospective observational study of all cases of candidemia was carried out at a 980-bedded University Hospital in Italy. Data regarding demographic characteristics and clinical risk factors were collected from the patient’s medical records. Antifungal susceptibility testing was performed and MIC results were interpreted according to CLSI species-specific clinical breakpoints. Results Of 270 patients diagnosed with Candida BSIs during the study period, 63 (23 %) were infected with isolates of C. parapsilosis complex which represented the second most frequently isolated yeast after C. albicans. The overall incidence rate was 0.4 episodes/1000 hospital admissions. All the strains were in vitro susceptible to all antifungal agents. The overall crude mortality at 30 days was 27 % (17/63), which was significantly lower than that reported for C. albicans BSIs (42 % [61/146], p = 0.042). Being hospitalized in ICU resulted independently associated with a significant higher risk of mortality (HR 4.625 [CI95% 1.015–21.080], p = 0.048). Conversely, early CVC removal was confirmed to be significantly associated with a lower risk of mortality (HR 0.299 [CI95% 0.102–0.874], p = 0.027). Finally, the type of primary antifungal therapy did not influence the outcome of infection. Conclusions Candidemia due to C. parapsilosis complex, the second most commonly causative agent of yeast BSIs in our center, is characterized by a non-negligible mortality at 30 days. An early CVC removal is associated with a significant reduced mortality.
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Affiliation(s)
- Francesco Barchiesi
- Clinica Malattie Infettive; Università Politecnica delle Marche, Azienda Ospedaliero-Universitaria, Ospedali Riuniti Umberto I°- G.M. Lancisi - G. Salesi, Ancona, Italy.
| | - Elena Orsetti
- Clinica Malattie Infettive; Università Politecnica delle Marche, Azienda Ospedaliero-Universitaria, Ospedali Riuniti Umberto I°- G.M. Lancisi - G. Salesi, Ancona, Italy
| | - Patrizia Osimani
- Pediatria, Azienda Ospedaliero-Universitaria, Ospedali Riuniti Umberto I°- G.M. Lancisi - G. Salesi, Ancona, Italy
| | - Carlo Catassi
- Clinica Pediatrica; Università Politecnica delle Marche, Azienda Ospedaliero-Universitaria, Ospedali Riuniti Umberto I°- G.M. Lancisi - G. Salesi, Ancona, Italy
| | - Fabio Santelli
- Anestesia e Rianimazione Pediatrica, Azienda Ospedaliero-Universitaria, Ospedali Riuniti Umberto I°- G.M. Lancisi - G. Salesi, Ancona, Italy
| | - Esther Manso
- Laboratorio di Microbiologia, Azienda Ospedaliero-Universitaria, Ospedali Riuniti Umberto I°- G.M. Lancisi - G. Salesi, Ancona, Italy
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50
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Gonçalves SS, Souza ACR, Chowdhary A, Meis JF, Colombo AL. Epidemiology and molecular mechanisms of antifungal resistance in CandidaandAspergillus. Mycoses 2016; 59:198-219. [DOI: 10.1111/myc.12469] [Citation(s) in RCA: 112] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2015] [Revised: 12/14/2015] [Accepted: 12/18/2015] [Indexed: 12/15/2022]
Affiliation(s)
- Sarah Santos Gonçalves
- Laboratório Especial de Micologia, Disciplina de Infectologia, Escola Paulista de Medicina; Universidade Federal de São Paulo; São Paulo SP Brazil
| | - Ana Carolina Remondi Souza
- Laboratório Especial de Micologia, Disciplina de Infectologia, Escola Paulista de Medicina; Universidade Federal de São Paulo; São Paulo SP Brazil
| | - Anuradha Chowdhary
- Department of Medical Mycology; Vallabhbhai Patel Chest Institute; University of Delhi; Delhi India
| | - Jacques F. Meis
- Department of Medical Microbiology and Infectious Diseases; Canisius Wilhelmina Hospital; Nijmegen the Netherlands
- Department of Medical Microbiology; Radboud University Medical Centre; Nijmegen the Netherlands
| | - Arnaldo Lopes Colombo
- Laboratório Especial de Micologia, Disciplina de Infectologia, Escola Paulista de Medicina; Universidade Federal de São Paulo; São Paulo SP Brazil
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