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Piccoli P, Lucini F, Al-Hatmi AMS, Rossato L. Fusariosis in burn patients: A systematic review of case reports. Med Mycol 2024; 62:myae013. [PMID: 38379099 DOI: 10.1093/mmy/myae013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2023] [Revised: 01/16/2024] [Accepted: 02/19/2024] [Indexed: 02/22/2024] Open
Abstract
Burns can cause skin damage, facilitating the entry of fungi and other microorganisms into the body, leading to infections. Fusarium is a fungus capable of infecting individuals with burn injuries. Diagnosing and treating Fusarium infections in burn patients can be challenging due to the manifestation of nonspecific symptoms. This study aims to investigate case reports and case series from published literature describing Fusarium infection in burned patients, in order to assess treatment regimens, clinical outcomes, and make recommendations for future management. We conducted searches on Web of Science, PubMed, ScienceDirect, and Medline for all case reports and case series containing keywords 'Burn', 'Burns', 'Burned', 'Fusarium', or 'Fusariosis' in the title or abstract. All burn patients who developed Fusarium fungal infections between January 1974 and March 2023 were included in the study. Demographic and clinical data were analyzed retrospectivity. The final analysis incorporates 24 case reports encompassing a total of 87 burn patients with Fusarium infection. Patient ages ranged from one to 85 years, with the majority being male (53%). The median percentage of burn surface area was 78%, and the skin in the face, upper limbs, and lower limbs were the most commonly infected sites. Fungal infections appeared around 10 days after the burn injury on average. The majority of the patients were identified through culture or histopathology. The Fusarium dimerum species complex, which was found in nine patients, was the most frequently identified Fusarium species complex. Amphotericin B was the most preferred treatment drug, followed by voriconazole, and 62% of patients underwent debridement. In our study, 23 patients (37%) died from fungal infections. Implementing early and effective treatment protocols targeting Fusarium spp. in burn treatment units can significantly reduce mortality rates. It is critical to enhance the understanding of fusariosis epidemiology and emphasize the importance of maintaining a high clinical suspicion for this condition in burn patients.
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Affiliation(s)
- Paola Piccoli
- Federal University of Grande Dourados (UFGD), Faculdade de Ciências da Saúde-FCS, Brazil
| | - Fabíola Lucini
- Federal University of Grande Dourados (UFGD), Faculdade de Ciências da Saúde-FCS, Brazil
| | | | - Luana Rossato
- Federal University of Grande Dourados (UFGD), Faculdade de Ciências da Saúde-FCS, Brazil
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2
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Ji S, Xiao S, Xia Z. Consensus on the treatment of second-degree burn wounds (2024 edition). BURNS & TRAUMA 2024; 12:tkad061. [PMID: 38343901 PMCID: PMC10858447 DOI: 10.1093/burnst/tkad061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/24/2023] [Revised: 11/29/2023] [Accepted: 12/08/2023] [Indexed: 02/21/2024]
Abstract
Second-degree burns are the most common type of burn in clinical practice and hard to manage. Their treatment requires not only a consideration of the different outcomes that may arise from the dressing changes or surgical therapies themselves but also an evaluation of factors such as the burn site, patient age and burn area. Meanwhile, special attention should be given to the fact that there is no unified standard or specification for the diagnosis, classification, surgical procedure, and infection diagnosis and grading of second-degree burn wounds. This not only poses great challenges to the formulation of clinical treatment plans but also significantly affects the consistency of clinical studies. Moreover, currently, there are relatively few guidelines or expert consensus for the management of second-degree burn wounds, and no comprehensive and systematic guidelines or specifications for the treatment of second-degree burns have been formed. Therefore, we developed the Consensus on the Treatment of Second-Degree Burn Wounds (2024 edition), based on evidence-based medicine and expert opinion. This consensus provides specific recommendations on prehospital first aid, nonsurgical treatment, surgical treatment and infection treatment for second-degree burns. The current consensus generated a total of 58 recommendations, aiming to form a standardized clinical treatment plan.
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Affiliation(s)
- Shizhao Ji
- Correspondence: Shizhao Ji, ; Shichu Xiao, ; Zhaofan Xia,
| | - Shichu Xiao
- Correspondence: Shizhao Ji, ; Shichu Xiao, ; Zhaofan Xia,
| | - Zhaofan Xia
- Correspondence: Shizhao Ji, ; Shichu Xiao, ; Zhaofan Xia,
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3
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Greenhalgh DG, Hill DM, Burmeister DM, Gus EI, Cleland H, Padiglione A, Holden D, Huss F, Chew MS, Kubasiak JC, Burrell A, Manzanares W, Gómez MC, Yoshimura Y, Sjöberg F, Xie WG, Egipto P, Lavrentieva A, Jain A, Miranda-Altamirano A, Raby E, Aramendi I, Sen S, Chung KK, Alvarez RJQ, Han C, Matsushima A, Elmasry M, Liu Y, Donoso CS, Bolgiani A, Johnson LS, Vana LPM, de Romero RVD, Allorto N, Abesamis G, Luna VN, Gragnani A, González CB, Basilico H, Wood F, Jeng J, Li A, Singer M, Luo G, Palmieri T, Kahn S, Joe V, Cartotto R. Surviving Sepsis After Burn Campaign. Burns 2023; 49:1487-1524. [PMID: 37839919 DOI: 10.1016/j.burns.2023.05.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Accepted: 05/02/2023] [Indexed: 10/17/2023]
Abstract
INTRODUCTION The Surviving Sepsis Campaign was developed to improve outcomes for all patients with sepsis. Despite sepsis being the primary cause of death after thermal injury, burns have always been excluded from the Surviving Sepsis efforts. To improve sepsis outcomes in burn patients, an international group of burn experts developed the Surviving Sepsis After Burn Campaign (SSABC) as a testable guideline to improve burn sepsis outcomes. METHODS The International Society for Burn Injuries (ISBI) reached out to regional or national burn organizations to recommend members to participate in the program. Two members of the ISBI developed specific "patient/population, intervention, comparison and outcome" (PICO) questions that paralleled the 2021 Surviving Sepsis Campaign [1]. SSABC participants were asked to search the current literature and rate its quality for each topic. At the Congress of the ISBI, in Guadalajara, Mexico, August 28, 2022, a majority of the participants met to create "statements" based on the literature. The "summary statements" were then sent to all members for comment with the hope of developing an 80% consensus. After four reviews, a consensus statement for each topic was created or "no consensus" was reported. RESULTS The committee developed sixty statements within fourteen topics that provide guidance for the early treatment of sepsis in burn patients. These statements should be used to improve the care of sepsis in burn patients. The statements should not be considered as "static" comments but should rather be used as guidelines for future testing of the best treatments for sepsis in burn patients. They should be updated on a regular basis. CONCLUSION Members of the burn community from the around the world have developed the Surviving Sepsis After Burn Campaign guidelines with the goal of improving the outcome of sepsis in burn patients.
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Affiliation(s)
- David G Greenhalgh
- Department of Burns, Shriners Children's Northern California and Department of Surgery, University of California, Davis, Sacramento, CA, USA.
| | - David M Hill
- Department of Clinical Pharmacy & Translational Scre have been several studies that have evaluatedience, College of Pharmacy, University of Tennessee, Health Science Center; Memphis, TN, USA
| | - David M Burmeister
- Department of Medicine, Uniformed Services University of the Health Sciences, Bethesda, MD, USA
| | - Eduardo I Gus
- Division of Plastic & Reconstructive Surgery, The Hospital for Sick Children; Department of Surgery, University of Toronto, Toronto, Canada
| | - Heather Cleland
- Department of Surgery, Monash University and Alfred Hospital, Melbourne, Australia
| | - Alex Padiglione
- Department of Surgery, Monash University and Alfred Hospital, Melbourne, Australia
| | - Dane Holden
- Department of Surgery, Monash University and Alfred Hospital, Melbourne, Australia
| | - Fredrik Huss
- Department of Surgical Sciences, Plastic Surgery, Uppsala University/Burn Center, Department of Plastic and Maxillofacial Surgery, Uppsala University Hospital, Uppsala, Sweden
| | - Michelle S Chew
- Department of Anaesthesia and Intensive Care, Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
| | - John C Kubasiak
- Department of Surgery, Loyola University Medical Center, Maywood, IL, USA
| | - Aidan Burrell
- Department of Epidemiology and Preventative Medicine, Monash University and Alfred Hospital, Intensive Care Research Center (ANZIC-RC), Melbourne, Australia
| | - William Manzanares
- Department of Critical Care Medicine, Universidad de la República (UdelaR), Montevideo, Uruguay
| | - María Chacón Gómez
- Division of Intensive Care and Critical Medicine, Centro Nacional de Investigacion y Atencion de Quemados (CENIAQ), National Rehabilitation Institute, LGII, Mexico
| | - Yuya Yoshimura
- Department of Emergency and Critical Care Medicine, Hachinohe City Hospital, Hachinohe, Japan
| | - Folke Sjöberg
- Department of Anaesthesia and Intensive Care, Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
| | - Wei-Guo Xie
- Institute of Burns, Tongren Hospital of Wuhan University (Wuhan Third Hospital), Wuhan, China
| | - Paula Egipto
- Centro Hospitalar e Universitário São João - Burn Unit, Porto, Portugal
| | | | | | | | - Ed Raby
- Infectious Diseases Department, Fiona Stanley Hospital, Murdoch, Western Australia, Australia
| | | | - Soman Sen
- Department of Burns, Shriners Children's Northern California and Department of Surgery, University of California, Davis, Sacramento, CA, USA
| | - Kevin K Chung
- Department of Medicine, Uniformed Services University of the Health Sciences, Bethesda, MD, USA
| | | | - Chunmao Han
- Department of Burn and Wound Repair, Second Affiliated Hospital, Zhejiang University College of Medicine, Hangzhou, China
| | - Asako Matsushima
- Department of Emergency and Critical Care, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Moustafa Elmasry
- Department of Hand, Plastic Surgery and Burns, Linköping University, Linköping, Sweden
| | - Yan Liu
- Department of Burn, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Carlos Segovia Donoso
- Intensive Care Unit for Major Burns, Mutual Security Clinical Hospital, Santiago, Chile
| | - Alberto Bolgiani
- Department of Surgery, Deutsches Hospital, Buenos Aires, Argentina
| | - Laura S Johnson
- Department of Surgery, Emory University School of Medicine and Grady Health System, Georgia
| | - Luiz Philipe Molina Vana
- Disciplina de Cirurgia Plastica da Escola Paulista de Medicina da Universidade Federal de Sao Paulo, Sao Paulo, Brazil
| | | | - Nikki Allorto
- Grey's Hospital Pietermaritzburg Metropolitan Burn Service, University of KwaZulu Natal, Pietermaritzburg, South Africa
| | - Gerald Abesamis
- Alfredo T. Ramirez Burn Center, Division of Burns, Department of Surgery, University of Philippines Manila - Philippine General Hospital, Manila, Philippines
| | - Virginia Nuñez Luna
- Unidad Michou y Mau Xochimilco for Burnt Children, Secretaria Salud Ciudad de México, Mexico
| | - Alfredo Gragnani
- Disciplina de Cirurgia Plastica da Escola Paulista de Medicina da Universidade Federal de Sao Paulo, Sao Paulo, Brazil
| | - Carolina Bonilla González
- Department of Pediatrics and Intensive Care, Pediatric Burn Unit, Clinical Studies and Clinical Epidemiology Division, Fundación Santa Fe de Bogotá, Bogotá, Colombia
| | - Hugo Basilico
- Intensive Care Area - Burn Unit - Pediatric Hospital "Prof. Dr. Juan P. Garrahan", Buenos Aires, Argentina
| | - Fiona Wood
- Department of Surgery, Fiona Stanley Hospital, Murdoch, Western Australia, Australia
| | - James Jeng
- Department of Surgery, University of California, Irvine, CA, USA
| | - Andrew Li
- Department of Surgery, Monash University and Alfred Hospital, Melbourne, Australia
| | - Mervyn Singer
- Department of Intensive Care Medicine, University College London, London, United Kingdom
| | - Gaoxing Luo
- Institute of Burn Research, Southwest Hospital, Army (Third Military) Medical University, Chongqing, China
| | - Tina Palmieri
- Department of Burns, Shriners Children's Northern California and Department of Surgery, University of California, Davis, Sacramento, CA, USA
| | - Steven Kahn
- The South Carolina Burn Center, Department of Surgery, Medical University of South Carolina, Charleston, SC, USA
| | - Victor Joe
- Department of Surgery, University of California, Irvine, CA, USA
| | - Robert Cartotto
- Department of Surgery, Sunnybrook Medical Center, Toronto, Ontario, Canada
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Nitsani Y, Michael T, Halpern D, Hasidim AA, Sher M, Givoli Vilensky R, Krieger Y, Silberstein E, Shoham Y. Blood Stream Infections in Burns: A 14-Year Cohort Analysis. Life (Basel) 2023; 13:1357. [PMID: 37374139 DOI: 10.3390/life13061357] [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: 05/01/2023] [Revised: 05/30/2023] [Accepted: 06/07/2023] [Indexed: 06/29/2023] Open
Abstract
BACKGROUND Blood stream infections are a significant cause of morbidity and mortality in burns, and pathogen identification is important for treatment. This study aims to characterize the microbiology of these infections and the association between the infecting pathogen and the hospitalization course. METHODS We conducted a cohort study that included records of burn patients treated at the Soroka University Medical Center between 2007-2020. Statistical analysis of demographic and clinical data was performed to explore relationships between burn characteristics and outcomes. Patients with positive blood cultures were divided into four groups: Gram-positive, Gram-negative, mixed-bacterial, and fungal. RESULTS Of the 2029 burn patients hospitalized, 11.7% had positive blood cultures. The most common pathogens were Candida and Pseudomonas. We found significant differences in ICU admission, need for surgery, and mortality between the infected and non-infected groups (p < 0.001). Pathogen groups differed significantly mean TBSA, ICU admission, need for surgery, and mortality (p < 0.001). Multivariate analysis showed flame (OR 2.84) and electric burns (OR 4.58) were independent risk factors for ICU admission and surgical intervention (p < 0.001). Gram-negative bacterial infection was found to be an independent predictor of mortality (OR = 9.29, p < 0.001). CONCLUSIONS Anticipating specific pathogens which are associated with certain burn characteristics may help guide future therapy.
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Affiliation(s)
- Yarden Nitsani
- Joyce & Irving Goldman Medical School, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheba 8410501, Israel
| | - Tal Michael
- Department of Epidemiology, Biostatistics, and Community Health Sciences, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheba 8410501, Israel
| | - Dor Halpern
- Joyce & Irving Goldman Medical School, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheba 8410501, Israel
| | - Ariel Avraham Hasidim
- Joyce & Irving Goldman Medical School, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheba 8410501, Israel
| | - Maayan Sher
- Joyce & Irving Goldman Medical School, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheba 8410501, Israel
| | - Rotem Givoli Vilensky
- Clinical Research Center, Soroka University Medical Center, Beer-Sheba 8410101, Israel
| | - Yuval Krieger
- Plastic and Reconstructive Surgery Department and Burn Unit, Soroka University Medical Center, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheba 8410501, Israel
| | - Eldad Silberstein
- Plastic and Reconstructive Surgery Department and Burn Unit, Soroka University Medical Center, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheba 8410501, Israel
| | - Yaron Shoham
- Plastic and Reconstructive Surgery Department and Burn Unit, Soroka University Medical Center, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheba 8410501, Israel
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5
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Invasive Candidiasis in Hospitalized Patients with Major Burns. J Pers Med 2022; 12:jpm12010047. [PMID: 35055361 PMCID: PMC8781724 DOI: 10.3390/jpm12010047] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Revised: 12/14/2021] [Accepted: 12/21/2021] [Indexed: 02/05/2023] Open
Abstract
Background: Invasive candidiasis (IC) is a major cause of morbidities and mortality in patients hospitalized with major burns. This study investigated the incidence of IC in this specific population and analyzed the possible risk factors. Materials and Methods: We retrospectively analyzed data from the National Health Insurance Research Database (NHIRD) of Taiwan. We identified 3582 patients hospitalized with major burns on over 20% of their total body surface area (TBSA) during 2000–2013; we further analyzed possible risk factors. Result: IC was diagnosed in 452 hospitalized patients (12.6%) with major burns. In the multivariate analysis, patients older than 50 years (adjusted odds ratio (OR) = 1.96, 95% confidence interval (CI) 1.36–2.82), those of female sex (adjusted OR = 1.33, 95% CI 1.03–1.72), those with burns on the head (adjusted OR = 1.33, 95% CI 1.02–1.73), and those with burns over a greater TBSA had higher risks of IC. Conclusion: Treating IC is crucial in healthcare for major burns. Our study suggests that several risk factors are associated with IC in patients hospitalized with major burns, providing reliable reference value for clinical decisions.
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6
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Jain N, Jansone I, Obidenova T, Sīmanis R, Meisters J, Straupmane D, Reinis A. Epidemiological Characterization of Clinical Fungal Isolates from Pauls Stradinš Clinical University Hospital, Latvia: A 4-Year Surveillance Report. Life (Basel) 2021; 11:1002. [PMID: 34685374 PMCID: PMC8537438 DOI: 10.3390/life11101002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2021] [Revised: 09/21/2021] [Accepted: 09/21/2021] [Indexed: 12/12/2022] Open
Abstract
Nosocomial fungal infections are an emerging global public health threat that requires urgent attention and proper management. With the limited availability of treatment options, it has become necessary to understand the emerging epidemiological trends, mechanisms, and risk factors. However, very limited surveillance reports are available in the Latvian and broader European context. We therefore conducted a retrospective analysis of laboratory data (2017-2020) from Pauls Stradinš Clinical University Hospital (PSCUH), Riga, Latvia, which is one of the largest public multispecialty hospitals in Latvia. A total of 2278 fungal isolates were analyzed during the study period, with Candida spp. comprising 95% of the isolates, followed by Aspergillus spp. and Geotrichum spp. Amongst the Candida spp., C. albicans and C. glabrata made up about 75% of the isolates. The Department of Lung Diseases and Thoracic Surgery had the highest caseload followed by Intensive Care Department. Majority of the fungal isolates were collected from the bronchoalveolar lavage (37%), followed by urine (19%) and sputum (18%) samples. A total of 34 cases of candidemia were noted during the study period with C. albicans being the most common candidemia pathogen. Proper surveillance of emerging epidemiological trends serve as the most reliable and powerful cornerstone towards tackling this emerging threat.
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Affiliation(s)
- Nityanand Jain
- Department of Biology and Microbiology, Faculty of Medicine, Riga Stradiņš University, Dzirciema Street 16, LV-1007 Riga, Latvia;
| | - Inese Jansone
- Joint Laboratory, Pauls Stradiņš Clinical University Hospital, LV-1002 Riga, Latvia; (I.J.); (T.O.); (J.M.); (D.S.)
| | - Tatjana Obidenova
- Joint Laboratory, Pauls Stradiņš Clinical University Hospital, LV-1002 Riga, Latvia; (I.J.); (T.O.); (J.M.); (D.S.)
| | - Raimonds Sīmanis
- Department of Infectology, Faculty of Medicine, Riga Stradiņš University, Dzirciema Street 16, LV-1007 Riga, Latvia;
| | - Jānis Meisters
- Joint Laboratory, Pauls Stradiņš Clinical University Hospital, LV-1002 Riga, Latvia; (I.J.); (T.O.); (J.M.); (D.S.)
| | - Dagnija Straupmane
- Joint Laboratory, Pauls Stradiņš Clinical University Hospital, LV-1002 Riga, Latvia; (I.J.); (T.O.); (J.M.); (D.S.)
| | - Aigars Reinis
- Department of Biology and Microbiology, Faculty of Medicine, Riga Stradiņš University, Dzirciema Street 16, LV-1007 Riga, Latvia;
- Joint Laboratory, Pauls Stradiņš Clinical University Hospital, LV-1002 Riga, Latvia; (I.J.); (T.O.); (J.M.); (D.S.)
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7
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Tu Y, Lineaweaver WC, Breland A, Zhang F. Fungal Infection in Burn Patents: A Review of 36 Case Reports. Ann Plast Surg 2021; 86:S463-S467. [PMID: 34002720 DOI: 10.1097/sap.0000000000002865] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
OBJECTIVES The aims of this study were to review recent fungal infection case reports published, evaluate the treatment regimens and clinical outcomes, and provide recommendations for future management. METHODS A review of case reports published over the last decade was conducted. PubMed was searched to collect the relevant citations using a combination of the key words ("burn," "burned," "burns," "fungal," "fungi," and "fungus") in title or abstract. Case series, reviews, guidelines, and experimental and non-English studies were excluded. Statistical analyses were performed using Microsoft Excel 2019. RESULTS A total of 36 case reports encompassing a total of 44 burn patients with fungal infection were included in the final analysis. Ablative surgeries, including surgical excision, debridement, skin graft, vitrectomy, teeth extraction, valve replacement, or amputation, were performed in 38 cases after the suspicion or identification of fungal infection. Twenty-nine of them were eventually discharged, yielding a survival rate of 76.3%. In the remaining 6 cases, ablative surgery was not mentioned and 3 of them eventually died, yielding a survival rate of 50%. The total mortality was 27.27%. Among the 12 death cases, 1 was infected with Candida albicans, 1 with non-albicans Candida, 2 with Aspergillus spp, 2 with Fusarium spp, 4 with Zygomycetes, and 2 with other fungal species. CONCLUSIONS The overall mortality of fungal wound infection is still high in burn patients around the world, especially those infected with non-Candida species. Early diagnosis of fungal infection, early initiation of appropriate antifungal therapy, and effective surgical intervention are key measures to improve the treatment effect and reduce the mortality of fungal infection in burn patients.
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Affiliation(s)
| | | | - Andrew Breland
- Joseph M. Still Burn and Reconstruction Center, Jackson, MS
| | - Feng Zhang
- Joseph M. Still Burn and Reconstruction Center, Jackson, MS
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Van Bang BN, Thanh Xuan N, Xuan Quang D, Ba Loi C, Thai Ngoc Minh N, Nhu Lam N, Ngoc Anh D, Thi Thu Hien T, Xuan Su H, Tran-Anh L. Prevalence, species distribution, and risk factors of fungal colonization and infection in patients at a burn intensive care unit in Vietnam. Curr Med Mycol 2021; 6:42-49. [PMID: 33834142 PMCID: PMC8018815 DOI: 10.18502/cmm.6.3.4664] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Background and Purpose : Burn patients are at a higher risk of infections caused by different organisms. This study aimed to address the prevalence, causative species, and factors related to fungal colonization or infection in patients with acute severe injuries admitted to the intensive care unit (ICU) of a burn hospital in northern Vietnam. Materials and Methods: This prospective study was conducted on 400 patients in a burn ICU between 2017 and 2019. Clinical samples were weekly collected and screened for fungi, and relevant clinical information was obtained from medical records. Results: According to the results, 90% of the patients were colonized with fungi. Out of this group, 12.75% of the cases had
invasive fungal infection (IFI). Eleven yeasts and six mold species were isolated from the patients, with the most
common species being Candida tropicalis (45.56%) and C. albicans (41.94%). Among the eleven species causing
fungal wound infection (FWI), the most common agents were Candida (66.7% of FWI patients) and Aspergillus (38.5%) species.
Three Candida species isolated from blood were C. tropicalis (66.7%), C. albicans (20.0%),
and C. parapsilosis (14.3%). No factors were found to expose the patients to a higher risk of fungal colonization.
However, hyperglycemia, prolonged ICU stay, and heavy Candida species colonization were found to be independently predictive of IFI. Conclusion: Burn patients are at the risk of fungal infection with Candida species (especially C. tropicalis)
and Aspergillus as the most frequently responsible agents. Continuous surveillance of fungi and appropriate management
of pathophysiological consequences are essential to prevent fungal infection in burn patients.
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Affiliation(s)
- Be Nguyen Van Bang
- Department of Hamatology, Toxicology, Radiation, and Occupational Diseases, Military Hospital 103, Vietnam Military Medical University, Ha Dong, Ha Noi, Vietnam
| | - Nguyen Thanh Xuan
- Department of Medical Education, Military Hospital 103, Vietnam Military Medical University, Ha Dong, Ha Noi, Vietnam
| | - Dinh Xuan Quang
- Department of Scientific and Training Management, National Institute of Malaria, Parasitology, and Entomology, Nam Tu Liem, Ha Noi, Vietnam
| | - Cao Ba Loi
- Department of Scientific and Training Management, National Institute of Malaria, Parasitology, and Entomology, Nam Tu Liem, Ha Noi, Vietnam
| | - Nguyen Thai Ngoc Minh
- Intensive Care Unit, National Hospital of Burn, Vietnam Military Medical University, Ha Dong, Ha Noi, Vietnam
| | - Nguyen Nhu Lam
- Intensive Care Unit, National Hospital of Burn, Vietnam Military Medical University, Ha Dong, Ha Noi, Vietnam
| | - Do Ngoc Anh
- Department of Parasitology, Vietnam Military Medical University, Ha Dong, Ha Noi, Vietnam
| | - Truong Thi Thu Hien
- Department of Microbiology, National Hospital of Burn, Vietnam Military Medical University, Ha Dong, Ha Noi, Vietnam
| | - Hoang Xuan Su
- Department of Microbiology and Pathogens, Institute of Biomedicine and Pharmacy, National Hospital of Burn, Vietnam Military Medical University, Ha Dong, Ha Noi, Vietnam These authors contributed equally to this work and acted as joint first authors
| | - Le Tran-Anh
- Department of Parasitology, Vietnam Military Medical University, Ha Dong, Ha Noi, Vietnam
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Active neutrophil responses counteract Candida albicans burn wound infection of ex vivo human skin explants. Sci Rep 2020; 10:21818. [PMID: 33311597 PMCID: PMC7732850 DOI: 10.1038/s41598-020-78387-y] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Accepted: 11/13/2020] [Indexed: 12/14/2022] Open
Abstract
Burn wounds are highly susceptible sites for colonization and infection by bacteria and fungi. Large wound surface, impaired local immunity, and broad-spectrum antibiotic therapy support growth of opportunistic fungi such as Candida albicans, which may lead to invasive candidiasis. Currently, it remains unknown whether depressed host defenses or fungal virulence drive the progression of burn wound candidiasis. Here we established an ex vivo burn wound model, where wounds were inflicted by applying preheated soldering iron to human skin explants, resulting in highly reproducible deep second-degree burn wounds. Eschar removal by debridement allowed for deeper C. albicans penetration into the burned tissue associated with prominent filamentation. Active migration of resident tissue neutrophils towards the damaged tissue and release of pro-inflammatory cytokine IL-1β accompanied the burn. The neutrophil recruitment was further increased upon supplementation of the model with fresh immune cells. Wound area and depth decreased over time, indicating healing of the damaged tissue. Importantly, prominent neutrophil presence at the infected site correlated to the limited penetration of C. albicans into the burned tissue. Altogether, we established a reproducible burn wound model of candidiasis using ex vivo human skin explants, where immune responses actively control the progression of infection and promote tissue healing.
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10
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Pereira R, Dos Santos Fontenelle RO, de Brito EHS, de Morais SM. Biofilm of Candida albicans: formation, regulation and resistance. J Appl Microbiol 2020; 131:11-22. [PMID: 33249681 DOI: 10.1111/jam.14949] [Citation(s) in RCA: 113] [Impact Index Per Article: 28.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2020] [Revised: 11/10/2020] [Accepted: 11/25/2020] [Indexed: 12/15/2022]
Abstract
Candida albicans is the most common human fungal pathogen, causing infections that range from mucous membranes to systemic infections. The present article provides an overview of C. albicans, with the production of biofilms produced by this fungus, as well as reporting the classes of antifungals used to fight such infections, together with the resistance mechanisms to these drugs. Candida albicans is highly adaptable, enabling the transition from commensal to pathogen due to a repertoire of virulence factors. Specifically, the ability to change morphology and form biofilms is central to the pathogenesis of C. albicans. Indeed, most infections by this pathogen are associated with the formation of biofilms on surfaces of hosts or medical devices, causing high morbidity and mortality. Significantly, biofilms formed by C. albicans are inherently tolerant to antimicrobial therapy, so the susceptibility of C. albicans biofilms to current therapeutic agents remains low. Therefore, it is difficult to predict which molecules will emerge as new clinical antifungals. The biofilm formation of C. albicans has been causing impacts on susceptibility to antifungals, leading to resistance, which demonstrates the importance of research aimed at the prevention and control of these clinical microbial communities.
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Affiliation(s)
- R Pereira
- Graduate Program in Biotechnology, Microbiology Laboratory (LABMIC), Vale do Acaraú State University, Sobral, Ceará, Brazil
| | | | - E H S de Brito
- Institute of Health Sciences of University for International Integration of Afro-Brazilian Lusophony, Redenção, Ceará, Brazil
| | - S M de Morais
- Graduate Program in Biotechnology, Laboratory of Chemistry of Natural Products (LQPN), Ceará State University, Fortaleza, Ceará, Brazil
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11
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Sobouti B, Dahmardehei M, Fallah S, Karrobi M, Ghavami Y, Vaghardoost R. Candidemia in pediatric burn patients: Risk factors and outcomes in a retrospective cohort study. Curr Med Mycol 2020; 6:33-41. [PMID: 33834141 PMCID: PMC8018818 DOI: 10.18502/cmm.6.3.4663] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023] Open
Abstract
Background and Purpose : Despite advances in burn care and management, infections are still a major contributor to morbidity and mortality rates in patients with burn injuries. Regarding this, the present study was conducted to investigate the prevalence and importance of candidemia in pediatric burn patients. Materials and Methods: Blood samples were collected from the patients and cultured in an automated blood culture system. Candida species were identified using specific culture media. The relationship between candidemia and possible risk factors was evaluated and compared to a control group. Results: A total of 71 patients with the mean age of 4.52±3.63 years were included in the study. Blood cultures showed candidemia in 19 (27%) patients. Based on the results,
C. albicans was the most common fungus among patients with and without candidemia. The results of statistical analysis also showed that
candidemia was significantly correlated with total body surface area (TBSA), mechanical ventilation, duration of total parenteral
nutrition, length of intensive care unit (ICU) stay, presence of neutropenia, and R-Baux score (all P≤0.001). In this regard, TBSA, length of ICU stay, R-Baux score, and Candida score were identified as the determinant factors for mortality due to candidemia. Conclusion: Candidemia increases the mortality and morbidity rates associated with burn injuries. Prompt diagnostic and prevention measures can reduce the unfortunate outcomes via controlling the possible risk factors.
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Affiliation(s)
- Behnam Sobouti
- Department of Pediatrics, Ali-Asghar Children Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Mostafa Dahmardehei
- Department of Plastic Surgery, Burn Research Center, Motahari Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Shahrzad Fallah
- Mofid Children Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Majid Karrobi
- Department of Pediatrics, Ali-Asghar Children Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Yaser Ghavami
- Department of Plastic Surgery, Burn Research Center, Motahari Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Reza Vaghardoost
- Department of Plastic Surgery, Burn Research Center, Motahari Hospital, Iran University of Medical Sciences, Tehran, Iran
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12
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Kaita Y, Tarui T, Otsu A, Tanaka Y, Suzuki J, Yoshikawa K, Yamaguchi Y. The Clinical Significance of Serum 1,3-β-D-Glucan For the Diagnosis of Candidemia in Severe Burn Patients. J Burn Care Res 2020; 40:104-106. [PMID: 30365029 DOI: 10.1093/jbcr/iry055] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Although the serum 1,3-β-D-glucan test has been used as an early diagnostic marker of candidemia, there are few studies regarding the association of serum 1,3-β-D-glucan levels with candidemia in severe burn patients. The purpose of this study was to elucidate the clinical significance of 1,3-β-D-glucan for the diagnosis of candidemia in severe burn patients. Data from 51 severe burn patients whose serum levels of 1,3-β-D-glucan had been measured for the suspicion of invasive fungal infection were analyzed retrospectively. The primary outcome in this study was the detection of candidemia. The levels of 1,3-β-D-glucan (pg/ml) in candidemia and noncandidemia groups ranged from 41.1 to 600.0 with a median of 90.6 and from 5.0 to 41.3 with a median of 6.8, respectively. A significant difference in the levels of 1,3-β-D-glucan was observed between the two groups. The optimal cutoff value was 40 pg/ml, with a sensitivity of 100% and a specificity of 95%, whereas the conventional cutoff value (11 pg/ml) resulted in a sensitivity of 100% and a specificity of 68%. The 1,3-β-D-glucan test was found to be useful for detecting candidemia in severe burn patients, and the cutoff value might be set to 40 pg/ml to detect it more accurately.
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Affiliation(s)
- Yasuhiko Kaita
- Department of Trauma and Critical Care Medicine, Kyorin University School of Medicine, Tokyo, Japan
| | - Takehiko Tarui
- Department of Trauma and Critical Care Medicine, Kyorin University School of Medicine, Tokyo, Japan
| | - Akiyasu Otsu
- Department of Trauma and Critical Care Medicine, Kyorin University School of Medicine, Tokyo, Japan
| | - Yuya Tanaka
- Department of Trauma and Critical Care Medicine, Kyorin University School of Medicine, Tokyo, Japan
| | - Jun Suzuki
- Department of Trauma and Critical Care Medicine, Kyorin University School of Medicine, Tokyo, Japan
| | - Kei Yoshikawa
- Department of Trauma and Critical Care Medicine, Kyorin University School of Medicine, Tokyo, Japan
| | - Yoshihiro Yamaguchi
- Department of Trauma and Critical Care Medicine, Kyorin University School of Medicine, Tokyo, Japan
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13
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Silva D, Diniz-Neto H, Cordeiro L, Silva-Neta M, Silva S, Andrade-Júnior F, Leite M, Nóbrega J, Morais M, Souza J, Rosa L, Melo T, Souza H, Sousa A, Rodrigues G, Oliveira-Filho A, Lima E. (R)-(+)-β-Citronellol and (S)-(-)-β-Citronellol in Combination with Amphotericin B against Candida Spp. Int J Mol Sci 2020; 21:ijms21051785. [PMID: 32150884 PMCID: PMC7084460 DOI: 10.3390/ijms21051785] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2019] [Revised: 01/10/2020] [Accepted: 01/13/2020] [Indexed: 12/02/2022] Open
Abstract
The enantiomers (R)-(+)-β-citronellol and (S)-(−)-β-citronellol are present in many medicinal plants, but little is understood about their bioactivity against Candida yeasts. This study aimed to evaluate the behavior of positive and negative enantiomers of β-citronellol on strains of Candida albicans and C. tropicalis involved in candidemia. The minimum inhibitory concentration (MIC) and minimum fungicide concentration (MFC) were determined. The evaluation of growth kinetics, mechanism of action, and association studies with Amphotericin B (AB) using the checkerboard method was also performed. R-(+)-β-citronellol and S-(−)-β-citronellol presented a MIC50% of 64 µg/mL and a MFC50% of 256 µg/mL for C. albicans strains. For C. tropicalis, the isomers exhibited a MIC50% of 256 µg/mL and a MFC50% of 1024 µg/mL. In the mechanism of action assay, both substances displayed an effect on the fungal membrane but not on the fungal cell wall. Synergism and indifference were observed in the association of R-(+)-β-citronellol and AB, while the association between S-(−)-β-citronellol and AB displayed synergism, additivity, and indifference. In conclusion, both isomers of β-citronellol presented a similar profile of antifungal activity. Hence, they can be contemplated in the development of new antifungal drugs providing that further research is conducted about their pharmacology and toxicity.
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Affiliation(s)
- Daniele Silva
- Postgraduate Program in Bioactive Natural and Synthetic Products, Federal University of Paraíba, João Pessoa 58051-970, Brazil; (H.D.-N.); (L.C.); (M.S.-N.); (S.S.); (F.A.-J.); (M.L.); (J.N.); (M.M.); (L.R.); (T.M.); (E.L.)
- Correspondence: ; Tel.: +55-83-99981-1977
| | - Hermes Diniz-Neto
- Postgraduate Program in Bioactive Natural and Synthetic Products, Federal University of Paraíba, João Pessoa 58051-970, Brazil; (H.D.-N.); (L.C.); (M.S.-N.); (S.S.); (F.A.-J.); (M.L.); (J.N.); (M.M.); (L.R.); (T.M.); (E.L.)
| | - Laísa Cordeiro
- Postgraduate Program in Bioactive Natural and Synthetic Products, Federal University of Paraíba, João Pessoa 58051-970, Brazil; (H.D.-N.); (L.C.); (M.S.-N.); (S.S.); (F.A.-J.); (M.L.); (J.N.); (M.M.); (L.R.); (T.M.); (E.L.)
| | - Maria Silva-Neta
- Postgraduate Program in Bioactive Natural and Synthetic Products, Federal University of Paraíba, João Pessoa 58051-970, Brazil; (H.D.-N.); (L.C.); (M.S.-N.); (S.S.); (F.A.-J.); (M.L.); (J.N.); (M.M.); (L.R.); (T.M.); (E.L.)
| | - Shellygton Silva
- Postgraduate Program in Bioactive Natural and Synthetic Products, Federal University of Paraíba, João Pessoa 58051-970, Brazil; (H.D.-N.); (L.C.); (M.S.-N.); (S.S.); (F.A.-J.); (M.L.); (J.N.); (M.M.); (L.R.); (T.M.); (E.L.)
| | - Francisco Andrade-Júnior
- Postgraduate Program in Bioactive Natural and Synthetic Products, Federal University of Paraíba, João Pessoa 58051-970, Brazil; (H.D.-N.); (L.C.); (M.S.-N.); (S.S.); (F.A.-J.); (M.L.); (J.N.); (M.M.); (L.R.); (T.M.); (E.L.)
| | - Maria Leite
- Postgraduate Program in Bioactive Natural and Synthetic Products, Federal University of Paraíba, João Pessoa 58051-970, Brazil; (H.D.-N.); (L.C.); (M.S.-N.); (S.S.); (F.A.-J.); (M.L.); (J.N.); (M.M.); (L.R.); (T.M.); (E.L.)
| | - Jefferson Nóbrega
- Postgraduate Program in Bioactive Natural and Synthetic Products, Federal University of Paraíba, João Pessoa 58051-970, Brazil; (H.D.-N.); (L.C.); (M.S.-N.); (S.S.); (F.A.-J.); (M.L.); (J.N.); (M.M.); (L.R.); (T.M.); (E.L.)
| | - Maria Morais
- Postgraduate Program in Bioactive Natural and Synthetic Products, Federal University of Paraíba, João Pessoa 58051-970, Brazil; (H.D.-N.); (L.C.); (M.S.-N.); (S.S.); (F.A.-J.); (M.L.); (J.N.); (M.M.); (L.R.); (T.M.); (E.L.)
| | - Juliana Souza
- Department of Chemistry, Federal University of Paraíba, João Pessoa 58051-970, Brazil; (J.S.); (H.S.)
| | - Lyvia Rosa
- Postgraduate Program in Bioactive Natural and Synthetic Products, Federal University of Paraíba, João Pessoa 58051-970, Brazil; (H.D.-N.); (L.C.); (M.S.-N.); (S.S.); (F.A.-J.); (M.L.); (J.N.); (M.M.); (L.R.); (T.M.); (E.L.)
| | - Thamara Melo
- Postgraduate Program in Bioactive Natural and Synthetic Products, Federal University of Paraíba, João Pessoa 58051-970, Brazil; (H.D.-N.); (L.C.); (M.S.-N.); (S.S.); (F.A.-J.); (M.L.); (J.N.); (M.M.); (L.R.); (T.M.); (E.L.)
| | - Helivaldo Souza
- Department of Chemistry, Federal University of Paraíba, João Pessoa 58051-970, Brazil; (J.S.); (H.S.)
| | - Aleson Sousa
- Postgraduate Program in Drug Development and Technological Innovation, Federal University of Paraíba, João Pessoa 58051-970, Brazil;
| | - Gregório Rodrigues
- Postgraduate Program in Dentistry, Federal University of Paraíba, João Pessoa 58051-970, Brazil;
| | - Abrahão Oliveira-Filho
- Health and Rural Technology Center, Federal University of Campina Grande, Patos 58700-970, Brazil;
| | - Edeltrudes Lima
- Postgraduate Program in Bioactive Natural and Synthetic Products, Federal University of Paraíba, João Pessoa 58051-970, Brazil; (H.D.-N.); (L.C.); (M.S.-N.); (S.S.); (F.A.-J.); (M.L.); (J.N.); (M.M.); (L.R.); (T.M.); (E.L.)
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14
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Abstract
Abstract
The purpose of this review is to summarize the current knowledge acquired during preclinical and clinical studies regarding topically used herbal products with burn wound-healing activity. Moreover, antimicrobial, anti-inflammatory, and antioxidant mechanisms of their action as well as adverse effects of herbal therapy will be also described.
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Affiliation(s)
- Anna Herman
- Faculty of Health Sciences, Warsaw School of Engineering and Health, Warsaw, Poland
| | - Andrzej P Herman
- Department of Genetic Engineering, The Kielanowski Institute of Animal Physiology and Nutrition, Polish Academy of Sciences, Jabłonna near Warsaw, Poland
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15
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Koulenti D, Blot S. Patterns in the epidemiology of candidemia as a consequence of antibiotic and antifungal exposure. Burns 2019; 46:500-501. [PMID: 31822351 DOI: 10.1016/j.burns.2019.11.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2019] [Accepted: 11/05/2019] [Indexed: 12/25/2022]
Affiliation(s)
- Despoina Koulenti
- Burns, Trauma and Critical Care Research Centre, Centre for Clinical Research, Faculty of Medicine, The University of Queensland, Brisbane, Australia; 2nd Critical Care Department, Attikon University Hospital, Athens, Greece
| | - Stijn Blot
- Burns, Trauma and Critical Care Research Centre, Centre for Clinical Research, Faculty of Medicine, The University of Queensland, Brisbane, Australia; Dept. of Internal Medicine and Pediatrics, Ghent University, Ghent, Belgium.
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16
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Ferreira EG, Yatsuda F, Pini M, Jarros IC, Veiga FF, de Oliveira AG, Negri M, Svidzinski TIE. Implications of the presence of yeasts in tracheobronchial secretions of critically ill intubated patients. EXCLI JOURNAL 2019; 18:801-811. [PMID: 31645841 PMCID: PMC6806203 DOI: 10.17179/excli2019-1631] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/11/2019] [Accepted: 09/03/2019] [Indexed: 12/28/2022]
Abstract
The presence of some microorganisms in the respiratory tract is a known risk factor for the infection of air passages; however, it is not clear whether this holds true for Candida spp. Thus, our objective was to determine the frequency of yeast colonization in the tracheobronchial secretions of critically ill intubated patients and to assess the presence of these yeasts in the infra-cuff region of the endotracheal tube (ET). Patients aged 18 years or older who had been using an endotracheal tube for 48 hours were recruited. Tracheal secretions were collected; after extubation, the ETs were cut into two fragments in the infra-cuff region. One of these fragments was placed in a solution containing antibiotics and sent to the lab for culture and identification of yeasts. The remaining fragment was fixed and subjected to scanning electron microscopy (SEM). In total, 20 patients with an average age of 73.3 years (± 13.1) participated in this study. These patients remained under endotracheal intubation and invasive mechanical ventilation for an average of 6.4 (± 1.8) and 13.5 days (± 15), respectively. Of these patients, 45 % showed respiratory tract colonization by yeasts of the Candida genus, with C. albicans being the most frequently isolated species (66.7 %). Moreover, in almost 90 % of these patients, blastoconidia of the same yeast were found in the infra-cuff portion of the ET, as evidenced by SEM, strongly fixed on the ET surface. Yeasts isolated from both the infra-cuff region and the tracheobronchial secretions were susceptible to amphotericin B and fluconazole. In conclusion, our results show that the frequency of colonization by yeasts of the Candida genus in the tracheobronchial secretions of intubated patients within 48 hours is high, and that these species can also be found as a biofilm on the ET surface.
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Affiliation(s)
- Elenice Gomes Ferreira
- Graduate Programme in Health Sciences, Universidade Estadual de Maringá (UEM), Maringá, PR, Brazil.,Department of Physiotherapy UniCesumar, Maringá, PR, Brazil
| | - Fabrício Yatsuda
- Department of Physiotherapy UniCesumar, Maringá, PR, Brazil.,PIC/UniCesumar/ICETI (Instituto Cesumar de Ciência, Tecnologia e Inovação)
| | - Marcio Pini
- Department of Physiotherapy UniCesumar, Maringá, PR, Brazil.,PIC/UniCesumar/ICETI (Instituto Cesumar de Ciência, Tecnologia e Inovação)
| | - Isabele Carrilho Jarros
- Graduate Programme in Health Sciences, Universidade Estadual de Maringá (UEM), Maringá, PR, Brazil
| | - Flávia Franco Veiga
- Graduate Programme in Health Sciences, Universidade Estadual de Maringá (UEM), Maringá, PR, Brazil
| | | | - Melyssa Negri
- Division of Medical Mycology, Teaching and Research Laboratory in Clinical Analyses, Department of Clinical Analysis of State University of Maringa, Avenida Colombo 5790, 87020-900 Maringá, PR, Brazil
| | - Terezinha Inez Estivalet Svidzinski
- Division of Medical Mycology, Teaching and Research Laboratory in Clinical Analyses, Department of Clinical Analysis of State University of Maringa, Avenida Colombo 5790, 87020-900 Maringá, PR, Brazil
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17
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Candida spp. and phagocytosis: multiple evasion mechanisms. Antonie van Leeuwenhoek 2019; 112:1409-1423. [PMID: 31079344 DOI: 10.1007/s10482-019-01271-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/18/2019] [Accepted: 05/02/2019] [Indexed: 01/01/2023]
Abstract
Invasive fungal infections are a global health problem, mainly in hospitals, where year by year hundreds of patients die because of these infections. Commensal yeasts may become pathogenic to human beings, affecting mainly immunocompromised patients. During infectious processes, the immune system uses phagocytes to eliminate invader microorganisms. In order to prevent or neutralize phagocyte attacks, pathogenic yeasts can use virulence factors to survive, as well as to colonize and infect the host. In this review, we describe how Candida spp., mainly Candida albicans, interact with phagocytes and use several factors that contribute to immune evasion. Polymorphism, biofilm formation, gene expression and enzyme production mediate distinct functions such as adhesion, invasion, oxidative stress response, proteolysis and escape from phagocytes. Fungal and human cells have similar structures and mechanisms that decrease the number of potential targets for antifungal drugs. Therefore, research on host-pathogen interaction may aid in the discovery of new targets and in the development of new drugs or treatments for these diseases and thus to save lives.
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18
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Zhou J, Tan J, Gong Y, Li N, Luo G. Candidemia in major burn patients and its possible risk factors: A 6-year period retrospective study at a burn ICU. Burns 2019; 45:1164-1171. [PMID: 30686692 DOI: 10.1016/j.burns.2019.01.005] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2018] [Revised: 12/26/2018] [Accepted: 01/03/2019] [Indexed: 02/06/2023]
Abstract
OBJECTIVE The aims of this study were to evaluate the epidemiological and clinical characteristics of candidemia in a typical burn ICU, and to determine the risk factors associated with candidemia among major burn patients. METHOD This retrospective observational study of candidemia from 2012 to 2017 in a burn ICU was conducted in the Department of Burn, Southwest hospital, Chongqing, China. RESULTS The study included 410 major burn patients (≥40% total body surface area), 39 (9.51%) of which were diagnosed with candidemia. The annual incidences of candidemia varied from 6.06% to 17.54%, and increased gradually in the 6 years. Candida parapsilosis was the dominant pathogen (28.21% strains). The overall resistance rate of Candida spp. to fluconazole was 35.89%. Candidemia cases most frequently occurred in the 2nd (30.77%) and 3rd (23.08%) weeks after burn, and intravascular catheters were the most common sources of bloodstream Candida infections (31.58%). The crude mortality of candidemia was 23.08%, and the mortality attributable to candidemia was 14.99%. Risk factors of candidemia included inhalation injury, renal dysfunction with replacement therapy, severe gastrointestinal complications, T-cell lymphopenia and prior Candida colonization. CONCLUSION Candidemia has a high incidence and mortality in major burn patients. The changes in etiology and drug sensitivity may make new challenges for the management of candidemia in burn ICUs.
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Affiliation(s)
- Junyi Zhou
- State Key Laboratory of Trauma, Burn and Combined Injury, Institute of Burn Research, Southwest Hospital, the Third Military Medical University, Chongqing 400038, China
| | - Jianglin Tan
- State Key Laboratory of Trauma, Burn and Combined Injury, Institute of Burn Research, Southwest Hospital, the Third Military Medical University, Chongqing 400038, China
| | - Yali Gong
- State Key Laboratory of Trauma, Burn and Combined Injury, Institute of Burn Research, Southwest Hospital, the Third Military Medical University, Chongqing 400038, China
| | - Ning Li
- State Key Laboratory of Trauma, Burn and Combined Injury, Institute of Burn Research, Southwest Hospital, the Third Military Medical University, Chongqing 400038, China
| | - Gaoxing Luo
- State Key Laboratory of Trauma, Burn and Combined Injury, Institute of Burn Research, Southwest Hospital, the Third Military Medical University, Chongqing 400038, China.
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19
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Zhou F, Xu H, Song Z, Zhu L, Feng S, Feng R. α-Linolenic acid-modified pluronic 127-CS copolymeric micelles for the skin targeted delivery of amphotericin B. NEW J CHEM 2019. [DOI: 10.1039/c8nj03847c] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
In this study, an α-linolenic acid modified pluronic F127-block-chitosan (F127-(CS-LNA)2) copolymer was synthesized to prepare topical amphotericin B (AMB)-loaded micelles (AMB-M) via a dialysis technique.
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Affiliation(s)
- Feilong Zhou
- School of Biological Science and Technology
- University of Jinan
- Jinan 250022
- P. R. China
| | - Hongmei Xu
- School of Biological Science and Technology
- University of Jinan
- Jinan 250022
- P. R. China
| | - Zhimei Song
- School of Biological Science and Technology
- University of Jinan
- Jinan 250022
- P. R. China
| | - Li Zhu
- School of Biological Science and Technology
- University of Jinan
- Jinan 250022
- P. R. China
| | - Sijia Feng
- School of Basic Medical Sciences
- Dali University
- Dali 671000
- P. R. China
| | - Runliang Feng
- School of Biological Science and Technology
- University of Jinan
- Jinan 250022
- P. R. China
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20
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Dudoignon E, Alanio A, Anstey J, Depret F, Coutrot M, Fratani A, Jully M, Cupaciu A, Chaussard M, Oueslati H, Ferry A, Benyamina M, de Tymowski C, Boccara D, Serror K, Chaouat M, Mimoun M, Lafaurie M, Denis B, Gits-Muselli M, Bretagne S, Mebazaa A, Legrand M, Soussi S. Outcome and potentially modifiable risk factors for candidemia in critically ill burns patients: A matched cohort study. Mycoses 2018; 62:237-246. [PMID: 30478963 DOI: 10.1111/myc.12872] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2018] [Revised: 10/26/2018] [Accepted: 11/20/2018] [Indexed: 12/14/2022]
Abstract
BACKGROUND Patients with extensive burns are at risk of developing candidemia. OBJECTIVES To identify potentially modifiable risk factors and outcomes of candidemia in critically ill burns patients. PATIENTS AND METHODS Retrospective matched cohort study including adult burns patients. Patients who developed candidemia were matched with burns patients with Candida spp colonisation and sepsis or septic shock without candidemia in a ratio of 1:3 (same severity scores and colonisation index). Univariate and multiple regression analyses were performed. RESULTS Of 130 severely burned patients with Candida spp colonisation and at least one episode of sepsis or septic shock, 14 were diagnosed with candidemia. In the candidemia group, patients had a median (IQR) total burns surface area (TBSA) of 57 (38-68)%, SAPSII of 43 (36-58) and ABSI of 11 (8-13). Multiple regression analysis showed that only duration of prior antibiotic therapy was independently associated with candidemia. ICU mortality was higher in the candidemia group (71% vs 35% [P = 0.02]). The log-rank test for 28-day mortality comparing patients with candidemia treated with an empirical strategy vs a curative strategy did not reach significance (P = 0.056). CONCLUSIONS Burns patients having received recent antibiotherapy have a higher risk of candidemia. Antifungal strategies did not influence outcome in this series.
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Affiliation(s)
- Emmanuel Dudoignon
- Department of Anesthesiology and Critical Care and Burn Unit, AP-HP, Hôpital Saint-Louis, Paris, France
| | - Alexandre Alanio
- Parasitology and Mycology laboratory, AP-HP, Hôpital Saint-Louis, Paris, France.,Université Paris Diderot, Paris, France.,Molecular mycology unit, Institut Pasteur, CNRS, UMR2000, Paris, France
| | - James Anstey
- Intensive Care Unit, Royal Melbourne Hospital, Parkville, Melbourne, Australia
| | - François Depret
- Department of Anesthesiology and Critical Care and Burn Unit, AP-HP, Hôpital Saint-Louis, Paris, France.,Université Paris Diderot, Paris, France
| | - Maxime Coutrot
- Department of Anesthesiology and Critical Care and Burn Unit, AP-HP, Hôpital Saint-Louis, Paris, France.,Université Paris Diderot, Paris, France
| | - Alexandre Fratani
- Department of Anesthesiology and Critical Care and Burn Unit, AP-HP, Hôpital Saint-Louis, Paris, France
| | - Marion Jully
- Department of Anesthesiology and Critical Care and Burn Unit, AP-HP, Hôpital Saint-Louis, Paris, France
| | - Alexandru Cupaciu
- Department of Anesthesiology and Critical Care and Burn Unit, AP-HP, Hôpital Saint-Louis, Paris, France
| | - Maïté Chaussard
- Department of Anesthesiology and Critical Care and Burn Unit, AP-HP, Hôpital Saint-Louis, Paris, France
| | - Haikel Oueslati
- Department of Anesthesiology and Critical Care and Burn Unit, AP-HP, Hôpital Saint-Louis, Paris, France
| | - Axelle Ferry
- Department of Anesthesiology and Critical Care and Burn Unit, AP-HP, Hôpital Saint-Louis, Paris, France
| | - Mourad Benyamina
- Department of Anesthesiology and Critical Care and Burn Unit, AP-HP, Hôpital Saint-Louis, Paris, France
| | - Christian de Tymowski
- Department of Anesthesiology and Critical Care and Burn Unit, AP-HP, Hôpital Saint-Louis, Paris, France
| | - David Boccara
- Plastic Surgery and Burn Unit, AP-HP, Hôpital Saint-Louis, Paris, France
| | - Kevin Serror
- Plastic Surgery and Burn Unit, AP-HP, Hôpital Saint-Louis, Paris, France
| | - Marc Chaouat
- Plastic Surgery and Burn Unit, AP-HP, Hôpital Saint-Louis, Paris, France
| | - Maurice Mimoun
- Plastic Surgery and Burn Unit, AP-HP, Hôpital Saint-Louis, Paris, France
| | - Matthieu Lafaurie
- Department of Infectious Diseases, AP-HP, Hôpital Saint-Louis, Paris, France
| | - Blandine Denis
- Department of Infectious Diseases, AP-HP, Hôpital Saint-Louis, Paris, France
| | - Maud Gits-Muselli
- Parasitology and Mycology laboratory, AP-HP, Hôpital Saint-Louis, Paris, France.,Université Paris Diderot, Paris, France.,Molecular mycology unit, Institut Pasteur, CNRS, UMR2000, Paris, France
| | - Stephane Bretagne
- Parasitology and Mycology laboratory, AP-HP, Hôpital Saint-Louis, Paris, France.,Université Paris Diderot, Paris, France.,Molecular mycology unit, Institut Pasteur, CNRS, UMR2000, Paris, France
| | - Alexandre Mebazaa
- Department of Anesthesiology and Critical Care and Burn Unit, AP-HP, Hôpital Saint-Louis, Paris, France.,Université Paris Diderot, Paris, France.,Institut National de la Santé et de la Recherche Médicale (INSERM), UMR INSERM 942, Hôpital Lariboisière, F-CRIN INI-CRCT network, Univ Paris Diderot, Paris, France
| | - Matthieu Legrand
- Department of Anesthesiology and Critical Care and Burn Unit, AP-HP, Hôpital Saint-Louis, Paris, France.,Université Paris Diderot, Paris, France.,Institut National de la Santé et de la Recherche Médicale (INSERM), UMR INSERM 942, Hôpital Lariboisière, F-CRIN INI-CRCT network, Univ Paris Diderot, Paris, France
| | - Sabri Soussi
- Department of Anesthesiology and Critical Care and Burn Unit, AP-HP, Hôpital Saint-Louis, Paris, France
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21
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Okuno E, Jarros IC, Bonfim-Mendonça PS, Vicente de Rezende G, Negri M, Svidzinski TE. Candida parapsilosis isolates from burn wounds can penetrate an acellular dermal matrix. Microb Pathog 2018; 118:330-335. [PMID: 29614369 DOI: 10.1016/j.micpath.2018.03.058] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2018] [Revised: 03/18/2018] [Accepted: 03/30/2018] [Indexed: 11/26/2022]
Abstract
We isolated and identified yeasts from burn wounds and evaluated the ability of Candida parapsilosis isolates from burn wounds to penetrate an acellular dermal matrix (ADM). A prospective study was conducted with patients from the burn treatment center of North Paraná University Hospital in Londrina, Brazil from February 2015 to January 2016. Yeast cultures were obtained from the tissue of burn wounds that had been debrided and cleansed with 2% chlorhexidine. After identification and confirmation of the purity of the culture, the yeasts were placed on ADM fragments and incubated for three or seven days. During the study period, 273 patients were treated, and 36 of these patients fulfilled the inclusion criteria and provided samples for culture. Yeasts were isolated in 19.44% (n = 7) of the cultures, and the following species were identified: C. parapsilosis (57.1%), C. albicans (28.6%), and C. glabrata (14.3%). C. parapsilosis, the most frequent species, was chosen for the ADM tests. We demonstrated active penetration of the ADM by the yeast isolates from burn wounds. C. parapsilosis grew on ADM and penetrated the matrix, indicating that this yeast, which is common in skin and cutaneous wounds, has the potential to colonize and pass through ADM, a medical device that is frequently used to dress and regenerate burn wounds.
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Affiliation(s)
- Erika Okuno
- Laboratory of Medical Mycology, State University of Maringá, Brazil; Burn Treatment Center of the North Paraná University Hospital, State University of Londrina, Brazil
| | | | | | | | - Melyssa Negri
- Laboratory of Medical Mycology, State University of Maringá, Brazil
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22
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Lipovy B, Kocmanova I, Holoubek J, Hanslianova M, Bezdicek M, Rihova H, Suchanek I, Brychta P. The first isolation of Westerdykella dispersa in a critically burned patient. Folia Microbiol (Praha) 2018; 63:479-482. [DOI: 10.1007/s12223-018-0590-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2018] [Accepted: 02/07/2018] [Indexed: 11/25/2022]
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23
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Jarros IC, Okuno É, Costa MI, Veiga FF, de Souza Bonfim-Mendonça P, Negri MFN, Svidzinski TIE. Yeasts from skin colonization are able to cross the acellular dermal matrix. Microb Pathog 2018; 117:1-6. [PMID: 29428422 DOI: 10.1016/j.micpath.2018.02.014] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2017] [Revised: 02/07/2018] [Accepted: 02/07/2018] [Indexed: 10/18/2022]
Abstract
In recent decades, the prognosis for burn patients has improved considerably with the development of specialized care. The acellular dermal matrix (ADM) is a totally artificial acellular device that functions to control water loss, prevent penetration by bacteria and allow migration of endothelial cells and fibroblasts from patient tissues. However, little is known about its effectiveness against yeasts. The present study evaluated the capacity of colonization and migration of some human commensal yeasts. Three clinical isolates from skin scales, identified as Candida parapsilosis, Candida glabrata and Rhodotorula mucilaginosa, were used. Their ability to cross the ADM was evaluated. After three days, all isolates had crossed the ADM. C. parapsilosis showed the lowest growth, while R. mucilaginosa showed intermediate and C. glabrata the highest growth. In the plates incubated for seven days, the growth of C. parapsilosis and C. glabrata increased by 1 log over the third day. All isolates have the capacity to colonize and migrate through the matrix, increasing the potential risk to burn patients, who can develop severe and even fatal infections by invasive fungi.
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Affiliation(s)
- Isabele Carrilho Jarros
- Division of Medical Mycology, Teaching and Research Laboratory in Clinical Analyses, Department of Clinical Analysis of State University of Maringá, Paraná, Brazil
| | - Érika Okuno
- Division of Medical Mycology, Teaching and Research Laboratory in Clinical Analyses, Department of Clinical Analysis of State University of Maringá, Paraná, Brazil
| | - Maiara Ignacio Costa
- Division of Medical Mycology, Teaching and Research Laboratory in Clinical Analyses, Department of Clinical Analysis of State University of Maringá, Paraná, Brazil
| | - Flávia Franco Veiga
- Division of Medical Mycology, Teaching and Research Laboratory in Clinical Analyses, Department of Clinical Analysis of State University of Maringá, Paraná, Brazil
| | - Patricia de Souza Bonfim-Mendonça
- Division of Medical Mycology, Teaching and Research Laboratory in Clinical Analyses, Department of Clinical Analysis of State University of Maringá, Paraná, Brazil
| | - Melyssa Fernanda Norman Negri
- Division of Medical Mycology, Teaching and Research Laboratory in Clinical Analyses, Department of Clinical Analysis of State University of Maringá, Paraná, Brazil
| | - Terezinha Inez Estivalet Svidzinski
- Division of Medical Mycology, Teaching and Research Laboratory in Clinical Analyses, Department of Clinical Analysis of State University of Maringá, Paraná, Brazil.
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24
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Udy AA, Roberts JA, Lipman J, Blot S. The effects of major burn related pathophysiological changes on the pharmacokinetics and pharmacodynamics of drug use: An appraisal utilizing antibiotics. Adv Drug Deliv Rev 2018; 123:65-74. [PMID: 28964882 DOI: 10.1016/j.addr.2017.09.019] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2017] [Revised: 08/31/2017] [Accepted: 09/22/2017] [Indexed: 12/13/2022]
Abstract
Patients suffering major burn injury represent a unique population of critically ill patients. Widespread skin and tissue damage causes release of systemic inflammatory mediators that promote endothelial leak, extravascular fluid shifts, and cardiovascular derangement. This phase is characterized by relative intra-vascular hypovolaemia and poor peripheral perfusion. Large volume intravenous fluid resuscitation is generally required. The patients' clinical course is then typically complicated by ongoing inflammation, protein catabolism, and marked haemodynamic perturbation. At all times, drug distribution, metabolism, and elimination are grossly distorted. For hydrophilic agents, changes in volume of distribution and clearance are marked, resulting in potentially sub-optimal drug exposure. In the case of antibiotics, this may then promote treatment failure, or the development of bacterial drug resistance. As such, empirical dose selection and pharmaceutical development must consider these features, with the application of strategies that attempt to counter the unique pharmacokinetic changes encountered in this setting.
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25
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Renau AI, García-Vidal C, Salavert M. Enfermedades invasivas por hongos levaduriformes en pacientes quemados graves. Rev Iberoam Micol 2016; 33:160-9. [DOI: 10.1016/j.riam.2016.02.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2016] [Accepted: 02/10/2016] [Indexed: 10/21/2022] Open
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26
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Gong X, Luan T, Wu X, Li G, Qiu H, Kang Y, Qin B, Fang Q, Cui W, Qin Y, Li J, Zang B. Invasive candidiasis in intensive care units in China: Risk factors and prognoses of Candida albicans and non-albicans Candida infections. Am J Infect Control 2016; 44:e59-63. [PMID: 26781222 DOI: 10.1016/j.ajic.2015.11.028] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2015] [Revised: 11/18/2015] [Accepted: 11/19/2015] [Indexed: 02/05/2023]
Abstract
BACKGROUND To investigate the risk factors and prognoses of patients with invasive Candida albicans and non-albicans Candida (NAC) infection in intensive care units (ICUs) in China. METHODS Between November 2009 and April 2011, we performed a prospective study of critically ill patients with invasive Candida infection from 67 ICUs across China to compare the risk factors and mortality between patients with C albicans and NAC infection. RESULTS There were 306 patients with proven invasive Candida; 244 cases (a total 389 Candida isolates) were sent to laboratory for strain identification (C albicans, 40.1%; NAC, 59.9%). More patients admitted for surgery or trauma had NAC infection than C albicans infection. C albicans infection was more common in patients with subclavian vein catheters or peritoneal drainage tubes. Compared with patients with C albicans infection, patients with NAC infection had longer antifungal therapy (P < .001), longer ICU (P = .004) or hospital stay (P = .002), and slightly higher mortality (38.4% vs 29.6%), but the difference was not significant (P = .17). CONCLUSIONS C albicans remains the most common pathogen in candidiasis in critical care patients. However, the number of NAC infections exceeded C albicans infections. Compared with patients with C albicans infection, patients with NAC infection had heavier disease burdens.
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Affiliation(s)
- Xiaoying Gong
- Department of Intensive Care Medicine, Shengjing Hospital of China Medical University, Shenyang, China
| | - Ting Luan
- Department of Intensive Care Medicine, Shengjing Hospital of China Medical University, Shenyang, China
| | - Xingmao Wu
- Department of Intensive Care Medicine, Shengjing Hospital of China Medical University, Shenyang, China
| | - Guofu Li
- Department of Intensive Care Medicine, Shengjing Hospital of China Medical University, Shenyang, China
| | - Haibo Qiu
- Department of Intensive Care Medicine, Nanjing Zhongda Hospital, Southeast University School of Medicine, Nanjing, China
| | - Yan Kang
- Department of Intensive Care Medicine, West China Hospital, Sichuan University, Chengdu, China
| | - Bingyu Qin
- Department of Intensive Care Medicine, Henan Provincial People's Hospital, Zhengzhou, China
| | - Qiang Fang
- Department of Intensive Care Medicine, The First Affiliated Hospital, Zhejiang University, Hangzhou, China
| | - Wei Cui
- Department of Intensive Care Medicine, The Second Affiliated Hospital, Zhejiang University School of Medcine, Hangzhou, China
| | - Yingzhi Qin
- Department of Intensive Care Medicine, Tianjin Third Central Hospital, Tianjin, China
| | - Jianguo Li
- Department of Intensive Care Medicine, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Bin Zang
- Department of Intensive Care Medicine, Shengjing Hospital of China Medical University, Shenyang, China.
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27
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Renau Escrig AI, Salavert M, Vivó C, Cantón E, Pérez Del Caz MD, Pemán J. Candidemia in major burns patients. Mycoses 2016; 59:391-8. [PMID: 26931414 DOI: 10.1111/myc.12488] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2015] [Revised: 12/06/2015] [Accepted: 02/02/2016] [Indexed: 11/28/2022]
Abstract
Major burn patients have characteristics that make them especially susceptible to candidemia, but few studies focused on this have been published. The objectives were to evaluate the epidemiological, microbiological and clinical aspects of candidemia in major burn patients, determining factors associated with a poorer prognosis and mortality. We conducted a retrospective observational study of candidemia between 1996 and 2012 in major burn patients admitted to the La Fe University Hospital, Valencia, Spain. The study included 36 episodes of candidemia in the same number of patients, 55.6% men, mean age 37.33 years and low associated comorbidity. The incidence of candidemia varied between 0.26 and 6.09 episodes/1000 days stay in the different years studied. Candida albicans was the most common species (61.1%) followed by Candida parapsilosis (27.8%). Candidemia by C. krusei, C. glabrata or C. tropicalis were all identified after 2004. Central vascular catheter (CVC) was established as a potential source of candidemia in 36.1%, followed by skin and soft tissues of thermal injury (22.2%) and urinary tract (8.3%). Fluconazole was used in 19 patients (52.7%) and its in vitro resistance rate was 13.9%. The overall mortality was 47.2%, and mortality related to candidemia was 30.6%. Factors associated with increased mortality were those related to severe infection and shock. CVC was the most usual focus of candidemia. Fluconazole was the most common antifungal drug administered. The management of candidemia in major burn patients is still a challenge.
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Affiliation(s)
- Ana I Renau Escrig
- Internal Medicine Department (Medical Clinic Area), La Fe University and Polytechnic Hospital, Valencia, Spain
| | - Miguel Salavert
- Infectious Diseases Unit (Medical Clinic Area), La Fe University and Polytechnic Hospital, Valencia, Spain
| | - Carmen Vivó
- Major Burns Unit, La Fe University and Polytechnic Hospital, Valencia, Spain
| | - Emilia Cantón
- Experimental Microbiology Unit, Research Centre, La Fe University and Polytechnic Hospital, Valencia, Spain
| | | | - Javier Pemán
- Mycology Unit, Microbiology Department, La Fe University and Polytechnic Hospital, Valencia, Spain
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28
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Improved detection of deeply invasive candidiasis with DNA aptamers specific binding to (1→3)-β-D-glucans from Candida albicans. Eur J Clin Microbiol Infect Dis 2016; 35:587-95. [PMID: 26810058 DOI: 10.1007/s10096-015-2574-8] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2015] [Accepted: 12/30/2015] [Indexed: 01/02/2023]
Abstract
Deeply invasive or disseminated candidiasis is a serious and often fatal complication that can occur frequently in immuno-compromised individuals. However, conventional diagnostic methods of Candida albicans display low sensitivity and lack of specificity; the development of rapid and accurate detection methods remains a high priority. Aptamers are single-strand DNA or RNA oligonucleotides that specifically bind to target molecules with high affinity. In this study, we sought to screen high-affinity DNA aptamers that specifically bound to (1→3)-β-D-glucans from cell wall of Candida albicans using a systematic evolution of ligands by exponential enrichment (SELEX) technique, and further evaluate the diagnostic potential for invasive or disseminated candidiasis with selected aptamers. (1→3)-β-D-glucans was purified from Candida albicans, and two single DNA aptamers (designated as AU1 and AD1) were selected. Analysis of dissociation constants and binding domains further revealed that these two selected single DNA aptamers (AU1 and AD1) showed high binding affinity (AD1: Kd = 79.76 nM, AD1: Kd = 103.7 nM) and did not bind to the same domain of (1→3)-β-D-glucans. Next, we further detected (1→3)-β-D-glucans in serum samples from different groups of patients with Candida albicans infection or simple bacterial infection by using a double-aptamer sandwich enzyme-linked oligonucleotide assay (ELONA). The results showed that the sensitivity and specificity of this aptamer-based sandwich ELONA were 92.31 % and 91.94 % respectively. Thus, our study suggests that AU1 and AD1 have potential application for the differentiate diagnosis of deeply invasive candidiasis and provide valuable clues for designing diagnostic agents for the identification of invasive fungal infection.
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29
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Lotfi N, Shokohi T, Nouranibaladezaei SZ, Nasrolahi Omran A, Kondori N. High Recovery Rate of Non-albicans Candida Species Isolated From Burn Patients With Candidemia in Iran. Jundishapur J Microbiol 2015; 8:e22929. [PMID: 26587207 PMCID: PMC4644265 DOI: 10.5812/jjm.22929] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2014] [Revised: 01/29/2015] [Accepted: 02/24/2015] [Indexed: 12/21/2022] Open
Abstract
Background: Blood stream infections (BSIs) are major causes of morbidity and mortality in burn patients. Microorganisms responsible for BSI are generally bacteria; however, Candida spp. are the infection agents in as many as 8% of all cases. Burn wound colonization and infections are generally the first steps to systemic infection. Candidemia in burn patients has been associated with high mortality and a prolonged hospital stay. Objectives: Candidemia in burn patients has been defined as a preterminal event, leading to high morbidity and mortality rates among these patients. The aim of this study was to establish the incidence of candidemia in burn patients in Iran. Patients and Methods: We consecutively collected 405 blood samples from 113 burn patients. The yeast isolates were identified to the species level using conventional procedures. In vitro antifungal susceptibility of the Candida isolates to amphotericin B, fluconazole, voriconazole and caspofungin was performed using the Etest. Results: Twenty-seven samples (6.7%) of the blood cultures from 13 patients (12%) were positive for Candida species. Candidaparapsilosis (38%) and C. tropicalis (38%) were the most commonly found Candida species, followed by C. albicans (15%) and C. guilliermondii (15%) in the patients. The incidence of candidemia was significantly correlated with increased duration of hospitalization, increased time of stay in the intensive care unit, and higher mortality. The antifungal susceptibility tests demonstrated that amphotericin B and voriconazole had the lowest minimum inhibitory concentrations (MICs) against Candida spp. Conclusions: Non-albicans Candida should be considered as significant pathogens in burned patients with candidemia.
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Affiliation(s)
- Nazanin Lotfi
- Department of Medical Mycology, Faculty of Medical Sciences, Tonekabon Branch, Islamic Azad University, Tonekabon, IR Iran
- Department of Medical Mycology and Parasitology, Invasive Fungi Research Center, School of Medicine, Mazandaran University of Medical Sciences, Sari, IR Iran
| | - Tahereh Shokohi
- Department of Medical Mycology and Parasitology, Invasive Fungi Research Center, School of Medicine, Mazandaran University of Medical Sciences, Sari, IR Iran
- Corresponding author: Tahereh Shokohi, Department of Medical Mycology and Parasitology, Invasive Fungi Research Center, School of Medicine, Mazandaran University of Medical Sciences, P. O. Box: 48175-1665, Sari, IR Iran. Tel/Fax: +98-1133543781, E-mail:
| | | | - Ayatollah Nasrolahi Omran
- Department of Medical Mycology, Faculty of Medical Sciences, Tonekabon Branch, Islamic Azad University, Tonekabon, IR Iran
| | - Nahid Kondori
- Department of Infectious Disease, University of Gothenburg, Gothenburg, Sweden
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30
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Schaal J, Leclerc T, Soler C, Donat N, Cirrode A, Jault P, Bargues L. Epidemiology of filamentous fungal infections in burned patients: A French retrospective study. Burns 2015; 41:853-63. [DOI: 10.1016/j.burns.2014.10.024] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2014] [Revised: 10/03/2014] [Accepted: 10/24/2014] [Indexed: 11/25/2022]
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31
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Tamayo Lomas L, Domínguez-Gil González M, Martín Luengo AI, Eiros Bouza JM, Piqueras Pérez JM. [Nosocomial infection due to Trichosporon asahii in a critical burned patient]. Rev Iberoam Micol 2014; 32:257-60. [PMID: 25579090 DOI: 10.1016/j.riam.2014.07.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2014] [Revised: 05/25/2014] [Accepted: 07/04/2014] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Invasive fungal infection is an important cause of morbimortality in patients with severe burns. The advances in burn care therapy have considerably extended the survival of seriously burned patients, exposing them to infectious complications, notably fungal infections, with increased recognition of invasive infections caused by Candida species. However, some opportunistic fungi, like Trichosporon asahii, have emerged as important causes of nosocomial infection. CASE REPORT A case of nosocomial infection due to T. asahii in a severely ill burned patient successfully treated with voriconazole is presented. The management of invasive fungal infections in burned patients, from diagnosis to selection of the therapeutic protocol, is often a challenge. Early diagnosis and treatment are associated with a better prognosis. In this case report, current treatment options are discussed, and a review of previously published cases is presented. CONCLUSIONS Due to the difficulty in the diagnosis of invasive mycoses and their high associated mortality rates, it is advisable to keep a high degree of clinical suspicion of trichosporonosis in susceptible patients, including burned patients. The isolation of T. asahii in clinical specimens of this type of host must raise clinical alert, since it may precede an invasive infection.
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Affiliation(s)
- Luis Tamayo Lomas
- Servicio de Medicina Intensiva, Hospital Universitario Río Hortega, Valladolid, España.
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32
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Luo G, Tan J, Peng Y, Wu J, Huang Y, Peng D, Wang X, Hu D, Xie S, Zhang G, Han C, Huang X, Jia C, Chai J, Huan J, Guo G, Zhan J, Xie W, Cen Y, Yu R, Chen H, Niu X, Wang Y, Fu J, Xue B. Guideline for diagnosis, prophylaxis and treatment of invasive fungal infection post burn injury in China 2013. BURNS & TRAUMA 2014; 2:45-52. [PMID: 27602362 PMCID: PMC5012031 DOI: 10.4103/2321-3868.130182] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/21/2013] [Revised: 11/04/2013] [Indexed: 02/05/2023]
Abstract
Invasive fungal infection is one of the major complication of severe burns which can induce local or systemic inflammatory response and cause serious substantial damage to the patient. The incidence of fungal infection for burn victims is increasing dramatically during recent years. This guideline, organized by Chinese Society of Burn Surgeons, aims to standardize the diagnosis, prevention and treatment of burn invasive fungal infection. It can be used as one of the tools for treatment of major burn patients.
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Affiliation(s)
- Gaoxing Luo
- State Key Laboratory of Trauma, Burns and Combined Injury, Institute of Burn Research, Southwest Hospital, The Third Military Medical University, Chongqing, 400038 China
| | - Jianglin Tan
- State Key Laboratory of Trauma, Burns and Combined Injury, Institute of Burn Research, Southwest Hospital, The Third Military Medical University, Chongqing, 400038 China
| | - Yizhi Peng
- State Key Laboratory of Trauma, Burns and Combined Injury, Institute of Burn Research, Southwest Hospital, The Third Military Medical University, Chongqing, 400038 China
| | - Jun Wu
- State Key Laboratory of Trauma, Burns and Combined Injury, Institute of Burn Research, Southwest Hospital, The Third Military Medical University, Chongqing, 400038 China
| | - Yuesheng Huang
- State Key Laboratory of Trauma, Burns and Combined Injury, Institute of Burn Research, Southwest Hospital, The Third Military Medical University, Chongqing, 400038 China
| | - Daizhi Peng
- State Key Laboratory of Trauma, Burns and Combined Injury, Institute of Burn Research, Southwest Hospital, The Third Military Medical University, Chongqing, 400038 China
| | - Xu Wang
- State Key Laboratory of Trauma, Burns and Combined Injury, Institute of Burn Research, Southwest Hospital, The Third Military Medical University, Chongqing, 400038 China
| | - Dahai Hu
- Department of Burns and Cutaneous Surgery, Xijing Hospital, Fourth Military Medical University, Xi'an, Shanxi, China
| | - Songtao Xie
- Department of Burns and Cutaneous Surgery, Xijing Hospital, Fourth Military Medical University, Xi'an, Shanxi, China
| | - Guoan Zhang
- Department of Burns, Beijing Jishuitan Hospital, Forth Medical College of Peking University, Beijing, China
| | - Chunmao Han
- Department of Burns & Wound Care Center, The Second Affiliated Hospital of Zhejiang University, College of Medicine, Hangzhou, China
| | - Xiaoyuan Huang
- Department of Burns and Plastic Surgery, Central South University, Changsha, Hunan, China
| | - Ciyu Jia
- Graduate School, Medical College of Chinese PLA, Beijing, China
| | - Jiake Chai
- Department of Burn & Plastic Surgery, The First Affiliated Hospital of PLA General Hospital, Beijing, China
| | - Jingning Huan
- Department of Burn and Plastic Surgery, Ruijin Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Guanghua Guo
- Department of Critical Care Medicine, The First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China
| | - Jianhua Zhan
- Department of Critical Care Medicine, The First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China
| | - Weiguo Xie
- Department of Anesthesia and Critical Care, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Ying Cen
- Department of Otorhinolaryngology Head and Neck Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Rong Yu
- Department of Otorhinolaryngology Head and Neck Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Huade Chen
- Department of Burns, General Hospital of Guangdong Province, Guangzhou, Guangdong, China
| | - Xihua Niu
- Department of Otolaryngology, Henan Province Hospital, Zhengzhou, Henan, China
| | - Yibing Wang
- Department of Aesthetic Plastic and Burn Surgery, Provincial Hospital Affiliated to Shandong University, Jinan, Shandong, China
| | - Jinfeng Fu
- Department of Burns, Second Affiliated Hospital of Kunmin Medical University, Yunnan, China
| | - Baosheng Xue
- Department of Burns, The First Affiliated Hospital of Chinese Medical University, Shenyang, Liaoning, China
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33
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Katz T, Wasiak J, Cleland H, Padiglione A. Incidence of non-candidal fungal infections in severe burn injury: an Australian perspective. Burns 2013; 40:881-6. [PMID: 24380706 DOI: 10.1016/j.burns.2013.11.025] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2013] [Revised: 11/25/2013] [Accepted: 11/30/2013] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Infection remains the primary cause of morbidity and mortality in the burns patient population. While candidal infection in burns patients is well described, there is dearth of information regarding non-candidal fungal infections in this setting. METHOD All adult burns patients who developed non-candidal fungal infections over a period of 10 years (between January 2001 and June 2011) were included. Retrospective data analyzed included patient demographics, organisms cultured, antibiotic susceptibility patterns, treatment, length of stay and overall mortality. RESULTS The incidence of non-candidal fungal infections at our centre over the time period studied was 0.04%. A total of 12 patients had a fungus other than Candida isolated. Of these 12 patients, seven were thought to have clinically significant fungal infections and were treated with targeted anti-fungal therapy. Between them, seven species of fungus were isolated: Aspergillus fumigatus (n=7), Scedosporium prolificans (n=2), Fusarium solani (n=2), Mucor spp. (n=2), Absydia corymbifera (n=1), Penicillium (n=1) and Alternaria spp. (n=1). Of those definitively treated, two died, although fungal infection was not believed to be a contributing factor to these deaths. CONCLUSION We demonstrate a low incidence and attributable mortality of non-candidal fungal infections in the setting of early antifungal therapy and extensive surgical debridement at our state-wide Burns Service.
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Affiliation(s)
- T Katz
- Victorian Adult Burns Service, The Alfred Hospital, Commercial Road, Melbourne, Victoria, Australia.
| | - J Wasiak
- Victorian Adult Burns Service and School of Public Health and Preventive Medicine, Monash University, The Alfred Hospital, Commercial Road, Melbourne, Victoria, Australia.
| | - H Cleland
- Victorian Adult Burns Service and Department of Surgery, Monash University, The Alfred Hospital, Commercial Road, Melbourne, Victoria, Australia
| | - A Padiglione
- Department of Infectious Diseases, The Alfred Hospital, Commercial Road, Melbourne, Victoria, Australia
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Sasaki J, Matsumoto K, Fujishima S, Morita K, Hori S. Pharmacokinetics of a polyene antifungal agent, liposomal amphotericin B (L-AMB), in a severely burned patient. J Chemother 2013; 26:312-4. [PMID: 24070023 DOI: 10.1179/1973947813y.0000000141] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
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Penetration of micafungin into the burn eschar in patients with severe burns. Eur J Drug Metab Pharmacokinet 2013; 39:93-7. [PMID: 23771854 DOI: 10.1007/s13318-013-0146-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2012] [Accepted: 05/31/2013] [Indexed: 10/26/2022]
Abstract
Micafungin (MCFG) concentrations in the plasma and in burn eschar were investigated after daily intravenous infusion (1 h) of MCFG (200 mg) in three patients with severe burns. MCFG treatment was initiated more than 72 h after the burn injuries. The MCFG concentrations in the plasma were determined at the end of the first administration of MCFG, immediately before the second dosing, at the end of the MCFG infusion after at least 4 days from the initial treatment, and immediately before the subsequent dosing using high-performance liquid chromatography. In addition, the trough levels in burn eschar after both the initial administration and repeated administration were measured. The peak and trough levels in the plasma were comparable to or slightly lower than the reported values in healthy volunteers. The mean (range) MCFG concentrations in the burn eschar after initial administration and repeated administration were 1.41 μg/mL (<0.1-3.98 μg/mL) and 6.65 μg/mL (1.10-14.81 μg/mL), respectively. In most cases, the MCFG concentrations in the burn eschar, especially after repeated administration, were higher than the reported MIC90 of MCFG against the clinically important pathogenic species of Candida and Aspergillus. These results suggest that MCFG is capable of penetrating burn eschar.
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Mikulska M, Del Bono V, Ratto S, Viscoli C. Occurrence, presentation and treatment of candidemia. Expert Rev Clin Immunol 2013; 8:755-65. [PMID: 23167687 DOI: 10.1586/eci.12.52] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Candida is one of the most common causes of nosocomial bloodstream infections. Candidemia is not confined to hematological patients, intensive care units or abdominal surgery wards, but it is remarkably frequent in the internal medicine setting. High mortality associated with candidemia can be reduced by prompt, appropriate antifungal therapy. The epidemiology of species has been shifting toward non-albicans strains. Significant improvements in nonculture-based diagnostic methods, such as serological markers, have been made in recent years, and novel diagnostic techniques should be further studied to enable early pre-emptive therapy. Treatment guidelines indicate that echinocandins are at present the best choice for patients who are severely ill or possibly infected with fluconazole-resistant strains.
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Affiliation(s)
- Małgorzata Mikulska
- Division of Infectious Diseases, Department of Health Science, University of Genoa, Genoa, Italy
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Seddiki SML, Boucherit-Otmani Z, Boucherit K, Badsi-Amir S, Taleb M, Kunkel D. Assessment of the types of catheter infectivity caused by Candida species and their biofilm formation. First study in an intensive care unit in Algeria. Int J Gen Med 2013; 6:1-7. [PMID: 23345986 PMCID: PMC3549679 DOI: 10.2147/ijgm.s38065] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
Nosocomial candidiasis remains a potential risk in intensive care units (ICUs), wherein Candida albicans is most responsible for its occurrence. Equally, non-C. albicans species, especially C. glabrata, are also involved. These infections are frequently associated with biofilms that contaminate medical devices, such as catheters. These biofilms constitute a significant clinical problem, and cause therapeutic failures, because they can escape the immune response and considerably decrease sensitivity to antifungal therapy. The diagnosis of catheter-related candidiasis is difficult; however, the differentiation between an infection of the catheter (or other medical implant) and a simple contamination is essential to start an antifungal treatment. Among the methods used for this type of study is the Brun-Buisson method, but this method only examines the infectivity of catheters caused by bacteria. For this reason, we wanted to adapt this method to the yeast cells of Candida spp. To assess the various types of infectivity of catheters (contamination, colonization, or infection) and their corresponding rates, as well as the responsible yeast species, we conducted our study, between February 2011 and January 2012, in the ICU at the University Hospital Center of Sidi Bel Abbes, Algeria; during this study, we took photographic images of the tongue of one patient and of that patient’s implanted orobronchial catheter. In addition, catheters contaminated by C. albicans biofilms were observed by scanning electron microscopy.
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Affiliation(s)
- Sidi Mohammed Lahbib Seddiki
- Laboratory: Antifungal Antibiotic, Physico-Chemical Synthesis and Biological Activity, University of Tlemcen, Algeria
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Trupkovic T, Gille J, Fischer H, Kleinschmidt S. [Antimicrobial treatment in burn injury patients]. Anaesthesist 2012; 61:249-51, 254-6, 258. [PMID: 22430556 DOI: 10.1007/s00101-012-1994-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Infections are a great diagnostic and therapeutic challenge in intensive care patients with burn injuries. The major problems are due to bacteria with hospital-acquired multiresistance to antibiotics but fungal and viral infections may also be life-threatening. The main key points addressing pharmacotherapy with antibiotic, antifungal and antiviral agents in this special setting are exact diagnosis, early therapy with suitable drugs, adequate duration of treatment and adequate doses based on pharmacokinetic and pharmacodynamic characteristics of these compounds. The latter parameters are significantly altered in burn patients and show a wide interindividual and intraindividual variation in drug response as a result of the characteristic phases of burn injury. Drug concentration analysis may help to avoid inadequate dosing. In this review the main characteristics of burn injuries and the pharmacology of antibiotics, antifungal and antiviral agents in these patients are presented.
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Affiliation(s)
- T Trupkovic
- Abteilung für Anästhesie, Intensivmedizin und Schmerztherapie, Berufsgenossenschaftliche Unfallklinik Ludwigshafen, Deutschland
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Ben Abdeljelil J, Saghrouni F, Cabaret O, Boukadida J, Bretagne S, Ben Saïd M. Temporal similarity between Candida albicans genotypes in a Tunisian neonatal intensive care unit suggests several nosocomial cross-contamination episodes. DNA Cell Biol 2012; 31:1161-6. [PMID: 22335233 DOI: 10.1089/dna.2011.1593] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
Abstract
The nosocomial transmission of Candida albicans in neonatal intensive care units (NICUs) is an increasing concern and understanding the route of this transmission is critical for adequate infection control measures. The aim of our study was to assess the likeliness of nosocomial acquisition of C. albicans in the NICU of Farhat Hached hospital in Sousse (Tunisia). We genotyped 82 isolates from 40 neonates and 7 isolates from 5 health care workers (HCWs) with onychomycosis, by using CDC3 microsatellite length polymorphism (MLP) and the high-resolution melting (HRM) analysis. Combined MLP and HRM CD3 analysis led to the delineation of 12 genotypes. Five temporal clustering caused by five genotypes occurred during the study period. Three of these genotypes were isolated in both neonates and HCWs. The first clustering included 28 isolates obtained between January 2003 and May 2004 from 16 neonates and 2 HCWs. The second clustering included three isolates collected in 2004 from three neonates and two HCWs. The third clustering included 11 isolates obtained from 6 neonates and 1 HCW in 2006. The two remaining clustering could not be associated with any HCW's contamination. These results argue for the nosocomial transmission of C. albicans in our NICU. The combined MLP and HRM analysis is a rapid first approach for tracking cross-contamination.
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Affiliation(s)
- Jihene Ben Abdeljelil
- Unité de Recherche UR 02SP13, Laboratoire de Parasitologie-Mycologie, Ministère de la Santé Publique, Sousse, Tunisie.
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Micafungin concentrations in the plasma and burn eschar of severely burned patients. Antimicrob Agents Chemother 2011; 56:1113-5. [PMID: 22083486 DOI: 10.1128/aac.05381-11] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Micafungin concentrations in plasma and burn eschar after daily intravenous infusion (1 h) of micafungin (200 to 300 mg) were investigated for six patients with severe burns. Micafungin treatment was initiated more than 72 h after the burn injuries. The peak and trough levels in the plasma after the initial administration and repeated administrations for more than 4 days were comparable with or slightly lower than the reported values for healthy volunteers. Micafungin concentrations in the plasma and burn eschar were between 3.6 and >1,000 times higher than the reported MIC(90)s of micafungin against clinically important Candida and Aspergillus species.
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