|
1
|
Scaglione G, Colaneri M, Offer M, Galli L, Borgonovo F, Genovese C, Fattore R, Schiavini M, Taino A, Calloni M, Casella F, Gidaro A, Fassio F, Breschi V, Leoni J, Cogliati C, Gori A, Foschi A. Epidemiology and Clinical Insights of Catheter-Related Candidemia in Non-ICU Patients with Vascular Access Devices. Microorganisms 2024; 12:1597. [PMID: 39203438 PMCID: PMC11356456 DOI: 10.3390/microorganisms12081597] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2024] [Revised: 08/01/2024] [Accepted: 08/03/2024] [Indexed: 09/03/2024] Open
Abstract
INTRODUCTION Vascular access devices (VADs), namely peripheral VADs (PVADs) and central venous VADs (CVADs), are crucial in both intensive care unit (ICU) and non-ICU settings. However, VAD placement carries risks, notably catheter-related bloodstream infections (CRBSIs). Candida spp. is a common pathogen in CRBSIs, yet its clinical and microbiological characteristics, especially in non-ICU settings, are underexplored. METHODS We conducted a monocentric, retrospective observational study at Luigi Sacco Hospital from 1 May 2021 to 1 September 2023. We reviewed medical records of non-ICU adult patients with CVADs and PVADs. Data on demographics, clinical and laboratory results, VAD placement, and CRBSI occurrences were collected. Statistical analysis compared Candida spp. CRBSI and bacterial CRBSI groups. RESULTS Out of 1802 VAD placements in 1518 patients, 54 cases of CRBSI were identified, and Candida spp. was isolated in 30.9% of episodes. The prevalence of CRBSI was 3.05%, with Candida spp. accounting for 0.94%. Incidence rates were 2.35 per 1000 catheter days for CRBSI, with Candida albicans and Candida non-albicans at 0.47 and 0.26 per 1000 catheter days, respectively-patients with Candida spp. CRBSI had more frequent SARS-CoV-2 infection, COVID-19 pneumonia, and hypoalbuminemia. CONCLUSIONS During the COVID-19 pandemic, Candida spp. was a notable cause of CRBSIs in our center, underscoring the importance of considering Candida spp. in suspected CRBSI cases, including those in non-ICU settings and in those with PVADs.
Collapse
Affiliation(s)
- Giovanni Scaglione
- Division of Infectious Diseases, Luigi Sacco Hospital, University of Milan, 20157 Milan, Italy; (G.S.); (L.G.); (F.B.); (C.G.); (R.F.); (M.S.); (A.G.); (A.F.)
| | - Marta Colaneri
- Division of Infectious Diseases, Fondazione IRCCS Policlinico San Matteo, 27100 Pavia, Italy;
| | - Martina Offer
- Department of Biomedical and Clinical Sciences, University of Milan, 20157 Milan, Italy;
| | - Lucia Galli
- Division of Infectious Diseases, Luigi Sacco Hospital, University of Milan, 20157 Milan, Italy; (G.S.); (L.G.); (F.B.); (C.G.); (R.F.); (M.S.); (A.G.); (A.F.)
| | - Fabio Borgonovo
- Division of Infectious Diseases, Luigi Sacco Hospital, University of Milan, 20157 Milan, Italy; (G.S.); (L.G.); (F.B.); (C.G.); (R.F.); (M.S.); (A.G.); (A.F.)
| | - Camilla Genovese
- Division of Infectious Diseases, Luigi Sacco Hospital, University of Milan, 20157 Milan, Italy; (G.S.); (L.G.); (F.B.); (C.G.); (R.F.); (M.S.); (A.G.); (A.F.)
- Department of Biomedical and Clinical Sciences, University of Milan, 20157 Milan, Italy;
| | - Rebecca Fattore
- Division of Infectious Diseases, Luigi Sacco Hospital, University of Milan, 20157 Milan, Italy; (G.S.); (L.G.); (F.B.); (C.G.); (R.F.); (M.S.); (A.G.); (A.F.)
| | - Monica Schiavini
- Division of Infectious Diseases, Luigi Sacco Hospital, University of Milan, 20157 Milan, Italy; (G.S.); (L.G.); (F.B.); (C.G.); (R.F.); (M.S.); (A.G.); (A.F.)
| | - Alba Taino
- Division of Internal Medicine, Luigi Sacco Hospital, University of Milan, 20157 Milan, Italy; (A.T.); (M.C.); (F.C.); (C.C.)
| | - Maria Calloni
- Division of Internal Medicine, Luigi Sacco Hospital, University of Milan, 20157 Milan, Italy; (A.T.); (M.C.); (F.C.); (C.C.)
| | - Francesco Casella
- Division of Internal Medicine, Luigi Sacco Hospital, University of Milan, 20157 Milan, Italy; (A.T.); (M.C.); (F.C.); (C.C.)
| | - Antonio Gidaro
- Division of Internal Medicine, Luigi Sacco Hospital, University of Milan, 20157 Milan, Italy; (A.T.); (M.C.); (F.C.); (C.C.)
| | - Federico Fassio
- Department of Public Health, Experimental and Forensic Medicine, Section of Biostatistics and Clinical Epidemiology, University of Pavia, 27100 Pavia, Italy;
| | - Valentina Breschi
- Department of Electrical Engineering, Eindhoven University of Technology, 5600 MB Eindhoven, The Netherlands; (V.B.); (J.L.)
| | - Jessica Leoni
- Department of Electrical Engineering, Eindhoven University of Technology, 5600 MB Eindhoven, The Netherlands; (V.B.); (J.L.)
| | - Chiara Cogliati
- Division of Internal Medicine, Luigi Sacco Hospital, University of Milan, 20157 Milan, Italy; (A.T.); (M.C.); (F.C.); (C.C.)
| | - Andrea Gori
- Division of Infectious Diseases, Luigi Sacco Hospital, University of Milan, 20157 Milan, Italy; (G.S.); (L.G.); (F.B.); (C.G.); (R.F.); (M.S.); (A.G.); (A.F.)
- Department of Biomedical and Clinical Sciences, University of Milan, 20157 Milan, Italy;
| | - Antonella Foschi
- Division of Infectious Diseases, Luigi Sacco Hospital, University of Milan, 20157 Milan, Italy; (G.S.); (L.G.); (F.B.); (C.G.); (R.F.); (M.S.); (A.G.); (A.F.)
| |
Collapse
|
|
2
|
Huang L, Li S, Jiang R, Lei S, Wu J, Huang L, Zhu M. Glucocorticoid use and parenteral nutrition are risk factors for catheter-related Candida bloodstream infection: a retrospective study. ASIAN BIOMED 2024; 18:109-115. [PMID: 39175949 PMCID: PMC11337845 DOI: 10.2478/abm-2024-0016] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/24/2024]
Abstract
Background Catheter-related candidemia (CRC) is a serious catheter-related bloodstream infection (CRBSI) caused by Candida spp., with higher mortality than CRBSIs caused by other organisms. Objective To identify the risk factors for Candida CRBSI. The clinical characteristics of 297 patients with CRBSI in a local hospital from January 2007 to June 2015 were collected, including 33 Candida CRBSI and 264 non-Candida CRBSI. Method The associations of Candida CRBSI with the clinical variables were examined using univariate and multivariate analyses. Results Multivariate analysis showed that glucocorticoid use (odds ratio [OR] = 10.313, 95% confidence interval [CI] = 2.032-52.330, P = 0.005) and parenteral nutrition (OR = 5.400, 95% CI = 0.472-61.752, P = 0.0175) were independent risk factors for Candida CRBSI. The most prevalent species were Candida tropicalis (42.4%) and Candida albicans (36.36%). Of the 33 Candida CRBSI cases, 31 (93.93%) had indwelling central venous catheters (CVC) for ≥14 d. The mortality of Candida CRBSI was remarkably higher than that of bacteria CRBSI. Patients with timely catheter removal and appropriate antifungal treatment had dramatically increased 28-d survival compared with those with untimely catheter removal + inappropriate antifungal treatment (88.89% vs. 0, P = 0.006). Conclusion The study identified glucocorticoid use and parenteral nutrition as independent risk factors for Candida CRBSI. The outcome of candidemia was associated with the duration of CVC indwelling and antifungal treatment.
Collapse
Affiliation(s)
- Lipeng Huang
- The Intensive Care Unit, Taizhou Cancer Hospital of Zhejiang Province, Taizhou, Zhejiang317500, China
| | - Shanshan Li
- Xiaoying District Community Health Service Center, Hangzhou, Zhejiang310006, China
| | - Ronglin Jiang
- The Intensive Care Unit, The First Affiliated Hospital of Zhejiang University of the Traditional Chinese Medicine, Hangzhou, Zhejiang310006, China
| | - Shu Lei
- The Intensive Care Unit, The First Affiliated Hospital of Zhejiang University of the Traditional Chinese Medicine, Hangzhou, Zhejiang310006, China
| | - Jiannong Wu
- The Intensive Care Unit, The First Affiliated Hospital of Zhejiang University of the Traditional Chinese Medicine, Hangzhou, Zhejiang310006, China
| | - Liquan Huang
- The Intensive Care Unit, The First Affiliated Hospital of Zhejiang University of the Traditional Chinese Medicine, Hangzhou, Zhejiang310006, China
| | - Meifei Zhu
- Xiaoying District Community Health Service Center, Hangzhou, Zhejiang310006, China
| |
Collapse
|
|
3
|
Diagnosis and treatment of catheter-related bloodstream infection: Clinical guidelines of the Spanish Society of Infectious Diseases and Clinical Microbiology and (SEIMC) and the Spanish Society of Spanish Society of Intensive and Critical Care Medicine and Coronary Units (SEMICYUC). Med Intensiva 2019; 42:5-36. [PMID: 29406956 DOI: 10.1016/j.medin.2017.09.012] [Citation(s) in RCA: 67] [Impact Index Per Article: 13.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2017] [Revised: 09/29/2017] [Accepted: 09/29/2017] [Indexed: 12/14/2022]
Abstract
Catheter-related bloodstream infections (CRBSI) constitute an important cause of hospital-acquired infection associated with morbidity, mortality, and cost. The aim of these guidelines is to provide updated recommendations for the diagnosis and management of CRBSI in adults. Prevention of CRBSI is excluded. Experts in the field were designated by the two participating Societies (the Spanish Society of Infectious Diseases and Clinical Microbiology and [SEIMC] and the Spanish Society of Spanish Society of Intensive and Critical Care Medicine and Coronary Units [SEMICYUC]). Short-term peripheral venous catheters, non-tunneled and long-term central venous catheters, tunneled catheters and hemodialysis catheters are covered by these guidelines. The panel identified 39 key topics that were formulated in accordance with the PICO format. The strength of the recommendations and quality of the evidence were graded in accordance with ESCMID guidelines. Recommendations are made for the diagnosis of CRBSI with and without catheter removal and of tunnel infection. The document establishes the clinical situations in which a conservative diagnosis of CRBSI (diagnosis without catheter removal) is feasible. Recommendations are also made regarding empirical therapy, pathogen-specific treatment (coagulase-negative staphylococci, Staphylococcus aureus, Enterococcus spp., Gram-negative bacilli, and Candida spp.), antibiotic lock therapy, diagnosis and management of suppurative thrombophlebitis and local complications.
Collapse
|
|
5
|
Kozik A, Karkowska-Kuleta J, Zajac D, Bochenska O, Kedracka-Krok S, Jankowska U, Rapala-Kozik M. Fibronectin-, vitronectin- and laminin-binding proteins at the cell walls of Candida parapsilosis and Candida tropicalis pathogenic yeasts. BMC Microbiol 2015; 15:197. [PMID: 26438063 PMCID: PMC4595241 DOI: 10.1186/s12866-015-0531-4] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2015] [Accepted: 09/25/2015] [Indexed: 11/18/2022] Open
Abstract
Background Candida parapsilosis and C. tropicalis increasingly compete with C. albicans—the most common fungal pathogen in humans—as causative agents of severe candidiasis in immunocompromised patients. In contrast to C. albicans, the pathogenic mechanisms of these two non-albicans Candida species are poorly understood. Adhesion of Candida yeast to host cells and the extracellular matrix is critical for fungal invasion of hosts. Methods The fungal proteins involved in interactions with extracellular matrix proteins were isolated from mixtures of β-1,3-glucanase– or β-1,6-glucanase–extractable cell wall-associated proteins by use of affinity chromatography and chemical cross-linking methods, and were further identified by liquid chromatography-coupled tandem mass spectrometry. Results In the present study, we characterized the binding of three major extracellular matrix proteins—fibronectin, vitronectin and laminin—to C. parapsilosis and C. tropicalis pseudohyphae. The major individual compounds of the fungal cell wall that bound fibronectin, vitronectin and laminin were found to comprise two groups: (1) true cell wall components similar to C. albicans adhesins from the Als, Hwp and Iff/Hyr families; and (2) atypical (cytoplasm-derived) surface-exposed proteins, including malate synthase, glucose-6-phosphate isomerase, 6-phosphogluconate dehydrogenase, enolase, fructose-1,6-bisphosphatase, transketolase, transaldolase and elongation factor 2. Discussion The adhesive abilities of two investigated non-albicans Candida species toward extracellular matrix proteins were comparable to those of C. albicans suggesting an important role of this particular virulence attribute in the pathogenesis of infections caused by C. tropicalis and C. parapsilosis. Conclusions Our results reveal new insight into host–pathogen interactions during infections by two important, recently emerging, fungal pathogens.
Collapse
Affiliation(s)
- Andrzej Kozik
- Department of Analytical Biochemistry, Faculty of Biochemistry, Biophysics and Biotechnology, Jagiellonian University in Krakow, Gronostajowa 7, 30-387, Krakow, Poland.
| | - Justyna Karkowska-Kuleta
- Department of Analytical Biochemistry, Faculty of Biochemistry, Biophysics and Biotechnology, Jagiellonian University in Krakow, Gronostajowa 7, 30-387, Krakow, Poland.
| | - Dorota Zajac
- Department of Analytical Biochemistry, Faculty of Biochemistry, Biophysics and Biotechnology, Jagiellonian University in Krakow, Gronostajowa 7, 30-387, Krakow, Poland.
| | - Oliwia Bochenska
- Department of Analytical Biochemistry, Faculty of Biochemistry, Biophysics and Biotechnology, Jagiellonian University in Krakow, Gronostajowa 7, 30-387, Krakow, Poland.
| | - Sylwia Kedracka-Krok
- Department of Physical Biochemistry, Faculty of Biochemistry, Biophysics and Biotechnology, Jagiellonian University in Krakow, Gronostajowa 7, 30-387, Krakow, Poland.
| | - Urszula Jankowska
- Department of Structural Biology, Malopolska Centre of Biotechnology, Jagiellonian University in Krakow, Gronostajowa 7, 30-387, Krakow, Poland.
| | - Maria Rapala-Kozik
- Department of Analytical Biochemistry, Faculty of Biochemistry, Biophysics and Biotechnology, Jagiellonian University in Krakow, Gronostajowa 7, 30-387, Krakow, Poland.
| |
Collapse
|