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Park JY, Yang KM, Kwak JY, Jung YT. Risk Factors for Invasive Candidiasis in Critically Ill Patients Who Underwent Emergency Gastrointestinal Surgery for Complicated Intra-Abdominal Infection. Surg Infect (Larchmt) 2024. [PMID: 38634791 DOI: 10.1089/sur.2023.333] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/19/2024] Open
Abstract
Background: Candida species account for approximately 15% of hospital-associated infections, causing fatal consequences, especially in critically ill patients. This study aimed to evaluate invasive candidiasis (IC) risk factors in critically ill patients undergoing surgery. Patients and Methods: We retrospectively reviewed the medical records of 583 patients who underwent emergency surgery for complicated intra-abdominal infections between January 2016 and December 2021. Patients were divided into two groups according to the presence or absence of IC during their hospital stay. IC was defined as culture-proven candidemia and intra-abdominal candidiasis. Results: This study included 373 patients for the final analysis, of whom 320 were discharged without IC (IC absent group) and 53 presented with IC (IC present group) during their hospital stay. The IC present group showed a higher in-hospital mortality rate (35.8 vs. 8.8%; p < 0.001), with 66.0% of the patients diagnosed within 10 days, whereas only 6.5% were diagnosed beyond 20 days after admission. Stomach (odds ratio [OR], 4.188; 95% confidence interval [CI], 1.204-14.561; p = 0.024) and duodenum (OR, 7.595; 95% CI, 1.934-29.832; p = 0.004) as infection origin, higher Acute Physiology and Chronic Health Evaluation II (APACHE II) score (OR, 1.097; 95% CI, 1.044-1.152; p < 0.001), and lower initial systolic blood pressure (OR, 0.983; 95% CI, 0.968-0.997; p = 0.018) were risk factors of IC after emergency gastrointestinal surgery. Conclusions: Patients who had stomach and duodenum as infection origin, higher APACHE II scores, and lower initial systolic blood pressure had a higher risk of developing IC during their hospital stay after emergency gastrointestinal surgery. Prophylactic antifungal agents can be carefully considered for critically ill patients with these features.
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Affiliation(s)
- Jung Yun Park
- Department of Surgery, Gangneung Asan Hospital, Gangneung, South Korea
| | - Kwan Mo Yang
- Department of Surgery, Gangneung Asan Hospital, Gangneung, South Korea
- Department of Surgery, University of Ulsan College of Medicine, Ulsan, South Korea
| | - Jae Young Kwak
- Department of Surgery, Gangneung Asan Hospital, Gangneung, South Korea
- Department of Surgery, University of Ulsan College of Medicine, Ulsan, South Korea
| | - Yun Tae Jung
- Department of Surgery, Gangneung Asan Hospital, Gangneung, South Korea
- Department of Surgery, University of Ulsan College of Medicine, Ulsan, South Korea
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2
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Bromuro C, Posteraro B, Murri R, Fantoni M, Tumbarello M, Sanguinetti M, Dattilo R, Cauda R, Cassone A, Torosantucci A. Identification of two anti- Candida antibodies associated with the survival of patients with candidemia. mBio 2024; 15:e0276923. [PMID: 38088540 PMCID: PMC10790786 DOI: 10.1128/mbio.02769-23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Accepted: 10/26/2023] [Indexed: 01/17/2024] Open
Abstract
IMPORTANCE Candidemia (bloodstream invasion by Candida species) is a major fungal disease in humans. Despite the recent progress in diagnosis and treatment, therapeutic options are limited and under threat of antimicrobial resistance. The disease mortality remains high (around 40%). In contrast with deep-seated invasive candidiasis, particularly that occurring in patients with hematologic malignancies and organ transplants, patients with candidemia are often not immunocompromised and therefore able to mount memory anticandidal immune responses, perhaps primed by Candida commensalism. We investigated antibody immunity in candidemia patients and report here on the ability of these patients to produce antibodies that react with Candida antigens. In particular, the patients with high titers of IgG reactive with two immunodominant, virulence-associated antigens (Als3 and MP65) had a higher 30-day survival. If confirmed by controlled, prospective clinical studies, our data could inform the development of antibody therapy to better treat a severe fungal infection such as candidiasis.
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Affiliation(s)
- Carla Bromuro
- Dipartimento di Malattie Infettive, Istituto Superiore di Sanità, Rome, Italy
| | - Brunella Posteraro
- Dipartimento di Scienze Biotecnologiche di Base, Cliniche Intensivologiche e Perioperatorie, Università Cattolica del Sacro Cuore, Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Rita Murri
- Dipartimento Salute e Bioetica, Sezione Malattie Infettive, Università Cattolica del Sacro Cuore, Policlinico Universitario A. Gemelli IRCCS , Rome, Italy
| | - Massimo Fantoni
- Dipartimento Salute e Bioetica, Sezione Malattie Infettive, Università Cattolica del Sacro Cuore, Policlinico Universitario A. Gemelli IRCCS , Rome, Italy
| | - Mario Tumbarello
- Dipartimento Biotecnologie Mediche, University of Siena, Siena, Italy
| | - Maurizio Sanguinetti
- Dipartimento di Scienze Biotecnologiche di Base, Cliniche Intensivologiche e Perioperatorie, Università Cattolica del Sacro Cuore, Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Rosanna Dattilo
- Dipartimento di Malattie Infettive, Istituto Superiore di Sanità, Rome, Italy
| | - Roberto Cauda
- Dipartimento Salute e Bioetica, Sezione Malattie Infettive, Università Cattolica del Sacro Cuore, Policlinico Universitario A. Gemelli IRCCS , Rome, Italy
| | - Antonio Cassone
- Polo d'Innovazione della Genomica, Genetica e Biologia, Siena, Italy
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3
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Durmuş M, Kalkan S, Güzel Karahan S, Biçakcioğlu M, Özdemir N, Gün ZÜ, Özer AB. Can antibiotics affect the clinical features of patients with candidemia? The retrospective evaluation of 5 years of data in an intensive care unit. Eur J Hosp Pharm 2023:ejhpharm-2022-003673. [PMID: 37098442 DOI: 10.1136/ejhpharm-2022-003673] [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: 12/27/2022] [Accepted: 04/11/2023] [Indexed: 04/27/2023] Open
Abstract
BACKGROUND Candidemia is an opportunistic infection of intensive care units (ICUs) and causes morbidity and mortality. Multiple antibiotic exposure was found to be an independent risk factor for mortality and non-albicans candidemia (NAC) in candidemia patients. AIM The aim of this study was to determine the relationship between antibiotics and clinical features of patients with candidemia, and to determine the independent risk factors for hospital stay >50 days, 30-day mortality in hospital, candidemia types, and septic shock in candidemia patients. METHODS Patients were evaluated retrospectively for 5 years. A total of 148 candidemia cases were detected and included in the study. Characteristics of cases were defined and recorded. The relationship between qualitative data was determined by the χ2 test. Logistic regression analysis was used to determine the independent risk factors for hospital stay >50 days, 30-day mortality in hospital, candidemia types, and septic shock in candidemia patients. RESULTS The incidence of candidemia for 5 years was 4.5%. Candida parapsilosis was the most reported species with 65% (n=97). Linezolid and central venous catheters (CVC) were found to be independent risk factors for NAC. Carbapenems and cephalosporins were found in association to lower mortality. No antibiotics or characteristics were found to be independent risk factors for mortality. Some broad spectrum antibiotics and antibiotic combinations were found in relationship with hospital stay >50 days; however, none of them were found to be independent risk factors. Metisilin resistant staphylococcus aureus (MRSA) antibiotics, meropenem+linezolid piperacillin-tazobactam+fluoroquinolones and comorbidity were found in association with septic shock, although only piperacillin-tazobactam+fluoroquinolones and comorbidity were found to be independent risk factors for septic shock. CONCLUSIONS This study concluded that many antibiotics were safe for candidemia patients. However, clinicians should pay attention when prescribing linezolid or piperacillin-tazobactam and flouroquinolons concomitantly or sequentially for patients with candidemia risk factors.
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Affiliation(s)
- Mefküre Durmuş
- Clinical Pharmacy, İnönü University Faculty of Pharmacy, Malatya, Turkey
| | - Serkan Kalkan
- Anesthesiology and Reanimation, İnönü University Faculty of Medicine, Malatya, Turkey
| | - Sena Güzel Karahan
- Clinical Pharmacy, İnönü University Faculty of Pharmacy, Malatya, Turkey
| | - Murat Biçakcioğlu
- Anesthesiology and Reanimation, İnönü University Faculty of Medicine, Malatya, Turkey
| | | | - Zeynep Ülkü Gün
- Clinical Pharmacy, İnönü University Faculty of Pharmacy, Malatya, Turkey
| | - Ayşe Belin Özer
- Anesthesiology and Reanimation, İnönü University Faculty of Medicine, Malatya, Turkey
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4
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Kim SH, Mun SJ, Kang JS, Moon C, Kim HT, Lee HY. Multifaceted Evaluation of Antibiotic Therapy as a Factor Associated with Candidemia in Non-Neutropenic Patients. J Fungi (Basel) 2023; 9:jof9020270. [PMID: 36836385 PMCID: PMC9960229 DOI: 10.3390/jof9020270] [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: 12/14/2022] [Revised: 02/04/2023] [Accepted: 02/12/2023] [Indexed: 02/22/2023] Open
Abstract
We aimed to evaluate various aspects of antibiotic therapy as factors associated with candidemia in non-neutropenic patients. A retrospective, matched, case-control study was conducted in two teaching hospitals. Patients with candidemia (cases) were compared to patients without candidemia (controls), matched by age, intensive care unit admission, duration of hospitalization, and type of surgery. Logistic regression analyses were performed to identify factors associated with candidemia. A total of 246 patients were included in the study. Of 123 candidemia patients, 36% had catheter-related bloodstream infections (CRBSIs). Independent factors in the whole population included immunosuppression (adjusted odds ratio [aOR] = 2.195; p = 0.036), total parenteral nutrition (aOR = 3.642; p < 0.001), and anti-methicillin-resistant S. aureus (MRSA) therapy for ≥11 days (aOR = 5.151; p = 0.004). The antibiotic factor in the non-CRBSI population was anti-pseudomonal beta-lactam treatment duration of ≥3 days (aOR = 5.260; p = 0.008). The antibiotic factors in the CRBSI population included anti-MRSA therapy for ≥11 days (aOR = 10.031; p = 0.019). Antimicrobial stewardship that reduces exposure to these antibacterial spectra could help prevent the development of candidemia.
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Affiliation(s)
- Si-Ho Kim
- Division of Infectious Diseases, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon 51353, Republic of Korea
| | - Seok Jun Mun
- Division of Infectious Diseases, Department of Internal Medicine, Inje University Busan Paik Hospital, Inje University College of Medicine, 75 Bokji-ro, Busanjin-gu, Busan 47392, Republic of Korea
- Correspondence: ; Tel.: +82-51-890-6986; Fax: +82-51-890-6341
| | - Jin Suk Kang
- Division of Infectious Diseases, Department of Internal Medicine, Inje University Busan Paik Hospital, Inje University College of Medicine, 75 Bokji-ro, Busanjin-gu, Busan 47392, Republic of Korea
| | - Chisook Moon
- Division of Infectious Diseases, Department of Internal Medicine, Inje University Busan Paik Hospital, Inje University College of Medicine, 75 Bokji-ro, Busanjin-gu, Busan 47392, Republic of Korea
| | - Hyoung-Tae Kim
- Department of Laboratory Medicine, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon 51353, Republic of Korea
| | - Ho Young Lee
- Division of Pulmonary, Allergy and Critical Care Medicine, Department of Internal Medicine, Inje University Busan Paik Hospital, Inje University College of Medicine, Busan 47392, Republic of Korea
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Ahmad S, Asadzadeh M. Strategies to Prevent Transmission of Candida auris in Healthcare Settings. CURRENT FUNGAL INFECTION REPORTS 2023; 17:36-48. [PMID: 36718372 PMCID: PMC9878498 DOI: 10.1007/s12281-023-00451-7] [Citation(s) in RCA: 12] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/18/2022] [Indexed: 01/27/2023]
Abstract
Purpose of Review Candida auris, a recently recognized yeast pathogen, has become a major public health threat due to the problems associated with its accurate identification, intrinsic and acquired resistance to antifungal drugs, and its potential to easily contaminate the environment causing clonal outbreaks in healthcare facilities. These outbreaks are associated with high mortality rates particularly among older patients with multiple comorbidities under intensive care settings. The purpose of this review is to highlight strategies that are being adapted to prevent transmission of C. auris in healthcare settings. Recent Findings Colonized patients shed C. auris into their environment which contaminates surrounding equipment. It resists elimination even by robust decontamination procedures and is easily transmitted to new patients during close contact resulting in outbreaks. Efforts are being made to rapidly identify C. auris-infected/C. auris-colonized patients, to determine its susceptibility to antifungals, and to perform effective cleaning and decontamination of the environment and isolation of colonized patients to prevent further transmission. Summary Rapid and accurate identification of hospitalized patients infected/colonized with C. auris, rapid detection of its susceptibility patterns, and appropriate use of infection control measures can help to contain the spread of this highly pathogenic yeast in healthcare settings and prevent/control outbreaks.
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Affiliation(s)
- Suhail Ahmad
- Faculty of Medicine, Department of Microbiology, Kuwait University, PO Box: 24923, 13110 Safat, Kuwait
| | - Mohammad Asadzadeh
- Faculty of Medicine, Department of Microbiology, Kuwait University, PO Box: 24923, 13110 Safat, Kuwait
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Brunetti G, Giuliani A, Navazio AS, Paradisi C, Raponi F, Conti LA, Raponi G. Candida gut colonization, yeast species distribution, and biofilm production in Clostridioides difficile infected patients: a comparison between three populations in two different time periods. Braz J Microbiol 2021; 52:1845-1852. [PMID: 34264501 PMCID: PMC8578342 DOI: 10.1007/s42770-021-00512-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2020] [Accepted: 04/27/2021] [Indexed: 02/08/2023] Open
Abstract
Candida gut colonization and yeast biofilm production capacity were investigated, by means of XTT reduction assay, in Clostridioides difficile infected (CDI) patients, in non-CDI diarrheic patients, and in healthy donors in two different time periods (2013-2015 and 2018-2019 respectively). Candida gut colonization was significantly (p < 0.001) associated to C. difficile infection, and to patients infected with hypervirulent C. difficile strains bearing the tcdC deletion at nucleotide 117 (p = 0.0003). Although there was not a prevalent yeast species in CDI patients, C. albicans was the species significantly (p < 0.001) associated to both the infections sustained by the non-hypervirulent C. difficile strains and those caused by the hypervirulent strain (p = 0.001). The biofilm production by the yeasts isolated from the CDI patients and from non-CDI diarrheic patients did not differ significantly. However, a significantly (p = 0.007) higher biofilm production was observed in the Candida strains, particularly C. albicans, isolated from healthy donors compared to that of the yeasts cultured from CDI patients. Seasonal occurrence was observed in the isolation rate of CDI and non-CDI diarrheic cases (p = 0.0019), peaking in winter for CDI patients and in spring for non-CDI diarrheic patients. Furthermore, seasonality emerged in the gut colonization by Candida of CDI patients in the winter. It seems, therefore, that the reduced capacity of biofilm production by Candida strains isolated from CDI patients might have a role in the development of C. difficile infection, probably facilitating the spread of the bacteria into the gut thus amplifying their pathogenic action.
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Affiliation(s)
- Grazia Brunetti
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Rome, Italy
| | - Alessandro Giuliani
- Department of Environment and Health, Istituto Superiore Di Sanità, Rome, Italy
| | - Anna Sara Navazio
- Department of Molecular Medicine, Laboratory of Microbiology and Pasteur Institute-Cenci Bolognetti Foundation, Sapienza University of Rome, Rome, Italy
| | - Camilla Paradisi
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Rome, Italy
| | - Flavia Raponi
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Rome, Italy
| | - Libenzio Adrian Conti
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Rome, Italy
- Confocal Microscopy Core Facility, IRCSS Bambino Gesù Pediatric Hospital, Research Center, Rome, Italy
| | - Giammarco Raponi
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Rome, Italy.
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7
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Rauseo AM, Aljorayid A, Olsen MA, Larson L, Lipsey KL, Powderly WG, Spec A. Clinical predictive models of invasive Candida infection: a systematic literature review. Med Mycol 2021; 59:1053-1067. [PMID: 34302351 DOI: 10.1093/mmy/myab043] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Revised: 06/30/2021] [Accepted: 07/22/2021] [Indexed: 12/23/2022] Open
Abstract
Clinical predictive models (CPM) serve to identify and categorize patients into risk categories to assist in treatment and intervention recommendations. Predictive accuracy and practicality of models varies depending on methods used for their development, and should be evaluated.The aim of this study was to summarize currently available CPM for invasive candidiasis, analyze their performance, and assess their suitability for use in clinical decision making.We identified studies that described the construction of a CPM for invasive candidiasis from PubMed/MEDLINE, EMBASE, SCOPUS, Web of Science, Cochrane Library databases and Clinicaltrials.gov. Data extracted included: author, data source, study design, recruitment period, characteristics of study population, outcome types, predictor types, number of study participants and outcome events, modelling method and list of predictors used in the final model. Calibration and discrimination in the derivative datasets were used to assess the performance of each model.Ten articles were identified in our search and included for full text review. Five models were developed using data from ICUs, and five models included all hospitalized patients. The findings of this review highlight the limitations of currently available models to predict invasive candidiasis, including lack of generalizability, difficulty in everyday clinical use, and overly optimistic performance.There are significant concerns regarding predictive performance and usability in every day practice of existing CPM to predict invasive candidiasis. LAY SUMMARY Clinical predictive models may assist in early identification of patients at risk for invasive candidiasis to initiate appropriate treatment. The findings of this systematic review highlight the limitations of currently available models to predict invasive candidiasis.
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Affiliation(s)
- Adriana M Rauseo
- Division of Infectious Diseases, Department of Medicine, Washington University School of Medicine, St. Louis, MO, USA
| | - Abdullah Aljorayid
- Division of Infectious Diseases, Department of Medicine, Washington University School of Medicine, St. Louis, MO, USA.,Department of Medicine, College of Medicine, Qassim University, Buraydah, Saudi Arabia
| | - Margaret A Olsen
- Division of Infectious Diseases, Department of Medicine, Washington University School of Medicine, St. Louis, MO, USA
| | - Lindsey Larson
- Division of Infectious Diseases, Department of Medicine, Washington University School of Medicine, St. Louis, MO, USA
| | - Kim L Lipsey
- Bernard Becker Medical Library, Washington University School of Medicine, St. Louis, MO, USA
| | - William G Powderly
- Division of Infectious Diseases, Department of Medicine, Washington University School of Medicine, St. Louis, MO, USA
| | - Andrej Spec
- Division of Infectious Diseases, Department of Medicine, Washington University School of Medicine, St. Louis, MO, USA
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d'Enfert C, Kaune AK, Alaban LR, Chakraborty S, Cole N, Delavy M, Kosmala D, Marsaux B, Fróis-Martins R, Morelli M, Rosati D, Valentine M, Xie Z, Emritloll Y, Warn PA, Bequet F, Bougnoux ME, Bornes S, Gresnigt MS, Hube B, Jacobsen ID, Legrand M, Leibundgut-Landmann S, Manichanh C, Munro CA, Netea MG, Queiroz K, Roget K, Thomas V, Thoral C, Van den Abbeele P, Walker AW, Brown AJP. The impact of the Fungus-Host-Microbiota interplay upon Candida albicans infections: current knowledge and new perspectives. FEMS Microbiol Rev 2021; 45:fuaa060. [PMID: 33232448 PMCID: PMC8100220 DOI: 10.1093/femsre/fuaa060] [Citation(s) in RCA: 125] [Impact Index Per Article: 41.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2020] [Accepted: 11/18/2020] [Indexed: 12/11/2022] Open
Abstract
Candida albicans is a major fungal pathogen of humans. It exists as a commensal in the oral cavity, gut or genital tract of most individuals, constrained by the local microbiota, epithelial barriers and immune defences. Their perturbation can lead to fungal outgrowth and the development of mucosal infections such as oropharyngeal or vulvovaginal candidiasis, and patients with compromised immunity are susceptible to life-threatening systemic infections. The importance of the interplay between fungus, host and microbiota in driving the transition from C. albicans commensalism to pathogenicity is widely appreciated. However, the complexity of these interactions, and the significant impact of fungal, host and microbiota variability upon disease severity and outcome, are less well understood. Therefore, we summarise the features of the fungus that promote infection, and how genetic variation between clinical isolates influences pathogenicity. We discuss antifungal immunity, how this differs between mucosae, and how individual variation influences a person's susceptibility to infection. Also, we describe factors that influence the composition of gut, oral and vaginal microbiotas, and how these affect fungal colonisation and antifungal immunity. We argue that a detailed understanding of these variables, which underlie fungal-host-microbiota interactions, will present opportunities for directed antifungal therapies that benefit vulnerable patients.
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Affiliation(s)
- Christophe d'Enfert
- Unité Biologie et Pathogénicité Fongiques, Département de Mycologie, Institut Pasteur, USC 2019 INRA, 25, rue du Docteur Roux, 75015 Paris, France
| | - Ann-Kristin Kaune
- Aberdeen Fungal Group, Institute of Medical Sciences, University of Aberdeen, Ashgrove Road West, Foresterhill, Aberdeen AB25 2ZD, UK
| | - Leovigildo-Rey Alaban
- BIOASTER Microbiology Technology Institute, 40 avenue Tony Garnier, 69007 Lyon, France
- Université de Paris, Sorbonne Paris Cité, 25, rue du Docteur Roux, 75015 Paris, France
| | - Sayoni Chakraborty
- Microbial Immunology Research Group, Emmy Noether Junior Research Group Adaptive Pathogenicity Strategies, and the Department of Microbial Pathogenicity Mechanisms, Leibniz Institute for Natural Product Research and Infection Biology – Hans Knöll Institute, Beutenbergstraße 11a, 07745 Jena, Germany
- Institute of Microbiology, Friedrich Schiller University, Neugasse 25, 07743 Jena, Germany
| | - Nathaniel Cole
- Gut Microbiology Group, Rowett Institute, University of Aberdeen, Ashgrove Road West, Foresterhill, Aberdeen AB25 2ZD, UK
| | - Margot Delavy
- Unité Biologie et Pathogénicité Fongiques, Département de Mycologie, Institut Pasteur, USC 2019 INRA, 25, rue du Docteur Roux, 75015 Paris, France
- Université de Paris, Sorbonne Paris Cité, 25, rue du Docteur Roux, 75015 Paris, France
| | - Daria Kosmala
- Unité Biologie et Pathogénicité Fongiques, Département de Mycologie, Institut Pasteur, USC 2019 INRA, 25, rue du Docteur Roux, 75015 Paris, France
- Université de Paris, Sorbonne Paris Cité, 25, rue du Docteur Roux, 75015 Paris, France
| | - Benoît Marsaux
- ProDigest BV, Technologiepark 94, B-9052 Gent, Belgium
- Center for Microbial Ecology and Technology (CMET), Department of Biotechnology, Faculty of Bioscience Engineering, Ghent University, Coupure Links, 9000 Ghent, Belgium
| | - Ricardo Fróis-Martins
- Immunology Section, Vetsuisse Faculty, University of Zurich, Winterthurerstrasse 266a, Zurich 8057, Switzerland
- Institute of Experimental Immunology, University of Zurich, Winterthurerstrasse 190, Zürich 8057, Switzerland
| | - Moran Morelli
- Mimetas, Biopartner Building 2, J.H. Oortweg 19, 2333 CH Leiden, The Netherlands
| | - Diletta Rosati
- Department of Internal Medicine and Radboud Center for Infectious Diseases, Radboud University Medical Center, Geert Grooteplein 28, 6525 GA Nijmegen, The Netherlands
| | - Marisa Valentine
- Microbial Immunology Research Group, Emmy Noether Junior Research Group Adaptive Pathogenicity Strategies, and the Department of Microbial Pathogenicity Mechanisms, Leibniz Institute for Natural Product Research and Infection Biology – Hans Knöll Institute, Beutenbergstraße 11a, 07745 Jena, Germany
| | - Zixuan Xie
- Gut Microbiome Group, Vall d'Hebron Institut de Recerca (VHIR), Vall d'Hebron Hospital Universitari, Vall d'Hebron Barcelona Hospital Campus, Passeig Vall d'Hebron 119–129, 08035 Barcelona, Spain
| | - Yoan Emritloll
- Unité Biologie et Pathogénicité Fongiques, Département de Mycologie, Institut Pasteur, USC 2019 INRA, 25, rue du Docteur Roux, 75015 Paris, France
| | - Peter A Warn
- Magic Bullet Consulting, Biddlecombe House, Ugbrook, Chudleigh Devon, TQ130AD, UK
| | - Frédéric Bequet
- BIOASTER Microbiology Technology Institute, 40 avenue Tony Garnier, 69007 Lyon, France
| | - Marie-Elisabeth Bougnoux
- Unité Biologie et Pathogénicité Fongiques, Département de Mycologie, Institut Pasteur, USC 2019 INRA, 25, rue du Docteur Roux, 75015 Paris, France
| | - Stephanie Bornes
- Université Clermont Auvergne, INRAE, VetAgro Sup, UMRF0545, 20 Côte de Reyne, 15000 Aurillac, France
| | - Mark S Gresnigt
- Microbial Immunology Research Group, Emmy Noether Junior Research Group Adaptive Pathogenicity Strategies, and the Department of Microbial Pathogenicity Mechanisms, Leibniz Institute for Natural Product Research and Infection Biology – Hans Knöll Institute, Beutenbergstraße 11a, 07745 Jena, Germany
| | - Bernhard Hube
- Microbial Immunology Research Group, Emmy Noether Junior Research Group Adaptive Pathogenicity Strategies, and the Department of Microbial Pathogenicity Mechanisms, Leibniz Institute for Natural Product Research and Infection Biology – Hans Knöll Institute, Beutenbergstraße 11a, 07745 Jena, Germany
| | - Ilse D Jacobsen
- Microbial Immunology Research Group, Emmy Noether Junior Research Group Adaptive Pathogenicity Strategies, and the Department of Microbial Pathogenicity Mechanisms, Leibniz Institute for Natural Product Research and Infection Biology – Hans Knöll Institute, Beutenbergstraße 11a, 07745 Jena, Germany
| | - Mélanie Legrand
- Unité Biologie et Pathogénicité Fongiques, Département de Mycologie, Institut Pasteur, USC 2019 INRA, 25, rue du Docteur Roux, 75015 Paris, France
| | - Salomé Leibundgut-Landmann
- Immunology Section, Vetsuisse Faculty, University of Zurich, Winterthurerstrasse 266a, Zurich 8057, Switzerland
- Institute of Experimental Immunology, University of Zurich, Winterthurerstrasse 190, Zürich 8057, Switzerland
| | - Chaysavanh Manichanh
- Gut Microbiome Group, Vall d'Hebron Institut de Recerca (VHIR), Vall d'Hebron Hospital Universitari, Vall d'Hebron Barcelona Hospital Campus, Passeig Vall d'Hebron 119–129, 08035 Barcelona, Spain
| | - Carol A Munro
- Aberdeen Fungal Group, Institute of Medical Sciences, University of Aberdeen, Ashgrove Road West, Foresterhill, Aberdeen AB25 2ZD, UK
| | - Mihai G Netea
- Department of Internal Medicine and Radboud Center for Infectious Diseases, Radboud University Medical Center, Geert Grooteplein 28, 6525 GA Nijmegen, The Netherlands
| | - Karla Queiroz
- Mimetas, Biopartner Building 2, J.H. Oortweg 19, 2333 CH Leiden, The Netherlands
| | - Karine Roget
- NEXBIOME Therapeutics, 22 allée Alan Turing, 63000 Clermont-Ferrand, France
| | - Vincent Thomas
- BIOASTER Microbiology Technology Institute, 40 avenue Tony Garnier, 69007 Lyon, France
| | - Claudia Thoral
- NEXBIOME Therapeutics, 22 allée Alan Turing, 63000 Clermont-Ferrand, France
| | | | - Alan W Walker
- Gut Microbiology Group, Rowett Institute, University of Aberdeen, Ashgrove Road West, Foresterhill, Aberdeen AB25 2ZD, UK
| | - Alistair J P Brown
- MRC Centre for Medical Mycology, Department of Biosciences, University of Exeter, Geoffrey Pope Building, Stocker Road, Exeter EX4 4QD, UK
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9
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Ahmad S, Alfouzan W. Candida auris: Epidemiology, Diagnosis, Pathogenesis, Antifungal Susceptibility, and Infection Control Measures to Combat the Spread of Infections in Healthcare Facilities. Microorganisms 2021; 9:microorganisms9040807. [PMID: 33920482 PMCID: PMC8069182 DOI: 10.3390/microorganisms9040807] [Citation(s) in RCA: 70] [Impact Index Per Article: 23.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2021] [Revised: 04/08/2021] [Accepted: 04/09/2021] [Indexed: 12/21/2022] Open
Abstract
Candida auris, a recently recognized, often multidrug-resistant yeast, has become a significant fungal pathogen due to its ability to cause invasive infections and outbreaks in healthcare facilities which have been difficult to control and treat. The extraordinary abilities of C. auris to easily contaminate the environment around colonized patients and persist for long periods have recently resulted in major outbreaks in many countries. C. auris resists elimination by robust cleaning and other decontamination procedures, likely due to the formation of 'dry' biofilms. Susceptible hospitalized patients, particularly those with multiple comorbidities in intensive care settings, acquire C. auris rather easily from close contact with C. auris-infected patients, their environment, or the equipment used on colonized patients, often with fatal consequences. This review highlights the lessons learned from recent studies on the epidemiology, diagnosis, pathogenesis, susceptibility, and molecular basis of resistance to antifungal drugs and infection control measures to combat the spread of C. auris infections in healthcare facilities. Particular emphasis is given to interventions aiming to prevent new infections in healthcare facilities, including the screening of susceptible patients for colonization; the cleaning and decontamination of the environment, equipment, and colonized patients; and successful approaches to identify and treat infected patients, particularly during outbreaks.
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10
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Omotani S, Hatsuda Y, Katsui Y, Asao A, Toujou H, Ihara K, Tani K, Myotoku M. Microbial growth and importance of flushing inside closed-type infusion devices during administration of lipid emulsion in vitro setting. Int J Med Sci 2021; 18:3106-3111. [PMID: 34400881 PMCID: PMC8364470 DOI: 10.7150/ijms.60200] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Accepted: 06/11/2021] [Indexed: 12/03/2022] Open
Abstract
Background: We investigated the extent of growth of microorganisms with simultaneous administration of lipid emulsions with infusions for Total Parenteral Nutrition (TPN), assuming that the lipid emulsions contaminated with microorganisms are stagnant in a closed-type infusion device. We also investigated if bacterial growth can be prevented in the infusion device by flushing the inside of the infusion device with saline solution after the administration of lipid emulsion from the side tube in vitro setting. Methods: We made a preparation by adding Escherichia coli to the lipid emulsion and started the infusion simultaneously with the infusion solution for TPN and lipid emulsion with the piggyback method. Immediately after the completion of lipid emulsion infusion, we conducted flushing with saline solution. The volume of saline solution was none, 5, 10, or 20 mL at a flow rate of 1 mL/s. Infusion solution that was stagnant in the infusion device was collected immediately before completing the lipid emulsion infusion and 20 h after flushing, i.e., 24 h after starting the infusion for TPN, and the number of viable bacteria was determined. Results: The number of viable E. coli increased in the infusion device of all three species used in this experiment 24 h after starting the lipid emulsion infusion without flushing. We found that bacterial growth could be prevented through flushing with saline solution after the completion of lipid emulsion infusion and flushing out the stagnant infusion solution in the closed-type infusion device. Conclusions: We found that if E. coli was present in the closed-type infusion device, it would multiply. We also found that the number of viable bacteria varied according to the variety and internal structure of the closed-type infusion device as well as the liquid volume used for flushing, although flushing can prevent the growth of microorganisms. Proper management and manipulation of infusion is required to prevent infection.
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Affiliation(s)
| | | | | | - Ayumi Asao
- Faculty of Pharmacy, Osaka Ohtani University
| | | | - Keigo Ihara
- Faculty of Pharmacy, Osaka Ohtani University
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11
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Keighley CL, Pope A, Marriott DJE, Chapman B, Bak N, Daveson K, Hajkowicz K, Halliday C, Kennedy K, Kidd S, Sorrell TC, Underwood N, van Hal S, Slavin MA, Chen SCA. Risk factors for candidaemia: A prospective multi-centre case-control study. Mycoses 2020; 64:257-263. [PMID: 33185290 DOI: 10.1111/myc.13211] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Revised: 11/04/2020] [Accepted: 11/07/2020] [Indexed: 01/22/2023]
Abstract
OBJECTIVES Candidaemia carries a mortality of up to 40% and may be related to increasing complexity of medical care. Here, we determined risk factors for the development of candidaemia. METHODS We conducted a prospective, multi-centre, case-control study over 12 months. Cases were aged ≥18 years with at least one blood culture positive for Candida spp. Each case was matched with two controls, by age within 10 years, admission within 6 months, admitting unit, and admission duration at least as long as the time between admission and onset of candidaemia. RESULTS A total of 118 incident cases and 236 matched controls were compared. By multivariate analysis, risk factors for candidaemia included neutropenia, solid organ transplant, significant liver, respiratory or cardiovascular disease, recent gastrointestinal, biliary or urological surgery, central venous access device, intravenous drug use, urinary catheter and carbapenem receipt. CONCLUSIONS Risk factors for candidaemia derive from the infection source, carbapenem use, host immune function and organ-based co-morbidities. Preventive strategies should target iatrogenic disruption of mucocutaneous barriers and intravenous drug use.
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Affiliation(s)
- Caitlin Livia Keighley
- Centre for Infectious Diseases and Microbiology Laboratory Services, ICPMR, New South Wales Health Pathology, Sydney, NSW, Australia.,Marie Bashir Institute for Infectious Diseases and Biosecurity, The University of Sydney, Sydney, NSW, Australia.,The Department of Infectious Diseases, Westmead Hospital, Sydney, NSW, Australia
| | - Alun Pope
- Eastern Health Clinical School, Monash University, Melbourne, VIC, Australia
| | - Deborah J E Marriott
- Department of Microbiology and Infectious Diseases, St. Vincent's Hospital, Sydney, NSW, Australia
| | - Belinda Chapman
- Westmead Institute for Medical Research, Westmead, NSW, Australia
| | - Narin Bak
- Department of Infectious Diseases, Royal Adelaide Hospital, Adelaide, SA, Australia
| | - Kathryn Daveson
- Department of Infectious Diseases and Microbiology, Canberra Hospital, Australian National University Medical School, Canberra, ACT, Australia
| | - Krispin Hajkowicz
- Department of Infectious Diseases, School of Medicine, Royal Brisbane and Women's Hospital, University of Queensland, Brisbane, QLD, Australia
| | - Catriona Halliday
- Centre for Infectious Diseases and Microbiology Laboratory Services, ICPMR, New South Wales Health Pathology, Sydney, NSW, Australia
| | - Karina Kennedy
- Department of Infectious Diseases and Microbiology, Canberra Hospital, Australian National University Medical School, Canberra, ACT, Australia
| | - Sarah Kidd
- National Mycology Reference Centre, SA Pathology, Adelaide, SA, Australia
| | - Tania C Sorrell
- Marie Bashir Institute for Infectious Diseases and Biosecurity, The University of Sydney, Sydney, NSW, Australia.,The Department of Infectious Diseases, Westmead Hospital, Sydney, NSW, Australia.,Westmead Institute for Medical Research, Westmead, NSW, Australia
| | - Neil Underwood
- Infection Management Services, Princess Alexandra Hospital, Brisbane, QLD, Australia
| | - Sebastiaan van Hal
- Department of Infectious Diseases and Microbiology, New South Wales Health Pathology, Royal Prince Alfred Hospital, Sydney, NSW, Australia
| | - Monica A Slavin
- Department of Infectious Diseases, Peter MacCallum Cancer Centre, National Centre for Infections in Cancer, Melbourne, VIC, Australia
| | - Sharon C-A Chen
- Centre for Infectious Diseases and Microbiology Laboratory Services, ICPMR, New South Wales Health Pathology, Sydney, NSW, Australia.,Marie Bashir Institute for Infectious Diseases and Biosecurity, The University of Sydney, Sydney, NSW, Australia.,The Department of Infectious Diseases, Westmead Hospital, Sydney, NSW, Australia.,Westmead Institute for Medical Research, Westmead, NSW, Australia
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12
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Das S, Tawde Y, Singh S, Chakrabarti A, Ray P, Rudramurthy SM, Kaur H, Ghosh A. Identification and broth-microdilution antifungal susceptibility testing of yeast directly from automated blood cultures. Future Microbiol 2020; 15:1453-1464. [PMID: 33179527 DOI: 10.2217/fmb-2020-0077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Aim: To standardize MALDI-TOF-MS based identification and antifungal susceptibility (AFST) for yeasts directly from automated blood cultures to reduce turnaround time. Materials & methods: Direct-ID after lysis-centrifugation (0.5% SDS) standardized in 40 and validated in 250 yeast positive samples. Direct-AFST was standardized with fluconazole (28 samples) and evaluated (70 samples) for seven antifungals. Results: Direct-ID had a high sensitivity (97.2%) and specificity (94.3%). Correct species-level identification showed 100% in C. tropicalis, C. krusei, C. parapsilosis. Direct-AFST had a 100% categorical agreement with culture-AFST for posaconazole, anidulafungin and >90% categorical agreement for amphotericin B, voriconazole and fluconazole. Conclusion: Direct-ID and subsequent direct-AFST is a rapid and robust method to reduce the turnaround time for the diagnosis of invasive candidiasis.
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Affiliation(s)
- Sourav Das
- Department of Medical Microbiology, Postgraduate Institute of Medical Education & Research (PGIMER), Chandigarh, India
| | - Yamini Tawde
- Department of Medical Microbiology, Postgraduate Institute of Medical Education & Research (PGIMER), Chandigarh, India
| | - Shreya Singh
- Department of Medical Microbiology, Postgraduate Institute of Medical Education & Research (PGIMER), Chandigarh, India
| | - Arunaloke Chakrabarti
- Department of Medical Microbiology, Postgraduate Institute of Medical Education & Research (PGIMER), Chandigarh, India
| | - Pallab Ray
- Department of Medical Microbiology, Postgraduate Institute of Medical Education & Research (PGIMER), Chandigarh, India
| | - Shivaprakash M Rudramurthy
- Department of Medical Microbiology, Postgraduate Institute of Medical Education & Research (PGIMER), Chandigarh, India
| | - Harsimran Kaur
- Department of Medical Microbiology, Postgraduate Institute of Medical Education & Research (PGIMER), Chandigarh, India
| | - Anup Ghosh
- Department of Medical Microbiology, Postgraduate Institute of Medical Education & Research (PGIMER), Chandigarh, India
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13
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Evaluation of the prognostic factors for candidemia in a medical intensive care unit. JOURNAL OF SURGERY AND MEDICINE 2020. [DOI: 10.28982/josam.804426] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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14
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Ripoli A, Sozio E, Sbrana F, Bertolino G, Pallotto C, Cardinali G, Meini S, Pieralli F, Azzini AM, Concia E, Viaggi B, Tascini C. Personalized machine learning approach to predict candidemia in medical wards. Infection 2020; 48:749-759. [PMID: 32740866 DOI: 10.1007/s15010-020-01488-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2019] [Accepted: 07/21/2020] [Indexed: 12/21/2022]
Abstract
PURPOSE Candidemia is a highly lethal infection; several scores have been developed to assist the diagnosis process and recently different models have been proposed. Aim of this work was to assess predictive performance of a Random Forest (RF) algorithm for early detection of candidemia in the internal medical wards (IMWs). METHODS A set of 42 potential predictors was acquired in a sample of 295 patients (male: 142, age: 72 ± 15 years; candidemia: 157/295; bacteremia: 138/295). Using tenfold cross-validation, a RF algorithm was compared with a classic stepwise multivariable logistic regression model; discriminative performance was assessed by C-statistics, sensitivity and specificity, while calibration was evaluated by Hosmer-Lemeshow test. RESULTS The best tuned RF algorithm demonstrated excellent discrimination (C-statistics = 0.874 ± 0.003, sensitivity = 84.24% ± 0.67%, specificity = 91% ± 2.63%) and calibration (Hosmer-Lemeshow statistics = 12.779 ± 1.369, p = 0.120), markedly greater than the ones guaranteed by the classic stepwise logistic regression (C-statistics = 0.829 ± 0.011, sensitivity = 80.21% ± 1.67%, specificity = 84.81% ± 2.68%; Hosmer-Lemeshow statistics = 38.182 ± 15.983, p < 0.001). In addition, RF suggests a major role of in-hospital antibiotic treatment with microbioma highly impacting antimicrobials (MHIA) that are found as a fundamental risk of candidemia, further enhanced by TPN. When in-hospital MHIA therapy is not performed, PICC is the dominant risk factor for candidemia, again enhanced by TPN. When PICC is not used and MHIA therapy is not performed, the risk of candidemia is minimum, slightly increased by in-hospital antibiotic therapy. CONCLUSION RF accurately estimates the risk of candidemia in patients admitted to IMWs. Machine learning technique might help to identify patients at high risk of candidemia, reduce the delay in empirical treatment and improve appropriateness in antifungal prescription.
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Affiliation(s)
- Andrea Ripoli
- Bioengineering Department, Fondazione Toscana Gabriele Monasterio, Pisa, Italy
| | - Emanuela Sozio
- Emergency Department, North-West District, Tuscany Health Care, Spedali Riuniti Livorno, Livorno, Italy
| | - Francesco Sbrana
- U.O. Lipoapheresis and Center for Inherited Dyslipidemias, Fondazione Toscana Gabriele Monasterio, Via Moruzzi,1, 56124, Pisa, Italy.
| | - Giacomo Bertolino
- Pharmaceutical Department, ASSL Cagliari, Cagliari, Italy.,Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy
| | - Carlo Pallotto
- UOC Malattie Infettive, Ospedale San Donato Arezzo, Sud-Est District, Tuscany Health Care, Arezzo, Italy.,Sezione Di Malattie Infettive, Dipartimento Di Medicina, Università Di Perugia, Perugia, Italy
| | - Gianluigi Cardinali
- Department of Pharmaceutical Sciences-Microbiology, University of Perugia, Perugia, Italy.,CEMIN, Centre of Excellence On Nanostructured Innovative Materials, Department of Chemistry, Biology and Biotechnology, University of Perugia, Perugia, Italy
| | - Simone Meini
- Internal Medicine Unit, Santa Maria Annunziata Hospital, Florence, Italy
| | - Filippo Pieralli
- Intermediate Care Unit, Azienda Ospedaliera Universitaria Careggi, Florence, Italy
| | - Anna Maria Azzini
- Dipartimento Di Diagnostica E Sanità Pubblica, Sezione Di Malattie Infettive, Università Di Verona, Verona, Italy
| | - Ercole Concia
- Dipartimento Di Diagnostica E Sanità Pubblica, Sezione Di Malattie Infettive, Università Di Verona, Verona, Italy
| | - Bruno Viaggi
- Department of Anesthesia, Neuro Intensive Care Unit, Careggi Universital Hospital, Florence, Italy
| | - Carlo Tascini
- First Division of Infectious Diseases, Cotugno Hospital, Azienda Ospedaliera Dei Colli, Napoli, Italy
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15
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Alves PGV, Melo SGO, Bessa MADS, Brito MDO, Menezes RDP, Araújo LBD, Penatti MPA, Pedroso RDS, Röder DVDDB. Risk factors associated with mortality among patients who had candidemia in a university hospital. Rev Soc Bras Med Trop 2020; 53:e20190206. [PMID: 32578699 PMCID: PMC7310371 DOI: 10.1590/0037-8682-0206-2019] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2019] [Accepted: 04/27/2020] [Indexed: 12/02/2022] Open
Abstract
INTRODUCTION: Bloodstream infection due to Candida spp. is a primary
cause of morbidity and mortality in tertiary hospitals. METHODS: In this retrospective study, we included patients with a positive blood
culture for Candida spp. after 48 h of hospitalization.
RESULTS A total of 335 patients who had candidemia were included in this study. Risk
factors associated with mortality were hospitalization in internal medicine
units and surgical clinics, age >60 years, mechanical ventilation,
orotracheal intubation, hemodialysis, corticosteroids use, and C.
parapsilosis infection. CONCLUSIONS: This study highlights the importance of health care related to invasive
procedures and actions to improve patient immunity.
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Affiliation(s)
| | | | | | | | | | | | | | - Reginaldo Dos Santos Pedroso
- Universidade Federal de Uberlândia, Faculdade de Medicina, Uberlândia, MG, Brasil.,Universidade Federal de Uberlândia, Escola Técnica de Saúde, Uberlândia, MG, Brasil
| | - Denise Von Dolinger de Brito Röder
- Universidade Federal de Uberlândia, Faculdade de Medicina, Uberlândia, MG, Brasil.,Universidade Federal de Uberlândia, Instituto de Ciências Biomédicas, Uberlândia, MG, Brasil
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16
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Poissy J, Damonti L, Bignon A, Khanna N, Von Kietzell M, Boggian K, Neofytos D, Vuotto F, Coiteux V, Artru F, Zimmerli S, Pagani JL, Calandra T, Sendid B, Poulain D, van Delden C, Lamoth F, Marchetti O, Bochud PY. Risk factors for candidemia: a prospective matched case-control study. CRITICAL CARE : THE OFFICIAL JOURNAL OF THE CRITICAL CARE FORUM 2020; 24:109. [PMID: 32188500 PMCID: PMC7081522 DOI: 10.1186/s13054-020-2766-1] [Citation(s) in RCA: 80] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/01/2019] [Accepted: 02/07/2020] [Indexed: 12/29/2022]
Abstract
Background Candidemia is an opportunistic infection associated with high morbidity and mortality in patients hospitalized both inside and outside intensive care units (ICUs). Identification of patients at risk is crucial to ensure prompt antifungal therapy. We sought to assess risk factors for candidemia and death, both outside and inside ICUs. Methods This prospective multicenter matched case-control study involved six teaching hospitals in Switzerland and France. Cases were defined by positive blood cultures for Candida sp. Controls were matched to cases using the following criteria: age, hospitalization ward, hospitalization duration, and, when applicable, type of surgery. One to three controls were enrolled by case. Risk factors were analyzed by univariate and multivariate conditional regression models, as a basis for a new scoring system to predict candidemia. Results One hundred ninety-two candidemic patients and 411 matched controls were included. Forty-four percent of included patients were hospitalized in ICUs, and 56% were hospitalized outside ICUs. Independent risk factors for candidemia in the ICU population included total parenteral nutrition, acute kidney injury, heart disease, prior septic shock, and exposure to aminoglycoside antibiotics. Independent risk factors for candidemia in the non-ICU population included central venous catheter, total parenteral nutrition, and exposure to glycopeptides and nitroimidazoles. The accuracy of the scores based on these risk factors is better in the ICU than in the non-ICU population. Independent risk factors for death in candidemic patients included septic shock, acute kidney injury, and the number of antibiotics to which patients were exposed before candidemia. Discussion While this study shows a role for known and novel risk factors for candidemia, it specifically highlights important differences in their distribution according to the hospital setting (ICU versus non-ICU). Conclusion This study provides novel risk scores for candidemia accounting for the hospital setting and recent progress in patients’ management strategies and fungal epidemiology.
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Affiliation(s)
- Julien Poissy
- Current affiliation : Univ. Lille, Inserm U1285, CHU Lille, Pôle de réanimation, NRS, UMR 8576 - UGSF - Unité de Glycobiologie Structurale et Fonctionnelle, F-59000, Lille, France.,Inserm, U995-2 "Fungal Associated Invasive and Inflammatory Diseases", F-59000, Lille, France.,Infectious Diseases Service, Department of Medicine, Lausanne University Hospital and University of Lausanne, rue du Bugnon 46, CH-1011, Lausanne, Switzerland
| | - Lauro Damonti
- Infectious Diseases Service, Department of Medicine, Lausanne University Hospital and University of Lausanne, rue du Bugnon 46, CH-1011, Lausanne, Switzerland.,Department of Infectious Diseases Department, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Anne Bignon
- Surgical Intensive Care Unit, University Hospital of Lille, F-59000, Lille, France
| | - Nina Khanna
- Division of Infectious Diseases and Hospital Epidemiology, University and University Hospital of Basel, Basel, Switzerland
| | - Matthias Von Kietzell
- Infectious Diseases Department, Cantonal Hospital of Saint Gallen, St. Gallen, Switzerland
| | - Katia Boggian
- Infectious Diseases Department, Cantonal Hospital of Saint Gallen, St. Gallen, Switzerland
| | - Dionysios Neofytos
- Transplant Infectious Diseases Unit, University Hospitals of Geneva, Geneva, Switzerland
| | - Fanny Vuotto
- Infectious Diseases Department, University Hospital of Lille, F-59000, Lille, France
| | - Valérie Coiteux
- Hematological Disorders Department, University Hospital and University of Lille, F-59000, Lille, France
| | - Florent Artru
- Digestive Intensive Care Department, University Hospital and University of Lille, F-59000, Lille, France
| | - Stephan Zimmerli
- Department of Infectious Diseases Department, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Jean-Luc Pagani
- Adult Intensive Care Service, University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Thierry Calandra
- Infectious Diseases Service, Department of Medicine, Lausanne University Hospital and University of Lausanne, rue du Bugnon 46, CH-1011, Lausanne, Switzerland
| | - Boualem Sendid
- Inserm, U995-2 "Fungal Associated Invasive and Inflammatory Diseases", F-59000, Lille, France.,Laboratory of Mycology and Parasitology, Hospital and University of Lille, F-59000, Lille, France
| | - Daniel Poulain
- Inserm, U995-2 "Fungal Associated Invasive and Inflammatory Diseases", F-59000, Lille, France.,Laboratory of Mycology and Parasitology, Hospital and University of Lille, F-59000, Lille, France
| | - Christian van Delden
- Transplant Infectious Diseases Unit, University Hospitals of Geneva, Geneva, Switzerland
| | - Frédéric Lamoth
- Infectious Diseases Service, Department of Medicine, Lausanne University Hospital and University of Lausanne, rue du Bugnon 46, CH-1011, Lausanne, Switzerland.,Microbiology Institute, Lausanne University Hospital and University of Lausanne, CH-1010, Lausanne, Switzerland
| | - Oscar Marchetti
- Infectious Diseases Service, Department of Medicine, Lausanne University Hospital and University of Lausanne, rue du Bugnon 46, CH-1011, Lausanne, Switzerland.,Department of Medicine, Ensemble Hospitalier de la Côte, CH-1110, Morges, Switzerland
| | - Pierre-Yves Bochud
- Infectious Diseases Service, Department of Medicine, Lausanne University Hospital and University of Lausanne, rue du Bugnon 46, CH-1011, Lausanne, Switzerland.
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17
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Bal AM, McGill M. Rapid species identification of Candida directly from blood culture broths by Sepsityper-MALDI-TOF mass spectrometry: impact on antifungal therapy. J R Coll Physicians Edinb 2019; 48:114-119. [PMID: 29992199 DOI: 10.4997/jrcpe.2018.203] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Rapid identification of Candida species facilitates pathogen-directed therapy with either fluconazole or an echinocandin. METHOD We applied Sepsityper matrix-assisted laser desorption ionisation time of flight mass spectrometry (MALDI-TOF-MS) technology on positive blood culture broths for rapid species identification. RESULTS Of the 74 patients with candidaemia, 25 had the species identified on the day of the positive blood culture directly from the broth (rapid identification group) while the remaining 49 had the species identified from culture (conventional identification group). Three (13.6%) out of 22 treated patients in the rapid identification group received echinocandin compared to 20/45 (44.4%) in the conventional identification group. The appropriateness of therapy was 90.9% in the rapid identification group and 62.2% in the conventional identification group (p = 0.01). Cost savings were more than £10,000 in the first three days of treatment. CONCLUSION Sepsityper-MALDI-TOF-MS is a useful tool in supporting antifungal stewardship programmes.
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Affiliation(s)
- A M Bal
- Department of Microbiology, University Hospital, Crosshouse, Kilmarnock KA2 0BE, UK,
| | - M McGill
- Department of Microbiology, University Hospital Crosshouse, Kilmarnock, UK
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18
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Prigitano A, Cavanna C, Passera M, Gelmi M, Sala E, Ossi C, Grancini A, Calabrò M, Bramati S, Tejada M, Lallitto F, Farina C, Rognoni V, Fasano MA, Pini B, Romanò L, Cogliati M, Esposto MC, Tortorano AM. Evolution of fungemia in an Italian region. J Mycol Med 2019; 30:100906. [PMID: 31708424 DOI: 10.1016/j.mycmed.2019.100906] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2019] [Revised: 09/09/2019] [Accepted: 10/09/2019] [Indexed: 11/29/2022]
Abstract
BACKGROUND Fungemia represents a public health concern. Knowing aetiology and activity of the antifungals is critical for the management of bloodstream infections. Therefore, surveillance on local/international levels is desirable for a prompt administration of appropriate therapy. METHODS Data on fungi responsible for fungemia and antifungal susceptibility profiles were collected from a laboratory-based surveillance over 2016-2017 in 12 hospitals located in Lombardia, Italy. The trend of this infection in twenty years was analysed. RESULTS A total of 1024 episodes were evaluated. Rate of candiaemia progressively increased up to 1.46/1000 admissions. C.albicans was the most common species (52%), followed by C. parapsilosis (15%) and C glabrata (13%). As in the previous surveys the antifungal resistance is rare (echinocandins<2%, fluconazole 6%, amphotericin B 0.6%). Fungi other than Candida were responsible for 18 episodes: Cryptococcus neoformans (5 cases), Fusarium spp. (4), Magnusiomyces clavatus (3), Saccharomyces cerevisiae (3), Rhodotorula spp. (2), Exophiala dermatitidis (1). All fungi, except S.cerevisiae, were intrinsically resistant to echinocandins. Some isolates showed also elevated azole MIC. CONCLUSIONS No particular changes in terms of species distribution and antifungal susceptibility patterns was noted. However, surveillance programs are needed to monitor trends in antifungal resistance, steer stewardship activities, orient empirical treatment.
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Affiliation(s)
- A Prigitano
- Department of Biomedical Science for Health, Università degli Studi di Milano, Via Pascal 36, 20133 Milano, Italy
| | - C Cavanna
- Microbiology and Virology Unit IRCCS Policlinico San Matteo, Pavia, Italy
| | - M Passera
- Microbiology Institute, ASST 'Papa G iovanni XXIII', Bergamo, Italy
| | - M Gelmi
- Microbiology Laboratory, A.O. Spedali Civili, Brescia, Italy
| | - E Sala
- Microbiology - ASST Lariana, Como, Italy
| | - C Ossi
- Laboratory of Microbiology and Virology, San Raffaele Scientific Institute, Milano, Italy
| | - A Grancini
- Microbiology Laboratory, Fondazione IRCCS C à Granda O. Maggiore Policlinico, Milano, Italy
| | - M Calabrò
- Microbiology Section, Humanitas Research Hospital, Milano, Italy
| | - S Bramati
- Microbiology Laboratory, Ospedale San Gerardo, Monza, Italy
| | - M Tejada
- Medicina di Laboratorio, IRCCS Policlinico San Donato, Milano, Italy
| | - F Lallitto
- Microbiology and Virology Unit IRCCS Policlinico San Matteo, Pavia, Italy
| | - C Farina
- Microbiology Institute, ASST 'Papa G iovanni XXIII', Bergamo, Italy
| | | | - M A Fasano
- Microbiology and Virology Unit, ASST Bergamo Ovest Treviglio, Italy
| | - B Pini
- Laboratory of Microbiology and Virology, ASST Lecco, Italy
| | - L Romanò
- Department of Biomedical Science for Health, Università degli Studi di Milano, Via Pascal 36, 20133 Milano, Italy
| | - M Cogliati
- Department of Biomedical Science for Health, Università degli Studi di Milano, Via Pascal 36, 20133 Milano, Italy
| | - M C Esposto
- Department of Biomedical Science for Health, Università degli Studi di Milano, Via Pascal 36, 20133 Milano, Italy
| | - A M Tortorano
- Department of Biomedical Science for Health, Università degli Studi di Milano, Via Pascal 36, 20133 Milano, Italy.
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19
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Morbidity and mortality of candidaemia in Europe: an epidemiologic meta-analysis. Clin Microbiol Infect 2019; 25:1200-1212. [DOI: 10.1016/j.cmi.2019.04.024] [Citation(s) in RCA: 101] [Impact Index Per Article: 20.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2019] [Revised: 04/15/2019] [Accepted: 04/18/2019] [Indexed: 01/30/2023]
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Ortega-Loubon C, Cano-Hernández B, Poves-Alvarez R, Muñoz-Moreno MF, Román-García P, Balbás-Alvarez S, de la Varga-Martínez O, Gómez-Sánchez E, Gómez-Pesquera E, Lorenzo-López M, Tamayo E, Heredia-Rodríguez M. The Overlooked Immune State in Candidemia: A Risk Factor for Mortality. J Clin Med 2019; 8:jcm8101512. [PMID: 31547077 PMCID: PMC6832466 DOI: 10.3390/jcm8101512] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2019] [Revised: 09/10/2019] [Accepted: 09/17/2019] [Indexed: 12/13/2022] Open
Abstract
Lymphopenia has been related to increased mortality in septic patients. Nonetheless, the impact of lymphocyte count on candidemia mortality and prognosis has not been addressed. We conducted a retrospective study, including all admitted patients with candidemia from 2007 to 2016. We examined lymphocyte counts during the first 5 days following the diagnosis of candidemia. Multivariable logistic regression analysis was performed to determine the relationship between lymphocyte count and mortality. Classification and Regression Tree analysis was used to identify the best cut-off of lymphocyte count for mortality associated with candidemia. From 296 cases of candidemia, 115 died, (39.8% 30-day mortality). Low lymphocyte count was related to mortality and poor outcome (p < 0.001). Lymphocyte counts <0.703 × 109 cells/L at diagnosis (area under the curve (AUC)-ROC, 0.783 ± 0.042; 95% confidence interval (CI), 0.700-0.867, p < 0.001), and lymphocyte count <1.272 × 109 cells/L five days later (AUC-ROC, 0.791 ± 0.038; 95%CI, 0.716-0.866, p < 0.001) increased the odds of mortality five-fold (odds ratio (OR), 5.01; 95%CI, 2.39-10.93) at time of diagnosis, and three-fold (OR, 3.27; 95%CI, 1.24-8.62) by day 5, respectively. Low lymphocyte count is an independent predictor of mortality in patients with candidemia and might serve as a biomarker for predicting candidemia-associated mortality and poor outcome.
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Affiliation(s)
- Christian Ortega-Loubon
- Department of Cardiac Surgery, Clinic University Hospital of Valladolid, Ramon y Cajal Ave. 3, 47003 Valladolid, Spain.
- BioCritic. Group for Biomedical Research in Critical Care Medicine, Ramon y Cajal Ave. 7, 47005 Valladolid, Spain.
| | - Beatriz Cano-Hernández
- Department of Anaesthesiology, Clinic University Hospital of Valladolid, Ramon y Cajal Ave. 3, 47003 Valladolid, Spain.
| | - Rodrigo Poves-Alvarez
- Department of Anaesthesiology, Clinic University Hospital of Valladolid, Ramon y Cajal Ave. 3, 47003 Valladolid, Spain.
| | - María Fe Muñoz-Moreno
- Unit of Research, Clinic University Hospital of Valladolid, Ramon y Cajal Ave. 3, 47003 Valladolid, Spain.
| | - Patricia Román-García
- Department of Anaesthesiology, Clinic University Hospital of Valladolid, Ramon y Cajal Ave. 3, 47003 Valladolid, Spain.
| | - Sara Balbás-Alvarez
- Department of Anaesthesiology, Clinic University Hospital of Valladolid, Ramon y Cajal Ave. 3, 47003 Valladolid, Spain.
| | - Olga de la Varga-Martínez
- Department of Anaesthesiology, Clinic University Hospital of Valladolid, Ramon y Cajal Ave. 3, 47003 Valladolid, Spain.
| | - Esther Gómez-Sánchez
- BioCritic. Group for Biomedical Research in Critical Care Medicine, Ramon y Cajal Ave. 7, 47005 Valladolid, Spain.
- Department of Anaesthesiology, Clinic University Hospital of Valladolid, Ramon y Cajal Ave. 3, 47003 Valladolid, Spain.
- Department of Surgery, Faculty of Medicine, University of Valladolid, Ramon y Cajal Ave 7, 47005 Valladolid, Spain.
| | - Estefanía Gómez-Pesquera
- BioCritic. Group for Biomedical Research in Critical Care Medicine, Ramon y Cajal Ave. 7, 47005 Valladolid, Spain.
- Department of Anaesthesiology, Clinic University Hospital of Valladolid, Ramon y Cajal Ave. 3, 47003 Valladolid, Spain.
- Department of Surgery, Faculty of Medicine, University of Valladolid, Ramon y Cajal Ave 7, 47005 Valladolid, Spain.
| | - Mario Lorenzo-López
- BioCritic. Group for Biomedical Research in Critical Care Medicine, Ramon y Cajal Ave. 7, 47005 Valladolid, Spain.
- Department of Anaesthesiology, Clinic University Hospital of Valladolid, Ramon y Cajal Ave. 3, 47003 Valladolid, Spain.
- Department of Surgery, Faculty of Medicine, University of Valladolid, Ramon y Cajal Ave 7, 47005 Valladolid, Spain.
| | - Eduardo Tamayo
- BioCritic. Group for Biomedical Research in Critical Care Medicine, Ramon y Cajal Ave. 7, 47005 Valladolid, Spain.
- Department of Anaesthesiology, Clinic University Hospital of Valladolid, Ramon y Cajal Ave. 3, 47003 Valladolid, Spain.
- Department of Surgery, Faculty of Medicine, University of Valladolid, Ramon y Cajal Ave 7, 47005 Valladolid, Spain.
| | - María Heredia-Rodríguez
- BioCritic. Group for Biomedical Research in Critical Care Medicine, Ramon y Cajal Ave. 7, 47005 Valladolid, Spain.
- Department of Surgery, Faculty of Medicine, University of Valladolid, Ramon y Cajal Ave 7, 47005 Valladolid, Spain.
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21
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Falcone M, Tiseo G, Gutiérrez-Gutiérrez B, Raponi G, Carfagna P, Rosin C, Luzzati R, Delle Rose D, Andreoni M, Farcomeni A, Venditti M, Rodríguez-Baño J, Menichetti F. Impact of Initial Antifungal Therapy on the Outcome of Patients With Candidemia and Septic Shock Admitted to Medical Wards: A Propensity Score-Adjusted Analysis. Open Forum Infect Dis 2019; 6:ofz251. [PMID: 31334296 PMCID: PMC6634434 DOI: 10.1093/ofid/ofz251] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2018] [Accepted: 05/23/2019] [Indexed: 11/15/2022] Open
Abstract
Background Echinocandins are recommended as firstline therapy in patients with candidemia. However, there is debate on their efficacy in survival outcomes. The aim of this study is to evaluate whether the choice of initial antifungal therapy improves mortality in patients with candidemia in relation to the presence of septic shock. Methods Patients with candidemia hospitalized in internal medicine wards of 5 tertiary care centers were included in the study (December 2012–December 2014). Patient characteristics, therapeutic interventions, and outcome were reviewed. Propensity score (PS) was used as a covariate of the multivariate analysis to perform a stratified analysis according to PS quartiles and to match patients receiving “echinocandins” or “azoles.” Results Overall, 439 patients with candidemia were included in the study. A total of 172 (39.2%) patients had septic shock. Thirty-day mortality was significantly higher in patients with septic shock (45.3%) compared with those without septic shock (31.5%; P = .003). Among patients with septic shock, the use of echinocandins in the first 48 hours, compared with azoles, did not affect 30-day mortality in the PS-adjusted Cox regression analysis (hazard ratio [HR], 0.77; 95% confidence interval [CI], 0.37–1.59; P = .48), the PS-stratified analysis, or the logistic regression model in matched cohorts (adjusted HR, 0.92; 95% CI, 0.51–1.63; P = .77). Conclusions Echinocandin therapy seems not to improve the outcome of non–intensive care unit patients with septic shock due to candidemia. These findings support the urgent need of further studies in this patient population.
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Affiliation(s)
- Marco Falcone
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Giusy Tiseo
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Belen Gutiérrez-Gutiérrez
- Unidad Clínica de Enfermedades Infecciosas, Microbiología y Medicina Preventiva, Hospital Universitario Virgen Macarena/Departamento de Medicina, Universidad de Sevilla/Instituto de Biomedicina de Sevilla (IBiS), Sevilla, Spain
| | - Giammarco Raponi
- Department of Public Health and Infectious Diseases, "Sapienza" University of Rome, Rome, Italy
| | | | | | | | - Diego Delle Rose
- Clinical Infectious Diseases, Department of Systems Medicine, Tor Vergata University, Rome, Italy
| | - Massimo Andreoni
- Clinical Infectious Diseases, Department of Systems Medicine, Tor Vergata University, Rome, Italy
| | - Alessio Farcomeni
- Department of Public Health and Infectious Diseases, "Sapienza" University of Rome, Rome, Italy
| | - Mario Venditti
- Department of Public Health and Infectious Diseases, "Sapienza" University of Rome, Rome, Italy
| | - Jesus Rodríguez-Baño
- Unidad Clínica de Enfermedades Infecciosas, Microbiología y Medicina Preventiva, Hospital Universitario Virgen Macarena/Departamento de Medicina, Universidad de Sevilla/Instituto de Biomedicina de Sevilla (IBiS), Sevilla, Spain
| | - Francesco Menichetti
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
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22
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Fazal F. European Committee on Antimicrobial Susceptibility Testing and Clinical and Laboratory Standards Institute breakpoints-the only point that matters in candidemia? J Thorac Dis 2019; 11:S1412-S1414. [PMID: 31245147 DOI: 10.21037/jtd.2019.03.12] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Affiliation(s)
- Farhan Fazal
- Department of Medicine and Microbiology (Infectious Disease), All India Institute of Medical Science (AIIMS), New Delhi, India
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23
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Falcone M, Tiseo G, Venditti M, Menichetti F. Updates in the epidemiology and management of candidemia and Clostridioides difficile coinfection. Expert Rev Anti Infect Ther 2019; 17:375-382. [PMID: 30982376 DOI: 10.1080/14787210.2019.1608183] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Introduction: In recent years, more and more studies have focused on the association between candidemia and Clostridioides difficile infection (CDI), highlighting the risk of subsequent candidemia in patients with CDI. However, a more recent model focuses on the Candida-Clostridioides difficile coinfection as a clinical entity in which candidemia could occur before or after the CDI episode. Areas covered: In this review we analyzed the physiopathological mechanisms underlying the Candida-Clostridioides difficile coinfection, both in case of candidemia preceding and following the CDI. We highlighted that gut alterations occurring during a CDI play a crucial role in the risk of subsequent candidemia. Moreover, we identified areas of interest about the management of Candida-Clostridioides difficile coinfection and proposed answers to relevant clinical questions. Expert opinion: The evaluation of risk factors for candidemia in patients with CDI and the rational antibiotic use in patients with candidemia remain the most efficacious and cost-free instruments to optimally manage the Candida-Clostridioides difficile coinfection. However, further studies are required to cover some unmet needs, such as the development of rapid diagnostic methods of candidemia and the use of new available drugs with minimal effect on the microbiome biodiversity in patients with CDI at high risk of fungemia.
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Affiliation(s)
- Marco Falcone
- a Department of Clinical and Experimental Medicine , University of Pisa , Pisa , Italy
| | - Giusy Tiseo
- a Department of Clinical and Experimental Medicine , University of Pisa , Pisa , Italy
| | - Mario Venditti
- b Department of Public Health and Infectious Diseases , 'Sapienza' University of Rome , Rome , Italy
| | - Francesco Menichetti
- a Department of Clinical and Experimental Medicine , University of Pisa , Pisa , Italy
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24
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Hesstvedt L, Gaustad P, Müller F, Torp Andersen C, Brunborg C, Mylvaganam H, Leiva RA, Berdal JE, Egil Ranheim T, Johnsen BO, Falch BM, Grimnes G, Skogen V, Haarr E, Sandmo Lyngøy A, Wik Larssen K, Hannula R, Åsheim Hansen B, Nordøy I. The impact of age on risk assessment, therapeutic practice and outcome in candidemia. Infect Dis (Lond) 2019; 51:425-434. [PMID: 31010380 DOI: 10.1080/23744235.2019.1595709] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND In Norway, the epidemiological situation of candidemia is followed closely. We have previously demonstrated the highest incidence of candidemia in elderly >65 years of age. However, knowledge of other aspects of this infection is lacking. OBJECTIVE The aim of this nationwide, retrospective study was to examine risk factors, therapeutic practice and outcome in adult candidemia patients according to age. METHODS We retrieved data from medical records from patients who developed candidemia in Norway between 1 January 2008 and 31 December 2012. Data were analyzed according to age, younger patients being between 18 and 65 years, elderly being ≥65 years of age. RESULTS From 771 eligible patients, 738 patients (95.7%) were included (58% men, mean age 65.2 years, 58.1% being ≥65 years). Exposure to health-care related risk factors for candidemia were significantly more common in the younger patients (neutropenia, central venous catheter, mechanical ventilation and chemotherapy) who received empirical treatment more often than the elderly (29.8% vs. 21.7%, p = .01). More elderly did not received any antifungal therapy (27.3% vs 16.8%, p < 0001) and had higher mortality compared to younger patients (45.5% vs 23.9%, p < .0001). In the study population, mortality was higher with age (per 10-years increase, OR 1.43;1.28-1.59, p < 0.0001), in patients not receiving targeted therapy (OR 2.5; CI 1.82-3.36, p < .0001) or any therapy at all (OR 4.64; 3.23-6.68, p < .0001). CONCLUSIONS Risk factors for candidemia, treatment and outcome differed significantly according to age. Given the increasing numbers of elderly, scrutiny on our clinical practice is warranted.
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Affiliation(s)
- Liv Hesstvedt
- a Research Institute for Internal Medicine, Oslo University Hospital, Rikshospitalet , Oslo , Norway.,b Department of Microbiology , Oslo University Hospital, Rikshospitalet , Oslo , Norway
| | - Peter Gaustad
- b Department of Microbiology , Oslo University Hospital, Rikshospitalet , Oslo , Norway.,c Norwegian Mycological Reference Laboratory, Oslo University Hospital , Oslo , Norway.,d Institute of Clinical Medicine, Faculty of Medicine, University of Oslo , Oslo , Norway
| | - Fredrik Müller
- c Norwegian Mycological Reference Laboratory, Oslo University Hospital , Oslo , Norway.,d Institute of Clinical Medicine, Faculty of Medicine, University of Oslo , Oslo , Norway
| | - Cecilie Torp Andersen
- b Department of Microbiology , Oslo University Hospital, Rikshospitalet , Oslo , Norway.,c Norwegian Mycological Reference Laboratory, Oslo University Hospital , Oslo , Norway
| | - Cathrine Brunborg
- e Oslo Centre for Biostatistics & Epidemiology, Oslo University Hospital , Oslo , Norway
| | - Haima Mylvaganam
- f Department of Microbiology , Haukeland University Hospital , Bergen , Norway
| | | | - Jan Erik Berdal
- h Department of Infectious Diseases , Akershus University Hospital , Lørenskog , Norway
| | - Trond Egil Ranheim
- i Department of Microbiology and Infection Control , Akershus University Hospital , Lørenskog , Norway
| | - Bjørn Odd Johnsen
- i Department of Microbiology and Infection Control , Akershus University Hospital , Lørenskog , Norway
| | - Birgit M Falch
- j Department of Microbiology , University Hospital of Northern Norway , Tromsø , Norway
| | - Gro Grimnes
- k Department of Infectious Diseases , University Hospital of Northern Norway , Tromsø , Norway
| | - Vegard Skogen
- k Department of Infectious Diseases , University Hospital of Northern Norway , Tromsø , Norway
| | - Elisebet Haarr
- l Department of Medical Microbiology , University Hospital of Stavanger , Stavanger , Norway
| | - Anita Sandmo Lyngøy
- m Department of Infectious Diseases , University Hospital of Stavanger , Stavanger , Norway
| | - Kjersti Wik Larssen
- n Department of Microbiology , Trondheim University Hospital , Trondheim , Norway
| | - Raisa Hannula
- o Department of Infectious Diseases , Trondheim University Hospital , Trondheim , Norway
| | - Bjørn Åsheim Hansen
- p Department of Infectious Diseases , Vestfold Hospital Trust , Tønsberg , Norway
| | - Ingvild Nordøy
- a Research Institute for Internal Medicine, Oslo University Hospital, Rikshospitalet , Oslo , Norway.,q Section of Clinical immunology and Infectious Diseases , Oslo University Hospital, Rikshospitalet , Oslo , Norway
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25
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Sozio E, Pieralli F, Azzini AM, Tintori G, Demma F, Furneri G, Sbrana F, Bertolino G, Fortunato S, Meini S, Bragantini D, Morettini A, Nozzoli C, Menichetti F, Concia E, Tascini C. A prediction rule for early recognition of patients with candidemia in Internal Medicine: results from an Italian, multicentric, case-control study. Infection 2018; 46:625-633. [PMID: 29949088 DOI: 10.1007/s15010-018-1162-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2018] [Accepted: 06/05/2018] [Indexed: 12/27/2022]
Abstract
PURPOSE Increasing prevalence of candidemia in Internal Medicine wards (IMWs) has been reported in recent years, but risk factors for candida bloodstream infection in patients admitted to IMW may differ from those known in other settings. The aim of this study was to identify risk factors and define a prediction rule for the early recognition of the risk of candidemia in IMW inpatients. METHODS This was a multicentric, retrospective, observational case-control study on non-neutropenic patients with candidemia admitted to IMWs of four large Italian Hospitals. Each eligible patient with candidemia (case) was matched to a control with bacteremia. Stepwise logistic regression analyses were performed. RESULTS Overall, 300 patients (150 cases and 150 controls) were enrolled. The following factors were associated with an increased risk of candidemia and weighted to build a score: total parenteral nutrition (OR 2.45, p = 0.008; 1 point); central venous catheter (OR 2.19, p = 0.031; 1 point); peripherally inserted central catheter (OR 5.63, p < 0.0001; 3 points), antibiotic treatment prior (OR 2.06; p = 0.059; 1 point) and during hospitalization (OR2.38, p = 0.033; 1 point); neurological disability (OR 2.25, p = 0.01; 1 point); and previous hospitalization within 3 months (OR 1.56, p = 0.163; 1 point). At ROC curve analysis, a final score ≥ 4 showed 84% sensitivity, 76% specificity, and 80% accuracy in predicting the risk of candidemia. CONCLUSIONS The proposed scoring system showed to be a simple and highly performing tool in distinguishing bloodstream infections due to Candida and bacteria in patients admitted to IMW. The proposed rule might help to reduce delay in empirical treatment and improve appropriateness in antifungal prescription in septic patients.
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Affiliation(s)
- Emanuela Sozio
- Emergency Department, North-West District, Tuscany HealthCare, Spedali Riuniti Livorno, Viale Alfieri 36, 57100, Leghorn, Italy.
| | - Filippo Pieralli
- Intermediate Care Unit, Azienda Ospedaliera Universitaria Careggi, Florence, Italy
| | - Anna Maria Azzini
- Infectious Disease Unit, Azienda Ospedaliera Universitaria Integrata di Verona, p.Le LA Scuro, Verona, Italy
| | - Giancarlo Tintori
- Emergency Medicine Unit, Nuovo Santa Chiara University Hospital, Azienda Ospedaliera Universitaria Pisana, Pisa, Italy
| | - Federica Demma
- Health Economics and Outcome Research Department-EBMA Consulting, Milan, Italy
| | - Gianluca Furneri
- Health Economics and Outcome Research Department-EBMA Consulting, Milan, Italy
| | | | | | - Simona Fortunato
- Infectious Diseases Clinic, Nuovo Santa Chiara University Hospital, Azienda Ospedaliera Universitaria Pisana, Pisa, Italy
| | - Simone Meini
- Department of Internal Medicine, S.M. Annunziata Hospital, Florence, Italy
| | - Damiano Bragantini
- Infectious Disease Unit, Azienda Ospedaliera Universitaria Integrata di Verona, p.Le LA Scuro, Verona, Italy
| | - Alessandro Morettini
- Internal Medicine Unit, Azienda Ospedaliera Universitaria Careggi, Florence, Italy
| | - Carlo Nozzoli
- Internal Medicine Unit, Azienda Ospedaliera Universitaria Careggi, Florence, Italy
| | - Francesco Menichetti
- Infectious Diseases Clinic, Nuovo Santa Chiara University Hospital, Azienda Ospedaliera Universitaria Pisana, Pisa, Italy
| | - Ercole Concia
- Infectious Disease Unit, Azienda Ospedaliera Universitaria Integrata di Verona, p.Le LA Scuro, Verona, Italy
| | - Carlo Tascini
- First Division of Infectious Diseases, Cotugno Hospital, Azienda Ospedaliera dei Colli, Naples, Italy
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26
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Sbrana F, Sozio E, Bassetti M, Ripoli A, Pieralli F, Azzini AM, Morettini A, Nozzoli C, Merelli M, Rizzardo S, Bertolino G, Carrara D, Scarparo C, Concia E, Menichetti F, Tascini C. Independent risk factors for mortality in critically ill patients with candidemia on Italian Internal Medicine Wards. Intern Emerg Med 2018; 13:199-204. [PMID: 29322386 DOI: 10.1007/s11739-017-1783-9] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2017] [Accepted: 12/25/2017] [Indexed: 12/31/2022]
Abstract
Candida is an increasing cause of bloodstream infection and is associated with significant morbidity and mortality. The aim of our study is to analyze risk factors for short-term mortality in patients with bloodstream Candida spp. infections admitted to Internal Medicine Wards (IMWs). This was a retrospective case-control study between January 2012 and December 2014 from four University Hospitals in Italy, where patients with candidemia dying within 30 days from diagnosis were matched to control cases with candidemia who survived in the same period of time. Two-hundred and fifty cases of candidemia were registered during the 36 months of enrollment. Among these, 112 patients died (45%) within 30 days from the first blood culture's positivity for Candida spp. At multivariate analysis, septic shock [odds ratio (95% CI) = 2.919 (1.62-5.35), p < 0.001] and concomitant chronic kidney failure [odds ratio (95% CI) = 2.296 (1.07-5.12), p = 0.036] were independent predictors of mortality. Low-dose chronic steroid therapy was protective [odds ratio (95% CI) = 0.461 (0.25-0.83), p = 0.011).
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Affiliation(s)
- Francesco Sbrana
- Fondazione Toscana Gabriele Monasterio, Via Moruzzi, 1, 56124, Pisa, Italy.
| | - Emanuela Sozio
- North-West District, Tuscany HealthCare, Spedali Riuniti Livorno, Emergency Department, Leghorn, Italy
| | - Matteo Bassetti
- Infectious Diseases Division, Santa Maria Misericordia University Hospital, Udine, Italy
| | - Andrea Ripoli
- Fondazione Toscana Gabriele Monasterio, Via Moruzzi, 1, 56124, Pisa, Italy
| | - Filippo Pieralli
- Intermediate Care Unit, Azienda Ospedaliera Universitaria Careggi, Florence, Italy
| | - Anna Maria Azzini
- Infectious Disease Unit, Azienda Ospedaliera Universitaria Integrata di Verona, Verona, Italy
| | - Alessandro Morettini
- Internal Medicine Unit, Azienda Ospedaliera Universitaria Careggi, Florence, Italy
| | - Carlo Nozzoli
- Internal Medicine Unit, Azienda Ospedaliera Universitaria Careggi, Florence, Italy
| | - Maria Merelli
- Infectious Diseases Division, Santa Maria Misericordia University Hospital, Udine, Italy
| | - Sebastiano Rizzardo
- Infectious Disease Unit, Azienda Ospedaliera Universitaria Integrata di Verona, Verona, Italy
| | - Giacomo Bertolino
- Pharmaceutical Department, Azienda Ospedaliera Universitaria Pisana, Santa Chiara, Pisa, Italy
| | - Davide Carrara
- U.O.C. Medicina Generale, Ospedale Versilia, Azienda U.S.L. Toscana Nord Ovest, Viareggio, Italy
| | - Claudio Scarparo
- Infectious Diseases Division, Santa Maria Misericordia University Hospital, Udine, Italy
| | - Ercole Concia
- Infectious Disease Unit, Azienda Ospedaliera Universitaria Integrata di Verona, Verona, Italy
| | - Francesco Menichetti
- Infectious Diseases Clinic, Nuovo Santa Chiara University Hospital, Azienda Ospedaliera Universitaria Pisana, Pisa, Italy
| | - Carlo Tascini
- First Division of Infectious Diseases, Cotugno Hospital, Azienda Ospedaliera dei Colli, Naples, Italy
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27
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Ku TSN, Bernardo S, Walraven CJ, Lee SA. Candidiasis and the impact of flow cytometry on antifungal drug discovery. Expert Opin Drug Discov 2017; 12:1127-1137. [PMID: 28876963 DOI: 10.1080/17460441.2017.1377179] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
INTRODUCTION Invasive candidiasis continues to be associated with significant morbidity and mortality as well as substantial health care costs nationally and globally. One of the contributing factors is the development of resistance to antifungal agents that are already in clinical use. Moreover, there are known treatment limitations with all of the available antifungal agents. Since traditional techniques in novel drug discovery are time consuming, high-throughput screening using flow cytometry presents as a potential tool to identify new antifungal agents that would be useful in the management of these patients. Areas covered: In this review, the authors discuss the use of automated high-throughput screening assays based upon flow cytometry to identify potential antifungals from a library comprised of a large number of bioactive compounds. They also review studies that employed the use of this research methodology that has identified compounds with antifungal activity. Expert opinion: High-throughput screening using flow cytometry has substantially decreased the processing time necessary for screening thousands of compounds, and has helped enhance our understanding of fungal pathogenesis. Indeed, the authors see this technology as a powerful tool to help scientists identify new antifungal agents that can be added to the clinician's arsenal in their fight against invasive candidiasis.
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Affiliation(s)
- Tsun Sheng N Ku
- a Section of Infectious Diseases , New Mexico VA Health Care System , Albuquerque , NM , USA.,b Division of Infectious Diseases , University of New Mexico Health Science Center , Albuquerque , NM , USA
| | - Stella Bernardo
- a Section of Infectious Diseases , New Mexico VA Health Care System , Albuquerque , NM , USA.,b Division of Infectious Diseases , University of New Mexico Health Science Center , Albuquerque , NM , USA
| | - Carla J Walraven
- c Department of Pharmaceutical Services , University of New Mexico Hospital , Albuquerque , NM , USA
| | - Samuel A Lee
- a Section of Infectious Diseases , New Mexico VA Health Care System , Albuquerque , NM , USA.,b Division of Infectious Diseases , University of New Mexico Health Science Center , Albuquerque , NM , USA
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28
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Giacobbe DR, Del Bono V, Mikulska M, Gustinetti G, Marchese A, Mina F, Signori A, Orsi A, Rudello F, Alicino C, Bonalumi B, Morando A, Icardi G, Beltramini S, Viscoli C. Impact of a mixed educational and semi-restrictive antimicrobial stewardship project in a large teaching hospital in Northern Italy. Infection 2017; 45:849-856. [PMID: 28856589 DOI: 10.1007/s15010-017-1063-7] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2017] [Accepted: 08/19/2017] [Indexed: 12/11/2022]
Abstract
BACKGROUND The overuse of antimicrobials favors the dissemination of antimicrobial resistance, as well as invasive fungal diseases and Clostridium difficile infections (CDI). In this study, we assessed the impact of a mixed educational and semi-restrictive antimicrobial stewardship (AMS) project in a large teaching hospital in Italy. METHODS The AMS project was conducted from May 2014 to April 2016. It consisted of two initiatives in two consecutive periods: (1) educational activities; (2) semi-restrictive control of antimicrobial prescribing through a computerized software. The primary endpoint was consumption of antibacterials and antifungals. Secondary endpoints were incidence of CDI, methicillin-resistant Staphylococcus aureus (MRSA) bloodstream infections (BSI), carbapenem-resistant Klebsiella pneumoniae (CRKP) BSI, and Candida BSI. RESULTS During the study period, a statistically significant reduction in consumption was observed for antibacterials (-1.45 defined daily doses (DDD)/1000 patient-days monthly, 95% confidence intervals [CI] -2.38 to -0.52, p 0.004), mainly driven by reductions in the use of fluoroquinolones, third/fourth generation cephalosporins, and carbapenems. No decrease in consumption of antifungals was observed (-0.04 DDD/1000 patient-days monthly, 95% CI -0.34 to +0.25, p 0.750). A statistically significant trend towards reduction was observed for incidence of CRKP BSI (incidence rate ratio 0.96, 95% CI 0.92-0.99, p 0.013). No statistically significant variations in trends were observed for CDI, MRSA BSI, and Candida BSI. CONCLUSIONS The mixed AMS project was effective in reducing the use of major antibacterials and the incidence of CRKP BSI. Further research is needed to assess the extent of long-term benefits of semi-restrictive approaches.
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Affiliation(s)
- Daniele Roberto Giacobbe
- U.O. Clinica Malattie Infettive, University of Genoa (DISSAL) and Ospedale Policlinico San Martino-IRCCS per L'Oncologia, L.go R. Benzi, 10, 16132, Genoa, Italy.
| | - Valerio Del Bono
- U.O. Clinica Malattie Infettive, University of Genoa (DISSAL) and Ospedale Policlinico San Martino-IRCCS per L'Oncologia, L.go R. Benzi, 10, 16132, Genoa, Italy
| | - Malgorzata Mikulska
- U.O. Clinica Malattie Infettive, University of Genoa (DISSAL) and Ospedale Policlinico San Martino-IRCCS per L'Oncologia, L.go R. Benzi, 10, 16132, Genoa, Italy
| | - Giulia Gustinetti
- U.O. Clinica Malattie Infettive, University of Genoa (DISSAL) and Ospedale Policlinico San Martino-IRCCS per L'Oncologia, L.go R. Benzi, 10, 16132, Genoa, Italy
| | - Anna Marchese
- S.S.D. Microbiologia, University of Genoa (DISC) and Ospedale Policlinico San Martino-IRCCS per L'Oncologia, Genoa, Italy
| | - Federica Mina
- U.O. Farmacia, Ospedale Policlinico San Martino-IRCCS per l'Oncologia, Genoa, Italy
| | | | - Andrea Orsi
- U.O. Igiene, University of Genoa (DISSAL) and Ospedale Policlinico San Martino-IRCCS per l'Oncologia, Genoa, Italy
| | - Fulvio Rudello
- SANTALUCIA PHARMA APPS©, Località Gragnanino, Gragnano Trebbiense, PC, Italy
| | - Cristiano Alicino
- U.O. Igiene, University of Genoa (DISSAL) and Ospedale Policlinico San Martino-IRCCS per l'Oncologia, Genoa, Italy
| | - Beatrice Bonalumi
- U.O. Farmacia, Ospedale Policlinico San Martino-IRCCS per l'Oncologia, Genoa, Italy
| | - Alessandra Morando
- U.O. Governo Clinico e Organizzazione Ospedaliera, Ospedale Policlinico San Martino-IRCCS per l'Oncologia, Genoa, Italy
| | - Giancarlo Icardi
- U.O. Igiene, University of Genoa (DISSAL) and Ospedale Policlinico San Martino-IRCCS per l'Oncologia, Genoa, Italy
| | - Sabrina Beltramini
- U.O. Farmacia, Ospedale Policlinico San Martino-IRCCS per l'Oncologia, Genoa, Italy
| | - Claudio Viscoli
- U.O. Clinica Malattie Infettive, University of Genoa (DISSAL) and Ospedale Policlinico San Martino-IRCCS per L'Oncologia, L.go R. Benzi, 10, 16132, Genoa, Italy
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