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Zhong L, Dong Z, Liu F, Li H, Tang K, Zheng C, Wang L, Zhang K, Cai J, Zhou H, Cui W, Gao Y, Zhang G. Incidence, clinical characteristics, risk factors and outcomes of patients with mixed Candida/bacterial bloodstream infections: a retrospective study. Ann Clin Microbiol Antimicrob 2022; 21:45. [PMID: 36320023 PMCID: PMC9628097 DOI: 10.1186/s12941-022-00538-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Accepted: 10/18/2022] [Indexed: 11/06/2022] Open
Abstract
Purpose The mixed Candida/bacterial bloodstream infections (mixed C/B-BSIs) is worthy of particular attention recently, and we analyzed the incidence, co-pathogens, clinical characteristics, risk factors, and outcomes of mixed C/B-BSIs compared with monomicrobial candidemia (mono-candidemia) in adult patients in China. Methods All hospitalized adults with candidemia were recruited for this retrospective observational study from January 1, 2013, to December 31, 2019. Results Of the 296 patients with candidemia, 78 cases (26.3%) were mixed C/B-BSIs. Candida albicans (C. albicans) was the most common Candida species among all candidemia, and Klebsiella pneumoniae (K. pneumoniae) was the most concomitant bacteria (30.6%), followed by Acinetobacter baumannii (A. baumannii) (12.9%) and Enterococcus faecium (E. faecium) (11.8%) in mixed C/B-BSIs. In the multivariable analysis, prior β-lactams exposure [adjusted odds ratio (aOR), 1.97; 95% confidence interval (CI), 1.01–3.87], burn injury (aOR, 6.35; 95% CI 1.82–22.21) and continuous renal replacement therapy (CRRT) (aOR, 3.00; 95% CI 1.46–6.17) were independent risk factors for mixed C/B-BSIs. Compared with mono-candidemia, patients with mixed C/B-BSIs developed with more proportion of septic shock (55.1% vs. 39.9%, P < 0.05), prolonged stay in ICU [22.0(12.0–57.0) vs. 9.5(0.0–37.0) days, P < 0.001] and longer mechanical ventilation time [19.0(4.5–40.8) vs. 6.0(0.0–24.8) days, P < 0.001]. The in-hospital mortality in patients with mixed C/B-BSIs was higher than those with mono-candidemia (59.0% vs. 34.9%, P < 0.001). Survival analysis revealed that 28-day and 60-day mortality were significantly higher in patients with mixed C/B-BSI than in those with mono-candidemia (57.7% vs. 31.7%, P < 0.001; 59.0% vs. 34.9%, P < 0.001; respectively). Conclusions There is a high rate of mixed C/B-BSIs cases among candidemia, and K. pneumoniae is the predominant coexisting species. Prior β-lactams exposure, burn injury, and CRRT are independent risk factors for mixed C/B-BSIs. The mortality of patients with mixed C/B-BSIs is significantly higher than those with mono-candidemia, this deserves further attention for clinicians. Supplementary Information The online version contains supplementary material available at 10.1186/s12941-022-00538-y.
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Affiliation(s)
- Li Zhong
- Department of Critical Care Medicine, First Affiliated Hospital, Huzhou Teachers College, The First People's Hospital of Huzhou, Huzhou, 313000, Zhejiang, China.,Department of Critical Care Medicine, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, 310009, Zhejiang, China
| | - Zhaohui Dong
- Department of Critical Care Medicine, First Affiliated Hospital, Huzhou Teachers College, The First People's Hospital of Huzhou, Huzhou, 313000, Zhejiang, China
| | - Fengqi Liu
- Department of Critical Care Medicine, First Affiliated Hospital, Huzhou Teachers College, The First People's Hospital of Huzhou, Huzhou, 313000, Zhejiang, China.,Department of Critical Care Medicine, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, 310009, Zhejiang, China
| | - Haidong Li
- Department of Spine Surgery, First Affiliated Hospital, Huzhou Teachers College, The First People's Hospital of Huzhou, Huzhou, 313000, China
| | - Kankai Tang
- Department of Critical Care Medicine, First Affiliated Hospital, Huzhou Teachers College, The First People's Hospital of Huzhou, Huzhou, 313000, Zhejiang, China
| | - Cheng Zheng
- Department of Critical Care Medicine, Taizhou Municipal Hospital, Taizhou, 318000, Zhejiang, China
| | - Lifang Wang
- Department of General Medicine, Jiading District Central Hospital Affiliated Shanghai University of Medicine & Health Science, Shanghai, 201800, China
| | - Kai Zhang
- Department of Critical Care Medicine, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, 310009, Zhejiang, China
| | - Jiachang Cai
- Clinical Microbiology Laboratory, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, 310009, China
| | - Hongwei Zhou
- Clinical Microbiology Laboratory, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, 310009, China
| | - Wei Cui
- Department of Critical Care Medicine, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, 310009, Zhejiang, China
| | - Yanqiu Gao
- Respiratory Intensive Care Unit, Zhengzhou Central Hospital Affiliated to Zhengzhou University, Zhengzhou, 450007, China.
| | - Gensheng Zhang
- Department of Critical Care Medicine, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, 310009, Zhejiang, China. .,Zhejiang Province Clinical Research Center for Emergency and Critical Care Medicine, Hangzhou, 310009, China.
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A longitudinal study of Candida bloodstream infections in a Japanese university hospital: species distribution, drug susceptibility, clinical features, and mortality predictors. Eur J Clin Microbiol Infect Dis 2022; 41:1315-1325. [PMID: 36156177 DOI: 10.1007/s10096-022-04499-0] [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: 07/12/2022] [Accepted: 09/16/2022] [Indexed: 11/03/2022]
Abstract
We aimed to detect possible changes in Candida species distribution over time and to know the antifungal susceptibility profile of isolates obtained from patients with bloodstream infection (BSI) due to this pathogen. Risk factors associated with 30-day mortality were also assessed. We conducted a retrospective cohort study of patients diagnosed with Candida BSI at a Japanese university hospital from 2013 to 2021. The change in the distribution pattern of the Candida spp. isolated was examined by considering three successive sub-periods of 3 years each. Risk factors for 30-day mortality were determined using Cox regression analysis. In the entire study period, Candida albicans was the most frequent species (46.7%), followed by Candida glabrata (21.5%) and Candida parapsilosis (18.7%). There was no change in Candida species distribution comparing the three sub-periods analyzed. All isolates were susceptible to micafungin, and most were susceptible to fluconazole, except for C. glabrata. No isolates were resistant to amphotericin B or voriconazole. The overall 30-day mortality was 40.2%. Univariate analysis revealed an association between 30-day mortality and central venous catheter (CVC) removal at any time, high Pitt bacteremia score (PBS), and high Charlson comorbidity index (CCI). Multivariate Cox analysis found that high PBS was the only independent predictor of 30-day mortality; subsequent multivariate Cox regression demonstrated that early CVC removal significantly reduced 30-day mortality. Candida species distribution and antifungal susceptibility profile in our hospital remained similar from 2013 to 2021. Early CVC removal may improve candidemia outcomes.
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Verlinden A, Jansens H, Goossens H, Anguille S, Berneman ZN, Schroyens WA, Gadisseur AP. Safety & efficacy of antibiotic de-escalation and discontinuation in high-risk haematological patients with febrile neutropenia: a single-centre experience. Open Forum Infect Dis 2021; 9:ofab624. [PMID: 35146042 PMCID: PMC8826378 DOI: 10.1093/ofid/ofab624] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2021] [Accepted: 12/07/2021] [Indexed: 11/26/2022] Open
Abstract
Background There is currently no consensus on optimal duration of antibiotic treatment in febrile neutropenia. We report on the clinical impact of implementation of antibiotic de-escalation and discontinuation strategies based on the Fourth European Conference on Infections in Leukaemia (ECIL-4) recommendations in high-risk hematological patients. Methods We studied 446 admissions after introduction of an ECIL-4–based protocol (hereafter “ECIL-4 group”) in comparison to a historic cohort of 512 admissions. Primary clinical endpoints were the incidence of infectious complications including septic shock, infection-related intensive care unit (ICU) admission, and overall mortality. Secondary endpoints included the incidence of recurrent fever, bacteremia, and antibiotic consumption. Results Bacteremia occurred more frequently in the ECIL-4 group (46.9% [209/446] vs 30.5% [156/512]; P < .001), without an associated increase in septic shock (4.7% [21/446] vs 4.5% [23/512]; P = .878) or infection-related ICU admission (4.9% [22/446] vs 4.1% [21/512]; P = .424). Overall mortality was significantly lower in the ECIL-4 group (0.7% [3/446] vs 2.7% [14/512]; P = .016), resulting mainly from a decrease in infection-related mortality (0.4% [2/446] vs 1.8% [9/512]; P = .058). Antibiotic consumption was significantly reduced by a median of 2 days on antibiotic therapy (12 vs 14; P = .001) and 7 daily antibiotic doses (17 vs 24; P < .001) per admission period. Conclusions Our results support implementation of ECIL-4 recommendations to be both safe and effective based on real-world data in a large high-risk patient population. We found no increase in infectious complications and total antibiotic exposure was significantly reduced.
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Affiliation(s)
- Anke Verlinden
- Department of Haematology, Antwerp University Hospital, Edegem, Belgium
- Vaccine & Infectious Disease Institute, Faculty of Medicine & Health Sciences, University of Antwerp, Antwerp, Belgium
| | - Hilde Jansens
- Department of Infection Control and Microbiology, Antwerp University Hospital, Edegem, Belgium
- Vaccine & Infectious Disease Institute, Faculty of Medicine & Health Sciences, University of Antwerp, Antwerp, Belgium
| | - Herman Goossens
- Department of Infection Control and Microbiology, Antwerp University Hospital, Edegem, Belgium
- Vaccine & Infectious Disease Institute, Faculty of Medicine & Health Sciences, University of Antwerp, Antwerp, Belgium
| | - Sébastien Anguille
- Department of Haematology, Antwerp University Hospital, Edegem, Belgium
- Vaccine & Infectious Disease Institute, Faculty of Medicine & Health Sciences, University of Antwerp, Antwerp, Belgium
| | - Zwi N Berneman
- Department of Haematology, Antwerp University Hospital, Edegem, Belgium
- Vaccine & Infectious Disease Institute, Faculty of Medicine & Health Sciences, University of Antwerp, Antwerp, Belgium
| | - Wilfried A Schroyens
- Department of Haematology, Antwerp University Hospital, Edegem, Belgium
- Vaccine & Infectious Disease Institute, Faculty of Medicine & Health Sciences, University of Antwerp, Antwerp, Belgium
| | - Alain P Gadisseur
- Department of Haematology, Antwerp University Hospital, Edegem, Belgium
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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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Chu S, McCormick TS, Lazarus HM, Leal LO, Ghannoum MA. Invasive fungal disease and the immunocompromised host including allogeneic hematopoietic cell transplant recipients: Improved understanding and new strategic approach with sargramostim. Clin Immunol 2021; 228:108731. [PMID: 33892201 DOI: 10.1016/j.clim.2021.108731] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2021] [Revised: 04/12/2021] [Accepted: 04/17/2021] [Indexed: 12/17/2022]
Abstract
In hosts with damaged or impaired immune systems such as those undergoing hematopoietic cell transplant (HCT) or intensive chemotherapy, breakthrough fungal infections can be fatal. Risk factors for breakthrough infections include severe neutropenia, use of corticosteroids, extended use of broad-spectrum antibiotics, and intensive care unit admission. An individual's cumulative state of immunosuppression directly contributes to the likelihood of experiencing increased infection risk. Incidence of invasive fungal infection (IFI) after HCT may be up to 5-8%. Early intervention may improve IFI outcomes, although many infections are resistant to standard therapies (voriconazole, caspofungin, micafungin, amphotericin B, posaconazole or itraconazole, as single agents or in combination). We review herein several contributing factors that may contribute to the net state of immunosuppression in recipients of HCT. We also review a new approach for IFI utilizing adjunctive therapy with sargramostim, a yeast-derived recombinant human granulocyte-macrophage colony-stimulating factor (rhu GM-CSF).
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Affiliation(s)
- Sherman Chu
- Department of Dermatology, Case Western Reserve University, Cleveland, OH, USA; College of Osteopathic Medicine of the Pacific, Northwest (COMP), Lebanon, OR, USA.
| | - Thomas S McCormick
- Department of Dermatology, Case Western Reserve University, Cleveland, OH, USA.
| | - Hillard M Lazarus
- Department of Medicine, Division of Hematology and Oncology, Case Western Reserve University, Cleveland, OH, USA.
| | - Luis O Leal
- Partner Therapeutics, Inc., 19 Muzzey St, Lexington, MA, USA.
| | - Mahmoud A Ghannoum
- Department of Dermatology, Case Western Reserve University, Cleveland, OH, USA; Center for Medical Mycology, University Hospitals Cleveland Medical Center, Cleveland, OH, USA.
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Pediatric and Neonatal Invasive Candidiasis: Species Distribution and Mortality Rate in a Thai Tertiary Care Hospital. Pediatr Infect Dis J 2021; 40:96-102. [PMID: 33021588 DOI: 10.1097/inf.0000000000002912] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
BACKGROUND Invasive candidiasis (IC) is a serious infection among children with underlying medical conditions. A shift from C. albicans to non-albicans Candida has been observed worldwide. This study aims to identify species of Candida and factors associated with the overall 30-day mortality rate. METHODS A retrospective chart review was conducted among children with culture-confirmed IC from birth to 15 years of age at King Chulalongkorn Memorial Hospital, Thailand. Multivariate Cox regression analysis was performed to determine associated factors with 30-day mortality. RESULTS From 2003 to 2019, 102 episodes of IC in pediatric group with a median age of 16 months (interquartile range 4-65) and 12 episodes of IC in neonatal group with a median age of 18 days (interquartile range 12-22). The species distribution were Candida albicans (35%), Candida parapsilosis (26%), Candida tropicalis (22%), Candida glabrata (6%) and other/unspecified species (11%). Antifungal treatment was given in 88% (67% Amphotericin B deoxycholate, 28% Fluconazole). Overall 30-day mortality rates were 28.5% [95% confidence interval (CI) 20.8%-38.4%] and 8.3% (95% CI 1.2%-46.1%) in pediatrics and neonates, respectively. Mortality rate among the neutropenic group was significantly higher than non-neutropenic group (46.4% vs. 20.6%, P = 0.005). Factors associated with 30-day mortality in pediatric IC were shock [adjusted hazard ratio (aHR) 4.2; 95% CI 1.8-9.4], thrombocytopenia (aHR 7.7; 95% CI 1.8-33.9) and no antifungal treatment (aHR 4.6; 95% CI 1.7-12.1). CONCLUSIONS Two-third of children with IC were diagnosed with non-albicans Candida. Children with high mortality rate included those with neutropenia, presented with shock or thrombocytopenia, such that the proper empiric antifungal treatment is recommended.
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Guisado-Gil AB, Aguilar-Guisado M, Peñalva G, Lepe JA, Espigado I, Rodríguez-Arbolí E, González-Campos J, Rodríguez-Torres N, Montero-Cuadrado MI, Falantes-González JF, Reguera-Ortega JL, Gil-Navarro MV, Molina J, Pérez-Simón JA, Cisneros JM. Long-Term Impact of an Educational Antimicrobial Stewardship Program on Management of Patients with Hematological Diseases. Antibiotics (Basel) 2021; 10:antibiotics10020136. [PMID: 33573180 PMCID: PMC7911074 DOI: 10.3390/antibiotics10020136] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Revised: 01/06/2021] [Accepted: 01/27/2021] [Indexed: 02/01/2023] Open
Abstract
Antimicrobial stewardship programs (ASPs) in hematological patients are especially relevant. However, information about ASPs in this population is scarce. For 11 years, we quarterly assessed antimicrobial consumption and incidence and death rates of multidrug-resistant (MDR) bloodstream infections (BSI) in the hematology Department. Healthcare activity indicators were also monitored yearly. We performed an interrupted time-series analysis. Antimicrobials showed a sustained reduction with a relative effect of −62.3% (95% CI −84.5 to −40.1) nine years after the inception of the ASP, being especially relevant for antifungals (relative effect −80.4%, −90.9 to −69.9), quinolones (relative effect −85.0%, −102.0 to −68.1), and carbapenems (relative effect −68.8%, −126.0 to −10.6). Incidence density of MDR BSI remained low and stable (mean 1.10 vs. 0.82 episodes per 1000 occupied bed days for the pre-intervention and the ASP period, respectively) with a quarterly percentage of change of −0.3% (95% CI −2.0 to 1.4). Early and late mortality of MDR BSI presented a steady trend (quarterly percentage of change −0.7%, 95% CI −1.7 to 0.3 and −0.6%, 95% CI −1.5 to 0.3, respectively). Volume and complexity of healthcare activity increased over the years. The ASP effectively achieved long-term reductions in antimicrobial consumption and improvements in the prescription profile, without increasing the mortality of MDR BSI.
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Affiliation(s)
- Ana Belén Guisado-Gil
- Department of Infectious Diseases, Microbiology and Preventive Medicine, Infectious Diseases Research Group, Institute of Biomedicine of Seville (IBiS), University of Seville/CSIC/University Hospital Virgen del Rocio, 41013 Seville, Spain; (A.B.G.-G.); (G.P.); (J.A.L.); (J.M.); (J.M.C.)
- Department of Pharmacy, University Hospital Virgen del Rocio, 41013 Seville, Spain;
| | - Manuela Aguilar-Guisado
- Department of Infectious Diseases, Microbiology and Preventive Medicine, Infectious Diseases Research Group, Institute of Biomedicine of Seville (IBiS), University of Seville/CSIC/University Hospital Virgen del Rocio, 41013 Seville, Spain; (A.B.G.-G.); (G.P.); (J.A.L.); (J.M.); (J.M.C.)
- Correspondence: ; Tel.: +34-670943816
| | - Germán Peñalva
- Department of Infectious Diseases, Microbiology and Preventive Medicine, Infectious Diseases Research Group, Institute of Biomedicine of Seville (IBiS), University of Seville/CSIC/University Hospital Virgen del Rocio, 41013 Seville, Spain; (A.B.G.-G.); (G.P.); (J.A.L.); (J.M.); (J.M.C.)
| | - José Antonio Lepe
- Department of Infectious Diseases, Microbiology and Preventive Medicine, Infectious Diseases Research Group, Institute of Biomedicine of Seville (IBiS), University of Seville/CSIC/University Hospital Virgen del Rocio, 41013 Seville, Spain; (A.B.G.-G.); (G.P.); (J.A.L.); (J.M.); (J.M.C.)
| | - Ildefonso Espigado
- Department of Hematology, Institute of Biomedicine of Seville (IBiS/CSIC/CIBERONC), University Hospital Virgen del Rocio, University of Seville, 41013 Seville, Spain; (I.E.); (E.R.-A.); (J.G.-C.); (N.R.-T.); (M.I.M.-C.); (J.F.F.-G.); (J.L.R.-O.); (J.-A.P.-S.)
| | - Eduardo Rodríguez-Arbolí
- Department of Hematology, Institute of Biomedicine of Seville (IBiS/CSIC/CIBERONC), University Hospital Virgen del Rocio, University of Seville, 41013 Seville, Spain; (I.E.); (E.R.-A.); (J.G.-C.); (N.R.-T.); (M.I.M.-C.); (J.F.F.-G.); (J.L.R.-O.); (J.-A.P.-S.)
| | - José González-Campos
- Department of Hematology, Institute of Biomedicine of Seville (IBiS/CSIC/CIBERONC), University Hospital Virgen del Rocio, University of Seville, 41013 Seville, Spain; (I.E.); (E.R.-A.); (J.G.-C.); (N.R.-T.); (M.I.M.-C.); (J.F.F.-G.); (J.L.R.-O.); (J.-A.P.-S.)
| | - Nancy Rodríguez-Torres
- Department of Hematology, Institute of Biomedicine of Seville (IBiS/CSIC/CIBERONC), University Hospital Virgen del Rocio, University of Seville, 41013 Seville, Spain; (I.E.); (E.R.-A.); (J.G.-C.); (N.R.-T.); (M.I.M.-C.); (J.F.F.-G.); (J.L.R.-O.); (J.-A.P.-S.)
| | - María Isabel Montero-Cuadrado
- Department of Hematology, Institute of Biomedicine of Seville (IBiS/CSIC/CIBERONC), University Hospital Virgen del Rocio, University of Seville, 41013 Seville, Spain; (I.E.); (E.R.-A.); (J.G.-C.); (N.R.-T.); (M.I.M.-C.); (J.F.F.-G.); (J.L.R.-O.); (J.-A.P.-S.)
| | - José Francisco Falantes-González
- Department of Hematology, Institute of Biomedicine of Seville (IBiS/CSIC/CIBERONC), University Hospital Virgen del Rocio, University of Seville, 41013 Seville, Spain; (I.E.); (E.R.-A.); (J.G.-C.); (N.R.-T.); (M.I.M.-C.); (J.F.F.-G.); (J.L.R.-O.); (J.-A.P.-S.)
| | - Juan Luis Reguera-Ortega
- Department of Hematology, Institute of Biomedicine of Seville (IBiS/CSIC/CIBERONC), University Hospital Virgen del Rocio, University of Seville, 41013 Seville, Spain; (I.E.); (E.R.-A.); (J.G.-C.); (N.R.-T.); (M.I.M.-C.); (J.F.F.-G.); (J.L.R.-O.); (J.-A.P.-S.)
| | | | - José Molina
- Department of Infectious Diseases, Microbiology and Preventive Medicine, Infectious Diseases Research Group, Institute of Biomedicine of Seville (IBiS), University of Seville/CSIC/University Hospital Virgen del Rocio, 41013 Seville, Spain; (A.B.G.-G.); (G.P.); (J.A.L.); (J.M.); (J.M.C.)
| | - José-Antonio Pérez-Simón
- Department of Hematology, Institute of Biomedicine of Seville (IBiS/CSIC/CIBERONC), University Hospital Virgen del Rocio, University of Seville, 41013 Seville, Spain; (I.E.); (E.R.-A.); (J.G.-C.); (N.R.-T.); (M.I.M.-C.); (J.F.F.-G.); (J.L.R.-O.); (J.-A.P.-S.)
| | - José Miguel Cisneros
- Department of Infectious Diseases, Microbiology and Preventive Medicine, Infectious Diseases Research Group, Institute of Biomedicine of Seville (IBiS), University of Seville/CSIC/University Hospital Virgen del Rocio, 41013 Seville, Spain; (A.B.G.-G.); (G.P.); (J.A.L.); (J.M.); (J.M.C.)
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8
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Changing epidemiology and risk factors for candidemia in critically ill patients. JOURNAL OF SURGERY AND MEDICINE 2021. [DOI: 10.28982/josam.871514] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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9
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Clinical characteristics, risk factors and outcomes of mixed Candida albicans/bacterial bloodstream infections. BMC Infect Dis 2020; 20:810. [PMID: 33158426 PMCID: PMC7648279 DOI: 10.1186/s12879-020-05536-z] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2020] [Accepted: 10/22/2020] [Indexed: 12/11/2022] Open
Abstract
Purpose The purpose of this study was to explore the clinical features, risk factors, and outcomes of mixed Candida albicans/bacterial bloodstream infections (mixed-CA/B-BSIs) compared with monomicrobial Candida albicans bloodstream infection (mono-CA-BSI) in adult patients in China. Methods All hospitalized adults with Candida albicans bloodstream infection (CA-BSI) were recruited for this retrospective observational study from January 1, 2013, to December 31, 2018. Results Of the 117 patients with CA-BSI, 24 patients (20.5%) had mixed-CA/B-BSIs. The most common copathogens were coagulase-negative Staphylococcus (CNS) (24.0%), followed by Klebsiella pneumoniae (20.0%) and Staphylococcus aureus (16.0%). In the multivariable analysis, a prior ICU stay > 2 days (adjusted odds ratio [OR], 7.445; 95% confidence interval [CI], 1.152–48.132) was an independent risk factor for mixed-CA/B-BSIs. Compared with patients with mono-CA-BSI, patients with mixed-CA/B-BSIs had a prolonged length of mechanical ventilation [17.5 (4.5, 34.8) vs. 3.0 (0.0, 24.5), p = 0.019] and prolonged length of ICU stay [22.0 (14.3, 42.2) vs. 8.0 (0.0, 31.5), p = 0.010]; however, mortality was not significantly different. Conclusions There was a high rate of mixed-CA/B-BSIs cases among CA-BSI cases, and CNS was the predominant coexisting species. A prior ICU stay > 2 days was an independent risk factor for mixed -CA/B-BSIs. Although there was no difference in mortality, the outcomes of patients with mixed -CA/B-BSIs, including prolonged length of mechanical ventilation and prolonged length of ICU stay, were worse than those with mono-CA-BSI; this deserves further attention from clinicians.
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Miao Q, Zhao L, Wang Y, Hao F, Sun P, He P, Liu Y, Huang J, Liu X, Liu X, Deng G, Li H, Li L, Tang Y, Wang L, Feng M, Jia W. Microbial metabolomics and network analysis reveal fungistatic effect of basil (Ocimum basilicum) oil on Candida albicans. JOURNAL OF ETHNOPHARMACOLOGY 2020; 260:113002. [PMID: 32502652 DOI: 10.1016/j.jep.2020.113002] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/26/2020] [Revised: 05/20/2020] [Accepted: 05/20/2020] [Indexed: 06/11/2023]
Abstract
ETHNOPHARMACOLOGICAL RELEVANCE Fungal infections remain a serious problem worldwide that require effective therapeutic strategies. Essential oil of basil (Ocimum basilicum L., BEO) being traditionally used extensively for the treatment of bacterial and fungal infection has a long history. However, the potential mechanism of action was still obscure, especially from the metabolic perspective. MATERIALS AND METHODS The fungistatic effect of BEO on Candida albicans (C. albicans) was evaluated by measurement of minimum inhibitory concentration (MIC) and morphological analysis. A high-coverage microbial metabolomics approach was utilized to identify the alterations of intracellular metabolites of C. albicans at mid-logarithmic growth phase in response to the subinhibitory concentration of BEO, by using gas chromatography coupled to time-of-fight mass spectrometry (GC-TOFMS). Following the metabolic fingerprinting, systematic network analysis was performed to illustrate the potential mechanism of BEO involved in the suppression of C. albicans. RESULTS The damage in cellular membranes of C. albicans treated by BEO above MIC was observed on the scanning electron microscope (SEM) micrographs. Metabolomics results showed that, among 140 intracellular metabolites identified by comparison with reference standards, thirty-four had significantly changed abundances under 0.2 MIC of BEO treatment, mainly involving in central carbon metabolism (glycolysis/gluconeogenesis, pentose phosphate pathway and TCA cycle), amino acids, polyamines and lipids metabolism. Pathway and network analyses further found that fifteen ingredients of BEO mainly terpenoids and phenyl-propanoids, potentially participated in the metabolic regulation and may be responsible for the suppression of C. albicans. CONCLUSIONS The findings highlighted that integrated microbial metabolomics and network analyses could provide a methodological support in understanding the functional mechanisms of natural antimicrobial agents and contribute to drug discovery.
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Affiliation(s)
- Qiandan Miao
- College of Chemistry and Chemical Engineering, Shanghai University of Engineering Science, Shanghai 201620, China
| | - Linjing Zhao
- College of Chemistry and Chemical Engineering, Shanghai University of Engineering Science, Shanghai 201620, China.
| | - Yuting Wang
- College of Chemistry and Chemical Engineering, Shanghai University of Engineering Science, Shanghai 201620, China
| | - Fangjia Hao
- College of Chemistry and Chemical Engineering, Shanghai University of Engineering Science, Shanghai 201620, China
| | - Peipei Sun
- College of Chemistry and Chemical Engineering, Shanghai University of Engineering Science, Shanghai 201620, China
| | - Peng He
- Minghang Hospital & School of Pharmacy, Fudan University, Shanghai, 201199, China; Shanghai Engineering Research Center of Immunotherapeutics, Shanghai, 201203, China
| | - Yumin Liu
- Instrumental Analysis Centre, Shanghai Jiao Tong University, Shanghai, 200240, China
| | - Jiashuai Huang
- College of Chemistry and Chemical Engineering, Shanghai University of Engineering Science, Shanghai 201620, China
| | - Xijian Liu
- College of Chemistry and Chemical Engineering, Shanghai University of Engineering Science, Shanghai 201620, China
| | - Xiaohui Liu
- College of Chemistry and Chemical Engineering, Shanghai University of Engineering Science, Shanghai 201620, China
| | - Guoying Deng
- Shanghai Jiao Tong University Affiliated First People's Hospital, Shanghai, 200233, China
| | - Hongsen Li
- College of Chemistry and Chemical Engineering, Shanghai University of Engineering Science, Shanghai 201620, China
| | - Lingai Li
- College of Chemistry and Chemical Engineering, Shanghai University of Engineering Science, Shanghai 201620, China
| | - Yingao Tang
- College of Chemistry and Chemical Engineering, Shanghai University of Engineering Science, Shanghai 201620, China
| | - Lixin Wang
- Integrated TCM & Western Medicine Department, Shanghai Pulmonary Hospital Affiliated to Tongji University, Shanghai, 200433, China
| | - Meiqing Feng
- Minghang Hospital & School of Pharmacy, Fudan University, Shanghai, 201199, China; Shanghai Engineering Research Center of Immunotherapeutics, Shanghai, 201203, China.
| | - Wei Jia
- School of Chinese Medicine, Hong Kong Baptist University, Hong Kong SAR, China
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11
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Wu Y, Wei D, Gong X, Shen Y, Zhu Y, Wang J, Gao Z. Initial use of voriconazole positively affects outcome of Candida parapsilosis bloodstream infection: a retrospective analysis. Transl Pediatr 2020; 9:480-486. [PMID: 32953545 PMCID: PMC7475306 DOI: 10.21037/tp-20-37] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND Concerns have arisen regarding the optimal antifungal regimen for Candida parapsilosis (C. parapsilosis) bloodstream infection (BSI) in view of its reduced sensitivity to fluconazole. METHODS The clinical characteristics of 58 C. parapsilosis BSI newborns who received treatment between June 2014 to December 2018 in the Shanghai Children's Hospital were retrospectively analyzed. Based on the initial antifungal drugs, these patients were divided into fluconazole group (n=30) and voriconazole group (n=21). After 7-10-day treatment, the antifungal drugs were replaced if blood culture still showed positive. The clinical characteristics and therapeutic effects were compared between two groups. RESULTS There were no significant differences in the clinical characteristics between two groups (P>0.05). The median time to a negative culture in the voriconazole group was 7 [interquartile range (IQR), 6-10] days, which was significantly shorter than in the fluconazole group [9 (IQR, 7-18.5) days; P=0.034]. The overall median time to a negative culture was 8 days. After 8-day antifungal therapy, in the voriconazole group and fluconazole group, negative culture was observed in 16 and 12 patients, respectively; the positive culture was noted in 5 and 16 patients, respectively; the effective rate was 76.1% and 40%, respectively, showing marked difference (χ2=6.535, P=0.011). None died in the voriconazole group, but 4 died in the fluconazole group. The median time of treatment for fungal sepsis in the voriconazole group was 22 (IQR, 20-26) days, which was significantly shorter than in the fluconazole group [32 (IQR, 23.5-40) days; P=0.000]. CONCLUSIONS The initial clinical manifestations of C. parapsilosis BSI vary among individuals, and voriconazole is superior to fluconazole in the treatment of C. parapsilosis BSI.
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Affiliation(s)
- Yejuan Wu
- Department of Neonatology, Shanghai Children's Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Dong Wei
- Department of Neonatology, Shanghai Children's Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Xiaohui Gong
- Department of Neonatology, Shanghai Children's Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Yunlin Shen
- Department of Neonatology, Shanghai Children's Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Yingying Zhu
- Department of Neonatology, Shanghai Children's Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Junfang Wang
- Department of Neonatology, Shanghai Children's Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Zhen Gao
- Department of Neonatology, Shanghai Children's Hospital, Shanghai Jiao Tong University, Shanghai, China
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König A, Hube B, Kasper L. The Dual Function of the Fungal Toxin Candidalysin during Candida albicans-Macrophage Interaction and Virulence. Toxins (Basel) 2020; 12:toxins12080469. [PMID: 32722029 PMCID: PMC7471981 DOI: 10.3390/toxins12080469] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Revised: 07/16/2020] [Accepted: 07/19/2020] [Indexed: 12/12/2022] Open
Abstract
The dimorphic fungus Candida albicans is both a harmless commensal organism on mucosal surfaces and an opportunistic pathogen. Under certain predisposing conditions, the fungus can overgrow the mucosal microbiome and cause both superficial and life-threatening systemic infections after gaining access to the bloodstream. As the first line of defense of the innate immune response, infecting C. albicans cells face macrophages, which mediate the clearance of invading fungi by intracellular killing. However, the fungus has evolved sophisticated strategies to counteract macrophage antimicrobial activities and thus evade immune surveillance. The cytolytic peptide toxin, candidalysin, contributes to this fungal defense machinery by damaging immune cell membranes, providing an escape route from the hostile phagosome environment. Nevertheless, candidalysin also induces NLRP3 inflammasome activation, leading to an increased host-protective pro-inflammatory response in mononuclear phagocytes. Therefore, candidalysin facilitates immune evasion by acting as a classical virulence factor but also contributes to an antifungal immune response, serving as an avirulence factor. In this review, we discuss the role of candidalysin during C. albicans infections, focusing on its implications during C. albicans-macrophage interactions.
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Affiliation(s)
- Annika König
- Department of Microbial Pathogenicity Mechanisms, Leibniz Institute for Natural Product Research and Infection Biology–Hans Knoell Institute, 07745 Jena, Germany;
| | - Bernhard Hube
- Department of Microbial Pathogenicity Mechanisms, Leibniz Institute for Natural Product Research and Infection Biology–Hans Knoell Institute, 07745 Jena, Germany;
- Center for Sepsis Control and Care, University Hospital Jena, 07747 Jena, Germany
- Institute of Microbiology, Friedrich Schiller University, 07743 Jena, Germany
- Correspondence: (B.H.); (L.K.)
| | - Lydia Kasper
- Department of Microbial Pathogenicity Mechanisms, Leibniz Institute for Natural Product Research and Infection Biology–Hans Knoell Institute, 07745 Jena, Germany;
- Correspondence: (B.H.); (L.K.)
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Epidemiology, species distribution, and predictive factors for mortality of candidemia in adult surgical patients. BMC Infect Dis 2020; 20:506. [PMID: 32660641 PMCID: PMC7359486 DOI: 10.1186/s12879-020-05238-6] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2020] [Accepted: 07/07/2020] [Indexed: 12/16/2022] Open
Abstract
Background We evaluated the epidemiology, clinical characteristics, microbiology, outcomes, and risk factors for mortality of candidemia in adult surgical patients in Shenyang from 2012 to 2018. Methods We designed a retrospective observational study of adult patients with candidemia in a teaching hospital including three hospital campuses. Data regarding clinical and demographic characteristics were collected from the patient’s medical records. Results Of the 236 cases of candidemia, 172 (72.9%) were identified in surgical patients, including 146 (84.9%) general surgeries, 11 (6.4%) urologic surgeries, 6 (3.5%) thoracic surgeries, and others. Higher proportions of solid tumors, total parenteral nutrition, the presence of a urinary catheter, and the presence of a gastric tube were observed in surgical patients with candidemia versus non-surgical ones, whereas the percentages of hematological malignancy, diabetes mellitus, and renal replacement therapy were relatively lower in surgical patients. Renal failure, leukopenia, and thrombocytopenia were less common laboratory findings in surgical patients with candidemia than compared to non-surgical ones. Among surgical patients with candidemia, Candida parapsilosis was the predominant species (43%), followed by C. albicans (33.7%), C. glabrata (11%), C. tropicalis (8.1%), and others (4.1%). Overall susceptibility, susceptible dose dependent or intermediate susceptibility, and resistance to fluconazole were detected in 73.3, 19.8, and 3.5% Candida isolates from surgical patients, respectively, but no resistance to amphotericin B was observed. Overall, the 30-day mortality in surgical patients was 19.2%. At multivariable analysis, independent risk factors for death in surgical patients with candidemia were ICU stay, thrombocytopenia, and C. albicans infection. Conclusions Surgical patients account for the majority of candidemia cases. Among patients with recent surgery, risk factors for species distribution, antifungal sensitivity patterns of Candida isolates causing candidemia, and independent risk factors for mortality should be evaluated and considered for a better outcome in the antifungal treatment.
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14
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Jaeger M, Pinelli M, Borghi M, Constantini C, Dindo M, van Emst L, Puccetti M, Pariano M, Ricaño-Ponce I, Büll C, Gresnigt MS, Wang X, Gutierrez Achury J, Jacobs CWM, Xu N, Oosting M, Arts P, Joosten LAB, van de Veerdonk FL, Veltman JA, Ten Oever J, Kullberg BJ, Feng M, Adema GJ, Wijmenga C, Kumar V, Sobel J, Gilissen C, Romani L, Netea MG. A systems genomics approach identifies SIGLEC15 as a susceptibility factor in recurrent vulvovaginal candidiasis. Sci Transl Med 2020; 11:11/496/eaar3558. [PMID: 31189718 DOI: 10.1126/scitranslmed.aar3558] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2017] [Revised: 08/13/2018] [Accepted: 05/14/2019] [Indexed: 12/30/2022]
Abstract
Candida vaginitis is a frequent clinical diagnosis with up to 8% of women experiencing recurrent vulvovaginal candidiasis (RVVC) globally. RVVC is characterized by at least three episodes per year. Most patients with RVVC lack known risk factors, suggesting a role for genetic risk factors in this condition. Through integration of genomic approaches and immunological studies in two independent cohorts of patients with RVVC and healthy individuals, we identified genes and cellular processes that contribute to the pathogenesis of RVVC, including cellular morphogenesis and metabolism, and cellular adhesion. We further identified SIGLEC15, a lectin expressed by various immune cells that binds sialic acid-containing structures, as a candidate gene involved in RVVC susceptibility. Candida stimulation induced SIGLEC15 expression in human peripheral blood mononuclear cells (PBMCs) and a polymorphism in the SIGLEC15 gene that was associated with RVVC in the patient cohorts led to an altered cytokine profile after PBMC stimulation. The same polymorphism led to an increase in IL1B and NLRP3 expression after Candida stimulation in HeLa cells in vitro. Last, Siglec15 expression was induced by Candida at the vaginal surface of mice, where in vivo silencing of Siglec15 led to an increase in the fungal burden. Siglec15 silencing was additionally accompanied by an increase in polymorphonuclear leukocytes during the course of infection. Identification of these pathways and cellular processes contributes to a better understanding of RVVC and may open new therapeutic avenues.
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Affiliation(s)
- M Jaeger
- Department of Internal Medicine and Radboud Centre for Infectious Diseases (RCI), Radboud University Medical Center, Nijmegen, 6525GA, Netherlands.,Radboud Institute for Molecular Life Sciences (RIMLS), Radboud University Nijmegen Medical Center (Radboudumc), Nijmegen, 6525GA, Netherlands
| | - M Pinelli
- Telethon Institute of Genetics and Medicine (TIGEM), Pozzuoli, Naples, 80078, Italy.,Department of Human Genetics, Donders Center for Neuroscience, Radboud University Medical Center, Nijmegen, 6525HR, Netherlands
| | - M Borghi
- Department of Experimental Medicine, University of Perugia, Polo Unico Sant'Andrea delle Fratte, Perugia, 06123, Italy
| | - C Constantini
- Department of Experimental Medicine, University of Perugia, Polo Unico Sant'Andrea delle Fratte, Perugia, 06123, Italy
| | - M Dindo
- Department of Experimental Medicine, University of Perugia, Polo Unico Sant'Andrea delle Fratte, Perugia, 06123, Italy
| | - L van Emst
- Department of Internal Medicine and Radboud Centre for Infectious Diseases (RCI), Radboud University Medical Center, Nijmegen, 6525GA, Netherlands
| | - M Puccetti
- Department of Experimental Medicine, University of Perugia, Polo Unico Sant'Andrea delle Fratte, Perugia, 06123, Italy
| | - M Pariano
- Department of Experimental Medicine, University of Perugia, Polo Unico Sant'Andrea delle Fratte, Perugia, 06123, Italy
| | - I Ricaño-Ponce
- University of Groningen, University Medical Centre Groningen, Department of Genetics, Groningen, 9713GZ, Netherlands
| | - C Büll
- Department of Radiation Oncology, Radiotherapy & OncoImmunology Laboratory, Radboud Institute for Molecular Life Sciences, Radboud University Medical Center, Geert Grooteplein Zuid 32, Nijmegen, 6525GA, Netherlands
| | - M S Gresnigt
- Department of Internal Medicine and Radboud Centre for Infectious Diseases (RCI), Radboud University Medical Center, Nijmegen, 6525GA, Netherlands.,Radboud Institute for Molecular Life Sciences (RIMLS), Radboud University Nijmegen Medical Center (Radboudumc), Nijmegen, 6525GA, Netherlands.,Department of Microbial Pathogenicity Mechanisms, Leibniz Institute for Natural Product Research and Infection Biology-Hans Knöll Institute, Beutenbergstraße 11a, Jena, 07745, Germany
| | - X Wang
- Department of Internal Medicine and Radboud Centre for Infectious Diseases (RCI), Radboud University Medical Center, Nijmegen, 6525GA, Netherlands.,College of Computer, Qinghai Normal University, 810008 Xining, China
| | - J Gutierrez Achury
- University of Groningen, University Medical Centre Groningen, Department of Genetics, Groningen, 9713GZ, Netherlands
| | - C W M Jacobs
- Department of Internal Medicine and Radboud Centre for Infectious Diseases (RCI), Radboud University Medical Center, Nijmegen, 6525GA, Netherlands
| | - N Xu
- BGI-Shenzhen, Shenzhen 518083, China
| | - M Oosting
- Department of Internal Medicine and Radboud Centre for Infectious Diseases (RCI), Radboud University Medical Center, Nijmegen, 6525GA, Netherlands
| | - P Arts
- Department of Human Genetics, Donders Center for Neuroscience, Radboud University Medical Center, Nijmegen, 6525HR, Netherlands
| | - L A B Joosten
- Department of Internal Medicine and Radboud Centre for Infectious Diseases (RCI), Radboud University Medical Center, Nijmegen, 6525GA, Netherlands
| | - F L van de Veerdonk
- Department of Internal Medicine and Radboud Centre for Infectious Diseases (RCI), Radboud University Medical Center, Nijmegen, 6525GA, Netherlands
| | - J A Veltman
- Department of Human Genetics, Donders Center for Neuroscience, Radboud University Medical Center, Nijmegen, 6525HR, Netherlands.,Department of Clinical Genetics, Maastricht University Medical Centre, Maastricht, 6229HX, Netherlands
| | - J Ten Oever
- Department of Internal Medicine and Radboud Centre for Infectious Diseases (RCI), Radboud University Medical Center, Nijmegen, 6525GA, Netherlands
| | - B J Kullberg
- Department of Internal Medicine and Radboud Centre for Infectious Diseases (RCI), Radboud University Medical Center, Nijmegen, 6525GA, Netherlands
| | - M Feng
- BGI-Shenzhen, Shenzhen 518083, China
| | - G J Adema
- Department of Radiation Oncology, Radiotherapy & OncoImmunology Laboratory, Radboud Institute for Molecular Life Sciences, Radboud University Medical Center, Geert Grooteplein Zuid 32, Nijmegen, 6525GA, Netherlands
| | - C Wijmenga
- University of Groningen, University Medical Centre Groningen, Department of Genetics, Groningen, 9713GZ, Netherlands
| | - V Kumar
- University of Groningen, University Medical Centre Groningen, Department of Genetics, Groningen, 9713GZ, Netherlands
| | - J Sobel
- Infectious Diseases, Wayne State University School of Medicine, Detroit, MI 48201, USA
| | - C Gilissen
- Department of Human Genetics, Donders Center for Neuroscience, Radboud University Medical Center, Nijmegen, 6525HR, Netherlands
| | - L Romani
- Department of Experimental Medicine, University of Perugia, Polo Unico Sant'Andrea delle Fratte, Perugia, 06123, Italy
| | - M G Netea
- Department of Internal Medicine and Radboud Centre for Infectious Diseases (RCI), Radboud University Medical Center, Nijmegen, 6525GA, Netherlands. .,Human Genomics Laboratory, Craiova University of Medicine and Pharmacy, Craiova, 200349
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Risk factors, clinical characteristics and mortality of candidemia in non-neutropenic, critically ill patients in a tertiary care hospital. JOURNAL OF SURGERY AND MEDICINE 2020. [DOI: 10.28982/josam.686677] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Silva LN, de Mello TP, de Souza Ramos L, Branquinha MH, Dos Santos ALS. New and Promising Chemotherapeutics for Emerging Infections Involving Drug-resistant Non-albicans Candida Species. Curr Top Med Chem 2020; 19:2527-2553. [PMID: 31654512 DOI: 10.2174/1568026619666191025152412] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2018] [Revised: 02/13/2019] [Accepted: 02/16/2019] [Indexed: 02/06/2023]
Abstract
Fungal infections are a veritable public health problem worldwide. The increasing number of patient populations at risk (e.g. transplanted individuals, cancer patients, and HIV-infected people), as well as the use of antifungal agents for prophylaxis in medicine, have favored the emergence of previously rare or newly identified fungal species. Indeed, novel antifungal resistance patterns have been observed, including environmental sources and the emergence of simultaneous resistance to different antifungal classes, especially in Candida spp., which are known for the multidrug-resistance (MDR) profile. In order to circumvent this alarming scenario, the international researchers' community is engaged in discovering new, potent, and promising compounds to be used in a near future to treat resistant fungal infections in hospital settings on a global scale. In this context, many compounds with antifungal action from both natural and synthetic sources are currently under clinical development, including those that target either ergosterol or β(1,3)-D-glucan, presenting clear evidence of pharmacologic/pharmacokinetic advantages over currently available drugs against these two well-known fungal target structures. Among these are the tetrazoles VT-1129, VT-1161, and VT-1598, the echinocandin CD101, and the glucan synthase inhibitor SCY-078. In this review, we compiled the most recent antifungal compounds that are currently in clinical trials of development and described the potential outcomes against emerging and rare Candida species, with a focus on C. auris, C. dubliniensis, C. glabrata, C. guilliermondii, C. haemulonii, and C. rugosa. In addition to possibly overcoming the limitations of currently available antifungals, new investigational chemical agents that can enhance the classic antifungal activity, thereby reversing previously resistant phenotypes, were also highlighted. While novel and increasingly MDR non-albicans Candida species continue to emerge worldwide, novel strategies for rapid identification and treatment are needed to combat these life-threatening opportunistic fungal infections.
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Affiliation(s)
- Laura Nunes Silva
- Laboratorio de Estudos Avancados de Microrganismos Emergentes e Resistentes, Departamento de Microbiologia Geral, Instituto de Microbiologia Paulo de Goes, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
| | - Thaís Pereira de Mello
- Laboratorio de Estudos Avancados de Microrganismos Emergentes e Resistentes, Departamento de Microbiologia Geral, Instituto de Microbiologia Paulo de Goes, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
| | - Lívia de Souza Ramos
- Laboratorio de Estudos Avancados de Microrganismos Emergentes e Resistentes, Departamento de Microbiologia Geral, Instituto de Microbiologia Paulo de Goes, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
| | - Marta Helena Branquinha
- Laboratorio de Estudos Avancados de Microrganismos Emergentes e Resistentes, Departamento de Microbiologia Geral, Instituto de Microbiologia Paulo de Goes, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
| | - André Luis Souza Dos Santos
- Laboratorio de Estudos Avancados de Microrganismos Emergentes e Resistentes, Departamento de Microbiologia Geral, Instituto de Microbiologia Paulo de Goes, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil.,Programa de Pós-Graduação em Bioquímica, Instituto de Química, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
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17
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Zhang MR, Zhao F, Wang S, Lv S, Mou Y, Yao CL, Zhou Y, Li FQ. Molecular mechanism of azoles resistant Candida albicans in a patient with chronic mucocutaneous candidiasis. BMC Infect Dis 2020; 20:126. [PMID: 32046674 PMCID: PMC7014776 DOI: 10.1186/s12879-020-4856-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2019] [Accepted: 02/06/2020] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND More and more azole-resistant strains emerged through the development of acquired resistance and an epidemiological shift towards inherently less susceptible species. The mechanisms of azoles resistance of Candida albicans is very complicated. In this study, we aim to investigate the mechanism of azole-resistant C. albicans isolated from the oral cavity of a patient with chronic mucocutaneous candidiasis (CMC). CASE PRESENTATION CMC diagnosis was given based on clinical manifestations, laboratory test findings and gene sequencing technique. Minimum inhibitory concentration (MIC) of the fungal isolate, obtained from oral cavity termed as CA-R, was obtained by in vitro anti-fungal drugs susceptibility test. To further investigate the resistant mechanisms, we verified the mutations of drug target genes (i.e. ERG11 and ERG3) by Sanger sequencing, and verified the over-expression of ERG11 and drug efflux genes (i.e. CDR1 and CDR2) by RT-PCR. A heterozygous mutation of c.1162A > G resulting in p.K388E was detected in STAT1 of the patient. The expression of CDR1 and CDR2 in CA-R was 4.28-fold and 5.25-fold higher than that of type strain SC5314, respectively. CONCLUSIONS Up-regulation of CDR1 and CDR2 was mainly responsible for the resistance of CA-R. For CMC or other immunodeficiency patients, drug resistance monitoring is necessary.
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Affiliation(s)
- Ming-Rui Zhang
- Department of Dermatology, the Second Hospital of Jilin University, No. 218, Ziqiang street, Nanguan district, Changchun, 130000, China
| | - Fei Zhao
- National Institute for Communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, State Key Laboratory of Infectious Disease Prevention and Control, Beijing, China
| | - Shuang Wang
- Department of Dermatology, the Second Hospital of Jilin University, No. 218, Ziqiang street, Nanguan district, Changchun, 130000, China
| | - Sha Lv
- Department of Dermatology, the Second Hospital of Jilin University, No. 218, Ziqiang street, Nanguan district, Changchun, 130000, China
| | - Yan Mou
- Department of Dermatology, the Second Hospital of Jilin University, No. 218, Ziqiang street, Nanguan district, Changchun, 130000, China
| | - Chun-Li Yao
- Department of Dermatology, the Second Hospital of Jilin University, No. 218, Ziqiang street, Nanguan district, Changchun, 130000, China
| | - Ying Zhou
- Department of Dermatology, the Second Hospital of Jilin University, No. 218, Ziqiang street, Nanguan district, Changchun, 130000, China
| | - Fu-Qiu Li
- Department of Dermatology, the Second Hospital of Jilin University, No. 218, Ziqiang street, Nanguan district, Changchun, 130000, China.
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18
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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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19
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Epidemiology, risk factors and outcomes of Candida albicans vs. non- albicans candidaemia in adult patients in Northeast China. Epidemiol Infect 2019; 147:e277. [PMID: 31552814 PMCID: PMC6805752 DOI: 10.1017/s0950268819001638] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
This study aimed to evaluate the clinical characteristics, risk factors and outcomes of adult patients with candidaemia caused by C. albicans vs. non-albicans Candida spp. (NAC). All adult hospitalised cases of candidaemia (2012-2017) at a tertiary hospital in Shenyang were included in the retrospective study, and a total of 180 episodes were analysed. C. parapsilosis was the most frequently isolated species (38.3%), followed by C. albicans (35.6%), C. glabrata (13.9%), C. tropicalis (10%) and others (2.2%). As initial antifungal therapy, 75.0%, 3.9%, 5.6% and 2.2% of patients received fluconazole, caspofungin, micafungin and voriconazole, respectively. Multivariate analyses revealed that total parenteral nutrition was associated with an increased risk of NAC bloodstream infections (BSI) (OR 2.535, 95% CI (1.066-6.026)) vs. C. albicans BSI. Additionally, the presence of a urinary catheter was associated with an increased risk of C. albicans BSI (OR 2.295 (1.129-4.666)) vs. NAC BSI. Moreover, ICU stay (OR 4.013 (1.476-10.906)), renal failure (OR 3.24 (1.084-9.683)), thrombocytopaenia (OR 7.171 (2.152-23.892)) and C. albicans (OR 3.629 (1.352-9.743)) were independent risk factors for candidaemia-related 30-day mortality, while recent cancer surgery was associated with reduced mortality risk (OR 26.479 (2.550-274.918)). All these factors may provide useful information to select initial empirical antifungal agents.
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20
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Távora FFF, Chocano APC, Oliveira DGD, Pereira JR, Almeida RS, Neppelenbroek KH, Porto VC. Beneficial Effects of Ethyl-Cyanoacrylate Coating Against Candida Albicans Biofilm Formation. Braz Dent J 2019; 30:266-271. [PMID: 31166390 DOI: 10.1590/0103-6440201901953] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2018] [Accepted: 01/19/2019] [Indexed: 11/21/2022] Open
Abstract
The aim of this study was to verify whether modifications made in a hard chairside reline resin by an ethyl-cyanoacrylate adhesive, ECA (Super Bonder®, Loctite, Itapevi, SP, Brazil) would be able to inhibit or reduce Candida albicans biofilm formation on its surface, comparing to a commercial surface sealant (BisCover®, Bisco, Schaumburg, USA). Reline resin specimens were fabricated and randomly divided into 6 groups (n=8): CG (control group), no surface treatment; ECA1, ECA coating on the surface before sterilization; ECA2, ECA coating after sterilization; ECA3, ECA incorporated in the resin bulk; DPE1, BisCover® coating before sterilization; DPE2, BisCover® coating after sterilization. Specimens were inoculated with C. albicans SC5314 (1x107 cells/mL) and incubated for 24 h. Then, the biofilm were stained with LIVE/DEAD® BaclightTM L7007 Kit and analyzed by Confocal Laser Scanning Microscopy. The images were evaluated by bioImageL® v.2.0 software and total biovolume (µm3), viable cells (%), and covered area (%) were calculated. Data were statistically analyzed by Kruskal-Wallis and Dunn tests (p<0.05). Results showed that ECA-coated groups presented better results, reducing C. albicans biofilm formation. Acquired images revealed that these groups (ECA1 and ECA2) presented a reduced number of cells, mostly in yeast form (less pathogenic), while the other groups presented higher number of cells, mostly in hyphae form (more pathogenic). Based on these findings, a beneficial effect of Super Bonder® coating reline resins surface could be demonstrated, suggesting a promising way to prevent fungal biofilm formation on dentures.
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Affiliation(s)
| | | | | | | | - Ricardo Sergio Almeida
- Department of Microbiology, UEL - Universidade Estadual de Londrina, Londrina, PR, Brazil
| | | | - Vinícius Carvalho Porto
- Department of Prosthodontics and Periodontics, USP - Universidade de São Paulo, Bauru, SP, Brazil
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21
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Nemer S, Imtiaz T, Varikkara M, Collier A, Bal AM. Management of candidaemia with reference to the European confederation of medical mycology quality indicators. Infect Dis (Lond) 2019; 51:527-533. [DOI: 10.1080/23744235.2019.1606436] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Affiliation(s)
- Sophia Nemer
- Department of Renal Medicine, University Hospital Crosshouse, Kilmarnock, UK
| | - Toufeeq Imtiaz
- Department of Renal Medicine, University Hospital Crosshouse, Kilmarnock, UK
| | - Mohan Varikkara
- Department of Ophthalmology, University Hospital Ayr, Kilmarnock, UK
| | - Andrew Collier
- Department of Medicine, University Hospital Ayr, Kilmarnock, UK
| | - Abhijit M. Bal
- Department of Microbiology, University Hospital Crosshouse, Kilmarnock, UK
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22
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Wouters Y, Roelofs HMJ, Netea MG, Te Morsche RHM, Wanten GJA. Contribution of Genetic and Clinical Risk Factors to Development of Candidemia in Patients Receiving Home Parenteral Nutrition. JPEN J Parenter Enteral Nutr 2019; 44:282-290. [PMID: 31074043 PMCID: PMC7065185 DOI: 10.1002/jpen.1604] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2019] [Accepted: 04/22/2019] [Indexed: 11/12/2022]
Abstract
BACKGROUND Patients receiving home parenteral nutrition (HPN) have an increased risk for central line-associated bloodstream infections (CLABSIs), including candidemia. Recently, 7 single-nucleotide polymorphisms (SNPs) in TLR1, CD58, LCE4A-Clorf68, and TAGAP have been associated with the development of candidemia. Identification of host-genetic as well as clinical risk factors may help to identify patients who have an increased susceptibility to such infections. The aim of this study was to investigate the relevance of the reported SNPs in patients receiving HPN, and to explore clinical risk factors associated with candidemia. METHODS We analyzed blood samples of adult patients who started HPN between 1976 and 2017 at our referral center for intestinal failure. Primary outcome was the association between TLR1, CD58, LCE4A-Clorf68, or TAGAP SNPs and candidemia. Secondary outcomes included the relation between severity of infection and these SNPs, and clinical risk factors for candidemia. RESULTS Of 341 included patients, 42 (12%) experienced a candidemia (range 1-6). None of the 7 SNPs were associated with candidemia or the severity of infection. The rate of non-Candida-related CLABSIs was significantly associated with candidemia (rate ratio, 1.29; 95% CI, 1.14-1.46; P < 0.001). CONCLUSIONS None of 7 known SNPs in TLR1, CD58, LCE4A-Clorf68, or TAGAP were associated with candidemia or severity of infection in patients receiving HPN. The rate of non-Candida-related CLABSIs was significantly associated with the development of candidemia. The latter supports the key role of aseptic catheter handling with respect to Candida susceptibility in patients receiving HPN.
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Affiliation(s)
- Yannick Wouters
- Intestinal Failure Unit, Department of Gastroenterology and Hepatology, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Hennie M J Roelofs
- Intestinal Failure Unit, Department of Gastroenterology and Hepatology, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Mihai G Netea
- Department of Internal Medicine and Radboud Center for Infectious Diseases, Radboud University Medical Center, Nijmegen, the Netherlands
| | - René H M Te Morsche
- Intestinal Failure Unit, Department of Gastroenterology and Hepatology, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Geert J A Wanten
- Intestinal Failure Unit, Department of Gastroenterology and Hepatology, Radboud University Medical Center, Nijmegen, the Netherlands
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23
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Gangneux JP, Cornet M, Bailly S, Fradin C, Féger C, Timsit JF, Leroy O, Sendid B, Bougnoux ME. Clinical Impact of Antifungal Susceptibility, Biofilm Formation and Mannoside Expression of Candida Yeasts on the Outcome of Invasive Candidiasis in ICU: An Ancillary Study on the Prospective AmarCAND2 Cohort. Front Microbiol 2018; 9:2907. [PMID: 30619103 PMCID: PMC6297146 DOI: 10.3389/fmicb.2018.02907] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2018] [Accepted: 11/13/2018] [Indexed: 01/03/2023] Open
Abstract
Background: The link between Candida phenotypical characteristics and invasive candidiasis (IC) prognosis is still partially unknown. Methods:Candida strains isolated during the AmarCAND2 study were centrally analyzed for species identification, antifungal susceptibility, biofilm formation, and expression of surface and glycoconjugate mannosides. Correlation between these phenotypical features and patient outcome was sought using a multivariable Cox survival model. Results:Candida albicans was predominant (65.4%, n = 285), with a mortality rate significantly lower than that in patients with non-albicans strains [HR 0.67 (0.46–1.00), p = 0.048]. The rate of fluconazole-resistant strains was low (C. albicans and Candida glabrata: 3.5 and 6.2%, respectively) as well as caspofungin-resistant ones (1 and 3.1%, respectively). Early biofilm formation was less frequent among C. albicans (45.4%) than among non-albicans (81.2%). While the strains of C. albicans showed variable levels of surface mannosides expression, strains isolated from candidemia exhibited a high expression of β-man, which was correlated with an increased mortality (p = 0.02). Conclusion:Candida albicans IC were associated with lower mortality, and with strains that exhibited less frequently early biofilm formation than non-albicans strains. A high expression of β-man was associated with increased IC mortality. Further studies are warranted to confirm this data and to evaluate other virulence factors in yeasts.
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Affiliation(s)
- Jean-Pierre Gangneux
- UMR_S 1085 - Inserm, Institut de Recherche en Santé, Environnement et Travail, CHU de Rennes, Université de Rennes, Rennes, France
| | - Muriel Cornet
- CNRS, CHU Grenoble Alpes, TIMC-IMAG, Institute of Engineering, Grenoble INP, Université Grenoble Alpes, Grenoble, France
| | - Sébastien Bailly
- Inserm UMR 1137 - IAME Team 5 - Decision Sciences in Infectious Diseases, Control and Care INSERM/Paris Diderot, Sorbonne Paris Cité University, Paris, France
| | - Chantal Fradin
- U995 - LIRIC, Inserm, CHU Lille, University of Lille, Lille, France
| | | | - Jean-François Timsit
- Inserm UMR 1137 - IAME Team 5 - Decision Sciences in Infectious Diseases, Control and Care INSERM/Paris Diderot, Sorbonne Paris Cité University, Paris, France.,Medical ICU, Paris Diderot University - Bichat University Hospital, Assistance Publique - Hôpitaux de Paris, Paris, France
| | | | - Boualem Sendid
- U995 - LIRIC, Inserm, CHU Lille, University of Lille, Lille, France.,Parasitology and Mycology Unit, Lille University Hospital, Lille, France
| | - Marie-Elisabeth Bougnoux
- Parasitology-Mycology Unit, Clinical Microbiology Ward, Necker-Enfants-Malades University Hospital, Assistance Publique - Hôpitaux de Paris, Paris Descartes University, Paris, France.,INRA USC 2019, Fungal Biology and Pathogenicity Unit, Institute Pasteur, Paris, France
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24
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Seleem D, Freitas-Blanco VS, Noguti J, Zancope BR, Pardi V, Murata RM. In Vivo Antifungal Activity of Monolaurin against Candida albicans Biofilms. Biol Pharm Bull 2018; 41:1299-1302. [PMID: 30068882 DOI: 10.1248/bpb.b18-00256] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Monolaurin is a natural compound that has been known for its broad antimicrobial activities. We evaluate the antifungal activity of monolaurin against Candida albicans biofilms in vivo using a novel bioluminescent model to longitudinally monitor oral fungal infection. Oral fungal infection in vivo was performed using bioluminescent engineered C. albicans (SKCa23-ActgLUC) biofilms on Balb/c mice. The antifungal activity of monolaurin was determined by comparing three groups of mice (n=5/group): monolaurin, vehicle control, and positive control (nystatin). All mice were immunosuppressed with cortisone acetate and oral topical treatments were applied for 5 d. In vivo imaging system (IVIS) imaging was used to monitor the progression of infection over a 5-d period. Total photon flux and ex vivo microbiological analysis of the excised tongues were used to determine the overall fungal burden. Oral topical treatments of monolaurin have resulted in a significant decrease (p<0.05) in the total photon flux over 4 and 5 d post-infection in comparison to the vehicle control group. Furthermore, monolaurin treated group had a significant decrease in colony formation unit of tongue tissue compared to the vehicle control. Our findings support monolaurin as a promising antifungal compound in vivo, which may translate to its future use in the treatment of oral candidiasis.
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Affiliation(s)
- Dalia Seleem
- Western University of Health Sciences, College of Dental Medicine
| | | | - Juliana Noguti
- Ostrow School of Dentistry, University of Southern California
| | - Bruna Raquel Zancope
- Department of Physiological Sciences, Piracicaba Dental School, University of Campinas
| | - Vanessa Pardi
- Ostrow School of Dentistry, University of Southern California
| | - Ramiro Mendonça Murata
- Department of Foundational Sciences, School of Dental Medicine, East Carolina University.,Department of Microbiology and Immunology, Brody School of Medicine, East Carolina University
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25
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Abstract
Invasive candida infections are the most important causes of nosocomial infections in intensive care units and in risky groups such as immunosuppressed patients. These infections lead to undesirable consequences such as increased morbidity and mortality in patients, prolongation of hospital stay, and increased hospital costs. In recent years, the incidence of non-albicans Candida spp.'s has increased. Unfortunately, some of these species are naturally resistant to first-line antifungals. In addition, biofilm formation on the central venous catheter and invasive devices may cause treatment failure. The age of the patients, co-morbid diseases, the units where they are treated, the antibiotics and antifungals that are used for the treatment, and invasive devices are risk factors for invasive candida infections. Some of these risk factors can be reduced by the behavior of health-care workers. The most important goal is to take precautions before the occurrence of invasive candida infections. Infection control measures to prevent hospital transmission of candida are very important. Compliance with hand hygiene before and after contact with the patient is the most important step to prevent the spreading of Candida spp. Observation of maximal barrier precautions during invasive catheterization is another important clause of this aim. Avoiding unnecessary invasive devices, antibiotics, and parenteral nutrition are also important to reduce the colonization of candida.
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Affiliation(s)
- Zeynep Ture
- a Department of Infectious Diseases and Clinical Microbiology , Health Ministry University of Kayseri Education and Research Hospital , Kayseri , Turkey
| | - Emine Alp
- b Department of Infectious Diseases and Clinical Microbiology, Infection Control Committee, Faculty of Medicine , Erciyes University , Kayseri , Turkey
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26
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Fidler G, Leiter E, Kocsube S, Biro S, Paholcsek M. Validation of a simplex PCR assay enabling reliable identification of clinically relevant Candida species. BMC Infect Dis 2018; 18:393. [PMID: 30103686 PMCID: PMC6090785 DOI: 10.1186/s12879-018-3283-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2017] [Accepted: 07/31/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Fungal bloodstream infections (BSI) may be serious and are associated with drastic rise in mortality and health care costs. Candida spp. are the predominant etiological agent of fungal sepsis. The prompt and species-level identification of Candida may influence patient outcome and survival. The aim of this study was to develop and evaluate the CanTub-simplex PCR assay coupled with Tm calling and subsequent high resolution melting (HRM) analysis to barcode seven clinically relevant Candida species. METHODS Efficiency, coefficient of correlation and the limit of reliable detection were estimated on purified Candida EDTA-whole blood (WB) reference panels seeded with Candida albicans, Candida glabrata, Candida parapsilosis, Candida tropicalis, Candida krusei, Candida guilliermondii, Candida dubliniensis cells in a 6-log range. Discriminatory power was measured on EDTA-WB clinical panels on three different PCR platforms; LightCycler®96, LightCycler® Nano, LightCycler® 2.0. Inter- and intra assay consistencies were also calculated. RESULTS The limit of reliable detection proved to be 0.2-2 genomic equivalent and the method was reliable on broad concentration ranges (106-10 CFU) providing distinctive melting peaks and characteristic HRM curves. The diagnostic accuracy of the discrimination proved to be the best on Roche LightCycler®2.0 platform. Repeatability was tested and proved to be % C.V.: 0.14 ± 0.06 on reference- and % C.V.: 0.14 ± 0.02 on clinical-plates accounting for a very high accuracy. Reproducibility was % C.V.: 0.11 between reference- and % C.V.: 0.12between clinical-panels which is highly acceptable. CONCLUSION Our assay demonstrates recent advances on Tm calling and HRM analysis for the molecular identification of relevant Candida species. This unique, simplex PCR assay may be capable to outperform conventional phenotypic methods by reducing time and providing accurate and reliable results directly from blood (2 h) or from whole blood culture bottles (12-24 h).
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Affiliation(s)
- Gabor Fidler
- Faculty of Medicine, Department of Human Genetics, University of Debrecen, Nagyerdei krt. 98, Debrecen, H-4032, Hungary
| | - Eva Leiter
- Faculty of Science and Technology, Department of Biotechnology and Microbiology, University of Debrecen, Debrecen, Hungary
| | - Sandor Kocsube
- Faculty of Science and Informatics, Department of Microbiology, University of Szeged, Szeged, Hungary
| | - Sandor Biro
- Faculty of Medicine, Department of Human Genetics, University of Debrecen, Nagyerdei krt. 98, Debrecen, H-4032, Hungary
| | - Melinda Paholcsek
- Faculty of Medicine, Department of Human Genetics, University of Debrecen, Nagyerdei krt. 98, Debrecen, H-4032, Hungary.
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27
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Cataldi V, Di Campli E, Fazii P, Traini T, Cellini L, Di Giulio M. Candida species isolated from different body sites and their antifungal susceptibility pattern: Cross-analysis of Candida albicans and Candida glabrata biofilms. Med Mycol 2018; 55:624-634. [PMID: 27915303 DOI: 10.1093/mmy/myw126] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2016] [Accepted: 09/23/2016] [Indexed: 12/27/2022] Open
Abstract
Candida species are regular commensal in humans, but-especially in immunocompromised patients-they represent opportunistic pathogens giving rise to systemic infection. The aim of the present work was to isolate and characterize for their antifungal profile Candida species from different body sites and to analyze the biofilms produced by C. albicans and C. glabrata isolates. Eighty-one strains of Candida species from 77 patients were identified. Epidemiological study showed that the most isolated species were C. albicans (44), C. glabrata (13) and C. parapsilosis (13) mainly from Hematology, Infectious Diseases, Medicine, Neonatology and Oncology Divisions, the majority of the biological samples were swabs (44) and blood cultures (16). The analysis of the biofilm formation was performed at 24 and 48-hours comparing resistant and susceptible strains of C. albicans to resistant and susceptible strains of C. glabrata. Candida albicans has a greater ability to form biofilm compared to C. glabrata, both in the susceptible and resistant strains reaching maturity after 24 hours with a complex structure composed of blastospores, pseudohyphae, and hyphae embedded in a matrix. On the contrary, C. glabrata biofilm was composed exclusively of blastospores that in the resistant strain, after 24 hours, were organized in a compact multilayer different to the discontinuous structure observed in the susceptible analyzed strains. In conclusion, the increasing of the incidence of Candida species infection together with their emerging drug resistance also related to the biofilm forming capability underline the need to monitor their distribution and susceptibility patterns for improving the surveillance and for a correct management of the infection.
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Affiliation(s)
- Valentina Cataldi
- Departments of Pharmacy and Medical, Oral and Biotechnological Sciences, University "G. d'Annunzio," Chieti-Pescara, Chieti, Italy
| | - Emanuela Di Campli
- Departments of Pharmacy and Medical, Oral and Biotechnological Sciences, University "G. d'Annunzio," Chieti-Pescara, Chieti, Italy
| | - Paolo Fazii
- Clinical Microbiology and Virology, Spirito Santo Hospital, Pescara, Italy
| | - Tonino Traini
- Medical, Oral and Biotechnological Sciences, University "G.d'Annunzio", Chieti-Pescara, Chieti, Italy
| | - Luigina Cellini
- Departments of Pharmacy and Medical, Oral and Biotechnological Sciences, University "G. d'Annunzio," Chieti-Pescara, Chieti, Italy
| | - Mara Di Giulio
- Departments of Pharmacy and Medical, Oral and Biotechnological Sciences, University "G. d'Annunzio," Chieti-Pescara, Chieti, Italy
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28
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Marins TA, Marra AR, Edmond MB, Martino MDV, Yokota PKO, Mafra ACCN, Durão Junior MS. Evaluation of Candida bloodstream infection and antifungal utilization in a tertiary care hospital. BMC Infect Dis 2018; 18:187. [PMID: 29669521 PMCID: PMC5907302 DOI: 10.1186/s12879-018-3094-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2017] [Accepted: 04/12/2018] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Candida bloodstream infections carry a significant mortality risk, justifying the importance of adequate antifungal therapy. This study describes trends in antifungal consumption using the Defined Daily Dose (DDD) and Days of Therapy (DOT) metrics, identifies the microbiological profile, the time to initiation of empirical therapy, the adjustment after positive blood culture results for Candida, and the impact on in-hospital mortality rate in patients with candidemia. METHODS An analysis of antifungal consumption from 2008 to 2016, and of candidemia cases from 2012 to 2016 was carried out in a private tertiary hospital. RESULTS A total of 11,273 admissions were identified with a prescription for at least one type of antifungal therapy. Fluconazole was the most prescribed antifungal drug in terms of general consumption. Through the DDD and DOT metrics, we observed that over time, there was an increase in the consumption of liposomal amphotericin B, micafungin and voriconazole. Candida albicans was the most isolated species in blood cultures. Regarding candidemia, we analyzed samples from 115 patients. Empirical therapy was started within 24 h of blood culture in 44.3% of the cases, and in 81.7% of the cases, the antifungal was deemed to be adequate based in antifungal susceptibility testing, both of which were not associated with the in-hospital mortality rate. CONCLUSIONS Our study reinforces the importance of monitoring the consumption of antifungal agents, which helps in proposing actions that lead to their rational use and, consequently, reduces the appearance of resistant strains.
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Affiliation(s)
| | - Alexandre R. Marra
- Division of Medical Practice, Hospital Israelita Albert Einstein, São Paulo, Brazil
- Office of Clinical Quality, Safety and Performance Improvement, University of Iowa Hospitals and Clinics, Iowa City, IA USA
| | - Michael B. Edmond
- Office of Clinical Quality, Safety and Performance Improvement, University of Iowa Hospitals and Clinics, Iowa City, IA USA
- Division of Infectious Diseases, Department of Internal Medicine, University of Iowa Carver College of Medicine, Iowa City, IA USA
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Kronen R, Hsueh K, Lin C, Powderly WG, Spec A. Creation and Assessment of a Clinical Predictive Calculator and Mortality Associated With Candida krusei Bloodstream Infections. Open Forum Infect Dis 2018; 5:ofx253. [PMID: 29450209 PMCID: PMC5808796 DOI: 10.1093/ofid/ofx253] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2017] [Accepted: 02/05/2018] [Indexed: 11/23/2022] Open
Abstract
Background Candida krusei bloodstream infection (CK BSI) is associated with high mortality, but whether this is due to underlying comorbidities in affected patients or the organism itself is unknown. Identifying patient characteristics that are associated with CK BSI is crucial for clinical decision-making and prognosis. Methods We conducted a retrospective analysis of hospitalized patients with Candida BSI at our institution between 2002 and 2015. Data were collected on demographics, comorbidities, medications, procedures, central lines, vital signs, and laboratory values. Multivariable logistic and Cox regression were used to identify risk factors associated with CK and mortality, respectively. Results We identified 1873 individual patients who developed Candida BSI within the study period, 59 of whom had CK BSI. CK BSI was predicted by hematologic malignancy, gastric malignancy, neutropenia, and the use of prophylactic azole antifungals, monoclonal antibodies, and β-lactam/β-lactamase inhibitor combinations. The C-statistic was 0.86 (95% confidence interval, 0.81–0.91). The crude mortality rates were 64.4% for CK BSI and 41.4% for non-CK BSI. Although CK was associated with higher mortality in univariable Cox regression, this relationship was no longer significant with the addition of the following confounders: lymphoma, neutropenia, glucocorticoid use, chronic liver disease, and elevated creatinine. Conclusions Six patient comorbidities predicted the development of CK BSI with high accuracy. Although patients with CK BSI have higher crude mortality rates than patients with non-CK BSI, this difference is not significant when accounting for other patient characteristics.
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Affiliation(s)
- Ryan Kronen
- Washington University School of Medicine, St Louis, Missouri
| | - Kevin Hsueh
- Division of Infectious Diseases, St Louis, Missouri
| | - Charlotte Lin
- Department of Medicine, Washington University School of Medicine, St Louis, Missouri
| | | | - Andrej Spec
- Division of Infectious Diseases, St Louis, Missouri
- Correspondence: A. Spec, MD, MSCI, Infectious Disease Clinical Research Unit, 4523 Clayton Ave., Campus Box 8051 St Louis, MO, 63110-0193 ()
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Davidson L, Netea MG, Kullberg BJ. Patient Susceptibility to Candidiasis-A Potential for Adjunctive Immunotherapy. J Fungi (Basel) 2018; 4:E9. [PMID: 29371502 PMCID: PMC5872312 DOI: 10.3390/jof4010009] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2017] [Revised: 12/15/2017] [Accepted: 12/30/2017] [Indexed: 12/11/2022] Open
Abstract
Candida spp. are colonizing fungi of human skin and mucosae of the gastrointestinal and genitourinary tract, present in 30-50% of healthy individuals in a population at any given moment. The host defense mechanisms prevent this commensal fungus from invading and causing disease. Loss of skin or mucosal barrier function, microbiome imbalances, or defects of immune defense mechanisms can lead to an increased susceptibility to severe mucocutaneous or invasive candidiasis. A comprehensive understanding of the immune defense against Candida is essential for developing adjunctive immunotherapy. The important role of underlying genetic susceptibility to Candida infections has become apparent over the years. In most patients, the cause of increased susceptibility to fungal infections is complex, based on a combination of immune regulation gene polymorphisms together with other non-genetic predisposing factors. Identification of patients with an underlying genetic predisposition could help determine which patients could benefit from prophylactic antifungal treatment or adjunctive immunotherapy. This review will provide an overview of patient susceptibility to mucocutaneous and invasive candidiasis and the potential for adjunctive immunotherapy.
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Affiliation(s)
- Linda Davidson
- Department of Internal Medicine and Radboud Center for Infectious diseases (RCI), Radboud University Medical Center, 6525 GA Nijmegen, The Netherlands.
| | - Mihai G Netea
- Department of Internal Medicine and Radboud Center for Infectious diseases (RCI), Radboud University Medical Center, 6525 GA Nijmegen, The Netherlands.
| | - Bart Jan Kullberg
- Department of Internal Medicine and Radboud Center for Infectious diseases (RCI), Radboud University Medical Center, 6525 GA Nijmegen, The Netherlands.
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Chakraborti A, Jaiswal A, Verma PK, Singhal R. A Prospective Study of Fungal Colonization and Invasive Fungal Disease in Long-Term Mechanically Ventilated Patients in a Respiratory Intensive Care Unit. Indian J Crit Care Med 2018; 22:597-601. [PMID: 30186011 PMCID: PMC6108304 DOI: 10.4103/ijccm.ijccm_181_18] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Background: Long-term mechanical ventilation in an Intensive Care Unit (ICU) exposes the patient to fungal colonization and invasive fungal disease due to the presence of indwelling catheters, administration of broad-spectrum antibiotics, and intravenous corticosteroids. A study is hence required to study the risk factors and incidence of fungal infection in these patients. Methods: A prospective observational study was carried out in the respiratory ICU of a tertiary care hospital for a period of approximately 1 year in which patients on mechanical ventilation (>7 days) were enrolled. Blood, urine, and endotracheal aspirate (ETA) of these patients were sent for fungal culture on day 1 and day 7 of mechanical ventilation. Fiberoptic bronchoscopy was done on day 7 and bronchoalveolar lavage along with transbronchial lung biopsy (TBLB) were sent for fungal culture. Results: During 7 days of ventilation, there was a statistically significant increase in the proportion of culture-positive ETA and urine samples. Overall, Candida albicans emerged as the most common colonizer. Blood candidemia was seen in 10% of patients on day 7 of mechanical ventilation. Fungal invasion of the lung, as evidenced by fungal culture-positive TBLB specimens, was seen in 17% of patients. Diabetes was found to be a statistically significant risk factor for respiratory and urinary tract colonization as well as invasive fungal disease. Conclusion: Long-term mechanical ventilation (>7 days) is strongly associated with fungal colonization of the respiratory tract and urinary tract. Appropriate prophylactic antifungals may be given and infection control practices to be observed to ensure minimum colonization and therefore infection in such settings.
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Affiliation(s)
- Amartya Chakraborti
- Department of Tuberculosis and Respiratory Diseases, National Institute of Tuberculosis and Respiratory Diseases, New Delhi, India
| | - Anand Jaiswal
- Department of Pulmonary and Sleep Medicine, Medanta, Gurgaon, Haryana, India
| | - Pushpendra Kumar Verma
- Department of Tuberculosis and Respiratory Diseases, National Institute of Tuberculosis and Respiratory Diseases, New Delhi, India
| | - Ritu Singhal
- Department of Microbiology, National Institute of Tuberculosis and Respiratory Diseases, New Delhi, India
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Carpino N, Naseem S, Frank DM, Konopka JB. Modulating Host Signaling Pathways to Promote Resistance to Infection by Candida albicans. Front Cell Infect Microbiol 2017; 7:481. [PMID: 29201860 PMCID: PMC5696602 DOI: 10.3389/fcimb.2017.00481] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2017] [Accepted: 11/06/2017] [Indexed: 12/29/2022] Open
Abstract
Candida albicans is a common human fungal pathogen capable of causing serious systemic infections that can progress to become lethal. Current therapeutic approaches have limited effectiveness, especially once a systemic infection is established, in part due to the lack of an effective immune response. Boosting the immune response to C. albicans has been the goal of immunotherapy, but it has to be done selectively to prevent deleterious hyperinflammation (sepsis). Although an efficient inflammatory response is necessary to fight infection, the typical response to C. albicans results in collateral damage to tissues thereby exacerbating the pathological effects of infection. For this reason, identifying specific ways of modulating the immune system holds promise for development of new improved therapeutic approaches. This review will focus on recent studies that provide insight using mutant strains of mice that are more resistant to bloodstream infection by C. albicans. These mice are deficient in signal transduction proteins including the Jnk1 MAP kinase, the Cbl-b E3 ubiquitin ligase, or the Sts phosphatases. Interestingly, the mutant mice display a different response to C. albicans that results in faster clearance of infection without hyper-inflammation and collateral damage. A common underlying theme between the resistant mouse strains is loss of negative regulatory proteins that are known to restrain activation of cell surface receptor-initiated signaling cascades. Understanding the cellular and molecular mechanisms that promote resistance to C. albicans in mice will help to identify new approaches for improving antifungal therapy.
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Affiliation(s)
- Nick Carpino
- Department of Molecular Genetics and Microbiology, Stony Brook University, Stony Brook, NY, United States
| | - Shamoon Naseem
- Department of Molecular Genetics and Microbiology, Stony Brook University, Stony Brook, NY, United States
| | - David M Frank
- Department of Molecular Genetics and Microbiology, Stony Brook University, Stony Brook, NY, United States
| | - James B Konopka
- Department of Molecular Genetics and Microbiology, Stony Brook University, Stony Brook, NY, United States
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Rajkowska K, Otlewska A, Kunicka-Styczyńska A, Krajewska A. Candida albicans Impairments Induced by Peppermint and Clove Oils at Sub-Inhibitory Concentrations. Int J Mol Sci 2017. [PMID: 28629195 PMCID: PMC5486128 DOI: 10.3390/ijms18061307] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
Members of Candida species cause significant health problems, inducing various types of superficial and deep-seated mycoses in humans. In order to prevent from Candida sp. development, essential oils are more and more frequently applied, due to their antifungal activity, low toxicity if used appropriately, and biodegrability. The aim of the study was to characterize the early alterations in Candida albicans metabolic properties in relation to proteins and chromosomal DNA profiles, after treatment with peppermint and clove oils at sub-inhibitory concentrations. The yeasts were affected by the oils even at a concentration of 0.0075% v/v, which resulted in changes in colony morphotypes and metabolic activities. Peppermint and clove oils at concentrations ranging from 0.015× MIC (minimal inhibitory concentration) to 0.5× MIC values substantially affected the enzymatic abilities of C. albicans, and these changes were primarily associated with the loss or decrease of activity of all 9 enzymes detected in the untreated yeast. Moreover, 29% isolates showed additional activity of N-acetyl-β-glucosaminidase and 14% isolates—α-fucosidase in comparison to the yeast grown without essential oils addition. In response to essential oils at 0.25–0.5× MIC, extensive changes in C. albicans whole-cell protein profiles were noted. However, the yeast biochemical profiles were intact with the sole exception of the isolate treated with clove oil at 0.5× MIC. The alterations were not attributed to gross chromosomal rearrangements in C. albicans karyotype. The predominantly observed decrease in protein fractions and the yeast enzymatic activity after treatment with the oils should be considered as a phenotypic response of C. albicans to the essential oils at their sub-inhibitory concentrations and may lead to the reduction of this yeast pathogenicity.
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Affiliation(s)
- Katarzyna Rajkowska
- Institute of Fermentation Technology and Microbiology, Faculty of Biotechnology and Food Sciences, Lodz University of Technology, Lodz 90-924, Poland.
| | - Anna Otlewska
- Institute of Fermentation Technology and Microbiology, Faculty of Biotechnology and Food Sciences, Lodz University of Technology, Lodz 90-924, Poland.
| | - Alina Kunicka-Styczyńska
- Institute of Fermentation Technology and Microbiology, Faculty of Biotechnology and Food Sciences, Lodz University of Technology, Lodz 90-924, Poland.
| | - Agnieszka Krajewska
- Institute of General Food Chemistry, Faculty of Biotechnology and Food Sciences, Lodz University of Technology, Lodz 90-924, Poland.
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Yeşilkaya A, Azap Ö, Aydın M, Akçil Ok M. Epidemiology, species distribution, clinical characteristics and mortality of candidaemia in a tertiary care university hospital in Turkey, 2007-2014. Mycoses 2017; 60:433-439. [PMID: 28338249 DOI: 10.1111/myc.12618] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2016] [Revised: 02/23/2017] [Accepted: 02/23/2017] [Indexed: 01/05/2023]
Abstract
Candidaemia still continues to be a serious medical concern and the epidemiology of candidaemia varies according to geographical areas. We aim to determine the incidence, local epidemiology, Candida species distribution and crude mortality rates of candidaemia. We retrospectively evaluated candidaemia episodes in between January 2007 and August 2014. We compared demographic, clinical, microbiological findings and mortality rates of episodes caused by Candida albicans and non-albicans Candida species. Overall the candidaemia incidences were 1.23 episodes/1000 admissions. A significant negative slope among candidaemia episodes and years was determined. Overall C. albicans (54.6%) was the most common species followed by Candida glabrata, Candida tropicalis and Candida parapsilosis respectively. Preinfection hospital stay and length of hospital stay were statistically longer in patients with non-albicans Candida candidaemia than in patients with C. albicans candidaemia. The source of candidaemia was unknown in 52.5% of all episodes. Central venous catheters among non-albicans Candida candidaemia episodes and urinary system among C. albicans candidaemia episodes were common source of candidaemia compared to each other. Previous antifungal therapy preceding candidaemia and concomitant bacteraemia were significantly associated with non-albicans Candida candidaemia. Continuous local surveillance will preserve its pivotal importance in formulating empirical antifungal therapy and improving management of candidaemia.
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Affiliation(s)
- Ayşegül Yeşilkaya
- Faculty of Medicine, Department of Infectious Diseases and Clinical Microbiology, Baskent University, Ankara, Turkey
| | - Özlem Azap
- Faculty of Medicine, Department of Infectious Diseases and Clinical Microbiology, Baskent University, Ankara, Turkey
| | - Mehtap Aydın
- Faculty of Medicine, Department of Infectious Diseases and Clinical Microbiology, Baskent University, Ankara, Turkey
| | - Mehtap Akçil Ok
- Faculty of Health Sciences, Department of Nutrition and Dietetic, Baskent University, Ankara, Turkey
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Candida krusei and Candida glabrata reduce the filamentation of Candida albicans by downregulating expression of HWP1 gene. Folia Microbiol (Praha) 2017; 62:317-323. [DOI: 10.1007/s12223-017-0500-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2016] [Accepted: 01/17/2017] [Indexed: 10/20/2022]
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Yılmaz Karadağ F, Ergen P, Aydın Ö, Doğru A, Tanıdır B, Vahaboğlu MH. Evaluation of epidemiological characteristics and risk factors affecting mortality in patients with candidemia. Turk J Med Sci 2016; 46:1724-1728. [PMID: 28081316 DOI: 10.3906/sag-1505-70] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2015] [Accepted: 04/07/2016] [Indexed: 11/03/2022] Open
Abstract
BACKGROUND/AIM The aim of this study was to determine epidemiologic characters of patients with candidemia and to evaluate risk factors that can affect mortality rates among these patients. MATERIALS AND METHODS Patients admitted to the İstanbul Medeniyet University Göztepe Training Hospital between 2009 and 2011 who had a positive blood culture for Candida spp. during hospitalization were studied retrospectively for demographic characteristics and risk factors. Statistical comparisons were estimated with the Stata 12 package. Independent variables associated with mortality were estimated by Cox regression analyses. RESULTS A total of 89 patients were identified with a positive blood culture. Of the isolates, 72% (64/89) were C. albicans and 10% (9/89) were non-albicans Candida, while 18% (16/89) were unidentified. C. parapsilosis was the most frequently isolated species among non-albicans Candida. The crude mortality rate among candidemia cases was 30% (27/89). By univariate analysis, being in the ICU and age (≥50 or ≥60) were found to be statistically significant, whereas by multivariate analysis only age of ≥50 years was independently more associated with mortality (OR, 2.7; CI, 1.05-6.73). CONCLUSION Candidemia is associated with high mortality rates. Patients older than 50 years are found to be at considerable risk in terms of adverse outcomes.
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Affiliation(s)
- Fatma Yılmaz Karadağ
- Department of Infectious Diseases and Clinical Microbiology, İstanbul Medeniyet University, Göztepe Training and Research Hospital, İstanbul, Turkey
| | - Pınar Ergen
- Department of Infectious Diseases and Clinical Microbiology, İstanbul Medeniyet University, Göztepe Training and Research Hospital, İstanbul, Turkey
| | - Özlem Aydın
- Department of Infectious Diseases and Clinical Microbiology, İstanbul Medeniyet University, Göztepe Training and Research Hospital, İstanbul, Turkey
| | - Arzu Doğru
- Department of Infectious Diseases and Clinical Microbiology, İstanbul Medeniyet University, Göztepe Training and Research Hospital, İstanbul, Turkey
| | - Berrin Tanıdır
- Department of Microbiology and Clinical Microbiology, İstanbul Medeniyet University, Göztepe Training and Research Hospital, İstanbul, Turkey
| | - Mustafa Haluk Vahaboğlu
- Department of Infectious Diseases and Clinical Microbiology, İstanbul Medeniyet University, Göztepe Training and Research Hospital, İstanbul, Turkey
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Das P, Pandey P, Harishankar A, Chandy M, Bhattacharya S. A high yield DNA extraction method for medically important Candida species: A comparison of manual versus QIAcube-based automated system. Indian J Med Microbiol 2016; 34:533-535. [PMID: 27934838 DOI: 10.4103/0255-0857.195360] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
The prognosis of infected individuals with candidemia depends on rapid and precise diagnosis which enables optimising treatment. Three fungal DNA extraction protocols have been compared in this study for medically important Candida species. The quality and quantity of the DNA extracted by physical, chemical and automated protocols was compared using NanoDrop ND-2000 spectrophotometer. It was found that the yield and purity (260/230) ratio of extracted DNA was significantly high in the physical treatment-based protocol as compared to chemical based or automated protocol. Extracted DNA-based real time-polymerase chain reaction showed an analytical sensitivity of 103 cfu/mL. The result of this study suggests physical treatment is the most successful extraction technique compared to other two protocols.
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Affiliation(s)
- P Das
- Department of Microbiology, Tata Medical Center, Kolkata, West Bengal, India
| | - P Pandey
- Department of Microbiology, Tata Medical Center, Kolkata, West Bengal, India
| | - A Harishankar
- Department of Microbiology, Tata Medical Center, Kolkata, West Bengal, India
| | - M Chandy
- Department of Microbiology, Tata Medical Center, Kolkata, West Bengal, India
| | - S Bhattacharya
- Department of Microbiology, Tata Medical Center, Kolkata, West Bengal, India
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Motoa G, Muñoz JS, Oñate J, Pallares CJ, Hernández C, Villegas MV. Epidemiology of Candida isolates from Intensive Care Units in Colombia from 2010 to 2013. Rev Iberoam Micol 2016; 34:17-22. [PMID: 27810262 DOI: 10.1016/j.riam.2016.02.006] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2015] [Revised: 11/25/2015] [Accepted: 02/12/2016] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND The frequency of Candida isolates as a cause of hospital infections has risen in recent years, leading to high rates of morbidity and mortality. The knowledge of the epidemiology of those hospital acquired fungal infections is essential to implement an adequate antifungal therapy. AIMS To describe the epidemiology of Candida infections in Intensive Care Units (ICUs) from a surveillance network in Colombia. METHODS Information was collected from the microbiology laboratories of 20 tertiary healthcare institutions from 10 Colombian cities using the Whonet® software version 5.6. A general descriptive analysis of Candida species and susceptibility profiles focusing on fluconazole and voriconazole was completed between 2010 and 2013, including a sub-analysis of healthcare associated infections (HAIs) during the last year. RESULTS Candida isolates made up 94.5% of the 2680 fungal isolates considered, with similar proportions for Candida albicans and non-C. albicans Candida species (48.3% and 51.7%, respectively). Among the latter, Candida tropicalis (38.6%) and Candida parapsilosis (28.5%) were the most frequent species. Of note, among the blood isolates C. albicans was not the main species. Most of the species isolated were susceptible to fluconazole and voriconazole. From the HAIs reported, 25.5% were caused by Candida; central line-associated bloodstream infection was the most common HAI (58.8%). There were no statistically significant differences regarding length of hospital stay and device days among HAIs. CONCLUSIONS In ICUs of Colombia, non-C. albicans Candida species are as frequent as C. albicans, except in blood samples where non-C. albicans Candida isolates predominate. Further studies are needed to evaluate Candida associated risk factors and to determine its clinical impact.
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Affiliation(s)
- Gabriel Motoa
- Centro Internacional de Entrenamiento e Investigaciones Médicas (CIDEIM), Cali, Colombia
| | - Juan Sebastián Muñoz
- Centro Internacional de Entrenamiento e Investigaciones Médicas (CIDEIM), Cali, Colombia
| | - José Oñate
- Centro Internacional de Entrenamiento e Investigaciones Médicas (CIDEIM), Cali, Colombia; Department of Internal Medicine, School of Medicine, Universidad del Valle, Cali, Colombia; Centro Medico Imbanaco, Cali, Colombia
| | | | - Cristhian Hernández
- Centro Internacional de Entrenamiento e Investigaciones Médicas (CIDEIM), Cali, Colombia
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Wang X, van de Veerdonk FL, Netea MG. Basic Genetics and Immunology of Candida Infections. Infect Dis Clin North Am 2016; 30:85-102. [PMID: 26897063 DOI: 10.1016/j.idc.2015.10.010] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Candida infections can cause superficial and invasive disease. Several essential mechanisms underlying the pathogenesis of these infections were known for some time, such as neutropenia predisposing to invasive disease, and CD4 lymphopenia causing increased susceptibility to mucosal candidiasis. However, the development of novel genetic screening techniques has led to several new insights in the genetics and immunology of candida infections. This article highlights novel insights in the pathogenesis of mucocutaneous and invasive candidiasis that have been identified in recent years.
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Affiliation(s)
- Xiaowen Wang
- Department of Internal Medicine, Radboud University Medical Center, Geert Grooteplein Zuid 8, Nijmegen, 6525 GA, The Netherlands; Department of Dermatology, Peking University First Hospital, Xishiku Street 8, Xicheng District, Beijing 10034, China
| | - Frank L van de Veerdonk
- Department of Internal Medicine, Radboud University Medical Center, Geert Grooteplein Zuid 8, Nijmegen, 6525 GA, The Netherlands; Radboud Center for Infectious Diseases (RCI), Geert Grooteplein Zuid 8, Nijmegen, 6525 GA, The Netherlands
| | - Mihai G Netea
- Department of Internal Medicine, Radboud University Medical Center, Geert Grooteplein Zuid 8, Nijmegen, 6525 GA, The Netherlands; Radboud Center for Infectious Diseases (RCI), Geert Grooteplein Zuid 8, Nijmegen, 6525 GA, The Netherlands.
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Montravers P, Perrigault PF, Timsit JF, Mira JP, Lortholary O, Leroy O, Gangneux JP, Guillemot D, Bensoussan C, Bailly S, Azoulay E, Constantin JM, Dupont H. Antifungal therapy for patients with proven or suspected Candida peritonitis: Amarcand2, a prospective cohort study in French intensive care units. Clin Microbiol Infect 2016; 23:117.e1-117.e8. [PMID: 27746395 DOI: 10.1016/j.cmi.2016.10.001] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2016] [Revised: 08/04/2016] [Accepted: 10/05/2016] [Indexed: 12/31/2022]
Abstract
OBJECTIVE The clinical characteristics and prognosis of patients treated for Candida peritonitis (CP) were compared according to the type of systemic antifungal therapy (SAT), empiric (EAF) or targeted (TAF) therapies, and the final diagnosis of infection. METHODS Patients in intensive care units (ICU) treated for CP were selected among the AmarCAND2 cohort, to compare patients receiving EAF for unconfirmed suspicion of CP (EAF/nonCP), to those with suspected secondarily confirmed CP (EAF/CP), or with primarily proven CP receiving TAF. RESULTS In all, 279 patients were evaluated (43.4% EAF/nonCP, 29.7% EAF/CP and 25.8% TAF patients). At SAT initiation, the severity of illness was similar among EAF/nonCP and EAF/CP patients, lower among TAF patients (median Simplified Acute Physiology Score II (SAPS II) 49 and 51 versus 35, respectively; p 0.001). Candida albicans was involved in 67%, Candida glabrata in 15.6%. All strains were susceptible to echinocandin; 84% to fluconazole. Echinocandin was administered to 51.2% EAF/nonCP, 49% EAF/CP and 40% TAF patients. At day 28, 72%, 76% and 75% of EAF/nonCP, EAF/CP and TAF patients, respectively, were alive. An increased mortality was observed in patients with a Sequential Organ Failure Assessment (SOFA) score <7 if SAT was delayed by ≥6 days (p 0.04). Healthcare-associated CP (OR 3.82, 95% CI 1.52-9.64, p 0.004), SOFA ≥8 at ICU admission (OR 2.61, 95% CI 1.08-6.34; p 0.03), and SAPS II ≥45 at SAT initiation (OR 5.08, 95% CI 1.04-12.67; p 0.001) impacted the 28-day mortality. CONCLUSIONS In summary, only 56.6% of ICU patients receiving SAT had CP. Most strains were susceptible to SAT. A similar 28-day mortality rate was observed among groups; the late administration of SAT significantly worsened the prognosis of patients with less severe CP.
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Affiliation(s)
- P Montravers
- Paris Diderot Sorbonne Cite University, and Anesthesiology and Critical Care Medicine, Bichat-Claude Bernard University Hospital, HUPNSV, AP-HP, Paris, France.
| | - P F Perrigault
- Medical-surgical ICU, Montpellier University Hospital, Montpellier, France
| | - J F Timsit
- Medical ICU, Paris Diderot University, and Bichat University Hospital, HUPNVS, AP-HP, Paris, France
| | - J P Mira
- Medical ICU, Cochin University Hospital, HUPC, AP-HP, and Paris Descartes, Sorbonne Paris Cité University, Paris, France
| | - O Lortholary
- University Paris Descartes, Necker Pasteur Centre for Infectious Diseases, HUNEM, AP-HP, IHU Imagine, Paris, France; Pasteur Institute, National Reference Centre for Invasive Mycoses and Antifungals, CNRS URA3012, Paris, France
| | - O Leroy
- Medical ICU, Chatilliez Hospital, Tourcoing, France
| | - J P Gangneux
- Mycology, Rennes University Hospital, Rennes, France
| | - D Guillemot
- Inserm UMR 1181 « Biostatistics, Biomathematics, Pharmaco-epidemiology and Infectious Diseases » (B2PHI), F-75015 Paris, France
| | - C Bensoussan
- Medical Affairs, Therapy Area Hospital, MSD France, Courbevoie, France
| | - S Bailly
- Inserm UMR 1137 - IAME Team 5 - DeSCID: Decision SCiences in Infectious Diseases, Control and Care INSERM/Paris Diderot, Sorbonne Paris Cité University, Paris, France
| | - E Azoulay
- Medical ICU, Saint-Louis University Hospital, HUSLLFW, AP-HP, Paris, France
| | - J M Constantin
- Perioperative Medicine Department, Clermont-Ferrand University Hospital, Clermont-Ferrand, France
| | - H Dupont
- Surgical ICU, Amiens University Hospital, Amiens, France
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Razzaghi R, Momen-Heravi M, Erami M, Nazeri M. Candidemia in patients with prolonged fever in Kashan, Iran. Curr Med Mycol 2016; 2:20-26. [PMID: 28681025 PMCID: PMC5490286 DOI: 10.18869/acadpub.cmm.2.3.20] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Abstract
Background and Purpose: Candida species are considered a common cause of fungal blood stream infections, which are associated with considerable mortality and morbidity rates, especially in the admitted and immunocompromised patients. Despite the increase in new and available antifungal agents, the emergence of resistant strains is growing. Regarding this, the aim of the present study was to assess the fungal epidemiology of candidemia and the antifungal susceptibility patterns against five current antifungal agents among the patients with prolonged fever, who were admitted to Beheshti Educational Hospital, Kashan, Iran. Materials and Methods: This cross-sectional study was conducted on 253 hospitalized patients with prolonged fever despite receiving broad-spectrum antibiotic therapy. Blood samples were collected aseptically, and then cultured using an automated blood culture system and conventional broth culture bottle. Candida isolates were identified at species level using morphological and physiological properties and produced color on the CHROMagar Candida. Furthermore, the antifungal susceptibility testing was performed using (CLSI M27-A3 and CLSI M27-S4) broth microdilution methods. Results: The most positive cultures were detected by the automated blood culture system. C.albicans (%50) was the most prevalent species, followed by C. glabrata (%40), and C. parapsilosis, (%10) respectively .The mortality rate was high (%60) and most patients with candidemia were admitted to the Intensive Care Unit and Neonatal Intensive Care Unit. All isolates were susceptible to amphotericin B, while the highest resistance belonged to caspofungin. Conclusion: In this study, high resistance was reported, especially for caspofungin, which can be regarded as the emergence of caspofungin-resistant strains. Regarding this, the establishment of a surveillance and prevention program for the reduction of the emergence of resistant species is necessary.
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Affiliation(s)
- R Razzaghi
- Department of Infectious Diseases, Faculty of Medicine, Kashan University of Medical Sciences, Kashan, Iran
| | - M Momen-Heravi
- Department of Infectious Diseases, Faculty of Medicine, Kashan University of Medical Sciences, Kashan, Iran
| | - M Erami
- Beheshti Hospital, Kashan University of Medical Sciences, Kashan, Iran
| | - M Nazeri
- Department of Medical Parasitology and Mycology, Faculty of Medicine, Kashan University of Medical Sciences, Kashan, Iran
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Seleem D, Pardi V, Murata RM. Review of flavonoids: A diverse group of natural compounds with anti-Candida albicans activity in vitro. Arch Oral Biol 2016; 76:76-83. [PMID: 27659902 DOI: 10.1016/j.archoralbio.2016.08.030] [Citation(s) in RCA: 93] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2016] [Revised: 07/14/2016] [Accepted: 08/25/2016] [Indexed: 12/13/2022]
Abstract
Flavonoids are a subdivision of polyphenols, a versatile class of natural compounds that represent secondary metabolites from higher plants and are abundant in human diet. Various protective effects of flavonoids have been reported, including antimicrobial and antifungal activities. Due to the nature of oral candidiasis and the increased use of antifungal agents, several drug-resistant strains have emerged making it impractical to rely on one standard therapeutic regime. The aim of this review is to summarize the antifungal activity of some examples of the major subclasses of flavonoids in pure extract forms against C. albicans in vitro, as reported in literature over the past 10 years (2004-2015). In addition, this review outlines the potential mechanism of actions of flavonoids studied in vitro, which may contribute to a better understanding of flavonoids as multi-targets agents in the treatment and/or prevention of oral candidiasis in clinical settings.
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Affiliation(s)
- Dalia Seleem
- University of Southern California, Herman Ostrow School of Dentistry, Division of Periodontology, and Diagnostic Sciences, Dental Hygiene & Biomedical Science, Los Angeles, CA, USA
| | - Vanessa Pardi
- University of Southern California, Herman Ostrow School of Dentistry, Division of Periodontology, and Diagnostic Sciences, Dental Hygiene & Biomedical Science, Los Angeles, CA, USA
| | - Ramiro Mendonça Murata
- East Carolina University, School of Dental Medicine, Department of Foundational Sciences, Greenville, NC, USA.
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Seleem D, Benso B, Noguti J, Pardi V, Murata RM. In Vitro and In Vivo Antifungal Activity of Lichochalcone-A against Candida albicans Biofilms. PLoS One 2016; 11:e0157188. [PMID: 27284694 PMCID: PMC4902220 DOI: 10.1371/journal.pone.0157188] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2016] [Accepted: 05/25/2016] [Indexed: 11/18/2022] Open
Abstract
Oral candidiasis (OC) is an opportunistic fungal infection with high prevalence among immunocompromised patients. Candida albicans is the most common fungal pathogen responsible for OC, often manifested in denture stomatitis and oral thrush. Virulence factors, such as biofilms formation and secretion of proteolytic enzymes, are key components in the pathogenicity of C. albicans. Given the limited number of available antifungal therapies and the increase in antifungal resistance, demand the search for new safe and effective antifungal treatments. Lichochalcone-A is a polyphenol natural compound, known for its broad protective activities, as an antimicrobial agent. In this study, we investigated the antifungal activity of lichochalcone-A against C. albicans biofilms both in vitro and in vivo. Lichochalcone-A (625 μM; equivalent to 10x MIC) significantly reduced C. albicans (MYA 2876) biofilm growth compared to the vehicle control group (1% ethanol), as indicated by the reduction in the colony formation unit (CFU)/ml/g of biofilm dry weight. Furthermore, proteolytic enzymatic activities of proteinases and phospholipases, secreted by C. albicans were significantly decreased in the lichochalcone-A treated biofilms. In vivo model utilized longitudinal imaging of OC fungal load using a bioluminescent-engineered C. albicans (SKCa23-ActgLUC) and coelenterazine substrate. Mice treated with lichochalcone-A topical treatments exhibited a significant reduction in total photon flux over 4 and 5 days post-infection. Similarly, ex vivo analysis of tongue samples, showed a significant decrease in CFU/ml/mg in tongue tissue sample of lichochalcone-A treated group, which suggest the potential of lichochalcone-A as a novel antifungal agent for future clinical use.
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Affiliation(s)
- Dalia Seleem
- Herman Ostrow School of Dentistry, Division of Periodontology Diagnostic Sciences, Dental Hygiene and Biomedical Sciences, University of Southern California, Los Angeles, CA, United States of America
| | - Bruna Benso
- School of Dentistry, Faculty of Medicine, Universidad Austral de Chile, Campus Isla Teja, Valdivia, Chile
| | - Juliana Noguti
- Herman Ostrow School of Dentistry, Division of Periodontology Diagnostic Sciences, Dental Hygiene and Biomedical Sciences, University of Southern California, Los Angeles, CA, United States of America
| | - Vanessa Pardi
- Herman Ostrow School of Dentistry, Division of Periodontology Diagnostic Sciences, Dental Hygiene and Biomedical Sciences, University of Southern California, Los Angeles, CA, United States of America
| | - Ramiro Mendonça Murata
- Herman Ostrow School of Dentistry, Division of Periodontology Diagnostic Sciences, Dental Hygiene and Biomedical Sciences, University of Southern California, Los Angeles, CA, United States of America
- * E-mail:
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Venturini J, Fraga-Silva TFC, Marchetti CM, Mimura LAN, Conti BJ, Golim MDA, Mendes RP, de Arruda MSP. Imbalanced Macrophage and Dendritic Cell Activations in Response to Candida albicans in a Murine Model of Diabetes Mellitus. Immunol Invest 2016; 45:420-38. [DOI: 10.3109/08820139.2016.1162798] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Affiliation(s)
- James Venturini
- Faculdade de Ciências, UNESP – Universidade Estadual Paulista, Bauru, SP, Brazil
| | - Thais Fernanda Campos Fraga-Silva
- Faculdade de Ciências, UNESP – Universidade Estadual Paulista, Bauru, SP, Brazil
- Instituto de Biocências de Botucatu, Universidade Estadual Paulista, Botucatu, SP, Brazil
| | | | - Luiza Ayumi Nishiyama Mimura
- Faculdade de Ciências, UNESP – Universidade Estadual Paulista, Bauru, SP, Brazil
- Instituto de Biocências de Botucatu, Universidade Estadual Paulista, Botucatu, SP, Brazil
| | - Bruno José Conti
- Instituto de Biocências de Botucatu, Universidade Estadual Paulista, Botucatu, SP, Brazil
| | - Márjorie de Assis Golim
- Faculdade de Medicina de Botucatu, UNESP – Universidade Estadual Paulista, Botucatu, SP, Brazil
| | - Rinaldo Poncio Mendes
- Faculdade de Medicina de Botucatu, UNESP – Universidade Estadual Paulista, Botucatu, SP, Brazil
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Freire F, Ferraresi C, Jorge AOC, Hamblin MR. Photodynamic therapy of oral Candida infection in a mouse model. JOURNAL OF PHOTOCHEMISTRY AND PHOTOBIOLOGY B-BIOLOGY 2016; 159:161-8. [PMID: 27074245 DOI: 10.1016/j.jphotobiol.2016.03.049] [Citation(s) in RCA: 67] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/07/2016] [Accepted: 03/30/2016] [Indexed: 11/17/2022]
Abstract
Species of the fungal genus Candida, can cause oral candidiasis especially in immunosuppressed patients. Many studies have investigated the use of photodynamic therapy (PDT) to kill fungi in vitro, but this approach has seldom been reported in animal models of infection. This study investigated the effects of PDT on Candida albicans as biofilms grown in vitro and also in an immunosuppressed mouse model of oral candidiasis infection. We used a luciferase-expressing strain that allowed non-invasive monitoring of the infection by bioluminescence imaging. The phenothiazinium salts, methylene blue (MB) and new methylene blue (NMB) were used as photosensitizers (PS), combined or not with potassium iodide (KI), and red laser (660nm) at four different light doses (10J, 20J, 40J and 60J). The best in vitro log reduction of CFU/ml on biofilm grown cells was: MB plus KI with 40J (2.31 log; p<0.001); and NMB without KI with 60J (1.77 log; p<0.001). These conditions were chosen for treating the in vivo model of oral Candida infection. After 5days of treatment the disease was practically eradicated, especially using MB plus KI with 40J. This study suggests that KI can potentiate PDT of fungal infection using MB (but not NMB) and could be a promising new approach for the treatment of oral candidiasis.
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Affiliation(s)
- Fernanda Freire
- Wellman Center for Photomedicine, Massachusetts General Hospital, Boston, MA, USA; Department of Biosciences and Oral Diagnosis, Institute of Science and Technology, Universidade Estadual Paulista (UNESP), São José dos Campos, São Paulo, Brazil
| | - Cleber Ferraresi
- Wellman Center for Photomedicine, Massachusetts General Hospital, Boston, MA, USA
| | - Antonio Olavo C Jorge
- Department of Biosciences and Oral Diagnosis, Institute of Science and Technology, Universidade Estadual Paulista (UNESP), São José dos Campos, São Paulo, Brazil
| | - Michael R Hamblin
- Wellman Center for Photomedicine, Massachusetts General Hospital, Boston, MA, USA; Department of Dermatology, Harvard Medical School, Boston, MA, USA; Harvard-MIT Division of Health Sciences and Technology, Cambridge, MA, USA.
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46
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Sanguinetti M, Posteraro B, Lass-Flörl C. Antifungal drug resistance among Candida species: mechanisms and clinical impact. Mycoses 2016; 58 Suppl 2:2-13. [PMID: 26033251 DOI: 10.1111/myc.12330] [Citation(s) in RCA: 254] [Impact Index Per Article: 31.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2015] [Accepted: 03/23/2015] [Indexed: 11/29/2022]
Abstract
The epidemiology of Candida infections has changed in recent years. Although Candida albicans is still the main cause of invasive candidiasis in most clinical settings, a substantial proportion of patients is now infected with non-albicans Candida species. The various Candida species vary in their susceptibility to the most commonly used antifungal agents, and the intrinsic resistance to antifungal therapy seen in some species, along with the development of acquired resistance during treatment in others, is becoming a major problem in the management of Candida infection. A better understanding of the mechanisms and clinical impact of antifungal drug resistance is essential for the efficient treatment of patients with Candida infection and for improving treatment outcomes. Herein, we report resistance to the azoles and echinocandins among Candida species.
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Affiliation(s)
| | - Brunella Posteraro
- Institute of Public Health, Section of Hygiene, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Cornelia Lass-Flörl
- Division of Hygiene and Medical Microbiology, Innsbruck Medical University, Innsbruck, Austria
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Zupančič J, Novak Babič M, Zalar P, Gunde-Cimerman N. The Black Yeast Exophiala dermatitidis and Other Selected Opportunistic Human Fungal Pathogens Spread from Dishwashers to Kitchens. PLoS One 2016; 11:e0148166. [PMID: 26867131 PMCID: PMC4750988 DOI: 10.1371/journal.pone.0148166] [Citation(s) in RCA: 72] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2015] [Accepted: 01/13/2016] [Indexed: 12/19/2022] Open
Abstract
We investigated the diversity and distribution of fungi in nine different sites inside 30 residential dishwashers. In total, 503 fungal strains were isolated, which belong to 10 genera and 84 species. Irrespective of the sampled site, 83% of the dishwashers were positive for fungi. The most frequent opportunistic pathogenic species were Exophiala dermatitidis, Candida parapsilosis sensu stricto, Exophiala phaeomuriformis, Fusarium dimerum, and the Saprochaete/Magnusiomyces clade. The black yeast E. dermatitidis was detected in 47% of the dishwashers, primarily at the dishwasher rubber seals, at up to 106 CFU/cm2; the other fungi detected were in the range of 102 to 105 CFU/cm2. The other most heavily contaminated dishwasher sites were side nozzles, doors and drains. Only F. dimerum was isolated from washed dishes, while dishwasher waste water contained E. dermatitidis, Exophiala oligosperma and Sarocladium killiense. Plumbing systems supplying water to household appliances represent the most probable route for contamination of dishwashers, as the fungi that represented the core dishwasher mycobiota were also detected in the tap water. Hot aerosols from dishwashers contained the human opportunistic yeast C. parapsilosis, Rhodotorula mucilaginosa and E. dermatitidis (as well as common air-borne genera such as Aspergillus, Penicillium, Trichoderma and Cladosporium). Comparison of fungal contamination of kitchens without and with dishwashers revealed that virtually all were contaminated with fungi. In both cases, the most contaminated sites were the kitchen drain and the dish drying rack. The most important difference was higher prevalence of black yeasts (E. dermatitidis in particular) in kitchens with dishwashers. In kitchens without dishwashers, C. parapsilosis strongly prevailed with negligible occurrence of E. dermatitidis. F. dimerum was isolated only from kitchens with dishwashers, while Saprochaete/Magnusiomyces isolates were only found within dishwashers. We conclude that dishwashers represent a reservoir of enriched opportunistic pathogenic species that can spread from the dishwasher into the indoor biome.
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Affiliation(s)
- Jerneja Zupančič
- Department of Biology, Biotechnical Faculty, University of Ljubljana, Ljubljana, Slovenia
| | - Monika Novak Babič
- Department of Biology, Biotechnical Faculty, University of Ljubljana, Ljubljana, Slovenia
| | - Polona Zalar
- Department of Biology, Biotechnical Faculty, University of Ljubljana, Ljubljana, Slovenia
| | - Nina Gunde-Cimerman
- Department of Biology, Biotechnical Faculty, University of Ljubljana, Ljubljana, Slovenia
- Centre of Excellence for Integrated Approaches in Chemistry and Biology of Proteins (CIPKeBiP), Ljubljana, Slovenia
- * E-mail:
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48
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Gonçalves SS, Souza ACR, Chowdhary A, Meis JF, Colombo AL. Epidemiology and molecular mechanisms of antifungal resistance in CandidaandAspergillus. Mycoses 2016; 59:198-219. [DOI: 10.1111/myc.12469] [Citation(s) in RCA: 112] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2015] [Revised: 12/14/2015] [Accepted: 12/18/2015] [Indexed: 12/15/2022]
Affiliation(s)
- Sarah Santos Gonçalves
- Laboratório Especial de Micologia, Disciplina de Infectologia, Escola Paulista de Medicina; Universidade Federal de São Paulo; São Paulo SP Brazil
| | - Ana Carolina Remondi Souza
- Laboratório Especial de Micologia, Disciplina de Infectologia, Escola Paulista de Medicina; Universidade Federal de São Paulo; São Paulo SP Brazil
| | - Anuradha Chowdhary
- Department of Medical Mycology; Vallabhbhai Patel Chest Institute; University of Delhi; Delhi India
| | - Jacques F. Meis
- Department of Medical Microbiology and Infectious Diseases; Canisius Wilhelmina Hospital; Nijmegen the Netherlands
- Department of Medical Microbiology; Radboud University Medical Centre; Nijmegen the Netherlands
| | - Arnaldo Lopes Colombo
- Laboratório Especial de Micologia, Disciplina de Infectologia, Escola Paulista de Medicina; Universidade Federal de São Paulo; São Paulo SP Brazil
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Teoh F, Pavelka N. How Chemotherapy Increases the Risk of Systemic Candidiasis in Cancer Patients: Current Paradigm and Future Directions. Pathogens 2016; 5:pathogens5010006. [PMID: 26784236 PMCID: PMC4810127 DOI: 10.3390/pathogens5010006] [Citation(s) in RCA: 51] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2015] [Revised: 01/08/2016] [Accepted: 01/11/2016] [Indexed: 02/07/2023] Open
Abstract
Candida albicans is a fungal commensal and a major colonizer of the human skin, as well as of the gastrointestinal and genitourinary tracts. It is also one of the leading causes of opportunistic microbial infections in cancer patients, often presenting in a life-threatening, systemic form. Increased susceptibility to such infections in cancer patients is attributed primarily to chemotherapy-induced depression of innate immune cells and weakened epithelial barriers, which are the body’s first-line defenses against fungal infections. Moreover, classical chemotherapeutic agents also have a detrimental effect on components of the adaptive immune system, which further play important roles in the antifungal response. In this review, we discuss the current paradigm regarding the mechanisms behind the increased risk of systemic candidiasis in cancer patients. We also highlight some recent findings, which suggest that chemotherapy may have more extensive effects beyond the human host, in particular towards C. albicans itself and the bacterial microbiota. The extent to which these additional effects contribute towards the development of candidiasis in chemotherapy-treated patients remains to be investigated.
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Affiliation(s)
- Flora Teoh
- Singapore Immunology Network, Agency for Science, Technology and Research (A*STAR), 8A Biomedical Grove, Immunos Building, Singapore 138648, Singapore.
- School of Biological Sciences, Nanyang Technological University, 60 Nanyang Drive, Singapore 637551, Singapore.
| | - Norman Pavelka
- Singapore Immunology Network, Agency for Science, Technology and Research (A*STAR), 8A Biomedical Grove, Immunos Building, Singapore 138648, Singapore.
- School of Biological Sciences, Nanyang Technological University, 60 Nanyang Drive, Singapore 637551, Singapore.
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Leroy O, Bailly S, Gangneux JP, Mira JP, Devos P, Dupont H, Montravers P, Perrigault PF, Constantin JM, Guillemot D, Azoulay E, Lortholary O, Bensoussan C, Timsit JF. Systemic antifungal therapy for proven or suspected invasive candidiasis: the AmarCAND 2 study. Ann Intensive Care 2016; 6:2. [PMID: 26743881 PMCID: PMC4705061 DOI: 10.1186/s13613-015-0103-7] [Citation(s) in RCA: 61] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2015] [Accepted: 12/13/2015] [Indexed: 01/09/2023] Open
Abstract
Background In the context of recent guidelines on invasive candidiasis (IC), how French intensive care units (ICUs) are managing IC? Methods This is a prospective observational multicenter cohort study. During 1 year (2012–2013), 87 French ICUs enrolled consecutive patients with suspected or proven IC (SIC or PIC) and receiving systemic antifungal therapy (SAT). Data were collected up to 28 days after inclusion. Results We studied 835 patients, 291 with PIC and 544 with SIC. At SAT initiation, patients with SIC were significantly more severe (SAPS II 50.1 ± 18.7 vs. 46.2 ± 18.0). Severe sepsis or septic shock prompted to initiate empiric SAT in 70 % of SIC. Within 4 days in median, the initial SAT was modified in 49 % of patients with PIC vs. 33 % patients with SIC. Modifications were most often motivated by mycological results, and de-escalation was the most frequent change. Regarding compliance to IC management guidelines, echinocandin was used for 182 (62.5 %) patients with PIC, and 287 (52.7 %) of those with SIC; central venous catheter was removed in 87 (54.3 %) of patients with candidaemia, and 43 of the remaining patients received echinocandin; and de-escalation was undertaken after 5 days of SAT in 142 patients, after 10 days in 13 patients. As 20.6 % of SIC were secondarily documented, 403/835 (48 %) patients had finally a proven IC. Candida albicans was the main pathogen (65.3 %), then Candida glabrata (15.9 %). The 28-day mortality rates were 40.0 % in candidaemia, 25.4 % in cIAI, and 26.7 % in deep-seated candidiasis. In the overall population of patients with proven IC, four independent prognostic factors were identified: immunosuppression (Odds Ratio (OR) = 1.977: 1.03–3.794 95 % confidence interval (CI), p = 0.04), age (OR = 1.035; 1.017–1.053 95 % CI; p < 0.001), SAPS >46 on ICU admission (OR = 2.894; 1.81–4.626 95 % CI; p < 0.001), and surgery just before or during ICU stay (OR = 0.473; 0.29–0.77 95 % CI; p < 0.001). Conclusion When SAT is initiated in French ICUs, the IC is ultimately proven for 48 % of patients. Empiric SAT is initiated in severely ill ICU patients. The initial SAT is often adapted, with de-escalation to fluconazole when possible. Mortality rate remains high. Electronic supplementary material The online version of this article (doi:10.1186/s13613-015-0103-7) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Olivier Leroy
- Medical ICU, Chatilliez Hospital, Tourcoing, France.
| | | | | | | | - Patrick Devos
- Bio Statistics Unit, Lille University Hospital, Lille, France
| | - Hervé Dupont
- Surgical ICU, Amiens University Hospital, Amiens, France
| | - Philippe Montravers
- Anesthesiology and Critical Care Medicine, Bichat-Claude Bernard University Hospital, Paris, France
| | | | - Jean-Michel Constantin
- Perioperative Medicine Department, Clermont-Ferrand University Hospital, Clermont-Ferrand, France
| | - Didier Guillemot
- Unité de Pharmaco-épidémiologie et Maladies Infectieuses, Institut Pasteur, Paris, France
| | - Elie Azoulay
- Medical ICU, Saint-Louis University Hospital, Paris, France
| | - Olivier Lortholary
- Necker Pasteur Center for Infectious Diseases, Necker Enfants-Malades Hospital, Paris, France
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