1
|
Soriano-Martín A, Alonso R, Machado M, Reigadas E, Muñoz P, Bouza E. Candida spp.: the burden of a microorganism in a microbiology department. Microbiol Spectr 2024; 12:e0386023. [PMID: 38980031 PMCID: PMC11302065 DOI: 10.1128/spectrum.03860-23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2023] [Accepted: 06/04/2024] [Indexed: 07/10/2024] Open
Abstract
There is no precise information available on the entire workload of isolating a specific microorganism in a clinical microbiology laboratory, and the costs associated with it have not been specifically estimated. In this descriptive retrospective study conducted at the microbiology department of a general teaching hospital from January 2021 to December 2022, we assessed the workload associated with identifying Candida species in all types of clinical samples and patients. Costs were estimated from data obtained from the hospital's finance department and microbiology laboratory cost records. In 2 years, 1,008,231 samples were processed at our microbiology department, of which 8,775 had one or more Candida spp. isolates (9,683 total isolates). Overall, 5,151 samples with Candida spp. were identified from 2,383 inpatients. We isolated Candida spp. from 515.3 samples/100,000 population/year and from 92 samples/1,000 hospital admissions/year. By sample type, 90.8% were superficial, mainly mucosal. Only 9.1% Candida spp. were isolated from deep, usually sterile, samples, being mostly from ordinarily sterile fluids. Candida albicans was the main species (58.5%) identified, followed by C. parapsilosis complex, C. glabrata, C. tropicalis, and C. krusei. In admitted patients, the incidences of samples with Candida spp. isolates were 302.7 samples/100,000 population/year and 54 samples/1,000 admissions/year. The average cost of isolating and identifying Candida spp. was estimated at 25€ per culture-positive sample. To our knowledge, this is the first attempt to gage the workload and costs of Candida spp. isolation at a hospital microbiology department. These data can help assess the burden and significance of Candida isolation at other institutions and also help design measures for streamlining. IMPORTANCE We believe that this work is of interest because at present, there is no really accurate information available on the total workload involved in isolating a specific microorganism in a clinical microbiology laboratory. The costs related to this have also not been described. We have described the unrestricted workload of Candida spp. in all types of samples for all types of species and patients. We believe that this information would be necessary to collect and share this information as well as to collect it in a standardized way to know the current situation of Candida spp. workload in all clinical microbiology laboratories.
Collapse
Affiliation(s)
- Ana Soriano-Martín
- Clinical Microbiology and Infectious Diseases Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain
- Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain
| | - Roberto Alonso
- Clinical Microbiology and Infectious Diseases Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain
- Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain
- Medicine Department, School of Medicine, Universidad Complutense de Madrid, Madrid, Spain
- CIBER Enfermedades Respiratorias-CIBERES (CB06/06/0058), Madrid, Spain
| | - Marina Machado
- Clinical Microbiology and Infectious Diseases Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain
- Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain
| | - Elena Reigadas
- Clinical Microbiology and Infectious Diseases Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain
- Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain
- Medicine Department, School of Medicine, Universidad Complutense de Madrid, Madrid, Spain
- CIBER Enfermedades Respiratorias-CIBERES (CB06/06/0058), Madrid, Spain
| | - Patricia Muñoz
- Clinical Microbiology and Infectious Diseases Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain
- Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain
- Medicine Department, School of Medicine, Universidad Complutense de Madrid, Madrid, Spain
- CIBER Enfermedades Respiratorias-CIBERES (CB06/06/0058), Madrid, Spain
| | - Emilio Bouza
- Clinical Microbiology and Infectious Diseases Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain
- Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain
- Medicine Department, School of Medicine, Universidad Complutense de Madrid, Madrid, Spain
- CIBER Enfermedades Respiratorias-CIBERES (CB06/06/0058), Madrid, Spain
| |
Collapse
|
2
|
Nascimento T, Inácio J, Guerreiro D, Patrício P, Proença L, Toscano C, Diaz P, Barroso H. Insights into Candida Colonization in Intensive Care Unit Patients: A Prospective Multicenter Study. J Fungi (Basel) 2024; 10:378. [PMID: 38921364 PMCID: PMC11204936 DOI: 10.3390/jof10060378] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2024] [Revised: 05/16/2024] [Accepted: 05/23/2024] [Indexed: 06/27/2024] Open
Abstract
The skin mycobiota plays a significant role in infection risk, pathogen transmission, and personalized medicine approaches in intensive care settings. This prospective multicenter study aimed to enhance our understanding of intensive care units' (ICUs') Candida colonization dynamics, identify modifiable risk factors, and assess their impact on survival risk. Specimens were taken from 675, 203, and 110 patients at the admission (D1), 5th (D5), and 8th (D8) days of ICU stay, respectively. The patient's demographic and clinical data were collected. Candida isolates were identified by conventional culture-based microbiology combined with molecular approaches. Overall, colonization was 184/675 (27.3%), 87/203 (42.8%), and 58/110 (52.7%) on D1, D5, and D8, respectively. Candida colonization dynamics were significantly associated with ICU type (odds ratio (OR) = 2.03, 95% CI 1.22-3.39, p = 0.007), respiratory infection (OR = 1.74, 95% CI 1.17-2.58, p = 0.006), hemodialysis (OR = 2.19, 95% CI 1.17-4.10, p = 0.014), COVID-19 (OR = 0.37, 95% CI 0.14-0.99, p = 0.048), and with a poor 3-month outcome (p = 0.008). Skin Candida spp. colonization can be an early warning tool to generate valuable insights into the epidemiology, risk factors, and survival rates of critically ill patients, and should be considered for epidemiological surveillance.
Collapse
Affiliation(s)
- Teresa Nascimento
- Unidade de Microbiologia Médica, Global Health and Tropical Medicine (GHTM), Instituto de Higiene e Medicina Tropical, Universidade Nova de Lisboa, 1349-008 Lisboa, Portugal
- Egas Moniz Center for Interdisciplinary Research (CiiEM), Egas Moniz School of Health & Science, Caparica, 2829-511 Almada, Portugal; (D.G.); (L.P.); (H.B.)
| | - João Inácio
- School of Applied Sciences, University of Brighton, Brighton BN2 4GJ, UK;
| | - Daniela Guerreiro
- Egas Moniz Center for Interdisciplinary Research (CiiEM), Egas Moniz School of Health & Science, Caparica, 2829-511 Almada, Portugal; (D.G.); (L.P.); (H.B.)
| | | | - Luís Proença
- Egas Moniz Center for Interdisciplinary Research (CiiEM), Egas Moniz School of Health & Science, Caparica, 2829-511 Almada, Portugal; (D.G.); (L.P.); (H.B.)
| | - Cristina Toscano
- Centro Hospitalar Lisboa Ocidental Hospital Egas Moniz, 1349-019 Lisboa, Portugal;
| | - Priscila Diaz
- Hospital Prof. Doutor Fernando da Fonseca, 2720-276 Amadora, Portugal;
| | - Helena Barroso
- Egas Moniz Center for Interdisciplinary Research (CiiEM), Egas Moniz School of Health & Science, Caparica, 2829-511 Almada, Portugal; (D.G.); (L.P.); (H.B.)
| |
Collapse
|
3
|
Çaklovica Küçükkaya I, Orhun G, Çağatay AA, Kalaycı S, Esen F, Şahin F, Ağaçfidan A, Erturan Z. Comparison of Candida colonization in intensive care unit patients with and without COVID-19: First prospective cohort study from Turkey. Med Mycol 2024; 62:myae035. [PMID: 38592959 DOI: 10.1093/mmy/myae035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2024] [Revised: 03/15/2024] [Accepted: 04/08/2024] [Indexed: 04/11/2024] Open
Abstract
Candida species are the primary cause of fungal infections in intensive care units (ICUs). Despite the increasing prevalence of Candida-related infections, monitoring the progression of these infections from colonization in COVID-19 ICU patients lacks sufficient information. This study aims prospectively to compare 62 COVID-19 and 60 non-COVID-19 ICU patients from admission to discharge in terms of colonization development, rates, isolated Candida species, risk factors, and Candida infections during hospitalization. A total of 1464 samples were collected at specific time intervals from various body sites [mouth, skin (axilla), rectal, and urine]. All samples were inoculated onto CHROMagar Candida and CHROMagar Candida Plus media, and isolates identified using MALDI-TOF MS. COVID-19 patients exhibited significantly higher colonization rates in oral, rectal, and urine samples compared to non-COVID-19 patients, (p < 0.05). Among the Candida species, non-albicans Candida was more frequently detected in COVID-19 patients, particularly in oral (75.8%-25%; p < 0.001) and rectal regions (74.19% - 46.66%; p < 0.05). Colonization with mixed Candida species was also more prevalent in the oropharyngeal region (p < 0.05). Mechanical ventilation and corticosteroid use emerged as elevated risk factors among COVID-19 patients (p < 0.05). Despite the colonization prevalence, both COVID-19-positive and negative patients exhibited low incidences of Candida infections, with rates of 9.67% (n = 6/62) and 6.67% (n = 3/60), respectively. Consequently, although Candida colonization rates were higher in COVID-19 ICU patients, there was no significant difference in Candida infection development compared to the non-COVID-19 group. However, the elevated rate of non-albicans Candida isolates highlights potential future infections, particularly given their intrinsic resistance in prophylactic or empirical treatments if needed. Additionally, the high rate of mixed colonization emphasizes the importance of using chromogenic media for routine evaluation.
Collapse
Affiliation(s)
- Ilvana Çaklovica Küçükkaya
- Istanbul University Istanbul Faculty of Medicine, Department of Medical Microbiology, 34093, Istanbul, Turkey
| | - Günseli Orhun
- Istanbul University Istanbul Faculty of Medicine, Department of Anesthesiology and Reanimation, 34093, Istanbul, Turkey
| | - Arif Atahan Çağatay
- Istanbul University Istanbul Faculty of Medicine, Department of Infectious Diseases and Clinical Microbiology, 34093, Istanbul, Turkey
| | - Sadık Kalaycı
- Yeditepe University Faculty of Engineering, Department of Genetics and Bioengineering, 34755, Istanbul, Turkey
| | - Figen Esen
- Istanbul University Istanbul Faculty of Medicine, Department of Anesthesiology and Reanimation, 34093, Istanbul, Turkey
| | - Fikrettin Şahin
- Istanbul University Istanbul Faculty of Medicine, Department of Infectious Diseases and Clinical Microbiology, 34093, Istanbul, Turkey
| | - Ali Ağaçfidan
- Istanbul University Istanbul Faculty of Medicine, Department of Medical Microbiology, 34093, Istanbul, Turkey
| | - Zayre Erturan
- Istanbul University Istanbul Faculty of Medicine, Department of Medical Microbiology, 34093, Istanbul, Turkey
| |
Collapse
|
4
|
Tokano M, Tarumoto N, Sakai J, Imai K, Koizumi S, Karaushi H, Hatanaka T, Kishi E, Seki M, Mitsutake K, Maesaki S. Multicenter Study of the Effectiveness of Antifungal Stewardship Team Intervention for Candidemia in Japan in 2008-2021. Infect Dis Rep 2024; 16:356-366. [PMID: 38667753 PMCID: PMC11050113 DOI: 10.3390/idr16020027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2024] [Revised: 04/10/2024] [Accepted: 04/12/2024] [Indexed: 04/28/2024] Open
Abstract
Candidemia, linked to high mortality rates, requires prompt antifungal therapy for better outcomes. Treatment is structured as an action bundle, which is beneficial when followed closely. However, the Japanese action bundle lacks detailed guidance on severe complications like endocarditis or ocular issues. To address this, we adjusted the action bundle and assessed outcomes with and without AFT intervention. We strengthened protocols for blood cultures and organ assessments, and the AFT contacted the primary physician when yeast-like fungi were detected in the patient's blood culture bottles. Analyzing 204 candidemia cases from 2008-2021, we observed increased adherence and reduced mortality post-AFT intervention. Ophthalmology consultations rose significantly, but many patients had only one visit, suggesting inadequate follow-up. If endophthalmitis is diagnosed, a change in the treatment approach may be necessary. There is a possibility that abnormal ocular findings will be detected during subsequent visits, which highlights the need for improvement in ophthalmology follow-up rates as a future challenge for our AFT activities.
Collapse
Affiliation(s)
- Mieko Tokano
- Department of Infectious Disease and Infection Control, Saitama Medical University, 38 Morohongo, Moroyama, Saitama 350-0495, Japan; (M.T.)
- Departments of Allergy and Immunology, Faculty of Medicine, Saitama Medical University, 38 Morohongo, Moroyama, Saitama 350-0495, Japan
| | - Norihito Tarumoto
- Department of Infectious Disease and Infection Control, Saitama Medical University, 38 Morohongo, Moroyama, Saitama 350-0495, Japan; (M.T.)
- Department of Infection Control, Saitama Medical University Hospital, 38 Morohongo, Moroyama, Saitama 350-0495, Japan
| | - Jun Sakai
- Department of Infectious Disease and Infection Control, Saitama Medical University, 38 Morohongo, Moroyama, Saitama 350-0495, Japan; (M.T.)
| | - Kazuo Imai
- Department of Infectious Disease and Infection Control, Saitama Medical University, 38 Morohongo, Moroyama, Saitama 350-0495, Japan; (M.T.)
| | - Sakaru Koizumi
- Department of Infection Control, Saitama Medical University Hospital, 38 Morohongo, Moroyama, Saitama 350-0495, Japan
| | - Haruka Karaushi
- Division of Pharmacy, Saitama Medical University International Medical Center, Hidaka, Saitama 350-1298, Japan
- Department of Infectious Diseases and Infection Control, Saitama Medical University International Medical Center, Hidaka, Saitama 350-1298, Japan
| | - Tamotsu Hatanaka
- Department of Infection Control, Saitama Medical University Hospital, 38 Morohongo, Moroyama, Saitama 350-0495, Japan
| | - Etsuko Kishi
- Department of Infection Control, Saitama Medical University Hospital, 38 Morohongo, Moroyama, Saitama 350-0495, Japan
| | - Masafumi Seki
- Department of Infectious Diseases and Infection Control, Saitama Medical University International Medical Center, Hidaka, Saitama 350-1298, Japan
| | - Koutaro Mitsutake
- Department of Infectious Diseases and Infection Control, Saitama Medical University International Medical Center, Hidaka, Saitama 350-1298, Japan
| | - Shigefumi Maesaki
- Department of Infectious Disease and Infection Control, Saitama Medical University, 38 Morohongo, Moroyama, Saitama 350-0495, Japan; (M.T.)
| |
Collapse
|
5
|
Lass-Flörl C, Kanj SS, Govender NP, Thompson GR, Ostrosky-Zeichner L, Govrins MA. Invasive candidiasis. Nat Rev Dis Primers 2024; 10:20. [PMID: 38514673 DOI: 10.1038/s41572-024-00503-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/15/2024] [Indexed: 03/23/2024]
Abstract
Invasive candidiasis is an important fungal disease caused by Candida albicans and, increasingly, non-albicans Candida pathogens. Invasive Candida infections originate most frequently from endogenous human reservoirs and are triggered by impaired host defences. Signs and symptoms of invasive candidiasis are non-specific; candidaemia is the most diagnosed manifestation, with disseminated candidiasis affecting single or multiple organs. Diagnosis poses many challenges, and conventional culture techniques are frequently supplemented by non-culture-based assays. The attributable mortality from candidaemia and disseminated infections is ~30%. Fluconazole resistance is a concern for Nakaseomyces glabratus, Candida parapsilosis, and Candida auris and less so in Candida tropicalis infection; acquired echinocandin resistance remains uncommon. The epidemiology of invasive candidiasis varies in different geographical areas and within various patient populations. Risk factors include intensive care unit stay, central venous catheter use, broad-spectrum antibiotics use, abdominal surgery and immune suppression. Early antifungal treatment and central venous catheter removal form the cornerstones to decrease mortality. The landscape of novel therapeutics is growing; however, the application of new drugs requires careful selection of eligible patients as the spectrum of activity is limited to a few fungal species. Unanswered questions and knowledge gaps define future research priorities and a personalized approach to diagnosis and treatment of invasive candidiasis is of paramount importance.
Collapse
Affiliation(s)
- Cornelia Lass-Flörl
- Institute of Hygiene and Medical Microbiology, ECMM Excellence Centres of Medical Mycology, Medical University of Innsbruck, Innsbruck, Austria.
| | - Souha S Kanj
- Infectious Diseases Division, and Center for Infectious Diseases Research, American University of Beirut Medical Center, Beirut, Lebanon
| | - Nelesh P Govender
- Faculty of Health Sciences, University of the Witwatersrand and National Institute for Communicable Diseases, Johannesburg, South Africa
- MRC Centre for Medical Mycology, University of Exeter, Exeter, UK
| | - George R Thompson
- UC Davis Health Medical Center, Division of Infectious Diseases, Sacramento, CA, USA
| | | | - Miriam Alisa Govrins
- Institute of Hygiene and Medical Microbiology, ECMM Excellence Centres of Medical Mycology, Medical University of Innsbruck, Innsbruck, Austria
| |
Collapse
|
6
|
Koulenti D, Karvouniaris M, Paramythiotou E, Koliakos N, Markou N, Paranos P, Meletiadis J, Blot S. Severe Candida infections in critically ill patients with COVID-19. JOURNAL OF INTENSIVE MEDICINE 2023; 3:291-297. [PMID: 38028641 PMCID: PMC10658040 DOI: 10.1016/j.jointm.2023.07.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Revised: 06/20/2023] [Accepted: 07/09/2023] [Indexed: 12/01/2023]
Abstract
The frequency of co-infections with bacterial or fungal pathogens has constantly increased among critically ill patients with coronavirus disease 2019 (COVID-19) during the pandemic. Candidemia was the most frequently reported invasive fungal co-infection. The onset of candidemia in COVID-19 patients was often delayed compared to non-COVID-19 patients. Additionally, Candida invasive infections in COVID-19 patients were more often linked to invasive procedures (e.g., invasive mechanical ventilation or renal replacement therapy) during the intensive care stay and the severity of illness rather than more "classic" risk factors present in patients without COVID-19 (e.g., underlying diseases and prior hospitalization). Moreover, apart from the increased incidence of candidemia during the pandemic, a worrying rise in fluconazole-resistant strains was reported, including a rise in the multidrug-resistant Candida auris. Regarding outcomes, the development of invasive Candida co-infection had a negative impact, increasing morbidity and mortality compared to non-co-infected COVID-19 patients. In this narrative review, we present and critically discuss information on the diagnosis and management of invasive fungal infections caused by Candida spp. in critically ill COVID-19 patients.
Collapse
Affiliation(s)
- Despoina Koulenti
- Second Critical Care Department, Attikon University Hospital, Athens, Greece
- UQ Centre for Clinical Research, Faculty of Medicine, The University of Queensland, Brisbane, Australia
| | | | | | - Nikolaos Koliakos
- Second Critical Care Department, Attikon University Hospital, Athens, Greece
| | - Nikolaos Markou
- ICU of Latseio Burns Centre, General Hospital of Elefsis ‘Thriasio’, Athens, Greece
| | - Paschalis Paranos
- Clinical Microbiology Laboratory, Medical School, National and Kapodistrian University of Athens, Attikon University Hospital, Athens, Greece
| | - Joseph Meletiadis
- Clinical Microbiology Laboratory, Medical School, National and Kapodistrian University of Athens, Attikon University Hospital, Athens, Greece
| | - Stijn Blot
- UQ Centre for Clinical Research, Faculty of Medicine, The University of Queensland, Brisbane, Australia
- Department of Internal Medicine and Pediatrics, Ghent University, Ghent, Belgium
| |
Collapse
|
7
|
Maseda E, Martín-Loeches I, Zaragoza R, Pemán J, Fortún J, Grau S, Aguilar G, Varela M, Borges M, Giménez MJ, Rodríguez A. Critical appraisal beyond clinical guidelines for intraabdominal candidiasis. Crit Care 2023; 27:382. [PMID: 37789338 PMCID: PMC10546659 DOI: 10.1186/s13054-023-04673-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Accepted: 09/28/2023] [Indexed: 10/05/2023] Open
Abstract
BACKGROUND Regardless of the available antifungals, intraabdominal candidiasis (IAC) mortality continues to be high and represents a challenge for clinicians. MAIN BODY This opinion paper discusses alternative antifungal options for treating IAC. This clinical entity should be addressed separately from candidemia due to the peculiarity of the required penetration of antifungals into the peritoneal cavity. Intraabdominal concentrations may be further restricted in critically ill patients where pathophysiological facts alter normal drug distribution. Echinocandins are recommended as first-line treatment in guidelines for invasive candidiasis. However, considering published data, our pharmacodynamic analysis suggests the required increase of doses, postulated by some authors, to attain adequate pharmacokinetic (PK) levels in peritoneal fluid. Given the limited evidence in the literature on PK/PD-based treatments of IAC, an algorithm is proposed to guide antifungal treatment. Liposomal amphotericin B is advocated as first-line therapy in patients with sepsis/septic shock presenting candidemia or endophthalmitis, or with prior exposure to echinocandins and/or fluconazole, or with infections by Candida glabrata. Other situations and alternatives, such as new compounds or combination therapy, are also analysed. CONCLUSION There is a critical need for more robust clinical trials, studies examining patient heterogeneity and surveillance of antifungal resistance to enhance patient care and optimise treatment outcomes. Such evidence will help refine the existing guidelines and contribute to a more personalised and effective approach to treating this serious medical condition. Meanwhile, it is suggested to broaden the consideration of other options, such as liposomal amphotericin B, as first-line treatment until the results of the fungogram are available and antifungal stewardship could be implemented to prevent the development of resistance.
Collapse
Affiliation(s)
- Emilio Maseda
- Service of Anesthesia, Hospital Quirónsalud Valle del Henares, Av. de La Constitución, 249, 28850, Torrejón de Ardoz, Madrid, Spain.
| | - Ignacio Martín-Loeches
- Department of Intensive Care Medicine, Multidisciplinary Intensive Care Research Organization (MICRO), St James's Hospital, James Street, Leinster, Dublin 8, D08 NHY1, Ireland.
- Pulmonary Intensive Care Unit, Respiratory Institute, Hospital Clinic of Barcelona, IDIBAPS (Institut d'Investigacions Biomèdiques August Pi I Sunyer), University of Barcelona, CIBERes, Barcelona, Spain.
| | | | - Javier Pemán
- Microbiology Department, Hospital Universitari I Politecnic La Fe, Valencia, Spain
- Fundación Micellium, La Eliana, Valencia, Spain
| | - Jesús Fortún
- Infectious Diseases Service, Hospital Universitario Ramón y Cajal, Madrid, Spain
| | - Santiago Grau
- Service of Pharmacy, Hospital del Mar, Barcelona, Spain
| | - Gerardo Aguilar
- Service of Anesthesia, Hospital Clínico Universitario de Valencia, Valencia, Spain
| | - Marina Varela
- Service of Anesthesia, Área Sanitaria de Pontevedra, Pontevedra, Spain
| | - Marcio Borges
- ICU, Hospital Universitario Son Llátzer, Palma, Spain
| | - María-José Giménez
- Faculty of Sports Sciences and Physiotherapy, Universidad Europea de Madrid, Madrid, Spain
| | | |
Collapse
|
8
|
Wijaya M, Halleyantoro R, Kalumpiu JF. Biofilm: The invisible culprit in catheter-induced candidemia. AIMS Microbiol 2023; 9:467-485. [PMID: 37649801 PMCID: PMC10462453 DOI: 10.3934/microbiol.2023025] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Revised: 04/20/2023] [Accepted: 04/24/2023] [Indexed: 09/01/2023] Open
Abstract
Candidemia is the most common form of invasive fungal infection associated with several risk factors, and one of them is the use of medical devices, to which microbial biofilms can attach. Candidemia related to the use of peripheral intravascular and central venous catheters (CVC) is referred to as Candida catheter-related bloodstream infection, with more than 90% being related to CVC usage. The infection is associated with a higher morbidity and mortality rate than nosocomial bacterial infections. Candida spp. can protect themselves from the host immune system and antifungal drugs because of the biofilm structure, which is potentiated by the extracellular matrix (ECM). Candida albicans and Candida parapsilosis are the most pathogenic species often found to form biofilms associated with catheter usage. Biofilm formation of C. albicans includes four mechanisms: attachment, morphogenesis, maturation and dispersion. The biofilms formed between C. albicans and non-albicans spp. differ in ECM structure and composition and are associated with the persistence of colonization to infection for various catheter materials and antifungal resistance. Efforts to combat Candida spp. biofilm formation on catheters are still challenging because not all patients, especially those who are critically ill, can be recommended for catheter removal; also to be considered are the characteristics of the biofilm itself, which readily colonizes the permanent medical devices used. The limited choice and increasing systemic antifungal resistance also make treating it more difficult. Hence, alternative strategies have been developed to manage Candida biofilm. Current options for prevention or therapy in combination with systemic antifungal medications include lock therapy, catheter coating, natural peptide products and photodynamic inactivation.
Collapse
Affiliation(s)
- Meiliyana Wijaya
- Department of Parasitology, School of Medicine and Health Sciences, Atma Jaya Catholic University of Indonesia, Jakarta, Indonesia
| | - Ryan Halleyantoro
- Department of Parasitology, Faculty of Medicine, Universitas Diponegoro, Semarang, Indonesia
| | - Jane Florida Kalumpiu
- Department of Parasitology, Faculty of Medicine, Pelita Harapan University, Banten, Indonesia
| |
Collapse
|
9
|
Anderson FM, Visser ND, Amses KR, Hodgins-Davis A, Weber AM, Metzner KM, McFadden MJ, Mills RE, O’Meara MJ, James TY, O’Meara TR. Candida albicans selection for human commensalism results in substantial within-host diversity without decreasing fitness for invasive disease. PLoS Biol 2023; 21:e3001822. [PMID: 37205709 PMCID: PMC10234564 DOI: 10.1371/journal.pbio.3001822] [Citation(s) in RCA: 14] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Revised: 06/01/2023] [Accepted: 04/12/2023] [Indexed: 05/21/2023] Open
Abstract
Candida albicans is a frequent colonizer of human mucosal surfaces as well as an opportunistic pathogen. C. albicans is remarkably versatile in its ability to colonize diverse host sites with differences in oxygen and nutrient availability, pH, immune responses, and resident microbes, among other cues. It is unclear how the genetic background of a commensal colonizing population can influence the shift to pathogenicity. Therefore, we examined 910 commensal isolates from 35 healthy donors to identify host niche-specific adaptations. We demonstrate that healthy people are reservoirs for genotypically and phenotypically diverse C. albicans strains. Using limited diversity exploitation, we identified a single nucleotide change in the uncharacterized ZMS1 transcription factor that was sufficient to drive hyper invasion into agar. We found that SC5314 was significantly different from the majority of both commensal and bloodstream isolates in its ability to induce host cell death. However, our commensal strains retained the capacity to cause disease in the Galleria model of systemic infection, including outcompeting the SC5314 reference strain during systemic competition assays. This study provides a global view of commensal strain variation and within-host strain diversity of C. albicans and suggests that selection for commensalism in humans does not result in a fitness cost for invasive disease.
Collapse
Affiliation(s)
- Faith M. Anderson
- Department of Microbiology and Immunology, University of Michigan Medical School, Ann Arbor, Michigan, United States of America
| | - Noelle D. Visser
- Department of Microbiology and Immunology, University of Michigan Medical School, Ann Arbor, Michigan, United States of America
| | - Kevin R. Amses
- Department of Ecology and Evolution, University of Michigan, Ann Arbor, Michigan, United States of America
| | - Andrea Hodgins-Davis
- Department of Microbiology and Immunology, University of Michigan Medical School, Ann Arbor, Michigan, United States of America
| | - Alexandra M. Weber
- Department of Computational Medicine and Bioinformatics, University of Michigan Medical School, Ann Arbor, Michigan, United States of America
| | - Katura M. Metzner
- Department of Microbiology and Immunology, University of Michigan Medical School, Ann Arbor, Michigan, United States of America
| | - Michael J. McFadden
- Department of Microbiology and Immunology, University of Michigan Medical School, Ann Arbor, Michigan, United States of America
| | - Ryan E. Mills
- Department of Computational Medicine and Bioinformatics, University of Michigan Medical School, Ann Arbor, Michigan, United States of America
- Department of Human Genetics, University of Michigan Medical School, Ann Arbor, Michigan, United States of America
| | - Matthew J. O’Meara
- Department of Computational Medicine and Bioinformatics, University of Michigan Medical School, Ann Arbor, Michigan, United States of America
| | - Timothy Y. James
- Department of Ecology and Evolution, University of Michigan, Ann Arbor, Michigan, United States of America
| | - Teresa R. O’Meara
- Department of Microbiology and Immunology, University of Michigan Medical School, Ann Arbor, Michigan, United States of America
| |
Collapse
|
10
|
Negm EM, Mohamed MS, Rabie RA, Fouad WS, Beniamen A, Mosallem A, Tawfik AE, Salama HM. Fungal infection profile in critically ill COVID-19 patients: a prospective study at a large teaching hospital in a middle-income country. BMC Infect Dis 2023; 23:246. [PMID: 37072718 PMCID: PMC10111294 DOI: 10.1186/s12879-023-08226-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2023] [Accepted: 04/05/2023] [Indexed: 04/20/2023] Open
Abstract
BACKGROUND Critically ill COVID-19 patients are highly susceptible to opportunistic fungal infection due to many factors, including virus-induced immune dysregulation, host-related comorbidities, overuse and misuse of antibiotics or corticosteroids, immune modulator drugs, and the emergencies caused by the pandemic. This study aimed to assess the incidence, identify the potential risk factors, and examine the impact of fungal coinfection on the outcomes of COVID-19 patients admitted to the intensive care unit (ICU). METHODS A prospective cohort study including 253 critically ill COVID-19 patients aged 18 years or older admitted to the isolation ICU of Zagazig University Hospitals over a 4-month period from May 2021 to August 2021 was conducted. The detection of a fungal infection was carried out. RESULTS Eighty-three (83) patients (32.8%) were diagnosed with a fungal coinfection. Candida was the most frequently isolated fungus in 61 (24.1%) of 253 critically ill COVID-19 patients, followed by molds, which included Aspergillus 11 (4.3%) and mucormycosis in five patients (1.97%), and six patients (2.4%) diagnosed with other rare fungi. Poor diabetic control, prolonged or high-dose steroids, and multiple comorbidities were all possible risk factors for fungal coinfection [OR (95% CI) = 10.21 (3.43-30.39), 14.1 (5.67-35.10), 14.57 (5.83-33.78), and 4.57 (1.83-14.88), respectively]. CONCLUSION Fungal coinfection is a common complication of critically ill COVID-19 patients admitted to the ICU. Candidiasis, aspergillosis, and mucormycosis are the most common COVID-19-associated fungal infections and have a great impact on mortality rates.
Collapse
Affiliation(s)
- Essamedin M Negm
- Anaesthesia, Intensive Care, and Pain Management Department, Faculty of Medicine, Zagazig University Hospital, Zagazig, Egypt.
| | - Mohamed Sorour Mohamed
- Internal Medicine Department, Faculty of Medicine, Zagazig University Hospital, Zagazig, Egypt
| | - Rehab A Rabie
- Medical Microbiology and Immunology Department, Faculty of Medicine, Zagazig University Hospital, Zagazig, Egypt
| | - Walaa S Fouad
- Family Medicine Department, Faculty of Medicine, Zagazig University Hospital, Zagazig, Egypt
| | - Ahmed Beniamen
- Anaesthesia, Intensive Care, and Pain Management Department, Faculty of Medicine, Zagazig University Hospital, Zagazig, Egypt
| | - Ahmed Mosallem
- Anaesthesia, Intensive Care, and Pain Management Department, Faculty of Medicine, Zagazig University Hospital, Zagazig, Egypt
| | | | - Hussein M Salama
- Internal Medicine Department, Faculty of Medicine, Zagazig University Hospital, Zagazig, Egypt
| |
Collapse
|
11
|
Antifungal Activity of Spent Coffee Ground Extracts. Microorganisms 2023; 11:microorganisms11020242. [PMID: 36838208 PMCID: PMC9963196 DOI: 10.3390/microorganisms11020242] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Revised: 01/14/2023] [Accepted: 01/14/2023] [Indexed: 01/21/2023] Open
Abstract
Coffee is one of the most popular and consumed products in the world, generating tons of solid waste known as spent coffee grounds (SCG), containing several bioactive compounds. Here, the antifungal activity of ethanolic SCG extract from caffeinated and decaffeinated coffee capsules was evaluated against yeasts and filamentous fungi. These extracts had antifungal activity against Candida krusei, Candida parapsilosis, Trichophyton mentagrophytes, and Trichophyton rubrum, all skin fungal agents. Moreover, SCG had fungicidal activity against T. mentagrophytes and T. rubrum. To understand the underlying mechanisms of the antifungal activity, fungal cell membrane and cell wall components were quantified. SCG caused a significant reduction of the ergosterol, chitin, and β-(1,3)-glucan content of C. parapsilosis, revealing the synthesis of this membrane component and cell wall components as possible targets of these extracts. These extracts were cytotoxic for the tumoral cell lines tested but not for the non-tumoral PLP2 cell line. The analysis of the phenolic compounds of these extracts revealed the presence of caffeoylquinic acid, feruloylquinic acid, and caffeoylshikimic acid derivatives. Overall, this confirmed the antifungal activity of spent coffee grounds, presenting a potential increase in the sustainability of the life cycle of coffee grounds, as a source for the development of novel antifungal formulations, especially for skin or mucosal fungal infections.
Collapse
|
12
|
Sharma M, Chakrabarti A. Candidiasis and Other Emerging Yeasts. CURRENT FUNGAL INFECTION REPORTS 2023; 17:15-24. [PMID: 36741271 PMCID: PMC9886541 DOI: 10.1007/s12281-023-00455-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/11/2023] [Indexed: 02/01/2023]
Abstract
Purpose of Review The review presents a comprehensive and updated information on the contemporary status of invasive candidiasis (IC), other emerging yeast infections, and the challenges they present in terms of at-risk population, specific virulence attributes, and antifungal susceptibility profile. Recent Findings With the advancement in medical field, there has been parallel expansion of vulnerable populations over the past two decades. This had led to the emergence of a variety of rare yeasts in healthcare settings, both Candida and non-Candida yeast causing sporadic cases and outbreaks. The advancements in diagnostic modalities have enabled accurate identification of rare Candida species and non-Candida yeast (NCY) of clinical importance. Their distribution and susceptibility profile vary across different geographical regions, thus necessitating surveillance of local epidemiology of these infections to improve patient outcomes. Summary The challenges in management of IC have been complicated with emergence of newer species and resistance traits. C. tropicalis has already overtaken C. albicans in many Asian ICUs, while C. auris is rising rapidly worldwide. Recent genomic research has reclassified several yeasts into newer genera, and an updated version of MALDI-TOF MS or ITS sequencing is necessary for accurate identification. Having a knowledge of the differences in predisposing factors, epidemiology and susceptibility profile of already established pathogenic yeasts, as well as new emerging yeasts, are imperative for better patient management.
Collapse
Affiliation(s)
- Megha Sharma
- Department of Microbiology, All India Institute of Medical Sciences, Bilaspur, India
| | | |
Collapse
|
13
|
Xia J, Huang W, Lu F, Li M, Wang B. Comparative Analysis of Epidemiological and Clinical Characteristics Between Invasive Candida Infection versus Colonization in Critically Ill Patients in a Tertiary Hospital in Anhui, China. Infect Drug Resist 2022; 15:3905-3918. [PMID: 35909934 PMCID: PMC9329706 DOI: 10.2147/idr.s368792] [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: 03/31/2022] [Accepted: 07/12/2022] [Indexed: 11/26/2022] Open
Abstract
Objective Invasive infections due to Candida spp. have unique epidemiology, strain distribution, antimicrobial susceptibility, and clinical features. This study aimed to compare and evaluate these characteristic variables between invasive Candida infection and colonization of critically ill patients in local China to potentially improve differential diagnosis and therapy. Methods A total of 193 critically ill patients were recruited and followed up for the study, and 133 Candida isolates were obtained from invasive Candida-infected or -colonized subjects. The strains were identified to species level through matrix-assisted laser desorption/ionization–time-of-flight mass spectrometry, assisted by DNA sequencing. Candida susceptibility to common antifungals, including azoles, was determined by microbroth ATB Fungus 3 methodology. Azole resistance–related gene sequencing and homologous 3D-structure modeling were employed. Patient demographics and clinical risk factors were documented and comparatively analyzed from the hospital information-management system. Results Non–C. albicans Candida (56%) principally caused invasive Candida infections, while C. albicans (55.17%) contributed more to Candida colonization in critically ill patients. Additional risk factors exerted significant impact on both Candida cohorts, primarily including invasive interventions, cancers, and concurrent infections in common. Most colonized Candida spp. harbored relatively higher sensitivity to azoles. ERG11 gene mutations of T348A and A1309G, A395T and C461T, and a novel G1193T to our knowledge were identified in azole-resistant C. albicans, C. tropicalis, and C. parapsilosis respectively, and their corresponding homologous 3D-structure modeling was putatively achieved. Conclusion Distinct epidemiological and clinical characteristics existed between invasive Candida infection and colonization in critically ill patients. Multiple risk factors significantly involved both the Candida cohorts. Colonized Candida exhibited generally higher azole sensitivity than invasively infectious counterparts. ERG11 point mutations had mechanistically potential ties with local Candida resistance to azoles.
Collapse
Affiliation(s)
- Jinxing Xia
- Department of Clinical Laboratory, First Affiliated Hospital of Anhui Medical University, Hefei, People's Republic of China
| | - Wei Huang
- Department of Oncology, First Affiliated Hospital of Anhui Medical University, Hefei, People's Republic of China
| | - Fanbo Lu
- Department of Clinical Laboratory, First Affiliated Hospital of Anhui Medical University, Hefei, People's Republic of China
| | - Moyan Li
- Department of Clinical Laboratory, First Affiliated Hospital of Anhui Medical University, Hefei, People's Republic of China
| | - Bo Wang
- Department of Clinical Laboratory, First Affiliated Hospital of Anhui Medical University, Hefei, People's Republic of China
| |
Collapse
|
14
|
Domingos EL, Vilhena RO, Santos JMMF, Fachi MM, Böger B, Adam LM, Tonin FS, Pontarolo R. Comparative efficacy and safety of systemic antifungal agents for candidemia: a systematic review with network meta-analysis and multicriteria acceptability analyses. Int J Antimicrob Agents 2022; 60:106614. [PMID: 35691603 DOI: 10.1016/j.ijantimicag.2022.106614] [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: 01/10/2022] [Revised: 05/19/2022] [Accepted: 05/30/2022] [Indexed: 11/05/2022]
Abstract
AIM Invasive candidiasis is the most common fungal infection in patients attending health services and is associated with high mortality rates and prolonged hospital stay. The aim of this review was to evaluate and compare efficacy and safety of antifungal agents for the treatment of candidemia. METHODS A systematic review with network meta-analysis (NMA), surface under the cumulative ranking analysis (SUCRA) and stochastic multicriteria acceptability analyses (SMAA) was performed (PROSPERO-CRD42020149264). Searches were conducted in PubMed and Scopus (Nov-2021). Randomised controlled trials evaluating the effect of oral antifungals (any dose or regimen) on mycological cure, discontinuation rates and adverse events were included. RESULTS Overall, 13 trials (n=3632) were analysed. There were no significant differences between therapies for the efficacy outcomes; however, caspofungin (50-150 mg), rezafungin (200-400 mg) and micafungin (100-150 mg) had higher rates of clinical and mycological responses (SUCRA overall response >60%) and were considered the most promising therapies. Fluconazole (400 mg) rated worst for overall response (17%). Rezafungin (200-400 mg) and micafungin (100 mg) were associated with lower discontinuation rates (<40%). Conventional amphotericin B (0.6-0.7 mg/kg) was more likely to be discontinued (odds ratio [OR] 0.08; 95% credibility interval [CrI] 0.00-0.95 vs. caspofungin 150 mg) and may impair liver function (87%). CONCLUSION Echinocandins are recommended as first-line treatments for invasive candidiasis following a priority order of caspofungin then micafungin. Rezafungin, an echinocandin under development, represents a potential option that should be further investigated. Azoles and liposomal amphotericin B can be used as second-line treatments in cases of fungal resistance or hypersensitivity.
Collapse
Affiliation(s)
- Eric L Domingos
- Pharmaceutical Sciences Postgraduate Program, Federal University of Paraná, Curitiba, Brazil.
| | - Raquel O Vilhena
- Pharmaceutical Sciences Postgraduate Program, Federal University of Paraná, Curitiba, Brazil.
| | - Josiane M M F Santos
- Pharmaceutical Sciences Postgraduate Program, Federal University of Paraná, Curitiba, Brazil.
| | - Mariana M Fachi
- Pharmaceutical Sciences Postgraduate Program, Federal University of Paraná, Curitiba, Brazil.
| | - Beatriz Böger
- Pharmaceutical Sciences Postgraduate Program, Federal University of Paraná, Curitiba, Brazil.
| | - Livia M Adam
- Pharmaceutical Sciences Postgraduate Program, Federal University of Paraná, Curitiba, Brazil.
| | - Fernanda S Tonin
- Pharmaceutical Sciences Postgraduate Program, Federal University of Paraná, Curitiba, Brazil; H&TRC- Health & Technology Research Center, ESTeSL- Escola Superior de Tecnologia da Saúde, Instituto Politécnico de Lisboa, Lisbon, Portugal.
| | - Roberto Pontarolo
- Department of Pharmacy, Federal University of Paraná, Curitiba, Brazil.
| |
Collapse
|
15
|
Bloos F, Held J, Kluge S, Simon P, Kogelmann K, de Heer G, Kuhn SO, Jarczak D, Motsch J, Hempel G, Weiler N, Weyland A, Drüner M, Gründling M, Meybohm P, Richter D, Jaschinski U, Moerer O, Günther U, Schädler D, Weiss R, Putensen C, Castellanos I, Kurzai O, Schlattmann P, Cornely OA, Bauer M, Thomas-Rüddel D. (1 → 3)-β-D-Glucan-guided antifungal therapy in adults with sepsis: the CandiSep randomized clinical trial. Intensive Care Med 2022; 48:865-875. [PMID: 35708758 PMCID: PMC9273538 DOI: 10.1007/s00134-022-06733-x] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2022] [Accepted: 05/07/2022] [Indexed: 12/15/2022]
Abstract
Purpose To investigate whether (1 → 3)-β-d-Glucan (BDG)-guidance shortens time to antifungal therapy and thereby reduces mortality of sepsis patients with high risk of invasive Candida infection (ICI). Methods Multicenter, randomized, controlled trial carried out between September 2016 and September 2019 in 18 intensive care units enrolling adult sepsis patients at high risk for ICI. Patients in the control group received targeted antifungal therapy driven by culture results. In addition to targeted therapy, patients in the BDG group received antifungals if at least one of two consecutive BDG samples taken during the first two study days was ≥ 80 pg/mL. Empirical antifungal therapy was discouraged in both groups. The primary endpoint was 28-day-mortality. Results 339 patients were enrolled. ICI was diagnosed in 48 patients (14.2%) within the first 96 h after enrollment. In the BDG-group, 48.8% (84/172) patients received antifungals during the first 96 h after enrollment and 6% (10/167) patients in the control group. Death until day 28 occurred in 58 of 172 patients (33.7%) in the BDG group and 51 of 167 patients (30.5%) in the control group (relative risk 1.10; 95% confidence interval, 0.80–1.51; p = 0.53). Median time to antifungal therapy was 1.1 [interquartile range (IQR) 1.0–2.2] days in the BDG group and 4.4 (IQR 2.0–9.1, p < 0.01) days in the control group. Conclusions Serum BDG guided antifungal treatment did not improve 28-day mortality among sepsis patients with risk factors for but unexpected low rate of IC. This study cannot comment on the potential benefit of BDG-guidance in a more selected at-risk population. Supplementary Information The online version contains supplementary material available at 10.1007/s00134-022-06733-x.
Collapse
Affiliation(s)
- Frank Bloos
- Center for Sepsis Control and Care, Jena University Hospital, Jena, Germany. .,Department of Anesthesiology and Intensive Care Medicine, Jena University Hospital, Am Klinikum 1, 07747, Jena, Germany.
| | - Jürgen Held
- Mikrobiologisches Institut-Klinische Mikrobiologie Immunologie und Hygiene, Universitätsklinikum Erlangen Und Friedrich-Alexander-Universität (FAU) Erlangen-Nürnberg, Erlangen, Germany
| | - Stefan Kluge
- Department of Intensive Care Medicine, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - Philipp Simon
- Department of Anesthesiology and Intensive Care Medicine, University of Leipzig Medical Centre, Leipzig, Germany.,Department of Anesthesiology and Surgical Intensive Care Medicine, University Hospital Augsburg, Augsburg, Germany
| | - Klaus Kogelmann
- Department of Anesthesiology and Intensive Care Medicine, Hospital Emden, Emden, Germany
| | - Geraldine de Heer
- Department of Intensive Care Medicine, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - Sven-Olaf Kuhn
- Department of Anesthesiology and Intensive Care Medicine, University Hospital Greifswald, Greifswald, Germany
| | - Dominik Jarczak
- Department of Intensive Care Medicine, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - Johann Motsch
- Department of Anesthesiology, University Hospital Heidelberg, Heidelberg, Germany
| | - Gunther Hempel
- Department of Anesthesiology and Intensive Care Medicine, University of Leipzig Medical Centre, Leipzig, Germany
| | - Norbert Weiler
- Department of Anesthesiology and Intensive Care Medicine, University Medical Center Kiel, Kiel, Germany
| | - Andreas Weyland
- Research Center Neurosensory Science, Carl von Ossietzky Universität Oldenburg, Oldenburg, Germany
| | - Matthias Drüner
- Department of Anesthesiology and Intensive Care Medicine, Hospital Emden, Emden, Germany
| | - Matthias Gründling
- Department of Anesthesiology and Intensive Care Medicine, University Hospital Greifswald, Greifswald, Germany
| | - Patrick Meybohm
- Department of Anesthesiology, Intensive Care, Emergency and Pain Medicine, University Hospital Wuerzburg, Würzburg, Germany
| | - Daniel Richter
- Department of Anesthesiology, University Hospital Heidelberg, Heidelberg, Germany
| | - Ulrich Jaschinski
- Department of Anesthesiology and Surgical Intensive Care Medicine, University Hospital Augsburg, Augsburg, Germany
| | - Onnen Moerer
- Department of Anesthesiology, University Medical Center, Georg-August-University, Göttingen, Germany
| | - Ulf Günther
- University Clinic of Anaesthesiology, Intensive Care, Emergency Medicine and Pain Therapy, Klinikum Oldenburg, Oldenburg, Germany
| | - Dirk Schädler
- Department of Anesthesiology and Intensive Care Medicine, University Medical Center Kiel, Kiel, Germany
| | - Raphael Weiss
- Department of Anesthesiology, Surgical Intensive Care Medicine and Pain Therapy, University Hospital Münster, Munster, Germany
| | - Christian Putensen
- Division of Intensive Care Medicine, Department of Anesthesiology and Intensive Care Medicine, University Hospital Bonn, Bonn, Germany
| | | | - Oliver Kurzai
- Institute for Hygiene and Microbiology, Julius Maximilians University Würzburg, Würzburg, Germany.,National Reference Center for Invasive Fungal Infections NRZMyk, Leibniz Institute for Natural Product Research and Infection Biology-Hans-Knoell-Insitute, Jena, Germany
| | - Peter Schlattmann
- Institute of Medical Statistics, Computer Sciences and Data Science, Jena University Hospital, Jena, Germany
| | - Oliver A Cornely
- Department I of Internal Medicine, Excellence Center for Medical Mycology (ECMM), Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany.,Chair Translational Research, Faculty of Medicine and University Hospital Cologne, Cologne Excellence Cluster on Cellular Stress Responses in Aging-Associated Diseases (CECAD), University of Cologne, Cologne, Germany.,Faculty of Medicine and University Hospital Cologne, Clinical Trials Centre Cologne (ZKS Köln), University of Cologne, Cologne, Germany.,German Centre for Infection Research (DZIF), Partner Site Bonn-Cologne, Cologne, Germany
| | - Michael Bauer
- Center for Sepsis Control and Care, Jena University Hospital, Jena, Germany.,Department of Anesthesiology and Intensive Care Medicine, Jena University Hospital, Am Klinikum 1, 07747, Jena, Germany
| | - Daniel Thomas-Rüddel
- Center for Sepsis Control and Care, Jena University Hospital, Jena, Germany.,Department of Anesthesiology and Intensive Care Medicine, Jena University Hospital, Am Klinikum 1, 07747, Jena, Germany
| | | |
Collapse
|
16
|
Marinelli T, Pennington KM, Hamandi B, Donahoe L, Rotstein C, Martinu T, Husain S. Epidemiology of Candidemia in Lung Transplant Recipients and Risk Factors for Candidemia in the Early Post-Transplant Period in the Absence of Universal Antifungal Prophylaxis. Transpl Infect Dis 2022; 24:e13812. [PMID: 35182095 DOI: 10.1111/tid.13812] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Revised: 01/27/2022] [Accepted: 01/31/2022] [Indexed: 12/01/2022]
Abstract
BACKGROUND Lung transplant recipients are at increased risk of candidemia, especially in the early post-transplant period. However, the specific predisposing factors have not been established. The natural history of candidemia post-lung transplantation, in the absence of universal antifungal prophylaxis, is not known. METHODS We retrospectively examined the epidemiology of candidemia at any time post-transplant in patients who underwent lung transplantation at our centre between 2016 and 2019. We undertook a case-control study and used logistic regression to evaluate the risk factors for candidemia during the first 30 days post transplantation. RESULTS During the study period 712 lung transplants were performed on 705 patients. Twenty-five lung transplant recipients (LTRs) (3.5%) experienced 31 episodes of candidemia. The median time to candidemia was 19.5 days (IQR 10.5-70.5), with 61.2% (n = 19) episodes of candidemia occurring within the first 30 days post-transplantation. Pre-transplant hospitalization, post-transplant ECMO and post-transplant renal replacement therapy were associated with an increased risk of candidemia in the first 30 days post-transplant. Of those with candidemia in the first 30 days, 31.2% died within 30 days of the index positive blood culture. Candidemia was associated with decreased survival within 30 days post-transplant. CONCLUSION This study highlights the greatest risk period of lung transplant recipients for development of candidemia and identifies several factors associated with increased risk of candidemia. These findings will help guide future studies on antifungal prophylaxis. This article is protected by copyright. All rights reserved.
Collapse
Affiliation(s)
- Tina Marinelli
- Multi-Organ Transplant Program, Division of Infectious Diseases, Department of Medicine, University of Toronto, University Health Network, Toronto, Canada.,Department of Infectious Diseases, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
| | - Kelly M Pennington
- Toronto Lung Transplant Program, University Health Network, Toronto, Ontario, Canada.,Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, Minnesota
| | - Bassem Hamandi
- Department of Pharmacy, University Health Network, Toronto, Ontario.,Canada and Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Ontario, Canada
| | - Laura Donahoe
- Division of Thoracic Surgery, Toronto General Hospital, University Health Network, University of Toronto, Ontario, Canada
| | - Coleman Rotstein
- Multi-Organ Transplant Program, Division of Infectious Diseases, Department of Medicine, University of Toronto, University Health Network, Toronto, Canada
| | - Tereza Martinu
- Toronto Lung Transplant Program, University Health Network, Toronto, Ontario, Canada.,Division of Respirology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Shahid Husain
- Multi-Organ Transplant Program, Division of Infectious Diseases, Department of Medicine, University of Toronto, University Health Network, Toronto, Canada
| |
Collapse
|
17
|
Spettel K, Bumberger D, Camp I, Kriz R, Willinger B. Efficacy of octenidine against emerging echinocandin-, azole- and multidrug-resistant Candida albicans and Candida glabrata. J Glob Antimicrob Resist 2022; 29:23-28. [DOI: 10.1016/j.jgar.2022.01.028] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2021] [Revised: 12/21/2021] [Accepted: 01/31/2022] [Indexed: 10/19/2022] Open
|