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Durmuş M, Kalkan S, Güzel Karahan S, Biçakcioğlu M, Özdemir N, Gün ZÜ, Özer AB. Can antibiotics affect the clinical features of patients with candidemia? The retrospective evaluation of 5 years of data in an intensive care unit. Eur J Hosp Pharm 2024; 31:416-422. [PMID: 37098442 DOI: 10.1136/ejhpharm-2022-003673] [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: 12/27/2022] [Accepted: 04/11/2023] [Indexed: 04/27/2023] Open
Abstract
BACKGROUND Candidemia is an opportunistic infection of intensive care units (ICUs) and causes morbidity and mortality. Multiple antibiotic exposure was found to be an independent risk factor for mortality and non-albicans candidemia (NAC) in candidemia patients. AIM The aim of this study was to determine the relationship between antibiotics and clinical features of patients with candidemia, and to determine the independent risk factors for hospital stay >50 days, 30-day mortality in hospital, candidemia types, and septic shock in candidemia patients. METHODS Patients were evaluated retrospectively for 5 years. A total of 148 candidemia cases were detected and included in the study. Characteristics of cases were defined and recorded. The relationship between qualitative data was determined by the χ2 test. Logistic regression analysis was used to determine the independent risk factors for hospital stay >50 days, 30-day mortality in hospital, candidemia types, and septic shock in candidemia patients. RESULTS The incidence of candidemia for 5 years was 4.5%. Candida parapsilosis was the most reported species with 65% (n=97). Linezolid and central venous catheters (CVC) were found to be independent risk factors for NAC. Carbapenems and cephalosporins were found in association to lower mortality. No antibiotics or characteristics were found to be independent risk factors for mortality. Some broad spectrum antibiotics and antibiotic combinations were found in relationship with hospital stay >50 days; however, none of them were found to be independent risk factors. Metisilin resistant staphylococcus aureus (MRSA) antibiotics, meropenem+linezolid piperacillin-tazobactam+fluoroquinolones and comorbidity were found in association with septic shock, although only piperacillin-tazobactam+fluoroquinolones and comorbidity were found to be independent risk factors for septic shock. CONCLUSIONS This study concluded that many antibiotics were safe for candidemia patients. However, clinicians should pay attention when prescribing linezolid or piperacillin-tazobactam and flouroquinolons concomitantly or sequentially for patients with candidemia risk factors.
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Affiliation(s)
- Mefküre Durmuş
- Clinical Pharmacy, İnönü University Faculty of Pharmacy, Malatya, Turkey
| | - Serkan Kalkan
- Anesthesiology and Reanimation, İnönü University Faculty of Medicine, Malatya, Turkey
| | - Sena Güzel Karahan
- Clinical Pharmacy, İnönü University Faculty of Pharmacy, Malatya, Turkey
| | - Murat Biçakcioğlu
- Anesthesiology and Reanimation, İnönü University Faculty of Medicine, Malatya, Turkey
| | | | - Zeynep Ülkü Gün
- Clinical Pharmacy, İnönü University Faculty of Pharmacy, Malatya, Turkey
| | - Ayşe Belin Özer
- Anesthesiology and Reanimation, İnönü University Faculty of Medicine, Malatya, Turkey
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Khateb AM, Alofi FS, Almutairi AZ. Increased prevalence of fungemia in Medina, Saudi Arabia. FRONTIERS IN EPIDEMIOLOGY 2023; 3:1180331. [PMID: 38455891 PMCID: PMC10910952 DOI: 10.3389/fepid.2023.1180331] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Accepted: 04/18/2023] [Indexed: 03/09/2024]
Abstract
Background The prevalence of fungal infection is increasing globally due to an increase in the immunocompromised and aging population. We investigated epidemiological changes in fungemia in one of the major centers in Medina over seven years period with 87,447 admissions. Methods Retrospective search of records for causative agents of fungemia in inpatients at King Fahad Hospital (KFH) in 2013-2019. Fungal-positive blood cultures, demographic, and treatment data were extracted. Results A total of 331 fungemia episodes proven by blood culture were identified in 46 patients. The annual prevalence of fungemia increased from 0.072 in 2013 to 1.546 patients per 1,000 in 2019. The mean age of fungemia episodes was 56 years, and 62% of episodes occurred in females. Samples from central blood incubated aerobically yielded the highest fungemia rate, accounting for 55% (n = 182). Among yeast species, Candida parapsilosis was responsible for the highest number of episodes 37% (n = 122), followed by Candida glabrata (32%; n = 107), Candid albicans (29%; n = 94), and Cryptococcus neoformans (1%; n = 4). Among molds, Lichtheimia (Absidia) species was the most common (1%; n = 3). Yeast-like fungi Trichosporion mucoides accounted for (0.003% n = 1). The use of antifungal treatment has increased (96%) over the years (2013-2019). An increase in resistance rate of 2% was found in C. albicans and C. glabrata. The most prevalent comorbidity was renal disease (24.2%). Conclusions C. parapsilosis was the leading cause of fungemia. The association of renal disease with increased candidemia was alarming. This study is a fundamental resource to establish management policies for fungal infection in the region.
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Affiliation(s)
- Aiah M. Khateb
- Department of Medical Laboratory Technology, Collage of Applied Medical Science, Taibah University, Medina, Saudi Arabia
| | - Fadwa S. Alofi
- Infectious Diseases Department, King Fahad Hospital, Medina, Saudi Arabia
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KORULMAZ A, ALAKAYA M, ARSLANKOYLU AE, KAYA S, ERDOGAN S, OZGUR D, OTAG ZF. Distribution of candida species and risk factors for invasive candidiasis. EGE TIP DERGISI 2022. [DOI: 10.19161/etd.1209148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Aim: The aim of this study was to investigate the Candida species isolated from the clinical samples of patients in the pediatric intensive care unit and to determine the risk factors for invasive candidiasis.
Materials and Methods: Patients with Candida species detected in clinical samples between January 2013 and December 2018 were included in this study. The demographic characteristics of the patients, the use of broad-spectrum antibiotics and immunosuppressive drugs, underlying diseases, blood transfusions, history of surgical operations, whether there is bacterial growth with Candida species in the same clinical sample, parenteral nutrition and invasive interventions were retrospectively analyzed and their relationship with invasive candidiasis was investigated.
Results: A total of 91 patients were included in the study. The mean age was 72.3 ± 70.1 months. Among the patients 48.4% had Candida albicans while 51.6% had non-albicans Candida. Candida parapsilosis (n = 18, 19.8%) and Candida tropicalis (n = 14, 15.4%) were the most common non-albicans Candida species. The most common antifungal treatment was fluconazole (n = 34, 59.6%). There was no statistically significant relationship between invasive candidiasis and the underlying disease, central venous and / or urinary catheter, broad-spectrum antibiotic, corticosteroid, gender and surgical operation (p> 0.05). On the other hand, there was a statistically significant relationship between invasive candidiasis and parenteral nutrition, blood transfusion and bacterial growth with Candida species in the same clinical sample (p <0.05).
Conclusions: Non-albicans Candida species are more common than Candida albicans in the pediatric intensive care units. Candida parapsilosis is the most common among non-albicans Candida species. Parenteral nutrition, blood transfusion and bacterial growth with Candida species in the same clinical sample increased the risk of invasive candidiasis.
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Affiliation(s)
- Ali KORULMAZ
- Mersin University Faculty of Medicine, Department of Pediatric Intensive Care Unit, Mersin, Türkiye
| | - Mehmet ALAKAYA
- Mersin University Faculty of Medicine, Department of Pediatric Intensive Care Unit, Mersin, Türkiye
| | - Ali Ertug ARSLANKOYLU
- Mersin University Faculty of Medicine, Department of Pediatric Intensive Care Unit, Mersin, Türkiye
| | - Sadik KAYA
- Mersin University Faculty of Medicine, Department of Pediatric Intensive Care Unit, Mersin, Türkiye
| | - Semra ERDOGAN
- Mersin University Faculty of Medicine, Department of Biostatistics, Mersin, Türkiye
| | - Didem OZGUR
- Mersin University Faculty of Medicine, Department of Microbiology, Mersin, Türkiye
| | - Zehra Feza OTAG
- Mersin University Faculty of Medicine, Department of Microbiology, Mersin, Türkiye
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Risk factors associated with nosocomial infections among end stage renal disease patients undergoing hemodialysis: A systematic review. PLoS One 2020; 15:e0234376. [PMID: 32569265 PMCID: PMC7307739 DOI: 10.1371/journal.pone.0234376] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2019] [Accepted: 05/26/2020] [Indexed: 02/07/2023] Open
Abstract
Background Profound healthcare challenges confront societies with an increase in prevalence of end-stage renal disease (ESRD), which is one of the leading causes of morbidity and mortality worldwide. Due to several facility and patient related factors, ESRD is significantly associated with increased morbidity and mortality attributed to infections. Aims and objective The aim of this study was to assess systematically the characteristics of patients and risk factors associated with nosocomial infections among ESRD patients undergoing hemodialysis. Methods A systematic literature search was performed to identify eligible studies published during the period from inception to December 2018 pertaining to risk factors associated with nosocomial infections among hemodialysis patients. The relevant studies were generated through a computerized search on five databases (PubMed, EBSCOhost, Google Scholar, ScienceDirect and Scopus) using the Mesh Words: nosocomial infections, hospital acquired infections, healthcare associated infections, end stage renal disease, end stage renal failure, hemodialysis, and risk factors. The complete protocol has been registered under PROSPERO (CRD42019124099). Results Initially, 1411 articles were retrieved. Out of these, 24 were duplicates and hence were removed. Out of 1387 remaining articles, 1337 were removed based on irrelevant titles and/or abstracts. Subsequently, the full texts of 50 articles were reviewed and 41 studies were excluded at this stage due to lack of relevant information. Finally, nine articles were selected for this review. Longer hospital stay, longer duration on hemodialysis, multiple catheter sites, longer catheterization, age group, lower white blood cell count, history of blood transfusion, and diabetes were identified as the major risk factors for nosocomial infections among hemodialysis patients. Conclusion The results of this review indicate an information gap and potential benefits of additional preventive measures to further reduce the risk of infections in hemodialysis population. Moreover, several patient-related and facility-related risk factors were consistently observed in the studies included in this review, which require optimal control measures.
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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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Taei M, Chadeganipour M, Mohammadi R. An alarming rise of non-albicans Candida species and uncommon yeasts in the clinical samples; a combination of various molecular techniques for identification of etiologic agents. BMC Res Notes 2019; 12:779. [PMID: 31783903 PMCID: PMC6883655 DOI: 10.1186/s13104-019-4811-1] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2019] [Accepted: 11/14/2019] [Indexed: 01/26/2023] Open
Abstract
OBJECTIVE Yeasts are unicellular microorganisms may cause systemic infection in immunocompromised patients. The aim of this study was to identify yeast strains isolated from clinical specimens using molecular techniques. RESULTS A total of 202 yeast strains isolated from 341 clinical samples between February 2017 and May 2019. All clinical isolates were identified using phenotypic and molecular tests including PCR-RFLP, duplex-PCR, multiplex-PCR, and PCR-sequencing. The most yeast fungal isolates were obtained from urine (66.8%), nail (9.4%), skin lesion (7.9%), bronchoalveolar lavage (5.9%), and blood (3.9%). One hundred and twenty-one Candida species were identified as non-albicans versus 76 Candida albicans. Trichosporon asahii, and Pichia terricola were uncommon non-Candida yeasts isolated from urine samples. For the first time, we isolated P. terricola as etiological agent of urinary tract infection in a pregnant female. Since Candida species show different levels of resistance to antifungal agents, precise identification of clinical isolates is critical for better treatment of infection.
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Affiliation(s)
- Monireh Taei
- Department of Medical Parasitology and Mycology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Mostafa Chadeganipour
- Department of Medical Parasitology and Mycology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Rasoul Mohammadi
- Department of Medical Parasitology and Mycology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran. .,Infectious Diseases and Tropical Medicine Research Center, Isfahan University of Medical Sciences, Isfahan, Iran.
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Wang K, Hsueh K, Kronen R, Lin C, Salazar AS, Powderly WG, Spec A. Creation and assessment of a clinical predictive model for candidaemia in patients with candiduria. Mycoses 2019; 62:554-561. [PMID: 31025417 DOI: 10.1111/myc.12917] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2019] [Revised: 04/19/2019] [Accepted: 04/20/2019] [Indexed: 12/28/2022]
Abstract
Candidaemia is the most common clinical presentation of invasive candidiasis and is a major cause of morbidity and mortality. Candiduria is a predictor for candidaemia; however, patient characteristics that are associated with concurrent candidaemia in the setting of candiduria are unclear. Identifying these characteristics could aid in the early detection of systemic disease. We performed a retrospective cohort analysis of hospitalised patients with candiduria at our institution over a 13-year period. Our evaluation of patient characteristics included demographics, comorbidities, medications, procedures, devices, vital signs and laboratory values. We developed a multivariable logistic model to identify factors associated with candidaemia in patients with candiduria. We identified 4240 patients with candiduria, 263 (6.2%) of whom had candidaemia. Predictors for increased risk of candidaemia with candiduria included hospitalisations > 12 days, central venous catheter, parenteral nutrition, haematological and gynaecological malignancy, and receipt of β-lactam/β-lactamase inhibitors. Vital signs and laboratory values associated with candidaemia included elevated heart rate, temperature and creatinine, along with neutropenia and neutrophilia. Factors that demonstrated a decreased risk of candidaemia included diabetes mellitus, gastrostomy and urinary catheter with antibiotic use. The c-statistic was 0.741 (95% CI, 0.710-0.772). We identified a set of clinical characteristics that can predict the presence of candidaemia with candiduria.
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Affiliation(s)
- Katie Wang
- Saint Louis University School of Medicine, Saint Louis, Missouri
| | - Kevin Hsueh
- Division of Infectious Diseases, Department of Medicine, Washington University School of Medicine, Saint Louis, Missouri
| | - Ryan Kronen
- Division of Infectious Diseases, Department of Medicine, Washington University School of Medicine, Saint Louis, Missouri.,Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - Charlotte Lin
- Division of Infectious Diseases, Department of Medicine, Washington University School of Medicine, Saint Louis, Missouri
| | - Ana S Salazar
- Division of Infectious Diseases, Department of Medicine, Washington University School of Medicine, Saint Louis, Missouri
| | - William G Powderly
- Division of Infectious Diseases, Department of Medicine, Washington University School of Medicine, Saint Louis, Missouri
| | - Andrej Spec
- Division of Infectious Diseases, Department of Medicine, Washington University School of Medicine, Saint Louis, Missouri
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Increase in Candida Parapsilosis Candidemia in Cancer Patients. Mediterr J Hematol Infect Dis 2019; 11:e2019012. [PMID: 30671218 PMCID: PMC6328045 DOI: 10.4084/mjhid.2019.012] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2018] [Accepted: 11/26/2018] [Indexed: 01/07/2023] Open
Abstract
This study aimed to identify the risk factors of candidemia and asses possible clinically significant differences between Candida parapsilosis and other Candida species in a Chinese tertiary cancer center over six years. A total of 323 cancer patients were enrolled and analyzed from 2012 to 2018. Among the isolates, the species most frequently isolated was C. parapsilosis (37.15%, 120/323), and C. albicans only accounted for 34.37%. Based on statistical analysis, when candidemia patients who had C. parapsilosis were compared with other Candida spp., the following factors were found to be significantly associated with C. parapsilosis fungemia: parenteral nutrition (p < 0.001), neutropenia (p < 0.001), receipt of chemotherapy (p = 0.002), and previous antifungal use (p < 0.001). Parenteral nutrition was a factor that independently predicted C. parapsilosis candidemia (OR, 0.183; 95% CI, 0.098–0.340; p < 0.001).In short, C. parapsilosis as the leading non-albicans Candida spp. isolates in candidemia are posing a major threat for cancer patients. The study highlights the urgent need to evaluate the possibility of development of C. parapsilosis candidemia in cancer patients exposed to these risk factors effective and prevention strategies against this causative agent transmitted through nosocomial route should be implemented.
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Rodríguez-Acelas AL, de Abreu Almeida M, Engelman B, Cañon-Montañez W. Risk factors for health care-associated infection in hospitalized adults: Systematic review and meta-analysis. Am J Infect Control 2017; 45:e149-e156. [PMID: 29031433 DOI: 10.1016/j.ajic.2017.08.016] [Citation(s) in RCA: 44] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2017] [Revised: 07/25/2017] [Accepted: 08/14/2017] [Indexed: 02/07/2023]
Abstract
BACKGROUND Health care-associated infections (HAIs) are a public health problem that increase health care costs. This article aimed to systematically review the literature and meta-analyze studies investigating risk factors (RFs) independently associated with HAIs in hospitalized adults. METHODS Electronic databases (MEDLINE, Embase, and LILACS) were searched to identify studies from 2009-2016. Pooled risk ratios (RRs) or odds ratios (ORs) or mean differences (MDs) and 95% confidence intervals (CIs) were calculated and compared across the groups. This review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement. RESULTS Of 867 studies, 65 met the criteria for review, and the data of 18 were summarized in the meta-analysis. The major RFs independently associated with HAIs were diabetes mellitus (RR, 1.76; 95% CI, 1.27-2.44), immunosuppression (RR, 1.24; 95% CI, 1.04-1.47), body temperature (MD, 0.62; 95% CI, 0.41-0.83), surgery time in minutes (MD, 34.53; 95% CI, 22.17-46.89), reoperation (RR, 7.94; 95% CI, 5.49-11.48), cephalosporin exposure (RR, 1.77; 95% CI, 1.30-2.42), days of exposure to central venous catheter (MD, 5.20; 95% CI, 4.91-5.48), intensive care unit (ICU) admission (RR, 3.76; 95% CI, 1.79-7.92), ICU stay in days (MD, 21.30; 95% CI, 19.81-22.79), and mechanical ventilation (OR, 12.95; 95% CI, 6.28-26.73). CONCLUSIONS Identifying RFs that contribute to develop HAIs may support the implementation of strategies for their prevention, therefore maximizing patient safety.
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Lustgarten MS, Fielding RA. Metabolites related to renal function, immune activation, and carbamylation are associated with muscle composition in older adults. Exp Gerontol 2017; 100:1-10. [PMID: 29030163 DOI: 10.1016/j.exger.2017.10.003] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2017] [Revised: 09/28/2017] [Accepted: 10/01/2017] [Indexed: 12/25/2022]
Abstract
Reduced skeletal muscle density in older adults is associated with insulin resistance, decreased physical function, and an increased all-cause mortality risk. To elucidate mechanisms that may underlie the maintenance of skeletal muscle density, we conducted a secondary analysis of previously published muscle composition and serum metabolomic data in 73 older adults (average age, 78y). Multivariable-adjusted linear regression was used to examine associations between 321 metabolites with muscle composition, defined as the ratio between normal density (NDM) with low density (LDM) thigh muscle cross sectional area (NDM/LDM). Sixty metabolites were significantly (p≤0.05 and q<0.30) associated with NDM/LDM. Decreased renal function and the immune response have been previously linked with reduced muscle density, but the mechanisms underlying these connections are less clear. Metabolites that were significantly associated with muscle composition were then tested for their association with circulating markers of renal function (blood urea nitrogen, creatinine, uric acid), and with the immune response (neutrophils/lymphocytes) and activation (kynurenine/tryptophan). 43 significant NDM/LDM metabolites (including urea) were co-associated with at least 1 marker of renal function; 23 of these metabolites have been previously identified as uremic solutes. The neutrophil/lymphocyte ratio was significantly associated with NDM/LDM (β±SE: -0.3±0.1, p=0.01, q=0.04). 35 significant NDM/LDM metabolites were co-associated with immune activation. Carbamylation (defined as homocitrulline/lysine) was identified as a pathway that may link renal function and immune activation with muscle composition, as 29 significant NDM/LDM metabolites were co-associated with homocitrulline/lysine, with at least 2 markers of renal function, and with kynurenine/tryptophan. When considering that elevated urea and uremic metabolites have been linked with an increased systemic microbial burden, that antimicrobial defense can be reduced in the presence of carbamylation, and that adipocytes can promote host defense, we propose the novel hypothesis that the age-related increase in adipogenesis within muscle may be a compensatory antimicrobial response to protect against an elevated microbial burden.
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Affiliation(s)
- Michael S Lustgarten
- Nutrition, Exercise Physiology, and Sarcopenia Laboratory, Jean Mayer USDA Human Nutrition Research Center, Tufts University, Boston, MA, USA.
| | - Roger A Fielding
- Nutrition, Exercise Physiology, and Sarcopenia Laboratory, Jean Mayer USDA Human Nutrition Research Center, Tufts University, Boston, MA, USA
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Chang CH, Huang MM, Yeih DF, Lu KC, Hou YC. A chronic hemodialysis patient with isolated pulmonary valve infective endocarditis caused by non-albicans Candida: a rare case and literature review. BMC Nephrol 2017; 18:286. [PMID: 28874131 PMCID: PMC5585904 DOI: 10.1186/s12882-017-0706-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2016] [Accepted: 08/24/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Isolated pulmonary valve infective endocarditis caused by Candida is rare in chronic hemodialysis patients. The 2009 Infectious Diseases Society of America guidelines suggest the combined use of surgery and antibiotics to treat candidiasis; however, successful nonsurgical treatment of Candida endocarditis has been reported. CASE PRESENTATION A 63-year-old woman with end-stage kidney disease was admitted to our hospital after experiencing disorientation for 5 days. The patient was permanently bedridden because of depression, and denied active intravenous drug use. She received maintenance hemodialysis through a tunneled-cuffed catheter. An initial blood culture grew Candida guilliermondii without other bacteria. Subsequent blood cultures and tip culture of tunneled-cuffed catheter also grew C. guilliermondii, even after caspofungin replaced fluconazole. A 1.2-cm mobile mass was observed on the pulmonary valve. Surgical intervention was suggested, but the family of the patient declined because of her multiple comorbidities. The patient was discharged with a prescription of fluconazole, but she died soon after. CONCLUSION Our patient is the first case with isolated pulmonary valve endocarditis caused by C. guilliermondii in patients with uremia. Hematologic disorders, in addition to long-term central venous catheter use, prolonged antibiotic intravenous injection, and congenital cardiac anomaly, predispose to the condition. The diagnosis "isolated" pulmonary IE is difficult, and combing surgery with antifungal antibiotics is the appropriate therapeutic management for Candida related pulmonary IE.
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Affiliation(s)
- Chih-Hao Chang
- Department of Thoracic Medicine, Chang-Gang Memorial Hospital, Linkou Branch, No.5, Fuxing St., Guishan Dist, Taoyuan City, 33305, Taiwan, Republic of China
| | - Myo-Ming Huang
- Department of Internal Medicine, Cardinal Tien Hospital An-Kang branch, School of Medicine, Fu-Jen Catholic University, No. 15, Chezi Road., Hsin-Tien District, New Taipei City, 23155, Taiwan, Republic of China
| | - Dong-Feng Yeih
- Department of Internal Medicine, Cardinal Tien Hospital, School of Medicine, Fu-Jen Catholic University, 362 Chung-Cheng Road, Hsin-Tien District, New Taipei City, 23148, Taiwan, Republic of China
| | - Kuo-Cheng Lu
- Department of Internal Medicine, Cardinal Tien Hospital, School of Medicine, Fu-Jen Catholic University, 362 Chung-Cheng Road, Hsin-Tien District, New Taipei City, 23148, Taiwan, Republic of China.,Graduate Institute of Clinical Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan, Republic of China.,Division of Nephrology, Department of Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan, Republic of China
| | - Yi-Chou Hou
- Department of Internal Medicine, Cardinal Tien Hospital An-Kang branch, School of Medicine, Fu-Jen Catholic University, No. 15, Chezi Road., Hsin-Tien District, New Taipei City, 23155, Taiwan, Republic of China. .,Graduate Institute of Clinical Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan, Republic of China.
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Rapid identification of Candida spp. frequently involved in invasive mycoses by using flow-through hybridization and Gene Chip (FHGC) technology. J Microbiol Methods 2017; 132:160-165. [DOI: 10.1016/j.mimet.2016.11.019] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2016] [Revised: 11/28/2016] [Accepted: 11/28/2016] [Indexed: 11/22/2022]
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13
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Gong X, Luan T, Wu X, Li G, Qiu H, Kang Y, Qin B, Fang Q, Cui W, Qin Y, Li J, Zang B. Invasive candidiasis in intensive care units in China: Risk factors and prognoses of Candida albicans and non-albicans Candida infections. Am J Infect Control 2016; 44:e59-63. [PMID: 26781222 DOI: 10.1016/j.ajic.2015.11.028] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2015] [Revised: 11/18/2015] [Accepted: 11/19/2015] [Indexed: 02/05/2023]
Abstract
BACKGROUND To investigate the risk factors and prognoses of patients with invasive Candida albicans and non-albicans Candida (NAC) infection in intensive care units (ICUs) in China. METHODS Between November 2009 and April 2011, we performed a prospective study of critically ill patients with invasive Candida infection from 67 ICUs across China to compare the risk factors and mortality between patients with C albicans and NAC infection. RESULTS There were 306 patients with proven invasive Candida; 244 cases (a total 389 Candida isolates) were sent to laboratory for strain identification (C albicans, 40.1%; NAC, 59.9%). More patients admitted for surgery or trauma had NAC infection than C albicans infection. C albicans infection was more common in patients with subclavian vein catheters or peritoneal drainage tubes. Compared with patients with C albicans infection, patients with NAC infection had longer antifungal therapy (P < .001), longer ICU (P = .004) or hospital stay (P = .002), and slightly higher mortality (38.4% vs 29.6%), but the difference was not significant (P = .17). CONCLUSIONS C albicans remains the most common pathogen in candidiasis in critical care patients. However, the number of NAC infections exceeded C albicans infections. Compared with patients with C albicans infection, patients with NAC infection had heavier disease burdens.
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Affiliation(s)
- Xiaoying Gong
- Department of Intensive Care Medicine, Shengjing Hospital of China Medical University, Shenyang, China
| | - Ting Luan
- Department of Intensive Care Medicine, Shengjing Hospital of China Medical University, Shenyang, China
| | - Xingmao Wu
- Department of Intensive Care Medicine, Shengjing Hospital of China Medical University, Shenyang, China
| | - Guofu Li
- Department of Intensive Care Medicine, Shengjing Hospital of China Medical University, Shenyang, China
| | - Haibo Qiu
- Department of Intensive Care Medicine, Nanjing Zhongda Hospital, Southeast University School of Medicine, Nanjing, China
| | - Yan Kang
- Department of Intensive Care Medicine, West China Hospital, Sichuan University, Chengdu, China
| | - Bingyu Qin
- Department of Intensive Care Medicine, Henan Provincial People's Hospital, Zhengzhou, China
| | - Qiang Fang
- Department of Intensive Care Medicine, The First Affiliated Hospital, Zhejiang University, Hangzhou, China
| | - Wei Cui
- Department of Intensive Care Medicine, The Second Affiliated Hospital, Zhejiang University School of Medcine, Hangzhou, China
| | - Yingzhi Qin
- Department of Intensive Care Medicine, Tianjin Third Central Hospital, Tianjin, China
| | - Jianguo Li
- Department of Intensive Care Medicine, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Bin Zang
- Department of Intensive Care Medicine, Shengjing Hospital of China Medical University, Shenyang, China.
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14
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Ourives APJ, Gonçalves SS, Siqueira RA, Souza ACR, Canziani MEF, Manfredi SR, Correa L, Colombo AL. High rate of Candida deep-seated infection in patients under chronic hemodialysis with extended central venous catheter use. Rev Iberoam Micol 2016; 33:100-3. [DOI: 10.1016/j.riam.2015.10.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2015] [Revised: 07/17/2015] [Accepted: 10/08/2015] [Indexed: 10/22/2022] Open
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15
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Ding X, Yan D, Sun W, Zeng Z, Su R, Su J. Epidemiology and risk factors for nosocomial Non-Candida albicans candidemia in adult patients at a tertiary care hospital in North China. Med Mycol 2015; 53:684-90. [PMID: 26229153 DOI: 10.1093/mmy/myv060] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2015] [Accepted: 06/02/2015] [Indexed: 01/08/2023] Open
Abstract
Nosocomial candidemia extends the length of hospital stay, increases the costs of medical care, and is associated with a high mortality rate. Epidemiological data that assist in the choice of initial therapy may help to improve the prognosis. The present study was undertaken to investigate the epidemiology of nosocomial candidemia and identify risk factors for nosocomial candidemia caused by C. albicans and non-albicans Candida species (NAC). A retrospective chart review was undertaken to analyze cases of nosocomial candidemia treated at the Beijing Friendship Hospital between January 2008 and December 2012. All cases of candidemia were identified using the previously published criteria. Among 106 patients analyzed, 53.8% had nosocomial candidemia caused by NAC. Candida albicans was the most common causative agent, accounting for 46.2% of all cases, followed by C. glabrata (25.5%), C. tropicalis (15.1%), C. parapsilosis (10.4%) and C. Krusei (0.9%). Comparison of nosocomial C. albicans and NAC candidemia by multivariate logistic regression showed that factors independently associated with nosocomial NAC candidemia included exposure to azole agents (odds ratio [OR]: 3.359; 95% confidence interval [CI]: 1.136-10.154; P = .031) and artificial surgical implants (OR: 37.519; 95% CI: 2.5-562.998; P = .009). A significant risk factor for nosocomial C. albicans candidemia was cancer surgery (OR: 0.075; 95% CI: 0.013-0.437; P = .004). Clinical and epidemiological differences in the risk factors between nosocomial candidemia caused by C. albicans and NAC should be considered when selecting an initial antifungal regimen for the treatment of adult patients. This should be undertaken before the availability of species identification and/or antifungal susceptibility results.
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Affiliation(s)
- Xiurong Ding
- Department of Clinical Laboratory, Beijing Youan Hospital, Capital Medical University, Beijing 100069, China
| | - Donghui Yan
- Clinical Laboratory Center, Beijing Friendship Hospital, Capital Medical University, Beijing100050, China
| | - Wei Sun
- Clinical Laboratory Center, Beijing Friendship Hospital, Capital Medical University, Beijing100050, China
| | - Zhaoyin Zeng
- Clinical Laboratory Center, Beijing Friendship Hospital, Capital Medical University, Beijing100050, China
| | - Ruirui Su
- Clinical Laboratory Center, Beijing Friendship Hospital, Capital Medical University, Beijing100050, China
| | - Jianrong Su
- Clinical Laboratory Center, Beijing Friendship Hospital, Capital Medical University, Beijing100050, China
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16
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Queiroz PA, Godoy JSR, Mendonça PDSB, Pedroso RB, Svidzinski TIE, Negri M. Adhesion and biofilm formation in artificial saliva and susceptibility of yeasts isolated from chronic kidney patients undergoing haemodialysis. J Med Microbiol 2015; 64:960-966. [PMID: 26297016 DOI: 10.1099/jmm.0.000122] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Yeasts of the genera Candida and Saccharomyces are opportunist pathogens and cause oral lesions, especially in immunocompromised patients. This study assessed yeasts isolated from chronic kidney patients undergoing haemodialysis for their adhesion capacity, biofilm formation and susceptibility to antifungal agents. Ten isolates of Candida spp. and one isolate of Saccharomyces cerevisiae were tested for adhesion to buccal epithelial cells (BECs), adhesion and formation of biofilm in artificial saliva and their susceptibility profile to antifungal agents. Adhesion and biofilm formation were undertaken in polystyrene plates with artificial saliva, whilst susceptibility to antifungal agents was evaluated by broth microdilution. Candida parapsilosis had the highest adhesion index in BECs (154.55 ± 22.13) and Candida rugosa was the species with the highest adhesion capacity (18 398 Abs cm(-2)) in abiotic surface with artificial saliva. Candida albicans provided the greatest biofilm formation (2035 Abs cm(-2) ± 0.09) but was revealed to be susceptible to the five antifungal agents under analysis. However, some non-albicans Candida isolates showed a lower susceptibility for the antifungal agents itraconazole, fluconazole and voriconazole. All of the species were sensitive to amphotericin B and nystatin. The current analysis showed that yeasts isolated from the mouth of chronic kidney patients undergoing haemodialysis varied significantly with regard to their capacity for adherence, biofilm formation and susceptibility to antifungal agents, underscoring the high virulence of non-albicans Candida species.
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Affiliation(s)
| | | | | | | | | | - Melyssa Negri
- Universidade Estadual de Maringá (UEM), Maringá, Paraná, Brazil
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17
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Li XY, Zhang K, Jiang ZY, Cai LH. MiR-204/miR-211 downregulation contributes to candidemia-induced kidney injuries via derepression of Hmx1 expression. Life Sci 2014; 102:139-44. [PMID: 24641951 DOI: 10.1016/j.lfs.2014.03.010] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2013] [Revised: 02/14/2014] [Accepted: 03/06/2014] [Indexed: 02/02/2023]
Abstract
AIMS This study was aimed to exploit the role of heme oxygenase Hmx1 and the potential miRNA mechanisms in the kidney injuries induced by urinary tract infection by Candida species/Candidemia. MAIN METHODS We employed a mouse model of systemic Candidiasis by injection of the Candida albicans strain SC5314 into C57BL/6 mice. Kidney injuries were assessed by measuring serum cystatin C (CysC), serum β2-microglobulin (β2-MG) and blood urea nitrogen (BUN). Validation of miRNA target gene was conducted by luciferase reporter gene assay, Western blot analysis and real-time RT-PCR. KEY FINDINGS We showed here that Candidemia caused significant downregulation of microRNAs miR-204 and miR-211. In sharp contrast, Hmx1 expression was remarkably upregulated, particularly at the protein level. Computational analysis predicted Hmx1 as a target gene for both miR-204 and miR-211 that share the same seed site sequence. We then experimentally validated the targeting relationship between miR-204/miR-211 and Hmx1, which explains the reciprocal changes of expression of miR-204/miR-211 and Hmx1 in Candidemia. Administration of miR-204/miR-211 mimics substantially downregulated Hmx1 and mitigated the severity of the kidney injuries induced by Candidemia, as reflected by improved renal glomerular filtration rate (GFR) determined by serum cystatin C (CysC), serum β2-microglobulin (β2-MG) and blood urea nitrogen (BUN). Knockdown of miR-204/miR-211 worsened while forced expression of miR-204/miR-211 ameliorated kidney injuries in mice with systemic Candidiasis. SIGNIFICANCE Our findings indicate that miR-204/miR-211 downregulation accounts at least partially for the Hmx1 upregulation and the miR-204/miR-211-Hmx1 signaling axis may contribute to immune-suppression in the host thereby the Candidemia-induced kidney dysfunction.
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Affiliation(s)
- Xiao-Yue Li
- Department of Critical Care Medicine, Dongguan People's Hospital, Dongguan, Guangdong 523059, China
| | - Ke Zhang
- Department of Infectious Diseases, PLA421 Hospital, Guangzhou, Guangdong 510318, China
| | - Zhi-Yi Jiang
- Department of Critical Care Medicine, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, Guangdong 510080, China
| | - Li-Hua Cai
- Department of Critical Care Medicine, Dongguan People's Hospital, Dongguan, Guangdong 523059, China.
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18
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Pan SC. Non-albicans Candida related candidemia among patients with chronic hemodialysis in the intensive care unit: true incidence or cluster infections? J Formos Med Assoc 2013; 112:438. [PMID: 23927987 DOI: 10.1016/j.jfma.2013.02.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2013] [Accepted: 02/20/2013] [Indexed: 10/27/2022] Open
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19
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Serefhanoglu K. Reply to "Non-albicans Candida related candidemia among patients with chronic hemodialysis in the intensive care unit: true incidence or cluster infections?". J Formos Med Assoc 2013; 112:439. [PMID: 23927988 DOI: 10.1016/j.jfma.2013.03.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2013] [Revised: 02/28/2013] [Accepted: 03/01/2013] [Indexed: 11/19/2022] Open
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