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Cerqueira FM, Bertsch J, DeMaet MA, York T, McDougal A, Patel JA, Ren P. Enhancing Candida auris Surveillance in High-Risk Settings by Implementing a High-Throughput Molecular Assay on the Hologic Fusion Open Access Platform. J Fungi (Basel) 2024; 10:285. [PMID: 38667956 PMCID: PMC11051439 DOI: 10.3390/jof10040285] [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: 02/06/2024] [Revised: 03/18/2024] [Accepted: 04/10/2024] [Indexed: 04/28/2024] Open
Abstract
Candida auris, a resilient pathogenic yeast with frequent multidrug resistance, presents a persistent challenge in healthcare settings. The timely identification of C. auris is crucial for infection control and prevention, especially in facilities facing unique hurdles, such as our institution, which serves four major hospitals and approximately 80% of the Texas inmate population. Understaffing, communal living, and financial constraints exacerbate infection control issues. To address common staff shortages, streamline testing services, and enhance testing efficiency, there was a pressing need for rapid and high-throughput detection of C. auris. This study presents the validation and utility of an assay implemented on the Hologic Fusion Open Access platform using samples collected from high-risk patients' axilla and groin areas, as well as environmental swab samples from patient rooms. Our assay complemented efforts to control C. auris outbreaks within our healthcare system, providing valuable insights into its presence within surveillance samples. This assay demonstrated the value of high-throughput molecular detection platforms in challenging healthcare environments by aiding infection preventionists in containing the spread of C. auris and preventing nosocomial infections. Our research contributes essential data on the suitability and performance of the Hologic Fusion Open Access platform for C. auris detection. These findings hold significant implications for enhancing surveillance and control measures in high-risk settings, making a significant impact on the field of infection control and prevention.
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Affiliation(s)
| | | | | | | | | | | | - Ping Ren
- Department of Pathology, University of Texas Medical Branch, Galveston, TX 77555, USA; (F.M.C.); (J.B.); (M.A.D.); (T.Y.); (A.M.); (J.A.P.)
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Gugsch F, Tan CK, Oh DY, Paßvogel L, Steinhauer K. Efficacy of octenidine- and chlorhexidine-based wash-mitts against Candida albicans and Candida auris - a comparative study. J Hosp Infect 2024; 143:91-96. [PMID: 37949371 DOI: 10.1016/j.jhin.2023.10.018] [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: 09/02/2023] [Revised: 10/13/2023] [Accepted: 10/22/2023] [Indexed: 11/12/2023]
Abstract
BACKGROUND Management of outbreaks of the newly emerging pathogen Candida auris may include use of antimicrobial wash-mitts for decolonization. However, currently there is little clinical evidence to support the wide adoption of 'whole-body decolonization' as part of the protocol to effectively manage C. auris outbreaks. The aim of this study was to investigate the chemical tolerance of C. auris compared with the surrogate test organism Candida albicans as established in the European Standards (EN). METHODS Two commercially available antiseptic-impregnated wash-mitts based on either chlorhexidine digluconate (CHG) or octenidine dihydrochloride (OCT) were studied. Comparison of susceptibility of C. auris and C. albicans was investigated based on the standardized test protocol EN 13624. Experiments were conducted using the impregnation liquid squeezed from the wash-mitts at a contact time of 30 s at different concentrations between 0.5% and 97% in the presence of low organic soiling. FINDINGS Yeasticidal efficacy according to EN 13624 was found for the OCT wash-mitts at 30 s at ≥10% concentration with C. albicans. In comparison, reduction ≥4 log10 was found at a much lower concentration of ≥1% for both C. auris strains. For the CHG wash-mitts, efficacy against C. albicans was below 2 log10 reduction at 97% concentration within 30 s. Efficacy against the two C. auris strains was around 3 log10 reduction. CONCLUSION Both C. auris strains were found to be significantly more susceptible when compared with C. albicans. Data also demonstrate that not all antiseptic-impregnated wash-mitts are equally effective against C. auris with OCT having a higher efficacy compared with CHG.
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Affiliation(s)
- F Gugsch
- bactologicum GmbH, Itzehoe, Germany
| | - C K Tan
- bactologicum GmbH, Itzehoe, Germany
| | - D Y Oh
- Schülke & Mayr GmbH, Norderstedt, Germany
| | - L Paßvogel
- Schülke & Mayr GmbH, Norderstedt, Germany
| | - K Steinhauer
- bactologicum GmbH, Itzehoe, Germany; University of Applied Sciences, Kiel, Germany.
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Fang T, Xiong J, Wang L, Feng Z, Hang S, Yu J, Li W, Feng Y, Lu H, Jiang Y. Unexpected Inhibitory Effect of Octenidine Dihydrochloride on Candida albicans Filamentation by Impairing Ergosterol Biosynthesis and Disrupting Cell Membrane Integrity. Antibiotics (Basel) 2023; 12:1675. [PMID: 38136708 PMCID: PMC10741164 DOI: 10.3390/antibiotics12121675] [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: 10/25/2023] [Revised: 11/20/2023] [Accepted: 11/25/2023] [Indexed: 12/24/2023] Open
Abstract
Candida albicans filamentation plays a significant role in developing both mucosal and invasive candidiasis, making it a crucial virulence factor. Consequently, exploring and identifying inhibitors that impede fungal hyphal formation presents an intriguing approach toward antifungal strategies. In line with this anti-filamentation strategy, we conducted a comprehensive screening of a library of FDA-approved drugs to identify compounds that possess inhibitory properties against hyphal growth. The compound octenidine dihydrochloride (OCT) exhibits potent inhibition of hyphal growth in C. albicans across different hyphae-inducing media at concentrations below or equal to 3.125 μM. This remarkable inhibitory effect extends to biofilm formation and the disruption of mature biofilm. The mechanism underlying OCT's inhibition of hyphal growth is likely attributed to its capacity to impede ergosterol biosynthesis and induce the generation of reactive oxygen species (ROS), compromising the integrity of the cell membrane. Furthermore, it has been observed that OCT demonstrates protective attributes against invasive candidiasis in Galleria mellonella larvae through its proficient eradication of C. albicans colonization in infected G. mellonella larvae by impeding hyphal formation. Although additional investigation is required to mitigate the toxicity of OCT in mammals, it possesses considerable promise as a potent filamentation inhibitor against invasive candidiasis.
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Affiliation(s)
| | | | | | | | | | | | | | | | - Hui Lu
- Department of Pharmacy, Shanghai Tenth People’s Hospital, School of Medicine, Tongji University, Shanghai 200072, China
| | - Yuanying Jiang
- Department of Pharmacy, Shanghai Tenth People’s Hospital, School of Medicine, Tongji University, Shanghai 200072, China
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van der Starre CM, Cremers-Pijpers SAJ, van Rossum C, Bowles EC, Tostmann A. The in situ efficacy of whole room disinfection devices: a literature review with practical recommendations for implementation. Antimicrob Resist Infect Control 2022; 11:149. [PMID: 36471395 PMCID: PMC9724435 DOI: 10.1186/s13756-022-01183-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2022] [Accepted: 11/10/2022] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Terminal cleaning and disinfection of hospital patient rooms must be performed after discharge of a patient with a multidrug resistant micro-organism to eliminate pathogens from the environment. Terminal disinfection is often performed manually, which is prone to human errors and therefore poses an increased infection risk for the next patients. Automated whole room disinfection (WRD) replaces or adds on to the manual process of disinfection and can contribute to the quality of terminal disinfection. While the in vitro efficacy of WRD devices has been extensively investigated and reviewed, little is known about the in situ efficacy in a real-life hospital setting. In this review, we summarize available literature on the in situ efficacy of WRD devices in a hospital setting and compare findings to the in vitro efficacy of WRD devices. Moreover, we offer practical recommendations for the implementation of WRD devices. METHODS The in situ efficacy was summarized for four commonly used types of WRD devices: aerosolized hydrogen peroxide, H2O2 vapour, ultraviolet C and pulsed xenon ultraviolet. The in situ efficacy was based on environmental and clinical outcome measures. A systematic literature search was performed in PubMed in September 2021 to identify available literature. For each disinfection system, we summarized the available devices, practical information, in vitro efficacy and in situ efficacy. RESULTS In total, 54 articles were included. Articles reporting environmental outcomes of WRD devices had large variation in methodology, reported outcome measures, preparation of the patient room prior to environmental sampling, the location of sampling within the room and the moment of sampling. For the clinical outcome measures, all included articles reported the infection rate. Overall, these studies consistently showed that automated disinfection using any of the four types of WRD is effective in reducing environmental and clinical outcomes. CONCLUSION Despite the large variation in the included studies, the four automated WRD systems are effective in reducing the amount of pathogens present in a hospital environment, which was also in line with conclusions from in vitro studies. Therefore, the assessment of what WRD device would be most suitable in a specific healthcare setting mostly depends on practical considerations.
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Affiliation(s)
- Caroline M. van der Starre
- grid.10417.330000 0004 0444 9382Unit of Hygiene and Infection Prevention, Department of Medical Microbiology, Radboud Center for Infectious Diseases (RCI), Radboudumc, Geert Grooteplein Zuid 10, 6525 GA Nijmegen, The Netherlands
| | - Suzan A. J. Cremers-Pijpers
- grid.10417.330000 0004 0444 9382Unit of Hygiene and Infection Prevention, Department of Medical Microbiology, Radboud Center for Infectious Diseases (RCI), Radboudumc, Geert Grooteplein Zuid 10, 6525 GA Nijmegen, The Netherlands
| | - Carsten van Rossum
- grid.10417.330000 0004 0444 9382Unit of Hygiene and Infection Prevention, Department of Medical Microbiology, Radboud Center for Infectious Diseases (RCI), Radboudumc, Geert Grooteplein Zuid 10, 6525 GA Nijmegen, The Netherlands
| | - Edmée C. Bowles
- grid.10417.330000 0004 0444 9382Unit of Hygiene and Infection Prevention, Department of Medical Microbiology, Radboud Center for Infectious Diseases (RCI), Radboudumc, Geert Grooteplein Zuid 10, 6525 GA Nijmegen, The Netherlands
| | - Alma Tostmann
- grid.10417.330000 0004 0444 9382Unit of Hygiene and Infection Prevention, Department of Medical Microbiology, Radboud Center for Infectious Diseases (RCI), Radboudumc, Geert Grooteplein Zuid 10, 6525 GA Nijmegen, The Netherlands
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Comparative Fungicidal Activities of N-Chlorotaurine and Conventional Antiseptics against Candida spp. Isolated from Vulvovaginal Candidiasis. J Fungi (Basel) 2022; 8:jof8070682. [PMID: 35887439 PMCID: PMC9322802 DOI: 10.3390/jof8070682] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2022] [Revised: 06/01/2022] [Accepted: 06/09/2022] [Indexed: 02/01/2023] Open
Abstract
N-chlorotaurine (NCT), the N-chloro derivative of the amino acid taurine, is a long-lived oxidant produced by stimulated human leucocytes. NCT has antimicrobial activities which are generally enhanced in the presence of organic material. The aim of this study was to investigate fungicidal effects of NCT and conventional antiseptics against Candida isolated from vulvovaginal candidiasis (VVC). Chlorhexidine (CHX, 1.6%), octenidine dihydrochloride (OCT, 0.08%), povidone iodine (PVP-I, 8%), boric acid (8%), and NCT (0.1% (5.5 mM)) were evaluated against forty-four Candida isolates, according to European Standard methods, at 30, 60, 90, and 120 min and 24 h in the presence of skim milk as an organic material. CHX, OCT, and PVP-I showed rapid fungicidal activity against all Candida isolates with 5–6 log10 reduction of viable counts after 30 min, whereas boric acid and NCT needed 1 h against Candida albicans and 2 h against non-albicans Candida for a significant 3 log10 reduction. NCT showed fungicidal activity (defined as ≥4 log10 reduction) against C. albicans within 90 min and C. non–albicans within 24 h. Based upon all presently available data, including our results, NCT could be used as a new agent for treatment of local fungal infections such as VVC.
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Bandara HMHN, Samaranayake LP. Emerging strategies for environmental decontamination of the nosocomial fungal pathogen Candida auris. J Med Microbiol 2022; 71. [PMID: 35687657 DOI: 10.1099/jmm.0.001548] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Candida auris is a recently emerged multidrug-resistant fungal pathogen that causes life-threatening infections to the human population worldwide. Recent rampant outbreaks of C. auris in coronavirus disease 2019 (COVID-19) patients, together with outbreaks in over 45 countries, highlight its threat to patients and healthcare economies. Unlike other pathogenic Candida species, C. auris is capable of surviving in abiotic surfaces of healthcare facilities for prolonged periods, leading to increased risk of transmission within nosocomial settings. C. auris is resistant to multiple classes of antifungal agents, forms dry biofilms and transmits independently to regional epicentres, making its eradication from nosocomial environment arduous. The lack of strategies for environmental decontamination of C. auris from nosocomial settings is evident from the generic guidance and recommendations provided by leading global healthcare bodies. Therefore, this minireview discusses the current guidelines for environmental decontamination of C. auris and compounds and strategies currently under investigation for potential future use. While established guidelines recommend the use of products mainly consisting of sodium hypochlorite and hydrogen peroxide, initial works have been reported on the promising anti-C. auris properties of various other compounds and some biocompatible alternatives. Further validation of these approaches, coupled up with environmentally friendly decontamination protocols, are warranted to achieve superior elimination of C. auris from healthcare settings.
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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
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Mariita RM, Davis JH, Lottridge MM, Randive RV. Shining light on multi-drug resistant Candida auris: Ultraviolet-C disinfection, wavelength sensitivity, and prevention of biofilm formation of an emerging yeast pathogen. Microbiologyopen 2022; 11:e1261. [PMID: 35212481 PMCID: PMC8767514 DOI: 10.1002/mbo3.1261] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2021] [Accepted: 12/13/2021] [Indexed: 12/22/2022] Open
Abstract
Candida auris is an emerging fungal superbug of worldwide interest. It is associated with high mortality rates and exhibits increased resistance to antifungals. Ultraviolet subtype C (UVC) light can be used to disinfect surfaces to mitigate its spread. The objectives of this study were (1) To investigate UVC disinfection performances and wavelength sensitivity of C. auris. (2) To evaluate the UVC dose required for the prevention of biofilm formation on stainless-steel, plastic (polystyrene), and poly-cotton fabric surfaces. C. auris was grown following standard procedures. The study utilized six different UVC LED arrays with wavelengths between 252 and 280 nm. Arrays were set at similar intensities, to obtain doses of 5-40 mJ cm-2 and similar irradiation time. Disinfection performance for each array was determined using log reduction value (LRV) and percentage reduction by comparing the controls against the irradiated treatments. Evaluation of the ability of 267 nm UVC LEDs to prevent C. auris biofilm formation was investigated using stainless-steel, plastic coupons, and poly-cotton fabric. Peak sensitivity to UVC disinfection was between 267 and 270 nm. With 20 mJ cm-2 , the study obtained ≥LRV3. On stainless-steel coupons, 30 mJ cm-2 was sufficient to prevent biofilm formation, while on plastic, this required 10 mJ cm-2 . A dose of 60 mJ cm-2 reduced biofilms on poly-cotton fabric significantly (R2 = 0.9750, p = 0.0002). The study may allow for the design and implementation of disinfection systems.
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Affiliation(s)
- Richard M. Mariita
- Product Engineering DepartmentCrystal IS Inc., an Asahi Kasei CompanyGreen IslandNew YorkUSA
| | - James H. Davis
- Product Engineering DepartmentCrystal IS Inc., an Asahi Kasei CompanyGreen IslandNew YorkUSA
| | - Michelle M. Lottridge
- Product Engineering DepartmentCrystal IS Inc., an Asahi Kasei CompanyGreen IslandNew YorkUSA
| | - Rajul V. Randive
- Product Engineering DepartmentCrystal IS Inc., an Asahi Kasei CompanyGreen IslandNew YorkUSA
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Pandian M, Kumar VA, Jayakumar R. Antiseptic chitosan bandage for preventing topical skin infections. Int J Biol Macromol 2021; 193:1653-1658. [PMID: 34742845 DOI: 10.1016/j.ijbiomac.2021.11.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2021] [Revised: 10/18/2021] [Accepted: 11/01/2021] [Indexed: 01/16/2023]
Abstract
Infections on the wound surface are the major problem in restricting the healing process. To reduce the transmission and treat the infection, we have developed 0.05% and 0.1% octenidine dihydrochloride (Ocd) incorporated chitosan (Cs) based flexible bandages. Ocd is extensively used skin antiseptic for its mode of action over a broad spectrum of antimicrobial activity. The prepared antiseptic Cs-Ocd bandage was characterized using Fourier transform infrared spectroscopy (FT-IR) and scanning electron microscope (SEM). In addition, swelling, degradation, cytocompability, antibacterial, and anti-biofilm property of the developed bandages were studied. This highly porous nature of Cs-Ocd bandage showed enhanced swelling property, slow degradation profile and controlled release of Ocd. The prepared antiseptic bandage exhibited synergistic effect showing good hemostatic potential with Cs, excellent antimicrobial and anti-biofilm activity with Ocd against Staphylococcus aureus (S. aureus) and Candida auris (C. auris). Thus, the developed Cs-Ocd bandage can be used as potential antiseptic bandage for skin infections.
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Affiliation(s)
- Mahalakshmi Pandian
- Centre for Nanosciences and Molecular Medicine, Amrita Vishwa Vidyapeetham, Kochi 682041, Kerala, India
| | - V Anil Kumar
- Department of Microbiology, Amrita Institute of Medical Sciences and Research Centre, Amrita Vishwa Vidyapeetham, Kochi 682041, India
| | - R Jayakumar
- Centre for Nanosciences and Molecular Medicine, Amrita Vishwa Vidyapeetham, Kochi 682041, Kerala, India.
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Astrid F, Beata Z, Van den Nest Miriam, Julia E, Elisabeth P, Magda DE. The use of a UV-C disinfection robot in the routine cleaning process: a field study in an Academic hospital. Antimicrob Resist Infect Control 2021; 10:84. [PMID: 34051861 PMCID: PMC8164075 DOI: 10.1186/s13756-021-00945-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2020] [Accepted: 02/26/2021] [Indexed: 12/02/2022] Open
Abstract
Background Environmental surface decontamination is a crucial tool to prevent the spread of infections in hospitals. However, manual cleaning and disinfection may be insufficient to eliminate pathogens from contaminated surfaces. Ultraviolet-C (UV-C) irradiation deploying autonomous disinfection devices, i.e. robots, are increasingly advertised to complement standard decontamination procedures with concurrent reduction of time and workload. Although the principle of UV-C based disinfection is proven, little is known about the operational details of UV-C disinfection delivered by robots. To explore the impact of a UV-C disinfection robot in the clinical setting, we investigated its usability and the effectiveness as an add-on to standard environmental cleaning and disinfection. Additionally, its effect on Candida auris, a yeast pathogen resistant to antifungals and disinfectants, was studied. Methods After setting the parameters “surface distance” and “exposure time” for each area as given by the manufacturer, the robot moved autonomously and emitted UV-C irradiation in the waiting areas of two hospital outpatient clinics after routine cleaning and/or disinfection. To quantify the efficacy of the robotic UV-C disinfection, we obtained cultures from defined sampling sites in these areas at baseline, after manual cleaning/disinfection and after the use of the robot. Four different C. auris strains at two concentrations and either in a lag or in a stationary growth phase were placed in these areas and exposed to UV-C disinfection as well. Results The UV-C irradiation significantly reduced the microbial growth on the surfaces after manual cleaning and disinfection. C. auris growth in the lag phase was inhibited by the UV-C irradiation but not in the presence of the rim shadows. The effects on C. auris in the stationary phase were differential, but overall C. auris strains were not effectively killed by the standard UV-C disinfection cycle. Regarding usability, the robot’s interface was not intuitive, requiring advanced technical knowledge or intensive training prior to its use. Additionally, the robot required interventions by the technical operator during the disinfection process, e.g. stopping due to unforeseen minor dislocation of items during the clinical service or due to moving individuals, making it a delicate high-tech device but not yet ready for the autonomous use in the clinical routine. Conclusions Presently, the UV-C robot tested in this study is not ready to be integrated in the environmental cleaning and disinfection procedures in our hospital. The single standard disinfection UV-C irradiation cycle is not sufficient to inactivate pathogens with augmented environmental resilience, e.g. C. auris, particularly when microbial loads are high. Supplementary Information The online version contains supplementary material available at 10.1186/s13756-021-00945-4.
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Affiliation(s)
- Füszl Astrid
- Department of Infection Control and Hospital Epidemiology, Medical University Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria
| | - Zatorska Beata
- Department of Infection Control and Hospital Epidemiology, Medical University Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria
| | - Van den Nest Miriam
- Department of Infection Control and Hospital Epidemiology, Medical University Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria
| | - Ebner Julia
- Department of Infection Control and Hospital Epidemiology, Medical University Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria
| | - Presterl Elisabeth
- Department of Infection Control and Hospital Epidemiology, Medical University Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria.
| | - Diab-Elschahawi Magda
- Department of Infection Control and Hospital Epidemiology, Medical University Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria
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Sathyapalan DT, Antony R, Nampoothiri V, Kumar A, Shashindran N, James J, Thomas J, Prasanna P, Sudhir AS, Philip JM, Edathadathil F, Prabhu B, Singh S, Moni M. Evaluating the measures taken to contain a Candida auris outbreak in a tertiary care hospital in South India: an outbreak investigational study. BMC Infect Dis 2021; 21:425. [PMID: 33957894 PMCID: PMC8101254 DOI: 10.1186/s12879-021-06131-6] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2021] [Accepted: 04/16/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Candida auris infections are an emerging global threat with poor clinical outcome, high mortality rate, high transmission rate and outbreak potential. The objective of this work is to describe a multidisciplinary approach towards the investigation and containment of a Candida auris outbreak and the preventive measures adopted in a resource limited setting. METHODS This outbreak investigational study was conducted at a 1300-bedded tertiary care academic hospital in South India. The study included 15 adult inpatients with laboratory confirmed Candida auris isolates. The outbreak cluster was identified in adult patients admitted from September 2017 to 2019. The system response consisted of a critical alert system for laboratory confirmed Candida auris infection and multidisciplinary 'Candida auris care team' for patient management. The team implemented stringent Infection Prevention and Control (IPC) measures including patient cohorting, standardized therapy and decolonization, staff training, prospective surveillance and introduction of Candida auris specific care bundle. RESULTS Two outbreak clusters were identified; first cluster occurring between October and November 2017 and the second cluster in May 2018. The cohorts consisted of 7 and 8 Candida auris positive patients in the first and second waves of the outbreak respectively with a total survival rate of 93% (14/15). Deployment of containment measures led to gradual decline in the incidence of adult Candida auris positive cases and prevented further cluster formation. CONCLUSIONS The sustained implementation of guideline and evidence-based IPC measures and training of healthcare workers for improving awareness on systematically following standardized protocols of Candida auris related IPC practices successfully contained Candida auris outbreaks at our hospital. This demonstrates the feasibility of establishing a multidisciplinary model and bundling of practices for preventing Candida auris outbreaks in a Low- and Middle-income country.
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Affiliation(s)
- Dipu Thareparambil Sathyapalan
- Department of General Medicine and Division of Infectious Diseases, Amrita Institute of Medical Sciences, Kochi, Kerala, India
| | - Remya Antony
- Department of Infection Control and Epidemiology, Amrita Institute of Medical Sciences, Kochi, Kerala, India
| | - Vrinda Nampoothiri
- Department of Infection Control and Epidemiology, Amrita Institute of Medical Sciences, Kochi, Kerala, India
| | - Anil Kumar
- Department of Microbiology, Amrita Institute of Medical Sciences, Kochi, Kerala, India
| | - Nandita Shashindran
- Department of Microbiology, Amrita Institute of Medical Sciences, Kochi, Kerala, India
| | - Jini James
- Department of Infection Control and Epidemiology, Amrita Institute of Medical Sciences, Kochi, Kerala, India
| | - Jisha Thomas
- Department of Infection Control and Epidemiology, Amrita Institute of Medical Sciences, Kochi, Kerala, India
| | - Preetha Prasanna
- Department of General Medicine and Division of Infectious Diseases, Amrita Institute of Medical Sciences, Kochi, Kerala, India
| | - Akkulath Sangita Sudhir
- Department of Infection Control and Epidemiology, Amrita Institute of Medical Sciences, Kochi, Kerala, India
| | - Jeslyn Mary Philip
- Department of Infection Control and Epidemiology, Amrita Institute of Medical Sciences, Kochi, Kerala, India
| | - Fabia Edathadathil
- Department of Infection Control and Epidemiology, Amrita Institute of Medical Sciences, Kochi, Kerala, India
| | - Binny Prabhu
- Department of Geriatrics and General Medicine, Epsom and St Heliers NHS trust, Epsom, UK
| | - Sanjeev Singh
- Department of Infection Control and Epidemiology, Amrita Institute of Medical Sciences, Kochi, Kerala, India
| | - Merlin Moni
- Department of General Medicine and Division of Infectious Diseases, Amrita Institute of Medical Sciences, Kochi, Kerala, India.
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Ahmad S, Alfouzan W. Candida auris: Epidemiology, Diagnosis, Pathogenesis, Antifungal Susceptibility, and Infection Control Measures to Combat the Spread of Infections in Healthcare Facilities. Microorganisms 2021; 9:microorganisms9040807. [PMID: 33920482 PMCID: PMC8069182 DOI: 10.3390/microorganisms9040807] [Citation(s) in RCA: 85] [Impact Index Per Article: 28.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2021] [Revised: 04/08/2021] [Accepted: 04/09/2021] [Indexed: 12/21/2022] Open
Abstract
Candida auris, a recently recognized, often multidrug-resistant yeast, has become a significant fungal pathogen due to its ability to cause invasive infections and outbreaks in healthcare facilities which have been difficult to control and treat. The extraordinary abilities of C. auris to easily contaminate the environment around colonized patients and persist for long periods have recently resulted in major outbreaks in many countries. C. auris resists elimination by robust cleaning and other decontamination procedures, likely due to the formation of 'dry' biofilms. Susceptible hospitalized patients, particularly those with multiple comorbidities in intensive care settings, acquire C. auris rather easily from close contact with C. auris-infected patients, their environment, or the equipment used on colonized patients, often with fatal consequences. This review highlights the lessons learned from recent studies on the epidemiology, diagnosis, pathogenesis, susceptibility, and molecular basis of resistance to antifungal drugs and infection control measures to combat the spread of C. auris infections in healthcare facilities. Particular emphasis is given to interventions aiming to prevent new infections in healthcare facilities, including the screening of susceptible patients for colonization; the cleaning and decontamination of the environment, equipment, and colonized patients; and successful approaches to identify and treat infected patients, particularly during outbreaks.
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Billamboz M, Fatima Z, Hameed S, Jawhara S. Promising Drug Candidates and New Strategies for Fighting against the Emerging Superbug Candida auris. Microorganisms 2021; 9:microorganisms9030634. [PMID: 33803604 PMCID: PMC8003017 DOI: 10.3390/microorganisms9030634] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Revised: 03/04/2021] [Accepted: 03/08/2021] [Indexed: 12/12/2022] Open
Abstract
Invasive fungal infections represent an expanding threat to public health. During the past decade, a paradigm shift of candidiasis from Candida albicans to non-albicans Candida species has fundamentally increased with the advent of Candida auris. C. auris was identified in 2009 and is now recognized as an emerging species of concern and underscores the urgent need for novel drug development strategies. In this review, we discuss the genomic epidemiology and the main virulence factors of C. auris. We also focus on the different new strategies and results obtained during the past decade in the field of antifungal design against this emerging C. auris pathogen yeast, based on a medicinal chemist point of view. Critical analyses of chemical features and physicochemical descriptors will be carried out along with the description of reported strategies.
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Affiliation(s)
- Muriel Billamboz
- Inserm, CHU Lille, Institut Pasteur Lille, Université Lille, U1167—RID-AGE—Facteurs de Risque et Déterminants Moléculaires des Maladies liées au Vieillissement, F-59000 Lille, France
- Junia, Health and Environment, Laboratory of Sustainable Chemistry and Health, F-59000 Lille, France
- Correspondence: (M.B.); (S.J.)
| | - Zeeshan Fatima
- Amity Institute of Biotechnology, Amity University Haryana, Manesar, Gurugram 122413, India; (Z.F.); (S.H.)
| | - Saif Hameed
- Amity Institute of Biotechnology, Amity University Haryana, Manesar, Gurugram 122413, India; (Z.F.); (S.H.)
| | - Samir Jawhara
- UMR 8576-UGSF-Unité de Glycobiologie Structurale et Fonctionnelle, Centre National de la Recherche Scientifique, INSERM U1285, University of Lille, F-59000 Lille, France
- Correspondence: (M.B.); (S.J.)
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Yakuschenko IK, Pozdeeva NN, Mumyatova VA, Terentiev AA, Gadomsky SY. Iso-octenidine: Promising Octenidine Analogue with Improved Solubility. Curr Org Synth 2021; 18:443-445. [PMID: 33390116 DOI: 10.2174/1570179417666201231104453] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2020] [Revised: 11/13/2020] [Accepted: 11/25/2020] [Indexed: 11/22/2022]
Abstract
Iso-octenidine, an isomer of octenidine dihydrochloride, was synthesized and studied for the first time. Iso-octenidine was demonstrated to be 3-fold more soluble in water in comparison to original octenidine, and both substances had remarkably similar antibacterial activity (tested on Escherichia Coli and Micrococcus luteus).
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Affiliation(s)
- Igor K Yakuschenko
- Institute of Problems of Chemical Physics of the Russian Academy of Sciences, 142432 Chernogolovka, Moscow Region, Russian Federation
| | - Nataliya N Pozdeeva
- Institute of Problems of Chemical Physics of the Russian Academy of Sciences, 142432 Chernogolovka, Moscow Region, Russian Federation
| | - Viktoriya A Mumyatova
- Institute of Problems of Chemical Physics of the Russian Academy of Sciences, 142432 Chernogolovka, Moscow Region, Russian Federation
| | - Alexey A Terentiev
- Institute of Problems of Chemical Physics of the Russian Academy of Sciences, 142432 Chernogolovka, Moscow Region, Russian Federation
| | - Svyatoslav Ya Gadomsky
- Institute of Problems of Chemical Physics of the Russian Academy of Sciences, 142432 Chernogolovka, Moscow Region, Russian Federation
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15
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Fu L, Le T, Liu Z, Wang L, Guo H, Yang J, Chen Q, Hu J. Different efficacies of common disinfection methods against candida auris and other candida species. J Infect Public Health 2020; 13:730-736. [PMID: 32005617 DOI: 10.1016/j.jiph.2020.01.008] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2019] [Revised: 12/20/2019] [Accepted: 01/06/2020] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Candida auris can form long-lasting colonies in the hospital environment and on human skin. There is limited evidence regarding the efficacy of different methods and products for disinfecting hospitals and colonized patients to prevent the spread of C. auris. METHODS The minimum inhibitory concentration of three disinfectant products ("84" disinfectant, IodineTincture disinfectant, and quaternary ammonium) and 75% ethanol against C. auris and other Candida species were measured. A pig skin model was used to evaluate the efficacy of three hand hygiene products in killing pathogens. The killing effect of ultraviolet-C (253.7 nm) and the LK/CXD bed unit ozone disinfection machine on C. auris was also evaluated. RESULTS Thirty seconds of pig skin washing with bacteriostatic hand sanitizer followed by drying and 15 s of ethanol-based gel can completely eradicate the colonization of C. auris (3.00 log10 CFU). The antifungal activity of ultraviolet-C to C. auris inoculated on bed sheets was significantly reduced (P < 0.01) at a distance of 1 m. Candida glabrata and C. auris showed greater resistance to ozone than other Candida species. The ozone could completely eradicate C. auris (3.60 log10 CFU) on bed sheets at dosage of 300 mg/m3 for 40 min of exposure. CONCLUSIONS We recommend extending the disinfection times of ultraviolet-C and ozone and emphasizing the effectiveness of washing skin with soap, drying skin, and then applying an ethanol-based gel to remove C. auris from skin.
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Affiliation(s)
- Leiwen Fu
- Department of Epidemiology, School of Public Health, Southern Medical University, Guangzhou, China
| | - Tingting Le
- Department of Nosocomial Infection Administration, Zhujiang Hospital, Southern Medical University, Guangzhou, China
| | - Zhihua Liu
- Department of Infectious Disease, Nanfang Hospital, Guangzhou, China
| | - Ling Wang
- Department of Nosocomial Infection Administration, Zhujiang Hospital, Southern Medical University, Guangzhou, China
| | - Huijie Guo
- Department of Epidemiology, School of Public Health, Southern Medical University, Guangzhou, China
| | - Jun Yang
- Department of Epidemiology, School of Public Health, Southern Medical University, Guangzhou, China
| | - Qing Chen
- Department of Epidemiology, School of Public Health, Southern Medical University, Guangzhou, China
| | - Jing Hu
- Department of Epidemiology, School of Public Health, Southern Medical University, Guangzhou, China; Department of Nosocomial Infection Administration, Zhujiang Hospital, Southern Medical University, Guangzhou, China.
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16
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Moshafi MH, Ranjbar M, Ilbeigi G. Eco-Friendly and Systematic Study for Synthesis of La 3+/α-Al 2O 3 Nanoparticles: Antibacterial Activity Against Pathogenic Microbial Strains. Int J Nanomedicine 2020; 14:10137-10146. [PMID: 31920309 PMCID: PMC6941601 DOI: 10.2147/ijn.s215372] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2019] [Accepted: 09/18/2019] [Indexed: 11/23/2022] Open
Abstract
Purpose In this study, for the first time, new nanoparticles of La3+/α-Al2O3 were synthesized with the ultrasonic-assisted hydrothermal method in the presence of honey as an eco-friendly and natural reagent. Methods The as-synthesized La3+/α-Al2O3 nanoparticles were characterized using scanning electron microscopy (SEM), transition electron microscopy (TEM), X-ray diffraction spectroscopy (XRD), energy dispersive X-ray (EDX), UV-visible spectroscopy, and Fourier transform infrared spectroscopy (FTIR) techniques. In this work, we report optimum conditions to synthesize La3+/α-Al2O3 nanoparticles as novel material and as a candidate for antibacterial activity in antibacterial drugs. Results and Conclusion The XRD and SEM micrograph results demonstrate the formation of pure La3+/α-Al2O3 nanoparticles with a particle size in the range of 30-80 nm. The synthesis parameters were systematically examined using analysis of variance (ANOVA) through 2k-1 factorial design, and the factors were an assay for product optimization. Various factors such as hydrothermal time, temperature, ultrasound irradiation and interaction between these factors were investigated on the product size of the products. To investigate antibacterial activity of the La3+/α-Al2O3 nanoparticles with the minimum inhibitory concentration (MIC) method, different dilutions of nanoparticles as 64, 32, 16, 8, 4, 2, 1 and 0.5 μg/mL were dissolved in dimethyl sulfoxide and diluted using distilled water and added to the Mueller-Hinton agar medium containing Escherichia coli, Klebsiella pneumonia, Pseudomonas aeruginosa and Serratia marcescens as gram-negative bacteria and Bacillus subtilis, Staphylococcus aureus, S. epidermidis and Micrococcus luteus as gram-positive bacteria.
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Affiliation(s)
- Mohammad Hasan Moshafi
- Neuroscience Research Center, Institute of Neuropharmacology, Kerman University of Medical Sciences, Kerman, Iran
| | - Mehdi Ranjbar
- Food Drug and Cosmetics Safety Research Center Kerman University of Medical Sciences, Kerman, Iran.,Pharmaceutics Research Center, Institute of Neuropharmacology, Kerman University of Medical Sciences, Kerman, Iran
| | - Ghazaleh Ilbeigi
- Student Research Committee, Kerman University of Medical Sciences, Kerman, Iran
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Kenters N, Kiernan M, Chowdhary A, Denning DW, Pemán J, Saris K, Schelenz S, Tartari E, Widmer A, Meis JF, Voss A. Control of Candida auris in healthcare institutions: Outcome of an International Society for Antimicrobial Chemotherapy expert meeting. Int J Antimicrob Agents 2019; 54:400-406. [PMID: 31419480 DOI: 10.1016/j.ijantimicag.2019.08.013] [Citation(s) in RCA: 57] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2019] [Revised: 08/02/2019] [Accepted: 08/05/2019] [Indexed: 12/23/2022]
Abstract
Candida auris (C. auris) is an emerging fungal pathogen causing invasive infections and outbreaks that have been difficult to control in healthcare facilities worldwide. There is a lack of current evidence for pragmatic infection prevention and control recommendations. The aim of this paper was to review the epidemiology of C. auris and identify best practices with a panel of experts, in order to provide guidance and recommendations for infection prevention and control measures based on available scientific evidence, existing guidelines and expert opinion. The Infection Prevention and Control working group of the International Society of Antimicrobial Chemotherapy organised an expert meeting with infection prevention and mycology experts to review recommendations for healthcare workers on infection prevention and control measures for C. auris at inpatient healthcare facilities. The most common interventions included: screening, standard precautions, cleaning and disinfection, inpatient transfer, outbreak management, decolonisation, and treatment.
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Affiliation(s)
- Nikki Kenters
- Department of Medical Microbiology and Infectious Diseases, Canisius Wilhelmina Hospital (CWZ), Nijmegen, the Netherlands.
| | - Martin Kiernan
- Richard Wells Research Centre, University of West London, UK
| | - Anuradha Chowdhary
- Department of Medical Mycology, Vallabhbhai Patel Chest Institute, University of Delhi, Delhi, India
| | - David W Denning
- Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, and National Aspergillosis Centre, Manchester University NHS Foundation Trust, Manchester, UK
| | - Javier Pemán
- Department of Clinical Microbiology, Hospital Universitari i Politècnic La Fe, Valencia, Spain
| | - Katja Saris
- Department of Medical Microbiology and Infectious Diseases, Canisius Wilhelmina Hospital (CWZ), Nijmegen, the Netherlands; Reshape, Radboudumc, Nijmegen, the Netherlands
| | - Silke Schelenz
- Department of Microbiology, Royal Brompton Hospital, London, UK
| | - Ermira Tartari
- Faculty of Health Sciences, University of Malta, Msida, Malta
| | - Andreas Widmer
- University of Basel Hospitals & Clinics, Basel, Switzerland
| | - Jacques F Meis
- Department of Medical Microbiology and Infectious Diseases, Canisius Wilhelmina Hospital (CWZ), Nijmegen, the Netherlands; Centre of Expertise in Mycology Radboudumc/CWZ, Nijmegen, the Netherlands
| | - Andreas Voss
- Department of Medical Microbiology and Infectious Diseases, Canisius Wilhelmina Hospital (CWZ), Nijmegen, the Netherlands; Department of Medical Mycology, Vallabhbhai Patel Chest Institute, University of Delhi, Delhi, India; Department of Medical Microbiology, Radboudumc, Nijmegen, the Netherlands
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de Groot T, Chowdhary A, Meis JF, Voss A. Killing of Candida auris by UV-C: Importance of exposure time and distance. Mycoses 2019; 62:408-412. [PMID: 30748018 PMCID: PMC6850319 DOI: 10.1111/myc.12903] [Citation(s) in RCA: 43] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2019] [Accepted: 02/05/2019] [Indexed: 11/28/2022]
Abstract
Background Candida auris is a globally emerging yeast, causing severe infections in patients with underlying diseases. This yeast is responsible for several outbreaks within healthcare facilities, where it can be found on hospital surfaces and patient care devices. Spread from these fomites may be prevented by improving the decontamination of hospital surfaces. UV‐C decontamination may constitute an effective adjunct to routine room cleaning. Objectives Our aim was to investigate the effect of different UV‐C exposure times and distance in killing C auris, using strains from different countries. Methods Candida auris was seeded on glass slides and exposed to UV‐C for 5, 10, 20 and 30 minutes at 2 and 4 m. Results A maximal effect of C auris killing was found after 30 minutes of UV‐C exposure at 2 m. With half the time or twice the distance, the efficacy strongly diminished to ~10 and ~50 fold, respectively. At suboptimal exposure times and distances, the C auris strains from Japan/Korea were more sensitive to UV‐C killing than C auris strains originating from Venezuela, Spain and India. Conclusions Altogether, UV‐C exposure times and distance are the most critical parameters to kill C auris, while strain variations of C auris also determine UV‐C efficacy. Future studies should aim to determine the effect and place of UV‐C on surface decontamination in hospital setting.
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Affiliation(s)
- Theun de Groot
- Department of Medical Microbiology and Infectious Diseases, Canisius Wilhelmina Hospital (CWZ), Nijmegen, The Netherlands
| | - Anuradha Chowdhary
- Department of Medical Mycology, Vallabhbhai Patel Chest Institute, University of Delhi, Delhi, India
| | - Jacques F Meis
- Department of Medical Microbiology and Infectious Diseases, Canisius Wilhelmina Hospital (CWZ), Nijmegen, The Netherlands.,Centre of Expertise in Mycology Radboudumc/CWZ, Nijmegen, The Netherlands.,Department of Medical Microbiology, Radboudumc, Nijmegen, The Netherlands
| | - Andreas Voss
- Department of Medical Microbiology and Infectious Diseases, Canisius Wilhelmina Hospital (CWZ), Nijmegen, The Netherlands.,Centre of Expertise in Mycology Radboudumc/CWZ, Nijmegen, The Netherlands.,Department of Medical Microbiology, Radboudumc, Nijmegen, The Netherlands
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