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Konje ET, Kizenga O, Charco NJ, Kibwana UO, Shango N, Tarimo F, Mushi MF. Five-year cross-sectional study to determine the burden of Candida spp. infections of the urinary tract system among patients attending tertiary hospital in Northwestern Tanzania. BMJ Open 2023; 13:e074833. [PMID: 38154909 PMCID: PMC10759120 DOI: 10.1136/bmjopen-2023-074833] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Accepted: 11/17/2023] [Indexed: 12/30/2023] Open
Abstract
OBJECTIVE Urinary tract infections (UTIs) stand as a prominent global health concern. This study entails a 5-year retrospective analysis, using a cross-sectional study design to examine microbiology laboratory data of individuals clinically diagnosed with UTIs at Bugando Medical Centre to gain insights into the prevalence and factors linked to candiduria. METHODOLOGY Data extracted were meticulously cleaned and coded in an MS Excel sheet, subsequently transferred to STATA V.15 for analysis. Binary logistic regression analysis was used to identify factors associated with candiduria. A probability value below 0.05 at a 95% CI was considered statistically significant. RESULTS Urine samples for culture and sensitivity comprised 33.4% (20755) of the total biological samples (62335). The median age of the patients stood at 19 years. A slight majority were female, accounting for 52.8% (10051), and two-thirds sought treatment at outpatient departments (67.5%, 12843). Among patients with significant pathogenic growth, the prevalence of candiduria was 4.6% (221 out of 4772). Notably, inpatients exhibited a higher incidence of candiduria compared with outpatients, with rates of 9.4% (1882) versus 1.6% (2890), p value of 0.000. Non-albicans Candida spp. (NAC) remained the most prevalent pathogen. Factors significantly associated with candiduria included being female (OR=1.7, 95% CI 1.3 to 2.3) and hospital admission (OR=6.6, 95% CI 4.7 to 9.2). In conclusion, candiduria affect 5 out of every 100 UTI-diagnosed patients, predominantly among females and those admitted to the hospital. Clinicians at tertiary hospitals should consider urinary candidiasis as a potential diagnosis for patients at risk who present with UTI-like symptoms.
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Affiliation(s)
- Eveline T Konje
- Department of biostatistics and epidemiology, School of public health, Catholic University of Health and Allied Sciences, Mwanza, Tanzania
| | - Omary Kizenga
- School of pharmacy, Catholic University of Health and Allied Sciences, Mwanza, Tanzania
| | - Noel J Charco
- Weill Bugando School of Medicine, Catholic University of Health and Allied Sciences, Mwanza, Tanzania
| | | | - Nyanda Shango
- Microbiology section, Central pathology laboratory of Bugando Medical Center, Mwanza, Tanzania
| | - Felix Tarimo
- Department of Biochemistry and Molecular Biology, Weill Bugando School of Medicine, Catholic University of Health and Allied Sciences, Mwanza, Tanzania
| | - Martha F Mushi
- Department of biostatistics and epidemiology, School of public health, Catholic University of Health and Allied Sciences, Mwanza, Tanzania
- Microbiology and Immunology Department, Weill Bugando School of Medicine, Catholic University of Health and Allied Sciences, Mwanza, Tanzania
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Spruijtenburg B, Ahmad S, Asadzadeh M, Alfouzan W, Al-Obaid I, Mokaddas E, Meijer EFJ, Meis JF, de Groot T. Whole genome sequencing analysis demonstrates therapy-induced echinocandin resistance in Candida auris isolates. Mycoses 2023; 66:1079-1086. [PMID: 37712885 DOI: 10.1111/myc.13655] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Revised: 08/30/2023] [Accepted: 09/02/2023] [Indexed: 09/16/2023]
Abstract
Candida auris is an emerging, multidrug-resistant yeast, causing outbreaks in healthcare facilities. Echinocandins are the antifungal drugs of choice to treat candidiasis, as they cause few side effects and resistance is rarely found. Previously, immunocompromised patients from Kuwait with C. auris colonisation or infection were treated with echinocandins, and within days to months, resistance was reported in urine isolates. To determine whether the development of echinocandin resistance was due to independent introductions of resistant strains or resulted from intra-patient resistance development, whole genome sequencing (WGS) single-nucleotide polymorphism (SNP) analysis was performed on susceptible (n = 26) and echinocandin-resistant (n = 6) isolates from seven patients. WGS SNP analysis identified three distinct clusters differing 17-127 SNPs from two patients, and the remaining isolates from five patients, respectively. Sequential isolates within patients had a maximum of 11 SNP differences over a time period of 1-10 months. The majority of isolates with reduced susceptibility displayed unique FKS1 substitutions including a novel FKS1M690V substitution, and nearly all were genetically related, ranging from only three to six SNP differences compared to susceptible isolates from the same patient. Resistant isolates from three patients shared the common FKS1S639F substitution; however, WGS analysis did not suggest a common source. These findings strongly indicate that echinocandin resistance is induced during antifungal treatment. Future studies should determine whether such echinocandin-resistant strains are capable of long-term colonisation, cause subsequent breakthrough candidiasis, have a propensity to cross-infect other patients, or remain viable for longer time periods in the hospital environment.
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Affiliation(s)
- Bram Spruijtenburg
- Department of Medical Microbiology and Infectious Diseases, Canisius-Wilhelmina Hospital, Nijmegen, The Netherlands
- Center of Expertise for Mycology Radboud University Medical Center/Canisius-Wilhelmina Hospital, Nijmegen, The Netherlands
| | - Suhail Ahmad
- Department of Microbiology, Faculty of Medicine, Kuwait University, Safat, Kuwait
| | - Mohammad Asadzadeh
- Department of Microbiology, Faculty of Medicine, Kuwait University, Safat, Kuwait
| | - Wadha Alfouzan
- Department of Microbiology, Faculty of Medicine, Kuwait University, Safat, Kuwait
- Microbiology Unit, Department of Laboratory Medicine, Farwania Hospital, Kuwait City, Kuwait
| | - Inaam Al-Obaid
- Department of Microbiology, Al-Sabah Hospital, Shuwaikh, Kuwait
| | - Eiman Mokaddas
- Department of Microbiology, Faculty of Medicine, Kuwait University, Safat, Kuwait
- Department of Microbiology, Ibn-Sina Hospital, Shuwaikh, Kuwait
| | - Eelco F J Meijer
- Department of Medical Microbiology and Infectious Diseases, Canisius-Wilhelmina Hospital, Nijmegen, The Netherlands
- Center of Expertise for Mycology Radboud University Medical Center/Canisius-Wilhelmina Hospital, Nijmegen, The Netherlands
| | - Jacques F Meis
- Center of Expertise for Mycology Radboud University Medical Center/Canisius-Wilhelmina Hospital, Nijmegen, The Netherlands
- Institute of Translational Research, Cologne Excellence Cluster on Cellular Stress Responses in Aging-Associated Diseases (CECAD), University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany
- Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf (CIO ABCD) and Excellence Center for Medical Mycology (ECMM), University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany
| | - Theun de Groot
- Department of Medical Microbiology and Infectious Diseases, Canisius-Wilhelmina Hospital, Nijmegen, The Netherlands
- Center of Expertise for Mycology Radboud University Medical Center/Canisius-Wilhelmina Hospital, Nijmegen, The Netherlands
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Capote-Bonato FG, Bonato DV, Ayer IM, Silva de Lima C, Magalhães LF, Spada CA, Magalhães GM, de Mattos Junior E, Maia Teixeira PP, Negri M, Crivellenti LZ, Estivalet Svidzinski TI. Ascending renal infection following experimental candiduria by Candida tropicalis in immunocompromised mice. Microb Pathog 2023; 183:106295. [PMID: 37562493 DOI: 10.1016/j.micpath.2023.106295] [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: 05/04/2023] [Revised: 08/07/2023] [Accepted: 08/07/2023] [Indexed: 08/12/2023]
Abstract
The present study evaluated renal infection resulting from the implantation of C. tropicalis in the bladder of immunosuppressed mice. Yeasts were implanted in two manners: planktonic and via preformed biofilm on a small catheter fragment (SCF). Renal histopathology and cultures was performed 72 and 144 h after cystotomy was carried out in mice from three groups: group I contained non-contaminated mice implanted with a sterile SCF; group II mice received a sterile SCF plus a yeast suspension containing 1 × 107 yeasts/mL in a planktonic form; group III mice were implanted with a SCF containing preformed C. tropicalis biofilm. Viable yeasts were found in the kidneys of mice from both groups II and III. However, after 72 h the planktonic cells (group II) invaded more quickly than the sessile cells (group III). Over a longer period (144 h), group III exhibited a more invasive infection (50% of the animals presented renal infection and the renal fungal load was 3.2 log10 CFU/g tissue) than in group II, where yeasts were not found. C. tropicalis introduced into the bladder in two ways (in planktonic or biofilm form) were able to reach the kidney and establish a renal fungal infection, causing interstitial disorders. The data of the present study therefore support the hypothesis of an ascending pathway for renal infections by C. tropicalis. Furthermore, the biofilm resulted in a greater and progressive risk of renal infection, attributed to the slow detachment of the yeasts.
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Affiliation(s)
- Francieli Gesleine Capote-Bonato
- Postgraduate Program in Animal Science with Emphasis on Bioactive Products, Paranaense University (UNIPAR), Praça Mascarenhas de Moraes, 4282-Centro, 87502-210, Umuarama, Paraná, Brazil.
| | - Denis Vinicius Bonato
- Postgraduate Program in Animal Science with Emphasis on Bioactive Products, Paranaense University (UNIPAR), Praça Mascarenhas de Moraes, 4282-Centro, 87502-210, Umuarama, Paraná, Brazil
| | - Ilan Munhoz Ayer
- Department of Veterinary Medicine, Franca University, São Paulo, Brazil
| | | | | | - Cecilia Aparecida Spada
- Postgraduate Program in Animal Science with Emphasis on Bioactive Products, Paranaense University (UNIPAR), Praça Mascarenhas de Moraes, 4282-Centro, 87502-210, Umuarama, Paraná, Brazil
| | | | | | | | - Melyssa Negri
- Department of Clinical Analysis, Medical Mycology Division, State University of Maringá, Paraná, Brazil
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Fan X, Tsui CKM, Chen X, Wang P, Liu ZJ, Yang CX. High prevalence of fluconazole resistant Candida tropicalis among candiduria samples in China: An ignored matter of concern. Front Microbiol 2023; 14:1125241. [PMID: 36937265 PMCID: PMC10017723 DOI: 10.3389/fmicb.2023.1125241] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2022] [Accepted: 02/10/2023] [Indexed: 03/06/2023] Open
Abstract
Introduction The rapid rise of azole resistance in Candida tropicalis causing invasive infections has become a public health concern; however, the prevalence of resistant isolates in urine samples was not well studied, because the clinical significance of candiduria was not unambiguous due to possible host colonization. Methods We performed a 12-year laboratory-based surveillance study of C. tropicalis causing either invasive infection or candiduria and studied their susceptibility profiles to common antifungal drugs. The complete coding domain sequence of the ERG11 gene was amplified in all fluconazole resistant isolates, and aligned with the wild-type sequence to detect nucleotide mutations. Results A total of 519 unique C. tropicalis strains isolates, 69.9% of which were isolated from urine samples and remaining 30.1% were invasive strains. Overall, 16.5% isolates were confirmed to be resistant to fluconazole, of which 91.9% were cross-resistant voriconazole. Of note, at the beginning of surveillance (2010-2011), the fluconazole resistance rates were low in both candiduria and invasive groups (6.8% and 5.9%, respectively). However, the resistant rate in the candiduria group significantly increased to 29.5% since 2012-2013 (p = 0.001) and stayed high since then, whilst the resistance rate in the invasive group only showed a gradually increasing trends till 2021 (p > 0.05). Sequence analysis of ERG11 from fluconazole-resistant strains revealed the prevalence of A395T/W mutations were relatively low (16.7%) in the beginning but reached 87.5-100% after 2014. Moreover, the A395W heterozygous mutation isolates became predominant (>60% of resistant strains) after 2016, and indeed isolates carrying corresponding amino acid substitution (Y132F) was highly resistant to fluconazole with MIC50 exceeded 256 μg/ml. Conclusion Our study revealed high azole resistant rate in candiduria with its increasing trends observed much earlier than stains causing invasive infections. Given antimicrobial resistance as a critical "One Health" issue, the emergence of antifungal resistance in Candida species that are common commensal colonizers in the human body should be concerned.
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Affiliation(s)
- Xin Fan
- Department of Infectious Diseases and Clinical Microbiology, Beijing Institute of Respiratory Medicine and Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
| | - Clement K. M. Tsui
- National Centre for Infectious Diseases, Tan Tock Seng Hospital, Singapore, Singapore
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
- Division of Infectious Diseases, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Xi Chen
- Department of Infectious Diseases and Clinical Microbiology, Beijing Institute of Respiratory Medicine and Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
| | - Peng Wang
- Department of Infectious Diseases and Clinical Microbiology, Beijing Institute of Respiratory Medicine and Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
| | - Zhen-jia Liu
- Department of Infectious Diseases and Clinical Microbiology, Beijing Institute of Respiratory Medicine and Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
- *Correspondence: Zhen-jia Liu,
| | - Chun-xia Yang
- Department of Infectious Diseases and Clinical Microbiology, Beijing Institute of Respiratory Medicine and Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
- Chun-xia Yang,
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Talapko J, Meštrović T, Škrlec I. Growing importance of urogenital candidiasis in individuals with diabetes: A narrative review. World J Diabetes 2022; 13:809-821. [PMID: 36311997 PMCID: PMC9606786 DOI: 10.4239/wjd.v13.i10.809] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2022] [Revised: 08/06/2022] [Accepted: 09/07/2022] [Indexed: 02/05/2023] Open
Abstract
Both diabetes and fungal infections contribute significantly to the global disease burden, with increasing trends seen in most developed and developing countries during recent decades. This is reflected in urogenital infections caused by Candida species that are becoming ever more pervasive in diabetic patients, particularly those that present with unsatisfactory glycemic control. In addition, a relatively new group of anti-hyperglycemic drugs, known as sodium glucose cotransporter 2 inhibitors, has been linked with an increased risk for colonization of the urogenital region with Candida spp., which can subsequently lead to an infectious process. In this review paper, we have highlighted notable virulence factors of Candida species (with an emphasis on Candida albicans) and shown how the interplay of many pathophysiological factors can give rise to vulvovaginal candidiasis, potentially complicated with recurrences and dire pregnancy outcomes. We have also addressed an increased risk of candiduria and urinary tract infections caused by species of Candida in females and males with diabetes, further highlighting possible complications such as emphysematous cystitis as well as the risk for the development of balanitis and balanoposthitis in (primarily uncircumcised) males. With a steadily increasing global burden of diabetes, urogenital mycotic infections will undoubtedly become more prevalent in the future; hence, there is a need for an evidence-based approach from both clinical and public health perspectives.
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Affiliation(s)
- Jasminka Talapko
- Laboratory for Microbiology, Faculty of Dental Medicine and Health, Josip Juraj Strossmayer University of Osijek, Osijek 31000, Croatia
| | - Tomislav Meštrović
- University North, University Centre Varaždin, Varaždin 42000, Croatia
- Institute for Health Metrics and Evaluation, Department for Health Metrics Sciences, University of Washington School of Medicine, Seattle, Washington 98195, United States
| | - Ivana Škrlec
- Department of Biophysics, Biology, and Chemistry, Faculty of Dental Medicine and Health, J. J. Strossmayer University of Osijek, Osijek 31000, Croatia
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In Vitro Activity of Nitroxoline in Antifungal-Resistant Candida Species Isolated from the Urinary Tract. Antimicrob Agents Chemother 2022; 66:e0226521. [PMID: 35543103 DOI: 10.1128/aac.02265-21] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Infections by drug-resistant fungi are increasingly reported worldwide; however, only few novel antifungals are being developed. The old antimicrobial nitroxoline is currently repurposed for oral treatment of bacterial urinary tract infections (UTI). Previously, antifungal activity has been demonstrated and in contrast to many antifungals nitroxoline reaches high urinary concentrations. In this study, the activity of nitroxoline was assessed in vitro in a collection of yeasts from the German National Reference Centre for Invasive Fungal Infections. Susceptibility was determined by broth microdilution (BMD) and disk diffusion (DD). The collection comprised 45 Candida isolates originating from the urinary tract. MICs of amphotericin, anidulafungin and azoles were analyzed using EUCAST BMD. Among the collection isolates, resistance to antifungals was common, e.g., for fluconazole the MIC50/90 was 16/>64 mg/L; in contrast MIC50/90 of nitroxoline was 2/2 mg/L (MIC range 0.25-4 mg/L), which is at least two dilutions below the EUCAST breakpoint for uncomplicated UTI defined for E. coli (susceptible ≤ 16mg/L). Activity of nitroxoline was high irrespective of resistance to other agents. As BMD is labor-intensive, DD was investigated as an alternative method using three different agars. Nitroxoline disks produced large inhibition zones on all agars (≥19mm), but the correlation of MICs and zone diameters was low, with the highest correlation recorded for the CLSI recommended agar for antifungal DD (Pearson's r = -0,52). In conclusion, isolates of different Candida species are highly susceptible to nitroxoline, which could be a promising antimicrobial to treat candiduria caused by multidrug resistant yeasts.
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Ekinci F, Yildizdas D, Horoz OO, Ozgur Gundeslioglu O, Alabaz D. Treatment of Candida urinary tract infections with micafungin in children. Pediatr Int 2022; 64:e15033. [PMID: 35146837 DOI: 10.1111/ped.15033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2021] [Revised: 08/30/2021] [Accepted: 10/13/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND Candida urinary tract infections (UTIs) are common nosocomial infections among critically ill patients hospitalized in pediatric intensive care Units (PICU). We aimed to report outcomes of critically ill pediatric patients who received micafungin for hospital acquired Candida UTIs. We analyzed treatment success rates and success rates among different Candida species. METHODS This retrospective cohort study included patients who received micafungin for Candida UTI as first choice in our PICU between January 2017 and July 2018. Data, including demographic and clinical features, were retrospectively collected from medical files of the patients. Treatment efficacy was defined as resolution of clinical symptoms and a negative culture for Candida at day 14 after initiation of micafungin treatment. RESULTS Twenty-four pediatric patients (median age 5.72 years, range, 2 months-16 years) were included in the present study. Fourteen (58.3%) patients had urinary catheters at the time of Candida isolation. Resolution of symptoms and a negative culture at day 3 of micafungin treatment were achieved in 17 (70.8%) and 14 (58.3%) patients, respectively. Moreover, 19 (79.2%) patients had a normal urine analysis and negative culture 14 days after initiation of micafungin treatment. Treatment responses did not statistically differ between Candida species. CONCLUSIONS Micafungin is safe and efficacious in critically ill pediatric patients with Candida UTIs. Its efficacy in our pediatric population was as comparable to that observed in adult studies, therefore, it should be considered as an effective therapeutic option in Candida UTIs of critically ill pediatric patients.
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Affiliation(s)
- Faruk Ekinci
- Department of Pediatric Intensive Care, Çukurova University Faculty of Medicine, Adana, Turkey
| | - Dincer Yildizdas
- Department of Pediatric Intensive Care, Çukurova University Faculty of Medicine, Adana, Turkey
| | - Ozden Ozgur Horoz
- Department of Pediatric Intensive Care, Çukurova University Faculty of Medicine, Adana, Turkey
| | - Ozlem Ozgur Gundeslioglu
- Department of Pediatric Infectious Diseases, Çukurova University Faculty of Medicine, Adana, Turkey
| | - Derya Alabaz
- Department of Pediatric Infectious Diseases, Çukurova University Faculty of Medicine, Adana, Turkey
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Outcomes of caspofungin use in the treatment of Candida-related urinary tract infections, a case series. IDCases 2022; 28:e01510. [PMID: 35646592 PMCID: PMC9136130 DOI: 10.1016/j.idcr.2022.e01510] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2022] [Revised: 04/28/2022] [Accepted: 05/16/2022] [Indexed: 11/23/2022] Open
Abstract
Echinocandins are generally excluded in the treatment of Candida-related urinary tract infections due to their poor urinary concentration. In the presence of fluconazole resistant Candida species, such as C. Glabrata and C. auris, alternative therapies are needed. We herein report the use of caspofungin for the treatment of 10 patients with candiduria, including C. auris. Mycological cure was achieved in 6 of 7 patients and clinical cure was achieved in 8 of 10 patients. Larger studies are needed to confirm our findings.
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Kamei J, Yamamoto S. Complicated urinary tract infections with diabetes mellitus. J Infect Chemother 2021; 27:1131-1136. [PMID: 34024733 DOI: 10.1016/j.jiac.2021.05.012] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Revised: 04/08/2021] [Accepted: 05/11/2021] [Indexed: 12/18/2022]
Abstract
Patients with diabetes mellitus (DM) sometimes exhibited impaired immune function and aggravated infectious diseases. Urinary tract infection (UTI) is one of the major complications of DM. A systematic literature search was performed in PubMed and Cochrane Library using the following keywords: diabetes mellitus, urinary tract infection, asymptomatic bacteriuria, emphysematous pyelonephritis, emphysematous cystitis, renal papillary necrosis, and sodium-glucose co-transporter 2 (SGLT2) inhibitors. The treatment of UTI in DM patients is not different from that in non-DM patients, and asymptomatic bacteriuria should not be screened or treated. Emphysematous pyelonephritis is a life-threatening renal infection with gas in the renal parenchyma or perirenal space, and 95% of affected patients had DM. Abdominal computed tomography is useful for diagnosis and determining treatment strategies. Medical management and percutaneous drainage are standard initial treatment, and subsequent nephrectomy for non-responders is considered. Nephrectomy, as an initial treatment, should be limited to a selected group of patients with severe conditions. In contrast, antibiotics, glycemic control, and bladder drainage are adequate treatment for most cases of emphysematous cystitis. SGLT2 inhibitors significantly increased the incidence of genital tract infection, but not that of UTI, pyelonephritis, or urosepsis. Here, we present cumulative evidence about etiology and management for complicated UTI with DM, but there was little information about racial differences and further evidence focusing on Asian population will be needed.
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Affiliation(s)
- Jun Kamei
- Department of Urology, Jichi Medical University, Tochigi, Japan.
| | - Shingo Yamamoto
- Department of Urology, Hyogo College of Medicine, Hyogo, Japan
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He Z, Su C, Bi Y, Cheng Y, Lei D, Wang F. Evaluation of a Novel Laboratory Candiduria Screening Protocol in the Intensive Care Unit. Infect Drug Resist 2021; 14:489-496. [PMID: 33603413 PMCID: PMC7882441 DOI: 10.2147/idr.s289885] [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: 11/04/2020] [Accepted: 01/13/2021] [Indexed: 01/03/2023] Open
Abstract
Background Since urine cultures are only guaranteed for patients with obvious urinary symptoms in most cases, most of candiduria episodes are ignored in clinic. Objective This study aimed to design a screening protocol to improve diagnostic efficiency of candiduria, and provide information of Candida species and drug susceptibility. Methods All patients, who were admitted to the intensive care unit (ICU) of our hospital during December 1, 2018 and October 1, 2019, were enrolled in this study. Urinalysis was performed every three days for each subject from the first day of ICU admission. Urine specimens were sampled for fungal culture with either condition: (1) yeast-like cell counting (YLCC) ≥200; (2) positive YLCCs were observed in two consecutive tests, and at least one YLCC ≥100. Results The screening protocol dramatically improved the candiduria diagnostic rate of ICU patients from 2.28% to 17.27%. However, compared to the historical control, the screening protocol has no time-saving advantage in candiduria diagnosing. Higher percentage of C. albicans in screening protocol-identified candiduria patients was observed, although there was no statistical difference. Our results indicated that female gender, pneumonia, diabetes and infarction/hemorrhage patients were more prone to develop candiduria. Non-candiduria patients showed a better tendency for survival and shorter ICU stay length. Multisite colonization was common in the surveyed candiduria patients, who were up to 70.83% showed Candida positive cultures in sputum. Conclusion The screening protocol established in the study was a convenient and practical tool for early warning and feasible management of candiduria and IC.
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Affiliation(s)
- Zhengxin He
- Laboratory Medicine, The 980th Hospital of PLA Joint Logistical Support Force (Bethune International Peace Hospital), Shijiazhuang, Hebei, 050082, People's Republic of China
| | - Chang Su
- Cardiothoracic Surgery, The 980th Hospital of PLA Joint Logistical Support Force (Bethune International Peace Hospital), Shijiazhuang, Hebei, 050082, People's Republic of China
| | - Yuwang Bi
- Information Center, The 980th Hospital of PLA Joint Logistical Support Force (Bethune International Peace Hospital), Shijiazhuang, Hebei, 050082, People's Republic of China
| | - Yan Cheng
- Laboratory Medicine, The 980th Hospital of PLA Joint Logistical Support Force (Bethune International Peace Hospital), Shijiazhuang, Hebei, 050082, People's Republic of China
| | - Daxin Lei
- Laboratory Medicine, The 980th Hospital of PLA Joint Logistical Support Force (Bethune International Peace Hospital), Shijiazhuang, Hebei, 050082, People's Republic of China
| | - Fukun Wang
- Laboratory Medicine, The 980th Hospital of PLA Joint Logistical Support Force (Bethune International Peace Hospital), Shijiazhuang, Hebei, 050082, People's Republic of China
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Dias BB, da Silva Dantas FG, Galvão F, Cupozak-Pinheiro WJ, Wender H, Pizzuti L, Rosa PP, Tenório KV, Gatto CC, Negri M, Casagrande GA, de Oliveira KMP. Synthesis, structural characterization, and prospects for new cobalt (II) complexes with thiocarbamoyl-pyrazoline ligands as promising antifungal agents. J Inorg Biochem 2020; 213:111277. [PMID: 33045593 DOI: 10.1016/j.jinorgbio.2020.111277] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Revised: 09/29/2020] [Accepted: 10/03/2020] [Indexed: 01/08/2023]
Abstract
Candida spp. cause invasive fungal infections. One species, Candida glabrata, may present intrinsic resistance to conventional antifungal agents, thereby increasing mortality rates in hospitalized patients. In this context, metal complexes present an alternative for the development of new antifungal drugs owing to their biological and pharmacological activities demonstrated in studies in the last decades. Accordingly, in this study we have synthesized and characterized two new Co(II) complexes with thiocarbamoyl-pyrazoline ligands to assess their antimicrobial, mutagenic, and cytotoxic potential. For antimicrobial activity, the broth microdilution method was performed against ATCC strains of Candida spp. and fluconazole dose-dependent isolates of C. glabrata obtained from urine samples. The Ames test was used to assess mutagenic potential. The reduction method of the MTS reagent (3 [4,5-dimethylthiazol-2-yl]-5-[3-carboxymethoxyphenyl]-2-[4-sulfophenyl]-2H-tetrazolium) was performed with HeLa, SiHa, and Vero cells to determine cytotoxicity. Both complexes exhibited fungistatic and fungicidal activity for the yeasts used in the study, demonstrating greater potential for C. glabrata ATCC 2001 and the C. glabrata CG66 isolate with a Minimum Inhibitory Concentration MIC from 3.90 to 7.81 μg mL-1 and fungicidal action from 7.81 to 15.62 μg mL-1. The complexes inhibited and degraded biofilms by up to 90% and did not present mutagenic and cytotoxic potential at the concentrations evaluated for MIC. Thus, the complexes examined herein suggest promising alternatives for the development of new antifungal drugs.
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Affiliation(s)
- Bianca Boni Dias
- Faculdade de Ciências da Saúde, Universidade Federal da Grande Dourados, Dourados, MS 79070-900, Brazil
| | - Fabiana Gomes da Silva Dantas
- Faculdade de Ciências Biológicas e Ambientais, Universidade Federal da Grande Dourados, Dourados, MS 79804-970, Brazil
| | - Fernanda Galvão
- Faculdade de Ciências da Saúde, Universidade Federal da Grande Dourados, Dourados, MS 79070-900, Brazil
| | | | - Heberton Wender
- Instituto de Física, Universidade Federal do Mato Grosso do Sul, Campo Grande, MS 79070-900, Brazil
| | - Lucas Pizzuti
- Grupo de Pesquisa em Síntese e Caracterização Molecular de Mato Grosso do Sul, Instituto de Química, Universidade Federal de Mato Grosso do Sul (Laboratório 2), Campo Grande, MS 79074-460, Brazil
| | - Persiely Pires Rosa
- Grupo de Pesquisa em Síntese e Caracterização Molecular de Mato Grosso do Sul, Instituto de Química, Universidade Federal de Mato Grosso do Sul (Laboratório 2), Campo Grande, MS 79074-460, Brazil
| | - Kátia Veronica Tenório
- Grupo de Pesquisa em Síntese e Caracterização Molecular de Mato Grosso do Sul, Instituto de Química, Universidade Federal de Mato Grosso do Sul (Laboratório 2), Campo Grande, MS 79074-460, Brazil
| | - Claudia Cristina Gatto
- Laboratório de Síntese Inorgânica e Cristalografia, Universidade de Brasília, Campus Universitário Darcy Ribeiro, 70.904-970 Brasília, DF, Brazil
| | - Melyssa Negri
- Departamento de Análises Clínicas e Biomedicina, Universidade Estadual de Maringá, Maringá, PR 87020-900, Brazil
| | - Gleison Antônio Casagrande
- Grupo de Pesquisa em Síntese e Caracterização Molecular de Mato Grosso do Sul, Instituto de Química, Universidade Federal de Mato Grosso do Sul (Laboratório 2), Campo Grande, MS 79074-460, Brazil.
| | - Kelly Mari Pires de Oliveira
- Faculdade de Ciências da Saúde, Universidade Federal da Grande Dourados, Dourados, MS 79070-900, Brazil; Faculdade de Ciências Biológicas e Ambientais, Universidade Federal da Grande Dourados, Dourados, MS 79804-970, Brazil.
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12
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Duque CM, Sanchez DM, Gaviria A, Vallejo Acosta A, Gómez B, Gómez OM, Rua Giraldo A, Hernandez O. Caracterización de Candida spp. aisladas a partir de urocultivos en la ciudad de Medellín. INFECTIO 2020. [DOI: 10.22354/in.v24i4.879] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Candida spp. es un agente etiológico importante en infecciones del tracto urinario, principalmente en población con terapia antimicótica de amplio espectro y con catéteres urinarios. Candida albicans es la especie más frecuente, pero otras especies han surgido como patógenos emergentes. En este trabajo se recolectaron aislamientos de Candida spp. de urocultivos de pacientes que consultaron en Dinamica IPS entre enero 2016 y noviembre 2017. Para estimar la frecuencia de las especies y observar los patrones de sensibilidad, se realizó la identificación fenotípica y su perfil de sensibilidad con el sistema comercial Vitek 2® (BioMérieux, Inc.), adicionalmente se evaluaron mediante análisis de las secuencia y filogenética ITS1-5.8S-ITS2. En el estudio se incluyeron 78 aislamientos de Candida spp. Las frecuencias de especies de Candida identificadas empleando las herramientas moleculares fueron: C. albicans (38,5%), C. tropicalis (23,1%), C. glabrata (21,8%), C. parapsilosis (10,3%), C. metapsilosis y C. krusei (2,5%) y C. guillermondi (1,3%). La identificación por métodos moleculares y por el sistema Vitek 2 fue: C. albicans (93,3%), C. glabrata (94,1 %), C. tropicalis (83,3%), C. parapsilosis (75%) C. guilliermondii y C. krusei (100%). La sensibilidad de todos los aislamientos al fluconazol fue 93,6%.
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13
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Tan X, Baugh K, Bulman ZP, Wenzler E. Review of the Current Management of Urinary Tract Infections due to Fluconazole-Resistant and Non-Albicans Candida Species. CURRENT FUNGAL INFECTION REPORTS 2020. [DOI: 10.1007/s12281-020-00388-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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14
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Oliveira JSD, Pereira VS, Castelo-Branco DDSCM, Cordeiro RDA, Sidrim JJC, Brilhante RSN, Rocha MFG. The yeast, the antifungal, and the wardrobe: a journey into antifungal resistance mechanisms of Candida tropicalis. Can J Microbiol 2020; 66:377-388. [PMID: 32319304 DOI: 10.1139/cjm-2019-0531] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Candida tropicalis is a prominent non-Candida albicans Candida species involved in cases of candidemia, mainly causing infections in patients in intensive care units and (or) those presenting neutropenia. In recent years, several studies have reported an increase in the recovery rates of azole-resistant C. tropicalis isolates. Understanding C. tropicalis resistance is of great importance, since resistant strains are implicated in persistent or recurrent and breakthrough infections. In this review, we address the main mechanisms underlying C. tropicalis resistance to the major antifungal classes used to treat candidiasis. The main genetic basis involved in C. tropicalis antifungal resistance is discussed. A better understanding of the epidemiology of resistant strains and the mechanisms involved in C. tropicalis resistance can help improve diagnosis and assessment of the antifungal susceptibility of this Candida species to improve clinical management.
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Affiliation(s)
- Jonathas Sales de Oliveira
- Department of Pathology and Legal Medicine, School of Medicine, Specialized Medical Mycology Center, Graduate Program in Medical Microbiology, Federal University of Ceará, Fortaleza-CE, Brazil
| | - Vandbergue Santos Pereira
- Department of Pathology and Legal Medicine, School of Medicine, Specialized Medical Mycology Center, Graduate Program in Medical Microbiology, Federal University of Ceará, Fortaleza-CE, Brazil
| | - Débora de Souza Collares Maia Castelo-Branco
- Department of Pathology and Legal Medicine, School of Medicine, Specialized Medical Mycology Center, Graduate Program in Medical Microbiology, Federal University of Ceará, Fortaleza-CE, Brazil
| | - Rossana de Aguiar Cordeiro
- Department of Pathology and Legal Medicine, School of Medicine, Specialized Medical Mycology Center, Graduate Program in Medical Microbiology, Federal University of Ceará, Fortaleza-CE, Brazil
| | - José Júlio Costa Sidrim
- Department of Pathology and Legal Medicine, School of Medicine, Specialized Medical Mycology Center, Graduate Program in Medical Microbiology, Federal University of Ceará, Fortaleza-CE, Brazil
| | - Raimunda Sâmia Nogueira Brilhante
- Department of Pathology and Legal Medicine, School of Medicine, Specialized Medical Mycology Center, Graduate Program in Medical Microbiology, Federal University of Ceará, Fortaleza-CE, Brazil
| | - Marcos Fábio Gadelha Rocha
- Department of Pathology and Legal Medicine, School of Medicine, Specialized Medical Mycology Center, Graduate Program in Medical Microbiology, Federal University of Ceará, Fortaleza-CE, Brazil.,School of Veterinary, Postgraduate Program in Veterinary Sciences, State University of Ceará, 1315 Coronel Nunes de Melo Street, Rodolfo Teófilo, CEP 60420-270, Fortaleza-CE, Brazil
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15
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Candida urinary tract infections in adults. World J Urol 2019; 38:2699-2707. [PMID: 31654220 DOI: 10.1007/s00345-019-02991-5] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2019] [Accepted: 10/14/2019] [Indexed: 02/06/2023] Open
Abstract
Candiduria is commonly seen in hospitalized patients and most of the patients are asymptomatic, but it may be due to cystitis, pyelonephritis, prostatitis, epididymo-orchitis or disseminated candidiasis. Major risk factors are diabetes mellitus, indwelling urinary catheters, use of broad-spectrum antibiotics, urinary obstruction, and admission to intensive care units. Candida urinary tract infections can be caused by hematogenous spread following candidemia, or retrograde route via the urethra. The presence of Candida species in urine in asymptomatic patients does not warrant antifungal therapy except neutropenic patients, very low-birth-weight infants and patients undergoing urologic procedures. Fluconazole is the treatment of choice for symptomatic infections, it achieves high urinary levels. The other azole antifungals and echinocandins do not reach sufficient urine levels. Amphotericin B deoxycholate is the alternative antifungal agent if fluconazole can not be used because of resistance, allergy or failure.
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16
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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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17
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Ramstedt M, Ribeiro IAC, Bujdakova H, Mergulhão FJM, Jordao L, Thomsen P, Alm M, Burmølle M, Vladkova T, Can F, Reches M, Riool M, Barros A, Reis RL, Meaurio E, Kikhney J, Moter A, Zaat SAJ, Sjollema J. Evaluating Efficacy of Antimicrobial and Antifouling Materials for Urinary Tract Medical Devices: Challenges and Recommendations. Macromol Biosci 2019; 19:e1800384. [PMID: 30884146 DOI: 10.1002/mabi.201800384] [Citation(s) in RCA: 51] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2018] [Revised: 01/18/2019] [Indexed: 01/05/2023]
Abstract
In Europe, the mean incidence of urinary tract infections in intensive care units is 1.1 per 1000 patient-days. Of these cases, catheter-associated urinary tract infections (CAUTI) account for 98%. In total, CAUTI in hospitals is estimated to give additional health-care costs of £1-2.5 billion in the United Kingdom alone. This is in sharp contrast to the low cost of urinary catheters and emphasizes the need for innovative products that reduce the incidence rate of CAUTI. Ureteral stents and other urinary-tract devices suffer similar problems. Antimicrobial strategies are being developed, however, the evaluation of their efficacy is very challenging. This review aims to provide considerations and recommendations covering all relevant aspects of antimicrobial material testing, including surface characterization, biocompatibility, cytotoxicity, in vitro and in vivo tests, microbial strain selection, and hydrodynamic conditions, all in the perspective of complying to the complex pathology of device-associated urinary tract infection. The recommendations should be on the basis of standard assays to be developed which would enable comparisons of results obtained in different research labs both in industry and in academia, as well as provide industry and academia with tools to assess the antimicrobial properties for urinary tract devices in a reliable way.
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Affiliation(s)
| | - Isabel A C Ribeiro
- Research Institute for Medicines (iMed.ULisboa), Faculty of Pharmacy, Universidade de Lisboa, 1649-004, Lisbon, Portugal
| | - Helena Bujdakova
- Department of Microbiology and Virology, Faculty of Natural Sciences, Comenius University in Bratislava, 81499, Bratislava 1, Slovakia
| | - Filipe J M Mergulhão
- Laboratory for Process Engineering, Environment, Biotechnology and Energy (LEPABE), Faculty of Engineering, University of Porto, Rua Dr. Roberto Frias, 4200-465, Porto, Portugal
| | - Luisa Jordao
- Department of Environmental Health, Research and Development Unit, National Institute of Health Dr. Ricardo Jorge (INSA), Avenida Padre Cruz, 1649-016, Lisbon, Portugal
| | - Peter Thomsen
- BioModics ApS, Stengårds Alle 31A, DK-2800, Lyngby, Denmark
| | - Martin Alm
- BioModics ApS, Stengårds Alle 31A, DK-2800, Lyngby, Denmark
| | - Mette Burmølle
- Department of Biology, University of Copenhagen, 2100, Copenhagen, Denmark
| | - Todorka Vladkova
- Department of Polymers, University of Chemical Technology and Metallurgy (UCTM), 8 Kliment Ohridski Blvd, 1756, Sofia, Bulgaria
| | - Fusun Can
- Department of Medical Microbiology, School of Medicine, Koc University, 34450, Sariyer, Istanbul, Turkey
| | - Meital Reches
- Institute of Chemistry and the Center for Nanoscience and Nanotechnology, The Hebrew University of Jerusalem, Jerusalem, 91904, Israel
| | - Martijn Riool
- Department of Medical Microbiology, Amsterdam UMC, Amsterdam Infection and Immunity Institute, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
| | - Alexandre Barros
- 3B's Research Group, I3Bs Research Institute on Biomaterials, Biodegradables and Biomimetics, University of Minho, Guimarães, 4710-057, Braga, Portugal
| | - Rui L Reis
- 3B's Research Group, I3Bs Research Institute on Biomaterials, Biodegradables and Biomimetics, University of Minho, Guimarães, 4710-057, Braga, Portugal
| | - Emilio Meaurio
- Department of Mining-Metallurgy Engineering and Materials Science, POLYMAT, School of Engineering, University of the Basque Country, 48940 Leina, Bizkaia, Bilbao, Spain
| | - Judith Kikhney
- Biofilmcenter, Department of Microbiology, Infectious Diseases and Immunology, Charité University Medicine Berlin, Hindenburgdamm 30, 12203, Berlin, Germany
| | - Annette Moter
- Biofilmcenter, Department of Microbiology, Infectious Diseases and Immunology, Charité University Medicine Berlin, Hindenburgdamm 30, 12203, Berlin, Germany
| | - Sebastian A J Zaat
- Department of Medical Microbiology, Amsterdam UMC, Amsterdam Infection and Immunity Institute, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
| | - Jelmer Sjollema
- University of Groningen, University Medical Center Groningen, Department of Biomedical Engineering, Antonius Deusinglaan 1, 9713 AV, Groningen, The Netherlands
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18
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Pemán J, Ruiz-Gaitán A. Candidemia from urinary tract source: the challenge of candiduria. Hosp Pract (1995) 2018; 46:243-245. [PMID: 30334630 DOI: 10.1080/21548331.2018.1538623] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2018] [Accepted: 10/17/2018] [Indexed: 06/08/2023]
Affiliation(s)
- Javier Pemán
- a Microbiology Department , Hospital Universitari i Politècnic La Fe; Severe Infection Research Group, Health Research Institute Hospital La Fe , Valencia , ( Spain )
| | - Alba Ruiz-Gaitán
- b Severe Infection Research Group , Health Research Institute Hospital La Fe , Valencia , ( Spain )
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19
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Tamm-Horsfall Protein Protects the Urinary Tract against Candida albicans. Infect Immun 2018; 86:IAI.00451-18. [PMID: 30297523 DOI: 10.1128/iai.00451-18] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2018] [Accepted: 10/01/2018] [Indexed: 02/07/2023] Open
Abstract
Urinary tract infections (UTIs) caused by the human fungal pathogen Candida albicans and related species are prevalent in hospitalized patients, especially those on antibiotic therapy, with indwelling catheters, or with predisposing conditions such as diabetes or immunodeficiency. Understanding of key host defenses against Candida UTI is critical for developing effective treatment strategies. Tamm-Horsfall glycoprotein (THP) is the most abundant urine protein, with multiple roles in renal physiology and bladder protection. THP protects against bacterial UTI by blocking bacterial adherence to the bladder epithelium, but its role in defense against fungal pathogens is not yet described. Here we demonstrate that THP restricts colonization of the urinary tract by C. albicans THP binds to C. albicans hyphae, but not the yeast form, in a manner dependent on fungal expression of the Als3 adhesion glycoprotein. THP directly blocks C. albicans adherence to bladder epithelial cells in vitro, and THP-deficient mice display increased fungal burden in a C. albicans UTI model. This work outlines a previously unknown role for THP as an essential component for host immune defense against fungal urinary tract infection.
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20
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García-Agudo L, Rodríguez-Iglesias M, Carranza-González R. Approach of clinicians to candiduria and related outcome in the elderly. J Mycol Med 2018; 28:428-432. [PMID: 29891222 DOI: 10.1016/j.mycmed.2018.05.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2017] [Revised: 05/21/2018] [Accepted: 05/25/2018] [Indexed: 01/05/2023]
Abstract
OBJECTIVE Candiduria is increasingly frequent in hospitalized debilitated patients. We aimed to evaluate the approach of clinicians to candiduria in the oldest old, and its effect on clearance and mortality. MATERIAL AND METHODS An observational study without intervention was carried out during 2012 and 2013 in three Spanish hospitals over patients with nosocomial candiduria aged 80 and over. Following a diagnostic algorithm, we assessed the appropriateness of antifungal therapy and analyzed the impact of the clinical approach (antifungal therapy, antibiotics discontinuation and catheter removal or replacement) on the outcome (mortality at 60 days and resolution, persistence or recurrence of candiduria). RESULTS Hundred and forty eight patients were included. Symptomatology was attributable to candiduria in 31 instances and 19 asymptomatic patients were found at risk of developing candidemia. In response to culture-results, 77 (52%) of patients were treated with antifungals, mainly fluconazole (97.4%). The use of pharmacological therapy was appropriate (P<0.05) but subtherapeutical doses of fluconazole were widely used and follow-up samples were scarcely submitted. At 60 days of diagnosis the mortality was high (29.7%). The replacement or removal of the catheter resulted in a decrease in mortality and the use of antifungal treatment was associated with recurrence (P<0.05). CONCLUSIONS In the absence of clinical practice guidelines with enough evidence, our study suggests that catheter removal should always be tried in the elderly with candiduria, since it reduces the mortality. The repetition of culture should help to better characterize the asymptomatic episodes, which are predominant, and to reduce the use of antifungals.
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Affiliation(s)
- L García-Agudo
- Avdeling for medisinsk mikrobiologi, Helse Møre og Romsdal, Molde sykehus, Parkvegen 84, 6412 Molde, Norway.
| | - M Rodríguez-Iglesias
- Servicio de Microbiología, Hospital Universitario Puerta del Mar, Avenida Ana de Viya 21, 11009 Cádiz, Spain
| | - R Carranza-González
- Laboratorio de Microbiología, Hospital General La Mancha-Centro, Avenida de la Constitución 3, 13600 Alcázar de San Juan, Ciudad Real, Spain
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21
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向 媛, 吕 毓, 郭 韧, 薛 娟. [Effect of bladder irrigation with amphotericin B for treatment of urinary tract fungal infection: a meta-analysis]. NAN FANG YI KE DA XUE XUE BAO = JOURNAL OF SOUTHERN MEDICAL UNIVERSITY 2018; 38:466-470. [PMID: 29735449 PMCID: PMC6765669 DOI: 10.3969/j.issn.1673-4254.2018.04.16] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 01/14/2018] [Indexed: 06/08/2023]
Abstract
OBJECTIVE To assess the efficacy and safety of bladder irrigation with amphotericin B for treatment of fungal infection in the urinary tract. METHODS All the available randomized controlled trials (published before March, 2018) examining bladder irrigation with amphotericin B for treatment of urinary tract fungal infection were searched in the Cochrane Central Register of Controlled Trials (Issue 12, 2017), PubMed, EMBase, Web of Knowledge Database, CNKI, CBM, Wanfang DATA and VIP information. Data were extracted from the selected trials for meta-analysis using RevMan 5.3 software. RESULTS A total of 96 studies were retrieved from the databases, and 9 trials involving 853 patients were included in the analysis. Meta-analysis results showed that compared with oral administration of fluconazole, bladder irrigation with amphotericin B was more effective in the treatment of fungal infection in the urinary tract (OR=1.66, 95%CI: 1.2-2.3, P=0.002) and was associated with less adverse reactions. CONCLUSION Bladder irrigation with amphotericin B can improve the curative effect of fungal infection in the urinary tract, but due to the small sample size of the included studies, this conclusion needs to be further validated by high-quality studies.
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Affiliation(s)
- 媛媛 向
- 中南大学湘雅三医院 药剂科,湖南 长沙 410013Department of Pharmacy, Third Xiangya Hospital of Central South University, Changsha 410013, China
| | - 毓 吕
- 中南大学湘雅三医院 药剂科,湖南 长沙 410013Department of Pharmacy, Third Xiangya Hospital of Central South University, Changsha 410013, China
| | - 韧 郭
- 中南大学湘雅三医院 药剂科,湖南 长沙 410013Department of Pharmacy, Third Xiangya Hospital of Central South University, Changsha 410013, China
| | - 娟 薛
- 中南大学湘雅三医院 泌尿外科,湖南 长沙 410013Department of Urology, Third Xiangya Hospital of Central South University, Changsha 410013, China
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22
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Saran S, Rao NS, Azim A. Diagnosing Catheter-associated Urinary Tract Infection in Critically Ill Patients: Do the Guidelines Help? Indian J Crit Care Med 2018; 22:357-360. [PMID: 29910547 PMCID: PMC5971646 DOI: 10.4103/ijccm.ijccm_434_17] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Catheter-associated urinary tract infection (CAUTI) is the leading cause of hospital-acquired infections in hospitalized patients in medical and surgical wards, but it is still commonly underdiagnosed in critically ill patients despite a higher device usage rate. The most commonly employed diagnostic criteria for such diagnosis come from the Infectious Disease Society of America and Centers for Disease Control and Prevention National Health Safety Network surveillance definition. It is surprising that no separate diagnostic criteria of CAUTI exist, for the critically ill patients – though these patients are of a different class of patients' altogether, due to decreased immunity, existence on multiple organ supports, and invasive lines, and an inability to communicate with a clinician. In this review, we highlight the difficulties in applying the available guidelines to diagnose CAUTI in critically ill patients. We also suggest an algorithm for the diagnosis of CAUTI in these patients.
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Affiliation(s)
- Sai Saran
- Department of Critical Care Medicine, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Namrata S Rao
- Department of Nephrology, Ram Manohar Lohia Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Afzal Azim
- Department of Critical Care Medicine, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
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