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Paixao de Sousa da Silva AM, de Moraes-Pinto MI, Teofilo Pignati L, Barbosa Teixeira B, Cordeiro Lima AP, Costa Pimentel Germano P, Petrilli AS, Marques LMA, Carlesse F. Candida spp bloodstream infections in a Latin American Pediatric Oncology Reference Center: Epidemiology and associated factors. Mycoses 2020; 63:812-822. [PMID: 32428294 DOI: 10.1111/myc.13106] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2020] [Revised: 05/11/2020] [Accepted: 05/13/2020] [Indexed: 12/19/2022]
Abstract
BACKGROUND Invasive fungal disease is a significant cause of morbidity and mortality in immunosuppressed children. The recognition of patients at risk for candidaemia is paramount to a better prognosis. OBJECTIVES To characterize Candida spp bloodstream infections (BSI) in a reference centre for paediatric oncology and to describe the most prevalent risk factors associated with candida infections. PATIENTS/METHODS This is a retrospective cohort study carried out with paediatric patients followed up with at the Institute of Pediatric Oncology, Brazil, who presented positive blood culture for Candida spp from January 2004 to December 2016. RESULTS Ninety episodes of candidaemia were analysed; patients had a median age of 4.5 years, and 57.8% were males, with a diagnosis of solid tumours in 54.5% of cases. The most common Candida species were C albicans (35.6%), C parapsilosis (30.0%) and C tropicalis (16.7%). C tropicalis BSI was associated with neutropenia and skin lesions. Therapy was successful in 67.1% of the episodes. Older age and thrombocytopenia were associated with therapeutic failure. Death within 30 days occurred in 24.4% of patients; predictive factors were older age and admission to an ICU C parapsilosis candidaemia was a protective factor for death when compared to C albicans. CONCLUSION The main species isolated were C albicans, C parapsilosis and C tropicalis. C tropicalis BSI was associated with neutropenia and skin lesions. The death rate was significant, and a worse prognosis was associated with older age, thrombocytopenia and admission to an ICU C parapsilosis infection proved to be a protective factor against mortality.
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Affiliation(s)
- Adriana Maria Paixao de Sousa da Silva
- Division of Pediatric Infectious Diseases, Federal University of Sao Paulo, Sao Paulo, Brazil.,Institute of Pediatric Oncology, Grupo de Apoio ao Adolescente e Criança com Câncer, Federal University of Sao Paulo, Sao Paulo, Brazil
| | | | - Luara Teofilo Pignati
- Division of Pediatric Infectious Diseases, Federal University of Sao Paulo, Sao Paulo, Brazil
| | - Bruno Barbosa Teixeira
- Division of Pediatric Infectious Diseases, Federal University of Sao Paulo, Sao Paulo, Brazil
| | - Ana Paula Cordeiro Lima
- Institute of Pediatric Oncology, Grupo de Apoio ao Adolescente e Criança com Câncer, Federal University of Sao Paulo, Sao Paulo, Brazil
| | - Priscila Costa Pimentel Germano
- Institute of Pediatric Oncology, Grupo de Apoio ao Adolescente e Criança com Câncer, Federal University of Sao Paulo, Sao Paulo, Brazil
| | - Antonio Sergio Petrilli
- Division of Pediatric Infectious Diseases, Federal University of Sao Paulo, Sao Paulo, Brazil.,Institute of Pediatric Oncology, Grupo de Apoio ao Adolescente e Criança com Câncer, Federal University of Sao Paulo, Sao Paulo, Brazil
| | - Leticia Maria Acioli Marques
- Division of Pediatric Infectious Diseases, Federal University of Sao Paulo, Sao Paulo, Brazil.,Institute of Pediatric Oncology, Grupo de Apoio ao Adolescente e Criança com Câncer, Federal University of Sao Paulo, Sao Paulo, Brazil
| | - Fabianne Carlesse
- Division of Pediatric Infectious Diseases, Federal University of Sao Paulo, Sao Paulo, Brazil.,Institute of Pediatric Oncology, Grupo de Apoio ao Adolescente e Criança com Câncer, Federal University of Sao Paulo, Sao Paulo, Brazil
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Santolaya ME, Thompson L, Benadof D, Tapia C, Legarraga P, Cortés C, Rabello M, Valenzuela R, Rojas P, Rabagliati R. A prospective, multi-center study of Candida bloodstream infections in Chile. PLoS One 2019; 14:e0212924. [PMID: 30849092 PMCID: PMC6407853 DOI: 10.1371/journal.pone.0212924] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2018] [Accepted: 02/12/2019] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Active surveillance is necessary for improving the management and outcome of patients with candidemia. The aim of this study was to describe epidemiologic and clinical features of candidemia in children and adults in tertiary level hospitals in Chile. METHODS We conducted a prospective, multicenter, laboratory-based survey study of candidemia in 26 tertiary care hospitals in Chile, from January 2013 to October 2017. RESULTS A total of 780 episodes of candidemia were included, with a median incidence of 0.47/1,000 admissions. Demographic, clinical and microbiological information of 384 cases of candidemia, from 18 hospitals (7,416 beds), was included in this report. One hundred and thirty-four episodes (35%) occurred in pediatric patients and 250 (65%) in adult population. Candida albicans (39%), Candida parapsilosis (30%) and Candida glabrata (10%) were the leading species, with a significant difference in the distribution of species between ages. The use of central venous catheter and antibiotics were the most frequent risk factors in all age groups (> 70%). Three hundred and fifteen strains were studied for antifungal susceptibility; 21 strains (6.6%) were resistant to fluconazole, itraconazole, voriconazole, anidulafungin or micafungin. The most commonly used antifungal therapies were fluconazole (39%) and echinocandins (36%). The overall 30-day survival was 74.2%, significantly higher in infants (82%) and children (86%) compared with neonates (72%), adults (71%) and elderly (70%). CONCLUSIONS Our prospective, multicenter surveillance study showed a low incidence of candidemia in Chile, with high 30-day survival, a large proportion of elderly patients, C. glabrata as the third most commonly identified strain, a 6.6% resistance to antifungal agents and a frequent use of echinocandins.
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Affiliation(s)
- Maria E. Santolaya
- Infectious Diseases Unit, Department of Pediatrics, Hospital Dr. Luis Calvo Mackenna, Faculty of Medicine, Universidad de Chile, Santiago, Chile
- Chilean Invasive Mycosis Network, Santiago, Chile
- * E-mail:
| | - Luis Thompson
- Chilean Invasive Mycosis Network, Santiago, Chile
- Infectious Diseases Unit, Department of Medicine, Clínica Alemana, Universidad del Desarrollo, Santiago, Chile
| | - Dona Benadof
- Chilean Invasive Mycosis Network, Santiago, Chile
- Microbiology Laboratory, Hospital Dr. Roberto del Río, Santiago, Chile
| | - Cecilia Tapia
- Chilean Invasive Mycosis Network, Santiago, Chile
- Microbiological and Micological Program, Instituto de Ciencias Biomédicas, Faculty of Medicine, Universidad de Chile, Santiago, Chile
| | - Paulette Legarraga
- Chilean Invasive Mycosis Network, Santiago, Chile
- Department of Clinical Laboratories, Faculty of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Claudia Cortés
- Chilean Invasive Mycosis Network, Santiago, Chile
- Medicine Department, Hospital San Borja Arriarán, Clínica Santa María, Faculty of Medicine, Universidad de Chile, Santiago Chile
| | - Marcela Rabello
- Infectious Diseases Unit, Department of Pediatrics, Hospital Dr. Luis Calvo Mackenna, Faculty of Medicine, Universidad de Chile, Santiago, Chile
- Chilean Invasive Mycosis Network, Santiago, Chile
| | - Romina Valenzuela
- Infectious Diseases Unit, Department of Pediatrics, Hospital Dr. Luis Calvo Mackenna, Faculty of Medicine, Universidad de Chile, Santiago, Chile
- Chilean Invasive Mycosis Network, Santiago, Chile
| | - Pamela Rojas
- Chilean Invasive Mycosis Network, Santiago, Chile
- Microbiology Laboratory, Hospital Padre Hurtado, Santiago, Chile
| | - Ricardo Rabagliati
- Chilean Invasive Mycosis Network, Santiago, Chile
- Department of Infectious Diseases, Faculty of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
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Isla G, Taverna CG, Szusz W, Vivot W, García-Effron G, Davel G. Candida haemulonii sensu lato: Update of the Determination of Susceptibility Profile in Argentina and Literature Review. CURRENT FUNGAL INFECTION REPORTS 2017. [DOI: 10.1007/s12281-017-0300-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
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Kaur H, Chakrabarti A. Strategies to Reduce Mortality in Adult and Neonatal Candidemia in Developing Countries. J Fungi (Basel) 2017; 3:E41. [PMID: 29371558 PMCID: PMC5715942 DOI: 10.3390/jof3030041] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2017] [Revised: 07/13/2017] [Accepted: 07/16/2017] [Indexed: 02/07/2023] Open
Abstract
Candidemia, the commonest invasive fungal infection, is associated with high morbidity and mortality in developing countries, though the exact prevalence is not known due to lack of systematic epidemiological data from those countries. The limited studies report a very high incidence of candidemia and unique epidemiology with a different spectrum of Candida species. The recent global emergence of multi-drug resistant Candida auris is looming large as an important threat in hospitalized patients of developing countries. While managing candidemia cases in those countries several challenges are faced, which include poor infrastructure; compromised healthcare and infection control practices; misuse and overuse of antibiotics and steroids; lack of awareness in fungal infections; non-availability of advance diagnostic tests and antifungal drugs in many areas; poor compliance to antifungal therapy and stewardship program. Considering the above limitations, innovative strategies are required to reduce mortality due to candidemia in adults and neonates. In the present review, we have unraveled the challenges of candidemia faced by low resource countries and propose a ten part strategy to reduce mortality due candidemia.
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Affiliation(s)
- Harsimran Kaur
- Department of Medical Microbiology, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh 160012, India.
| | - Arunaloke Chakrabarti
- Department of Medical Microbiology, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh 160012, India.
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ANDREOLA P, DEMATHÉ A, GALAFASSI D, ELSEMANN EB, ELSEMANN RB, GAZZONI AF. Estudo comparativo entre a produção de fosfolipases extracelulares e proteinases do gênero Candida isoladas a partir de infecções de cavidade oral. REVISTA DE ODONTOLOGIA DA UNESP 2016. [DOI: 10.1590/1807-2577.26115] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Resumo Introdução A habilidade da Candida spp. em produzir enzimas proteolíticas, tais como fosfolipase e proteinases, tem um papel importante na patogenicidade destas leveduras. Objetivo Determinar as espécies causadoras das infecções orais por Candida spp., além de investigar a atividade in vitro das fosfolipases e proteinases em isolados clínicos do gênero Candida, provenientes de pacientes com candidíase oral. Material e método Isolados de Candida spp., pertencentes à Coleção de Cultivos Fúngicos do Laboratório de Microbiologia e Patologia Oral do Departamento de Odontologia da Faculdade da Serra Gaúcha, foram analisados. Produção de fosfolipases foi analisada utilizando-se Ágar gema de ovo. Liberação de proteinases foi medida utilizando-se extrato de levedura adicionado à albumina bovina. Resultado Um total de 35 isolados clínicos do gênero Candida foi testado. C. albicans foi a espécie predominante (77%). Os demais isolados identificados foram: C. parapsilosis (20%) e C. tropicalis (2%). Ao comparar a atividade de fosfolipase do grupo C. albicans com o grupo Candida não-albicans, foi encontrada diferença significativa (P=0,04). Não foi encontrada diferença significativa entre a C. albicans e a C. não-albicans, para a produção de proteinase. A liberação de proteinase foi significativamente maior quando comparada à produção de fosfolipase para o gênero Candida (P=0,04). Diferença estatisticamente significativa foi encontrada quando a atividade de fosfolipase e proteinase da C. albicans foi comparada à atividade das espécies de C. não-albicans (P=0,02). Conclusão Diferentes quantificações de fosfolipase extracelular e atividade de proteinase têm sido atribuídas aos isolados clínicos de C. albicans quando comparados a outras espécies de Candida.
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