1
|
Candiduria: Evidence-based approach to management, are we there yet? J Mycol Med 2017; 27:293-302. [PMID: 28501465 DOI: 10.1016/j.mycmed.2017.04.005] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2017] [Revised: 03/15/2017] [Accepted: 04/07/2017] [Indexed: 12/30/2022]
Abstract
Candiduria is considered one of the most controversial issues in patient management. Neither the diagnosis nor the optimal treatment options are standardized. This is further complicated by lack of defined laboratory criteria for diagnosis as most of the studies were set for bacterial rather than fungal urinary tract infection (UTI). Furthermore, since Candida species is a known commensal of the genitourinary tract its presence in the urine sample adds ambiguity to making a definitive diagnosis of candidal UTI. Guidelines for diagnosis and management of candiduria have changed considerably over the past decades. In 1960s, the condition was believed to be benign with no intervention required. However, over the years new dimensions were added to address the issues associated with candiduria until the latest Infectious Diseases Association of America (IDSA) guidelines were published in 2009, which indicated that there was an increase in the incidence of candiduria caused by more resistant non-Candida albicans species. Further complicating the issue is the observation that candiduria may be the only indicator of a more serious invasive candidiasis, especially in immunocompromised patients. Long-term urinary catheterization is considered to be the most significant risk factor for candiduria followed by antibiotic use and diabetes. Strategies for management are based on the evaluation of candiduria in the context of the clinical setting to determine its relevance and make an appropriate decision about the need for antifungal therapy. Fluconazole is the main drug used for its efficacy and least complications. Other options include bladder irrigation with amphotericin B, flucytosine or parenteral amphotericin B. Since azoles other than fluconazole and all echinocandins are poorly excreted in urine they have been found to be less effective in candiduric patients.
Collapse
|
2
|
Kang J, Sickbert-Bennett EE, Brown VM, Weber DJ, Rutala WA. Changes in the incidence of health care-associated pathogens at a university hospital from 2005 to 2011. Am J Infect Control 2014; 42:770-5. [PMID: 24775560 DOI: 10.1016/j.ajic.2014.03.019] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2013] [Revised: 03/14/2014] [Accepted: 03/17/2014] [Indexed: 11/25/2022]
Abstract
BACKGROUND Data on health care-associated infections (HAIs) outside of intensive care units (ICU) are scarce. We assessed hospital-wide changes in the incidence of health care-associated pathogens by infection site and by service between 2005 and 2011. METHODS All data on health care-associated pathogens in 2005-2011 based on comprehensive hospital-wide surveillance were extracted from an electronic database. The incidence of HAI by pathogen was calculated per 1000 patient-days and per 1000 device-days. Regression analyses were conducted to estimate trend changes in the yearly incidence of pathogens for selected HAIs. RESULTS The majority (8784 of 10,070; 87.2%) of the HAIs recorded over the 7-year period had at least 1 pathogen; a total of 10,585 pathogens were isolated. Overall, across all major service categories (eg, ICU, medicine), significant trends toward decreasing incidence were observed for all pathogens except Clostridium difficile. The decrease in incidence was greatest for central line-associated bloodstream infections, less for catheter-associated urinary tract infections, and lowest for ventilator-associated pneumonias. CONCLUSIONS This study showed significant decreases in incidence of the majority of HAIs caused by various pathogens, but significant increases in patient-days during the study period. Only HAIs due to C difficile showed a significantly increased incidence.
Collapse
|
3
|
Kang J, Sickbert-Bennett EE, Brown VM, Weber DJ, Rutala WA. Relative frequency of health care-associated pathogens by infection site at a university hospital from 1980 to 2008. Am J Infect Control 2012; 40:416-20. [PMID: 21943832 DOI: 10.1016/j.ajic.2011.06.013] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2011] [Revised: 06/17/2011] [Accepted: 06/20/2011] [Indexed: 11/30/2022]
Abstract
BACKGROUND We describe the relative frequency of health care-associated pathogens by infection site over 29 years using hospital-wide surveillance data from a large academic hospital. METHODS Comprehensive hospital-wide surveillance was provided by trained infection preventionists using Centers for Disease Control and Prevention definitions. Five 5-year blocks and one 4-year block were created for each site: bloodstream infections (BSI), urinary tract infections (UTI), respiratory tract infections (RTI), and surgical site infections (SSI). The blocks of relative frequency of health care-associated pathogens were compared by χ(2) analysis, and trends for each pathogen were estimated by regression analysis. RESULTS At least 1 pathogen was isolated from 28,208 (83.5%) of 33,797 health care-associated infections (HAI). Staphylococcus aureus, coagulase-negative staphylococci (CoNS), Enterococcus species, and Clostridium difficile and other anaerobes significantly increased, whereas Escherichia coli, Pseudomonas aeruginosa, Klebsiella species, Enterobacter species, and other streptococci significantly decreased in the relative proportion of pathogens during the study period. By infection site, results showed significant increasing trends of S aureus in UTI, RTI, and SSI; CoNS in BSI and SSI; Candida in SSI; and Enterococcus in BSI and UTI. CONCLUSION Significant changes in relative frequency of health care-associated pathogens by infection site occurred over the 29-year period. These findings have implications for implementation of infection prevention strategies.
Collapse
Affiliation(s)
- JaHyun Kang
- University of North Carolina School of Nursing, Chapel Hill, NC 27599, USA.
| | | | | | | | | |
Collapse
|
4
|
Abstract
The prevalence of candiduria has increased in patients admitted to intensive care units (ICUs) and it has emerged as a common nosocomial infection among critically ill patients. Generally, urinary candidiasis should be regarded as a risk factor for invasive candidiasis, but not as a disease that needs to be treated on its own. However, decision-making in critically ill patients with candiduria may become a balancing act, because candiduria may be the only indication for invasive candidaemia with significant morbidity and mortality. Of further concern, there is a worldwide increase in the incidence of non-albicans spp. isolated from urine with highly variable susceptibility to fluconazole, which has been the first-line therapy for Candida infections during the last decades. This article discusses everyday problems with urinary candidiasis in interdisciplinary ICUs.
Collapse
Affiliation(s)
- Eike Hollenbach
- Interdisciplinary Intensive Care Unit, Department of Medicine, University of Leipzig, Leipzig, Germany.
| |
Collapse
|
5
|
Rocha LA, Ferreira de Almeida e Borges L, Gontijo Filho PP. Changes in hands microbiota associated with skin damage because of hand hygiene procedures on the health care workers. Am J Infect Control 2009; 37:155-9. [PMID: 19249642 DOI: 10.1016/j.ajic.2008.04.251] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2007] [Revised: 04/02/2008] [Accepted: 04/04/2008] [Indexed: 10/21/2022]
Abstract
BACKGROUND The purpose of this study was evaluating the microbial flora of nurses' healthy (n = 30) and damaged hand (n = 30) by frequent handwashing and/or wearing of gloves. METHODS Hand cultures were obtained both before and after washing hands with nonantimicrobial soap, through the sterile polyethylene bag method. RESULTS The bacteria counts of the hands of professionals with damaged hands were higher than those with healthy hands, and those with damaged hands presented higher frequency of Staphylococcus aureus, 16.7% versus 10%; gram-negative bacteria, 20% versus 6.7%; and yeast, 26.7% versus 20%, respectively, as well as the sum of these microorganisms. The presence of Staphylococcus haemolyticus was only seen in nurses with damaged hands (P = .02), and enterococci were not recovered from the hands of any volunteer. The presence of antimicrobial-resistant S aureus and gram-negative bacteria was also greater among damaged hands. CONCLUSION The irritation caused on the skin by frequent washing and/or wearing of gloves is associated with changes in hands microbial flora, and their potential risks should be considered when institutions/users are selecting products/formulations to assure hands skin health and consequent compliance with their own hygiene procedures.
Collapse
|
6
|
Point-of-use water filtration reduces endemic Pseudomonas aeruginosa infections on a surgical intensive care unit. Am J Infect Control 2008; 36:421-9. [PMID: 18675148 DOI: 10.1016/j.ajic.2007.09.012] [Citation(s) in RCA: 62] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2007] [Revised: 09/17/2007] [Accepted: 09/17/2007] [Indexed: 11/21/2022]
Abstract
BACKGROUND Endemic infections because of Pseudomonas aeruginosa were observed on a surgical intensive care unit (ICU) for a period of >24 months. Tap water probing revealed persistent colonization of all ICU water taps with a single P aeruginosa clonotype. METHODS Water outlets of the ICU were equipped with disposable point-of-use water filters, changed in weekly and, later, 2-week intervals. To delineate the effect of the filters, 4 study approaches were followed: (1) a descriptive analysis of the incidence of P aeruginosa colonizations and infections, (2) microbiologic examinations of tap water before and after installation of the filters, (3) a comparative cohort analysis of representative patient samples from the prefilter and postfilter time periods, and (4) an analysis of general ward variables for the 2 periods. RESULTS (1) The mean monthly rate (+/-SD) of P aeruginosa infection/colonization episodes was 3.9 +/- 2.4 in the prefilter and 0.8 +/- 0.8 in the postfilter period. P aeruginosa colonizations were reduced by 85% (P < .0001) and invasive infections by 56% (P < .0003) in the postfilter period. (2) Microbiologic examinations of tap water revealed growth of P aeruginosa in 113 of 117 (97%) samples collected during the prefilter period, compared with 0 of 52 samples taken from filter-equipped taps. (3) In the comparative cohort analysis, a number of patient-related variables were significantly associated with P aeruginosa colonization/infection. Considering these variables in a multivariate analysis, belonging to the postfilter cohort was the factor most strongly associated with a reduced risk of P aeruginosa positivity (relative risk, 0.04; P = .0002). (4) General ward variables such as bed occupancy, personnel-to-patient ratio, or microbiologic culturing density did not differ significantly between the 2 periods. CONCLUSION Taking into account various patient-related and general ward variables, point-of-use water filtration was associated with a significant reduction of chronically endemic P aeruginosa colonizations/infections on a surgical ICU.
Collapse
|
7
|
Community-acquired and hospital-acquired candiduria: comparison of prevalence and clinical characteristics. Eur J Clin Microbiol Infect Dis 2007; 27:301-5. [DOI: 10.1007/s10096-007-0438-6] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2007] [Accepted: 11/23/2007] [Indexed: 10/22/2022]
|
8
|
Binelli CA, Moretti ML, Assis RS, Sauaia N, Menezes PR, Ribeiro E, Geiger DCP, Mikami Y, Miyaji M, Oliveira MS, Barone AA, Levin AS. Investigation of the possible association between nosocomial candiduria and candidaemia. Clin Microbiol Infect 2006; 12:538-43. [PMID: 16700702 DOI: 10.1111/j.1469-0691.2006.01435.x] [Citation(s) in RCA: 48] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
This study aimed to determine whether candiduria is associated with the occurrence of nosocomial candidaemia. In the case-control part of the study, 115 cases (nosocomial candidaemia) and 115 controls (nosocomial bacteraemia) were similar in age, severity of condition and time of hospitalisation. There was a significant association of candidaemia with candiduria (OR 9.79; 95% CI 2.14-44.76). In the microbiology part of the study, 23 pairs of Candida-positive urine and blood cultures were obtained from 23 patients. In ten (43%) cases, the urine and blood culture isolates belonged to different species, and molecular typing showed a difference in two of the 13 cases yielding the same species from both specimens. Overall, there was a significant association between candiduria and candidaemia, but the Candida isolates from urine and blood were different for 52% of the patients. Thus, the data indicated that the urinary tract was probably not a source for the candidaemia.
Collapse
Affiliation(s)
- C A Binelli
- Faculty of Medicine of the University of São Paulo, São Paulo, Brazil
| | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
9
|
Sellami A, Sellami H, Makni F, Bahloul M, Cheikh-Rouhou F, Bouaziz M, Ayadi A. [Candiduria in intensive care unit: significance and value of yeast numeration in urine]. ACTA ACUST UNITED AC 2006; 25:584-8. [PMID: 16626924 DOI: 10.1016/j.annfar.2006.02.019] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2005] [Accepted: 02/17/2006] [Indexed: 11/25/2022]
Abstract
JUSTIFICATION Candiduria is increasingly frequent among patients admitted to intensive care units but its significance remains unclear. OBJECTIVES Search for eventual correlation between quantitative candiduria and known risk factors for invasive candidiasis. STUDY DESIGN Prospective. PATIENTS AND METHODS A four-month study was conducted in 162 patients hospitalized in the intensive care unit for more than 72 hours. All patients underwent a weekly research of candiduria added to sampling from different body sites to determine the Pittet Candida colonization index. RESULTS Candiduria has been proved in 56 cases (34%). It was superior or equal to 10(4) UFC/ml among 28 patients (50%). Candida tropicalis, Candida glabrata and Candida albicans has been isolated in 41, 22 and 20% respectively. All patients had at least one major and two minor risk factors for Candida infection. Six patients (10%) developed invasive candidiasis. The global mortality rate was at 52%. Pittet colonization index was significantly different between patients with candiduria and those with invasive candidiasis (p=0.01). There was a statistically significant correlation between candiduria superior or equal to 10(4) UFC/ml and Pittet colonization index superior or equal to 0.5 (p=0.01). CONCLUSION Candiduria superior or equal to 10(4) UFC/ml associated with risk factors may predict invasive candidiasis in critically ill patients.
Collapse
Affiliation(s)
- A Sellami
- Laboratoire de Parasitologie-Mycologie, Faculté de Médecine, Sfax, Tunisie
| | | | | | | | | | | | | |
Collapse
|
10
|
Passos XS, Sales WS, Maciel PJ, Costa CR, Miranda KC, Lemos JDA, Batista MDA, Silva MDRR. Candida colonization in intensive care unit patients' urine. Mem Inst Oswaldo Cruz 2006; 100:925-8. [PMID: 16444426 DOI: 10.1590/s0074-02762005000800016] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
The objective of this study was to identify possible predisposing factors for candiduria in intensive care unit (ICU) patients from Hospital das Clínicas, Universidade Federal de Goiás, Goiânia, Brazil, during one year. Urine samples from 153 ICU patients were obtained by catheterization on admission day and every seven days. Data such as sex, age, antifungal therapy, and variables as antibiotics, underlying diseases or comorbid conditions and stay in the hospital, were collected from patients who had at least one urine culture that yielded > 10(3) yeast colonies/ml. Candiduria was recovered in 68 patients and the commonest predisposing factors were antibiotic therapy (100%) and indwelling urinary catheter (92.6%). The percentage of Candida spp. isolation increased during the extended periods in which patients remained in the ICU. C. albicans was isolated in 69.1%, and the other species non-albicans as C. glabrata, C. kefyr, C. parapsilosis, C. famata, C. guilliermondii, C. krusei, and C. tropicalis were isolated in lower percentage. The high frequency of candiduria and the possible predisposing factors found in ICU patients show that candiduria surveillance should be performed to help reducing nosocomial infections.
Collapse
|
11
|
Trautmann M, Lepper PM, Haller M. Ecology of Pseudomonas aeruginosa in the intensive care unit and the evolving role of water outlets as a reservoir of the organism. Am J Infect Control 2005; 33:S41-9. [PMID: 15940115 DOI: 10.1016/j.ajic.2005.03.006] [Citation(s) in RCA: 182] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
In spite of the significant changes in the spectrum of organisms causing intensive care unit (ICU)-associated infections, Pseudomonas aeruginosa has held a nearly unchanged position in the rank order of pathogens causing ICU-related infections during the last 4 decades. Horizontal transmissions between patients have long been considered the most frequent source of P aeruginosa colonizations/infections. The application of molecular typing methods made it possible, during the last approximately 7 years, to identify ICU tap water as a significant source of exogenous P aeruginosa isolates. A review of prospective studies published between 1998 and 2005 showed that between 9.7% and 68.1% of randomly taken tap water samples on different types of ICUs were positive for P aeruginosa , and between 14.2% and 50% of infection/colonization episodes in patients were due to genotypes found in ICU water. Faucets are easily accessible for preventive measures, and the installation of single-use filters on ICU water outlets appears to be an effective concept to reduce water-to-patient transmissions of this important nosocomial pathogen.
Collapse
|
12
|
Kampf G, Kramer A. Epidemiologic background of hand hygiene and evaluation of the most important agents for scrubs and rubs. Clin Microbiol Rev 2004; 17:863-93, table of contents. [PMID: 15489352 PMCID: PMC523567 DOI: 10.1128/cmr.17.4.863-893.2004] [Citation(s) in RCA: 416] [Impact Index Per Article: 20.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
The etiology of nosocomial infections, the frequency of contaminated hands with the different nosocomial pathogens, and the role of health care workers' hands during outbreaks suggest that a hand hygiene preparation should at least have activity against bacteria, yeasts, and coated viruses. The importance of efficacy in choosing the right hand hygiene product is reflected in the new Centers for Disease Control and Prevention guideline on hand hygiene (J. M. Boyce and D. Pittet, Morb. Mortal. Wkly. Rep. 51:1-45, 2002). The best antimicrobial efficacy can be achieved with ethanol (60 to 85%), isopropanol (60 to 80%), and n-propanol (60 to 80%). The activity is broad and immediate. Ethanol at high concentrations (e.g., 95%) is the most effective treatment against naked viruses, whereas n-propanol seems to be more effective against the resident bacterial flora. The combination of alcohols may have a synergistic effect. The antimicrobial efficacy of chlorhexidine (2 to 4%) and triclosan (1 to 2%) is both lower and slower. Additionally, both agents have a risk of bacterial resistance, which is higher for chlorhexidine than triclosan. Their activity is often supported by the mechanical removal of pathogens during hand washing. Taking the antimicrobial efficacy and the mechanical removal together, they are still less effective than the alcohols. Plain soap and water has the lowest efficacy of all. In the new Centers for Disease Control and Prevention guideline, promotion of alcohol-based hand rubs containing various emollients instead of irritating soaps and detergents is one strategy to reduce skin damage, dryness, and irritation. Irritant contact dermatitis is highest with preparations containing 4% chlorhexidine gluconate, less frequent with nonantimicrobial soaps and preparations containing lower concentrations of chlorhexidine gluconate, and lowest with well-formulated alcohol-based hand rubs containing emollients and other skin conditioners. Too few published data from comparative trials are available to reliably rank triclosan. Personnel should be reminded that it is neither necessary nor recommended to routinely wash hands after each application of an alcohol-based hand rub. Long-lasting improvement of compliance with hand hygiene protocols can be successful if an effective and accessible alcohol-based hand rub with a proven dermal tolerance and an excellent user acceptability is supplied, accompanied by education of health care workers and promotion of the use of the product.
Collapse
Affiliation(s)
- Günter Kampf
- Bode Chemie GmbH & Co., Scientific Affairs, Melanchthonstrasse 27, 22525 Hamburg, Germany.
| | | |
Collapse
|
13
|
Simpson C, Blitz S, Shafran SD. The effect of current management on morbidity and mortality in hospitalised adults with funguria. J Infect 2004; 49:248-52. [PMID: 15337343 DOI: 10.1016/j.jinf.2003.08.008] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/15/2003] [Indexed: 11/27/2022]
Abstract
BACKGROUND To compare morbidity and mortality in inpatients with asymptomatic funguria between those treated and those observed for funguria. METHODS Retrospective analyses were performed in 149 consecutive adult tertiary care inpatients with asymptomatic funguria. The primary endpoints were death, length of hospitalisation and progression to invasive fungal infection (IFI). RESULTS Of the 149 subjects, 70% were female, 55% were >65 years, recent antibiotic and urinary catheter use occurred in >70%, diabetes in 32%, recent ICU admission in 29%, and concomitant bacteriuria in 28%. Forty-seven percent did not receive active intervention. Of the remainder, 46% were managed by controlling or eliminating risk factors for funguria or progression to IFI; fluconazole or amphotericin B were used to treat the other 54%. Fourteen percent died and 2.7 % progressed to IFI, with no significant difference between the treated versus observed groups for either endpoint (p>0.2). Median length of hospitalisation was significantly greater in the treated group (p<0.01); multivariate analysis demonstrated an exclusive relationship to the greater number of risk factors present in the treated group. CONCLUSION Asymptomatic funguric patients who were managed with risk reduction and/or antifungal therapy were older, had more risk factors for funguria and subsequent progression to IFI, and had a longer hospital admission than those managed with observation. Treatment of asymptomatic funguria with risk reduction and/or antifungal therapy did not impact adult inpatient morbidity or mortality in this review; rather, the presence of multiple risk factors for funguria or IFI appeared to serve as a 'sickness indicator'. SUMMARY In this study, we found that treatment for asymptomatic funguria in hospitalised adults did not impact morbidity or mortality. Rather, the presence of multiple risk factors for funguria or IFI correlated with a longer duration of hospitalisation, suggesting that funguria may be a 'sickness indicator', similar to bacteriuria in the elderly.
Collapse
Affiliation(s)
- Christine Simpson
- Department of Medicine, University of Alberta, 2F1.13 Walter C. Mackenzie Health Sciences Centre, 8440-112 Street, Edmonton, Alta., Canada T6G 2R7
| | | | | |
Collapse
|
14
|
McMullan R, McClurg R, Xu J, Moore JE, Millar BC, Crowe M, Hedderwick S. Trends in the epidemiology of Candida bloodstream infections in Northern Ireland between January 1984 and December 2000. J Infect 2002; 45:25-8. [PMID: 12217727 DOI: 10.1053/jinf.2002.0999] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVE To describe the epidemiology of Candida bloodstream infections (BSI) in Northern Ireland. METHODS Retrospective collation of data relating to all clinically significant BSI in a university teaching hospital, which had been recorded prospectively, between 1984 and 2000. RESULTS One hundred and forty five episodes of candidaemia occurred in 144 patients (of mean age 56.6 years). The contribution of Candida spp. towards all significant BSI increased from 2.0% to 2.5%. C. albicans was the most frequently isolated species, however, its incidence fell from 70% to 53% during the study period. The greatest increase in incidence was seen with C. glabrata which was the most common non-albicans species. Twenty-nine per cent of isolates occurred in patients from an intensive care unit and, surprisingly, a further 25.5% occurred in patients from a surgical service. CONCLUSION There appears to be several subtle differences in the epidemiology of candidal BSI between Northern Ireland and other countries.
Collapse
Affiliation(s)
- R McMullan
- Department of Microbiology, Northern Ireland Public Health Laboratory, Belfast City Hospital, Lisburn Road, Belfast, Northern Ireland.
| | | | | | | | | | | | | |
Collapse
|
15
|
Lundstrom T, Sobel J. Nosocomial candiduria: a review. Clin Infect Dis 2001; 32:1602-7. [PMID: 11340532 DOI: 10.1086/320531] [Citation(s) in RCA: 105] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2000] [Revised: 01/17/2001] [Indexed: 11/04/2022] Open
Abstract
Fungal infections of the urinary tract, especially those caused by Candida species, are becoming increasingly common. Often the line between Candida colonization and infection is blurred. Diagnosis typically depends on the discovery of pyuria with high colony Candida counts in the urine. To date, there have been few studies to have addressed treatment regimens for patients with candiduria. Fluconazole has become a mainstay of therapy; however, questions regarding when to treat, whom to treat, and how long to treat are still largely unanswered. Asymptomatic nosocomial candiduria does not frequently require treatment intervention, because morbidity is low and ascending infection and candidemia are rare complications. Treatment decisions are driven by an understanding of the anatomic site of infection. For Candida cystitis, the first-line treatment is fluconazole, given orally. Ascending pyelonephritis usually requires the administration of a systemic antifungal agent and often requires correction of the obstruction or surgical drainage. More research is needed to define diagnostic criteria and therapeutic pathways. This review will attempt to summarize the state of the art of diagnosis and management of candiduria.
Collapse
Affiliation(s)
- T Lundstrom
- Division of Infectious Disease, Detroit Medical Center, Wayne State University School of Medicine, Detroit, MI 48201, USA.
| | | |
Collapse
|
16
|
Chabasse D. [Yeast count in urine. Review of the literature and preliminary results of a multicenter prospective study carried out in 15 hospital centers]. ANNALES FRANCAISES D'ANESTHESIE ET DE REANIMATION 2001; 20:400-6. [PMID: 11392253 DOI: 10.1016/s0750-7658(01)00376-8] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
Candida spp. are increasingly involved in nosocomial infections in severely ill patients and the diagnosis is difficult. In this context, the significance of candiduria remains unclear. Management of this condition is still equivocal, because of the lack of information about its natural history and its predictive value for disseminated infection. Little is known about the discriminant value of colony count. After a comprehensive review of the available published data, the preliminary results of a multicentric prospective survey in critically ill patients hospitalised in intensive care units are given. The aim of the study was to search for correlations between quantitative candiduria and known risk factors for disseminated candidiasis. There is a statistically significant correlation (p = 0.003) between heavy candiduria (> 10(4) cfu.mL-1) and high Pittet colonisation index (> or = 0.5). Quantification of candiduria could be useful to select patients at high risk for disseminated candidiasis.
Collapse
Affiliation(s)
- D Chabasse
- Laboratoire de parasitologie-mycologie, centre hospitalier universitaire, 4, rue Larrey, 49033 Angers, France
| |
Collapse
|
17
|
Benjamin DK, Ross K, McKinney RE, Benjamin DK, Auten R, Fisher RG. When to suspect fungal infection in neonates: A clinical comparison of Candida albicans and Candida parapsilosis fungemia with coagulase-negative staphylococcal bacteremia. Pediatrics 2000; 106:712-8. [PMID: 11015513 DOI: 10.1542/peds.106.4.712] [Citation(s) in RCA: 146] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES To determine the epidemiology of candidemia in our neonatal intensive care unit; to compare risk factors, clinical presentation, and outcomes for neonates infected with Candida albicans, Candida parapsilosis, and coagulase-negative staphylococcus (CoNS); and to suggest a rational approach to empiric antifungal therapy of neonates at risk for nosocomial infection. DESIGN Retrospective chart review of all neonatal intensive care unit patients with systemic candidiasis or CoNS infection between January 1, 1995 and July 31, 1998 at Duke University Medical Center. RESULTS Fifty-one patients were reviewed. Nine of 19 patients infected with C parapsilosis and 5 of 15 patients infected with C albicans died of fungemia. Seventeen neonates had >2 positive cultures for CoNS obtained within 96 hours and 1 died. There was no statistically significant difference in birth weight, gestational age, or age at diagnosis between patient groups; however, candidemic patients had a sevenfold higher mortality rate. Before diagnosis, candidemic patients had greater exposure to systemic steroids, antibiotics, and catecholamine infusions. Of the 51 patients, 32 received third-generation cephalosporins in the 2 weeks before diagnosis and 19 did not. Twenty-nine of the 32 who were treated with third-generation cephalosporins subsequently developed candidemia, while candidemia occurred in only 5 of 19 patients who were not treated with cephalosporins. At the time of diagnosis, candidemic patients were more likely to have required mechanical ventilation and were less likely to be tolerating enteral feeding. Multivariate clustered logistic regression analysis revealed that candidemic patients had more exposure to third-generation cephalosporins. Once the clinician was notified of a positive blood culture for Candida, patients infected with C parapsilosis retained their central catheters longer than patients infected with C albicans. CONCLUSIONS In this retrospective review, we were able to identify aspects of the clinical presentation and medication history that may be helpful in differentiating between candidemia and CoNS bacteremia. Those key features may be used by clinicians to initiate empiric amphotericin B therapy in premature neonates at risk for nosocomial infections. Prolonged use of third-generation cephalosporins was strongly associated with candidemia. There was no statistically significant difference in the morbidity and mortality between patients infected with C parapsilosis and those infected with C albicans. Observed delays in removal of the central venous catheter may have contributed to finding a mortality rate from C parapsilosis that was higher than was previously reported.
Collapse
MESH Headings
- Amphotericin B/therapeutic use
- Analysis of Variance
- Anti-Bacterial Agents/therapeutic use
- Antifungal Agents/adverse effects
- Antifungal Agents/therapeutic use
- Bacteremia/diagnosis
- Bacteremia/drug therapy
- Bacteremia/microbiology
- Candida/isolation & purification
- Candida albicans/isolation & purification
- Candidiasis/diagnosis
- Candidiasis/drug therapy
- Candidiasis/etiology
- Candidiasis/mortality
- Catheterization, Central Venous/adverse effects
- Cephalosporins/adverse effects
- Cephalosporins/therapeutic use
- Cross Infection/diagnosis
- Cross Infection/drug therapy
- Cross Infection/etiology
- Diagnosis, Differential
- Fungemia/diagnosis
- Fungemia/drug therapy
- Fungemia/etiology
- Fungemia/microbiology
- Humans
- Infant, Newborn
- Infant, Premature
- Infant, Premature, Diseases/diagnosis
- Infant, Premature, Diseases/drug therapy
- Infant, Premature, Diseases/etiology
- Infant, Premature, Diseases/mortality
- Infant, Very Low Birth Weight
- Intensive Care Units, Neonatal
- Logistic Models
- Retrospective Studies
- Risk Factors
- Staphylococcal Infections/diagnosis
- Staphylococcal Infections/drug therapy
- Staphylococcal Infections/mortality
Collapse
Affiliation(s)
- D K Benjamin
- Department of Pediatrics, Duke University, Medical Center, Durham, North Carolina 27710, USA.
| | | | | | | | | | | |
Collapse
|
18
|
Kauffman CA, Vazquez JA, Sobel JD, Gallis HA, McKinsey DS, Karchmer AW, Sugar AM, Sharkey PK, Wise GJ, Mangi R, Mosher A, Lee JY, Dismukes WE. Prospective multicenter surveillance study of funguria in hospitalized patients. The National Institute for Allergy and Infectious Diseases (NIAID) Mycoses Study Group. Clin Infect Dis 2000; 30:14-8. [PMID: 10619726 DOI: 10.1086/313583] [Citation(s) in RCA: 266] [Impact Index Per Article: 11.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Although fungal urinary tract infections are an increasing nosocomial problem, the significance of funguria is still not clear. This multicenter prospective surveillance study of 861 patients was undertaken to define the epidemiology, management, and outcomes of funguria. Diabetes mellitus was present in 39% of patients, urinary tract abnormalities in 37.7%, and malignancy in 22.2%; only 10.9% had no underlying illnesses. Concomitant nonfungal infections were present in 85%, 90% had received antimicrobial agents, and 83.2% had urinary tract drainage devices. Candida albicans was found in 51.8% of patients and Candida glabrata in 15.6%. Microbiological and clinical outcomes were documented for 530 (61.6%) of the 861 patients. No specific therapy for funguria was given to 155 patients, and the yeast cleared from the urine of 117 (75.5%) of them. Of the 116 patients who had a catheter removed as the only treatment, the funguria cleared in 41 (35.3%). Antifungal therapy was given to 259 patients, eradicating funguria in 130 (50.2%). The rate of eradication with fluconazole was 45.5%, and with amphotericin B bladder irrigation it was 54.4%. Only 7 patients (1.3%) had documented candidemia. The mortality rate was 19.8%, reflecting the multiple serious underlying illnesses found in these patients with funguria.
Collapse
Affiliation(s)
- C A Kauffman
- University of Michigan and Veterans Affairs Medical Center, Ann Arbor, MI 48105, USA.
| | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
19
|
Sobel JD, Kauffman CA, McKinsey D, Zervos M, Vazquez JA, Karchmer AW, Lee J, Thomas C, Panzer H, Dismukes WE. Candiduria: a randomized, double-blind study of treatment with fluconazole and placebo. The National Institute of Allergy and Infectious Diseases (NIAID) Mycoses Study Group. Clin Infect Dis 2000; 30:19-24. [PMID: 10619727 DOI: 10.1086/313580] [Citation(s) in RCA: 182] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Management of candiduria is limited by the lack of information about its natural history and lack of data from controlled studies on the efficacy of treating it with antimycotic agents. We compared fungal eradication rates among 316 consecutive candiduric (asymptomatic or minimally symptomatic) hospitalized patients treated with fluconazole (200 mg) or placebo daily for 14 days. In an intent-to-treat analysis, candiduria cleared by day 14 in 79 (50%) of 159 receiving fluconazole and 46 (29%) of 157 receiving placebo (P<.001), with higher eradication rates among patients completing 14 days of therapy (P<.0001), including 33 (52%) of 64 catheterized and 42 (78%) of 54 noncatheterized patients. Pretreatment serum creatinine levels were inversely related to candiduria eradication. Fluconazole initially produced high eradication rates, but cultures at 2 weeks revealed similar candiduria rates among treated and untreated patients. Oral fluconazole was safe and effective for short-term eradication of candiduria, especially following catheter removal. Long-term eradication rates were disappointing and not associated with clinical benefit.
Collapse
Affiliation(s)
- J D Sobel
- Wayne State University, Detroit, MI 48201, USA. . edu
| | | | | | | | | | | | | | | | | | | |
Collapse
|
20
|
Rezende EM, Couto BRGM, Starling CEF, Módena CM. Prevalence of Nosocomial Infections in General Hospitals in Belo Horizonte. Infect Control Hosp Epidemiol 1998. [DOI: 10.2307/30141571] [Citation(s) in RCA: 21] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
|
21
|
Tresoldi AT, Branchini ML, Moreira Filho DDC, Padoveze MC, Dantas SP, Reginato L, von Nowakonski A, de Oliveira UM, Trabasso P. Relative frequency of nosocomial microorganisms at UNICAMP University Hospital from 1987 to 1994. Rev Inst Med Trop Sao Paulo 1997; 39:333-6. [PMID: 9674284 DOI: 10.1590/s0036-46651997000600005] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
The frequency of microorganisms identified in nosocomial infections at Unicamp University Hospital from 1987 to 1994 was analysed. The most common microorganism was S. aureus (20.9%), which was found in surgical wound, bloodstream and arterial-venous infections. In urinary tract infections (UTI), gram-negative rods (56.5%) and yeasts (9%) predominated. A. baumannii isolates were observed to have increased in the last three years. There was a gradual increase in the frequency of coagulase-negative staphylococci and A. baumannii in bloodstream infections but there wasn't any change in Candida sp.
Collapse
Affiliation(s)
- A T Tresoldi
- University Hospital, Microbiology Laboratory, Faculty of Medical Sciences, State University of Campinas (UNICAMP), Brazil
| | | | | | | | | | | | | | | | | |
Collapse
|
22
|
Weinberger M, Sacks T, Sulkes J, Shapiro M, Polacheck I. Increasing fungal isolation from clinical specimens: experience in a university hospital over a decade. J Hosp Infect 1997; 35:185-95. [PMID: 9093917 DOI: 10.1016/s0195-6701(97)90206-1] [Citation(s) in RCA: 24] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
The local patterns of fungal isolates were studied by a retrospective analysis of fungal species isolated from clinical specimens in a university hospital in Jerusalem. Between 1984 and 1993, 5630 fungi [4071 patient unique isolates (PUI)] were isolated and identified. During the study decade, the annual incidence of all isolates increased 2.7-fold, and PUI increased 1.6-fold. Candida albicans accounted for 61% of PUI; urine was the source of 53%. The intensive care units (ICUs) and the Bone Marrow Transplantation (BMT) Department had the highest incidence of fungal isolation. The following trends were observed: (1) a decrease in the relative frequency of C. albicans and increase in Candida tropicalis; (2) increased number of isolates from urine, surgical wounds and intra-abdominal sites; (3) increased number of isolates from ICUs and BMT. Fungi are emerging as important hospital-acquired pathogens in tertiary care and teaching hospitals, and are associated with high rates of morbidity and mortality. It is important to be familiar with the local patterns of fungal isolation in order to improve treatment.
Collapse
Affiliation(s)
- M Weinberger
- Department of Clinical Microbiology and Infectious Diseases, Hadassah University Hospital, Jerusalem, Israel
| | | | | | | | | |
Collapse
|
23
|
Voss A, Kluytmans JA, Koeleman JG, Spanjaard L, Vandenbroucke-Grauls CM, Verbrugh HA, Vos MC, Weersink AY, Hoogkamp-Korstanje JA, Meis JF. Occurrence of yeast bloodstream infections between 1987 and 1995 in five Dutch university hospitals. Eur J Clin Microbiol Infect Dis 1996; 15:909-12. [PMID: 9031872 DOI: 10.1007/bf01690507] [Citation(s) in RCA: 90] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
The aim of this study was to identify retrospectively trends in fungal bloodstream infections in The Netherlands in the period from 1987 to 1995. Results of over 395,000 blood cultures from five Dutch university hospitals were evaluated. Overall, there were more than 12 million patient days of care during the nine-year study period. The rate of candidemia doubled in the study period, reaching an incidence of 0.71 episodes per 10,000 patient days in 1995. The general increase in candidemia was paralleled by an increase in non-Candida albicans bloodstream infections, mainly due to Candida glabrata. However, more than 60% of the infections were caused by Candida albicans. Fluconazole-resistant species such as Candida krusei did not emerge during the study period. The increasing rate of candidemia found in Dutch university hospitals is similar to the trend observed in the USA, but the rate is lower and the increase is less pronounced.
Collapse
Affiliation(s)
- A Voss
- University of Hospital Nijmegen, Department of Medical Microbiology, Nijmegen, The Netherlands
| | | | | | | | | | | | | | | | | | | |
Collapse
|
24
|
Odds FC, Dams G, Just G, Lewi P. Susceptibilities of Candida spp. to antifungal agents visualized by two-dimensional scatterplots of relative growth. Antimicrob Agents Chemother 1996; 40:588-94. [PMID: 8851576 PMCID: PMC163163 DOI: 10.1128/aac.40.3.588] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Abstract
The growth of 811 clinical yeast isolates in the presence of single concentrations of antifungal agents was measured spectrophotometrically and expressed as a percentage of growth in inhibitor-free control cultures. Two-dimensional scatterplots of the relative growth data allowed for the simple visual determination of some susceptibility trends, including correlations in relative growth between different agents and in relative susceptibilities between different yeast species. A positive susceptibility correlation was found for relative growth results with the azole antifungal agents fluconazole, itraconazole, and ketoconazole for 504 Candida albicans isolates. The relative growth scatterplots for fluconazole versus itraconazole showed that 50 (9.9%) of 504 C. albicans isolates were outliers with respect to the 95% confidence limits for a line of correlated relative growth established with an initial test panel of 59 isolates of this species. The outlying isolates were relatively less susceptible to fluconazole than to itraconazole under the conditions of the test. Most of the outliers were received in 1993 and 1994; only 3.9% of the isolates received in 1991 and 1992 and 1.7% of the isolates received before 1991 showed this differential susceptibility. In addition, most of the outliers came from patients with human immunodeficiency virus infections. The relative growth scatterplots confirmed the known high susceptibility of most Candida parapsilosis isolates to both fluconazole and itraconazole and the specifically low susceptibility of Candida krusei isolates to fluconazole. The scatterplots also illustrated a tendency towards lower (and correlative) relative growth among oral isolates obtained from AIDS patients who responded to azole antifungal treatment than among isolates from clinical nonresponders.
Collapse
Affiliation(s)
- F C Odds
- Department of Bacteriology and Mycology, Janssen Research Foundation, Beerse, Belgium
| | | | | | | |
Collapse
|
25
|
Gutiérrez F, Wall P, Cohen J. An analysis of the trends in the use of antifungal drugs and fungal isolates in a UK University Hospital. J Hosp Infect 1995; 31:149-52. [PMID: 8551021 DOI: 10.1016/0195-6701(95)90170-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
|
26
|
Schmid J, Tay YP, Wan L, Carr M, Parr D, McKinney W. Evidence for nosocomial transmission of Candida albicans obtained by Ca3 fingerprinting. J Clin Microbiol 1995; 33:1223-30. [PMID: 7615732 PMCID: PMC228135 DOI: 10.1128/jcm.33.5.1223-1230.1995] [Citation(s) in RCA: 39] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
The moderately repetitive sequence Ca3 was used to fingerprint Candida albicans isolates from 32 patients hospitalized for more than 3 days, 17 recent admissions or outpatients, and 8 recently readmitted patients and 10 commensal isolates from the community in Wellington, New Zealand, plus isolates from 21 hospitalized patients, 26 outpatients or recent admissions, 4 recently readmitted patients, and 10 healthy individuals in the community in Auckland, New Zealand. In Wellington, isolates from patients hospitalized in Wellington Hospital for more than 3 days were genetically significantly less diverse than were isolates from outpatients or recent admissions or isolates from healthy individuals in the community. In addition, two clusters of genetically similar strains were isolated from hospitalized patients significantly more often than from other individuals. These observations provide evidence (albeit indirectly) for nosocomial transmission of hospital-specific C. albicans strains. In contrast, no indication of hospital-specific transmission of C. albicans was found in Auckland Hospital. Since these results were obtained under conditions in which no candidiasis outbreak occurred in either hospital, they also suggest that Ca3 fingerprinting may be a useful tool in preventive nosocomial infection control programs, allowing assessment of the extent of C. albicans transmission occurring in a hospital.
Collapse
Affiliation(s)
- J Schmid
- Department of Microbiology and Genetics, Massey University, Palmerston North, New Zealand
| | | | | | | | | | | |
Collapse
|
27
|
|
28
|
Voss A, Meis JF, Hoogkamp-Korstanje JA. Fluconazole in the management of fungal urinary tract infections. Infection 1994; 22:247-51. [PMID: 8002084 DOI: 10.1007/bf01739908] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
The presence of Candida in the urine is not considered normal but does not necessarily indicate urinary tract infection. On the other hand, yeasts in urine cultures might be the first symptom of systemic fungal infections. Despite the difficulties that exist, establishment of an accurate diagnosis is important especially in high risk patients because ascending infections may lead to disseminated disease. Amphotericin B bladder irrigation is a common mode of therapy for fungal urinary tract infection, although no specific guidelines exist as to the use of the procedure. The pharmacokinetic parameters possessed by the triazole antifungal agent fluconazole make it a candidate for treating fungal urinary tract infections. Five case reports and 99 patients reported in several small studies were reviewed. As evident from these reports, fluconazole appears to be of value in the treatment of both uncomplicated and complicated fungal urinary tract infections.
Collapse
Affiliation(s)
- A Voss
- Dept. of Medical Microbiology, University Hospital Nijmegen, The Netherlands
| | | | | |
Collapse
|