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da Silva RB, Neves RP, Hinrichsen SL, de Lima-Neto RG. Candidemia in a public hospital in Northeastern Brazil: Epidemiological features and risk factors in critically ill patients. Rev Iberoam Micol 2019; 36:181-185. [PMID: 31759839 DOI: 10.1016/j.riam.2019.06.003] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2018] [Revised: 06/03/2019] [Accepted: 06/13/2019] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND Candidemia is a life-threatening fungal infection characterized by the presence of Candida in the blood. AIMS To describe the clinical-epidemiological features and main risk factors among patients with candidemia admitted to Intensive Care Unit. METHODS A cross-sectional, retrospective and observational study was performed between January 2015 and July 2016. Laboratory reports and medical records from ICU patients admitted to a public hospital in northeastern Brazil were analyzed. RESULTS There were 1573 admissions and 67 of them were positive for candidemia. The majority of patients were male (53.3%) and remained at the hospital for more than seven days (86.6%). Non-C. albicansCandida infections (60%) were predominant. Broad-spectrum antibiotic therapy was prescribed in 98.4% of the cases. The most frequent underlying diseases were sepsis (73.3%), presence of solid tumors (15%), respiratory condition (60%), urinary tract disease (56.6%) and gastrointestinal tract diseases (23.3%). Surgeries were carried out on 43% of the patients, consisting of 23.3% abdominal surgeries, with a mortality rate of 92.8%. Risk factors were venous central access (93.3%), mechanical ventilation (81.6%), nasoenteral tube (83.3%), nasogastric tube (25%), indwelling bladder catheter (88.3%), diabetes mellitus (55%) and tracheostomy (36.6%). Statistical analysis correlated the use of indwelling bladder catheter with a higher mortality rate (r=0.07412, p=0.0353). CONCLUSIONS The current study reveals the high case fatality rates among critically ill patients suffering from candidemia admitted to ICU. Herein, we highlight the importance of identifying non-C. albicansCandida species and reinforce the idea of carrying out epidemiological surveillances and antifungal susceptibility tests.
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Affiliation(s)
- Renata Baltar da Silva
- Hospital das Clínicas de Pernambuco (HC/PE), Brazil; Nucleus of Education, Research and Assistance in Infectious Diseases, HC/PE, Brazil
| | - Rejane Pereira Neves
- Department of Mycology, Biosciences Center, Federal University of Pernambuco (UFPE), Brazil; Department of Tropical Medicine, Center of Health Science, UFPE, Brazil; Nucleus of Education, Research and Assistance in Infectious Diseases, HC/PE, Brazil
| | - Sylvia Lemos Hinrichsen
- Department of Tropical Medicine, Center of Health Science, UFPE, Brazil; Nucleus of Education, Research and Assistance in Infectious Diseases, HC/PE, Brazil
| | - Reginaldo Gonçalves de Lima-Neto
- Department of Tropical Medicine, Center of Health Science, UFPE, Brazil; Nucleus of Education, Research and Assistance in Infectious Diseases, HC/PE, Brazil.
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Mermutluoglu C, Deveci O, Dayan S, Aslan E, Bozkurt F, Tekin R. Antifungal Susceptibility and Risk Factors in Patients with Candidemia. Eurasian J Med 2017; 48:199-203. [PMID: 28149146 DOI: 10.5152/eurasianmed.2016.0021] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE This study aimed to investigate the antifungal susceptibility, typology, and risk factors of candidemia among adult and pediatric inpatients at a university hospital. MATERIALS AND METHODS A case-control study was designed, and data collected between December 2013 and December 2014 were retrospectively evaluated. The case group consisted of patients with candidemia. The control group was selected from the inpatients that did not develop candidemia but were admitted in the same clinic and during the same period as the candidemia group. The diagnosis of candidemia was based on a compatible clinical picture and positive blood culture of Candida spp. The demographic characteristics, sequential organ failure assessment (SOFA) scores, comorbidities, use of invasive devices, antibiotics administered, and duration of antibiotic uses were compared between both the groups. RESULTS Out of the 84 patients, 42 (50%) were included in the case group, and the remaining 42 (50%) were included in the control group. Out of all the patients, 31 (36.9%) were female, and 53 (63.1%) were male. When the clinical findings of the case and control groups were compared, the prevalence of nosocomial infections, sepsis, candiduria, and fever was statistically significantly higher in the case group. Among the isolated group in the study, 22 (52.4%) were identified as C. albicans, while the others were non-albicans Candida strains. The C. albicans strain (4.5%) was resistant to fluconazole, while 7 among the non-albicans Candida strains (35%) were resistant to fluconazole. In the case group, abdominal surgery, CVP catheter presence, TPN, endotracheal intubation, frequency of blood transfusion, and SOFA scores were significantly higher than the control groups. The logistic regression test demonstrated that TPN and blood transfusion are the most important risk factors for candidemia (OR=8.14 and OR=5.96, respectively). CONCLUSION The invasive Candida infections continue to be a major health problem in Turkey and in our hospital. Particularly, it was observed that it is important to perform invasive procedures, antibiotic administration and parenteral nutrition carefully in patients hospitalized in the ICU.
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Affiliation(s)
- Cigdem Mermutluoglu
- Clinic of Infectious diseases and Clinical Microbiology, Diyarbakır Training and Research Hospital, Diyarbakır, Turkey
| | - Ozcan Deveci
- Department of Infectious diseases and Clinical Microbiology, Dicle University School of Medicine, Diyarbakır, Turkey
| | - Saim Dayan
- Department of Infectious diseases and Clinical Microbiology, Dicle University School of Medicine, Diyarbakır, Turkey
| | - Emel Aslan
- Department of Infectious diseases and Clinical Microbiology, Dicle University School of Medicine, Diyarbakır, Turkey
| | - Fatma Bozkurt
- Department of Infectious diseases and Clinical Microbiology, Dicle University School of Medicine, Diyarbakır, Turkey
| | - Recep Tekin
- Department of Infectious diseases and Clinical Microbiology, Dicle University School of Medicine, Diyarbakır, Turkey
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San Miguel LG, Cobo J, Otheo E, Sánchez-Sousa A, Abraira V, Moreno S. Secular Trends of Candidemia in a Large Tertiary-Care Hospital From 1988 to 2000: Emergence ofCandida parapsilosis. Infect Control Hosp Epidemiol 2016; 26:548-52. [PMID: 16018430 DOI: 10.1086/502582] [Citation(s) in RCA: 63] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
AbstractObjective:To analyze the secular trends of candidemia in a large tertiary-care hospital to determine the overall incidence, as well as the incidence by ward and by species, and to detect the occurrence of outbreaks.Design:Retrospective descriptive analysis. Secular trends were calculated using the Mantel-Haenszel test.Setting:A large tertiary-care referral center in Spain with a pediatric intensive care unit (ICU) to which more than 500 children with congenital cardiac disease are admitted annually.Patients:All patients with candidemia occurring from 1988 to 2000 were included. Cases were identified from laboratory records of blood cultures.Results:There were 331 episodes of candidemia. The overall incidence of nosocomial candidemia was 0.6 episode per 1,000 admissions and remained stable throughout the study period (P= .925). The species most frequently isolated wasCandida albicans, but the incidence ofC. parapsilosiscandidemia increased (P= .035). In the pediatric ICU, the incidence ofC. parapsilosiswas 5.6 episodes per 1,000 admissions and it was the predominant species. Outbreaks occurred occasionally in the pediatric ICU, suggesting nosocomial transmission.Conclusions:During this 13-year period, the incidence of candidemia remained stable in this hospital, butC. parapsilosisincreased in frequency. Occasional outbreaks of candidemia suggested nosocomial transmission ofCandidaspecies (Infect Control Hosp Epidemiol2005;26:548-552).
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Alkatan HM, Maktabi A, Al-Harby M, Al-Rajhi AA. Candida parapsilosis corneal graft infection from a single eye center: Histopathologic report of 2 cases. Saudi J Ophthalmol 2015; 29:303-6. [PMID: 26586985 PMCID: PMC4625137 DOI: 10.1016/j.sjopt.2015.06.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2015] [Revised: 06/25/2015] [Accepted: 06/29/2015] [Indexed: 11/25/2022] Open
Abstract
Fungal keratitis accounts for 6–53% of all cases of ulcerative keratitis in variable studies. The majority of cases are due to septate fungi. The abnormal cornea in cases of dry eye syndrome, chronic ulceration, erythema multiform and possibly HIV infection is infected more commonly with Candida, most commonly Candida albicans. Candida parapsilosis affects neonates and intensive care unit (ICU) patients and it has been recently found with increasing frequency. In a previous study on mycotic keratitis in our tertiary eye hospital, filamentous fungi were more commonly isolated than yeasts. We are presenting 2 successive cases of corneal graft infection by Candida parapsilosis referred to us from another eye center to attract the attention of ophthalmologists and health workers to such an infection.
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Affiliation(s)
- Hind M Alkatan
- Ophthalmology Department, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Azza Maktabi
- Department of Pathology & Laboratory Medicine, King Khaled Eye Specialist Hospital, Riyadh, Saudi Arabia
| | - Mosa Al-Harby
- Anterior Segment and Uveitis Division, King Khaled Eye Specialist Hospital, Riyadh, Saudi Arabia
| | - Ali A Al-Rajhi
- College of Medicine, Al Faisal University; Anterior Segment Consultant, Al Magrabi Hospital, Riyadh, Saudi Arabia
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Corzo-León DE, Satlin MJ, Soave R, Shore TB, Schuetz AN, Jacobs SE, Walsh TJ. Epidemiology and outcomes of invasive fungal infections in allogeneic haematopoietic stem cell transplant recipients in the era of antifungal prophylaxis: a single-centre study with focus on emerging pathogens. Mycoses 2015; 58:325-36. [DOI: 10.1111/myc.12318] [Citation(s) in RCA: 82] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2014] [Revised: 02/18/2015] [Accepted: 02/26/2015] [Indexed: 11/29/2022]
Affiliation(s)
- Dora E. Corzo-León
- Instituto Nacional de Ciencias Médicas y Nutrición ‘Salvador Zubirán’; Mexico City Mexico
- Transplatation-Oncology Infectious Diseases Program; Division of Infectious Diseases; Weill Cornell Medical College; New York NY USA
| | - Michael J. Satlin
- Transplatation-Oncology Infectious Diseases Program; Division of Infectious Diseases; Weill Cornell Medical College; New York NY USA
- New York-Presbyterian Hospital; Weill Cornell Medical College; New York NY USA
| | - Rosemary Soave
- Transplatation-Oncology Infectious Diseases Program; Division of Infectious Diseases; Weill Cornell Medical College; New York NY USA
- New York-Presbyterian Hospital; Weill Cornell Medical College; New York NY USA
| | - Tsiporah B. Shore
- New York-Presbyterian Hospital; Weill Cornell Medical College; New York NY USA
- Division of Hematology and Medical Oncology; Weill Cornell Medical College; New York NY USA
| | - Audrey N. Schuetz
- New York-Presbyterian Hospital; Weill Cornell Medical College; New York NY USA
- Department of Pathology and Laboratory Medicine; Weill Cornell Medical College; New York NY USA
| | - Samantha E. Jacobs
- Transplatation-Oncology Infectious Diseases Program; Division of Infectious Diseases; Weill Cornell Medical College; New York NY USA
- New York-Presbyterian Hospital; Weill Cornell Medical College; New York NY USA
| | - Thomas J. Walsh
- Transplatation-Oncology Infectious Diseases Program; Division of Infectious Diseases; Weill Cornell Medical College; New York NY USA
- New York-Presbyterian Hospital; Weill Cornell Medical College; New York NY USA
- Department of Pediatrics; Weill Cornell Medical College; New York NY USA
- Department of Microbiology and Immunology; Weill Cornell Medical College; New York NY USA
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Puig-Asensio M, Ruiz-Camps I, Fernández-Ruiz M, Aguado JM, Muñoz P, Valerio M, Delgado-Iribarren A, Merino P, Bereciartua E, Fortún J, Cuenca-Estrella M, Almirante B. Epidemiology and outcome of candidaemia in patients with oncological and haematological malignancies: results from a population-based surveillance in Spain. Clin Microbiol Infect 2015; 21:491.e1-10. [PMID: 25703212 DOI: 10.1016/j.cmi.2014.12.027] [Citation(s) in RCA: 48] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2014] [Revised: 11/11/2014] [Accepted: 12/30/2014] [Indexed: 01/13/2023]
Abstract
A prospective, population-based surveillance on candidaemia was implemented in five metropolitan areas of Spain from May 2010 to April 2011. We aimed to describe the distribution and susceptibility pattern of Candida species, and to evaluate risk factors for mortality in patients with oncological (solid tumours) and haematological malignancies. Adults (≥ 16 years) with cancer were included in the present report. Impact of therapeutic strategies on 7- and 30-day mortality were analysed by logistic regression, adjusting for propensity score by inverse weighting probability of receiving early antifungal treatment and catheter removal. We included 238 (32.6%) patients (195 oncological, 43 haematological). Compared with oncological patients, haematological patients were more likely to have received chemotherapy (53.5% versus 17.4%, p < 0.001) or corticosteroids (41.9% versus 21%, p < 0.001), and have neutropenia (44.2% versus 1.5%, p < 0.001). Overall, 14.8% of patients developed breakthrough candidaemia. Non-albicans Candida species (71.1% versus 55.6%, p 0.056) and Candida tropicalis (22.2% versus 7.6%, p 0.011) were more frequent in haematological patients. Based on EUCAST breakpoints, 27.6% of Candida isolates were non-susceptible to fluconazole. Resistance to echinocandins was negligible. Mortality at 7 and 30 days was 12.2% and 31.5%, respectively, and did not differ significantly between the patient groups. Prompt antifungal therapy together with catheter removal (≤ 48 hours) was associated with lower mortality at 7 days (adjusted OR 0.05; 95% CI 0.01-0.42) and 30 days (adjusted OR 0.27; 95% CI 0.16-0.46). In conclusion, non-albicans species are emerging as the predominant isolates, particularly in haematological patients. Prompt, adequate antifungal treatment plus catheter removal may lead to a reduction in mortality.
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Affiliation(s)
- M Puig-Asensio
- Department of Infectious Diseases, Hospital Universitari Vall d'Hebron, Barcelona, Spain; Department of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - I Ruiz-Camps
- Department of Infectious Diseases, Hospital Universitari Vall d'Hebron, Barcelona, Spain; Department of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain.
| | - M Fernández-Ruiz
- Infectious Diseases Unit, Hospital Universitario 12 de Octubre, Instituto de Investigación Hospital 12 de Octubre (i+12), Madrid, Spain
| | - J M Aguado
- Infectious Diseases Unit, Hospital Universitario 12 de Octubre, Instituto de Investigación Hospital 12 de Octubre (i+12), Madrid, Spain
| | - P Muñoz
- Clinical Microbiology and Infectious Diseases Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain; Department of Medicine, Universidad Complutense de Madrid, Madrid, Spain; Instituto de Investigación Sanitaria del Hospital Gregorio Marañón, Madrid, Spain; CIBER de Enfermedades Respiratorias (CIBER RES CD6/06/0058), Palma de Mallorca, Spain
| | - M Valerio
- Clinical Microbiology and Infectious Diseases Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain; Department of Medicine, Universidad Complutense de Madrid, Madrid, Spain; Instituto de Investigación Sanitaria del Hospital Gregorio Marañón, Madrid, Spain; CIBER de Enfermedades Respiratorias (CIBER RES CD6/06/0058), Palma de Mallorca, Spain
| | - A Delgado-Iribarren
- Microbiology Department, Hospital Universitario Fundación de Alcorcón, Alcorcón, Madrid, Spain
| | - P Merino
- Clinical Microbiology Department, Hospital Universitario Clinico San Carlos, Madrid, Spain
| | - E Bereciartua
- Department of Infectious Diseases, Hospital de Cruces, Bilbao, Spain
| | - J Fortún
- Infectious Diseases Department, Hospital Ramón y Cajal, Instituto Ramón y Cajal de Investigaciones Sanitarias, IRYCIS, Madrid, Spain
| | - M Cuenca-Estrella
- Department of Mycology, Spanish National Centre for Microbiology, Instituto de Salud Carlos III, Madrid, Spain
| | - B Almirante
- Department of Infectious Diseases, Hospital Universitari Vall d'Hebron, Barcelona, Spain; Department of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain
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Robl D, Thimoteo SS, de Souza GCCF, Beux MR, Dalzoto PR, Pinheiro RL, Pimentel IC. Occurrence of Candida orthopsilosis in Brazilian tomato fruits (Lycopersicum esculentum Mill.). Braz J Microbiol 2014; 45:105-9. [PMID: 24948920 PMCID: PMC4059283 DOI: 10.1590/s1517-83822014000100015] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
We aimed to isolate and identify yeasts found in the tomato fruit in order to obtain isolates with biotechnological potential, such as in control of fungal diseases that damage postharvest fruits. We identified Candida orthopsilosis strains LT18 and LT24. This is the first report of this yeast on Lycopersicum esculentum fruits in Brazil.
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Affiliation(s)
- D Robl
- Departamento de Microbiologia Universidade de São Paulo São PauloSP Brazil
| | - S S Thimoteo
- Departamento de Bioquímica e Biologia Molecular Universidade Federal do Paraná CuritibaPR Brazil
| | - G C C F de Souza
- Departamento de Engenharia de Bioprocessos e Biotecnologia Universidade Federal do Paraná CuritibaPR Brazil
| | - M R Beux
- Departamento de Patologia Básica Universidade Federal do Paraná CuritibaPR Brazil
| | - P R Dalzoto
- Departamento de Patologia Básica Universidade Federal do Paraná CuritibaPR Brazil
| | - R L Pinheiro
- Laboratório de Micologia Hospital de Clínicas Universidade Federal do Paraná CuritibaPR Brazil
| | - I C Pimentel
- Departamento de Patologia Básica Universidade Federal do Paraná CuritibaPR Brazil
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Candida parapsilosis meningitis in a patient with AIDS. Report of a case and review of the literature. Rev Iberoam Micol 2013; 30:122-4. [DOI: 10.1016/j.riam.2012.11.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2011] [Revised: 11/18/2012] [Accepted: 11/20/2012] [Indexed: 11/24/2022] Open
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Bergamasco MD, Garnica M, Colombo AL, Nucci M. Epidemiology of candidemia in patients with hematologic malignancies and solid tumours in Brazil. Mycoses 2012; 56:256-63. [DOI: 10.1111/myc.12013] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Garcia-Effron G, Canton E, Pemán J, Dilger A, Romá E, Perlin DS. Epidemiology and echinocandin susceptibility of Candida parapsilosis sensu lato species isolated from bloodstream infections at a Spanish university hospital. J Antimicrob Chemother 2012; 67:2739-48. [PMID: 22868644 DOI: 10.1093/jac/dks271] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVES The aims of this work were to study the epidemiological profiles, differences in echinocandin susceptibilities and clinical relevance of the Candida parapsilosis sensu lato species isolated from proven fungaemia cases at La Fe University Hospital of Valencia (Spain) from 1995 to 2007. RESULTS The prevalence of these species was: C. parapsilosis sensu stricto, 74.4%; Candida orthopsilosis, 23.54%; and Candida metapsilosis, 2.05%. The incidence of the species complex as agents of fungaemia remained stationary until 2005 and doubled in 2006. The incidence of C. orthopsilosis showed an increasing trend during the study period, while C. parapsilosis sensu stricto incidence diminished. Also, an important epidemiological change was observed starting in 2004, when 86.5% of the C. parapsilosis sensu lato strains were found in adult patients, while before that year only 13.5% of the isolates were found in this population. CONCLUSIONS Echinocandin drug susceptibility testing using the CLSI M27-A3 document showed a wide range of MIC values (0.015-4 mg/L), with micafungin being the most potent in vitro inhibitor followed by anidulafungin and caspofungin (MIC geometric mean of 0.68, 0.74 and 0.87 mg/L, respectively). C. metapsilosis was the most susceptible species of the complex to anidulafungin and micafungin in vitro (MIC(50) for anidulafungin and micafungin: 0.06 mg/L), while there were no differences between C. parapsilosis sensu lato species when caspofungin MIC(50)s were compared (MIC(50) 1.00 mg/L). Differences in caspofungin in vitro susceptibility were observed between the different clinical service departments of La Fe Hospital.
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Safdar A, Armstrong D. Infections in patients with hematologic neoplasms and hematopoietic stem cell transplantation: neutropenia, humoral, and splenic defects. Clin Infect Dis 2011; 53:798-806. [PMID: 21890754 DOI: 10.1093/cid/cir492] [Citation(s) in RCA: 85] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Infections are common in patients with hematologic neoplasms and following allogeneic hematopoietic transplantation. Neutropenia and defects in adaptive B-cell-mediated immunity and/or lack of splenic function predispose patients to a host of diverse and often serious infections. It is important to recognize that patients who undergo treatment for hematologic neoplasms may have mixed immune defects, and their vulnerability to infection may continue to change, in part as a reflection of the dynamic developments in the practice of oncology. The main obstacle in providing targeted, evidence-based antimicrobial treatment is the unpredictable results of even the new generation of diagnostic assays. A definite diagnosis for most end-organ opportunistic diseases requires tissue samples that are seldom available. Because immune defects may coexist, empirical therapy is directed toward a wide spectrum of pathogens. Real-time information about innate and adaptive immune functions and the role of acute and chronic phase molecules may improve target-specific therapy.
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Affiliation(s)
- Amar Safdar
- New York University Langone Medical Center, Memorial Sloan Kettering Cancer Center, New York, USA.
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A novel ascosporogenous yeast species, Zygosaccharomyces siamensis, and the sugar tolerant yeasts associated with raw honey collected in Thailand. FUNGAL DIVERS 2011. [DOI: 10.1007/s13225-011-0115-z] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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de Toro M, Torres M, Maite R, Aznar J. Characterization of Candida parapsilosis complex isolates. Clin Microbiol Infect 2011; 17:418-24. [DOI: 10.1111/j.1469-0691.2010.03302.x] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Safdar A, Bodey G, Armstrong D. Infections in Patients with Cancer: Overview. PRINCIPLES AND PRACTICE OF CANCER INFECTIOUS DISEASES 2011. [PMCID: PMC7122113 DOI: 10.1007/978-1-60761-644-3_1] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
Patients with neoplastic disease are often highly susceptible to severe infections. The following factors influence the types, severity, and response to therapy of these infections: (1) Changing epidemiology of infections; (2) cancer- and/or treatment-associated neutropenia; (3) acquired immune deficiency states such as cellular immune defect; (4) recent development of new-generation diagnostic tools including widely available DNA amplification tests; (5) effective intervention for infection prevention; (6) empiric or presumptive therapy during high-risk periods; (7) availability of new classes of highly active antimicrobial drugs; (8) strategies to promote hosts’ immune response; and (9) future measures. This introductory chapter intended for the reader to become familiar with the important historical milestones in the understanding and development in the field of infectious diseases in immunosuppressed patients with an underlying neoplasms and patients undergoing hematopoietic stem cell transplantation.
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Affiliation(s)
- Amar Safdar
- grid.240145.60000 0001 2291 4776MD Anderson Cancer Center, Infectious Diseases Department, The University of Texas, 800 5th Avenue, Apt. 12-G, New York, 10065 New York USA
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Gürcüoğlu E, Akalın H, Ener B, Ocakoğlu G, Sınırtaş M, Akçağlar S, Yılmaz E, Evci C, Oral B. Nosocomial candidemia in adults: Risk and prognostic factors. J Mycol Med 2010. [DOI: 10.1016/j.mycmed.2010.07.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Muñoz P, Giannella M, Fanciulli C, Guinea J, Valerio M, Rojas L, Rodríguez-Créixems M, Bouza E. Candida tropicalis fungaemia: incidence, risk factors and mortality in a general hospital. Clin Microbiol Infect 2010; 17:1538-45. [PMID: 20718804 DOI: 10.1111/j.1469-0691.2010.03338.x] [Citation(s) in RCA: 55] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
The risk factors and clinical features of patients with Candida tropicalis fungaemia have not been fully defined. We performed a case-control study comparing 59 cases of C. tropicalis fungaemia with 177 episodes of fungaemia caused by other species of Candida in our hospital over a 24-year period (January 1985 to December 2008). Patients with C. tropicalis fungaemia were more likely to be older (median age, 67 vs. 56 years; p 0.01), to have cancer (45.5% vs. 31.6%, p 0.04), and to have the abdomen as the portal of entry (32.2% vs. 11.9%, p 0.001), and had a higher in-hospital mortality rate (61% vs. 44%, p 0.03). Multivariate analysis showed that the independent risk factors for C. tropicalis fungaemia were cancer (OR 4.5; 95% CI 1.05-3.83; p 0.03) and the abdomen as the portal of entry (OR 13.6; 95% CI 1.9-8.2; p <0.001). When survivors were compared with non-survivors, the risk factors associated with a poor outcome were neutropenia (19.4% vs. 0; p 0.03), corticosteroid treatment (36% vs. 13%; p 0.07), and septic shock (50% vs. 17.4%; p 0.01). The independent risk factors for mortality in the multivariate analysis were corticosteroid treatment (OR 8.2; 95% CI 0.9-27.7; p 0.04) and septic shock (OR 14.6; 95% CI 2.4-90.2; p 0.004), whereas urinary tract infection (OR 0.07; 95% CI 0.01-0.8; p 0.03) and catheter removal (OR 0.06; 95% CI 0.01-0.4; p 0.002) were protective factors. C. tropicalis is the fourth most common cause of fungaemia in our hospital. It is associated with underlying malignancy, the abdomen as the portal of entry, and poor outcome.
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Affiliation(s)
- P Muñoz
- Clinical Microbiology and Infectious Diseases Department, Hospital General Universitario Gregorio Marañón, Universidad Complutense, Madrid, Spain
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Echinocandin Antifungal Drug Resistance in Candida Species: A Cause for Concern? Curr Infect Dis Rep 2010; 12:437-43. [DOI: 10.1007/s11908-010-0131-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Abstract
The incidence of invasive mycoses is increasing, especially among patients who are immunocompromised or hospitalized with serious underlying diseases. Such infections may be broken into two broad categories: opportunistic and endemic. The most important agents of the opportunistic mycoses are Candida spp., Cryptococcus neoformans, Pneumocystis jirovecii, and Aspergillus spp. (although the list of potential pathogens is ever expanding); while the most commonly encountered endemic mycoses are due to Histoplasma capsulatum, Coccidioides immitis/posadasii, and Blastomyces dermatitidis. This review discusses the epidemiologic profiles of these invasive mycoses in North America, as well as risk factors for infection, and the pathogens' antifungal susceptibility.
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Characterisation of breakthrough invasive mycoses in echinocandin recipients: an evidence-based review. Int J Antimicrob Agents 2010; 35:211-8. [DOI: 10.1016/j.ijantimicag.2009.09.020] [Citation(s) in RCA: 61] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2009] [Revised: 09/22/2009] [Accepted: 09/29/2009] [Indexed: 11/17/2022]
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Concia E, Azzini AM, Conti M. Epidemiology, incidence and risk factors for invasive candidiasis in high-risk patients. Drugs 2010; 69 Suppl 1:5-14. [PMID: 19877728 DOI: 10.2165/11315500-000000000-00000] [Citation(s) in RCA: 53] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
Candida spp. are an increasing cause of bloodstream infections, and are associated with high morbidity and mortality in both neutropenic and non-neutropenic critically ill patients. Risk factors associated with candidaemia are diverse and include exposure to broad spectrum antimicrobial agents, mucosal colonization by Candida spp., indwelling vascular catheters, prior surgery and cancer chemotherapy. During the last 20 years, there has been an increasing incidence worldwide in invasive candidiasis, but differences in geographical epidemiology are emerging, in particular regarding a shift towards non-albicans species. This shift has been correlated with routine fluconazole prophylaxis adopted in some patients, and the intrinsic/acquired azole resistance of Candida spp., which represents a very real problem, in terms of both selecting the appropriate empirical therapeutic approach and making prophylactic choices.
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Affiliation(s)
- Ercole Concia
- Department of Pathology, Infectious Disease Unit, University of Verona, Verona, Italy
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van Asbeck EC, Clemons KV, Stevens DA. Candida parapsilosis: a review of its epidemiology, pathogenesis, clinical aspects, typing and antimicrobial susceptibility. Crit Rev Microbiol 2010; 35:283-309. [PMID: 19821642 DOI: 10.3109/10408410903213393] [Citation(s) in RCA: 146] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
The Candida parapsilosis family has emerged as a major opportunistic and nosocomial pathogen. It causes multifaceted pathology in immuno-compromised and normal hosts, notably low birth weight neonates. Its emergence may relate to an ability to colonize the skin, proliferate in glucose-containing solutions, and adhere to plastic. When clusters appear, determination of genetic relatedness among strains and identification of a common source are important. Its virulence appears associated with a capacity to produce biofilm and production of phospholipase and aspartyl protease. Further investigations of the host-pathogen interactions are needed. This review summarizes basic science, clinical and experimental information about C. parapsilosis.
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Affiliation(s)
- Eveline C van Asbeck
- Division of Infectious Diseases, Santa Clara Valley Medical Center, and California Institute for Medical Research, San Jose, CA 95128, USA
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Abstract
BACKGROUND There are few recent studies evaluating trends in the epidemiology of candidemia including changes in species or utilization of antifungal agents in children. METHODS We performed a retrospective case series of candidemia at our children's hospital from 2002 to 2006. Our objectives were to study trends in the rates of candidemia, demographic characteristics, Candida species, antifungal susceptibility, and antifungal utilization. These data were obtained from the electronic medical records. RESULTS There were 203 episodes of candidemia in 154 subjects. During the study period, the average rate of candidemia was 5.52 per 1000 patient-discharges and did not change throughout the study. The mean and median ages of subjects were 3 years versus 9 months, respectively, and 38% were less than 3 months of age. Gastrointestinal disorders were a common comorbid condition (33%), especially for subjects with multiple episodes of candidemia. Overall, Candida parapsilosis and Candida albicans caused 43% and 26% of episodes, respectively, and candidemia caused by Candida glabrata (5.3%-23%) and Candida krusei (0%-8.5%) increased during the study. Ninety-eight percent of C. albicans and C. parapsilosis isolates remained susceptible to all antifungal drugs. From 2003-2006, the use of antifungal agents increased from 79 days to 150 days per 1000 hospital-days. CONCLUSIONS While antifungal use at our hospital increased, candidemia rates remained stable. C. parapsilosis was the most common species but other non-C. albicans species increased during the study period. Local epidemiology should be monitored in pediatric populations for potential impact on management strategies.
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Camargo MR, Venturini J, Vilani-Moreno FR, Arruda MSP. Modulation of macrophage cytokine profiles during solid tumor progression: susceptibility to Candida albicans infection. BMC Infect Dis 2009; 9:98. [PMID: 19534779 PMCID: PMC2705374 DOI: 10.1186/1471-2334-9-98] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2008] [Accepted: 06/17/2009] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND In order to attain a better understanding of the interactions between opportunist fungi and their hosts, we investigated the cytokine profile associated with the inflammatory response to Candida albicans infection in mice with solid Ehrlich tumors of different degrees. METHODS Groups of eight animals were inoculated intraperitoneally with 5 x 106 C. albicans 7, 14 or 21 days after tumor implantation. After 24 or 72 hours, the animals were euthanized and intraperitoneal lavage fluid was collected. Peritoneal macrophages were cultivated and the levels of IFN-gamma, TNF-alpha, IL-12, IL-10 and IL-4 released into the supernatants were measured by ELISA. Kidney, liver and spleen samples were evaluated for fungal dissemination. Tumor-free animals and animals that had only been subjected to C. albicans infection were used as control groups. RESULTS Our results demonstrated that the mice produced more IFN-gamma and TNF-alpha and less IL-10, and also exhibited fungal clearance, at the beginning of tumor evolution. With the tumor progression, this picture changed: IL-10 production increased and IFN-gamma and TNF-alpha release decreased; furthermore, there was extensive fungal dissemination. CONCLUSION Our results indicate that solid tumors can affect the production of macrophage cytokines and, in consequence, affect host resistance to opportunistic infections.
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Affiliation(s)
- Marcela R Camargo
- Department of Biological Sciences, Experimental Immunopathology Laboratory, College of Sciences, São Paulo State University, UNESP, Bauru, SP 17047-001, Brazil.
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Hrusková-Heidingsfeldová O, Dostál J, Majer F, Havlíkova J, Hradilek M, Pichová I. Two aspartic proteinases secreted by the pathogenic yeast Candida parapsilosis differ in expression pattern and catalytic properties. Biol Chem 2009; 390:259-68. [PMID: 19166319 DOI: 10.1515/bc.2009.034] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Secreted aspartic proteinases (Sap) play a role in the virulence of pathogenic Candida spp. Candida parapsilosis possesses three genes encoding these enzymes: SAPP1, SAPP2, and SAPP3. We analyzed the expression of the SAPP1 and SAPP2 genes and the production of Sapp1p and Sapp2p proteinases in the presence of different nitrogen sources. While the SAPP2 transcript was present under all of the conditions tested, expression of SAPP1 was induced only by the presence of exogenous protein as the sole nitrogen source. The concentration of Sapp1 p in the medium upon induction was at least one order of magnitude higher than the concentration of Sapp2p in all media tested in this study. Enzymological characterization of purified Sapp1 p and Sapp2p demonstrated that Sapp2p has a more restricted substrate specificity and significantly lower catalytic activity than Sapp1p. Homology models of Sapp1p and Sapp2p revealed structural motifs that may be responsible for the differences between these two enzymes. Our results indicate that C. parapsilosis secretes a low level of Sapp2p proteinase with narrow substrate specificity and low proteolytic activity under most conditions, while expression and secretion of a higher amount of catalytically efficient Sapp1p enzymes is triggered in the presence of exogenous protein serving as a nitrogen source.
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Affiliation(s)
- Olga Hrusková-Heidingsfeldová
- Gilead Sciences Research Center, Institute of Organic Chemistry and Biochemistry, Academy of Sciences of the Czech Republic, Flemingovo námĕstí 2, CZ-166 10 Prague 6, Czech Republic.
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Farkas Z, Kocsubé S, Tóth M, Vágvölgyi C, Kucsera J, Varga J, Pfeiffer I. Genetic variability of Candida albicans isolates in a university hospital in Hungary. Mycoses 2008; 52:318-25. [PMID: 18983433 DOI: 10.1111/j.1439-0507.2008.01627.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
The occurrence and genetic variability of Candida albicans isolates in a Hungarian hospital were examined. Among the 103 Candida isolates, 44 (42.7%) proved to be C. albicans species. Comparing with a previous study carried out in 2002, the percentage of infections caused by C. albicans decreased in Hungary in this period with an increasing incidence of non-albicans species, in accordance with the world-wide trend. The genetic variability of the isolates was examined using mitochondrial DNA (mtDNA), restriction fragment length polymorphism (RFLP), random amplified polymorphic DNA (RAPD) analysis and electrophoretic karyotyping. The examined C. albicans isolates could be clustered into four groups based on their mtDNA profiles. The electrophoretic karyotypes of the isolates were mostly identical to that of the reference strain 1006, with the exception of mtDNA type II isolates. RAPD analysis could be used to cluster the isolates into different groups, but this clustering was not in complete agreement with their assignment to mtDNA types. Population genetic analyses of the data indicated low amounts of recombination among these C. albicans strains. None of the isolates exhibited decreased susceptibilities to 5-fluorocytosine.
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Affiliation(s)
- Zoltán Farkas
- Department of Microbiology, Faculty of Science and Informatics, University of Szeged, Szeged, Hungary CBS Fungal Biodiversity Centre, Utrecht, The Netherlands
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A naturally occurring proline-to-alanine amino acid change in Fks1p in Candida parapsilosis, Candida orthopsilosis, and Candida metapsilosis accounts for reduced echinocandin susceptibility. Antimicrob Agents Chemother 2008; 52:2305-12. [PMID: 18443110 DOI: 10.1128/aac.00262-08] [Citation(s) in RCA: 233] [Impact Index Per Article: 14.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Candida parapsilosis has emerged as a common cause of invasive fungal infection, especially in Latin America and in the neonatal setting. C. parapsilosis is part of a closely related group of organisms that includes the species Candida orthopsilosis and Candida metapsilosis. All three species show elevated MICs for the new echinocandin class drugs caspofungin, micafungin, and anidulafungin relative to other Candida species. Despite potential impacts on therapy, the mechanism behind this reduced echinocandin susceptibility has not been determined. In this report, we investigated the role of a naturally occurring Pro-to-Ala substitution at amino acid position 660 (P660A), immediately distal to the highly conserved hot spot 1 region of Fks1p, in the reduced-echinocandin-susceptibility phenotype. Kinetic inhibition studies demonstrated that glucan synthase from the C. parapsilosis group was 1 to 2 logs less sensitive to echinocandin drugs than the reference enzyme from C. albicans. Furthermore, clinical isolates of C. albicans and C. glabrata which harbor mutations at this equivalent position also showed comparable 2-log decreases in target enzyme sensitivity, which correlated with increased MICs. These mutations also resulted in 2.4- to 18.8-fold-reduced V(max) values relative to those for the wild-type enzyme, consistent with kinetic parameters obtained for C. parapsilosis group enzymes. Finally, the importance of the P660A substitution for intrinsic resistance was confirmed by engineering an equivalent P647A mutation into Fks1p of Saccharomyces cerevisiae. The mutant glucan synthase displayed characteristic 2-log decreases in sensitivity to the echinocandin drugs. Overall, these data firmly indicate that a naturally occurring P660A substitution in Fks1p from the C. parapsilosis group accounts for the reduced susceptibility phenotype.
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Dimopoulos G, Ntziora F, Rachiotis G, Armaganidis A, Falagas ME. Candida Albicans Versus Non-Albicans Intensive Care Unit-Acquired Bloodstream Infections: Differences in Risk Factors and Outcome. Anesth Analg 2008; 106:523-9, table of contents. [DOI: 10.1213/ane.0b013e3181607262] [Citation(s) in RCA: 136] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Geographic and temporal trends in isolation and antifungal susceptibility of Candida parapsilosis: a global assessment from the ARTEMIS DISK Antifungal Surveillance Program, 2001 to 2005. J Clin Microbiol 2008; 46:842-9. [PMID: 18199791 DOI: 10.1128/jcm.02122-07] [Citation(s) in RCA: 87] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
We examined data from the ARTEMIS DISK Antifungal Surveillance Program to describe geographic and temporal trends in the isolation of Candida parapsilosis from clinical specimens and the in vitro susceptibilities of 9,371 isolates to fluconazole and voriconazole. We also report the in vitro susceptibility of bloodstream infection (BSI) isolates of C. parapsilosis to the echinocandins, anidulafungin, caspofungin, and micafungin. C. parapsilosis represented 6.6% of the 141,383 isolates of Candida collected from 2001 to 2005 and was most common among isolates from North America (14.3%) and Latin America (9.9%). High levels of susceptibility to both fluconazole (90.8 to 95.8%) and voriconazole (95.3 to 98.1%) were observed in all geographic regions with the exception of the Africa and Middle East region (79.3 and 85.8% susceptible to fluconazole and voriconazole, respectively). C. parapsilosis was most often isolated from blood and skin and/or soft tissue specimens and from patients hospitalized in the medical, surgical, intensive care unit (ICU) and dermatology services. Notably, isolates from the surgical ICU were the least susceptible to fluconazole (86.3%). There was no evidence of increasing azole resistance over time among C. parapsilosis isolates tested from 2001 to 2005. Of BSI isolates tested against the three echinocandins, 92, 99, and 100% were inhibited by concentrations of < or = 2 microg/ml of anidulafungin (621 isolates tested), caspofungin (1,447 isolates tested), and micafungin (539 isolates tested), respectively. C. parapsilosis is a ubiquitous pathogen that remains susceptible to the azoles and echinocandins; however, both the frequency of isolation and the resistance of C. parapsilosis to fluconazole and voriconazole may vary by geographic region and clinical service.
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Pontón J, del Palacio A. Avances y limitaciones del diagnóstico precoz de las infecciones invasoras causadas por levaduras. Rev Iberoam Micol 2007; 24:181-6. [PMID: 17874854 DOI: 10.1016/s1130-1406(07)70041-4] [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] [Indexed: 10/20/2022] Open
Abstract
In the last years, the main advances in the serological diagnosis of mycoses caused by yeasts have occurred in the area of antibody and (1-3)-beta-D-glucan detection. Commercialization of the Candida albicans IFA IgG test and detection of antibodies against recombinant antigens Hwp1 and enolase are the most important contributions to the first area. Detection of (1-3)-beta-D-glucan confirms its usefulness as a good marker for the diagnosis of invasive candidiasis. The most recent studies suggest that combination of two tests to detect antígen, antibodies, (1-3)-beta-D-glucan and DNA will be needed to optimize the diagnosis of systemic yeast infections.
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Affiliation(s)
- José Pontón
- Laboratorio de Micología Médica, Departamento de Inmunología, Microbiología y Parasitología, Facultad de Medicina y Odontología, Universidad del País Vasco, Bilbao, Spain.
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Dimopoulos G, Karabinis A, Samonis G, Falagas ME. Candidemia in immunocompromised and immunocompetent critically ill patients: a prospective comparative study. Eur J Clin Microbiol Infect Dis 2007; 26:377-84. [PMID: 17525857 PMCID: PMC7101586 DOI: 10.1007/s10096-007-0316-2] [Citation(s) in RCA: 55] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
The purpose of this study was to compare the risk factors, clinical manifestations, and outcome of candidemia in immunocompromised (IC) and nonimmunocompromised (NIC) critically ill patients. Data were collected prospectively over a 2-year period (02/2000–01/2002) from patients in a 25-bed, medical–surgical intensive care unit (ICU). Eligible for participation in this study were patients who developed candidemia during their ICU stay. Patients under antifungal therapy and with a confirmed systemic fungal infection prior to the diagnosis of candidemia were excluded. Cultures of blood, urine, and stool were performed for all patients in the study, and all patients underwent endoscopy/biopsy of the esophagus for detection of Candida. Smears and/or scrapings of oropharyngeal and esophageal lesions were examined for hyphae and/or pseudohyphae and were also cultured for yeasts. During the study period, 1,627 patients were hospitalized in the ICU, 57% for primary medical reasons and 43% for surgical reasons. After application of the study’s inclusion and exclusion criteria, 24 patients with candidemia (9 IC and 15 NIC) were analyzed. Total parenteral nutrition was more common in IC than in NIC patients (9/9 [100%] vs 8/15 [53%], p = 0.02). Oropharyngeal candidiasis was detected in 5 of 9 (55.5%) IC patients and in 1 of 15 (6.5%) NIC patients (p = 0.015). Esophageal candidiasis was also more common in IC than in NIC patients (4/9 [44%] vs 0/15 [0%], p = 0.012). Among the 9 IC patients, all except 2 died, resulting in a crude mortality of 78%; among the 15 NIC patients, 9 died, resulting in a crude mortality of 60% (p > 0.05). Autopsy was performed in two IC and in six NIC patients, with disseminated candidiasis found in one IC patient. Oropharyngeal and esophageal candidiasis are frequent in IC patients with candidemia. In contrast, this coexistence is rare in NIC critically ill patients with Candida bloodstream infections. A high mortality was noted in both IC and NIC critically ill patients with candidemia.
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Affiliation(s)
- G. Dimopoulos
- Department of Intensive Care Medicine, Medical School, University of Athens, Athens, Greece
| | - A. Karabinis
- Intensive Care Unit, “G. Gennimatas” General Hospital, Athens, Greece
| | - G. Samonis
- Department of Medicine, University of Crete School of Medicine, Heraklion, Crete Greece
| | - M. E. Falagas
- Alfa Institute of Biomedical Sciences (AIBS), 9 Neapoleos Street, 151 23 Marousi, Athens, Greece
- Department of Medicine, Tufts University School of Medicine, Boston, MA USA
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Kocsubé S, Tóth M, Vágvölgyi C, Dóczi I, Pesti M, Pócsi I, Szabó J, Varga J. Occurrence and genetic variability of Candida parapsilosis sensu lato in Hungary. J Med Microbiol 2007; 56:190-195. [PMID: 17244799 DOI: 10.1099/jmm.0.46838-0] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
The occurrence and genetic variability of Candida parapsilosis isolates in two Hungarian hospitals, located in Debrecen and Pécs, were examined. Among the 209 Candida isolates examined, 20 were found to belong to C. parapsilosis sensu lato, based on morphological, physiological and molecular data. The frequency of occurrence of C. parapsilosis isolates (9.6%) was lower than that observed in Europe but higher than that observed previously in Hungary. The genetic variability of C. parapsilosis sensu lato isolates was also examined using random amplified polymorphic DNA (RAPD) analysis and sequence analysis of the intergenic transcribed spacer (ITS) region of the rRNA gene cluster. The genetic variability of the isolates was relatively high, as revealed by RAPD analysis. Two isolates were found to belong to the recently described Candida metapsilosis species (C. parapsilosis group III), based on ITS sequence data, RAPD analysis and phenotypic data. These two isolates could also be distinguished from C. parapsilosis sensu stricto isolates using a primer pair developed for the detection of C. parapsilosis group I isolates. To the best of the authors' knowledge, this is the first report on the identification of C. metapsilosis from bloodstream infection.
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Affiliation(s)
- Sándor Kocsubé
- Department of Microbiology, Faculty of Sciences, University of Szeged, PO Box 533, H-6701 Szeged, Hungary
| | - Mónika Tóth
- Department of Microbiology, Faculty of Sciences, University of Szeged, PO Box 533, H-6701 Szeged, Hungary
| | - Csaba Vágvölgyi
- Department of Microbiology, Faculty of Sciences, University of Szeged, PO Box 533, H-6701 Szeged, Hungary
| | - Ilona Dóczi
- Department of Clinical Microbiology, Faculty of Medicine, University of Szeged, PO Box 427, H-6701 Szeged, Hungary
| | - Miklós Pesti
- Department of General and Environmental Microbiology, University of Pécs, H-7601 Pécs, Hungary
| | - István Pócsi
- Department of Microbiology and Biotechnology, Medical and Health Science Center, University of Debrecen, PO Box 63, H-4010, Debrecen, Hungary
| | - Judit Szabó
- Institute of Medical Microbiology, Faculty of Sciences, University of Debrecen, PO Box 63, H-4010, Debrecen, Hungary
| | - János Varga
- CBS Fungal Biodiversity Centre, Uppsalalaan 8, 3584 CT Utrecht, The Netherlands
- Department of Microbiology, Faculty of Sciences, University of Szeged, PO Box 533, H-6701 Szeged, Hungary
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Kennedy HF, Shankland GS, Bagg J, Chalmers EA, Gibson BES, Williams CL. Fluconazole and itraconazole susceptibilities of Candida spp. isolated from oropharyngeal specimens and blood cultures of paediatric haematology/oncology patients. Mycoses 2006; 49:457-62. [PMID: 17022761 DOI: 10.1111/j.1439-0507.2006.01272.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
This study examined the in vitro susceptibilities to fluconazole and itraconazole of isolates of Candida spp. from surveillance oropharyngeal specimens and blood cultures from paediatric patients with malignancy. The species distribution of 100 isolates from oropharyngeal specimens was C. albicans 86%, C. glabrata 7%, C. lusitaniae 4%, C. parapsilosis 2% and C. tropicalis 1%. From a total of nine isolates from blood cultures the species distribution was C. albicans 33.3%, C. parapsilosis 33.3 % and C. guilliermondii 33.3%. Only three of the oropharyngeal isolates were resistant to fluconazole (MIC > or = 64 mg l(-1)) and only two were resistant to itraconazole (MIC > or = 1 mg l(-1)). None of the blood culture isolates was resistant to either agent. At this centre, C. albicans is the predominant species from oropharyngeal specimens, but non-albicans Candida species predominate in blood cultures. Although resistance to fluconazole and itraconazole is rare at present, continued surveillance is warranted to monitor trends in species distribution and antifungal susceptibility.
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Affiliation(s)
- H F Kennedy
- Department of Microbiology, Royal Hospital for Sick Children, Yorkhill Division, Glasgow, UK.
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Almirante B, Rodríguez D, Cuenca-Estrella M, Almela M, Sanchez F, Ayats J, Alonso-Tarres C, Rodriguez-Tudela JL, Pahissa A. Epidemiology, risk factors, and prognosis of Candida parapsilosis bloodstream infections: case-control population-based surveillance study of patients in Barcelona, Spain, from 2002 to 2003. J Clin Microbiol 2006; 44:1681-5. [PMID: 16672393 PMCID: PMC1479182 DOI: 10.1128/jcm.44.5.1681-1685.2006] [Citation(s) in RCA: 181] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Candida parapsilosis has emerged as an important yeast species causing fungemia. We describe the incidence and epidemiology of C. parapsilosis fungemia. Data from active population-based surveillance in Barcelona, Spain, from January 2002 to December 2003 were analyzed. We focused on 78 episodes of C. parapsilosis fungemia, and we compared them with 175 Candida albicans controls. C. parapsilosis accounted for 23% of all fungemias. The annual incidences were 1 episode per 10(5) patients, 1.2 episodes per 10(4) discharges, and 1.7 episodes per 10(5) patient days. All isolates but one (99%) were fluconazole susceptible. Seventy-two isolates (92%) were inpatient candidemias. Forty-two episodes (51%) were considered catheter-related fungemia, 35 (45%) were considered primary fungemia, and 3 (4%) were considered secondary fungemia. Risk factors for candidemia were vascular catheterization (97%), prior antibiotic therapy (91%), parenteral nutrition (54%), prior surgery (46%), prior immunosuppressive therapy (38%), malignancy (27%), prior antifungal infection (26%), transplant recipient (16%), neutropenia (12%), and prior colonization (11%). Multivariate analysis of the differential characteristics showed that the factors that independently predicted the presence of C. parapsilosis fungemia were neonate patients (odds ratio [OR], 7.5; 95% confidence interval [CI], 2.1 to 26.8; P = 0.002), transplant recipients (OR, 9.2; 95% CI, 1.9 to 43.3; P = 0.005), patients with a history of prior antifungal therapy (OR, 5.4; 95% CI, 1.8 to 15.9; P = 0.002), and patients who received parenteral nutrition (OR, 2.2; 95% CI, 1.09 to 4.6; P = 0.028). The overall mortality rate was lower than that associated with C. albicans candidemia (23% versus 43%; P < 0.01). In summary, C. parapsilosis was responsible for 23% of all candidemias and was more frequent in neonates, in transplant recipients, and in patients who received parenteral nutrition or previous antifungal therapy, mainly fluconazole. The mortality rate was lower than that associated with C. albicans fungemia.
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Affiliation(s)
- Benito Almirante
- Infectious Diseases Department, Hospital Universitari Vall d'Hebron, Pg. Vall d'Hebron 119-129, 08035 Barcelona, Spain.
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Medrano DJA, Brilhante RSN, Cordeiro RDA, Rocha MFG, Rabenhorst SHB, Sidrim JJC. Candidemia in a Brazilian hospital: the importance of Candida parapsilosis. Rev Inst Med Trop Sao Paulo 2006; 48:17-20. [PMID: 16547574 DOI: 10.1590/s0036-46652006000100004] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/11/2023] Open
Abstract
The aim of this study was to perform a retrospective analysis of cases of candidemia in a Brazilian hospital in the city of Fortaleza, Ceará. A total of 50 blood cultures were analyzed from 40 candidemic patients. The mycological diagnosis was based on the phenotypical analysis and the patients' data were recorded in appropriate files. The most frequent species were Candida parapsilosis (n = 18), followed by C. albicans (n = 14), C. tropicalis (n = 8), C. guillermondii (n = 6), C. glabrata (n = 2), and Candida spp. (n = 2). A detailed descriptive study was undertaken with 21 patients whose medical records were complete. The candidemia episodes occurred in eight male patients and 13 female patients. The most representative risk factors implicated in candidemia were prior antibiotic therapy, central venous catheters, parenteral nutrition, gastric probes and mechanical ventilation. Death occurred in 13 of the 21-candidemic patients. This study demonstrated the emergence of candidemia caused by C. parapsilosis in a Brazilian hospital in the city of Fortaleza, Ceará.
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Affiliation(s)
- Delia Jessica Astete Medrano
- Medical Mycology Specialized Center, Department of Pathology and Legal Medicine, Faculty of Medicine, Federal University of Ceará, Fortaleza, CE, Brazil
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Bassetti M, Righi E, Costa A, Fasce R, Molinari MP, Rosso R, Pallavicini FB, Viscoli C. Epidemiological trends in nosocomial candidemia in intensive care. BMC Infect Dis 2006; 6:21. [PMID: 16472387 PMCID: PMC1379648 DOI: 10.1186/1471-2334-6-21] [Citation(s) in RCA: 229] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2005] [Accepted: 02/10/2006] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Infection represents a frequent complication among patients in Intensive Care Units (ICUs) and mortality is high. In particular, the incidence of fungal infections, especially due to Candida spp., has been increasing during the last years. METHODS In a retrospective study we studied the etiology of candidemia in critically ill patients over a five-year period (1999-2003) in the ICU of the San Martino University Hospital in Genoa, Italy. RESULTS In total, 182 episodes of candidaemia were identified, with an average incidence of 2.22 episodes/10,000 patient-days/year (range 1.25-3.06 episodes). Incidence of candidemia increased during the study period from 1.25 in 1999 to 3.06/10,000 patient-days/year in 2003. Overall, 40% of the fungemia episodes (74/182) were due to C.albicans, followed by C. parapsilosis (23%), C.glabrata (15%), C.tropicalis (9%) and other species (13%). Candidemia due to non-albicans species increased and this was apparently correlated with an increasing use of azoles for prophylaxis or empirical treatment. CONCLUSION The study demonstrates a shift in the species of Candida causing fungemia in a medical and surgical ICU population during a 5 year period. The knowledge of the local epidemiological trends in Candida species isolated in blood cultures is important to guide therapeutic choices.
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Affiliation(s)
- Matteo Bassetti
- Infectious Diseases Department, S. Martino Hospital and University of Genoa, Genoa, Italy
| | - Elda Righi
- Infectious Diseases Department, S. Martino Hospital and University of Genoa, Genoa, Italy
| | | | - Roberta Fasce
- Intensive Care Unit, S. Martino Hospital, Genoa, Italy
| | | | - Raffaella Rosso
- Infectious Diseases Department, S. Martino Hospital and University of Genoa, Genoa, Italy
| | | | - Claudio Viscoli
- Infectious Diseases Department, S. Martino Hospital and University of Genoa, Genoa, Italy
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Mukherjee PK, Zhou G, Munyon R, Ghannoum MA. Candida biofilm: a well-designed protected environment. Med Mycol 2005; 43:191-208. [PMID: 16010846 DOI: 10.1080/13693780500107554] [Citation(s) in RCA: 87] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
Abstract
Biofilms are colonies of microbial cells encased in a self-produced organic polymeric matrix and represent a common mode of microbial growth. Microbes growing as biofilm are highly resistant to commonly used antimicrobial drugs. Recently, microbial biofilms have gained prominence because of the increase in infections related to indwelling medical devices (IMD). Candida albicans, the pathogenic fungus which is a major cause of morbidity and mortality in blood stream infections, is the most common fungal pathogen isolated from patients with IMD-associated infections. Biofilm formation by Candida species is believed to contribute to invasiveness of these fungal species. We discuss experimental methods used to study fungal biofilms as well as the biology of biofilm formation by clinically relevant Candida species. Recent advances that are discussed in this review include the role of specific, differentially expressed genes and proteins, quorum sensing molecule in C. albicans biofilms, and the correlation between biofilm formation and fungal pathogenesis.
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Affiliation(s)
- Pranab K Mukherjee
- Center for Medical Mycology, Department of Dermatology, University Hospitals of Cleveland, Case Western Reserve University, Cleveland, OH 44106-5028, USA
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Bow EJ. Long-term antifungal prophylaxis in high-risk hematopoietic stem cell transplant recipients. Med Mycol 2005; 43 Suppl 1:S277-87. [PMID: 16110821 DOI: 10.1080/13693780400019990] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
Abstract
The risks for invasive fungal infections, particularly mould infections such as invasive aspergillosis, among hematopoietic stem cell transplant (HSCT) recipients are linked to the duration and severity of myelosuppression and immunosuppression. Strategies to prevent invasive fungal infections have focused primarily on the use of orally administered azole antifungal agents during the neutropenic period rather than on the more prolonged post-engraftment period. The major limitations of these studies included the heterogeneity among the subjects studied for fungal infection risk factors, the agents administered, the dosing, and duration of prophylaxis. More recent studies have attempted to examine the efficacy of antifungal prophylaxis strategies among allogeneic HSCT recipients to day 100 and beyond. It is clear that a variety of products have efficacy in preventing invasive candidiasis, including imidazole and triazole antifungals, low-dose amphotericin B, and the echinocandin, micafungin; however, only the extended spectrum azole, itraconazole, has been shown to impact the incidence of proven invasive aspergillosis. Other extended spectrum azole antifungal agents, voriconazole and posaconazole, are being studied as long-term prophylaxis in high-risk HSCT recipients. While clinical trials have suggested that a duration of prophylaxis against moulds of six months or more may be required, it remains unclear if this is required in all cases. The prophylactic efficacy over time may be linked to the degree of immunosuppression as measured by markers such as the numbers of circulating CD4 T lymphocytes. Concerns about selection for resistant moulds among long-term recipients of these drugs are emerging. The cumulative experience to date suggests that long-term antifungal chemoprophylaxis is feasible and effective when applied in defined circumstances. The concerns about treatment-related toxicities, resistance, and costs are valid.
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Affiliation(s)
- E J Bow
- Section of Infectious Diseases and Haematology, Department of Internal Medicine, The University of Manitoba, Manitoba, Canada.
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Kuhn DM, Mukherjee PK, Clark TA, Pujol C, Chandra J, Hajjeh RA, Warnock DW, Soll DR, Ghannoum MA. Candida parapsilosis characterization in an outbreak setting. Emerg Infect Dis 2004; 10:1074-81. [PMID: 15207060 PMCID: PMC3323144 DOI: 10.3201/eid1006.030873] [Citation(s) in RCA: 106] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Candida parapsilosis is an important non-albicans species which infects hospitalized patients. No studies have correlated outbreak infections of C. parapsilosis with multiple virulence factors. We used DNA fingerprinting to determine genetic variability among isolates from a C. parapsilosis outbreak and from our clinical database. We compared phenotypic markers of pathogenesis, including adherence, biofilm formation, and protein secretion (secretory aspartic protease [SAP] and phospholipase). Adherence was measured as colony counts on silicone elastomer disks immersed in agar. Biofilms formed on disks were quantified by dry weight. SAP expression was measured by hydrolysis of bovine albumin; a colorimetric assay was used to quantitate phospholipase. DNA fingerprinting indicated that the outbreak isolates were clonal and genetically distinct from our database. Biofilm expression by the outbreak clone was greater than that of sporadic isolates (p < 0.0005). Adherence and protein secretion did not correlate with strain pathogenicity. These results suggest that biofilm production plays a role in C. parapsilosis outbreaks.
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Affiliation(s)
- Duncan M. Kuhn
- University Hospitals of Cleveland and Case Western Reserve University, Cleveland, Ohio, USA
| | - Pranab K. Mukherjee
- University Hospitals of Cleveland and Case Western Reserve University, Cleveland, Ohio, USA
| | - Thomas A. Clark
- Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | | | - Jyotsna Chandra
- University Hospitals of Cleveland and Case Western Reserve University, Cleveland, Ohio, USA
| | - Rana A. Hajjeh
- Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - David W. Warnock
- Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | | | - Mahmoud A. Ghannoum
- University Hospitals of Cleveland and Case Western Reserve University, Cleveland, Ohio, USA
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Safdar A, Bannister TW, Safdar Z. The predictors of outcome in immunocompetent patients with hematogenous candidasis. Int J Infect Dis 2004; 8:180-6. [PMID: 15109594 DOI: 10.1016/j.ijid.2003.05.003] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2002] [Revised: 04/27/2003] [Accepted: 05/03/2003] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVE Clinical parameters that predict outcome in non-immunosuppressed candidemic patients are not fully understood. METHODS Eighty-one consecutive episodes of candidemia were retrospectively evaluated in 75 patients during 1998-2000. RESULTS Infection due to Candida albicans was common (n = 30; 37%) followed by Candida glabrata (n = 25; 31%), Candida parapsilosis (n = 14; 17%), Candida tropicalis (n = 6; 7%), Candida krusei (n = 5; 6%), and Candida lusitaniae (n = 1; 1%). Among 70 evaluable patients, 31 (44%) had fungemia-associated mortality; advanced age (P < 0.004), underlying malignancy (P < 0.025), coronary artery disease (P < 0.01), and concurrent non-Candida species fungal infection (P < 0.047) were significant prognosticators of compromised short-term survival by multivariate analysis. Mortality was higher in patients with Candida glabrata (60%) and C. tropicalis (75%) infection compared to 44% deaths in individuals with C. albicans infection (P > 0.1). 11/25 (44%) of non-immunocompromised individuals died and 20/45 (44%) immunosuppressed patients succumbed to fungemia: persistent vs. non-persistent (< 3 days) Candida bloodstream invasion, neutropenia, diabetes mellitus, renal insufficiency, prior antimicrobial therapy, cirrhosis of liver, abdomino-pelvis surgery, and critical-care-unit vs. non critical-care-unit admission did not significantly impact outcome in either group. All 11 infants, including nine with prematurity, survived Candida species bloodstream infection (P < 0.025). CONCLUSIONS Short-term mortality in candidemic non-immunocompromised patients was comparable to fungemia-associated deaths in immunosuppressed patients. Ischemic heart disease has appeared as a new predictor of unfavorable outcome in patients with hematogenous candidiasis.
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Affiliation(s)
- Amar Safdar
- University of South Carolina School of Medicine, Columbia, SC 29203, USA
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Abstract
Invasive candidiasis is a condition of major medical importance. Its incidence has increased dramatically over the last 50 years, reflecting increasingly interventional standards of medical care. Candida spp. are regularly reported to be the fourth commonest cause of bloodstream infection, and it is perceived that the incidence of invasive Candida spp. infections continues to increase. The global disease burden of invasive Candida spp. infections is difficult to quantify because of wide geographic variation. Data originating from the United States indicate that mortality from candidiasis has been falling since 1989. Data from several locations have shown that the dramatic increases in Candida spp. bloodstream infections seen during the 1980s were not sustained through the 1990s. Some authors have reported a decreasing incidence. The contribution of non-albicans Candida spp. to invasive infection is rising. Invasive infections with Candida spp. continue to represent a major economic burden, increasing both mortality and morbidity in an already expensive group of hospital patients. There remains much scope for ongoing and future research into the epidemiology and basic disease processes underlying these infections.
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Affiliation(s)
- R P Hobson
- Mycology Reference Centre, Department of Microbiology, Old Medical School, Leeds General Infirmary, LS1 3EX, Leeds, UK.
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Current awareness on yeast. Yeast 2003; 20:455-62. [PMID: 12728936 DOI: 10.1002/yea.943] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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