1
|
Araujo JM, de Almeida Junior JN, Magri MMC, Costa SF, Guimarães T. Epidemiological Assessment and Risk Factors for Mortality of Bloodstream Infections by Candida sp. and the Impact of the COVID-19 Pandemic Era. J Fungi (Basel) 2024; 10:268. [PMID: 38667939 PMCID: PMC11051234 DOI: 10.3390/jof10040268] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2024] [Revised: 03/22/2024] [Accepted: 03/29/2024] [Indexed: 04/28/2024] Open
Abstract
Candidemia is one of the healthcare-associated infections that has high mortality. The risk factors that predispose a patient to develop this infection are mostly found in patients of greater severity and COVID-19 contributes to the risk of death. The aim of this study is to evaluate epidemiological characteristics and risk factors for mortality in patients with candidemia before and during the COVID-19 pandemic era. This is a retrospective study conducted at Instituto Central from 2016 to 2020 of patients with candidemia that were evaluated for demographic data, medical history, risk factors, microbiological data, therapeutic measures, complementary exams, device management, and outcome defined by 30-day mortality. A total of 170 episodes were included (58.2% males; mean age of 56 years). The overall incidence density of candidemia per 1000 admissions and per 1000 patient-days was 1.17 and 0.17, respectively, with an increase of 38% in the year 2020. The use of a central venous catheter was the most prevalent (93.5%) condition, followed by the previous use of antibiotics (91.1%). Corticosteroid use ranked seventh (56.4%). C. albicans was responsible for 71 (41.7%) of the isolates, followed by C. tropicalis and C. glabrata, with 34 (20%) isolates each. Echinocandin was prescribed in 60.1% of cases and fluconazole in 37%. Echocardiography resulted in six (5.08%) cases of endocarditis and fundoscopy resulting in two (2.4%) endophthalmitis. The 30-day mortality was 93/170 (54.7%). The risk factors associated with mortality were age (OR 1.03, CI 95% 1.01-1.06), heart disease (OR 7.51, CI 95% 1.48-37.9), hemodialysis (OR 3.68, CI 95% 1.28-10.57), and use of corticosteroids (OR 2.83, CI 95% 1.01-7.92). The COVID-19 pandemic had an impact on the increase incidence of candidemia. The persistently high mortality highlights the need for better management strategies, control of risk factors, and guarantee of adequate treatment.
Collapse
Affiliation(s)
- Jordana Machado Araujo
- Infection Control Department, Hospital das Clínicas, University of São Paulo, São Paulo 05403-900, Brazil;
| | | | - Marcello Mihailenko Chaves Magri
- Infectious Diseases Department, Hospital das Clínicas, University of São Paulo, São Paulo 05403-900, Brazil; (M.M.C.M.); (S.F.C.)
| | - Silvia Figueiredo Costa
- Infectious Diseases Department, Hospital das Clínicas, University of São Paulo, São Paulo 05403-900, Brazil; (M.M.C.M.); (S.F.C.)
| | - Thaís Guimarães
- Infection Control Department, Hospital das Clínicas, University of São Paulo, São Paulo 05403-900, Brazil;
| |
Collapse
|
2
|
do Nascimento FB, Valente Sá LG, de Andrade Neto JB, Cabral VP, Rodrigues DS, Barbosa AD, Moreira LE, Oliveira LC, Silva A, Lima IS, Silva J, Marinho ES, Santos HS, Cavalcanti BC, Morais MO, Júnior HV, Silva CR. Antifungal activity of cisatracurium against fluconazole-resistant Candida isolates and its antibiofilm effects. Future Microbiol 2023; 18:649-660. [PMID: 37522164 DOI: 10.2217/fmb-2022-0224] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/01/2023] Open
Abstract
Aim: To evaluate the antifungal activity of cisatracurium against Candida spp. resistant to fluconazole strains in planktonic and biofilm forms, in addition to determining its mechanism of action. Materials & methods: Antifungal activity and pharmacological interactions were determined using broth microdilution methods and the mechanism of action was evaluated by flow cytometry and molecular docking. Results: Cisatracurium presented antifungal activity against Candida spp. planktonic cells due to alterations of mitochondrial transmembrane potential leading to cellular apoptosis in addition to interacting with important targets related to cellular respiration, membrane and cell wall evidenced by molecular docking. Furthermore, the drug both prevented biofilm formation and impaired mature biofilms. Conclusion: Cisatracurium exhibits potential antifungal activity against Candida spp.
Collapse
Affiliation(s)
- Francisca Ba do Nascimento
- School of Pharmacy, Federal University of Ceará, Fortaleza, CEP, 60.430-372, Brazil
- Drug Research and Development Center, Federal University of Ceará, Fortaleza, CE, Brazil, CE, CEP, 60.430-275, Brasil
| | - Lívia Ga Valente Sá
- School of Pharmacy, Federal University of Ceará, Fortaleza, CEP, 60.430-372, Brazil
- Christus University Center, Fortaleza, CE, Brasil
- Drug Research and Development Center, Federal University of Ceará, Fortaleza, CE, Brazil, CE, CEP, 60.430-275, Brasil
| | - João B de Andrade Neto
- School of Pharmacy, Federal University of Ceará, Fortaleza, CEP, 60.430-372, Brazil
- Christus University Center, Fortaleza, CE, Brasil
- Drug Research and Development Center, Federal University of Ceará, Fortaleza, CE, Brazil, CE, CEP, 60.430-275, Brasil
| | - Vitória Pf Cabral
- School of Pharmacy, Federal University of Ceará, Fortaleza, CEP, 60.430-372, Brazil
- Drug Research and Development Center, Federal University of Ceará, Fortaleza, CE, Brazil, CE, CEP, 60.430-275, Brasil
| | - Daniel S Rodrigues
- School of Pharmacy, Federal University of Ceará, Fortaleza, CEP, 60.430-372, Brazil
- Drug Research and Development Center, Federal University of Ceará, Fortaleza, CE, Brazil, CE, CEP, 60.430-275, Brasil
| | - Amanda D Barbosa
- School of Pharmacy, Federal University of Ceará, Fortaleza, CEP, 60.430-372, Brazil
- Drug Research and Development Center, Federal University of Ceará, Fortaleza, CE, Brazil, CE, CEP, 60.430-275, Brasil
| | - Lara Ea Moreira
- School of Pharmacy, Federal University of Ceará, Fortaleza, CEP, 60.430-372, Brazil
- Drug Research and Development Center, Federal University of Ceará, Fortaleza, CE, Brazil, CE, CEP, 60.430-275, Brasil
| | - Leilson C Oliveira
- School of Pharmacy, Federal University of Ceará, Fortaleza, CEP, 60.430-372, Brazil
- Drug Research and Development Center, Federal University of Ceará, Fortaleza, CE, Brazil, CE, CEP, 60.430-275, Brasil
| | - Anderson Silva
- Institute of Advanced Chemistry, Higher Council for Scientific Research, Spain
| | - Iri Sp Lima
- Faculty of Medicine, Federal University of Ceará, Barbalha, 63048-080, CE, Brasil
| | - Jacilene Silva
- Theoretical Chemistry & Electrochemistry Group, State University of Ceará, Limoeiro do Norte, Ceará, 62.930-000, Brasil
| | - Emmanuel S Marinho
- Theoretical Chemistry & Electrochemistry Group, State University of Ceará, Limoeiro do Norte, Ceará, 62.930-000, Brasil
| | - Hélcio S Santos
- Science and Technology Centre, Course of Chemistry, State University Vale do Acaraú, Sobral, CE, Brazil
| | - Bruno C Cavalcanti
- Drug Research and Development Center, Federal University of Ceará, Fortaleza, CE, Brazil, CE, CEP, 60.430-275, Brasil
- Department of Physiology and Pharmacology, Federal University of Ceará, Fortaleza, CE, Brazil.CEP, 60.430-275, Brasil
| | - Manoel O Morais
- Drug Research and Development Center, Federal University of Ceará, Fortaleza, CE, Brazil, CE, CEP, 60.430-275, Brasil
- Department of Physiology and Pharmacology, Federal University of Ceará, Fortaleza, CE, Brazil.CEP, 60.430-275, Brasil
| | - Hélio Vn Júnior
- School of Pharmacy, Federal University of Ceará, Fortaleza, CEP, 60.430-372, Brazil
- Drug Research and Development Center, Federal University of Ceará, Fortaleza, CE, Brazil, CE, CEP, 60.430-275, Brasil
| | - Cecília R Silva
- School of Pharmacy, Federal University of Ceará, Fortaleza, CEP, 60.430-372, Brazil
- Drug Research and Development Center, Federal University of Ceará, Fortaleza, CE, Brazil, CE, CEP, 60.430-275, Brasil
| |
Collapse
|
3
|
Erjefält JS, de Souza Xavier Costa N, Jönsson J, Cozzolino O, Dantas KC, Clausson CM, Siddhuraj P, Lindö C, Alyamani M, Lombardi SCFS, Mendroni Júnior A, Antonangelo L, Faria CS, Duarte-Neto AN, de Almeida Monteiro RA, Rebello Pinho JR, Gomes-Gouvêa MS, Verciano Pereira R, Monteiro JS, Setubal JC, de Oliveira EP, Theodoro Filho J, Sanden C, Orengo JM, Sleeman MA, da Silva LFF, Saldiva PHN, Dolhnikoff M, Mauad T. Diffuse alveolar damage patterns reflect the immunological and molecular heterogeneity in fatal COVID-19. EBioMedicine 2022; 83:104229. [PMID: 36027872 PMCID: PMC9398470 DOI: 10.1016/j.ebiom.2022.104229] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Revised: 07/20/2022] [Accepted: 08/01/2022] [Indexed: 11/25/2022] Open
Abstract
Background Severe COVID-19 lung disease exhibits a high degree of spatial and temporal heterogeneity, with different histological features coexisting within a single individual. It is important to capture the disease complexity to support patient management and treatment strategies. We provide spatially decoded analyses on the immunopathology of diffuse alveolar damage (DAD) patterns and factors that modulate immune and structural changes in fatal COVID-19. Methods We spatially quantified the immune and structural cells in exudative, intermediate, and advanced DAD through multiplex immunohistochemistry in autopsy lung tissue of 18 COVID-19 patients. Cytokine profiling, viral, bacteria, and fungi detection, and transcriptome analyses were performed. Findings Spatial DAD progression was associated with expansion of immune cells, macrophages, CD8+ T cells, fibroblasts, and (lymph)angiogenesis. Viral load correlated positively with exudative DAD and negatively with disease/hospital length. In all cases, enteric bacteria were isolated, and Candida parapsilosis in eight cases. Cytokines correlated mainly with macrophages and CD8+T cells. Pro-coagulation and acute repair were enriched pathways in exudative DAD whereas intermediate/advanced DAD had a molecular profile of elevated humoral and innate immune responses and extracellular matrix production. Interpretation Unraveling the spatial and molecular immunopathology of COVID-19 cases exposes the responses to SARS-CoV-2-induced exudative DAD and subsequent immune-modulatory and remodeling changes in proliferative/advanced DAD that occur side-by-side together with secondary infections in the lungs. These complex features have important implications for disease management and the development of novel treatments. Funding CNPq, Bill and Melinda Gates Foundation, HC-Convida, FAPESP, Regeneron Pharmaceuticals, and the Swedish Heart & Lung Foundation.
Collapse
Affiliation(s)
- Jonas S Erjefält
- Unit of Airway inflammation, Department of Experimental Medicine Sciences, Lund University, Sweden; Department of Allergology and Respiratory Medicine, Lund University, Sweden
| | - Natália de Souza Xavier Costa
- Departamento de Patologia, LIM-05 Laboratório de Patologia Ambiental, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | | | - Olga Cozzolino
- Unit of Airway inflammation, Department of Experimental Medicine Sciences, Lund University, Sweden
| | - Katia Cristina Dantas
- Departamento de Patologia, LIM-05 Laboratório de Patologia Ambiental, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Carl-Magnus Clausson
- Unit of Airway inflammation, Department of Experimental Medicine Sciences, Lund University, Sweden
| | - Premkumar Siddhuraj
- Unit of Airway inflammation, Department of Experimental Medicine Sciences, Lund University, Sweden
| | | | - Manar Alyamani
- Unit of Airway inflammation, Department of Experimental Medicine Sciences, Lund University, Sweden
| | - Suzete Cleusa Ferreira Spina Lombardi
- Divisão de Pesquisa & Medicina Transfusional, Fundação Pró-Sangue Hemocentro de São Paulo, São Paulo, Brazil; Laboratório Investigação Médica em Patogênese e Terapia dirigida em Onco-Imuno-Hematologia (LIM-31), Departamento de Hematologia, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - Alfredo Mendroni Júnior
- Divisão de Pesquisa & Medicina Transfusional, Fundação Pró-Sangue Hemocentro de São Paulo, São Paulo, Brazil; Laboratório Investigação Médica em Patogênese e Terapia dirigida em Onco-Imuno-Hematologia (LIM-31), Departamento de Hematologia, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - Leila Antonangelo
- Laboratório de Investigação Médica (LIM03), Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil; Divisão de Patologia Clínica - Departamento de Patologia, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - Caroline Silvério Faria
- Laboratório de Investigação Médica (LIM03), Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - Amaro Nunes Duarte-Neto
- Departamento de Patologia, LIM-05 Laboratório de Patologia Ambiental, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | | | - João Renato Rebello Pinho
- Laboratório de Investigação Médica (LIM03), Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil; Hospital Israelita Albert Einstein, São Paulo, Brazil
| | - Michele Soares Gomes-Gouvêa
- Departamento de Gastroenterologia (LIM-07), Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Roberta Verciano Pereira
- Laboratório de Investigação Médica (LIM03), Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | | | - João Carlos Setubal
- Departamento de Bioquímica, Instituto de Química Universidade de São Paulo, São Paulo, Brazil
| | - Ellen Pierre de Oliveira
- Departamento de Cardiopneumologia, Instituto do Coração, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Jair Theodoro Filho
- Departamento de Patologia, LIM-05 Laboratório de Patologia Ambiental, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | | | | | | | - Luiz Fernando Ferraz da Silva
- Departamento de Patologia, LIM-05 Laboratório de Patologia Ambiental, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil; Serviço de Verificação de Óbitos da Capital, Universidade de São Paulo, São Paulo, Brazil
| | - Paulo Hilário Nascimento Saldiva
- Departamento de Patologia, LIM-05 Laboratório de Patologia Ambiental, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Marisa Dolhnikoff
- Departamento de Patologia, LIM-05 Laboratório de Patologia Ambiental, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Thais Mauad
- Departamento de Patologia, LIM-05 Laboratório de Patologia Ambiental, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil.
| |
Collapse
|
4
|
Rocha da Silva C, Sá LGDAV, Dos Santos EV, Ferreira TL, Coutinho TDNP, Moreira LEA, de Sousa Campos R, de Andrade CR, Barbosa da Silva WM, de Sá Carneiro I, Silva J, Dos Santos HS, Marinho ES, Cavalcanti BC, de Moraes MO, Júnior HVN, Andrade Neto JB. Evaluation of the antifungal effect of chlorogenic acid against strains of Candida spp. resistant to fluconazole: apoptosis induction and in silico analysis of the possible mechanisms of action. J Med Microbiol 2022; 71. [PMID: 35575783 DOI: 10.1099/jmm.0.001526] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
Introduction. Candida spp. are commensal fungal pathogens of humans, but when there is an imbalance in the microbiota, or weak host immunity, these yeasts can become pathogenic, generating high medical costs.Gap Statement. With the increase in resistance to conventional antifungals, the development of new therapeutic strategies is necessary. This study evaluated the in vitro antifungal activity of chlorogenic acid against fluconazole-resistant strains of Candida spp. Mechanism of action through flow cytometry and in silico analyses, as well as molecular docking assays with ALS3 and SAP5, important proteins in the pathogenesis of Candida albicans associated with the adhesion process and biofilm formation.Results. The chlorogenic acid showed in vitro antifungal activity against the strains tested, causing reduced cell viability, increased potential for mitochondrial depolarization and production of reactive oxygen species, DNA fragmentation and phosphatidylserine externalization, indicating an apoptotic process. Concerning the analysis through docking, the complexes formed between chlorogenic acid and the targets Thymidylate Kinase, CYP51, 1Yeast Cytochrome BC1 Complex e Exo-B-(1,3)-glucanase demonstrated more favourable binding energy. In addition, chlorogenic acid presented significant interactions with the ALS3 active site residues of C. albicans, important in the adhesion process and resistance to fluconazole. Regarding molecular docking with SAP5, no significant interactions were found between chlorogenic acid and the active site of the enzyme.Conclusion. We concluded that chlorogenic acid has potential use as an adjuvant in antifungal therapies, due to its anti-Candida activity and ability to interact with important drug targets.
Collapse
Affiliation(s)
- Cecília Rocha da Silva
- School of Pharmacy, Laboratory of Bioprospection in Antimicrobial Molecules (LABIMAN), Federal University of Ceará, Fortaleza, CE, Brazil.,Drug Research and Development Center, Federal University of Ceará, Fortaleza, CE, Brazil
| | - Lívia Gurgel do Amaral Valente Sá
- School of Pharmacy, Laboratory of Bioprospection in Antimicrobial Molecules (LABIMAN), Federal University of Ceará, Fortaleza, CE, Brazil.,Drug Research and Development Center, Federal University of Ceará, Fortaleza, CE, Brazil.,Christus University Center (UNICHRISTUS), Fortaleza, CE, Brazil
| | | | | | | | - Lara Elloyse Almeida Moreira
- School of Pharmacy, Laboratory of Bioprospection in Antimicrobial Molecules (LABIMAN), Federal University of Ceará, Fortaleza, CE, Brazil.,Drug Research and Development Center, Federal University of Ceará, Fortaleza, CE, Brazil
| | - Rosana de Sousa Campos
- School of Pharmacy, Laboratory of Bioprospection in Antimicrobial Molecules (LABIMAN), Federal University of Ceará, Fortaleza, CE, Brazil.,Christus University Center (UNICHRISTUS), Fortaleza, CE, Brazil
| | | | | | - Igor de Sá Carneiro
- School of Pharmacy, Laboratory of Bioprospection in Antimicrobial Molecules (LABIMAN), Federal University of Ceará, Fortaleza, CE, Brazil
| | - Jacilene Silva
- Department of Chemistry, Group of Theoretical Chemistry and Electrochemistry (GQTE), State University of Ceará, Limoeiro do Norte, Ceará, Brazil
| | - Hélcio Silva Dos Santos
- Science and Technology Centre, Course of Chemistry, State University Vale do Acaraú, Sobral, CE, Brazil
| | - Emmanuel Silva Marinho
- Department of Chemistry, Group of Theoretical Chemistry and Electrochemistry (GQTE), State University of Ceará, Limoeiro do Norte, Ceará, Brazil
| | - Bruno Coelho Cavalcanti
- Drug Research and Development Center, Federal University of Ceará, Fortaleza, CE, Brazil.,Department of Physiology and Pharmacology, Federal University of Ceará, Fortaleza, CE, Brazil
| | - Manoel Odorico de Moraes
- Drug Research and Development Center, Federal University of Ceará, Fortaleza, CE, Brazil.,Department of Physiology and Pharmacology, Federal University of Ceará, Fortaleza, CE, Brazil
| | - Hélio Vitoriano Nobre Júnior
- School of Pharmacy, Laboratory of Bioprospection in Antimicrobial Molecules (LABIMAN), Federal University of Ceará, Fortaleza, CE, Brazil.,Drug Research and Development Center, Federal University of Ceará, Fortaleza, CE, Brazil
| | - João Batista Andrade Neto
- School of Pharmacy, Laboratory of Bioprospection in Antimicrobial Molecules (LABIMAN), Federal University of Ceará, Fortaleza, CE, Brazil.,Drug Research and Development Center, Federal University of Ceará, Fortaleza, CE, Brazil.,Christus University Center (UNICHRISTUS), Fortaleza, CE, Brazil
| |
Collapse
|
5
|
Molecular Identification and Antifungal Susceptibility Patterns of Candida Species Isolated from Candidemia Patients in Yasuj, Southwestern Iran. Jundishapur J Microbiol 2021. [DOI: 10.5812/jjm.117643] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background: Candidemia is the most common systemic infection in hospitalized patients causing high mortality. Hence, the diagnosis of this infection in the early stage with appropriate antifungal therapy is paramount. Objectives: The study aimed at molecular identification of Candida species isolated from candidemia patients and evaluation of the in vitro antifungal susceptibility patterns of these strains to fluconazole, amphotericin B, and caspofungin. Methods: In the present study, 800 hospitalized patients who were suspected to have candidemia were sampled. Candida species were isolated and identified based on morphological characteristics and PCR-sequencing of the ITS1-5.8S-ITS2 region. Antifungal susceptibility tests for fluconazole, amphotericin B, and caspofungin were performed according to the Clinical and Laboratory Standards Institute protocol M27-A3. Also, clinical data were recorded from the patients' records. Results: Twenty-seven patients among the sample of hospitalized patients were found to have candidemia. A total of 33.3% of candidemia patients were treated with amphotericin B, in which case the mortality rate was 14.8%. The majority of patients (59%) were from the neonatal intensive care unit, and premature birth was the most common underlying condition. Candida albicans (n = 18; 66.6%) was the most common species isolated from blood cultures, followed by C. parapsilosis (n = 7; 25.9%), C. pelliculosa (n = 1; 3.7%), and C. tropicalis (n = 1; 3.7%). Only one C. albicans isolate resistant to fluconazole (minimum inhibitory concentration = 32 µg/mL). Conclusions: Generally, C. albicans has been the most frequent causative agent of candidemia. Resistance to antifungal drugs among candidemia agents was rare. Also, the identification of Candida isolates at the species level with in vitro antifungal susceptibility tests helps manage candidemia patients better and decrease the mortality rate among them.
Collapse
|
6
|
Rodrigues DKB, Bonfietti LX, Garcia RA, Araujo MR, Rodrigues JS, Gimenes VMF, Melhem MSC. Antifungal susceptibility profile of Candida clinical isolates from 22 hospitals of São Paulo State, Brazil. ACTA ACUST UNITED AC 2021; 54:e10928. [PMID: 34133538 PMCID: PMC8208770 DOI: 10.1590/1414-431x2020e10928] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2020] [Accepted: 04/27/2021] [Indexed: 01/08/2023]
Abstract
This study aimed to evaluate the frequency of cryptic Candida species from candidemia cases in 22 public hospitals in São Paulo State, Brazil, and their antifungal susceptibility profiles. During 2017 and 2018, 144 isolates were molecularly identified as 14 species; C. parapsilosis (32.6%), C. albicans (27.7%), C. tropicalis (14.6%), C. glabrata (9.7%), C. krusei (2.8%), C. orthopsilosis (2.8%), C. haemulonii var. vulnera (2.1%), C. haemulonii (1.4%), C. metapsilosis (1.4%), C. dubliniensis (1.4%), C. guilliermondii (1.4%), C. duobushaemulonii (0.7%), C. kefyr (0.7%), and C. pelliculosa (0.7%). Poor susceptibility to fluconazole was identified in 6.4% of C. parapsilosis isolates (0.12 to >64 µg/mL), 50% of C. guilliermondii (64 µg/mL), 66.6% of C. haemulonii var. vulnera (16-32 µg/mL), and C. duobushaemulonii strain (MIC 64 µg/mL). Our results corroborated the emergence of C. glabrata in Brazilian cases of candidemia as previously reported. Importantly, we observed a large proportion of non-wild type C. glabrata isolates to voriconazole (28.6%; <0.015 to 4 µg/mL) all of which were also resistant to fluconazole (28.6%). Of note, C. haemulonii, a multidrug resistant species, has emerged in the Southeast region of Brazil. Our findings suggested a possible epidemiologic change in the region with an increase in fluconazole-resistant species causing candidemia. We stress the relevance of routine accurate identification to properly manage therapy and monitor epidemiologic trends.
Collapse
Affiliation(s)
| | - L X Bonfietti
- Núcleo de Micologia do Instituto Adolfo Lutz, Secretaria de Saúde, São Paulo, SP, Brasil
| | - R A Garcia
- Núcleo de Micologia do Instituto Adolfo Lutz, Secretaria de Saúde, São Paulo, SP, Brasil
| | - M R Araujo
- Núcleo de Micologia do Instituto Adolfo Lutz, Secretaria de Saúde, São Paulo, SP, Brasil
| | - J S Rodrigues
- Núcleo de Micologia do Instituto Adolfo Lutz, Secretaria de Saúde, São Paulo, SP, Brasil
| | - V M F Gimenes
- Laboratório de Micologia Médica-LIM 53, Instituto de Medicina Tropical, Universidade de São Paulo, São Paulo, SP, Brasil
| | - M S C Melhem
- Núcleo de Micologia do Instituto Adolfo Lutz, Secretaria de Saúde, São Paulo, SP, Brasil.,Escola de Medicina, Universidade Federal do Mato Grosso do Sul, Mato Grosso do Sul, MS, Brasil
| |
Collapse
|
7
|
Juvêncio da Silva L, Dias Barroso FD, Vieira LS, Carlos Mota DR, da Silva Firmino BK, Rocha da Silva C, de Farias Cabral VP, Cândido TM, Sá LGDAV, Barbosa da Silva WM, Silva J, Marinho ES, Cavalcanti BC, de Moraes MO, Júnior HVN, de Andrade Neto JB. Diazepam's antifungal activity in fluconazole-resistant Candida spp. and biofilm inhibition in C. albicans: evaluation of the relationship with the proteins ALS3 and SAP5. J Med Microbiol 2021; 70. [PMID: 33560202 DOI: 10.1099/jmm.0.001308] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
The genus Candida spp. has been highlighted as one of the main etiological agents causing fungal infections, with Candida albicans being the most prominent, responsible for most cases of candidemia. Due to its capacity for invasion and tissue adhesion, it is associated with the formation of biofilms, mainly in the environment and hospital devices, decreasing the effectiveness of available treatments. The repositioning of drugs, which is characterized by the use of drugs already on the market for other purposes, together with molecular-docking methods can be used aiming at the faster development of new antifungals to combat micro-organisms. This study aimed to evaluate the antifungal effect of diazepam on mature C. albicans biofilms in vitro and its action on biofilm in formation, as well as its mechanism of action and interaction with structures related to the adhesion of C. albicans, ALS3 and SAP5. To determine the MIC, the broth microdilution test was used according to protocol M27-A3 (CLSI, 2008). In vitro biofilm formation tests were performed using 96-well plates, followed by molecular-docking protocols to analyse the binding agent interaction with ALS3 and SAP5 targets. The results indicate that diazepam has antimicrobial activity against planktonic cells of Candida spp. and C. albicans biofilms, interacting with important virulence factors related to biofilm formation (ALS3 and SAP5). In addition, treatment with diazepam triggered a series of events in C. albicans cells, such as loss of membrane integrity, mitochondrial depolarization and increased production of EROs, causing DNA damage and consequent cell apoptosis.
Collapse
Affiliation(s)
- Lisandra Juvêncio da Silva
- Drug Research and Development Center, Federal University of Ceará, Fortaleza, CE, Brazil.,School of Pharmacy, Laboratory for Bioprospection of Antimicrobial Molecules (LABIMAN), Federal University of Ceará, Fortaleza, CE, Brazil
| | - Fátima Daiana Dias Barroso
- Drug Research and Development Center, Federal University of Ceará, Fortaleza, CE, Brazil.,School of Pharmacy, Laboratory for Bioprospection of Antimicrobial Molecules (LABIMAN), Federal University of Ceará, Fortaleza, CE, Brazil
| | | | | | | | - Cecília Rocha da Silva
- Drug Research and Development Center, Federal University of Ceará, Fortaleza, CE, Brazil.,School of Pharmacy, Laboratory for Bioprospection of Antimicrobial Molecules (LABIMAN), Federal University of Ceará, Fortaleza, CE, Brazil
| | - Vitória Pessoa de Farias Cabral
- School of Pharmacy, Laboratory for Bioprospection of Antimicrobial Molecules (LABIMAN), Federal University of Ceará, Fortaleza, CE, Brazil
| | - Thiago Mesquita Cândido
- Drug Research and Development Center, Federal University of Ceará, Fortaleza, CE, Brazil.,School of Pharmacy, Laboratory for Bioprospection of Antimicrobial Molecules (LABIMAN), Federal University of Ceará, Fortaleza, CE, Brazil
| | - Lívia Gurgel do Amaral Valente Sá
- Drug Research and Development Center, Federal University of Ceará, Fortaleza, CE, Brazil.,School of Pharmacy, Laboratory for Bioprospection of Antimicrobial Molecules (LABIMAN), Federal University of Ceará, Fortaleza, CE, Brazil
| | | | - Jacilene Silva
- Department of Chemistry, Group for Theoretical Chemistry and Electrochemistry (GQTE), State University of Ceará, Limoeiro do Norte, Ceará, Brazil
| | - Emmanuel Silva Marinho
- Department of Chemistry, Group for Theoretical Chemistry and Electrochemistry (GQTE), State University of Ceará, Limoeiro do Norte, Ceará, Brazil
| | - Bruno Coelho Cavalcanti
- Department of Physiology and Pharmacology, Federal University of Ceará, Fortaleza, CE, Brazil.,Drug Research and Development Center, Federal University of Ceará, Fortaleza, CE, Brazil
| | - Manoel Odorico de Moraes
- Department of Physiology and Pharmacology, Federal University of Ceará, Fortaleza, CE, Brazil.,Drug Research and Development Center, Federal University of Ceará, Fortaleza, CE, Brazil
| | - Hélio Vitoriano Nobre Júnior
- Drug Research and Development Center, Federal University of Ceará, Fortaleza, CE, Brazil.,School of Pharmacy, Laboratory for Bioprospection of Antimicrobial Molecules (LABIMAN), Federal University of Ceará, Fortaleza, CE, Brazil
| | - João Batista de Andrade Neto
- School of Pharmacy, Laboratory for Bioprospection of Antimicrobial Molecules (LABIMAN), Federal University of Ceará, Fortaleza, CE, Brazil.,Christus University Center (UNICHRISTUS), Fortaleza, CE, Brazil
| |
Collapse
|
8
|
de Oliveira CS, Colombo AL, Francisco EC, de Lima B, Gandra RF, de Carvalho MCP, Carrilho CMDDM, Petinelli R, Pelison M, Helbel C, Czelusniak G, Paz Morales HM, Perozin JS, Pinheiro RL, Cognialli R, Breda GL, Queiroz-Telles F. Clinical and epidemiological aspects of Candidemia in eight medical centers in the state of Parana, Brazil: Parana Candidemia Network. Braz J Infect Dis 2020; 25:101041. [PMID: 33370563 PMCID: PMC9392142 DOI: 10.1016/j.bjid.2020.11.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Revised: 11/23/2020] [Accepted: 11/30/2020] [Indexed: 12/02/2022] Open
Abstract
Objectives Candida spp. has been reported as one of the common agents of nosocomial bloodstream infections and is associated with a high mortality. Therefore, this study evaluated the clinical findings, local epidemiology, and microbiological aspects of candidemia in eight tertiary medical centers in the state of Parana, South of Brazil. Methods In this study, we reported 100 episodes of candidemia in patients admitted to eight different hospitals in five cities of the state of Parana, Brazil, using data collected locally (2016 and 2017) and tabulated online. Results The incidence was found to be 2.7 / 1000 patients / day and 1.2 / 1000 admissions. C. albicans was responsible for 49% of all candidemia episodes. Cancer and surgery were the two most common underlying conditions associated with candidemia. The mortality rate within 30 days was 48%, and removal of the central venous catheter (p = 0.029) as well as empirical or prophylactic exposure to antifungals were both related to improved survival (p = 0.033). Conclusions This study highlights the high burden and mortality rates of candidemia in hospitals from Parana as well as the need to enhance antifungal stewardship program in the enrolled medical centers.
Collapse
Affiliation(s)
| | - Arnaldo Lopes Colombo
- Universidade Federal de São Paulo, Laboratório Especial de Micologia, São Paulo, SP, Brazil
| | | | | | | | | | | | | | | | - Cesar Helbel
- Hospital Santa Casa de Maringá, Maringá, PR, Brazil
| | | | | | | | - Rosangela Lameira Pinheiro
- Hospital de Clínicas da Universidade Federal do Paraná, Setor de Micologia, Departamento de Saúde Coletiva, Curitiba, PR, Brazil
| | - Regielly Cognialli
- Hospital de Clínicas da Universidade Federal do Paraná, Setor de Micologia, Departamento de Saúde Coletiva, Curitiba, PR, Brazil
| | - Giovanni Luis Breda
- Hospital de Clínicas da Universidade Federal do Paraná, Setor de Micologia, Departamento de Saúde Coletiva, Curitiba, PR, Brazil
| | - Flávio Queiroz-Telles
- Hospital de Clínicas da Universidade Federal do Paraná, Setor de Micologia, Departamento de Saúde Coletiva, Curitiba, PR, Brazil
| |
Collapse
|
9
|
Clinical characteristics, management and outcome of patients with invasive candidiasis hospitalized in Internal Medicine Units: findings from a registry by the Italian Scientific Society FADOI. Infection 2020; 49:277-285. [PMID: 33095391 DOI: 10.1007/s15010-020-01535-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Accepted: 10/01/2020] [Indexed: 10/23/2022]
Abstract
PURPOSE Invasive candidiasis (IC) is a challenging clinical condition, burdened by relevant mortality and morbidity. There is limited knowledge on the occurrence and management of IC in Internal Medicine Units (IMUs). Aim of this study was to provide real-world data on this topic. METHODS Consecutive objectively diagnosed cases of IC were collected in this prospective registry, which involved 18 IMUs in Italy. Patients were followed-up to 90 days from the diagnosis of candidemia. RESULTS A total of 111 patients were observed (median age 78, IQR 67-83) for an overall incidence of infection of 1.89 cases/1000 hospital admissions. Candida albicans was the most frequent isolated species (62%), followed by Candida parapsilosis (17%) and Candida glabrata (13%). Echinocandins and fluconazole were used as initial therapy in 56.8 and 43.2% of patients, respectively. Antifungal therapy was started within 24 h in 18.9% of patients, in 40.6% in the period 1-3 days, and in 40.5% of patients more than 3 days after blood cultures. Death rate was 19.8% at 30 days and 40.5% at 90 days. At multivariable analysis concomitant bacteremia (i.e. polymicrobial sepsis), and fluconazole as the initial therapy were associated with an increased risk of death at 90 days. CONCLUSIONS The incidence of IC is not negligible, and our registry confirmed that these patients have a relevant mortality rate at 90 days. Concomitant bacteremia, featuring polymicrobial sepsis, and starting antifungal treatment with fluconazole instead of echinocandins independently increase the risk of death. Efforts are needed to improve the awareness and management of IC in IMUs.
Collapse
|
10
|
Mirhendi H, Charsizadeh A, Eshaghi H, Nikmanesh B, Arendrup MC. Species distribution and antifungal susceptibility profile of Candida isolates from blood and other normally sterile foci from pediatric ICU patients in Tehran, Iran. Med Mycol 2020; 58:201-206. [PMID: 31111910 DOI: 10.1093/mmy/myz047] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2018] [Revised: 02/27/2019] [Accepted: 04/16/2019] [Indexed: 01/23/2023] Open
Abstract
As data on pediatric invasive candidiasis (IC) and the antifungal susceptibility pattern of associated isolates are scarce in Iran, this study aimed to determine species distribution and antifungal susceptibility profile of Candida species isolated from pediatric patients with suspected or documented IC. A total of 235 yeast strains recovered from normally sterile body fluids of patients admitted at the intensive care units of Children's Medical Centre, Tehran, Iran, were identified using CHROMagar Candida, molecular methods (ITS PCR-RFLP and sequencing), and MALDI-TOF. Susceptibility to amphotericin B, fluconazole, voriconazole, micafungin, and anidulafungin was determined according to the European on Antimicrobial Susceptibility testing reference microdilution method (EUCAST E.Def 7.3.1). Candida albicans (53.6%), C. parapsilosis (24.7%), and C. tropicalis (8.5%) were the most common species, followed by C. lusitaniae (4.3%), C. glabrata (3.0%), C. guilliermondii and C. orthopsilosis (each 1.7%), C. kefyr (1.3%), C. dubliniensis (0.8%), and C. intermedia (0.4%). Amphotericin B MICs were ≤1 mg/l for all Candida isolates. C. albicans isolates were susceptible to all five antifungal agents. All C. parapsilosis isolates categorised as intermediate to micafungin and anidulafungin, except two isolates that had the MICs >2 mg/l for micafungin. MIC50, MIC90, and MIC range for fluconazole were 0.25 mg/l, 1 mg/l, and 0.125 - ≥32 mg/l, respectively. Fluconazole and voriconazole showed 100% activity against the most prevalent Candida species. The low resistance rate, favorable safety profile and low cost of fluconazole make it a reasonable choice for treatment of candidemia/invasive candidemia in Iran.
Collapse
Affiliation(s)
- Hossein Mirhendi
- Departments of Medical Parasitology and Mycology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Arezoo Charsizadeh
- Immunology, Asthma, and Allergy Research Institute, Tehran University of Medical Sciences, Tehran Iran
| | - Hamid Eshaghi
- Infectious Disease Research Center, Children's Medical Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Bahram Nikmanesh
- Department of Medical Laboratory Sciences, School of Allied Medical Sciences, Tehran University of Medical Sciences, Tehran, Iran
| | - Maiken Cavling Arendrup
- Unit of Mycology, Statens Serum Institut, Copenhagen, Denmark.,Department of Clinical Medicine, University of Copenhagen, Denmark
| |
Collapse
|
11
|
Rodrigues LS, Motta FA, Picharski GL, Vasconcelos TM, Riccieri MC, Dalla-Costa LM. Invasive candidiasis: Risk factor for mortality in a pediatric tertiary care hospital in south of Brazil. Medicine (Baltimore) 2019; 98:e15933. [PMID: 31169713 PMCID: PMC6571356 DOI: 10.1097/md.0000000000015933] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2019] [Revised: 04/23/2019] [Accepted: 05/10/2019] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Invasive candidiasis (IC) is a major cause of morbimortality in children. Previous studies described the clinical characteristics and risk factors for this infection; however, limited data are available on the predictors of mortality in these patients. In this context, we evaluated the risk factors associated with death due to IC in a pediatric tertiary care hospital in South of Brazil. METHODS This is a retrospective, cross-sectional, observational, and analytical study of a series of pediatric patients with clinical and laboratory diagnosis of IC from March 2014 to September 2017. Univariate and multivariate analysis were performed to estimate the association between the characteristics of the patients and death. RESULTS A total of 94 cases of IC were included. The incidence was 1.13 cases per 1000 patients/d, with a mortality rate of 14%. There was a predominance of non-albicans Candida (71.3%) in IC cases and, although there is no species difference in mortality rates, biofilm formation was associated with increased mortality. Clinical characteristics such as male sex, stay in the intensive care unit, and thrombocytopenia; comorbidities such as cardiological disease and renal insufficiency; and risks such as mechanical ventilation and dialysis were associated with increased mortality. CONCLUSION Data from this study suggest that biofilm formation by Candida sp. is associated with increased mortality, and this is the first study to correlate the male sex and cardiological disease as risk factors for death in pediatric IC patients.
Collapse
|
12
|
Lamoth F, Lockhart SR, Berkow EL, Calandra T. Changes in the epidemiological landscape of invasive candidiasis. J Antimicrob Chemother 2019; 73:i4-i13. [PMID: 29304207 DOI: 10.1093/jac/dkx444] [Citation(s) in RCA: 288] [Impact Index Per Article: 57.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
The epidemiology of invasive candidiasis has evolved in recent years, warranting a review of the changes and the implications for current and future diagnosis and treatment. The overall burden of invasive candidiasis remains high, particularly in the expanding populations of patients at risk of opportunistic infection, such as the elderly or immunosuppressed. Progressive shifts from Candida albicans to non-albicans Candida spp. have been observed globally. The recent emergence of novel, multiresistant species, such as Candida auris, amplifies the call for vigilance in detection and advances in treatment. Among the current treatment options, fluconazole is still widely used throughout the world. Increased resistance to fluconazole, both acquired and naturally emerging, has been observed. Resistance to echinocandins is presently low but this may change with increased use. Improvement of diagnostic techniques and strategies, development of international surveillance networks and implementation of antifungal stewardship programmes represent major challenges for a better epidemiological control of invasive candidiasis.
Collapse
Affiliation(s)
- Frederic Lamoth
- Infectious Diseases Service, Department of Medicine, Lausanne University, Lausanne, Switzerland.,Institute of Microbiology, Lausanne University Hospital, Lausanne, Switzerland
| | - Shawn R Lockhart
- Mycotic Diseases Branch, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Elizabeth L Berkow
- Mycotic Diseases Branch, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Thierry Calandra
- Infectious Diseases Service, Department of Medicine, Lausanne University, Lausanne, Switzerland
| |
Collapse
|
13
|
Braga PR, Cruz IL, Ortiz I, Barreiros G, Nouér SA, Nucci M. Secular trends of candidemia at a Brazilian tertiary care teaching hospital. Braz J Infect Dis 2018; 22:273-277. [PMID: 30118654 PMCID: PMC9427822 DOI: 10.1016/j.bjid.2018.07.008] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2018] [Revised: 07/17/2018] [Accepted: 07/19/2018] [Indexed: 11/19/2022] Open
Affiliation(s)
- Paula Rocha Braga
- Universidade Federal do Rio de Janeiro, Hospital Universitário, Rio de Janeiro, RJ, Brazil
| | - Isabela L Cruz
- Universidade Federal do Rio de Janeiro, Hospital Universitário, Rio de Janeiro, RJ, Brazil
| | - Isadora Ortiz
- Universidade Federal do Rio de Janeiro, Hospital Universitário, Rio de Janeiro, RJ, Brazil
| | - Gloria Barreiros
- Universidade Federal do Rio de Janeiro, Hospital Universitário, Rio de Janeiro, RJ, Brazil
| | - Simone A Nouér
- Universidade Federal do Rio de Janeiro, Hospital Universitário, Rio de Janeiro, RJ, Brazil
| | - Marcio Nucci
- Universidade Federal do Rio de Janeiro, Hospital Universitário, Rio de Janeiro, RJ, Brazil.
| |
Collapse
|
14
|
Brancini GTP, Rodrigues GB, Rambaldi MDSL, Izumi C, Yatsuda AP, Wainwright M, Rosa JC, Braga GÚL. The effects of photodynamic treatment with new methylene blue N on the Candida albicans proteome. Photochem Photobiol Sci 2018; 15:1503-1513. [PMID: 27830217 DOI: 10.1039/c6pp00257a] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Candida albicans is a human pathogenic fungus mainly affecting immunocompromised patients. Resistance to the commonly used fungicides can lead to poor treatment of mucosal infections which, in turn, can result in life-threatening systemic candidiasis. In this scenario, antimicrobial photodynamic treatment (PDT) has emerged as an effective alternative to treat superficial and localized fungal infections. Microbial death in PDT is a consequence of the oxidation of many cellular biomolecules, including proteins. Here, we report a combination of two-dimensional electrophoresis and tandem mass spectrometry to study the protein damage resulting from treating C. albicans with PDT with new methylene blue N and red light. Two-dimensional gels of treated cells showed an increase in acidic spots in a fluence-dependent manner. Amino acid analysis revealed a decrease in the histidine content after PDT, which is one plausible explanation for the observed acidic shift. However, some protein spots remained unchanged. Protein identification by mass spectrometry revealed that both modified and unmodified proteins could be localized to the cytoplasm, ruling out subcellular location as the only explanation for damage selectivity. Therefore, we hypothesize that protein modification by PDT is a consequence of both photosensitizer binding affinity and the degree of exposure of the photooxidizable residues on the protein surface.
Collapse
Affiliation(s)
| | - Gabriela Braga Rodrigues
- Faculdade de Ciências Farmacêuticas de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brazil.
| | | | - Clarice Izumi
- Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, Brazil.
| | - Ana Patrícia Yatsuda
- Faculdade de Ciências Farmacêuticas de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brazil.
| | - Mark Wainwright
- School of Pharmacy and Biomolecular Sciences, Liverpool John Moores University, Liverpool, UK.
| | - José César Rosa
- Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, Brazil.
| | - Gilberto Úbida Leite Braga
- Faculdade de Ciências Farmacêuticas de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brazil.
| |
Collapse
|
15
|
Sbrana F, Sozio E, Bassetti M, Ripoli A, Pieralli F, Azzini AM, Morettini A, Nozzoli C, Merelli M, Rizzardo S, Bertolino G, Carrara D, Scarparo C, Concia E, Menichetti F, Tascini C. Independent risk factors for mortality in critically ill patients with candidemia on Italian Internal Medicine Wards. Intern Emerg Med 2018; 13:199-204. [PMID: 29322386 DOI: 10.1007/s11739-017-1783-9] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2017] [Accepted: 12/25/2017] [Indexed: 12/31/2022]
Abstract
Candida is an increasing cause of bloodstream infection and is associated with significant morbidity and mortality. The aim of our study is to analyze risk factors for short-term mortality in patients with bloodstream Candida spp. infections admitted to Internal Medicine Wards (IMWs). This was a retrospective case-control study between January 2012 and December 2014 from four University Hospitals in Italy, where patients with candidemia dying within 30 days from diagnosis were matched to control cases with candidemia who survived in the same period of time. Two-hundred and fifty cases of candidemia were registered during the 36 months of enrollment. Among these, 112 patients died (45%) within 30 days from the first blood culture's positivity for Candida spp. At multivariate analysis, septic shock [odds ratio (95% CI) = 2.919 (1.62-5.35), p < 0.001] and concomitant chronic kidney failure [odds ratio (95% CI) = 2.296 (1.07-5.12), p = 0.036] were independent predictors of mortality. Low-dose chronic steroid therapy was protective [odds ratio (95% CI) = 0.461 (0.25-0.83), p = 0.011).
Collapse
Affiliation(s)
- Francesco Sbrana
- Fondazione Toscana Gabriele Monasterio, Via Moruzzi, 1, 56124, Pisa, Italy.
| | - Emanuela Sozio
- North-West District, Tuscany HealthCare, Spedali Riuniti Livorno, Emergency Department, Leghorn, Italy
| | - Matteo Bassetti
- Infectious Diseases Division, Santa Maria Misericordia University Hospital, Udine, Italy
| | - Andrea Ripoli
- Fondazione Toscana Gabriele Monasterio, Via Moruzzi, 1, 56124, Pisa, Italy
| | - Filippo Pieralli
- Intermediate Care Unit, Azienda Ospedaliera Universitaria Careggi, Florence, Italy
| | - Anna Maria Azzini
- Infectious Disease Unit, Azienda Ospedaliera Universitaria Integrata di Verona, Verona, Italy
| | - Alessandro Morettini
- Internal Medicine Unit, Azienda Ospedaliera Universitaria Careggi, Florence, Italy
| | - Carlo Nozzoli
- Internal Medicine Unit, Azienda Ospedaliera Universitaria Careggi, Florence, Italy
| | - Maria Merelli
- Infectious Diseases Division, Santa Maria Misericordia University Hospital, Udine, Italy
| | - Sebastiano Rizzardo
- Infectious Disease Unit, Azienda Ospedaliera Universitaria Integrata di Verona, Verona, Italy
| | - Giacomo Bertolino
- Pharmaceutical Department, Azienda Ospedaliera Universitaria Pisana, Santa Chiara, Pisa, Italy
| | - Davide Carrara
- U.O.C. Medicina Generale, Ospedale Versilia, Azienda U.S.L. Toscana Nord Ovest, Viareggio, Italy
| | - Claudio Scarparo
- Infectious Diseases Division, Santa Maria Misericordia University Hospital, Udine, Italy
| | - Ercole Concia
- Infectious Disease Unit, Azienda Ospedaliera Universitaria Integrata di Verona, Verona, Italy
| | - Francesco Menichetti
- Infectious Diseases Clinic, Nuovo Santa Chiara University Hospital, Azienda Ospedaliera Universitaria Pisana, Pisa, Italy
| | - Carlo Tascini
- First Division of Infectious Diseases, Cotugno Hospital, Azienda Ospedaliera dei Colli, Naples, Italy
| |
Collapse
|
16
|
Vieira JN, Feijó AM, Bueno ME, Gonçalves CL, Lund RG, Mendes JF, Villarreal JPV, Villela MM, Nascente PS. Evaluation of the frequency of Candida spp. in hospitalized and non-hospitalized subjects. BRAZ J BIOL 2018; 78:644-652. [PMID: 29451605 DOI: 10.1590/1519-6984.169623] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2016] [Accepted: 05/27/2017] [Indexed: 11/21/2022] Open
Abstract
The aim of this study was to evaluate the frequency of Candida species between a non-hospitalized and a hospitalized population. For this purpose, samples of saliva were sampled through sterile swabs, moistened in peptone water and rubbed in the oral cavity of 140 individuals, from which, 70 were hospitalized patients from the Medical Clinic of a Teaching Hospital and the other 70 were non-hospitalized subjects. All saliva samples were plated in Sabouraud Dextrose agar added with Chloramphenicol and incubated at 36 °C for 48 hours. The morphology identification was performed through macroscopic and microscopic characterization, the CHROMagar Candida medium and the VITEK® system Yeast Biochemical Card (bio Mérieux SA, France). The results showed a colonization of Candida spp. in 85.7% the hospitalized individuals, where the species found were C. albicans (60%), C. tropicalis (23.4%), C. krusei (3.3%) and Candida spp. (13.3%). In the non-hospitalized individuals the colonization by Candida spp was 47.1%, and the species found were: C. albicans (45.5%), C.krusei (9.1%), C. guilliermondii (9.1% %), C. tropicalis (3.0%), C. famata (3.0%) and Candida spp. (30.3%). In spite of their presence in oral cavity in both groups, Candida spp. was more frequently isolated in hospitalized individuals, who were 6.73 times more likely to have this fungus in the oral cavity and were 3.88 times more likely to have Candida albicans.
Collapse
Affiliation(s)
- J N Vieira
- Laboratório de Parasitologia, Instituto de Biologia, Departamento de Microbiologia e Parasitologia, Universidade Federal de Pelotas - UFPEL, Campus universitário Capão do Leão, s/n, Prédio 18, Sala 3, CEP 96010-900, Pelotas, RS, Brazil
| | - A M Feijó
- Laboratório de Parasitologia, Instituto de Biologia, Departamento de Microbiologia e Parasitologia, Universidade Federal de Pelotas - UFPEL, Campus universitário Capão do Leão, s/n, Prédio 18, Sala 3, CEP 96010-900, Pelotas, RS, Brazil
| | - M E Bueno
- Laboratório de Parasitologia, Instituto de Biologia, Departamento de Microbiologia e Parasitologia, Universidade Federal de Pelotas - UFPEL, Campus universitário Capão do Leão, s/n, Prédio 18, Sala 3, CEP 96010-900, Pelotas, RS, Brazil
| | - C L Gonçalves
- Laboratório de Parasitologia, Instituto de Biologia, Departamento de Microbiologia e Parasitologia, Universidade Federal de Pelotas - UFPEL, Campus universitário Capão do Leão, s/n, Prédio 18, Sala 3, CEP 96010-900, Pelotas, RS, Brazil
| | - R G Lund
- Departamento de Odontologia Restauradora, Faculdade de Medicina Dentária, Universidade Federal de Pelotas - UFPEL, Rua Gonçalves Chaves, nº 457, Centro, CEP 96020-080, Pelotas, RS, Brazil
| | - J F Mendes
- Laboratório de Parasitologia, Instituto de Biologia, Departamento de Microbiologia e Parasitologia, Universidade Federal de Pelotas - UFPEL, Campus universitário Capão do Leão, s/n, Prédio 18, Sala 3, CEP 96010-900, Pelotas, RS, Brazil
| | - J P V Villarreal
- Laboratório de Parasitologia, Instituto de Biologia, Departamento de Microbiologia e Parasitologia, Universidade Federal de Pelotas - UFPEL, Campus universitário Capão do Leão, s/n, Prédio 18, Sala 3, CEP 96010-900, Pelotas, RS, Brazil
| | - M M Villela
- Laboratório de Parasitologia, Instituto de Biologia, Departamento de Microbiologia e Parasitologia, Universidade Federal de Pelotas - UFPEL, Campus universitário Capão do Leão, s/n, Prédio 18, Sala 3, CEP 96010-900, Pelotas, RS, Brazil
| | - P S Nascente
- Laboratório de Parasitologia, Instituto de Biologia, Departamento de Microbiologia e Parasitologia, Universidade Federal de Pelotas - UFPEL, Campus universitário Capão do Leão, s/n, Prédio 18, Sala 3, CEP 96010-900, Pelotas, RS, Brazil
| |
Collapse
|
17
|
Canela HMS, Cardoso B, Vitali LH, Coelho HC, Martinez R, Ferreira MEDS. Prevalence, virulence factors and antifungal susceptibility of Candida spp. isolated from bloodstream infections in a tertiary care hospital in Brazil. Mycoses 2017; 61:11-21. [PMID: 28940753 DOI: 10.1111/myc.12695] [Citation(s) in RCA: 43] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2017] [Revised: 06/20/2017] [Accepted: 08/22/2017] [Indexed: 12/13/2022]
Abstract
Candida spp. are responsible for 80% of all systemic fungal infections and are associated with high mortality rates. This study characterised 79 bloodstream isolates of C. albicans, C. glabrata, C. orthopsilosis, C. parapsilosis and C. tropicalis from patients in a Brazilian hospital. The susceptibility to amphotericin B, caspofungin, fluconazole and voriconazole was determined; virulence factor production was assessed based on haemolysin, phospholipase and proteinase activities, and the patients' clinical characteristics were analysed. C. albicans was the predominant species (44%), followed by C. glabrata (19%), C. tropicalis (19%), C. parapsilosis (14%) and C. orthopsilosis (4%). The candidemia incidence was 1.52 per 1000 admissions, and the crude mortality rate was 52%. One C. albicans isolate was resistant to fluconazole and voriconazole. Moreover, 20.2%, 2.5% and 3.8% of the isolates exhibited dose-dependent susceptibility to fluconazole, voriconazole and caspofungin, respectively. In conclusion, although the C. glabrata incidence was higher than that usually described in Brazil, its increase was previously observed in studies conducted worldwide. Furthermore, the azole resistance of the C. albicans isolate could be due to previous exposure to these antifungals. These results highlight the importance of epidemiological studies and will facilitate an improved understanding of candidemia in the studied hospital.
Collapse
Affiliation(s)
- Heliara Maria Spina Canela
- Faculdade de Ciências Farmacêuticas de Ribeirão Preto-Universidade de São Paulo, Ribeirão Preto, São Paulo, Brazil
| | - Bárbara Cardoso
- Faculdade de Ciências Farmacêuticas de Ribeirão Preto-Universidade de São Paulo, Ribeirão Preto, São Paulo, Brazil
| | - Lucia Helena Vitali
- Faculdade de Medicina de Ribeirão Preto-Universidade de São Paulo, Ribeirão Preto, São Paulo, Brazil
| | - Harnoldo Colares Coelho
- Faculdade de Ciências Farmacêuticas de Ribeirão Preto-Universidade de São Paulo, Ribeirão Preto, São Paulo, Brazil
| | - Roberto Martinez
- Faculdade de Medicina de Ribeirão Preto-Universidade de São Paulo, Ribeirão Preto, São Paulo, Brazil
| | | |
Collapse
|
18
|
Invasive Candidiasis in Brescia, Italy: Analysis of Species Distribution and Antifungal Susceptibilities During Seven Years. Mycopathologia 2017; 182:897-905. [DOI: 10.1007/s11046-017-0155-3] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2016] [Accepted: 06/01/2017] [Indexed: 10/19/2022]
|
19
|
Revisiting Species Distribution and Antifungal Susceptibility of Candida Bloodstream Isolates from Latin American Medical Centers. J Fungi (Basel) 2017; 3:jof3020024. [PMID: 29371542 PMCID: PMC5715916 DOI: 10.3390/jof3020024] [Citation(s) in RCA: 54] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2017] [Revised: 05/12/2017] [Accepted: 05/12/2017] [Indexed: 02/03/2023] Open
Abstract
The epidemiology of candidemia varies geographically, and there is still scarce data on the epidemiology of candidemia in Latin America (LA). After extensive revision of medical literature, we found reliable and robust information on the microbiological aspects of candidemia in patients from 11 out of 21 medical centers from LA countries and 1 out of 20 from Caribbean countries/territories. Based on 40 papers attending our search strategy, we noted that C. albicans remains the most common species causing candidemia in our region, followed by C. parapsilosis and C. tropicalis. In Argentina, Brazil, and Colombia, a trend towards an increase in frequency of C. glabrata candidemia was observed. Although resistance rates to fluconazole is under 3%, there was a slight increase in the resistance rates to C. albicans, C. parapsilosis and C. tropicalis isolates. Echinocandin resistance has been reported in a few surveys, but no single study confirmed the resistant phenotype reported by using molecular methods. We highlight the importance of conducting continuous surveillance studies to identify new trends in terms of species distribution of Candida and antifungal resistance related to episodes of candidemia in LA. This information is critical for helping clinicians to prevent and control Candida bloodstream infections in their medical centers.
Collapse
|
20
|
Castro LL, Schütze M, Bücker DH, Vasconcellos LDS. Prevalence of fungemia in a tertiary hospital: Analysis of the last decade. Rev Assoc Med Bras (1992) 2017; 62:315-9. [PMID: 27437675 DOI: 10.1590/1806-9282.62.04.315] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2014] [Accepted: 11/03/2014] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION The prevalence of nosocomial fungemia has increased worldwide, and mortality caused by this disease is high. OBJECTIVE To assess progress in the last decade, and the prevalence and profile of fungal agents isolated in blood cultures performed in a tertiary university hospital. METHOD All the results of blood cultures processed at Hospital das Clínicas, Universidade Federal de Minas Gerais (HC-UFMG), in the time intervals 2001-2003 and 2011-2013 were analyzed retrospectively. For each three-year period, the number of collected blood cultures, the overall positivity rate and the percentage of fungemia were recorded. In addition, all identified fungal species were cataloged. All blood samples were incubated in the BacT/ALERT® (bioMérieux) automation system. RESULTS In 2001-2003, 34,822 samples were evaluated, with 5,510 (15.8%) positive results. In 2011-2013, the number of blood cultures processed increased to 55,052 samples, with 4,873 (8.9%) positive results. There was an increase in the number of positive cultures for fungi in the analyzed period (2001-2003: 4.16%; 2011-2013: 5.95%; p<0.001). Among the agents, candidemias were predominant, especially those caused by non-albicans Candida species (2001-2003: 57.64%; 2011-2013: 65.17%; p<0.05). There was also an increase in fungemia caused by other genera (2001-2003: 2.62%; 2011-2013: 4.48%; p<0.01). CONCLUSION There was an increase in the prevalence of fungemia in the last decade at HC-UFMG. Although candidemias have been responsible for most of the cases, there has been an increase in fungemias caused by other species.
Collapse
Affiliation(s)
- Luísa Lima Castro
- MD from Faculdade de Medicina, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, MG, Brazil
| | - Manuel Schütze
- MD from Faculdade de Medicina, UFMG. MSc in Molecular Medicine from UFMG, Belo Horizonte, MG, Brazil
| | - Daniel Henrique Bücker
- Biologist, degree from Universidade Federal de Rondônia. MSc in Genetics from UFMG. Employee of the Laboratory Medicine Service at Hospital das Clínicas, UFMG, Belo Horizonte, MG, Brazil
| | - Leonardo de Souza Vasconcellos
- MSc and PhD in Medicine from UFMG. Adjunct Professor, Department of Complementary Propedeutics, Faculdade de Medicina, UFMG. MD, Clinical Pathologist, Belo Horizonte, MG, Brazil
| |
Collapse
|
21
|
Peron IH, Reichert-Lima F, Busso-Lopes AF, Nagasako CK, Lyra L, Moretti ML, Schreiber AZ. Resistance Surveillance in Candida albicans: A Five-Year Antifungal Susceptibility Evaluation in a Brazilian University Hospital. PLoS One 2016; 11:e0158126. [PMID: 27414653 PMCID: PMC4945058 DOI: 10.1371/journal.pone.0158126] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2016] [Accepted: 06/11/2016] [Indexed: 11/25/2022] Open
Abstract
Candida albicans caused 44% of the overall candidemia episodes from 2006 to 2010 in our university tertiary care hospital. As different antifungal agents are used in therapy and also immunocompromised patients receive fluconazole prophylaxis in our institution, this study aimed to perform an antifungal susceptibility surveillance with the C.albicans bloodstream isolates and to characterize the fluconazole resistance in 2 non-blood C.albicans isolates by sequencing ERG11 gene. The study included 147 C. albicans bloodstream samples and 2 fluconazole resistant isolates: one from oral cavity (LIF 12560 fluconazole MIC: 8μg/mL) and one from esophageal cavity (LIF-E10 fluconazole MIC: 64μg/mL) of two different patients previously treated with oral fluconazole. The in vitro antifungal susceptibility to amphotericin B (AMB), 5-flucytosine (5FC), fluconazole (FLC), itraconazole (ITC), voriconazole (VRC), caspofungin (CASP) was performed by broth microdilution methodology recommended by the Clinical and Laboratory Standards Institute documents (M27-A3 and M27-S4, CLSI). All blood isolates were classified as susceptible according to CLSI guidelines for all evaluated antifungal agents (MIC range: 0,125–1.00 μg/mL for AMB, ≤0.125–1.00 μg/mL for 5FC, ≤0.125–0.5 μg/mL for FLC, ≤0.015–0.125 μg/mL for ITC, ≤0.015–0.06 μg/mL for VRC and ≤0.015–0.125 μg/mL for CASP). In this study, we also amplified and sequenced the ERG11 gene of LIF 12560 and LIF-E10 C.albicans isolates. Six mutations encoding distinct amino acid substitutions were found (E116D, T128K, E266D, A298V, G448V and G464S) and these mutations were previously described as associated with fluconazole resistance. Despite the large consumption of antifungals in our institution, resistant blood isolates were not found over the trial period. Further studies should be conducted, but it may be that the very prolonged direct contact with the oral antifungal agent administered to the patient from which was isolated LIF E-10, may have contributed to the development of resistance.
Collapse
Affiliation(s)
- Isabela Haddad Peron
- Clinical Pathology Department Faculty of Medical Sciences, University of Campinas, Campinas, Sao Paulo, Brazil
- * E-mail:
| | - Franqueline Reichert-Lima
- Clinical Pathology Department Faculty of Medical Sciences, University of Campinas, Campinas, Sao Paulo, Brazil
| | - Ariane Fidelis Busso-Lopes
- Internal Medicine Department, Faculty of Medical Sciences, University of Campinas, Campinas, Sao Paulo, Brazil
| | - Cristiane Kibune Nagasako
- Internal Medicine Department, Faculty of Medical Sciences, University of Campinas, Campinas, Sao Paulo, Brazil
| | - Luzia Lyra
- Clinical Pathology Department Faculty of Medical Sciences, University of Campinas, Campinas, Sao Paulo, Brazil
| | - Maria Luiza Moretti
- Internal Medicine Department, Faculty of Medical Sciences, University of Campinas, Campinas, Sao Paulo, Brazil
| | | |
Collapse
|
22
|
Menezes RDP, Ferreira JC, de Sá WM, Moreira TDA, Malvino LDS, de Araujo LB, Röder DVDDB, Penatti MPA, Candido RC, Pedroso RDS. FREQUENCY OF Candida SPECIES IN A TERTIARY CARE HOSPITAL IN TRIANGULO MINEIRO, MINAS GERAIS STATE, BRAZIL. Rev Inst Med Trop Sao Paulo 2016. [PMID: 26200956 PMCID: PMC4544240 DOI: 10.1590/s0036-46652015000300001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Infections by Candida species are a high-impact problem in public
health due to their wide incidence in hospitalized patients. The goal of this study
was to evaluate frequency, susceptibility to antifungals, and genetic polymorphism of
Candida species isolated from clinical specimens of hospitalized
patients. The Candida isolates included in this study were obtained
from blood cultures, abdominal fluids, and central venous catheters (CVC) of
hospitalized patients at the Clinical Hospital of the Federal University of
Uberlândia during the period of July 2010 - June 2011. Susceptibility tests were
conducted by the broth microdilution method. The RAPD-PCR tests used employed
initiator oligonucleotides OPA09, OPB11, and OPE06. Of the 63
Candida isolates, 18 (28.5%) were C. albicans,
20 (31.7%) were C. parapsilosis complex species, 14 (22.2%)
C. tropicalis, four (6.4%) C. glabrata, four
(6.4%) C. krusei, two (3.3%) C. kefyr, and one
(1.6%) C. lusitaniae. In vitro resistance to
amphotericin B was observed in 12.7% of isolates. In vitroresistance
to azoles was not detected, except for C. krusei. The two primers,
OPA09 and OPB11, were able to distinguish different species. Isolates of C.
albicans and C. parapsilosis complex species presented
six and five clusters, respectively, with the OPA09 marker by RAPD-PCR, showing the
genetic variability of the isolates of those species. It was concluded that members
of the C. parapsilosis complex were the most frequent species found,
and most isolates were susceptible to the antifungals amphotericin B, flucozanole,
and itraconazole. High genetic polymorphisms were observed for isolates of C.
albicans and C. parapsilosis complex species, mainly
with the OPA09 marker.
Collapse
Affiliation(s)
| | - Joseane Cristina Ferreira
- Faculty of Pharmaceutical Sciences of Ribeirao Preto, University of São Paulo, Ribeirão Preto, São Paulo, Brazil
| | | | | | | | | | | | | | - Regina Celia Candido
- Faculty of Pharmaceutical Sciences of Ribeirao Preto, University of São Paulo, Ribeirão Preto, São Paulo, Brazil
| | | |
Collapse
|
23
|
Yang Q, Wang T, Xie J, Chen L, Wang Y, Cheng X, Dong H, Dong W, Wei Y, Wang X, Dong Y. A sensitive liquid chromatography-tandem mass spectrometry method for monitoring the caspofungin trough plasma concentration and its association with caspofungin efficacy in intensive-care-unit patients. RSC Adv 2015. [DOI: 10.1039/c5ra21080a] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
LC-MS/MS method for monitoring the caspofungin trough plasma concentration and its association efficacy in intensive-care-unit patients.
Collapse
Affiliation(s)
- Qianting Yang
- Department of Pharmacy
- The First Affiliated Hospital of Xi'an Jiaotong University
- Xi'an 710061
- China
| | - Taotao Wang
- Department of Pharmacy
- The First Affiliated Hospital of Xi'an Jiaotong University
- Xi'an 710061
- China
| | - Jiao Xie
- Department of Pharmacy
- The First Affiliated Hospital of Xi'an Jiaotong University
- Xi'an 710061
- China
| | - Lu Chen
- Department of Pharmacy
- The First Affiliated Hospital of Xi'an Jiaotong University
- Xi'an 710061
- China
| | - Yan Wang
- Department of Pharmacy
- The First Affiliated Hospital of Xi'an Jiaotong University
- Xi'an 710061
- China
| | - Xiaoliang Cheng
- Department of Pharmacy
- The First Affiliated Hospital of Xi'an Jiaotong University
- Xi'an 710061
- China
| | - Haiyan Dong
- Department of Pharmacy
- The First Affiliated Hospital of Xi'an Jiaotong University
- Xi'an 710061
- China
| | - Weihua Dong
- Department of Pharmacy
- The First Affiliated Hospital of Xi'an Jiaotong University
- Xi'an 710061
- China
| | - Youxia Wei
- Department of Pharmacy
- The First Affiliated Hospital of Xi'an Jiaotong University
- Xi'an 710061
- China
| | - Xue Wang
- Central Intensive Care Unit
- The First Affiliated Hospital of Xi'an Jiaotong University
- Xi'an 710061
- China
| | - Yalin Dong
- Department of Pharmacy
- The First Affiliated Hospital of Xi'an Jiaotong University
- Xi'an 710061
- China
| |
Collapse
|
24
|
Ece G. Distribution of yeast-like fungi at a university hospital in Turkey. Jundishapur J Microbiol 2014; 7:e13141. [PMID: 25741432 PMCID: PMC4335567 DOI: 10.5812/jjm.13141] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2013] [Revised: 09/25/2013] [Accepted: 10/14/2013] [Indexed: 01/10/2023] Open
Abstract
Background: The increased life span has led to application of more invasive procedures for diagnosis and treatment of particularly immunosuppressed individuals. This situation drew more attention to fungal infections due to existence of yeast-like fungi. Candida infections have increased due to transplant in patients, prolonged intensive care unit (ICU) stays, and invasive procedures. Recently, identification of yeast-like fungi as well as antifungal susceptibility test has been gaining more importance. Objectives: In our study, we aimed to evaluate the distribution of yeast-like fungi strains isolated from blood, urine, wound and respiratory specimens, which were sent from various departments of Izmir University School of Medicine University Hospital. Materials and Methods: The 262 yeast strains (of 13860 clinical specimens), isolated during 30.05.2012-20.05.2013, which were sent from various departments of Izmir University School of Medicine to Medical Microbiology Laboratory, were included in this study. Blood, wound, respiratory (sputum, tracheal secretion), and urine specimens were cultivated on blood agar and Sabouraud dextrose agar and incubated for 24-48 hours at 37°C. The isolates were cultivated on CHROMagar Candida and Cornmeal Tween 80 medium for identification. Besides, the automatized Vitek version 2.0 system was used for identification of the yeast strains as well as the antifungal susceptibility of blood culture strains. Results: A total of 262 strains, isolated from the Anesthesiology and Reanimation Unit, as well as from the departments of Hematology, Urology, Infectious Diseases, Gynecology and Obstetrics, and Ear Nose and Throat, were included in this study. The most common isolated yeast-like species was Candida albicans. C. parapsilosis was the most common yeast-like fungus isolated from blood cultures. All the blood culture strains were susceptible to amphotericin B, flucytosine, fluconazole and voriconazole. Conclusions: Candida strains isolated from newborns, elderly patients, and intensive care patients, identified and isolates from blood cultures, should be studied for antifungal susceptibility for management of the treatment. Our University Hospital is a recently opened center and these are the first data of our center. Gradually, as the number of patients increases, this data will be evaluated further.
Collapse
Affiliation(s)
- Gulfem Ece
- Department of Medical Microbiology, Izmir University, School of Medicine, Izmir, Turkey
- Corresponding author: Gulfem Ece, Department of Medical Microbiology, Izmir University, School of Medicine, Izmir, Turkey. Tel: +90-2323995050-2135,, E-mail:
| |
Collapse
|
25
|
Oliveira VKP, Ruiz LDS, Oliveira NAJ, Moreira D, Hahn RC, Melo ASDA, Nishikaku AS, Paula CR. Fungemia caused by Candida species in a children's public hospital in the city of São Paulo, Brazil: study in the period 2007-2010. Rev Inst Med Trop Sao Paulo 2014; 56:301-5. [PMID: 25076430 PMCID: PMC4131815 DOI: 10.1590/s0036-46652014000400006] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2013] [Accepted: 01/10/2014] [Indexed: 11/21/2022] Open
Abstract
Candidemia remains a major cause of morbidity and mortality in the health care environment. The epidemiology of Candida infection is changing, mainly in relation to the number of episodes caused by species C. non-albicans. The overall objective of this study was to evaluate the frequency of yeasts of the genus Candida, in a four-year period, isolated from blood of pediatric patients hospitalized in a public hospital of the city of São Paulo, Brazil. In this period, yeasts from blood of 104 patients were isolated and, the identified species of Candida by phenotypic and genotypic methods were: C. albicans (39/104), C. tropicalis (25/104), C. parapsilosis (23/104), Pichia anomala (6/104), C. guilliermondii (5/104), C. krusei (3/104), C. glabrata (2/104) and C. pararugosa (1/104). During the period of the study, a higher frequency of isolates of C. non-albicans (63.55%) (p = 0.0286) was verified. In this study we verified the increase of the non-albicans species throughout the years (mainly in 2009 and 2010). Thus, considering the peculiarities presented by Candida species, a correct identification of species is recommended to lead to a faster diagnosis and an efficient treatment.
Collapse
Affiliation(s)
| | - Luciana da Silva Ruiz
- Department of Microbiology, Institute of Biomedical Science II, University of São Paulo, São Paulo, SP, Brazil
| | | | - Débora Moreira
- Department of Microbiology, Institute of Biomedical Science II, University of São Paulo, São Paulo, SP, Brazil
| | - Rosane Christine Hahn
- Division of Infectious and Tropical Diseases, Federal University of Mato Grosso, MT, Brazil
| | | | | | | |
Collapse
|
26
|
Clinical and epidemiological characteristics and risk factors for mortality in patients with candidemia in hospitals from Bogotá, Colombia. Braz J Infect Dis 2014; 18:631-7. [PMID: 25181401 PMCID: PMC9425269 DOI: 10.1016/j.bjid.2014.06.009] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2014] [Revised: 05/29/2014] [Accepted: 06/27/2014] [Indexed: 11/25/2022] Open
Abstract
Background Bloodstream infection by Candida species has a high mortality in Latin American countries. The aim of this study was to describe the characteristics of patients with documented bloodstream infections caused by Candida species in third level hospitals and determine the risk factors for in-hospital-mortality. Methods Patients from seven tertiary-care hospitals in Bogotá, Colombia, with isolation of a Candida species from a blood culture were followed prospectively from March 2008 to March 2009. Epidemiologic information, risk factors, and mortality were prospectively collected. Isolates were sent to a reference center, and fluconazole susceptibility was tested by agar-based E-test. The results of susceptibility were compared by using 2008 and 2012 breakpoints. A multivariate analysis was used to determinate risk factors for mortality. Results We identified 131 patients, with a median age of 41.2 years. Isolates were most frequently found in the intensive care unit (ICU). Candida albicans was the most prevalent species (66.4% of the isolates), followed by C. parapsilosis (14%). Fluconazole resistance was found in 3.2% and 17.6% of the isolates according to the 2008 and 2012 breakpoints, respectively. Fluconazole was used as empirical antifungal therapy in 68.8% of the cases, and amphotericin B in 22%. Hospital crude mortality rate was 35.9%. Mortality was associated with age and the presence of shock at the time of Candida detection. Fluconazole therapy was a protective factor for mortality. Conclusions Candidemia is associated with a high mortality rate. Age and shock increase mortality, while the use of fluconazole was shown to be a protective factor. A higher resistance rate with new breakpoints was noted.
Collapse
|
27
|
|
28
|
Milazzo L, Peri AM, Mazzali C, Grande R, Cazzani C, Ricaboni D, Castelli A, Raimondi F, Magni C, Galli M, Antinori S. Candidaemia observed at a university hospital in Milan (northern Italy) and review of published studies from 2010 to 2014. Mycopathologia 2014; 178:227-41. [PMID: 25056143 DOI: 10.1007/s11046-014-9786-9] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2014] [Accepted: 07/07/2014] [Indexed: 01/08/2023]
Abstract
BACKGROUND Candida species represent the fourth leading cause of nosocomial bloodstream infections (BSI) worldwide. However, candidaemia rates and species involved vary geographically. OBJECTIVES To evaluate the epidemiological pattern, risk factors for mortality and antifungal therapy of Candida BSI over a 5-year period (2008-2012) in a university hospital in northern Italy together with a review of the recent literature concerning candidaemia. METHODS A retrospective cohort study cross-linked with microbiology database was performed. RESULTS A total of 89 Candida BSI were identified in 42 males (47 %) and 47 females (52.8 %). The median age was 69 years (interquartile range 55-78) with 61.8 % of patients being older than 65 years. Considering all hospitalized patients, the overall incidence rate of candidaemia increased significantly from 2008 to 2012 (from 0.4 to 1.68 episodes per 10,000 patient/days) (p = 0.0001) with a mean linear increase in 5 new cases per year. Candida albicans was the predominant species isolated (64 %) followed by C. glabrata (19.1 %). The latter species was observed with significantly higher frequency in Internal Medicine and Intensive Care Units (ICU). In-hospital crude mortality was 41.6 %. CONCLUSIONS Candidaemia is an increasing BSI in our university hospital, in accordance with that observed in northern Italy, and it is still associated with high in-hospital crude mortality.
Collapse
Affiliation(s)
- Laura Milazzo
- III Division of Infectious Diseases, Department of Biomedical and Clinical Sciences L. Sacco, Luigi Sacco Hospital, University of Milan, Via G.B. Grassi 74, 20157, Milan, Italy,
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
29
|
Wille MP, Guimarães T, Furtado GHC, Colombo AL. Historical trends in the epidemiology of candidaemia: analysis of an 11-year period in a tertiary care hospital in Brazil. Mem Inst Oswaldo Cruz 2014; 108:S0074-02762013000300288. [PMID: 23778668 DOI: 10.1590/s0074-02762013000300005] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2012] [Accepted: 12/07/2012] [Indexed: 02/12/2023] Open
Abstract
Candida species are an important cause of bloodstream infections (BSI). To evaluate the epidemiological, clinical and microbiological aspects of two cohorts {1994-1999 [period 1 (P1) ]; 2000-2004 [period 2 (P2) ]} of candidaemic patients, we performed a retrospective analysis from a laboratory-based survey. A total of 388 candidaemias were identified, with an incidence of 0.20/1,000 patient-days and a significant increase in P2 vs. P1 (0.25 vs. 0.15, p = 0.04). Cancer and prior antibiotic use were frequent and Candida albicans was the most prevalent species found (42.4%). Resistance to fluconazole was found in 2.47% of the strains. No differences were observed in the species distribution of Candida during the study periods. In the P2 cohort, there were higher prevalence of elderly individuals, cardiac, pulmonary and liver diseases, renal failure, central venous catheters and antibiotic therapy. In P1, there were higher prevalence of neurological diseases and chemotherapy. The crude mortality was 55.4%. In conclusion, our incidence rates remained high. Furthermore, the distribution pattern of Candida species and the fluconazole resistance profile remained unchanged. Moreover, we found a clear trend of higher prevalence of candidaemia among the elderly and among patients with comorbidities. Finally, it is necessary to discuss strategies for the prevention and control of Candida BSI in Brazil.
Collapse
Affiliation(s)
- Marcos Paulo Wille
- Laboratório Especializado em Micologia, Comissão de Controle de Infecção Hospitalar, São Paulo, SP, Brasil
| | | | | | | |
Collapse
|
30
|
Al Thaqafi AHO, Farahat FM, Al Harbi MI, Al Amri AFW, Perfect JR. Predictors and outcomes of Candida bloodstream infection: eight-year surveillance, western Saudi Arabia. Int J Infect Dis 2014; 21:5-9. [PMID: 24468816 DOI: 10.1016/j.ijid.2013.12.012] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2013] [Revised: 11/29/2013] [Accepted: 12/07/2013] [Indexed: 01/17/2023] Open
Abstract
OBJECTIVES To assess the epidemiological pattern of Candida bloodstream infection (BSI) over an 8-year period (2002-2009) in King Abdulaziz Medical City, western Saudi Arabia. METHOD A retrospective chart review was performed. RESULTS A total of 258 BSI were identified in 134 males (53.2%) and 118 females (46.8%). There were 86 (34.1%) cases of Candida albicans and 166 (65.9%) non-albicans Candida species. Malignancy was independently associated with the development of candidemia by non-albicans Candida species (odds ratio 3.24, 95% confidence interval 1.25-8.41). Fluconazole in vitro susceptibility was 38.5% for C. albicans and 52.5% for other Candida species. The overall, crude 12-month mortality rate was 50% for C. albicans and 57.8% for non-albicans Candida species. CONCLUSIONS The antifungal resistance coinciding with a change in the epidemiologic pattern of candidemia identified in this study is alarming and urges the need for a review of empiric antifungal therapy and potential contributing environmental factors.
Collapse
Affiliation(s)
- Abdul Hakeem O Al Thaqafi
- College of Medicine, King Saud bin Abdulaziz University for Health Sciences (KSAU- HS), Jeddah, Saudi Arabia; Section of Infectious Diseases, King Abdulaziz Medical City, National Guard Health Affairs, PO Box 9515, 21423 Jeddah, Saudi Arabia.
| | - Fayssal M Farahat
- College of Medicine, King Saud bin Abdulaziz University for Health Sciences (KSAU- HS), Jeddah, Saudi Arabia; Section of Infectious Diseases, King Abdulaziz Medical City, National Guard Health Affairs, PO Box 9515, 21423 Jeddah, Saudi Arabia; Department of Community Medicine and Public Health, Faculty of Medicine, Menoufia University, Egypt
| | - Maher I Al Harbi
- Section of Infectious Diseases, King Abdulaziz Medical City, National Guard Health Affairs, PO Box 9515, 21423 Jeddah, Saudi Arabia
| | - Abdul Fattah W Al Amri
- College of Medicine, King Saud bin Abdulaziz University for Health Sciences (KSAU- HS), Jeddah, Saudi Arabia; Division of Microbiology, King Abdulaziz Medical City, National Guard Health Affairs, Jeddah, Saudi Arabia
| | - John R Perfect
- Department of Medicine, Duke University Medical Centre, Durham, North Carolina, USA
| |
Collapse
|
31
|
Sanitá PV, Mima EGDO, Pavarina AC, Jorge JH, Machado AL, Vergani CE. Susceptibility profile of a Brazilian yeast stock collection of Candida species isolated from subjects with Candida-associated denture stomatitis with or without diabetes. Oral Surg Oral Med Oral Pathol Oral Radiol 2013; 116:562-9. [PMID: 24055150 DOI: 10.1016/j.oooo.2013.07.002] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2013] [Revised: 07/04/2013] [Accepted: 07/05/2013] [Indexed: 01/24/2023]
Abstract
OBJECTIVE This study investigated the susceptibility of 198 clinical isolates of Candida species against caspofungin, amphotericin B, itraconazole, and fluconazole. STUDY DESIGN Suspensions of the microorganisms were spread on Roswell Park Memorial Institute (RPMI) agar plates. Etest strips were placed on the plates, and the minimal inhibitory concentration (MIC) was read after incubation (48 h at 37 °C). Data were analyzed by a factorial analysis of variance and a 2 × 2 post hoc test (α = .05). RESULTS C glabrata showed the highest MIC values (P < .001) against caspofungin, itraconazole, and fluconazole. For amphotericin B, the MIC values of C tropicalis and C glabrata (P = .0521) were higher than those of C albicans (P < .001). Itraconazole was the least effective antifungal; 93.3% of the C glabrata isolates, 3.3% of the C albicans, and 1.3% of the C tropicalis were resistant. All microorganisms were susceptible to caspofungin and amphotericin B. CONCLUSIONS Caspofungin and amphotericin B should be recommended as an effective alternative for the management of oral Candida infections when treatment with topical or other systemic drugs has definitely failed.
Collapse
Affiliation(s)
- Paula Volpato Sanitá
- Postdoctoral Fellow, Department of Dental Materials and Prosthodontics, Araraquara Dental School, Univ Estadual Paulista (UNESP), Araraquara, São Paulo, Brazil
| | | | | | | | | | | |
Collapse
|
32
|
Ma CF, Li FQ, Shi LN, Hu YA, Wang Y, Huang M, Kong QQ. Surveillance study of species distribution, antifungal susceptibility and mortality of nosocomial candidemia in a tertiary care hospital in China. BMC Infect Dis 2013; 13:337. [PMID: 23875950 PMCID: PMC3723814 DOI: 10.1186/1471-2334-13-337] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2013] [Accepted: 07/18/2013] [Indexed: 12/02/2022] Open
Abstract
Background Bloodstream infections due to Candida species cause significant morbidity and mortality, and the epidemiology of Candida infection is changing. Surveillance for candidemia is necessary to detect trends in species distribution and antifungal resistance. Methods The medical and electronic records of all patients who had candidemia at the authors’ hospital from 2009 to 2011 were reviewed for demographic data and clinical information, including the infecting Candida species, resistance to antifungals and survival, and the presence of risk factors associated with candidemia. Results A total of 133 distinct episodes of candidemia were identified over the study period. The annual incidence of candidemia ranged between 0.71 and 0.85 cases/1000 hospital discharges. The most frequent Candida species were C. tropicalis (28.6%), followed by C. albicans (23.3%) and C. parapsilosis (19.5%). The rates of susceptibility to antifungal agents were as followed: voriconazole (97.8%), itraconazole (69.5%), fluconazole (46.1%), ketoconazole (38.9%). Out of 131 evaluable patients, 34 (26.0%) died within 30 days from the onset of candidemia. C. tropicalis candidemia was associated with the highest mortality rate (44.7%). Regarding the crude mortality in the different units, patients in Hemato-Oncology ward had the highest mortality rate (66.7%), followed by patients in cardiovascular wards and ICU (57.1% and 25.6%, respectively). Predictors of 30-day mortality were identified by uni- and multivariate analyses. Complicated abdominal surgery, presence of central venous catheter (CVC), neutropenia, candidemia due to C. tropicalis and poor treatment with fluconazole were significantly associated with the 30-day mortality. Presence of CVC (odds ratio[OR] = 4.177; 95% confidence interval [CI] = 1.698 to 10.278; P = 0.002) was the only independent predictor for mortality in the multivariate analysis. Conclusion This report provides baseline data for future epidemiological and susceptibility studies and for the mortality rates associated with candidemia in our hospital. The knowledge of the local epidemiological trends in Candida species isolated in blood cultures is important to guide therapeutic choices.
Collapse
Affiliation(s)
- Chun-fang Ma
- Laboratory of Molecular Biology, Institute of Medical Laboratory Sciences, Jinling Hospital, School of Medicine, Nanjing University, Nanjing 210002, PR China
| | | | | | | | | | | | | |
Collapse
|
33
|
Silva NC, Nery JM, Dias ALT. Aspartic proteinases of Candida spp.: role in pathogenicity and antifungal resistance. Mycoses 2013; 57:1-11. [PMID: 23735296 DOI: 10.1111/myc.12095] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2013] [Revised: 05/03/2013] [Accepted: 05/08/2013] [Indexed: 12/20/2022]
Abstract
Fungal infections represent a serious health risk as they are particularly prevalent in immunocompromised individuals. Candida spp. pathogenicity depends on several factors and secreted aspartic proteinases (Sap) are considered one of the most critical factors as they are associated with adhesion, invasion and tissue damage. The production of proteinases is encoded by a family of 10 genes known as SAP, which are distributed differently among the species. The expression of these genes may be influenced by environmental conditions, which generally result in a higher fungal invasive potential. Non-pathogenic Candida spp. usually have fewer SAP genes, which are not necessarily expressed in the genome. Exposure to subinhibitory concentrations of antifungal agents promotes the development of resistant strains with an increased expression of SAP genes. In general, Candida spp. isolates that are resistant to antifungals show a higher secretion of Sap than the susceptible isolates. The relationship between Sap secretion and the susceptibility profile of the isolates is of great interest, although the role of SAPs in the development of resistance to antifungal agents remains still unclear. This review is the first one to address these issues.
Collapse
Affiliation(s)
- Naiara C Silva
- Microbiology and Immunology Department, Federal University of Alfenas (UNIFAL-MG), Alfenas, Minas Gerais, Brazil
| | | | | |
Collapse
|
34
|
Brazilian guidelines for the management of candidiasis - a joint meeting report of three medical societies: Sociedade Brasileira de Infectologia, Sociedade Paulista de Infectologia and Sociedade Brasileira de Medicina Tropical. Braz J Infect Dis 2013; 17:283-312. [PMID: 23693017 PMCID: PMC9427385 DOI: 10.1016/j.bjid.2013.02.001] [Citation(s) in RCA: 79] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2013] [Accepted: 02/16/2013] [Indexed: 01/07/2023] Open
Abstract
Candida infections account for 80% of all fungal infections in the hospital environment, including bloodstream, urinary tract and surgical site infections. Bloodstream infections are now a major challenge for tertiary hospitals worldwide due to their high prevalence and mortality rates. The incidence of candidemia in tertiary public hospitals in Brazil is approximately 2.5 cases per 1000 hospital admissions. Due to the importance of this infection, the authors provide a review of the diversity of the genus Candida and its clinical relevance, the therapeutic options and discuss the treatment of major infections caused by Candida. Each topography is discussed with regard to epidemiological, clinical and laboratory diagnostic and therapeutic recommendations based on levels of evidence.
Collapse
|
35
|
Epidemiology of candidemia in Latin America: a laboratory-based survey. PLoS One 2013; 8:e59373. [PMID: 23527176 PMCID: PMC3601956 DOI: 10.1371/journal.pone.0059373] [Citation(s) in RCA: 243] [Impact Index Per Article: 22.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2013] [Accepted: 02/14/2013] [Indexed: 02/01/2023] Open
Abstract
Background The epidemiology of candidemia varies depending on the geographic region. Little is known about the epidemiology of candidemia in Latin America. Methods We conducted a 24-month laboratory-based survey of candidemia in 20 centers of seven Latin American countries. Incidence rates were calculated and the epidemiology of candidemia was characterized. Results Among 672 episodes of candidemia, 297 (44.2%) occurred in children (23.7% younger than 1 year), 36.2% in adults between 19 and 60 years old and 19.6% in elderly patients. The overall incidence was 1.18 cases per 1,000 admissions, and varied across countries, with the highest incidence in Colombia and the lowest in Chile. Candida albicans (37.6%), C. parapsilosis (26.5%) and C. tropicalis (17.6%) were the leading agents, with great variability in species distribution in the different countries. Most isolates were highly susceptible to fluconazole, voriconazole, amphotericin B and anidulafungin. Fluconazole was the most frequent agent used as primary treatment (65.8%), and the overall 30-day survival was 59.3%. Conclusions This first large epidemiologic study of candidemia in Latin America showed a high incidence of candidemia, high percentage of children, typical species distribution, with C. albicans, C. parapsilosis and C. tropicalis accounting for the majority of episodes, and low resistance rates.
Collapse
|
36
|
Magri MMC, Gomes-Gouvêa MS, de Freitas VLT, Motta AL, Moretti ML, Shikanai-Yasuda MA. Multilocus sequence typing of Candida tropicalis shows the presence of different clonal clusters and fluconazole susceptibility profiles in sequential isolates from candidemia patients in Sao Paulo, Brazil. J Clin Microbiol 2013; 51:268-77. [PMID: 23152555 PMCID: PMC3536249 DOI: 10.1128/jcm.02366-12] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2012] [Accepted: 11/05/2012] [Indexed: 11/20/2022] Open
Abstract
The profiles of 61 Candida tropicalis isolates from 43 patients (28 adults and 15 children) diagnosed with candidemia at two teaching hospitals in São Paulo, Brazil, were characterized by multilocus sequence typing (MLST). For the 14 patients who had bloodstream infections, 32 isolates were serially collected from their blood and/or catheters. Thirty-nine diploid sequence types (DSTs) were differentiated. According to the C. tropicalis MLST database (http://pubmlst.org/ctropicalis/), 36 DSTs and 23 genotypes identified from the 61 isolates had not previously been described. This report represents the first study to characterize sequential isolates of C. tropicalis from candidemia cases in South America. Microvariation in a single gene was found in the sequential isolates from 7 patients. The main polymorphisms occurred in the alleles of the XYR1 gene, specifically at nucleotide positions 215, 242, and 344. Macrovariation in six gene fragments was detected in the isolates from 3 patients. eBURST analysis added two new groups to this study (groups 6 and 18). Additionally, susceptibility tests indicate that 3 isolates were resistant to fluconazole. No correlation was found between the DSTs and susceptibility to fluconazole and/or selective antifungal pressure. Two patients were sequentially infected with resistant and susceptible strains. MLST is an important tool for studying the genetic diversity of multiple/sequential isolates of patients with candidemia, allowing the comparison of our data with those from other regions of the world, as well as allowing an analysis of the genetic relationship among several clones in sequential isolates from the same or different candidemia patient sites (blood or catheter).
Collapse
Affiliation(s)
- Marcello Mihailenko Chaves Magri
- Medical Investigation Laboratory of Immunology, Clinics Hospital, Medical School, University of São Paulo (LIM-48), São Paulo, Brazil.
| | | | | | | | | | | |
Collapse
|
37
|
Fernando FDSELD, Ferreira AM, Colombo TE, Rubio FG, Almeida MTGD. Contaminação por fungos antes e após limpeza e desinfecção de colchões hospitalares. ACTA PAUL ENFERM 2013. [DOI: 10.1590/s0103-21002013000500013] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
OBJETIVO: Verificar se existe contaminação por fungos antes e após limpeza e desinfecção terminal de colchões hospitalares utilizados por portadores de candidemia. MÉTODOS: Estudo transversal que investigou 25 colchões de diferentes unidades hospitalares e utilizados por pacientes com candidemia, confirmados por hemocultura. Utilizou-se amostragem por conveniência. Após crescimento em Ágar Sabouraud Dextrose as leveduras isoladas foram identificadas pelas características macroscópicas, microscópicas e fisiológicas. RESULTADOS: Totalizou-se 15 (60%) colchões contaminados com Candida spp. Desse total, 10 (66,7%) e cinco (33,3%) corresponderam respectivamente à coleta antes e após a desinfecção dos colchões, sendo que a espécie mais frequentemente isolada foi Candida parapsilosis. CONCLUSÃO: Considerando que a metade dos colchões permaneceram contaminados após o processo de limpeza e desinfecção, pode-se inferir sobre o risco destes atuarem como reservatórios secundários na cadeia de infecção.
Collapse
|
38
|
Rodrigues GB, Dias-Baruffi M, Holman N, Wainwright M, Braga GUL. In vitro photodynamic inactivation of Candida species and mouse fibroblasts with phenothiazinium photosensitisers and red light. Photodiagnosis Photodyn Ther 2012; 10:141-9. [PMID: 23769280 DOI: 10.1016/j.pdpdt.2012.11.004] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2012] [Revised: 10/24/2012] [Accepted: 11/01/2012] [Indexed: 10/27/2022]
Abstract
In the present study, the in vitro susceptibilities of five Candida spp. to photodynamic antimicrobial chemotherapy (PACT) with four phenothiazinium derivatives, methylene blue (MB), new methylene blue N (NMBN), toluidine blue O (TBO) and the novel pentacyclic phenothiazinium photosensitiser S137, in combination with red light were investigated. The efficacy of each PS was determined, initially, based on its minimal inhibitory concentration (MIC). Additionally, we evaluated the effect of the photodynamic treatment with NMBN and S137 on Candida survival and on the mouse fibroblast cell line L929. MICs varied both among PS and species and decreased with light dose increase. For most treatments (species and fluences) NMBN and S137 showed the lowest MICs. MICs for NMBN and S137 were <2.5 μM for all the Candida species when a fluence of 25 J cm⁻² was used. PACT with NMBN (fluence of 15 J cm⁻²) resulted in reductions in survival from 0.3 log (Candida krusei) to 3 logs (C. parapsilosis). PACT with S137 was more effective than with NMBN. Fluence of 15 J cm⁻² resulted in reductions in survival from 1 log (C. krusei) to 3 logs (C. parapsilosis) and fluence of 25 J cm⁻² resulted in a reduction of approximately 2 logs (C. krusei) and between 3 and 4 logs in survival of the other 4 species of Candida. In vitro relative toxicities of the phenothiazinium PS to mammalian cells exhibited a similar trend to the antifungal data, i.e. greater toxicity and phototoxicity with NMBN and S137 compared to the established PS.
Collapse
Affiliation(s)
- Gabriela B Rodrigues
- Departamento de Análises Clínicas, Toxicológicas e Bromatológicas, Faculdade de Ciências Farmacêuticas de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, Brazil
| | | | | | | | | |
Collapse
|
39
|
Almeida JND, Motta AL, Rossi F, Abdala E, Pierrotti LC, Kono ASG, Diz MDPE, Benard G, Del Negro GMB. First report of a clinical isolate of Candida haemulonii in Brazil. Clinics (Sao Paulo) 2012; 67:1229-31. [PMID: 23070353 PMCID: PMC3460029 DOI: 10.6061/clinics/2012(10)18] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Affiliation(s)
- João Nobrega de Almeida
- Microbiology Section, Divisão de Laboratório Central, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo/SP, Brazil.
| | | | | | | | | | | | | | | | | |
Collapse
|
40
|
Brazilian guidelines for the management of candidiasis: a joint meeting report of three medical societies – Sociedade Brasileira de Infectologia, Sociedade Paulista de Infectologia, Sociedade Brasileira de Medicina Tropical. Braz J Infect Dis 2012. [DOI: 10.1016/s1413-8670(12)70336-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
|
41
|
Minimal inhibitory concentration (MIC) of caspofungin and itraconazole inhibiting growth of Candida strains calculated from the linear regression equation. Adv Med Sci 2012; 57:148-51. [PMID: 22543256 DOI: 10.2478/v10039-012-0022-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
PURPOSE The aim of the study was to compare the susceptibility of Candida species to caspofungin and itraconazole. MATERIAL AND METHODS 118 strains of Candida species were used in the study: 8 pattern strains and 110 strains isolated from different ontocenoses. The susceptibility of fungi strains to drugs was determined by diffusion in agar gel. The minimal inhibitory concentration (MIC) was calculated from the linear regression equation with the use of the method by Kadłubowski. RESULTS The MIC value for caspofungin for the pattern strains ranged from 0.321 mg/L to 0.552 mg/L and for itraconazole from 0.019 mg/L to 0.11 mg/L. All the analyzed strains isolated from patients exhibited susceptibility to caspofungin; 5 strains of Candida albicans (8.06%) proved to be resistant to itraconazole. The MIC values for caspofungin ranged from 0.114 mg/L to 1.26 mg/L and for itraconazole from 0.012 mg/L to 16.1 mg/L. CONCLUSIONS 1. All the studied pattern strains are susceptible to the examined drugs; all those isolated from patients show susceptibility to caspofungin; some Candida albicans strains (8.06%) are resistant to itraconazole. 2. The mean MIC values calculated from the activity curves are 0.426 mg/L for caspofungin and 1.0245 mg/L for itraconazole. 3. The mean MIC values calculated for caspofungin are lower than for itraconazole in the case of Candida albicans, C. glabrata and C. tropicalis. Having compared the influence of the drugs on C. famata, C. lusitaniae, C. parapsilosis and C. ciferri we proved there are statistically significant differences (0.0046>p<0.044).
Collapse
|