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Wasfi R, Elkhatib WF, Ashour HM. Molecular typing and virulence analysis of multidrug resistant Klebsiella pneumoniae clinical isolates recovered from Egyptian hospitals. Sci Rep 2016; 6:38929. [PMID: 28004732 PMCID: PMC5177892 DOI: 10.1038/srep38929] [Citation(s) in RCA: 76] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2016] [Accepted: 11/15/2016] [Indexed: 01/30/2023] Open
Abstract
Klebsiella pneumonia infection rates have increased dramatically. Molecular typing and virulence analysis are powerful tools that can shed light on Klebsiella pneumonia infections. Whereas 77.7% (28/36) of clinical isolates indicated multidrug resistant (MDR) patterns, 50% (18/36) indicated carpabenem resistance. Gene prevalence for the AcrAB efflux pump (82.14%) was more than that of the mdtK efflux pump (32.14%) in the MDR isolates. FimH-1 and mrkD genes were prevalent in wound and blood isolates. FimH-1 gene was prevalent in sputum while mrkD gene was prevalent in urine. Serum resistance associated with outer membrane protein coding gene (traT) was found in all blood isolates. IucC, entB, and Irp-1 were detected in 32.14%, 78.5% and 10.7% of MDR isolates, respectively. We used two Polymerase Chain Reaction (PCR) analyses: Enterobacterial Repetitive Intergenic Consensus (ERIC) and Random Amplified Polymorphic DNA (RAPD). ERIC-PCR revealed 21 and RAPD-PCR revealed 18 distinct patterns of isolates with similarity ≥80%. ERIC genotyping significantly correlated with resistance patterns and virulence determinants. RAPD genotyping significantly correlated with resistance patterns but not with virulence determinants. Both RAPD and ERIC genotyping methods had no correlation with the capsule types. These findings can help up better predict MDR Klebsiella pneumoniae outbreaks associated with specific genotyping patterns.
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Affiliation(s)
- Reham Wasfi
- Department of Microbiology & Immunology, Faculty of Pharmacy, October University for Modern Sciences and Arts, Giza, Egypt
| | - Walid F. Elkhatib
- Department of Microbiology & Immunology, Faculty of Pharmacy, Ain Shams University, Cairo, Egypt
- Department of Pharmacy Practice, School of Pharmacy, Chapman University, Orange, California, USA
| | - Hossam M. Ashour
- Department of Biological Sciences, College of Arts and Sciences, University of South Florida St. Petersburg, St. Petersburg, Florida, USA
- Department of Microbiology and Immunology, Faculty of Pharmacy, Cairo University, Cairo, Egypt
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Guinea J. Global trends in the distribution of Candida species causing candidemia. Clin Microbiol Infect 2014; 20 Suppl 6:5-10. [PMID: 24506442 DOI: 10.1111/1469-0691.12539] [Citation(s) in RCA: 421] [Impact Index Per Article: 42.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Only five species account for 92% of cases of candidemia (Candida albicans, C. glabrata, C. tropicalis, C. parapsilosis, and C. krusei); however, their distribution varies in population-based studies conducted in different geographical areas. C. albicans is the most frequent species, but considerable differences are found between the number of cases caused by C. glabrata and C. parapsilosis. Studies from Northern Europe and the USA reported a high number of cases caused by C. glabrata, whereas studies from Spain and Brazil demonstrated a lower number of cases caused by C. glabrata and a higher number of cases attributed to C. parapsilosis. Globally, the frequency of C. albicans is decreasing, while that of C. glabrata and C. krusei is stable, and C. parapsilosis and C. tropicalis are increasing. Patient characteristics and prior antifungal therapy also have a considerable influence on the distribution and frequency of Candida spp., regardless of the geographical area. C. albicans is more frequent in patients aged up to 18 years, the frequency of C. parapsilosis decreases with age, and C. glabrata is more common in the elderly. Finally, the presence of horizontal transmission of Candida spp. isolates (reported mainly in patients from the adult medical and post-surgical ICU, patients from oncology-haematology units, and neonates) can affect species distribution.
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Affiliation(s)
- J Guinea
- Clinical Microbiology and Infectious Diseases Department, Hospital General Universitario Gregorio Marañón, Universidad Complutense de Madrid, Madrid, Spain; Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain; CIBER de Enfermedades Respiratorias (CIBER RES CB06/06/0058), Madrid, Spain; Medicine Department, School of Medicine, Universidad Complutense de Madrid, Madrid, Spain
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Hammarskjöld F, Mernelius S, Andersson RE, Berg S, Hanberger H, Löfgren S, Malmvall BE, Petzold M, Matussek A. Possible transmission of Candida albicans on an intensive care unit: genotype and temporal cluster analyses. J Hosp Infect 2013; 85:60-5. [PMID: 23927923 DOI: 10.1016/j.jhin.2013.06.002] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2012] [Accepted: 06/03/2013] [Indexed: 11/18/2022]
Abstract
BACKGROUND Nosocomial transmission of Candida spp. has not been fully explored and previous studies have shown conflicting results. AIM To evaluate the possible nosocomial transmission of Candida spp. on an intensive care unit (ICU). METHODS A prospective study was conducted for a period of 19 months, including all patients on our ICU with growth of Candida spp. from surveillance and directed cultures. Molecular typing with repetitive sequence-based polymerase chain reaction was used to define genotype relationships between the Candida albicans and Candida glabrata isolates. Candida isolates obtained from blood cultures taken from patients in our county outside the ICU were used as a reference. Temporal cluster analysis was performed to evaluate genotype distribution over time. FINDINGS Seventy-seven patients with 78 ICU stays, representing 12% of all ICU stays, were found to harbour 180 isolates of Candida spp. Molecular typing revealed 27 C. albicans genotypes and 10 of C. glabrata. Possible clustering, indicated by overlapping stays of patients with indistinguishable candida genotypes, was observed on seven occasions with C. albicans and on two occasions with C. glabrata. Two C. albicans genotypes were found significantly more often in the ICU group compared with the reference group. Moreover, C. albicans genotypes isolated from more than one patient were significantly more often found in the ICU group. Temporal cluster analysis revealed a significantly increased number of pairs with indistinguishable genotypes at a 21-day interval, indicating clustering. CONCLUSION This study indicates possible transmission of C. albicans between ICU patients based on genotyping and temporal cluster analysis.
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Affiliation(s)
- F Hammarskjöld
- Department of Anaesthesia and Intensive Care, Ryhov County Hospital, Jönköping, Sweden.
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Mikulska M, Calandra T, Sanguinetti M, Poulain D, Viscoli C. The use of mannan antigen and anti-mannan antibodies in the diagnosis of invasive candidiasis: recommendations from the Third European Conference on Infections in Leukemia. CRITICAL CARE : THE OFFICIAL JOURNAL OF THE CRITICAL CARE FORUM 2010; 14:R222. [PMID: 21143834 PMCID: PMC3219989 DOI: 10.1186/cc9365] [Citation(s) in RCA: 216] [Impact Index Per Article: 15.4] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/17/2010] [Revised: 11/02/2010] [Accepted: 12/08/2010] [Indexed: 12/16/2022]
Abstract
Introduction Timely diagnosis of invasive candidiasis (IC) remains difficult as the clinical presentation is not specific and blood cultures lack sensitivity and need a long incubation time. Thus, non-culture-based methods for diagnosing IC have been developed. Mannan antigen (Mn) and anti-mannan antibodies (A-Mn) are present in patients with IC. On behalf of the Third European Conference on Infections in Leukemia, the performance of these tests was analysed and reviewed. Methods The literature was searched for studies using the commercially available sandwich enzyme-linked immunosorbent assays (Platelia™, Bio-Rad Laboratories, Marnes-la-Coquette, France) for detecting Mn and A-Mn in serum. The target condition of this review was IC defined according to 2008 European Organization for Research and Treatment of Cancer/Mycoses Study Group criteria. Sensitivity, specificity and diagnostic odds ratios (DOR) were calculated for Mn, A-Mn and combined Mn/A-Mn testing. Results Overall, 14 studies that comprised 453 patients and 767 controls were reviewed. The patient populations included in the studies were mainly haematological and cancer cases in seven studies and mainly intensive care unit and surgery cases in the other seven studies. All studies but one were retrospective in design. Mn sensitivity was 58% (95% confidence interval [CI], 53-62); specificity, 93% (95% CI, 91-94) and DOR, 18 (95% CI 12-28). A-Mn sensitivity was 59% (95% CI, 54-65); specificity, 83% (95% CI, 79-97) and DOR, 12 (95% CI 7-21). Combined Mn/A-Mn sensitivity was 83% (95% CI, 79-87); specificity, 86% (95% CI, 82-90) and DOR, 58 (95% CI 27-122). Significant heterogeneity of the studies was detected. The sensitivity of both Mn and A-Mn varied for different Candida species, and it was the highest for C. albicans, followed by C. glabrata and C. tropicalis. In 73% of 45 patients with candidemia, at least one of the serological tests was positive before the culture results, with mean time advantage being 6 days for Mn and 7 days for A-Mn. In 21 patients with hepatosplenic IC, 18 (86%) had Mn or A-Mn positive test results at a median of 16 days before radiological detection of liver or spleen lesions. Conclusions Mn and A-Mn are useful for diagnosis of IC. The performance of combined Mn/A-Mn testing is superior to either Mn or A-Mn testing.
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Affiliation(s)
- Malgorzata Mikulska
- Division of Infectious Diseases, San Martino University Hospital, L,go R, Benzi, 10, Genoa, Italy.
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Essendoubi M, Toubas D, Lepouse C, Leon A, Bourgeade F, Pinon JM, Manfait M, Sockalingum GD. Epidemiological investigation and typing of Candida glabrata clinical isolates by FTIR spectroscopy. J Microbiol Methods 2007; 71:325-31. [DOI: 10.1016/j.mimet.2007.09.018] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2007] [Revised: 09/07/2007] [Accepted: 09/28/2007] [Indexed: 10/22/2022]
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Fanello S, Bouchara JP, Sauteron M, Delbos V, Parot E, Marot-Leblond A, Moalic E, Flohicc AML, Brangerd B. Predictive value of oral colonization by Candida yeasts for the onset of a nosocomial infection in elderly hospitalized patients. J Med Microbiol 2006; 55:223-228. [PMID: 16434716 DOI: 10.1099/jmm.0.46155-0] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
The incidence of nosocomial yeast infections has increased markedly in recent decades, especially among the elderly. The present study was therefore initiated not only to determine the predictive value of oral colonization by yeasts for the onset of a nosocomial Candida infection in elderly hospitalized patients (>65 years), but also to clarify the factors that promote infection and to establish a relationship between the intensity of oral carriage and the onset of yeast infection. During this prospective cohort study, 256 patients (156 women and 100 men with a mean age of 83±8 years) were surveyed for yeast colonization or infection. Samples were collected every 4 days from day 0 to day 16 from four sites in the mouth, and intrinsic and extrinsic factors that might promote infection were recorded for each patient. Pulsed field gel electrophoresis was performed on Candida albicans isolates from all infected patients. Poor nutritional status was observed in 81 % of the patients and hyposalivation in 41 %. The colonization level was 67 % on day 0 (59 % C. albicans) and a heavy carriage of yeasts (>50 c.f.u.) was observed for 51 % of the patients. The incidence of nosocomial colonization reached 6·9 % on day 4 (6·1 % on day 8 and 2·7 % on day 12), and that of nosocomial infection was 3·7 % on day 4 (6·8 % on day 8, 11·3 % on day 12 and 19·2 % on day 16). Of the 35 patients infected, 57 % were suffering from oral candidiasis. The principal risk factors for colonization were a dental prosthesis, poor oral hygiene and the use of antibiotics. The risk factors for infection, in addition to those already mentioned for colonization, were endocrine disease, poor nutritional status, prolonged hospitalization and high colony counts. Genotyping revealed person-to-person transmission in two patients. Thus, this study demonstrates a significant association between oral colonization and the onset of yeast infections in elderly hospitalized patients. Therefore, oral samples should be collected at admission and antifungal treatment should be administered in cases of colonization, especially in patients presenting a heavy carriage of yeasts. Genotyping of the strains confirmed the possibility of person-to-person transmission.
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Affiliation(s)
- S Fanello
- Department of Public Health, Faculty of Medicine, 49045 Angers Cedex 01, France
| | - J P Bouchara
- Host-parasite Interactions Study Group (UPRES-EA 3142), Laboratory of Parasitology and Mycology, Angers University Hospital, 49933 Angers Cedex 9, France
| | - M Sauteron
- Department of Public Health, Faculty of Medicine, 49045 Angers Cedex 01, France
| | - V Delbos
- Department of Public Health, Faculty of Medicine, 49045 Angers Cedex 01, France
| | - E Parot
- Department of Public Health, Faculty of Medicine, 49045 Angers Cedex 01, France
| | - A Marot-Leblond
- Host-parasite Interactions Study Group (UPRES-EA 3142), Laboratory of Parasitology and Mycology, Angers University Hospital, 49933 Angers Cedex 9, France
| | - E Moalic
- Department of Microbiology, Morvan University Hospital, 29609 Brest Cedex, France
| | - A M Le Flohicc
- Department of Microbiology, Morvan University Hospital, 29609 Brest Cedex, France
| | - B Brangerd
- CCLIN OUEST, Pontchaillou University Hospital, 35033 Rennes Cedex, France
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Cliff PR, Sandoe JA, Heritage J, Barton RC. Retrospective survey of candidaemia in hospitalized patients and molecular investigation of a suspected outbreak. J Med Microbiol 2005; 54:391-394. [PMID: 15770026 DOI: 10.1099/jmm.0.45895-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Episodes of candida infection at a teaching hospital were investigated. During a 3-year period from 1998 to 2000, there were 53 cases of candidaemia. Candida albicans (64.2 %) was the most common causative species, followed by Candida glabrata (17.0 %) and Candida parapsilosis (15.1 %). Molecular analysis of a cluster of eight infections from a single unit was performed using Southern blotting with Ca3 probe hybridization. This showed that the patients were each infected by unrelated strains of C. albicans. On occasion, isolates were found to be closely related within individual patients. Following Southern blot analysis, it was concluded that the infections were not part of an outbreak caused by a single, epidemic strain.
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Affiliation(s)
- Penelope R Cliff
- Mycology Reference Centre1 and Department of Microbiology3, The General Infirmary at Leeds, Leeds LS1 3EX, UK 2School of Biochemistry and Microbiology, University of Leeds, Leeds LS2 9JT, UK
| | - Jonathan At Sandoe
- Mycology Reference Centre1 and Department of Microbiology3, The General Infirmary at Leeds, Leeds LS1 3EX, UK 2School of Biochemistry and Microbiology, University of Leeds, Leeds LS2 9JT, UK
| | - John Heritage
- Mycology Reference Centre1 and Department of Microbiology3, The General Infirmary at Leeds, Leeds LS1 3EX, UK 2School of Biochemistry and Microbiology, University of Leeds, Leeds LS2 9JT, UK
| | - Richard C Barton
- Mycology Reference Centre1 and Department of Microbiology3, The General Infirmary at Leeds, Leeds LS1 3EX, UK 2School of Biochemistry and Microbiology, University of Leeds, Leeds LS2 9JT, UK
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Posteraro B, Bruno S, Boccia S, Ruggiero A, Sanguinetti M, Romano Spica V, Ricciardi G, Fadda G. Candida parapsilosis bloodstream infection in pediatric oncology patients: results of an epidemiologic investigation. Infect Control Hosp Epidemiol 2004; 25:641-5. [PMID: 15357154 DOI: 10.1086/502454] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
OBJECTIVE To investigate an outbreak of Candida parapsilosis bloodstream infections (BSIs) involving three patients admitted to a pediatric oncology unit between April and June 2002. METHODS After the third case was documented, cultures were performed of the hands of all medical and paramedical staff members in the pediatric oncology unit and of environmental surfaces in the rooms occupied by the three patients. Electrophoretic karyotyping with pulsed-field gel electrophoresis and arbitrarily primed polymerase chain reaction were used to assess the genetic relatedness among C. parapsilosis isolates. RESULTS The three cases of C. parapsilosis BSI were diagnosed based on blood cultures performed during a 38-day period. Evidence of prior C parapsilosis colonization of the gastrointestinal tract was present in only the first case. Each patient had an indwelling central venous catheter (CVC), which was promptly removed, and semiquantitative catheter tip cultures also revealed C. parapsilosis. None of the 30 environmental cultures performed was positive for C. parapsilosis, but the fungus was isolated from the hands of 6 of the 20 nurses tested. Both molecular typing methods revealed identical DNA fingerprinting patterns for all 13 patient isolates (7 from blood, 3 from CVC tips, and 3 from the gastrointestinal tract) and for 5 of the 6 recovered from the nurses' hands. CONCLUSIONS These findings suggest the possibility of cross-infection with a single C. parapsilosis strain that was transmitted (probably during CVC dressing changes) by nurses whose hands were colonized with it. The role of previous gastrointestinal colonization in the first case cannot be excluded.
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Lephart P, Ferrieri P, van Burik JA. Reservoir ofCandidaalbicansinfection in a vascular bypass graft demonstrates a stable karyotype over six months. Med Mycol 2004; 42:255-60. [PMID: 15283240 DOI: 10.1080/13693780310001644662] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
Abstract
We retrospectively analyzed five Candida albicans isolates from two infection episodes in a single patient 6 months apart. Using contour-clamped homogeneous field electrophoresis (CHEF), random amplified polymorphic DNA (RAPD) fingerprinting, and restriction fragment length polymorphism (RFLP) complex probe 27A as means of molecular typing, we demonstrate an unvarying genotype amongst the infection-causing C. albicans strains. Several months later, the patient yielded C. glabrata in a yeast survey of oral and rectal sites. The preponderance of C. glabrata and lack of C. albicans isolated from normal flora sites suggests that this patient harbored the prior C. albicans bloodstream isolate on a Gore-Tex graft for 6 months prior to the second episode of fungemia.
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Affiliation(s)
- Paul Lephart
- Department of Medicine, University of Minnesota, Minneapolis, Minnesota, USA
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Current awareness on yeast. Yeast 2002; 19:1183-90. [PMID: 12371408 DOI: 10.1002/yea.828] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
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