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Soulountsi V, Schizodimos T, Kotoulas SC. Deciphering the epidemiology of invasive candidiasis in the intensive care unit: is it possible? Infection 2021; 49:1107-1131. [PMID: 34132989 DOI: 10.1007/s15010-021-01640-7] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2021] [Accepted: 06/08/2021] [Indexed: 12/12/2022]
Abstract
Invasive candidiasis (IC) has emerged in the last decades as an important cause of morbidity, mortality, and economic load in the intensive care unit (ICU). The epidemiology of IC is still a difficult and unsolved enigma for the literature. Accurate estimation of the true burden of IC is difficult due to variation in definitions and limitations inherent to available case-finding methodologies. Candidemia and intra-abdominal candidiasis (IAC) are the two predominant types of IC in ICU. During the last two decades, an increase in the incidence of candidemia has been constantly reported particularly in the expanding populations of elderly or immunosuppressed patents, with a parallel change in Candida species (spp.) distribution worldwide. Epidemiological shift in non-albicans spp. has reached worrisome trends. Recently, a novel, multidrug-resistant Candida spp., Candida auris, has globally emerged as a nosocomial pathogen causing a broad range of healthcare-associated invasive infections. Epidemiological profile of IAC remains imprecise. Though antifungal drugs are available for Candida infections, mortality rates continue to be high, estimated to be up to 50%. Increased use of fluconazole and echinocandins has been associated with the emergence of resistance to these drugs, which affects particularly C. albicans and C. glabrata. Crucial priorities for clinicians are to recognize the epidemiological trends of IC as well as the emergence of resistance to antifungal agents to improve diagnostic techniques and strategies, develop international surveillance networks and antifungal stewardship programmes for a better epidemiological control of IC.
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Affiliation(s)
- Vasiliki Soulountsi
- Department of Intensive Care Medicine, George Papanikolaou General Hospital, Thessaloniki, Greece.
| | - Theodoros Schizodimos
- Department of Intensive Care Medicine, George Papanikolaou General Hospital, Thessaloniki, Greece
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Morbidity and mortality of candidaemia in Europe: an epidemiologic meta-analysis. Clin Microbiol Infect 2019; 25:1200-1212. [DOI: 10.1016/j.cmi.2019.04.024] [Citation(s) in RCA: 101] [Impact Index Per Article: 20.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2019] [Revised: 04/15/2019] [Accepted: 04/18/2019] [Indexed: 01/30/2023]
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Ala-Houhala M, Valkonen M, Kolho E, Friberg N, Anttila VJ. Clinical and microbiological factors associated with mortality in candidemia in adult patients 2007–2016. Infect Dis (Lond) 2019; 51:824-830. [DOI: 10.1080/23744235.2019.1662941] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Affiliation(s)
- Mari Ala-Houhala
- Department of Infectious Diseases, Inflammation Center, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Miia Valkonen
- Intensive Care Medicine, Department of Perioperative, Intensive Care and Pain Medicine University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Elina Kolho
- Department of Infectious Diseases, Inflammation Center, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Nathalie Friberg
- Department of Clinical Microbiology, University of Helsinki and Helsinki University Hospital, HUSLAB, Helsinki, Finland
| | - Veli-Jukka Anttila
- Department of Infectious Diseases, Inflammation Center, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
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Liao Y, Lu X, Yang S, Luo Y, Chen Q, Yang R. Epidemiology and Outcome of Trichosporon Fungemia: A Review of 185 Reported Cases From 1975 to 2014. Open Forum Infect Dis 2015; 2:ofv141. [PMID: 26566536 PMCID: PMC4630454 DOI: 10.1093/ofid/ofv141] [Citation(s) in RCA: 61] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2015] [Accepted: 09/16/2015] [Indexed: 12/20/2022] Open
Abstract
We first reviewed the English-language literature for reported cases of Trichosporon fungemia over the past four decades, and did comprehensive analysis in order to guide our understanding of epidemiology and outcome-related aspects, especially the antifungal treatment and CVC management. Background. Trichosporon species have emerged as an important non-Candida spp yeast pathogen in immunocompromised patients in recent decades; however, the systemic analysis of Trichosporon epidemiology has seldom been reported. Methods. We reviewed 185 reported cases of Trichosporon fungemia from 1975 to 2014 in the English-language literature, and the epidemiology and prognostic factors of the included cases are described. Results. The number of cases reported has increased with time, especially over the past decade. During the 3 decades from 1975 to 2004, the most commonly used antifungal compounds were amphotericin B/liposomal amphotericin B; however, in recent decades (2005–2014), triazoles (especially voriconazole) have become the most widely used agents, significantly improving outcome in the reported cases. Correlation analysis revealed that negative outcome is associated with several prognostic factors, including a history of antimicrobial use, bacterial bloodstream coinfection, prophylactic/empirical antifungal therapy, Trichosporon beigelii infection, and receiving the antifungal regimen of amphotericin B/liposomal amphotericin B. In addition, a significantly greater proportion of patients with a positive outcome had fungemia without invasive tissue infection and received a voriconazole regimen or an AmB-triazole combined regimen. Significant positive outcome was also associated with patients who had recovered from neutropenia or after central venous catheter removal. Conclusions. Voriconazole can be recommended as a first-line antifungal compound to treat Trichosporon fungemia; the immune status of the host plays a crucial role in the outcome of this infection, and the removal of vascular catheters should be considered if feasible.
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Affiliation(s)
- Yong Liao
- Department of Dermatology , General Hospital of Beijing Military Command ; The Clinical Medical College in the Beijing Military Region of Second Military Medical University of People's Liberation Army
| | - Xuelian Lu
- Department of Dermatology , General Hospital of Beijing Military Command
| | - Suteng Yang
- Department of Dermatology , General Hospital of Beijing Military Command ; The Clinical Medical College in the Beijing Military Region of Second Military Medical University of People's Liberation Army
| | - Yi Luo
- Medical Clinic, General Political Department of People's Liberation Army, Beijing
| | - Qi Chen
- Department of Statistics , Second Military Medical University , Shanghai , China
| | - Rongya Yang
- Department of Dermatology , General Hospital of Beijing Military Command
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Dewan E, Biswas D, Kakati B, Verma SK, Kotwal A, Oberoi A. Epidemiological and mycological characteristics of candidemia in patients with hematological malignancies attending a tertiary-care center in India. Hematol Oncol Stem Cell Ther 2015; 8:99-105. [PMID: 26173033 DOI: 10.1016/j.hemonc.2015.06.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2014] [Revised: 05/21/2015] [Accepted: 06/01/2015] [Indexed: 10/23/2022] Open
Abstract
BACKGROUND AND OBJECTIVES We undertook the present study to ascertain the contributing risk factors and explore the epidemiological and mycological characteristics of opportunistic candidemia among patients with hematological malignancies. DESIGN AND SETTINGS Observational cross-sectional study in a tertiary care center. PATIENTS AND METHODS Consecutive patients with hematological malignancies reporting to the collaborating medical and pediatric units with a febrile episode were recruited and screened for candidemia by blood culture. Recovered Candida isolates were speciated and antifungal susceptibility testing was performed as per Clinical and Laboratory Standards Institute guideline (CLSI) guidelines M44-A. Further analysis was done for potential risk factors and compared between culture positive and negative patients. RESULTS Of 150 patients recruited, the majority (n=27) were between 51 and 60 years and the male to female ratio was 1.63:1. Fifteen patients (10%) were culture positive. The culture positivity was significantly higher in acute lymphocytic leukemia (ALL) than in non-ALL patients (p=0.03). There was significant association of candidaemia with leucopenia, chemotherapeutic drugs, corticosteroids and presence of indwelling devices. Duration of disease (p=0.032) and duration of hospitalization (p=0.003) were significantly prolonged in culture positive patients. C. tropicalis was the commonest isolate (46.67%), with non- Candida albicans outnumbering C. albicans in all categories of hematological malignancies (2.75:1). All isolates of C. albicans were uniformly sensitive to all the azoles, but only 50% were sensitive to amphotericin B and none to nystatin and flucytosine. CONCLUSIONS This observational study identifies ALL and chronic lymphocytic leukemia (CLL) as the forms of hematological malignancy predominantly associated with candidemia; specifies risk factors and chemotherapeutic agents predisposing patients towards its occurrence; reports a preponderance of C. tropicalis among the causative agents and finds voriconazole to be the most effective antifungal agent against the recovered isolates. This information could assist in tailoring prophylactic and therapeutic antifungal practices for this infection, according to local epidemiological and mycological characteristics.
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Affiliation(s)
- Eshani Dewan
- Department of Microbiology, Himalayan Institute of Medical Sciences, Dehradun, Uttarakhand, India; Department of Microbiology, Christian Medical College and Hospital, Ludhiana, Punjab, India.
| | - Debasis Biswas
- Department of Microbiology, Himalayan Institute of Medical Sciences, Dehradun, Uttarakhand, India; Department of Microbiology, All India Institute of Medical Sciences, Bhopal, Madhya Pradesh, India
| | - Barnali Kakati
- Department of Microbiology, Himalayan Institute of Medical Sciences, Dehradun, Uttarakhand, India
| | - S K Verma
- Department of Medicine, Himalayan Institute of Medical Sciences, Dehradun, Uttarakhand, India
| | - Aarti Kotwal
- Department of Microbiology, Himalayan Institute of Medical Sciences, Dehradun, Uttarakhand, India
| | - Aroma Oberoi
- Department of Microbiology, Christian Medical College and Hospital, Ludhiana, Punjab, India
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Antibiotic overuse as a risk factor for candidemia in an Indian pediatric ICU. Indian J Pediatr 2015; 82:530-6. [PMID: 25429999 DOI: 10.1007/s12098-014-1631-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2014] [Accepted: 11/03/2014] [Indexed: 10/24/2022]
Abstract
OBJECTIVE To identify risk factors and mycological characteristics of candidemia in Pediatric ICU of a tertiary-care hospital. METHODS Patients were screened for candidemia by blood culture. Recovered isolates were speciated and subjected to antifungal susceptibility testing. For every candidemic patient, three controls were matched for age, underlying diagnosis and period of hospitalization. Premature neonates were also matched for birth-weight. Proportion of cases and controls on specific antibiotics or indwelling devices was compared using Chi-square test, while unpaired t-test was used for comparing the number of antibiotics used and the number of days of antibiotic administration. Concordance between susceptibility testing methods was evaluated using Chi-square test. RESULTS Significantly wider spectrum of antibiotic coverage was observed among the 28 candidemic patients. While every patient received antibiotic against enteric gram-negative bacilli, antibiotic usage for additional groups of microorganisms was significantly higher among cases. Association of candidemia with increasing use of indwelling devices was also observed. Endogenous colonization was higher in candidemic infants. Candida albicans was the commonest species (n = 18), followed by C. tropicalis (n = 7). Fluconazole and ketoconazole resistance was observed in 10.7 % cases. CONCLUSIONS This information on pediatric candidemia could be used to devise locally-tailored strategies for identifying at-risk patients, underline the importance of routine antifungal susceptibility testing and formulate appropriate guidelines for management.
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Seddiki S, Boucherit-Otmani Z, Boucherit K, Kunkel D. Infectivités fongiques des cathéters implantés dues à Candida sp. Formation des biofilms et résistance. J Mycol Med 2015; 25:130-5. [DOI: 10.1016/j.mycmed.2015.03.003] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2014] [Revised: 03/01/2015] [Accepted: 03/02/2015] [Indexed: 01/12/2023]
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Drgona L, Khachatryan A, Stephens J, Charbonneau C, Kantecki M, Haider S, Barnes R. Clinical and economic burden of invasive fungal diseases in Europe: focus on pre-emptive and empirical treatment of Aspergillus and Candida species. Eur J Clin Microbiol Infect Dis 2014; 33:7-21. [PMID: 24026863 PMCID: PMC3892112 DOI: 10.1007/s10096-013-1944-3] [Citation(s) in RCA: 66] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2013] [Accepted: 07/29/2013] [Indexed: 11/23/2022]
Abstract
Invasive fungal diseases (IFDs) have been widely studied in recent years, largely because of the increasing population at risk. Aspergillus and Candida species remain the most common causes of IFDs, but other fungi are emerging. The early and accurate diagnosis of IFD is critical to outcome and the optimisation of treatment. Rapid diagnostic methods and new antifungal therapies have advanced disease management in recent years. Strategies for the prevention and treatment of IFDs include prophylaxis, and empirical and pre-emptive therapy. Here, we review the available primary literature on the clinical and economic burden of IFDs in Europe from 2000 to early 2011, with a focus on the value and outcomes of different approaches.
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Affiliation(s)
- L. Drgona
- Department of Haematology/Oncology, National Cancer Institute and Comenius University, Bratislava, Slovakia
| | - A. Khachatryan
- Pharmerit International, 4350 East West Highway, Suite 430, Bethesda, MD 20814 USA
| | - J. Stephens
- Pharmerit International, 4350 East West Highway, Suite 430, Bethesda, MD 20814 USA
| | - C. Charbonneau
- Pfizer Global Outcomes Research, Pfizer Inc., New York, NY USA
| | - M. Kantecki
- Pfizer International Operations, Pfizer Inc., Paris, France
| | - S. Haider
- Pfizer Global Research and Development, Pfizer Inc., Groton, CT USA
| | - R. Barnes
- Cardiff University School of Medicine, Cardiff, UK
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Arendrup M, Dzajic E, Jensen R, Johansen H, Kjaldgaard P, Knudsen J, Kristensen L, Leitz C, Lemming L, Nielsen L, Olesen B, Rosenvinge F, Røder B, Schønheyder H. Epidemiological changes with potential implication for antifungal prescription recommendations for fungaemia: data from a nationwide fungaemia surveillance programme. Clin Microbiol Infect 2013; 19:E343-53. [DOI: 10.1111/1469-0691.12212] [Citation(s) in RCA: 157] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2012] [Revised: 01/24/2013] [Accepted: 02/24/2013] [Indexed: 01/18/2023]
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Dóczi I, Pető Z, Fodor E, Bereczki L, Nagy E, Hajdú E. Evaluation of fungaemia infections in a Hungarian university hospital between 1996 and 2009. Acta Microbiol Immunol Hung 2012; 59:29-41. [PMID: 22510285 DOI: 10.1556/amicr.59.2012.1.4] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
The incidence of Candida species causing bloodstream infections in the University Hospital of Szeged, Hungary, between 1996 and 2009, and the susceptibilities of these isolates to antifungal agents were evaluated.Automated blood culture systems (Vital, bioMérieux, Marcy-l'Etoile, France; and BACTEC 9120, Becton-Dickinson Diagnostic Systems, Sparks, USA) were used. The in vitro susceptibilities of the yeast isolates to antifungal agents were determined by the Etest method (AB Biodisk, Solna, Sweden).Bloodstream infections were caused by yeast strains in 231 cases during this period, and 226 Candida strains were cultured from 216 candidaemia patients. Bloodstream infections caused by multiple Candida spp. were diagnosed almost every year. Of the 216 patients, 67 were children; and 55 infants needed intensive care. In 2005, C. glabrata caused an increase in the incidence of invasive fungal infections in the Neonatal Intensive Care Unit. The PFGE analysis of 12 isolates distinguished 4 different karyotypes. The incidence of bloodstream infections caused by fungi did not change during the 14-year study period. The most frequent species cultured from blood samples were C. albicans and C. glabrata. The incidence of resistant isolates remained constant. The local trends of fungaemia must be monitored and compared with global reports.
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Affiliation(s)
- Ilona Dóczi
- 1 University of Szeged Institute of Clinical Microbiology Szeged Hungary
| | - Zoltán Pető
- 2 University of Szeged Institute of Anaesthesiology and Intensive Care Szeged Hungary
| | - Eleonóra Fodor
- 1 University of Szeged Institute of Clinical Microbiology Szeged Hungary
| | - László Bereczki
- 1 University of Szeged Institute of Clinical Microbiology Szeged Hungary
| | - Elisabeth Nagy
- 1 University of Szeged Institute of Clinical Microbiology Szeged Hungary
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Kotwal A, Biswas D, Sharma JP, Gupta A, Jindal P. An observational study on the epidemiological and mycological profile of Candidemia in ICU patients. Med Sci Monit 2012; 17:CR663-668. [PMID: 22037747 PMCID: PMC3539502 DOI: 10.12659/msm.882053] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Background This study aimed to analyze the epidemiological and mycological profile of candidemia in intensive care unit (ICU) patients attending a tertiary care teaching hospital in the Himalayan region of northern India. Material/Methods A 15-bed medico-surgical ICU and a 5-bed pediatric ICU. Ninety-one consecutively admitted ICU patients were screened for the presence of candidemia by performing blood cultures at periodic intervals. Results The recovered Candida isolates were speciated and subjected to antifungal susceptibility testing using standard procedures. Forty-one of the recruited patients (45%) were found to be candidemic, with the majority of patients being in the extremes of age (13 neonates and 15 >65 years of age). Four risk factors were found to be significantly associated with the occurrence of candidemia in our patients – a period of hospitalization exceeding 7 days (p=0.0008), previous use of antibiotics (p=0.001), presence of chronic renal failure (p=0.003), and ongoing cancer chemotherapy (p= 0.041). Ninety-six Candida isolates were recovered from the 41 culture-positive patients, with Candida albicans being the commonest isolate recovered (n=75, 78.1%), followed by Candida tropicalis (n=15, 16%), and Candida glabrata (n=6, 6.5%). Fluconazole resistance was observed among 26% of all Candida isolates and 17.3% of C. albicans isolates. Conclusions Contrary to the majority of recent reports, species shift towards non-albicans candidemia has not been observed in our center, though the prevalence of azole resistance is alarmingly high even among the C. albicans isolates.
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Affiliation(s)
- Aarti Kotwal
- Department of Microbiology, Himalayan Institute of Medical Sciences, Swami Ram Nagar, Jolly Grant, Dehradun, India
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Birinci A, Cayci YT, Bilgin K, Gunaydin M, Acuner C, Esen S. Comparison of nosocomial candidemia of pediatric and adult cases in 2-years period at a Turkish university hospital. Eurasian J Med 2011; 43:87-91. [PMID: 25610170 DOI: 10.5152/eajm.2011.20] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2011] [Accepted: 06/24/2011] [Indexed: 12/16/2022] Open
Abstract
OBJECTIVE Although there are limited numerous reports of candidemia in adults, data on paediatrics are stil limeted. The aim of the present study was to compare the aetiology and risk factors of nosocomial candidemia among the paediatric and adults in our hospital. MATERIALS AND METHODS This study includes the patients hospitalised and diagnosed as fungemia at Ondokuz Mayis University Hospital between June 30, 2007 and June 30, 2009 whose blood cultures sent to our microbiology laboratory. After fungal growth was observed in blood cultures, the yeast cells were inoculated onto Saboraud glucose agar. The colonies were identified by conventional yeast identification methods and ID 32C yeast identification system according to the manifacturer's instructions. RESULTS During this period 51 paediatric and 69 adults were studied. The most common yeast form was Candida albicans (43.3%) followed by C. parapsilosis (25.0%) and C. tropicalis (17.5%). Although the non-albicans Candida species represent more than half (56.7%) of all candidemic cases C. albicans was the most common frequent etiologic agent. There was no statistically significant difference between patient age (paediatric and adult) and distribution of Candida species (p>0.05) Neoplasia (in adults) and prematurity (in paediatrics) were the main underlying diseases. Predisposing factors and mortality rates were not different among paediatrics and adults. CONCLUSION We reinforce the necessity of continous epidomiologic surveillance to follow the dynamics of candidemia.
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Affiliation(s)
- Asuman Birinci
- Department of Clinical Microbiology, Faculty of Medicine, Ondokuz Mayis University, Samsun, Turkey
| | - Yeliz Tanriverdi Cayci
- Department of Clinical Microbiology, Faculty of Medicine, Ondokuz Mayis University, Samsun, Turkey
| | - Kemal Bilgin
- Department of Clinical Microbiology, Faculty of Medicine, Ondokuz Mayis University, Samsun, Turkey
| | - Murat Gunaydin
- Department of Clinical Microbiology, Faculty of Medicine, Ondokuz Mayis University, Samsun, Turkey
| | - Cagatay Acuner
- Department of Clinical Microbiology, Faculty of Medicine, Ondokuz Mayis University, Samsun, Turkey
| | - Saban Esen
- Department of Infectiousus Diseases, Faculty of Medicine, Ondokuz Mayis University, Samsun, Turkey
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Diagnostic issues, clinical characteristics, and outcomes for patients with fungemia. J Clin Microbiol 2011; 49:3300-8. [PMID: 21715585 DOI: 10.1128/jcm.00179-11] [Citation(s) in RCA: 129] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
This study investigated microbiological, clinical, and management issues and outcomes for Danish fungemia patients. Isolates and clinical information were collected at six centers. A total of 334 isolates, 316 episodes, and 305 patients were included, corresponding to 2/3 of the national episodes. Blood culture positivity varied by system, species, and procedure. Thus, cases with concomitant bacteremia were reported less commonly by BacT/Alert than by the Bactec system (9% [11/124 cases] versus 28% [53/192 cases]; P < 0.0001), and cultures with Candida glabrata or those drawn via arterial lines needed longer incubation. Species distribution varied by age, prior antifungal treatment (57% occurrence of C. glabrata, Saccharomyces cerevisiae, or C. krusei in patients with prior antifungal treatment versus 28% occurrence in those without it; P = 0.007), and clinical specialty (61% occurrence of C. glabrata or C. krusei in hematology wards versus 27% occurrence in other wards; P = 0.002). Colonization samples were not predictive for the invasive species in 11/100 cases. Fifty-six percent of the patients had undergone surgery, 51% were intensive care unit (ICU) patients, and 33% had malignant disease. Mortality increased by age (P = 0.009) and varied by species (36% for C. krusei, 25% for C. parapsilosis, and 14% for other Candida species), severity of underlying disease (47% for ICU patients versus 24% for others; P = 0.0001), and choice but not timing of initial therapy (12% versus 48% for patients with C. glabrata infection receiving caspofungin versus fluconazole; P = 0.023). The initial antifungal agent was deemed suboptimal upon species identification in 15% of the cases, which would have been 6.5% if current guidelines had been followed. A large proportion of Danish fungemia patients were severely ill and received suboptimal initial antifungal treatment. Optimization of diagnosis and therapy is possible.
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Abstract
PURPOSE OF REVIEW This review covers candidaemia in numbers, susceptibility issues, host groups, risk factors and outcome. RECENT FINDINGS The incidence of candidaemia has increased over the last decades. Candida glabrata is particularly common in the northern hemisphere and with increasing age whilst the opposite is true for C. parapsilosis, C. glabrata, C. krusei and a number of emerging species are not fully susceptible to azoles. C. parapsilosis and C. guilliermondii are not fully susceptible to echinocandins. Increasing rates of C. parapsilosis have been observed at centres with a high use of echinocandins, and outcome for this species is not superior comparing echinocandins with fluconazole. Acquired azole resistance has recently been described in as many as a third of 19% resistant isolates and echinocandin resistance has emerged and been detected as early as day 12 of echinocandin therapy. ICU stay and abdominal surgery are among the most important risk factors. Outcome is dependent on species involved, timing, dosing and choice of therapy and management of the primary focus of infection. However, host factors are dominating predictors of mortality in recent studies of ICU candidiasis. SUMMARY The changing epidemiology highlights the need for close monitoring of local incidence, species distribution and susceptibility in order to optimize therapy and outcome.
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Falagas ME, Roussos N, Vardakas KZ. Relative frequency of albicans and the various non-albicans Candida spp among candidemia isolates from inpatients in various parts of the world: a systematic review. Int J Infect Dis 2010; 14:e954-66. [PMID: 20797887 DOI: 10.1016/j.ijid.2010.04.006] [Citation(s) in RCA: 201] [Impact Index Per Article: 14.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2010] [Revised: 03/29/2010] [Accepted: 04/09/2010] [Indexed: 01/23/2023] Open
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Gómez J, García-Vázquez E, Espinosa C, Ruiz J, Canteras M, Hernández-Torres A, Baños V, Herrero JA, Valdés M. Nosocomial candidemia at a general hospital: prognostic factors and impact of early empiric treatment on outcome (2002–2005). Med Clin (Barc) 2010; 134:1-5. [DOI: 10.1016/j.medcli.2009.06.066] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2009] [Accepted: 06/16/2009] [Indexed: 10/20/2022]
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Di Santo R. Natural products as antifungal agents against clinically relevant pathogens. Nat Prod Rep 2010; 27:1084-98. [DOI: 10.1039/b914961a] [Citation(s) in RCA: 81] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Ruan SY, Huang YT, Chu CC, Yu CJ, Hsueh PR. Candida glabrata fungaemia in a tertiary centre in Taiwan: antifungal susceptibility and outcomes. Int J Antimicrob Agents 2009; 34:236-9. [PMID: 19361960 DOI: 10.1016/j.ijantimicag.2009.02.021] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2008] [Revised: 02/13/2009] [Accepted: 02/13/2009] [Indexed: 11/29/2022]
Abstract
The proportion of non-albicans candidaemia has increased during recent decades, especially Candida glabrata. We evaluated the antifungal susceptibility, clinical features and outcome of C. glabrata fungaemia treated in a tertiary centre in Taiwan. All episodes of C. glabrata fungaemia during 1999-2005 were identified from microbiology laboratory records and all C. glabrata isolates were subjected to antifungal susceptibility testing by the broth microdilution method. A total of 177 episodes of C. glabrata fungaemia were documented, accounting for 30% of the 598 episodes of candidaemia. A dramatic decline of C. glabrata causing candidaemia from 2003 (46.8%) to 2005 (15.8%) was noted, accompanied by decreased fluconazole consumption. The most common underlying diseases in these patients were cancer (49%), diabetes (34%) and renal failure (25%). The most common risk factors were central venous catheter use (88%), antimicrobial treatment (87%) and parenteral nutrition (51%). The 30-day all-cause mortality was 48.6%, but only 31% of patients were eventually discharged from the hospital. There was no significant survival difference between patients with C. glabrata and Candida albicans fungaemia. Rates of antifungal susceptibility were 63% for fluconazole, 93% for voriconazole, 96% for caspofungin, 98% for amphotericin B and 99% for flucytosine. The different levels of susceptibility to fluconazole (susceptible, susceptible-dose dependent and resistant) were not significantly associated with 30-day mortality.
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Affiliation(s)
- Sheng-Yuan Ruan
- Department of Internal Medicine, National Taiwan University Hospital Yun-Lin Branch, Yun-Lin, Taiwan
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Queiroz-Telles F, Berezin E, Leverger G, Freire A, van der Vyver A, Chotpitayasunondh T, Konja J, Diekmann-Berndt H, Koblinger S, Groll AH, Arrieta A. Micafungin versus liposomal amphotericin B for pediatric patients with invasive candidiasis: substudy of a randomized double-blind trial. Pediatr Infect Dis J 2008; 27:820-6. [PMID: 18679151 DOI: 10.1097/inf.0b013e31817275e6] [Citation(s) in RCA: 171] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Invasive candidiasis is increasingly prevalent in premature infants and seriously ill children, and pediatric data on available antifungal therapies are lacking. METHODS We conducted a pediatric substudy as part of a double-blind, randomized, multinational trial to compare micafungin (2 mg/kg) with liposomal amphotericin B (3 mg/kg) as first-line treatment of invasive candidiasis. Treatment success was defined as clinical and mycologic response at the end of therapy. Statistical analyses were descriptive, as the sample size meant that the study was not powered for hypothesis testing. RESULTS One hundred six patients were included in the intent-to-treat population; and 98 patients-48 patients in the micafungin group and 50 patients in the liposomal amphotericin B group-in the modified intent-to-treat population. Baseline characteristics were balanced between treatment groups. Overall, 57 patients were <2 years old including 19 patients who were premature at birth; and 41 patients were 2 to <16 years old. Most patients (91/98, 92.9%) had candidemia, and 7/98 (7.1%) patients had other forms of invasive candidiasis. Treatment success was observed for 35/48 (72.9%) patients treated with micafungin and 38/50 (76.0%) patients treated with liposomal amphotericin B. The difference in proportions adjusted for neutropenic status was -2.4% [95% CI: (-20.1 to 15.3)]. Efficacy findings were consistent, independent of the neutropenic status, the age of the patient, and whether the patient was premature at birth. Both treatments were well tolerated, but with a lower incidence of adverse events that led to discontinuation in the micafungin group (2/52, 3.8%) compared with the liposomal amphotericin B group (9/54, 16.7%) (P = 0.05, Fisher exact test). CONCLUSIONS Micafungin seems to be similarly effective and as safe as liposomal amphotericin B for the treatment of invasive candidiasis in pediatric patients. (ClinicalTrials.gov number, NCT00106288).
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Jordà-Marcos R, Alvarez-Lerma F, Jurado M, Palomar M, Nolla-Salas J, León MA, León C. Risk factors for candidaemia in critically ill patients: a prospective surveillance study. Mycoses 2007; 50:302-10. [PMID: 17576324 DOI: 10.1111/j.1439-0507.2007.01366.x] [Citation(s) in RCA: 70] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
Candidaemia is frequently a life-threatening complication in patients admitted to the intensive care unit (ICU). To assess the risk factors for candidaemia in critically ill patients with prolonged ICU stay, a total of 1765 adult patients admitted for at least 7 days to 73 medical-surgical ICUs of 70 tertiary care hospitals in Spain participated in a prospective cohort study. Candidaemia was defined as recovery of Candida spp. from blood culture. Sixty-eight episodes of candidaemia occurred in 63 patients, representing 35.7 episodes per 1000 ICU patients admitted, with an incidence rate of 1.5 episodes per 1000 days of ICU stay. Causative fungi were C. albicans in 57.1% of cases and non-albicans Candida spp. in 42.9%. In the multivariate analysis, independent factors significantly associated with candidaemia were Candida colonisation (OR = 4.12, 95% CI: 1.82-9.33), total parenteral nutrition (OR = 3.89, 95% CI: 1.73-8.78), elective surgery (OR = 2.75, 95% CI: 1.17-6.45) and haemofiltration procedures (OR = 1.96, 95% CI: 1.06-3.62). In the ICU setting in Spain and in patients who have stayed in units for >7 days, more than half of cases of candidaemia were caused by C. albicans. Risk factors for candidaemia identified included Candida colonisation, elective surgery, total parenteral nutrition and haemodialysis.
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Affiliation(s)
- Ricard Jordà-Marcos
- Department of Intensive Care Medicine, Hospital Son Dureta and Clínica Rotger, Palma de Mallorca, Spain.
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Metwally L, Walker MJ, Coyle PV, Hay RJ, Hedderwick S, McCloskey BV, O'Neill HJ, Webb CH, McMullan R. Trends in candidemia and antifungal susceptibility in a university hospital in Northern Ireland 2001-2006. J Infect 2007; 55:174-8. [PMID: 17560655 DOI: 10.1016/j.jinf.2007.04.003] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2007] [Revised: 02/28/2007] [Accepted: 04/07/2007] [Indexed: 10/23/2022]
Abstract
OBJECTIVES To describe the species distribution and antifungal susceptibility trends for documented episodes of candidemia at the Royal Hospitals, Belfast, 2001-2006. METHODS Laboratory-based retrospective observational study of all episodes of candidemia. RESULTS There were 151 episodes of candidemia. The species recovered were: 96 C. albicans; 26 C. glabrata; 18 C. parapsilosis; five C. tropicalis; four C. guilliermondii; one C. famata and one C. dubliniensis. We separated the data into two periods 2001-2003 and 2004-2006; contrary to the findings of other investigators, there was a notable trends toward increasing frequency of C. albicans and decreasing frequency of non-albicans species over time. Although the proportion of C. albicans, C. parapsilosis and C. tropicalis isolates susceptible to fluconazole was unchanged over time, a trend of decreased susceptibility of C. glabrata to fluconazole was noted over the six-year period. Overall, 73% and 7.7% of C. glabrata isolates had susceptible-dose-dependent and resistant phenotypes, respectively. The percentage of C. glabrata isolates susceptible to fluconazole (MIC <8 microg/ml) decreased from 36% in 2001-2003 to 0% in 2004-2006. Flucytosine resistance was detected in only 4 (2.7%) isolates. None of the isolates had an amphotericin B MIC <1 microg/ml. CONCLUSION A shift towards increasing dominance of C. albicans contrasts both with reports from other countries and previous data from Northern Ireland. Upwards fluconazole MIC drift among C. glabrata has important implications for empirical therapeutic decisions.
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Affiliation(s)
- L Metwally
- Department of Medical Microbiology, The Royal Hospitals, School of Medicine and Dentistry, Belfast, Northern Ireland.
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Gallien S, Sordet F, Enache-Angoulvant A. Traitement des candidémies chez un patient porteur d’un cathéter vasculaire. J Mycol Med 2007. [DOI: 10.1016/j.mycmed.2006.10.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Pachl J, Svoboda P, Jacobs F, Vandewoude K, van der Hoven B, Spronk P, Masterson G, Malbrain M, Aoun M, Garbino J, Takala J, Drgona L, Burnie J, Matthews R. A randomized, blinded, multicenter trial of lipid-associated amphotericin B alone versus in combination with an antibody-based inhibitor of heat shock protein 90 in patients with invasive candidiasis. Clin Infect Dis 2006; 42:1404-13. [PMID: 16619152 DOI: 10.1086/503428] [Citation(s) in RCA: 206] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2005] [Accepted: 01/23/2006] [Indexed: 11/03/2022] Open
Abstract
BACKGROUND Mycograb (NeuTec Pharma) is a human recombinant monoclonal antibody against heat shock protein 90 that, in laboratory studies, was revealed to have synergy with amphotericin B against a broad spectrum of Candida species. METHODS A double-blind, randomized study was conducted to determine whether lipid-associated amphotericin B plus Mycograb was superior to amphotericin B plus placebo in patients with culture-confirmed invasive candidiasis. Patients received a lipid-associated formulation of amphotericin B plus a 5-day course of Mycograb or placebo, having been stratified on the basis of Candida species (Candida albicans vs. non-albicans species of Candida). Inclusion criteria included clinical evidence of active infection at trial entry plus growth of Candida species on culture of a specimen from a clinically significant site within 3 days after initiation of study treatment. The primary efficacy variable was overall response to treatment (clinical and mycological resolution) by day 10. RESULTS Of the 139 patients enrolled from Europe and the United States, 117 were included in the modified intention-to-treat population. A complete overall response by day 10 was obtained for 29 (48%) of 61 patients in the amphotericin B group, compared with 47 (84%) of 56 patients in the Mycograb combination therapy group (odds ratio [OR], 5.8; 95% confidence interval [CI], 2.41-13.79; P<.001). The following efficacy criteria were also met: clinical response (52% vs. 86%; OR, 5.4; 95% CI, 2.21-13.39; P<.001), mycological response (54% vs. 89%; OR, 7.1; 95% CI, 2.64-18.94; P<.001), Candida-attributable mortality (18% vs. 4%; OR, 0.2; 95% CI, 0.04-0.80; P = .025), and rate of culture-confirmed clearance of the infection (hazard ratio, 2.3; 95% CI, 1.4-3.8; P = .001). Mycograb was well tolerated. CONCLUSIONS Mycograb plus lipid-associated amphotericin B produced significant clinical and culture-confirmed improvement in outcome for patients with invasive candidiasis.
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Affiliation(s)
- Jan Pachl
- Charles University, Prague, Czech Republic
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Abstract
Candida species are an important cause of health care-related bloodstream infections (BSI). Understanding the current Candida BSI incidence trends, the dominant species causing disease, and the mortality associated with this infection are important to help guide therapeutic and prophylaxis measures. In this review, trends in the incidence of Candida BSI are assessed using data extracted from reports published worldwide during 1995 to 2005. The incidence trend of Candida BSI was found to be stable for most of the reports reviewed, and Candida albicans remains the most common species causing Candida BSIs. Surveillance to monitor the burden of disease and emergence of resistance, among the general patient population and among high risk patient populations, should be continued.
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Affiliation(s)
- Juliette Morgan
- Mycotic Disease Branch, Centers for Disease Control and Prevention, 1600 Clifton Road, Atlanta, GA 30333, USA.
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