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Shiyadeh ZS, Farahyar S, Vahedi Larijani L, Beardsley J, Nouri N, Mahmoudi S, Roudbar Mohammadi S, Rodrigues CF, Roudbary M. Hospitalized COVID-19 Patients with Urinary Tract Infection in Iran: Candida Species Distribution and Antifungal Susceptibility Patterns. Antibiotics (Basel) 2024; 13:633. [PMID: 39061315 PMCID: PMC11273823 DOI: 10.3390/antibiotics13070633] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2024] [Revised: 06/29/2024] [Accepted: 07/04/2024] [Indexed: 07/28/2024] Open
Abstract
Candida species, typically part of the human skin and mucous membrane flora, can cause opportunistic fungal infections, notably urinary tract infections (UTIs), which are on the rise among hospitalized COVID-19 patients. The lack of understanding of UTIs in this population, coupled with the emergence of multidrug-resistant strains, poses significant challenges for effective treatment and further investigations. In this study, urine samples were collected from 70 COVID-19 patients with UTIs in sterile containers for microbiology examination. After microscopic observation, the isolates were identified both by phenotypic and molecular techniques such as multiplex PCR. Antifungal susceptibility testing (AFST) against fluconazole (Flu), itraconazole (Itr), and amphotericin B (AMB) was performed according to CLSI M27/S4 standard methods, with the frequency of isolates including Candida albicans (n = 20, 51.3%), Candida tropicalis (n = 15, 38.4%), Nakaseomyces glabrata (previously Candida glabrata) (n = 2, 5.1%), Pichia kudriavzevii (previously Candida krusei), and Candida parapsilosis (n = 1, 2.5%). All isolates of C. albicans, C. tropicalis, C. glabrata, and C. parapsilosis were sensitive to amphotericin B, while C. kruzei was resistant to AMB. Around 70% of C. albicans isolates were sensitive to Flu; 20% of C. tropicalis were resistant to itraconazole, while 33% were resistant to fluconazole. C. albicans and C. tropicalis were the main causes of candiduria in infected cases and both Flu and AMB showed good results in AFST in these species. Performing drug susceptibility testing for clinical isolates of Candida spp. provided guidance for appropriate management and control, and timely antifungal treatment.
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Affiliation(s)
- Zeinab Soleimani Shiyadeh
- Department of Parasitology and Mycology, School of Medicine, Iran University of Medical Sciences, Tehran 1449614535, Iran; (Z.S.S.); (S.F.); (S.M.)
| | - Shirin Farahyar
- Department of Parasitology and Mycology, School of Medicine, Iran University of Medical Sciences, Tehran 1449614535, Iran; (Z.S.S.); (S.F.); (S.M.)
- Microbial Biotechnology Research Center (MBiRC), School of Medicine, Iran University of Medical Sciences, Tehran 1449614535, Iran
| | - Laleh Vahedi Larijani
- Department of Pathology, School of Medicine, Mazandaran University of Medical Sciences, Sari 48175-866, Iran;
| | - Justin Beardsley
- Sydney Infectious Diseases Institute, University of Sydney, Sydney, NSW 2145, Australia;
- Westmead Hospital, NSW Health, Sydney, NSW 2145, Australia
| | - Noura Nouri
- Department of Mycology, Faculty of Medical Sciences, Tarbiat Modares University, Tehran 14115111, Iran; (N.N.); (S.R.M.)
| | - Shahram Mahmoudi
- Department of Parasitology and Mycology, School of Medicine, Iran University of Medical Sciences, Tehran 1449614535, Iran; (Z.S.S.); (S.F.); (S.M.)
| | - Shahla Roudbar Mohammadi
- Department of Mycology, Faculty of Medical Sciences, Tarbiat Modares University, Tehran 14115111, Iran; (N.N.); (S.R.M.)
| | - Célia Fortuna Rodrigues
- Associate Laboratory i4HB—Institute for Health and Bioeconomy, University Institute of Health Sciences—CESPU, 4585-116 Gandra, Portugal
- UCIBIO—Applied Molecular Biosciences Unit, Translational Toxicology Research Laboratory, University Institute of Health Sciences (1H-TOXRUN, IUCS-CESPU), 4585-116 Gandra, Portugal
- LEPABE—Laboratory for Process Engineering, Environment, Biotechnology and Energy, Faculty of Engineering, University of Porto, 4200-465 Porto, Portugal
- ALiCE—Associate Laboratory in Chemical Engineering, Faculty of Engineering, University of Porto, 4200-465 Porto, Portugal
| | - Maryam Roudbary
- Department of Parasitology and Mycology, School of Medicine, Iran University of Medical Sciences, Tehran 1449614535, Iran; (Z.S.S.); (S.F.); (S.M.)
- Sydney Infectious Diseases Institute, University of Sydney, Sydney, NSW 2145, Australia;
- Westmead Hospital, NSW Health, Sydney, NSW 2145, Australia
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Facchini N, Wernli L, Rieken M, Bonkat G, Wirz D, Braissant O. Again and Again-Survival of Candida albicans in Urine Containing Antifungals. Pharmaceutics 2024; 16:605. [PMID: 38794267 PMCID: PMC11124869 DOI: 10.3390/pharmaceutics16050605] [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: 03/22/2024] [Revised: 04/25/2024] [Accepted: 04/26/2024] [Indexed: 05/26/2024] Open
Abstract
BACKGROUND Relapse of Candida albicans urinary tract infection (UTI) is frequent despite appropriate treatment, as commonly used antifungals such fluconazole and flucytosine are only fungistatics. To improve treatment of Candida UTI and decrease relapses, understanding the long-term metabolic activity and survival of C. albicans in urine containing antifungals at minimal inhibitory concentration (MIC) is needed. METHODS we monitored the survival, metabolic activity and consumption of glucose and proteins by C. albicans using conventional methods and isothermal microcalorimetry (IMC). We also investigated the influence of dead Candida cells on the growth of their living counterparts. RESULTS For 33 days, weak activity was observed in samples containing antifungals in which C. albicans growth rate was reduced by 48%, 60% and 88%, and the lag increased to 172 h, 168 h and 6 h for amphotericin, flucytosine and fluconazole, respectively. The metabolic activity peaks corresponded to the plate counts but were delayed compared to the exhaustion of resources. The presence of dead cells promoted growth in artificial urine, increasing growth rate and reducing lag in similar proportions. CONCLUSIONS Even with antifungal treatment, C. albicans relapses are possible. The low metabolic activity of surviving cells leading to regrowth and chlamydospore formation possibly supported by autophagy are likely important factors in relapses.
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Affiliation(s)
- Nevio Facchini
- Department of Biomedical Engineering, University of Basel, Hegenheimermattweg 167B/C, 4123 Allschwil, Switzerland; (N.F.)
- Faculty of Medicine, University of Basel, Klingelbergstrasse 61, 4056 Basel, Switzerland
| | - Lukas Wernli
- Department of Biomedical Engineering, University of Basel, Hegenheimermattweg 167B/C, 4123 Allschwil, Switzerland; (N.F.)
- Department of Urology, Kantonsspital Baselland, Rheinstrasse 26, 4410 Liestal, Switzerland
| | - Malte Rieken
- Faculty of Medicine, University of Basel, Klingelbergstrasse 61, 4056 Basel, Switzerland
- alta uro AG, Centralbahnplatz 6, 4051 Basel, Switzerland
| | - Gernot Bonkat
- Faculty of Medicine, University of Basel, Klingelbergstrasse 61, 4056 Basel, Switzerland
- alta uro AG, Centralbahnplatz 6, 4051 Basel, Switzerland
| | - Dieter Wirz
- Department of Biomedical Engineering, University of Basel, Hegenheimermattweg 167B/C, 4123 Allschwil, Switzerland; (N.F.)
| | - Olivier Braissant
- Department of Biomedical Engineering, University of Basel, Hegenheimermattweg 167B/C, 4123 Allschwil, Switzerland; (N.F.)
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Singh M, Sahai R, Pattnaik S. A novel home-use culture mechanism for identifying microbial load in urine samples. PLoS One 2023; 18:e0285881. [PMID: 37256899 DOI: 10.1371/journal.pone.0285881] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Accepted: 05/03/2023] [Indexed: 06/02/2023] Open
Abstract
Diagnosing a urinary tract infection (UTI) is typically a clinical procedure involving multiple steps. The need to perform a test depends on the presence of relevant symptoms. Given the current pandemic situation, visiting a clinic may not be a preferable choice for many users. Many vulnerable groups of patients, namely, males with certain predispositions and pregnant women, may not present with symptoms of UTI and may go undiagnosed, which could give rise to a more complicated situation. So far, microbial cultures have been used as the gold standard for the diagnosis of an infection. However, performing microbial cultures currently requires trained professionals and laboratory grade equipment. Therefore, there is a need for a home-use culture kit that can serve this purpose. To our knowledge, no such kit exists. Here, we present a feasibility study of an affordable and easy-to-use home-based setup for quantifying bacterial load in a urine. We believe that such a system can be used by people at home to monitor recurrent UTI infections and also by physicians to remotely monitor and prescribe narrow-spectrum antibiotics for more effective treatment.
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Affiliation(s)
- Monika Singh
- Samplytics Technologies Pvt. Ltd., Koramangala, Bangalore, India
| | - Riya Sahai
- Samplytics Technologies Pvt. Ltd., Koramangala, Bangalore, India
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Deng R, Meng X, Li R, Wang A, Song Y. Asymptomatic Candida glabrata urinary tract infection in an immunocompetent young female: A case report. Medicine (Baltimore) 2023; 102:e33798. [PMID: 37335701 DOI: 10.1097/md.0000000000033798] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/21/2023] Open
Abstract
INTRODUCTION Fungal urinary tract infections (UTIs) are becoming increasingly common in hospitalized patients and Candida species are the most prevalent organisms. However, recurrent candiduria in young healthy outpatients is rare thus require further examination to find the etiologic factors. CASE PRESENTATION We described a case of recurrent asymptomatic c caused by azole-resistant C. glabrata in a healthy young female who only had previous use of antibiotics without other risk factors. However, after removal of the predisposing factor and the use of sensitive antifungal agents, the patient's urine cultures remained positive. This phenomenon indicated to us that the patient might have an immune-related genetic deficiency. We found a novel caspase-associated recruitment domain-containing protein 9 (CARD9) gene mutation (c.808-11G > T) which might be the cause of recurrent asymptomatic candiduria in this immune-competent young female without any underlying diseases. CONCLUSIONS We report a case of recurrent asymptomatic candiduria caused by azole-resistant Candida glabrata in a young healthy female with a novel CARD9 mutation. A functional study of this mutation should be performed in the future to determine its effect on asymptomatic fungal UTIs.
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Affiliation(s)
- Ruixin Deng
- Department of Dermatology and Venerology, Peking University First Hospital, Beijing, China
- National Clinical Research Center for Skin and Immune Diseases, Beijing, China
- Research Center for Medical Mycology, Peking University, Beijing, China
- Beijing Key Laboratory of Molecular Diagnosis on Dermatoses, Beijing, China
| | - Xingye Meng
- Department of Dermatology and Venerology, Peking University First Hospital, Beijing, China
- National Clinical Research Center for Skin and Immune Diseases, Beijing, China
- Research Center for Medical Mycology, Peking University, Beijing, China
- Beijing Key Laboratory of Molecular Diagnosis on Dermatoses, Beijing, China
| | - Ruoyu Li
- Department of Dermatology and Venerology, Peking University First Hospital, Beijing, China
- National Clinical Research Center for Skin and Immune Diseases, Beijing, China
- Research Center for Medical Mycology, Peking University, Beijing, China
- Beijing Key Laboratory of Molecular Diagnosis on Dermatoses, Beijing, China
| | - Aiping Wang
- Department of Dermatology and Venerology, Peking University First Hospital, Beijing, China
- National Clinical Research Center for Skin and Immune Diseases, Beijing, China
- Research Center for Medical Mycology, Peking University, Beijing, China
- Beijing Key Laboratory of Molecular Diagnosis on Dermatoses, Beijing, China
| | - Yinggai Song
- Department of Dermatology and Venerology, Peking University First Hospital, Beijing, China
- National Clinical Research Center for Skin and Immune Diseases, Beijing, China
- Research Center for Medical Mycology, Peking University, Beijing, China
- Beijing Key Laboratory of Molecular Diagnosis on Dermatoses, Beijing, China
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Yadav RK, Singh G, Kiran KS, Iram A, Rana B, Cs S, Xess I. A study on candiduria in neonates and infants from a tertiary care center, North India. Indian J Med Microbiol 2023; 42:25-29. [PMID: 36967211 DOI: 10.1016/j.ijmmb.2022.12.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Revised: 12/21/2022] [Accepted: 12/30/2022] [Indexed: 01/21/2023]
Abstract
PURPOSE Candida albicans is the major cause of fungal UTI in neonates and infants but nowadays non albicans Candida is also increasing and these are mostly multidrug resistant. So it's important to know the species of candidal UTI for the proper management. This study was undertaken to determine the Candida species distribution in UTI along with their susceptibility pattern and outcome in infants and neonates admitted in different wards and ICU of our hospital. We also assess the incidence rate of candiduria in ICUs. METHOD Urine samples were collected from infants and neonates presented in pediatrics and neonatal ICU (intensive care units) and clinical wards with a clinical suspicion of candiduria and infants at risk of invasive candidiasis were also included in the study. Identification of Candida sp. was done by Gram's staining, germ tube test, chlamydospore formation on corn meal agar, color appearance on CHROM agar and also confirmed by MALDI-TOF Assay. Antifungal susceptibility was performed by using broth microdilution method as per the CLSI M27-A3/M27-S4. RESULT Urine samples were received from 219 infants, and Candida was isolated from samples from 52 infants (isolation rate 23.75%), of which 30 were admitted in pediatric or neonatal ICU and 22 in the wards. The incidence rate of candiduria in ICU was 3.25%. Candida albicans was the most frequently isolated species from the samples of infants in the wards (13/22 i.e. 59%), while Candida tropicalis was most frequently isolated from samples of infants in the ICUs (13/30 i.e. 43.34%). Candida glabrata was the least commonly isolated species and was only encopuntered in the ICU. There was no discrepancy between the results of conventional methods of identification and MALDI-TOF. Antifungal susceptibility was performed for 18 randomly selected isolates. All were found to be susceptible to caspofungin, micafungin, itraconazole, voriconazole, fluconazole, amphotericin B. CONCLUSION High suspicion of candiduria is needed especially in ICU admitted infants and identification of candida at species level along with the susceptibility pattern is important for the better management of patients.
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Maternal Age and Stage of Pregnancy as Determinants of UTI in Pregnancy: A Case of Tamale, Ghana. Infect Dis Obstet Gynecol 2022; 2022:3616028. [PMID: 35462970 PMCID: PMC9019433 DOI: 10.1155/2022/3616028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2022] [Revised: 03/09/2022] [Accepted: 03/26/2022] [Indexed: 12/03/2022] Open
Abstract
Introduction Urinary tract infection (UTI) is the world's second most common cause of death, trailing only respiratory tract infections. Because of anatomical and physiological changes along the urinary tract, pregnant women accounted for approximately 20% of all cases of urinary tract infection. Aim This study sought to assess maternal age and stage of pregnancy as determinants of UTI among pregnant women in Tamale. Methods This study employed a descriptive cross-sectional survey as the study design in the antenatal clinic of Tamale Central Hospital (TCH). This was carried out by reviewing laboratory records of urinalysis results done on pregnant women. Data entry and analysis were performed by the Statistical Package for the Social Sciences (SPSS) version 20. Chi-square and binary logistics analysis were used to determine the relationship. Results Data analysis was done for 158 pregnant women, most (35.4%) were within the age group of 36-45 years, and most (38.6%) were within their first trimester. The overall prevalence of UTI infections among pregnant women was 33.5%. The prevalence was 27.8% for candiduria and 8.9% for bacteriuria. Women in the first trimester of their pregnancy were more likely to have UTI (AOR = 2.48, 95% CI =1.03–5.94). Also, Pregnant women of the age group of 26-35 years were less likely to get UTIs as compared to those of the age group 15-25 years (AOR = 0.40, 95% CI =0.17–0.92). Finally, those of the age group of 36-45 years were less likely to get UTI as compared to those of the age group 15-25 years (AOR = 0.28, 95% CI =0.12–0.66). Conclusion The prevalence of UTI among studied pregnant women was high (38.0%), and the most prone maternal age group and trimesters to UTI are 15-25 years and first trimester, respectively.
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Hasandka A, Singh AR, Prabhu A, Singhal HR, Nandagopal MSG, Mani NK. Paper and thread as media for the frugal detection of urinary tract infections (UTIs). Anal Bioanal Chem 2022; 414:847-865. [PMID: 34668042 PMCID: PMC8724062 DOI: 10.1007/s00216-021-03671-3] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2021] [Revised: 09/02/2021] [Accepted: 09/15/2021] [Indexed: 12/22/2022]
Abstract
Urinary tract infections (UTIs) make up a significant proportion of the global burden of disease in vulnerable groups and tend to substantially impair the quality of life of those affected, making timely detection of UTIs a priority for public health. However, economic and societal barriers drastically reduce accessibility of traditional lab-based testing methods for critical patient groups in low-resource areas, negatively affecting their overall healthcare outcomes. As a result, cellulose-based materials such as paper and thread have garnered significant interest among researchers as substrates for so-called frugal analytical devices which leverage the material's portability and adaptability for facile and reproducible diagnoses of UTIs. Although the field may be only in its infancy, strategies aimed at commercial penetration can appreciably increase access to more healthcare options for at-risk people. In this review, we catalogue recent advances in devices that use cellulose-based materials as the primary housing or medium for UTI detection and chart out trends in the field. We also explore different modalities employed for detection, with particular emphasis on their ability to be ported onto discreet casings such as sanitary products.
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Affiliation(s)
- Amrutha Hasandka
- Microfluidics, Sensors and Diagnostics Laboratory (μSenD), Department of Biotechnology, Manipal Institute of Technology, Manipal Academy of Higher Education, Manipal, Karnataka, 576104, India
| | - Ankita Ramchandran Singh
- Microfluidics, Sensors and Diagnostics Laboratory (μSenD), Department of Biotechnology, Manipal Institute of Technology, Manipal Academy of Higher Education, Manipal, Karnataka, 576104, India
| | - Anusha Prabhu
- Microfluidics, Sensors and Diagnostics Laboratory (μSenD), Department of Biotechnology, Manipal Institute of Technology, Manipal Academy of Higher Education, Manipal, Karnataka, 576104, India
| | - Hardik Ramesh Singhal
- Department of Chemical Engineering, Manipal Institute of Technology, Manipal Academy of Higher Education, Manipal, Karnataka, 576104, India
| | - M S Giri Nandagopal
- Department of Mechanical Engineering, Indian Institute of Technology, Kharagpur, Kharagpur, 721302, India
| | - Naresh Kumar Mani
- Microfluidics, Sensors and Diagnostics Laboratory (μSenD), Department of Biotechnology, Manipal Institute of Technology, Manipal Academy of Higher Education, Manipal, Karnataka, 576104, India.
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Javorova Rihova Z, Slobodova L, Hrabovska A. Micafungin Is an Efficient Treatment of Multi Drug-Resistant Candida glabrata Urosepsis: A Case Report. J Fungi (Basel) 2021; 7:800. [PMID: 34682222 PMCID: PMC8538929 DOI: 10.3390/jof7100800] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2021] [Revised: 09/20/2021] [Accepted: 09/23/2021] [Indexed: 11/23/2022] Open
Abstract
Candiduria is a common nosocomial infection in hospitalized patients, which may progress into life-threatening candidemia. Successful treatment of urosepsis requires early and effective antifungal therapy, while the available agents within three pharmacological classes each have characteristic pharmacokinetics and side effect profiles. Moreover, treatment of Candida spp. infections is becoming challenging due to increasing multi drug-resistance. Here, we present a case of candidemia resulting from a multi drug-resistant C. glabrata infection of the urinary tract. Due to resistance to fluconazole and a contraindication for amphotericin B, micafungin was used in the treatment, regardless of its unfavorable pharmacokinetic properties. Our study showed that despite the expected low levels in the urinary tract, micafungin was successful in the eradication of C. glabrata allowing full recovery of the patient. Thus, micafungin should be considered in the management of urosepsis caused by sensitive Candida spp.
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Affiliation(s)
- Zuzana Javorova Rihova
- Department of Clinical Pharmacology, Teaching Hospital Trnava, A. Zarnova 11, 917 75 Trnava, Slovakia;
- Department of Pharmacology, Faculty of Medicine, Slovak Medical University in Bratislava, Limbova 12, 833 03 Bratislava, Slovakia;
- Department of Pharmacology and Toxicology, Faculty of Pharmacy, Comenius University in Bratislava, Odbojarov 10, 832 32 Bratislava, Slovakia
| | - Lubica Slobodova
- Department of Pharmacology, Faculty of Medicine, Slovak Medical University in Bratislava, Limbova 12, 833 03 Bratislava, Slovakia;
- Department of Pharmacology and Toxicology, Faculty of Pharmacy, Comenius University in Bratislava, Odbojarov 10, 832 32 Bratislava, Slovakia
| | - Anna Hrabovska
- Department of Pharmacology, Faculty of Medicine, Slovak Medical University in Bratislava, Limbova 12, 833 03 Bratislava, Slovakia;
- Department of Pharmacology and Toxicology, Faculty of Pharmacy, Comenius University in Bratislava, Odbojarov 10, 832 32 Bratislava, Slovakia
- Biomedical Research Centre, University Hospital Hradec Kralove, Sokolska 581, 500 05 Hradec Kralove, Czech Republic
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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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Retrospective assessment of fungal pathogens isolated from various clinical samples in a tertiary care hospital in Turkey: A cross-sectional study. JOURNAL OF SURGERY AND MEDICINE 2021. [DOI: 10.28982/josam.910783] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Wang Q, Li C, Tang D, Tang K. Molecular epidemiology of Candida tropicalis isolated from urogenital tract infections. Microbiologyopen 2020; 9:e1121. [PMID: 32985133 PMCID: PMC7658454 DOI: 10.1002/mbo3.1121] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Revised: 09/01/2020] [Accepted: 09/04/2020] [Indexed: 12/22/2022] Open
Abstract
Candida tropicalis is a common human pathogenic yeast, and its molecular typing is important for studying the population structure and epidemiology of this opportunistic yeast, such as epidemic genotype, population dynamics, nosocomial infection, and drug resistance surveillance. In this study, the antifungal susceptibility test and multilocus sequence typing (MLST) analysis were carried out on C. tropicalis from central China. Among 64 urogenital isolates, 45 diploid sequence types (DST) were found, of which 20 DSTs (44.4%) were new to the central database. The goeBURST analysis showed that CC1 (clonal complex) was the only azole‐resistant (100%, 10/10) cluster in Wuhan, which was composed of DST546, DST225, DST376, and DST506, and most of the strains (90%, 9/10) were isolated from the urinary tract. Potential nosocomial infections were mainly caused by CC1 strains. The azole resistance rate of urinary isolates (50.0%, 21/42) was higher than that of vaginal isolates (27.3%, 6/22). The genotype diversity and novelty of vaginal isolates were higher than those of urinary isolates. C. tropicalis population in Wuhan was genetically diverse and divergent from that seen in other countries. In this study, there were significant differences in genotype and azole susceptibility between urine and vaginal strains. The azole‐resistant cluster (CC1) found in urine is of great significance for the clinical treatment and prevention of nosocomial infection. The newly discovered DSTs will contribute to further study the similarity, genetic relationship, and molecular epidemiology of C. tropicalis worldwide.
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Affiliation(s)
- Qianyu Wang
- Department of Clinical Laboratory, Renmin Hospital of Wuhan University, Wuhan, China
| | - Congrong Li
- Department of Clinical Laboratory, Renmin Hospital of Wuhan University, Wuhan, China
| | - Dongling Tang
- Department of Clinical Laboratory, Renmin Hospital of Wuhan University, Wuhan, China
| | - Kewen Tang
- Department of Clinical Laboratory, Renmin Hospital of Wuhan University, Wuhan, China
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12
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Dias V. Candida species in the urinary tract: is it a fungal infection or not? Future Microbiol 2020; 15:81-83. [DOI: 10.2217/fmb-2019-0262] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Affiliation(s)
- Vanessa Dias
- Department of Parasitology, Microbiology and Immunology Federal University of Juiz de Fora – UFJF Rua José Lourenço Kelmer, S/n, São Pedro, Juiz de Fora, MG 36036 900, Brazil
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Santana MMPD, Hoffmann-Santos HD, Dias LB, Tadano T, Karhawi ASK, Dutra V, Cândido SL, Hahn RC. Epidemiological profile of patients hospitalized with candiduria in the Central-Western region of Brazil. Rev Iberoam Micol 2019; 36:175-180. [PMID: 31699523 DOI: 10.1016/j.riam.2019.04.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2017] [Revised: 03/07/2019] [Accepted: 04/15/2019] [Indexed: 10/25/2022] Open
Abstract
BACKGROUND Candida yeasts are considered the main agents of nosocomial fungal infections. AIMS This study aimed to establish the epidemiological profile of patients with candiduria hospitalized in the capital of the State of Mato Grosso, in the Central-Western region of Brazil. METHODS Patients from three private hospitals and a public hospital participated in the study. This was an observational and cross-sectional study including analysis of patients mortality. It was carried out from March to August 2015. RESULTS A total of 93 patients with candiduria were evaluated. Candida tropicalis was found most commonly (37.6%; n=35), followed by Candida albicans (36.6%; n=34), Candida glabrata (19.3%; n=18), psilosis complex (4.3%; n=4), Candida lusitaniae (1.1%; n=1) and Candida krusei (1.1%; n=1). Antibiotic therapy (100%) and the use of an indwelling urinary catheter (89.2%; n=83) were the most frequent predisposing factors. Antifungal treatment was given to 65.6% of the patients, and anidulafungin was the most used antifungal. Mortality rates were 48% higher among patients with candiduria who had renal failure. Micafungin was the antifungal most prescribed among the patients who died. Candidemia concomitant with candiduria occurred in eight (8.6%; n=8) cases. Considering the species recovered in the blood and urine, only one patient had genetically distinct clinical isolates. CONCLUSIONS Non-C. albicans Candida species were predominant, with C. tropicalis being the most responsible for most cases of candiduria.
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Affiliation(s)
- Milena Melges Pesenti de Santana
- Laboratory of Investigation - Laboratory of Mycology, Faculty of Medicine, Federal University of Mato Grosso (UFMT), Cuiabá, Mato Grosso, Brazil
| | - Hugo Dias Hoffmann-Santos
- Laboratory of Investigation - Laboratory of Mycology, Faculty of Medicine, Federal University of Mato Grosso (UFMT), Cuiabá, Mato Grosso, Brazil
| | - Luciana Basili Dias
- Laboratory of Investigation - Laboratory of Mycology, Faculty of Medicine, Federal University of Mato Grosso (UFMT), Cuiabá, Mato Grosso, Brazil
| | - Tomoko Tadano
- University Hospital Júlio Muller (HUJM), Federal University of Mato Grosso (UFMT), Cuiabá, Mato Grosso, Brazil
| | - Abdon Salam Khaled Karhawi
- University Hospital Júlio Muller (HUJM), Federal University of Mato Grosso (UFMT), Cuiabá, Mato Grosso, Brazil
| | - Valéria Dutra
- Molecular Biology Laboratory, Faculty of Veterinary Sciences, Federal University of Mato Grosso (UFMT), Cuiabá, Mato Grosso, Brazil
| | - Stephano Luiz Cândido
- Molecular Biology Laboratory, Faculty of Veterinary Sciences, Federal University of Mato Grosso (UFMT), Cuiabá, Mato Grosso, Brazil
| | - Rosane Christine Hahn
- Laboratory of Investigation - Laboratory of Mycology, Faculty of Medicine, Federal University of Mato Grosso (UFMT), Cuiabá, Mato Grosso, Brazil.
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Gajdács M, Dóczi I, Ábrók M, Lázár A, Burián K. Epidemiology of candiduria and Candida urinary tract infections in inpatients and outpatients: results from a 10-year retrospective survey. Cent European J Urol 2019; 72:209-214. [PMID: 31482032 PMCID: PMC6715075 DOI: 10.5173/ceju.2019.1909] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2019] [Revised: 04/22/2019] [Accepted: 06/09/2019] [Indexed: 12/28/2022] Open
Abstract
Introduction The presence of Candida species in urine (candiduria) is a common clinical finding, which may frequently represent colonization or contamination of specimens, however, they may be etiological agents in urinary tract infections (UTIs) or be indicators of underlying pathology in the genitourinary system or disseminated candidaemia. C. albicans is the most frequently isolated species of the genus, however, an increase in the occurrence of non-albicans Candida species (NACS) has been reported, which may be attributable to frequent exposure to fluconazole. Material and methods The aim of this study was to retrospectively assess and compare the prevalence of candiduria and UTIs caused by Candida spp. among inpatients and outpatients at a major clinical center in Hungary, during a 10-year period (2008-2017). Results Candiduria was detected in 0.11-0.75% of positive samples from outpatients, while this number was significantly higher for inpatients, ranging between 3.49-10.63% (p <0.001). Overall, C. albicans was the most frequently isolated species (65.22% in outpatients and 59.64% in inpatients), however, the presence of C. glabrata as a relevant etiologic agent (~20-30%) is also noteworthy, because there are corresponding therapeutic consequences. Conclusions A pronounced female dominance (1.7-2.15-fold), advanced age (~70 years) and hospitalization of affected patients during candiduria is in line with the findings in literature.
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Affiliation(s)
- Márió Gajdács
- University of Szeged, Faculty of Pharmacy, Department of Pharmacodynamics and Biopharmacy, Szeged, Hungary.,University of Szeged, Faculty of Medicine, Institute of Clinical Microbiology, Szeged, Hungary
| | - Ilona Dóczi
- University of Szeged, Faculty of Medicine, Institute of Clinical Microbiology, Szeged, Hungary
| | - Marianna Ábrók
- University of Szeged, Faculty of Medicine, Institute of Clinical Microbiology, Szeged, Hungary
| | - Andrea Lázár
- University of Szeged, Faculty of Medicine, Institute of Clinical Microbiology, Szeged, Hungary
| | - Katalin Burián
- University of Szeged, Faculty of Medicine, Institute of Clinical Microbiology, Szeged, Hungary
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Ruiz-Ruigómez M, Dueñas C, Hernandez C, Vinuesa D, Coronado-Álvarez NM, Portillo-Tuñón V, Cardozo C, Muñoz-Medina L, Cabo-Magadán R, Luna JD, Mensa J, Parra-Ruiz J. Clinical predictors of candidemia in medical non-neutropenic, non-ICU patients. The CaMed score. Int J Clin Pract 2018; 72:e13275. [PMID: 30375125 DOI: 10.1111/ijcp.13275] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2018] [Accepted: 09/18/2018] [Indexed: 11/28/2022] Open
Abstract
INTRODUCTION Candida species are the leading cause of invasive fungal infections in hospitalised patients and are the fourth most common isolates recovered from patients with bloodstream infection. Few data exist on risk factors for candidemia in non-ICU patients. We performed a population-based case-control study to evaluate the main predictors for candidemia in non-ICU patients. METHODS AND FINDINGS We included all non-neutropenic, non-critically ill and non-surgical adult patients with candidemia between January 2010 and June 2014. Patients with positive, non-candidal blood culture obtained at the same day (±2 days) were selected as controls. Cases and controls were matched according to hospital ward and clinical characteristics. Risk factors for candidemia were identified through a logistic regression. We included 56 candidemic and 512 bacteriemic non-candidemic patients. Most of candidemic patients (52) had received antibiotics prior to candidemia. Among them, the 30-day mortality rate was 34% (19/56). Multivariate analysis identified male sex, prior use of steroids, prior use of antibiotics, total parenteral nutrition and urinary catheterisation as independent predictors of candidemia. To develop the CaMed score, we rounded up weights of different risk factors as follows; total parenteral nutrition (+2), prior antibiotic therapy (+5), each of the other risk factors (+1). A score ≥ 7 identified patients at high risk of candidemia (P < 0.001; RR 29.805; CI 95% 10.652-83.397; sensitivity 79.2, specificity 82.6%, Youden index 0,62). CONCLUSIONS Our set of easy independent predictors of candidemia in non-neutropenic, non-ICU, non-surgical patients provide a rationale for early initiation of antifungals and could reduce candidemia-related mortality.
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Affiliation(s)
- María Ruiz-Ruigómez
- Laboratorio de Investigación Anti Microbiana, Hospital Inmaculada, Grupo HLA SLU Granada, Granada, Spain
- Unidad de Enfermedades Infecciosas, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - Carlos Dueñas
- Servicio de Medicina Interna, Complejo Hospitalario Asistencial Universitario, Burgos, Spain
| | | | - David Vinuesa
- Servicio de Enfermedades Infecciosas, Complejo Hospitalario Universitario de Granada, Granada, Spain
| | - Nieves M Coronado-Álvarez
- Laboratorio de Investigación Anti Microbiana, Hospital Inmaculada, Grupo HLA SLU Granada, Granada, Spain
| | - Vera Portillo-Tuñón
- Servicio de Medicina Interna, Complejo Hospitalario Asistencial Universitario, Burgos, Spain
| | - Cristina Cardozo
- Servicio de Enfermedades Infecciosas, Hospital Clinic, Barcelona, Spain
| | - Leopoldo Muñoz-Medina
- Servicio de Enfermedades Infecciosas, Complejo Hospitalario Universitario de Granada, Granada, Spain
| | - Rebeca Cabo-Magadán
- Servicio de Medicina Interna, Complejo Hospitalario Asistencial Universitario, Burgos, Spain
| | - Juan D Luna
- Departamento de Estadística, Universidad de Granada, Granada, Spain
| | - Josep Mensa
- Servicio de Enfermedades Infecciosas, Hospital Clinic, Barcelona, Spain
| | - Jorge Parra-Ruiz
- Laboratorio de Investigación Anti Microbiana, Hospital Inmaculada, Grupo HLA SLU Granada, Granada, Spain
- Servicio de Medicina Interna, Hospital Inmaculada, Grupo HLA SLU Granada, Granada, Spain
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Pemán J, Ruiz-Gaitán A. Candidemia from urinary tract source: the challenge of candiduria. Hosp Pract (1995) 2018; 46:243-245. [PMID: 30334630 DOI: 10.1080/21548331.2018.1538623] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2018] [Accepted: 10/17/2018] [Indexed: 06/08/2023]
Affiliation(s)
- Javier Pemán
- a Microbiology Department , Hospital Universitari i Politècnic La Fe; Severe Infection Research Group, Health Research Institute Hospital La Fe , Valencia , ( Spain )
| | - Alba Ruiz-Gaitán
- b Severe Infection Research Group , Health Research Institute Hospital La Fe , Valencia , ( Spain )
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17
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Colombo AL, de Almeida Júnior JN, Slavin MA, Chen SCA, Sorrell TC. Candida and invasive mould diseases in non-neutropenic critically ill patients and patients with haematological cancer. THE LANCET. INFECTIOUS DISEASES 2017; 17:e344-e356. [PMID: 28774702 DOI: 10.1016/s1473-3099(17)30304-3] [Citation(s) in RCA: 102] [Impact Index Per Article: 14.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/06/2016] [Revised: 01/06/2017] [Accepted: 03/07/2017] [Indexed: 12/11/2022]
Abstract
Critically ill patients and patients with haematological cancer are HIV-negative populations at high risk of invasive fungal infections. In intensive-care units, candidaemia and intra-abdominal candidiasis predominate, but aspergillosis has emerged as a lethal, under-recognised cause of pneumonia. In patients with haematological malignancies or who have undergone stem-cell transplantations, pulmonary disease due to aspergillus and other mould diseases predominate. In this Series paper, we provide an update on risk assessment, new diagnostic strategies, and therapeutic approaches. New concepts have emerged for use of risk prediction rules and an evidence base now exists for inclusion of biomarkers (eg, galactomannan, 1,3-β-D-glucan, and PCR assays for Aspergillus spp) into early diagnostic and therapeutic strategies. Imaging techniques remain helpful for early diagnosis of pulmonary mould diseases, with PET techniques offering potential improvements in diagnostic specificity and evaluation of clinical response. Echinocandins and triazoles have been validated extensively for prophylaxis, empirical therapy, and targeted therapy, but an increase in intrinsically resistant fungi and emergence of secondary resistance as a result of drug-induced selection pressure are of major concern. Echinocandins remain a major component of treatment of invasive candidiasis and new triazoles are the best alternative for prophylaxis and therapy of invasive aspergillosis.
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Affiliation(s)
- A L Colombo
- Department of Medicine, Division of Infectious Diseases, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, Brazil.
| | - J N de Almeida Júnior
- Central Laboratory Division (LIM03) and Laboratory of Medical Mycology (LIM53), Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Monica A Slavin
- Department of Infectious Diseases, Peter MacCallum Cancer Center, Melbourne, VIC, Australia; Victorian Infectious Diseases Service, Royal Melbourne Hospital at the Peter Doherty Institute, Melbourne, VIC, Australia
| | - Sharon C-A Chen
- The Center for Infectious Diseases and Microbiology Laboratory Services, ICPMR Pathology West, New South Wales Health Pathology, Westmead and Marie Bashir Institute for Infectious Diseases and Biosecurity, University of Sydney, Westmead, NSW, Australia
| | - Tania C Sorrell
- Marie Bashir Institute for Infectious Diseases and Biosecurity, University of Sydney and Westmead Institute for Medical Research, Westmead, NSW, Australia
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Drogari-Apiranthitou M, Anyfantis I, Galani I, Kanioura L, Daikos GL, Petrikkos G. Association Between Candiduria and Candidemia: A Clinical and Molecular Analysis of Cases. Mycopathologia 2017; 182:1045-1052. [PMID: 28744769 DOI: 10.1007/s11046-017-0180-2] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2017] [Accepted: 07/16/2017] [Indexed: 11/26/2022]
Abstract
The risk of developing candidemia after candiduria is reportedly very low, but it has not been adequately investigated. The aim of this study was to examine the molecular relatedness between Candida strains isolated from adult patients with candidemia and concomitant candiduria in association with the clinical characteristics of the cases. All episodes of candidemia occurring in a tertiary care academic hospital during a 5-year period were recorded prospectively. Patients with episodes of candiduria occurring two weeks preceding to or one week following a positive for Candida blood culture were included in the study. The genotypic relatedness of Candida strains isolated from blood and urine was investigated by pulsed-field gel electrophoresis after digestion with the BssHII restriction endonuclease. We recorded 141 candidemia episodes, occurring in 134 patients. Twelve episodes of candidemia with concomitant candiduria occurred in 11 patients (8% of all candidemias). In six of these episodes, the strains in the blood-urine pairs belonged to different species. In two episodes, the isolates belonged to the same species but were not genetically related, and only in four (2.8% of all candidemias), the strains were related. All four patients were severely ill and had multiple risk factors for candidemia. These findings indicate that in hospitalized patients with candidemia, concomitant candiduria is rare and usually an independent event, confirming previous reports. In the critically ill, however, the existence of genetically related strains in blood and urine appears to be more frequent, with more probable the hematogenous dissemination.
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Affiliation(s)
- Maria Drogari-Apiranthitou
- Infectious Diseases Research Laboratory, 4th Department of Internal Medicine, University General Hospital "Attikon", Medical School, National and Kapodistrian University of Athens, Rimini 1, 12462, Athens, Greece.
- 1st Department of Propaedeutic Medicine, "Laiko" General Athens Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece.
| | - Ioannis Anyfantis
- 1st Department of Propaedeutic Medicine, "Laiko" General Athens Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Irene Galani
- Infectious Diseases Research Laboratory, 4th Department of Internal Medicine, University General Hospital "Attikon", Medical School, National and Kapodistrian University of Athens, Rimini 1, 12462, Athens, Greece
| | - Labrini Kanioura
- 1st Department of Propaedeutic Medicine, "Laiko" General Athens Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Georgios L Daikos
- 1st Department of Medicine, "Laiko" General Athens Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Georgios Petrikkos
- Infectious Diseases Research Laboratory, 4th Department of Internal Medicine, University General Hospital "Attikon", Medical School, National and Kapodistrian University of Athens, Rimini 1, 12462, Athens, Greece
- 1st Department of Propaedeutic Medicine, "Laiko" General Athens Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
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Candiduria: Evidence-based approach to management, are we there yet? J Mycol Med 2017; 27:293-302. [PMID: 28501465 DOI: 10.1016/j.mycmed.2017.04.005] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2017] [Revised: 03/15/2017] [Accepted: 04/07/2017] [Indexed: 12/30/2022]
Abstract
Candiduria is considered one of the most controversial issues in patient management. Neither the diagnosis nor the optimal treatment options are standardized. This is further complicated by lack of defined laboratory criteria for diagnosis as most of the studies were set for bacterial rather than fungal urinary tract infection (UTI). Furthermore, since Candida species is a known commensal of the genitourinary tract its presence in the urine sample adds ambiguity to making a definitive diagnosis of candidal UTI. Guidelines for diagnosis and management of candiduria have changed considerably over the past decades. In 1960s, the condition was believed to be benign with no intervention required. However, over the years new dimensions were added to address the issues associated with candiduria until the latest Infectious Diseases Association of America (IDSA) guidelines were published in 2009, which indicated that there was an increase in the incidence of candiduria caused by more resistant non-Candida albicans species. Further complicating the issue is the observation that candiduria may be the only indicator of a more serious invasive candidiasis, especially in immunocompromised patients. Long-term urinary catheterization is considered to be the most significant risk factor for candiduria followed by antibiotic use and diabetes. Strategies for management are based on the evaluation of candiduria in the context of the clinical setting to determine its relevance and make an appropriate decision about the need for antifungal therapy. Fluconazole is the main drug used for its efficacy and least complications. Other options include bladder irrigation with amphotericin B, flucytosine or parenteral amphotericin B. Since azoles other than fluconazole and all echinocandins are poorly excreted in urine they have been found to be less effective in candiduric patients.
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Toka Özer T, Durmaz S, Yula E. Antifungal susceptibilities of Candida species isolated from urine culture. J Infect Chemother 2016; 22:629-32. [DOI: 10.1016/j.jiac.2016.06.012] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2015] [Revised: 06/13/2016] [Accepted: 06/29/2016] [Indexed: 11/25/2022]
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Maldonado I, Arechavala A, Guelfand L, Relloso S, Garbasz C. [Yeast urinary tract infections. Multicentre study in 14 hospitals belonging to the Buenos Aires City Mycology Network]. Rev Iberoam Micol 2016; 33:104-9. [PMID: 26810887 DOI: 10.1016/j.riam.2015.07.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2015] [Revised: 07/07/2015] [Accepted: 07/20/2015] [Indexed: 10/22/2022] Open
Abstract
BACKGROUND Urinary tract infections are a frequent ailment in patients in intensive care units. Candida and other yeasts cause 5-12% of these infections. The value of the finding of any yeast is controversial, and there is no consensus about which parameters are adequate for differentiating urinary infections from colonization or contamination. AIMS To analyse the epidemiological characteristics of patients with funguria, to determine potential cut-off points in cultures (to distinguish an infection from other conditions), to identify the prevalent yeast species, and to determine the value of a second urine sample. METHODS A multicentre study was conducted in intensive care units of 14 hospitals in the Buenos Aires City Mycology Network. The first and second samples of urine from every patient were cultured. The presence of white cells and yeasts in direct examination, colony counts, and the identification of the isolated species, were evaluated. RESULTS Yeasts grew in 12.2% of the samples. There was no statistical correlation between the number of white cells and the fungal colony-forming units. Eighty five percent of the patients had indwelling catheters. Funguria was not prevalent in women or in patients over the age of 65. Candida albicans, followed by Candida tropicalis, were the most frequently isolated yeasts. Candida parapsilosis and Candida glabrata appeared less frequently. The same species were isolated in 70% of second samples, and in 23% of the cases the second culture was negative. CONCLUSIONS It was not possible to determine a useful cut-off point for colony counts to help in the diagnosis of urinary infections. As in other publications, C. albicans, followed by C. tropicalis, were the most prevalent species.
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Affiliation(s)
- Ivana Maldonado
- Laboratorio de Microbiología, Hospital Alemán, Buenos Aires, Argentina
| | - Alicia Arechavala
- Unidad Micología, Hospital de Infecciosas F. J. Muñiz, Buenos Aires, Argentina.
| | - Liliana Guelfand
- Sección Microbiología, Hospital General de Agudos J. A. Fernández, Buenos Aires, Argentina
| | - Silvia Relloso
- Laboratorio de Bacteriología, Micología y Parasitología, Centro de Educación Médica e Investigaciones Clínicas Norberto Quirno (CEMIC), Buenos Aires, Argentina
| | - Claudia Garbasz
- Sección Microbiología, Hospital General de Agudos I. Pirovano, Buenos Aires, Argentina
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Badiee P. Evaluation of human body fluids for the diagnosis of fungal infections. BIOMED RESEARCH INTERNATIONAL 2013; 2013:698325. [PMID: 23984401 PMCID: PMC3747334 DOI: 10.1155/2013/698325] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/18/2013] [Revised: 07/09/2013] [Accepted: 07/18/2013] [Indexed: 01/01/2023]
Abstract
Invasive fungal infections are a major cause of morbidity and mortality in immunocompromised patients. Because the etiologic agents of these infections are abundant in nature, their isolation from biopsy material or sterile body fluids is needed to document infection. This review evaluates and discusses different human body fluids used to diagnose fungal infections.
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Affiliation(s)
- Parisa Badiee
- Alborzi Clinical Microbiology Research Center, Namazi Hospital, Shiraz University of Medical Sciences, Zand Avenue, Shiraz 7193711351, Iran.
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Candiduria in children and susceptibility patterns of recovered Candida species to antifungal drugs in Ahvaz. J Nephropathol 2013. [DOI: 10.5812/nephropathol.10113] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Clerckx C, Wilmes D, Aydin S, Yombi JC, Goffin E, Morelle J. Candida glabrata renal abscesses in a peritoneal dialysis patient. Perit Dial Int 2012; 32:114-5. [PMID: 22302932 DOI: 10.3747/pdi.2011.00097] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Helbig S, Achkar JM, Jain N, Wang X, Gialanella P, Levi M, Fries BC. Diagnosis and inflammatory response of patients with candiduria. Mycoses 2012; 56:61-9. [PMID: 22574854 DOI: 10.1111/j.1439-0507.2012.02201.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Candiduria is common in hospitalised patients, but the clinical relevance is still unclear. This study was done to further our knowledge on detection of and host responses to candiduria. Urines and clinical data from 136 patients in whom presence of yeast was diagnosed by microscopic urinalysis were collected. Diagnosis by standard urine culture methods on blood and MacConkey agar as well as on fungal culture medium (Sabouraud dextrose agar) was compared. Inflammatory parameters (IL-6 and IL-17, Ig) were quantified in the urine and compared with levels in control patients without candiduria. Standard urine culture methods detected only 37% of Candida spp. in urine. Sensitivity was especially low (23%) for C. glabrata and was independent of fungal burden. Candida specific IgG but not IgA was significantly elevated when compared with control patients (P < 0.0001 and 0.07 respectively). In addition, urine levels of IL-6 and IL-17 were significantly higher in candiduric patients when compared with control patients (P < 0.001). Multivariate analysis documented an independent association between an increased IgG (odds ratio (OR) 136.0, 95% confidence interval (CI) 25.7-719.2; P < 0.0001), an increased IL-17 (OR 17.4, 95% CI 5.3-57.0; P < 0.0001) and an increased IL-6 level (OR 4.9, 95% CI 1.9-12.4; P = 0.001) and candiduria. In summary, our data indicate that clinical studies on candiduria should include fungal urine culture and that inflammatory parameters may be helpful to identify patients with clinically relevant candiduria.
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Affiliation(s)
- S Helbig
- Jacobi Medical Center HHC, Bronx, NY, USA
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Zehm S, Schweinitz S, Würzner R, Colvin HP, Rieder J. Detection of Candida albicans by Mass Spectrometric Fingerprinting. Curr Microbiol 2011; 64:271-5. [DOI: 10.1007/s00284-011-0064-5] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2011] [Accepted: 11/20/2011] [Indexed: 12/01/2022]
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Chandra J, Mukherjee PK, Ghannoum MA. Fungal Biofilms in the Clinical Lab Setting. CURRENT FUNGAL INFECTION REPORTS 2010. [DOI: 10.1007/s12281-010-0020-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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28
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Playford EG, Lipman J, Sorrell TC. Management of Invasive Candidiasis in the Intensive Care Unit. Drugs 2010; 70:823-39. [DOI: 10.2165/10898550-000000000-00000] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
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29
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Sriskandan S. Management of candiduria in the ICU. Infect Dis (Lond) 2010. [DOI: 10.1016/b978-0-323-04579-7.00232-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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