1
|
Dalyan Cilo B. Species Distribution and Antifungal Susceptibilities of Candida Species Isolated From Blood Culture. Cureus 2023; 15:e38183. [PMID: 37252597 PMCID: PMC10224711 DOI: 10.7759/cureus.38183] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/26/2023] [Indexed: 05/31/2023] Open
Abstract
Introduction Candida species (spp.) are among the leading agents of bloodstream infections. Candidemias are a major cause of morbidity and mortality. Having an understanding of Candida epidemiology and antifungal susceptibility patterns in each center is crucial in guiding the management of candidemia. In this study, the species distribution and antifungal susceptibility of Candida spp. isolated from blood culture at the University of Health Sciences, Bursa Yuksek Ihtisas Training & Research Hospital were examined and the first data on the epidemiology of candidemia in our center were presented. Methods A total of 236 Candida strains isolated from blood cultures in our hospital over a four-year period were analyzed and their antifungal susceptibilities were studied retrospectively. Strains were identified at the species complex (SC) level by the germ tube test, morphology in cornmeal-tween 80 medium, and the automated VITEK 2 Compact (bioMérieux, Marcy-l'Étoile, France) system. Antifungal susceptibility tests were performed on VITEK 2 Compact (bioMérieux, Marcy-l'Étoile, France) system. The susceptibilities of the strains to fluconazole, voriconazole, micafungin, and amphotericin B were determined according to Clinical and Laboratory Standards Institute (CLSI) guidelines and epidemiologic cut-off values. Results Of the Candida (C.) strains, 131 were C. albicans (55.5%), 40 were C. parapsilosis SC (16.9%), 21 were C. tropicalis (8.9%), 19 were C. glabrata SC (8.1%), eight were C. lusitaniae (3.4%), seven were C. kefyr (3.0%), six were C. krusei (2.6%), two were C. guilliermondii (0.8%) and two were C. dubliniensis (0.8%). Amphotericin B resistance was not detected in Candida strains. Micafungin susceptibility was 98.3%, and four C. parapsilosis SC strains (10%) were intermediate (I) to micafungin. Fluconazole susceptibility was 87.2%. Apart from C. krusei strains which intrinsically resistant to fluconazole, three C. parapsilosis (7.5%), one C. glabrata SC (5.3%) strain were resistant (R) to fluconazole, and one C. lusitaniae (12.5%) strain was wild-type (WT). Voriconazole susceptibility of Candida strains was 98.6%. Two C. parapsilosis SC strains were I to voriconazole, while one strain was R. Conclusion In this study, the first epidemiological data of candidemia agents in our hospital were presented. It was determined that rare and naturally resistant species did not cause any problem in our center yet. C. parapsilosis SC strains showed decreased susceptibility to fluconazole, whereas Candida strains were highly susceptible to the four antifungals tested. Close monitoring of these data will help guide the treatment of candidemia.
Collapse
Affiliation(s)
- Burcu Dalyan Cilo
- Section of Medical Mycology, University of Health Sciences, Bursa Yuksek Ihtisas Training & Research Hospital, Bursa, TUR
| |
Collapse
|
2
|
Erol Ç, Sarı N, Yanık-Yalçın T, Yeşilkaya A, Asena L, Gür-Güngör S, Kurt-Azap Ö. Ophthalmologic Examination and Echocardiography Should be the Essential Components of Candidemia Bundle. INFECTIOUS DISEASES & CLINICAL MICROBIOLOGY 2023; 5:40-48. [PMID: 38633906 PMCID: PMC10986693 DOI: 10.36519/idcm.2023.203] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Accepted: 02/16/2023] [Indexed: 04/19/2024]
Abstract
Objective Candidemia is the most common form of invasive candidiasis, and it is associated with end-organ involvement, prolonged hospitalization, increased mortality, and higher healthcare costs. Candidemia can lead to metastatic heart and ocular infections. This study aimed to define the incidence, characteristics, and mortality of candidemia episodes and compare the data with our center's previous results. Materials and Methods In this single-center retrospective observational study, we enrolled 250 patients over 18 years diagnosed with candidemia between January 2015 and December 2020. We obtained patients' demographic, clinical, laboratory, and therapeutic data from medical records. An ophthalmologic examination and screening with echocardiography were carried out within the first week after candidemia diagnosis. Results There were 275 candidemia episodes from 250 patients. The incidence of candidemia was 2.8/1000 admissions and 5.68/ 10,000 inpatient days, higher than our previous results (1.23/1000 and 3.29/10,000). The median age was 65 (interquartile range [IQR]=52-75) years. Malignancies were the most frequent comorbidity (50%). The most common type was Candida albicans (n=115, 41.8%). Candida glabrata (n=61, 22.2%) was common, particularly in surgical patients, patients with malignancy, and critically ill patients. There was Infectious disease consultation in 93.3% (257) episodes.The ophthalmoscopic examination was made in 145 episodes (52.7%), and ophthalmitis was detected in 16 (11.0%). Echocardiography was performed in 139 (50.5%) episodes; one case had an endocarditis diagnosis. The 30-day mortality was 44.7% (n=123). Mortality rates in C. glabrata and Candida krusei infections were higher (54.1% and 66.7). The factors related to mortality were intensive care unit requirement (p=0.0001), chronic liver disease (p=0.005), corticosteroid usage (p=0.0001), previous antibiotic usage (p=0.013), multiple antibiotic usage ( p=0.020), and CVC related candidemia (p=0.010). Conclusion Because of the life-threatening complications such as endocarditis, increased mortality rates, and higher healthcare costs, systematic and comprehensive candidemia bundle applications would be effective strategies for providing an effective antifungal stewardship program.
Collapse
Affiliation(s)
- Çiğdem Erol
- Department of Infectious Diseases and Clinical Microbiology, Başkent University School of Medicine, Ankara, Turkey
| | - Nuran Sarı
- Department of Infectious Diseases and Clinical Microbiology, Başkent University School of Medicine, Ankara, Turkey
| | - Tuğba Yanık-Yalçın
- Department of Infectious Diseases and Clinical Microbiology, Başkent University School of Medicine, Ankara, Turkey
| | - Ayşegül Yeşilkaya
- Department of Infectious Diseases and Clinical Microbiology, Başkent İstanbul Hospital, İstanbul, Turkey
| | - Leyla Asena
- Department of Ophthalmology, Başkent University School of Medicine, Ankara, Turkey
| | - Sirel Gür-Güngör
- Department of Ophthalmology, Başkent University School of Medicine, Ankara, Turkey
| | - Özlem Kurt-Azap
- Department of Infectious Diseases and Clinical Microbiology, Başkent University School of Medicine, Ankara, Turkey
| |
Collapse
|
3
|
Ruiz de Alegría Puig C, García Merino MDS, De Malet Pintos-Fonseca A, Agüero Balbín J. Characterization, antifungal susceptibility and virulence of Candida parapsilosis complex isolates in a tertiary hospital in Cantabria, Northern Spain. ENFERMEDADES INFECCIOSAS Y MICROBIOLOGIA CLINICA (ENGLISH ED.) 2023; 41:99-102. [PMID: 36759059 DOI: 10.1016/j.eimce.2022.11.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Accepted: 08/04/2021] [Indexed: 04/14/2023]
Abstract
INTRODUCTION The correct identification of the species within the Candida parapsilosis complex has become relevant due to the resistance of Candida metapsilosis to antifungals. We describe the characteristics of the Candida parapsilosis complex isolates, with respect to antifungal resistance and biofilm formation. METHODS We perform a descriptive cross-sectional study in 30 strains, collected in a tertiary hospital. All strains, were identified by Vitek2, Vitek-MS™ systems and by ITS sequencing. The antifungal susceptibility profile was obtained with Sensititre™ panels, while biomass production and metabolic activity were quantified by means of crystal violet and XTT reduction assay, respectively. RESULTS There was a 100% correlation between Vitek-MS™ and ITS sequencing. All isolates were susceptible to the nine antifungals tested. The metabolic activity and biomass production tests did not show any difference among the subtypes. CONCLUSIONS The Vitek-MS™ system provides acceptable identification. We did not find significant differences neither in azole resistance nor in biofilm formation.
Collapse
Affiliation(s)
| | | | | | - Jesús Agüero Balbín
- Microbiology Service, University Hospital Marqués de Valdecilla-IDIVAL, Santander, Spain; Department of Molecular Biology, University of Cantabria, Santander, Spain
| |
Collapse
|
4
|
Kutlu M, Sayın-Kutlu S, Alp-Çavuş S, Öztürk ŞB, Taşbakan M, Özhak B, Kaya O, Kutsoylu OE, Şenol-Akar Ş, Turhan Ö, Mermut G, Ertuğrul B, Pullukcu H, Çetin ÇB, Avkan-Oğuz V, Yapar N, Yeşim-Metin D, Ergin Ç. Mortality-associated factors of candidemia: a multi-center prospective cohort in Turkey. Eur J Clin Microbiol Infect Dis 2022; 41:597-607. [PMID: 35083558 DOI: 10.1007/s10096-021-04394-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2021] [Accepted: 12/06/2021] [Indexed: 11/26/2022]
Abstract
Candidemia may present as severe and life-threatening infections and is associated with a high mortality rate. This study aimed to evaluate the risk factors associated with 30-day mortality in patients with candidemia. A multi-center prospective observational study was conducted in seven university hospitals in six provinces in the western part of Turkey. Patient data were collected with a structured form between January 2018 and April 2019. In total, 425 episodes of candidemia were observed during the study period. Two hundred forty-one patients died within 30 days, and the 30-day crude mortality rate was 56.7%. Multivariable analysis found that SOFA score (OR: 1.28, CI: 1.154-1.420, p < 0.001), parenteral nutrition (OR: 3.9, CI: 1.752-8.810, p = 0.001), previous antibacterial treatment (OR: 9.32, CI: 1.634-53.744, p = 0.012), newly developed renal failure after candidemia (OR: 2.7, CI: 1.079-6.761, p = 0.034), and newly developed thrombocytopenia after candidemia (OR: 2.6, CI: 1. 057-6.439, p = 0.038) were significantly associated with 30-day mortality. Central venous catheter removal was the only factor protective against mortality (OR: 0.34, CI:0.147-0.768, p = 0.010) in multivariable analysis. Candidemia mortality is high in patients with high SOFA scores, those receiving TPN therapy, and those who previously received antibacterial therapy. Renal failure and thrombocytopenia developing after candidemia should be followed carefully in patients. Antifungal therapy and removing the central venous catheter are essential in the management of candidemia.
Collapse
Affiliation(s)
- Murat Kutlu
- Infectious Diseases and Clinical Microbiology, Pamukkale University, Denizli, Turkey.
- Infectious Diseases and Clinical Microbiology Department, Pamukkale University, School of Medicine, Kınıklı/Pamukkale, 20070, Denizli, Turkey.
| | - Selda Sayın-Kutlu
- Infectious Diseases and Clinical Microbiology, Pamukkale University, Denizli, Turkey
| | - Sema Alp-Çavuş
- Infectious Diseases and Clinical Microbiology, Dokuz Eylul University, İzmir, Turkey
| | - Şerife Barçın Öztürk
- Infectious Diseases and Clinical Microbiology, Adnan Menderes University, Aydın, Turkey
| | - Meltem Taşbakan
- Infectious Diseases and Clinical Microbiology, Ege University, İzmir, Turkey
| | - Betil Özhak
- Medical Microbiology, Akdeniz University, Antalya, Turkey
| | - Onur Kaya
- Infectious Diseases and Clinical Microbiology, Süleyman Demirel University, Isparta, Turkey
| | - Oya Eren Kutsoylu
- Infectious Diseases and Clinical Microbiology, Dokuz Eylul University, İzmir, Turkey
| | - Şebnem Şenol-Akar
- Infectious Diseases and Clinical Microbiology, Celal Bayar University, Manisa, Turkey
| | - Özge Turhan
- Infectious Diseases and Clinical Microbiology, Akdeniz University, Antalya, Turkey
| | - Gülşen Mermut
- Infectious Diseases and Clinical Microbiology, Ege University, İzmir, Turkey
| | - Bülent Ertuğrul
- Infectious Diseases and Clinical Microbiology, Adnan Menderes University, Aydın, Turkey
| | - Hüsnü Pullukcu
- Infectious Diseases and Clinical Microbiology, Ege University, İzmir, Turkey
| | - Çiğdem Banu Çetin
- Infectious Diseases and Clinical Microbiology, Celal Bayar University, Manisa, Turkey
| | - Vildan Avkan-Oğuz
- Infectious Diseases and Clinical Microbiology, Dokuz Eylul University, İzmir, Turkey
| | - Nur Yapar
- Infectious Diseases and Clinical Microbiology, Dokuz Eylul University, İzmir, Turkey
| | | | - Çağrı Ergin
- Medical Microbiology, Pamukkale University, Denizli, Turkey
| |
Collapse
|
5
|
Changing Trends of Candida Species and Antifungal Susceptibility Profile of Candida Bloodstream Isolates: A 5-Year Retrospective Survey. Jundishapur J Microbiol 2022. [DOI: 10.5812/jjm.120801] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background: Candida species have emerged as one of the most common causes of bloodstream infections (BSIs). There are limited data on the distribution of Candida spp. and susceptibility by year. Objectives: In this study, we analyzed changes in the distribution of Candida spp. and their antifungal susceptibility profiles from blood cultures. Methods: Records from January 2016 to December 2020 were obtained from the microbiology laboratory in Istanbul. Antifungal susceptibility tests were performed using the VITEK 2 compact system and evaluated according to EUCAST breakpoints. A total of 241 unique candidemia episodes were included in this study. Results: Candida albicans was the predominant pathogen (n = 95, 39.42%), followed by C. parapsilosis (n = 82, 34.02%), C. glabrata (n = 18, 7.47%), C. tropicalis (n = 17, 7.05%), C. krusei (n = 15, 6.22%), and other Candida spp. (n = 14, 5.79%). There was no statistically significant difference in the percentage of episodes of Candida spp. After data analysis, a tendency to shift from C. albicans to C. parapsilosis was observed in the period analyzed in this study. Candida albicans was the most common species in intensive care units (ICUs), hematology and hemopoietic stem cell transplantation units, and surgical clinics, with C. parapsilosis predominant in medical clinics. In general, micafungin susceptibility was the highest, and fluconazole was the lowest. There was reduced sensitivity to fluconazole and voriconazole for C. albicans and C. parapsilosis over 5 years. Conclusions: Detecting changes in the distribution of Candida spp. and antifungal susceptibility over time will lead to the selection of appropriate empirical therapy and monitor phenomena of antifungal resistance. Empirical treatment with antifungal agents is associated with high costs, toxicities, and risk of antifungal resistance. Therefore, it is mandatory to determine and monitor Candida spp. and antifungal susceptibility testing to select appropriate antifungal agents.
Collapse
|
6
|
Dalyan Cilo B, Ener B. Comparison of Clinical Laboratory Standards Institute (CLSI) Microdilution Method and VITEK 2 Automated Antifungal Susceptibility System for the Determination of Antifungal Susceptibility of Candida Species. Cureus 2021; 13:e20220. [PMID: 35004039 PMCID: PMC8733416 DOI: 10.7759/cureus.20220] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/03/2021] [Indexed: 12/20/2022] Open
Abstract
Introduction Changes in the epidemiology of Candida infections, increasing resistance, and advances in treatment have increased the need to perform antifungal susceptibility testing in clinical laboratories. Standardized reference, the microbroth dilution method, and various commercial antifungal susceptibility test systems are used to determine antifungal susceptibility. This study aims to determine and compare the antifungal susceptibility of various Candida species isolated from blood cultures in our laboratory with the CLSI M27 microdilution reference method and VITEK 2 automated system (bioMérieux, Marcy-l'Étoile, France). Methods The antifungal susceptibility of a total of 140 Candida strains to fluconazole, voriconazole, and amphotericin B, and a total of 92 strains to anidulafungin was tested with the CLSI M27 method and the VITEK 2 automated system. For fluconazole, voriconazole, and amphotericin B, essential and categorical agreement percentages were calculated between the two methods. Because there is no anidulafungin in the VITEK 2 system, anidulafungin results obtained with CLSI were compared with micafungin only in terms of categorical agreement. In the category comparison, CLSI clinical breakpoints were used; the epidemiological cut-off values were used when they were not available. Very major error, major error, and minor error rates were calculated. Results In general, the minimum inhibitory concentration (MIC) values obtained with VITEK 2 for azole group drugs were found to be one-fold higher than the CLSI MICs read at the 24th hour. While the essential agreement between the two methods was >90% for amphotericin B and voriconazole, it remained at 85% for fluconazole. Overall, the best categorical agreement was obtained with amphotericin B (99.3%), and the least categorical agreement was obtained with voriconazole (85.7%). A very major error was seen with amphotericin B (0.7%) and fluconazole (0.7%) in one C. parapsilosis strain each. No resistance was detected with VITEK 2 in one C. glabrata strain found to be resistant to fluconazole by the reference method. Major and minor error rates were higher for azole drugs than amphotericin B and anidulafungin/micafungin. Conclusion The VITEK 2 system is a fast and highly applicable system, and with these features, it is advantageous for routine laboratories. In this study, although the error rate was not very high, one fluconazole-resistant C. parapsilosis and C. glabrata strain could not be detected with VITEK 2. The increase in data on the antifungal performance of the VITEK 2 system, which is available in many routine laboratories due to its ability to be used for bacteria identification and sensitivity, will contribute to the usability of the system for this purpose. In this study, data that will support the literature information in terms of the antifungal performance of the VITEK 2 system are presented.
Collapse
Affiliation(s)
- Burcu Dalyan Cilo
- Clinical Microbiology, University of Health Sciences, Bursa Yuksek Ihtisas Training & Research Hospital, Bursa, TUR
| | - Beyza Ener
- Microbiology, Microbiology, Uludag University Medical Faculty, Bursa, TUR
| |
Collapse
|
7
|
Puig CRDA, Merino MDSG, Fonseca ADMP, Balbín JA. Characterization, antifungal susceptibility and virulence of Candida parapsilosis complex isolates in a tertiary hospital in Cantabria, Northern Spain. Enferm Infecc Microbiol Clin 2021. [DOI: 10.1016/j.eimc.2021.08.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
|
8
|
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.
Collapse
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
| | | |
Collapse
|
9
|
Candidemia in Non-neutropenic Pediatric Patients in an Intensive Care Unit. JOURNAL OF CONTEMPORARY MEDICINE 2021. [DOI: 10.16899/jcm.843796] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
|
10
|
Mete B, Zerdali EY, Aygun G, Saltoglu N, Balkan II, Karaali R, Kaya SY, Karaismailoglu B, Kaya A, Urkmez S, Can G, Tabak F, Ozturk R. Change in species distribution and antifungal susceptibility of candidemias in an intensive care unit of a university hospital (10-year experience). Eur J Clin Microbiol Infect Dis 2021; 40:325-333. [PMID: 32935158 DOI: 10.1007/s10096-020-03994-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Accepted: 07/20/2020] [Indexed: 10/23/2022]
Abstract
Candidemia is a nosocomial infection mostly found in critically ill patients. Our objectives were to evaluate the change in distribution and resistance profile of Candida spp. isolated from candidemic patients in our intensive care unit over two 5-year periods spanning 15 years and to evaluate the risk factors. Records from the microbiology laboratory were obtained, from January 2004 to December 2008 and from January 2013 to December 2017, retrospectively. Antifungal susceptibility was performed by E-test and evaluated according to EUCAST breakpoints. A total of 210 candidemia cases occurred; 238 Candida spp. were isolated in 197 patients (58.8% male; mean age, 59.2 ± 19.6 years). The most predominant risk factor was central venous catheter use. Species distribution rates were 32%, 28%, 17%, and 11% for C. albicans (n = 76), C. parapsilosis (n = 67), C. glabrata (n = 40), and C. tropicalis (n = 27), respectively. Resistance rate to anidulafungin was high in C. parapsilosis over both periods and increased to 73% in the second period. Fluconazole showed a remarkable decrease for susceptibility in C. parapsilosis (94 to 49%). The prevalence of MDR C. parapsilosis (6%/33%) and C. glabrata (0%/44%) increased in the second period. We observed a predominance of non-albicans Candida spp., with C. parapsilosis being the most frequent and C. glabrata infections presenting with the highest mortality. High level of echinocandin resistance in C. parapsilosis and increasing prevalences of MDR C. parapsilosis and C. glabrata seem emerging challenges in our institution.
Collapse
Affiliation(s)
- Bilgul Mete
- Department of Infectious Diseases and Clinical Microbiology, Cerrahpasa School of Medicine, Istanbul University-Cerrahpasa, Istanbul, Turkey.
| | - Esra Yerlikaya Zerdali
- Department of Infectious Diseases and Clinical Microbiology, Istanbul Haseki Research and Training Hospital, Istanbul, Turkey
| | - Gokhan Aygun
- Department of Medical Microbiology, Cerrahpasa School of Medicine, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Nese Saltoglu
- Department of Infectious Diseases and Clinical Microbiology, Cerrahpasa School of Medicine, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Ilker Inanc Balkan
- Department of Infectious Diseases and Clinical Microbiology, Cerrahpasa School of Medicine, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Ridvan Karaali
- Department of Infectious Diseases and Clinical Microbiology, Cerrahpasa School of Medicine, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Sibel Yildiz Kaya
- Department of Infectious Diseases and Clinical Microbiology, Sungurlu State Hospital, Corum, Turkey
| | - Berna Karaismailoglu
- Department of Infectious Diseases and Clinical Microbiology, Cerrahpasa School of Medicine, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Abdurrahman Kaya
- Department of Infectious Diseases and Clinical Microbiology, Istanbul Research and Training Hospital, Istanbul, Turkey
| | - Seval Urkmez
- Department of Anesthesiology and Reanimation, Cerrahpasa School of Medicine, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Gunay Can
- Department of Public Health, Cerrahpasa School of Medicine, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Fehmi Tabak
- Department of Infectious Diseases and Clinical Microbiology, Cerrahpasa School of Medicine, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Recep Ozturk
- Department of Infectious Diseases and Clinical Microbiology, Medical Faculty, Istanbul Medipol University, Istanbul, Turkey
| |
Collapse
|
11
|
Osman M, Al Bikai A, Rafei R, Mallat H, Dabboussi F, Hamze M. Update on invasive fungal infections in the Middle Eastern and North African region. Braz J Microbiol 2020; 51:1771-1789. [PMID: 32623654 PMCID: PMC7335363 DOI: 10.1007/s42770-020-00325-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2019] [Accepted: 06/22/2020] [Indexed: 12/18/2022] Open
Abstract
In the recent years, the epidemiology of invasive fungal infections (IFIs) has changed worldwide. This is remarkably noticed with the significant increase in high-risk populations. Although surveillance of such infections is essential, data in the Middle Eastern and North African (MENA) region remain scarce. In this paper, we reviewed the existing data on the epidemiology of different IFIs in the MENA region. Epidemiological surveillance is crucial to guide optimal healthcare practices. This study can help to guide appropriate interventions and to implement antimicrobial stewardship and infection prevention and control programs in countries.
Collapse
Affiliation(s)
- Marwan Osman
- Laboratoire Microbiologie Santé et Environnement (LMSE), Doctoral School of Science and Technology, Faculty of Public Health, Lebanese University, Tripoli, Lebanon
| | - Aisha Al Bikai
- Laboratoire Microbiologie Santé et Environnement (LMSE), Doctoral School of Science and Technology, Faculty of Public Health, Lebanese University, Tripoli, Lebanon
| | - Rayane Rafei
- Laboratoire Microbiologie Santé et Environnement (LMSE), Doctoral School of Science and Technology, Faculty of Public Health, Lebanese University, Tripoli, Lebanon
| | - Hassan Mallat
- Laboratoire Microbiologie Santé et Environnement (LMSE), Doctoral School of Science and Technology, Faculty of Public Health, Lebanese University, Tripoli, Lebanon
| | - Fouad Dabboussi
- Laboratoire Microbiologie Santé et Environnement (LMSE), Doctoral School of Science and Technology, Faculty of Public Health, Lebanese University, Tripoli, Lebanon
| | - Monzer Hamze
- Laboratoire Microbiologie Santé et Environnement (LMSE), Doctoral School of Science and Technology, Faculty of Public Health, Lebanese University, Tripoli, Lebanon.
| |
Collapse
|
12
|
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]
|
13
|
Önal U, Metin DY, Karaca C, Hilmioğlu Polat S, Ersin S, Işıkgöz Taşbakan M. Retrospective evaluation of candidemic patients among general surgery department in a tertiary care university hospital. Turk J Surg 2019; 35:210-213. [PMID: 32550330 DOI: 10.5578/turkjsurg.4252] [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: 06/20/2018] [Accepted: 10/10/2018] [Indexed: 12/16/2022]
Abstract
Objectives Candida species are among the most important causes of hospital acquired blood borne infections, and with high rates of mortality and morbidity, these infections are still a major problem today. History of gastrointestinal surgery, administration of total parenteral nutrition and/or wide spectrum antibiotics and immune suppression following organ transplantations are considered serious risk factors for these infections. This study aimed to evaluate the patients from our general surgery department with diagnosed candidemia; by means of strain, treatment and prognosis. Material and Methods Patients with positive blood cultures for Candida species who were treated in the wards and Ege University Faculty of Medicine general surgery department of surgical intensive care units of our between 2012 and 2017 were retrospectively analyzed by means of strain, treatment and prognosis. Results A total of 50 patients were enrolled in the study. Mean age was 58.96 years and 54% of the patients were female. There were nine patients with organ transplantation (four liver and five kidney transplantations), six with intestinal perforation and three with anastomotic leakage. Isolated strains were Candida albicans (36%; 18/50), Candida tropicalis (14%; 7/50), Candida glabrata (12%; 6/50), Candida parapsilosis (8%; 4/50), Candida kefyr (6%; 3/50), Candida krusei (4%; 2/50), Candida pulcherrima (2%; 1/50), Cryptococcus neoformans (2%, 1/50), Geotrichum capitatum (2%, 1/50), Candida spp. (unidentified, 14%; 7/50) with decreasing frequency. The highest antifungal sensitivity rates (> 90%) were measured for amphotericin B, voriconazole and echinocandins among all isolates. One-month mortality rate was 43.4% (20/46). Documented eradication was achieved among 24 of the 33 patients who had control blood culture samples (72.7%), and mean eradication time was 7.6 days. Echocardiography was performed in 14% (7/50) and ophthalmic examination in 8% (4/50). Conclusion Although C. albicans appears to be the dominant strain in patients with candidemia, frequencies of other strains are increasing. Early diagnosis and treatment of patients with candidemia is of vital importance due to high mortality and morbidity rates.
Collapse
Affiliation(s)
- Uğur Önal
- Department of Infectious Diseases and Clinical Microbiology, Ege University School of Medicine, İzmir, Turkey
| | - Dilek Yeşim Metin
- Department of Medical Microbiology, Ege University School of Medicine, İzmir, Turkey
| | - Can Karaca
- Department of General Surgery, İzmir Economics University School of Medicine, İzmir, Turkey
| | | | - Sinan Ersin
- Department of General Surgery, Ege University School of Medicine, İzmir, Turkey
| | - Meltem Işıkgöz Taşbakan
- Department of Infectious Diseases and Clinical Microbiology, Ege University School of Medicine, İzmir, Turkey
| |
Collapse
|
14
|
Arikan-Akdagli S, Gülmez D, Doğan Ö, Çerikçioğlu N, Doluca Dereli M, Birinci A, Yıldıran ŞT, Ener B, Öz Y, Metin DY, Hilmioğlu-Polat S, Kalkancı A, Koç N, Erturan Z, Fındık D. First multicentre report of in vitro resistance rates in candidaemia isolates in Turkey. J Glob Antimicrob Resist 2019; 18:230-234. [DOI: 10.1016/j.jgar.2019.04.003] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2019] [Revised: 03/29/2019] [Accepted: 04/03/2019] [Indexed: 10/27/2022] Open
|
15
|
Ghazi S, Rafei R, Osman M, El Safadi D, Mallat H, Papon N, Dabboussi F, Bouchara JP, Hamze M. The epidemiology of Candida species in the Middle East and North Africa. J Mycol Med 2019; 29:245-252. [PMID: 31400864 DOI: 10.1016/j.mycmed.2019.07.006] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2019] [Revised: 06/30/2019] [Accepted: 07/09/2019] [Indexed: 12/23/2022]
Abstract
In recent decades, the epidemiology of invasive candidiasis (IC) has progressively changed worldwide. This notably includes emergence of several Candida species. Although some surveillance programs provided global trends in IC epidemiology, data from countries from the Middle East and North Africa (MENA) remain scarce. In this manuscript, we reviewed the existing available data on the epidemiology of Candida species associated with IC, particularly candidemia, in MENA region regarding species distribution. As witnessed worldwide, an evident shift of Candidaalbicans towards non-albicansCandida (NAC) has been observed in the MENA region. The worrying emergence of multi-drug resistant Candida species in MENA calls for a better understanding of their epidemiology. This represents an essential prerequisite for the implementation of effective infection control strategies and surveillance systems to prevent IC among high-risk patients.
Collapse
Affiliation(s)
- S Ghazi
- Laboratoire Microbiologie Santé et Environnement (LMSE), Doctoral School of Sciences and Technology, Faculty of Public Health, Lebanese University, Tripoli, Lebanon
| | - R Rafei
- Laboratoire Microbiologie Santé et Environnement (LMSE), Doctoral School of Sciences and Technology, Faculty of Public Health, Lebanese University, Tripoli, Lebanon
| | - M Osman
- Laboratoire Microbiologie Santé et Environnement (LMSE), Doctoral School of Sciences and Technology, Faculty of Public Health, Lebanese University, Tripoli, Lebanon
| | - D El Safadi
- Laboratoire Microbiologie Santé et Environnement (LMSE), Doctoral School of Sciences and Technology, Faculty of Public Health, Lebanese University, Tripoli, Lebanon
| | - H Mallat
- Laboratoire Microbiologie Santé et Environnement (LMSE), Doctoral School of Sciences and Technology, Faculty of Public Health, Lebanese University, Tripoli, Lebanon
| | - N Papon
- Groupe d'Etude des Interactions Hôte-Pathogène, GEIHP, EA 3142, SFR ICAT 4208, UNIV Angers, UNIV Brest, Institut de Biologie en Santé, IRIS, CHU Angers, 4, rue Larrey, 49933 Angers cedex 9, France
| | - F Dabboussi
- Laboratoire Microbiologie Santé et Environnement (LMSE), Doctoral School of Sciences and Technology, Faculty of Public Health, Lebanese University, Tripoli, Lebanon
| | - J-P Bouchara
- Groupe d'Etude des Interactions Hôte-Pathogène, GEIHP, EA 3142, SFR ICAT 4208, UNIV Angers, UNIV Brest, Institut de Biologie en Santé, IRIS, CHU Angers, 4, rue Larrey, 49933 Angers cedex 9, France
| | - M Hamze
- Laboratoire Microbiologie Santé et Environnement (LMSE), Doctoral School of Sciences and Technology, Faculty of Public Health, Lebanese University, Tripoli, Lebanon.
| |
Collapse
|
16
|
Abstract
BACKGROUND Amphotericin B deoxycholate (AmB-D) is standard of care treatment for neonatal invasive candidiasis (IC). Micafungin (MCA) has broad-spectrum fungicidal activity against Candida spp. We compared the efficacy and safety of intravenous MCA with intravenous AmB-D and assessed the pharmacokinetics of MCA in infants >2-120 days of age with proven IC in a phase 3, randomized, double-blind, multicenter, parallel-group, noninferiority study (NCT00815516). METHODS Infants were randomized 2:1 to MCA (10 mg/kg/d) or AmB-D (1 mg/kg/d) for ≥21 days. Primary efficacy endpoint was fungal-free survival (FFS) 1 week after last study drug dose. MCA population pharmacokinetics included simulated area under the curve (AUC) at steady state and maximum plasma concentration after 2-hour infusion. AUC pharmacodynamic target exposure was 170 µg·h/mL. RESULTS Thirty infants received MCA (n = 20) or AmB-D (n = 10). The trial was terminated early because of slow recruitment. FFS was observed in 12 of 20 [60%; 95% confidence interval (CI): 36%-81%] MCA-group infants and in 7 of 10 (70%; 95% CI: 35%-93%) AmB-D-group infants. The most common treatment-emergent adverse events were anemia [MCA: n = 9 (45%); AmB-D: n = 3 (30%)] and thrombocytopenia [n = 2 (10%) and n = 3 (30%), respectively]. Model-derived mean AUC at steady state for MCA was 399.3 ± 163.9 µg·h/mL (95% prediction interval: 190.3-742.3 µg/mL); steady state and maximum plasma concentration after 2-hour infusion was 31.1 ± 10.5 µg/mL (95% prediction interval: 17.0-49.7 µg/mL). MCA exposures were above the AUC pharmacodynamic target exposure. CONCLUSIONS Within the study limitations, infants with IC treated with MCA achieved similar FFS compared with AmB-D. Both agents were safe and well tolerated.
Collapse
|
17
|
Evaluation of candidemia and antifungal consumption in a large tertiary care Italian hospital over a 12-year period. Infection 2018; 46:469-476. [PMID: 29654496 DOI: 10.1007/s15010-018-1139-z] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2018] [Accepted: 04/09/2018] [Indexed: 12/24/2022]
Abstract
PURPOSE An early adequate antifungal therapy based on the knowledge of local epidemiology can reduce the candidemia-attributable mortality and the length of hospitalization. We performed a retrospective study to analyze the epidemiology of candidemia and the antifungal consumption in our hospital. METHODS We analyzed Candida spp. isolated from the blood, and their susceptibility profile from 2005 to 2016 in Careggi University Hospital, Florence, Italy. We also performed a stratified analysis by clinical setting where Candida spp. were isolated (Medical Wards, Surgery, Intensive Care Unit-ICU). Then, we retrospectively reviewed the annual consumption of antifungal agents and calculated the defined daily dosing for 10,000 hospital days. RESULTS The rate of candidemia was higher in ICU than other settings and Candida albicans was the first cause of candidemia (61.2%). After adjustment for hospital days, the rate of C. albicans showed a statistically significant parabolic trend (p < 0.001), with a peak of incidence in 2010. After 2010, we observed a reduction of candidemia due to both C. albicans and non-albicans species. Between 2005 and 2015, we reported an increasing increased use of echinocandins. As far as resistance profile is concerned, only one Candida glabrata isolate was resistant to caspofungin (1.9%) and 30% of C. glabrata were resistant to fluconazole. CONCLUSIONS Our data describe C. albicans as the first cause of candidemia in all the studied settings and the low rate of echinocandin resistance, despite their increased use over the study period. ICU was confirmed as the setting with the highest incidence of candidemia.
Collapse
|
18
|
Goemaere B, Becker P, Van Wijngaerden E, Maertens J, Spriet I, Hendrickx M, Lagrou K. Increasing candidaemia incidence from 2004 to 2015 with a shift in epidemiology in patients preexposed to antifungals. Mycoses 2017; 61:127-133. [PMID: 29024057 DOI: 10.1111/myc.12714] [Citation(s) in RCA: 43] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2017] [Revised: 10/04/2017] [Accepted: 10/06/2017] [Indexed: 11/30/2022]
Abstract
Candidaemia is an important health problem in immunocompromised patients with an epidemiology varying with region, period and patient population involved. The occurrence of candidaemia and the associated species distribution over a 12-year period at a large tertiary care centre in Belgium were analysed. The trend in incidence in the intensive care units (ICUs) and non-ICUs was investigated as well as the influence of antifungal exposure on the species distribution. From 2004 until 2015, 865 candidaemia episodes occurred in 826 patients at the University Hospitals Leuven. Candida albicans (59%) remained the most important cause of candidaemia, followed by C. glabrata (22.4%) and C. parapsilosis (8%). The mean incidence in the whole hospital was 1.48 per 10 000 patient days (PD). The incidence in ICUs increased reaching up to 10.7 per 10 000 PD whereas in the non-ICUs, the incidence decreased. Prior exposure to fluconazole and echinocandins was associated with candidaemia caused by less susceptible species. Candidaemia incidence increased in the whole hospital, driven by ICUs. Surveillance of candidaemia epidemiology on a local scale is of high value to guide empirical treatment strategies.
Collapse
Affiliation(s)
- Berdieke Goemaere
- Service of Mycology and Aerobiology, BCCM/IHEM Fungal Collection, Scientific Institute of Public Health, Brussels, Belgium
| | - Pierre Becker
- Service of Mycology and Aerobiology, BCCM/IHEM Fungal Collection, Scientific Institute of Public Health, Brussels, Belgium
| | - Eric Van Wijngaerden
- Department of Microbiology and Immunology, Laboratory for Clinical Infectious and Inflammatory Disorders, University of Leuven, University Hospitals Leuven, Leuven, Belgium
| | - Johan Maertens
- Department of Microbiology and Immunology, Laboratory of Clinical Bacteriology and Mycology, University of Leuven, University Hospitals Leuven, Leuven, Belgium
| | - Isabel Spriet
- Department of Pharmaceutical and Pharmacological Sciences, Clinical Pharmacology and Pharmacotherapy, University of Leuven, University Hospitals Leuven, Leuven, Belgium
| | - Marijke Hendrickx
- Service of Mycology and Aerobiology, BCCM/IHEM Fungal Collection, Scientific Institute of Public Health, Brussels, Belgium
| | - Katrien Lagrou
- Department of Microbiology and Immunology, Laboratory of Clinical Bacteriology and Mycology, University of Leuven, University Hospitals Leuven, Leuven, Belgium
| |
Collapse
|
19
|
Abstract
INTRODUCTION AND AIM Spontaneous bacterial peritonitis is the most common infectious complication in cirrhosis. Spontaneous fungal peritonitis is rare and remains unknown. In this work, spontaneous fungal peritonitis as well as risk factors and prognosis are characterized. PATIENTS AND METHODS A retrospective case-control study of 253 consecutive admissions by peritonitis in cirrhotic patients was carried out between 2006 and 2015. Comparison of patients with spontaneous fungal peritonitis (cases) and spontaneous bacterial peritonitis with positive microbiologic ascitic fluid culture (controls) was performed. Variables such as sociodemographic and clinical features, cirrhosis etiology, liver dysfunction scores, ascitic and laboratory parameters, invasive procedures, and prognosis were evaluated. RESULTS Of the 231 patients, eight (3.5%) developed spontaneous fungal peritonitis, 62.5% of cases being coinfected with bacteria. Candida spp. was isolated in 87.5% of cases, mainly Candida albicans (37.5%) and C. krusei (25.0%). Patients with spontaneous fungal peritonitis had higher ascitic fluid lactate dehydrogenase (288.4±266.6 vs. 161.0±179.5; P=0.011), blood leukocyte count (15187.5±5432.3 vs. 10969.8±6949.5; P=0.028), blood urea nitrogen (69.8±3.1 vs. 36.3±25.5; P=0.001), higher number of invasive procedures (colonoscopy: 25.0 vs. 0.8%, P=0.001; urinary catheterization: 87.5 vs. 49.6%, P=0.038; nasogastric intubation: 87.5 vs. 26.9%, P=0.001), and longer duration of hospital stay (30.0±32.9 vs. 18.9±17.0 days; P=0.031). No statistical difference was found between the two groups for Model for End-Stage Liver Disease, Model for End-Stage Liver Disease-sodium, and Child-Pugh scores. Spontaneous fungal peritonitis was associated with a worse prognosis, particularly severe sepsis/septic shock (87.5 vs. 42.8%, P=0.023), admission in the gastroenterology intensive care unit (87.5 vs. 24.4%; P=0.001), and overall (62.5 vs. 31.9%; P=0.039) or 30-day mortality (50.0 vs. 24.4%; P=0.034), with a mean diagnosis-death time of 17.6±11.5 days. CONCLUSION Despite being a rare condition, spontaneous fungal peritonitis was associated with worse prognosis and higher mortality than SBP. The ascitic fluid lactate dehydrogenase, blood leukocyte count and urea nitrogen, invasive procedures, and longer admission time were independent risk factors for spontaneous fungal peritonitis.
Collapse
|
20
|
Yeşilkaya A, Azap Ö, Aydın M, Akçil Ok M. Epidemiology, species distribution, clinical characteristics and mortality of candidaemia in a tertiary care university hospital in Turkey, 2007-2014. Mycoses 2017; 60:433-439. [PMID: 28338249 DOI: 10.1111/myc.12618] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2016] [Revised: 02/23/2017] [Accepted: 02/23/2017] [Indexed: 01/05/2023]
Abstract
Candidaemia still continues to be a serious medical concern and the epidemiology of candidaemia varies according to geographical areas. We aim to determine the incidence, local epidemiology, Candida species distribution and crude mortality rates of candidaemia. We retrospectively evaluated candidaemia episodes in between January 2007 and August 2014. We compared demographic, clinical, microbiological findings and mortality rates of episodes caused by Candida albicans and non-albicans Candida species. Overall the candidaemia incidences were 1.23 episodes/1000 admissions. A significant negative slope among candidaemia episodes and years was determined. Overall C. albicans (54.6%) was the most common species followed by Candida glabrata, Candida tropicalis and Candida parapsilosis respectively. Preinfection hospital stay and length of hospital stay were statistically longer in patients with non-albicans Candida candidaemia than in patients with C. albicans candidaemia. The source of candidaemia was unknown in 52.5% of all episodes. Central venous catheters among non-albicans Candida candidaemia episodes and urinary system among C. albicans candidaemia episodes were common source of candidaemia compared to each other. Previous antifungal therapy preceding candidaemia and concomitant bacteraemia were significantly associated with non-albicans Candida candidaemia. Continuous local surveillance will preserve its pivotal importance in formulating empirical antifungal therapy and improving management of candidaemia.
Collapse
Affiliation(s)
- Ayşegül Yeşilkaya
- Faculty of Medicine, Department of Infectious Diseases and Clinical Microbiology, Baskent University, Ankara, Turkey
| | - Özlem Azap
- Faculty of Medicine, Department of Infectious Diseases and Clinical Microbiology, Baskent University, Ankara, Turkey
| | - Mehtap Aydın
- Faculty of Medicine, Department of Infectious Diseases and Clinical Microbiology, Baskent University, Ankara, Turkey
| | - Mehtap Akçil Ok
- Faculty of Health Sciences, Department of Nutrition and Dietetic, Baskent University, Ankara, Turkey
| |
Collapse
|
21
|
Ulu Kilic A, Alp E, Cevahir F, Ture Z, Yozgat N. Epidemiology and cost implications of candidemia, a 6-year analysis from a developing country. Mycoses 2016; 60:198-203. [PMID: 27862414 DOI: 10.1111/myc.12582] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2016] [Revised: 08/29/2016] [Accepted: 10/07/2016] [Indexed: 11/28/2022]
Abstract
Surveillance of candidemia is essential to monitor trends in species distribution and change in the incidence and antifungal resistance. In this study, we aimed to investigate prevalence, resistance rates, antifungal utilization and costs. A 6-year retrospective analysis of the data belonging to patients with candidemia hospitalized between 2010 and 2016 was performed. The annual usage of fluconazole and caspofungin and the usage of these antifungals in different units were described in defined daily doses (DDD) per 1000 patient days. In total, 351 patients of candidemia were included. Median age of the patients was 45 (0-88) and 55.1% of them were male. Overall, 48.1% of the candidemia episodes (169/351) were due to C. albicans, followed by C. parapsilosis (25.1%), C. glabrata (11.7%). Length of hospital stay was longer with a median of 20 days among patients with non-albicans candidemia. Presence of a central venous catheter was found to be an associated risk for candidemia caused by non-albicans strains. Annual incidence of candidemia increased from 0.10 to 0.30 cases/1000 patient days. Antifungal use was increased over years correlated with the cost paid for it. The policy against candidemia should be specified by each institution with respect to candidemia prevalence, resistance rates, antifungal use and costs.
Collapse
Affiliation(s)
- Aysegul Ulu Kilic
- Department of Infectious Diseases, Faculty of Medicine, Erciyes University, Kayseri, Turkey
| | - Emine Alp
- Department of Infectious Diseases, Faculty of Medicine, Erciyes University, Kayseri, Turkey
| | - Fatma Cevahir
- Infection Control Committee, Faculty of Medicine, Fatma Cevahir Erciyes University, Kayseri, Turkey
| | - Zeynep Ture
- Department of Infectious Diseases, Faculty of Medicine, Zeynep Türe Erciyes University, Kayseri, Turkey
| | - Nuran Yozgat
- Department of Pharmacy, Faculty of Medicine, Nuran Yozgat Erciyes University, Kayseri, Turkey
| |
Collapse
|
22
|
Khatib R, Johnson LB, Fakih MG, Riederer K, Briski L. Current trends in candidemia and species distribution among adults: Candida glabrata surpasses C. albicans in diabetic patients and abdominal sources. Mycoses 2016; 59:781-786. [PMID: 27402377 DOI: 10.1111/myc.12531] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2016] [Revised: 06/02/2016] [Accepted: 06/08/2016] [Indexed: 01/18/2023]
Abstract
Candidemia rate and species distribution vary according to the type of patients, country of origin and antifungal prophylaxis use. To present current candidemia epidemiological trends. A retrospective examination of candidemia in adults (≥18 years-old) hospitalised from 2007 to 2015. Cases were identified through the microbiology laboratory. Candida species were distinguished based on colony morphology and VITEK-2 YBC cards, (bioMerieux, Durham, NC, USA). Patient characteristics, species distribution, source and outcome were assessed. We encountered 275 patients (294 episodes) with candidemia. The rate of candidemia dropped in 2010 (P = 0.003) without further decline. Nearly all cases (97.5%) were healthcare-associated. C. albicans (n = 118) and C. glabrata (n = 77) proportions varied without a discernable trend. C. glabrata was more common in diabetics [52.9% vs. 32.0% (non-diabetics); P = 0.004] and abdominal sources [53.3% vs. 35.5% (other sources); P = 0.03], especially gastric/duodenal foci [88.9% vs. 44.1% (other abdominal foci); P = 0.02]. All-cause 30-day mortality rate was 43.3% without changes over time or differences between C. albicans and C. glabrata. In conclusion, the candidemia rate remains stable after a decline in 2010. C. albicans remains the most common species but C. glabrata predominates in diabetics and abdominal sources. These findings suggest possible species-related differences in colonisation dynamics or pathogenicity.
Collapse
Affiliation(s)
- Riad Khatib
- Department of Medicine, St. John Hospital & Medical Center, Grosse Pointe Woods, MI, USA
| | - Leonard B Johnson
- Department of Medicine, St. John Hospital & Medical Center, Grosse Pointe Woods, MI, USA
| | - Mohamad G Fakih
- Department of Medicine, St. John Hospital & Medical Center, Grosse Pointe Woods, MI, USA
| | - Kathleen Riederer
- Department of Medical Education, St. John Hospital & Medical Center, Grosse Pointe Woods, MI, USA
| | - Laurence Briski
- Department of Pathology, St. John Hospital & Medical Center, Grosse Pointe Woods, MI, USA
| |
Collapse
|
23
|
Calandra T, Roberts JA, Antonelli M, Bassetti M, Vincent JL. Diagnosis and management of invasive candidiasis in the ICU: an updated approach to an old enemy. CRITICAL CARE : THE OFFICIAL JOURNAL OF THE CRITICAL CARE FORUM 2016; 20:125. [PMID: 27230564 PMCID: PMC4882871 DOI: 10.1186/s13054-016-1313-6] [Citation(s) in RCA: 65] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Invasive fungal infections, particularly those caused by Candida species, are not uncommon in critically ill patients and are associated with considerable morbidity and mortality. Diagnosis and management of these infections can be challenging. In this review, we will briefly discuss recent epidemiological data on invasive candidiasis and current diagnostic approaches before concentrating on antifungal treatments.
Collapse
Affiliation(s)
- Thierry Calandra
- Infectious Diseases Service, Centre Hospitalier Universitaire Vaudois, University of Lausanne, Rue du Bugnon 46, 1011, Lausanne, Switzerland
| | - Jason A Roberts
- Burns, Trauma and Critical Care Research Centre, The University of Queensland, Royal Brisbane and Women's Hospital, Butterfield Street, 4029 Herston, Brisbane, Australia
| | - Massimo Antonelli
- Department of Anesthesiology and Intensive Care Medicine, Catholic University of Rome, A. Gemelli University Hospital, Largo A. Gemelli 8, 00168, Rome, Italy
| | - Matteo Bassetti
- Infectious Diseases Division, Santa Maria Misericordia University Hospital, Piazzale Santa MAria della Misericordia 15, 33100, Udine, Italy
| | - Jean-Louis Vincent
- Department of Intensive Care, Erasme Hospital, Université libre de Bruxelles, Route de Lennik 808, 1070, Brussels, Belgium.
| |
Collapse
|
24
|
Tadec L, Talarmin JP, Gastinne T, Bretonnière C, Miegeville M, Le Pape P, Morio F. Epidemiology, risk factor, species distribution, antifungal resistance and outcome of Candidemia at a single French hospital: a 7-year study. Mycoses 2016; 59:296-303. [PMID: 26806101 DOI: 10.1111/myc.12470] [Citation(s) in RCA: 43] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2015] [Revised: 12/17/2015] [Accepted: 12/18/2015] [Indexed: 11/27/2022]
Abstract
Candidemia remains a major cause of disease worldwide and is associated with a high mortality rate. We conducted a retrospective study of candidemia at Nantes Hospital, France, between 2004 and 2010. A total of 191 episodes (n = 188 patients) were reviewed. Incidence, demographics, risk factors, antifungal management, species identification, in vitro susceptibility and 12 weeks survival were analysed. Global incidence of candidemia was 0.37‰ admissions. Higher incidences were observed in haematology (6.65‰) and intensive care units (2‰). Central venous catheter and antibiotic exposure were the most frequent risk factors (77% and 76% respectively). Candida albicans was the predominant species (51.8%) followed by C. parapsilosis (14.5%), C. glabrata (9.8%), C. tropicalis (9.8%) and C. krusei (4.1%). However, species distribution differed significantly between medical units with frequency of C. tropicalis being higher in haematology compared to other medical units. Fluconazole and caspofungin were the main antifungals given as first-line therapy. Although not significant, 12 weeks mortality rate was 30.9%, being higher for C. tropicalis (44.4%) than for C. parapsilosis (16%). Acquired azole or echinocandin resistance was noted in some isolates, underlining the need for systematic antifungal susceptibility testing in patients with candidemia. These epidemiological findings will be of interest for antifungal stewardship at our hospital.
Collapse
Affiliation(s)
- Laurent Tadec
- Département de Parasitologie et Mycologie Médicale, EA1155 - IICiMed, Faculté de Pharmacie, Université de Nantes, Nantes Atlantique Universités, Nantes, France.,Laboratoire de Parasitologie-Mycologie, CHU de Nantes, Nantes, France
| | | | - Thomas Gastinne
- Service d'Hématologie Clinique, CHU de Nantes, Nantes, France
| | | | - Michel Miegeville
- Département de Parasitologie et Mycologie Médicale, EA1155 - IICiMed, Faculté de Pharmacie, Université de Nantes, Nantes Atlantique Universités, Nantes, France.,Laboratoire de Parasitologie-Mycologie, CHU de Nantes, Nantes, France
| | - Patrice Le Pape
- Département de Parasitologie et Mycologie Médicale, EA1155 - IICiMed, Faculté de Pharmacie, Université de Nantes, Nantes Atlantique Universités, Nantes, France.,Laboratoire de Parasitologie-Mycologie, CHU de Nantes, Nantes, France
| | - Florent Morio
- Département de Parasitologie et Mycologie Médicale, EA1155 - IICiMed, Faculté de Pharmacie, Université de Nantes, Nantes Atlantique Universités, Nantes, France.,Laboratoire de Parasitologie-Mycologie, CHU de Nantes, Nantes, France
| |
Collapse
|
25
|
Ataides FS, Costa CR, Souza LKHE, Fernandes ODL, Jesuino RSA, Silva MDRR. Molecular identification and antifungal susceptibility profiles of Candida parapsilosis complex species isolated from culture collection of clinical samples. Rev Soc Bras Med Trop 2015; 48:454-9. [DOI: 10.1590/0037-8682-0120-2015] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2015] [Accepted: 07/08/2015] [Indexed: 11/21/2022] Open
|
26
|
Alp S, Arikan-Akdagli S, Gulmez D, Ascioglu S, Uzun O, Akova M. Epidemiology of candidaemia in a tertiary care university hospital: 10-year experience with 381 candidaemia episodes between 2001 and 2010. Mycoses 2015; 58:498-505. [DOI: 10.1111/myc.12349] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2014] [Revised: 02/06/2015] [Accepted: 03/26/2015] [Indexed: 01/02/2023]
Affiliation(s)
- Sehnaz Alp
- Faculty of Medicine; Department of Infectious Diseases and Clinical Microbiology; Hacettepe University; Ankara Turkey
| | - Sevtap Arikan-Akdagli
- Faculty of Medicine; Department of Medical Microbiology; Hacettepe University; Ankara Turkey
| | - Dolunay Gulmez
- Faculty of Medicine; Department of Medical Microbiology; Hacettepe University; Ankara Turkey
| | - Sibel Ascioglu
- Faculty of Medicine; Department of Infectious Diseases and Clinical Microbiology; Hacettepe University; Ankara Turkey
| | - Omrum Uzun
- Faculty of Medicine; Department of Infectious Diseases and Clinical Microbiology; Hacettepe University; Ankara Turkey
| | - Murat Akova
- Faculty of Medicine; Department of Infectious Diseases and Clinical Microbiology; Hacettepe University; Ankara Turkey
| |
Collapse
|
27
|
Components of the calcium-calcineurin signaling pathway in fungal cells and their potential as antifungal targets. EUKARYOTIC CELL 2015; 14:324-34. [PMID: 25636321 DOI: 10.1128/ec.00271-14] [Citation(s) in RCA: 118] [Impact Index Per Article: 13.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
In recent years, the emergence of fungal resistance has become frequent, partly due to the widespread clinical use of fluconazole, which is minimally toxic and effective in the prevention and treatment of Candida albicans infections. The limited selection of antifungal drugs for clinical fungal infection therapy has prompted us to search for new antifungal drug targets. Calcium, which acts as the second messenger in both mammals and fungi, plays a direct role in controlling the expression patterns of its signaling systems and has important roles in cell survival. In addition, calcium and some of the components, mainly calcineurin, in the fungal calcium signaling pathway mediate fungal resistance to antifungal drugs. Therefore, an overview of the components of the fungal calcium-calcineurin signaling network and their potential roles as antifungal targets is urgently needed. The calcium-calcineurin signaling pathway consists of various channels, transporters, pumps, and other proteins or enzymes. Many transcriptional profiles have indicated that mutant strains that lack some of these components are sensitized to fluconazole or other antifungal drugs. In addition, many researchers have identified efficient compounds that exhibit antifungal activity by themselves or in combination with antifungal drugs by targeting some of the components in the fungal calcium-calcineurin signaling pathway. This targeting disrupts Ca(2+) homeostasis, which suggests that this pathway contains potential targets for the development of new antifungal drugs.
Collapse
|
28
|
Inhibition of nucleic acid biosynthesis makes little difference to formation of amphotericin B-tolerant persisters in Candida albicans biofilm. Antimicrob Agents Chemother 2014; 59:1627-33. [PMID: 25547355 DOI: 10.1128/aac.03765-14] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Candida albicans persisters constitute a small subpopulation of biofilm cells and play a major role in recalcitrant chronic candidiasis; however, the mechanism underlying persister formation remains unclear. Persisters are often described as dormant, multidrug-tolerant, nongrowing cells. Persister cells are difficult to isolate and study not only due to their low levels in C. albicans biofilms but also due to their transient, reversible phenotype. In this study, we tried to induce persister formation by inducing C. albicans cells into a dormant state. C. albicans cells were pretreated with 5-fluorocytosine (planktonic cells, 0.8 μg ml(-1); biofilm cells, 1 μg ml(-1)) for 6 h at 37°C, which inhibits nucleic acid and protein synthesis. Biofilms and planktonic cultures of eight C. albicans strains were surveyed for persisters after amphotericin B treatment (100 μg ml(-1) for 24 h) and CFU assay. None of the planktonic cultures, with or without 5-fluorocytosine pretreatment, contained persisters. Persister cells were found in biofilms of all tested C. albicans strains, representing approximately 0.01 to 1.93% of the total population. However, the persister levels were not significantly increased in C. albicans biofilms pretreated with 5-fluorocytosine. These results suggest that inhibition of nucleic acid synthesis did not seem to increase the formation of amphotericin B-tolerant persisters in C. albicans biofilms.
Collapse
|