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Önal P, Aygün FD, Sever GA, Eren BA, Kes G, Aygün F, Zübarioğlu T, Beşer ÖF, Ocak S, Yazgan Z, Zeybek ÇA, Aygün G, Camcıoğlu Y, Çokuğraş H. Emerging trends in pediatric candidemia: mapping the rise in Candida parapsilosis incidence and antifungal resistance in Turkey. J Trop Pediatr 2024; 70:fmae015. [PMID: 39142804 DOI: 10.1093/tropej/fmae015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/16/2024]
Abstract
Candidemia is emerging as a significant concern in children, particularly among those with underlying conditions like malignancies or prematurity. The interpretation of epidemiological data on candidemias and their antifungal resistance plays a vital role in aiding diagnosis and guiding clinicians in treatment decisions. From 2014 to 2021, a retrospective analysis was conducted in İstanbul, Turkey; comparing Candida albicans and non-albicans (NAC) spp in both surviving and deceased groups. Furthermore, an examination of Candida parapsilosis and other species was performed, assessing various clinical and laboratory parameters. Among 93 patients, with a median age of 17 months, C. parapsilosis emerged as the predominant isolated species (44%), followed by C. albicans (34.4%). Resistance to fluconazole, voricanozole, and echinocandins, along with a history of broad-spectrum antibiotic use were found to be significantly higher in the non-albicans Candida group compared to C. albicans group. In the C. parapsilosis group, statistically lower age was identified in comparison to the other groups (P = .018). In addition, high fluconazole and voriconazole resistance was detected in Candida parapsilosis spp. Our study highlights a notable prevalence of C. parapsilosis, particularly in younger children, which is different from similar studies in childhood. This trend may be attributed to the common use of total parenteral nutrition and central venous catheter in gastrointestinal disorders and metabolic diseases. Furthermore, as anticipated, high azole resistance is noted in C. parapsilosis and other non-albicans Candida species. Interestingly, resistance to both amphotericin B and echinocandins within this group has been notably high. It is crucial to emphasize the considerable antifungal resistance seen in C. parapsilosis isolates.
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Affiliation(s)
- Pınar Önal
- Department of Pediatric Infectious Diseases, Cerrahpasa Medical School, Istanbul University-Cerrahpasa, İstanbul 34098, Turkey
| | - Fatma Deniz Aygün
- Department of Pediatric Infectious Diseases, Cerrahpasa Medical School, Istanbul University-Cerrahpasa, İstanbul 34098, Turkey
| | - Gözde Apaydın Sever
- Department of Pediatric Infectious Diseases, Cerrahpasa Medical School, Istanbul University-Cerrahpasa, İstanbul 34098, Turkey
| | - Beste Akdeniz Eren
- Department of Pediatric Infectious Diseases, Cerrahpasa Medical School, Istanbul University-Cerrahpasa, İstanbul 34098, Turkey
| | - Gülşen Kes
- Department of Pediatric Infectious Diseases, Cerrahpasa Medical School, Istanbul University-Cerrahpasa, İstanbul 34098, Turkey
| | - Fatih Aygün
- Department of Pediatric Intensive Care, Cerrahpasa Medical School, Istanbul University-Cerrahpasa, İstanbul 34098, Turkey
| | - Tanyel Zübarioğlu
- Department of Pediatric Metabolic Diseases, Cerrahpasa Medical School, Istanbul University-Cerrahpasa, İstanbul 34098, Turkey
| | - Ömer Faruk Beşer
- Department of Pediatric Gastroenterology, Hepatology and Nutrition, Istanbul University-Cerrahpasa, İstanbul 34098, Turkey
| | - Süheyla Ocak
- Department of Pediatric Hematology-Oncology, Cerrahpasa Medical School, Istanbul University-Cerrahpasa, İstanbul 34098, Turkey
| | - Zeynep Yazgan
- Department of Medical Microbiology, Cerrahpasa Medical School, Istanbul University-Cerrahpasa, İstanbul 34098, Turkey
| | - Çiğdem Aktuglu Zeybek
- Department of Pediatric Metabolic Diseases, Cerrahpasa Medical School, Istanbul University-Cerrahpasa, İstanbul 34098, Turkey
| | - Gökhan Aygün
- Department of Medical Microbiology, Cerrahpasa Medical School, Istanbul University-Cerrahpasa, İstanbul 34098, Turkey
| | - Yıldız Camcıoğlu
- Department of Pediatric Infectious Diseases, Cerrahpasa Medical School, Istanbul University-Cerrahpasa, İstanbul 34098, Turkey
| | - Haluk Çokuğraş
- Department of Pediatric Infectious Diseases, Cerrahpasa Medical School, Istanbul University-Cerrahpasa, İstanbul 34098, Turkey
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Saavedra-Lozano J, Slocker-Barrio M, Fresán-Ruiz E, Grasa C, Martín Pedraz L, Menasalvas Ruiz A, Santos Sebastián M. Consensus document of the Spanish Society of Paediatric Infectious Diseases (SEIP) and the Spanish Society of Paediatric Intensive Care (SECIP) for the diagnosis and treatment of central venous catheter-related infections in paediatric care. An Pediatr (Barc) 2024; 100:448-464. [PMID: 38925786 DOI: 10.1016/j.anpede.2024.05.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2024] [Accepted: 04/24/2024] [Indexed: 06/28/2024] Open
Abstract
Intravascular devices are essential for the diagnostic and therapeutic approach to multiple diseases in paediatrics, and central venous catheters (CVCs) are especially important. One of the most frequent complications is the infection of these devices, which is associated with a high morbidity and mortality. These infections are highly complex, requiring the use of substantial resources, both for their diagnosis and treatment, and affect vulnerable paediatric patients admitted to high-complexity units more frequently. There is less evidence on their management in paediatric patients compared to adults, and no consensus documents on the subject have been published in Spain. The objective of this document, developed jointly by the Spanish Society of Paediatric Infectious Diseases (SEIP) and the Spanish Society of Paediatric Intensive Care (SECIP), is to provide consensus recommendations based on the greatest degree of evidence available to optimize the diagnosis and treatment of catheter-related bloodstream infections (CRBSIs). This document focuses on non-neonatal paediatric patients with CRBSIs and does not address the prevention of these infections.
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Affiliation(s)
- Jesús Saavedra-Lozano
- Sección de Enfermedades Infecciosas Pediátricas, Servicio de Pediatría, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Universidad Complutense de Madrid, Centro de Investigación Biomédica en Red de Enfermedades Infecciosas (CIBERINFEC), Madrid, Spain.
| | - María Slocker-Barrio
- Servicio de Cuidados Intensivos Pediátricos, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Primary Care Interventions to Prevent Maternal and Child Chronic Diseases of Perinatal and Developmental Origin Network (RICORS), Madrid, Spain
| | - Elena Fresán-Ruiz
- Unidad de Cuidados Intensivos Pediátricos, Hospital Sant Joan de Déu, Barcelona, Spain
| | - Carlos Grasa
- Servicio de Pediatría, Enfermedades Infecciosas y Tropicales, Hospital Universitario La Paz, Fundación de Investigación Biomédica Hospital La Paz (IdiPAZ), Centro de Investigación Biomédica en Red de Enfermedades Infecciosas (CIBERINFEC), Madrid, Spain
| | - Laura Martín Pedraz
- Sección de Enfermedades Infecciosas Pediátricas, Hospital Regional de Málaga, Madrid, Spain
| | - Ana Menasalvas Ruiz
- Unidad de Infectología Pediátrica, Servicio de Pediatría, Hospital Universitario Virgen de la Arrixaca, Murcia, Spain
| | - Mar Santos Sebastián
- Sección de Enfermedades Infecciosas Pediátricas, Servicio de Pediatría, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Centro de Investigación Biomédica en Red de Enfermedades Infecciosas (CIBERINFEC), Madrid, Spain
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Groisman Sieben R, Paternina-de la Ossa R, Waack A, Casale Aragon D, Bellissimo-Rodrigues F, Israel do Prado S, Celia Cervi M. Risk factors and mortality of candidemia in a children's public hospital in Sao Paulo, Brazil. Rev Argent Microbiol 2024:S0325-7541(24)00039-7. [PMID: 38632020 DOI: 10.1016/j.ram.2023.09.002] [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: 05/10/2022] [Revised: 06/07/2023] [Accepted: 09/14/2023] [Indexed: 04/19/2024] Open
Abstract
Candida bloodstream infections in children are of special concern in neonatal and pediatric intensive care and patients with comorbidities. This study aimed to estimate the incidence and risk factors associated with mortality in candidemia cases occurring in a public children's hospital in Ribeirao Preto, Brazil. It is a retrospective transversal study. Every patient under the age of 18 admitted to the study facility from January 1, 2013, to December 31, 2019, was considered potentially eligible to be included if they had candidemia. We collected clinical data from medical records. We included 113 blood cultures yielding positive results for Candida. The incidence rate was 2.12 per 1000 admissions. The most common Candida species was Candida parapsilosis. Septic shock during the candidemia episode was the only clinical outcome associated with a relative risk-adjusted (RRa) of 2.77 with an interval >1 (1.12-6.85). Our findings show that the incidence rate and mortality rates of candidemia are in line with those in other children's services in Brazil. We found a global mortality rate of 28.31% (32/113) from candidemia episodes. We highlight the predominance of non-albicans Candida species including C. parapsilosis. Septic shock was the most important factor showing a significant risk of mortality.
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Affiliation(s)
- Rodrigo Groisman Sieben
- Pediatric Department, Faculty of Medicine of Ribeirão Preto, University of São Paulo, Ribeirão Preto, São Paulo, Brazil
| | - Rolando Paternina-de la Ossa
- Pediatric Department, Faculty of Medicine of Ribeirão Preto, University of São Paulo, Ribeirão Preto, São Paulo, Brazil.
| | - Amaury Waack
- Pediatric Department, Faculty of Medicine of Ribeirão Preto, University of São Paulo, Ribeirão Preto, São Paulo, Brazil
| | - Davi Casale Aragon
- Pediatric Department, Faculty of Medicine of Ribeirão Preto, University of São Paulo, Ribeirão Preto, São Paulo, Brazil
| | - Fernando Bellissimo-Rodrigues
- Social Department, Faculty of Medicine of Ribeirão Preto, University of São Paulo, Ribeirão Preto, São Paulo, Brazil
| | | | - Maria Celia Cervi
- Pediatric Department, Faculty of Medicine of Ribeirão Preto, University of São Paulo, Ribeirão Preto, São Paulo, Brazil
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Devrim İ, Celebi MY, Karakaya N, Sahinkaya S, Acar SO, Cem E, Demirağ B, Oruc Y, Kara AA, Oymak Y, Karapınar TH, Bayram N. The evaluation of Candida-related central line-related bloodstream infections in pediatric cancer patients: A pre- and post-intervention study. J Infect Prev 2023; 24:219-222. [PMID: 37736125 PMCID: PMC10510660 DOI: 10.1177/17571774231191334] [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: 12/01/2022] [Accepted: 03/28/2023] [Indexed: 09/23/2023] Open
Abstract
Aim/Objections The purpose of this study was to assess the efficacy of a central line maintenance bundle in preventing catheter-related (implanted venous access devices, port) Candida bloodstream infections. Methods The study encompassed two distinct time periods, namely, pre-bundle and bundle. The number of catheter-related bloodstream infections (CRBSI) episodes per catheter days for each timeframe was determined. Findings/Results Upon implementation of the central line bundle, the rate of CRBSI reduced significantly from 4.27 per 1000 central line days in the pre-bundle period to 1.0 per 1000 central line days in the bundle period (p < .001). Discussion Using a central line bundle to avoid CRBSIs in pediatric cancer patients with ports led to a significant decrease in Candida species-related CRBSIs.
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Affiliation(s)
- İlker Devrim
- Department of Pediatric Hematology and Oncology, Dr Behcet Uz Child Disease and Surgery Training and Research Hospital, Izmir, Turkey
| | - Miray Yılmaz Celebi
- Department of Pediatric Infectious Diseases, Dr Behcet Uz Child Disease and Surgery Training and Research Hospital, Izmir, Turkey
| | - Nurgul Karakaya
- Department of Pediatric Hematology and Oncology, Dr Behcet Uz Child Disease and Surgery Training and Research Hospital, Izmir, Turkey
| | - Sahika Sahinkaya
- Department of Pediatric Infectious Diseases, Dr Behcet Uz Child Disease and Surgery Training and Research Hospital, Izmir, Turkey
| | - Sultan Okur Acar
- Department of Pediatric Hematology and Oncology, Dr Behcet Uz Child Disease and Surgery Training and Research Hospital, Izmir, Turkey
| | - Ela Cem
- Department of Pediatric Infectious Diseases, Dr Behcet Uz Child Disease and Surgery Training and Research Hospital, Izmir, Turkey
| | - Bengü Demirağ
- Department of Pediatric Hematology and Oncology, Dr Behcet Uz Child Disease and Surgery Training and Research Hospital, Izmir, Turkey
| | - Yeliz Oruc
- Department of Pediatric Infectious Diseases, Dr Behcet Uz Child Disease and Surgery Training and Research Hospital, Izmir, Turkey
| | - Aybuke Akaslan Kara
- Department of Pediatric Infectious Diseases, Dr Behcet Uz Child Disease and Surgery Training and Research Hospital, Izmir, Turkey
| | - Yesim Oymak
- Department of Pediatric Hematology and Oncology, Dr Behcet Uz Child Disease and Surgery Training and Research Hospital, Izmir, Turkey
| | - Tuba Hilkay Karapınar
- Department of Pediatric Hematology and Oncology, Dr Behcet Uz Child Disease and Surgery Training and Research Hospital, Izmir, Turkey
| | - Nuri Bayram
- Department of Pediatric Hematology and Oncology, Dr Behcet Uz Child Disease and Surgery Training and Research Hospital, Izmir, Turkey
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Peixoto PH, Silva ML, Portela FV, da Silva B, Milanez E, de Oliveira D, Ribeiro A, de Almeida H, Lima-Neto R, Guedes GM, Castelo-Branco D, Cordeiro R. Clinical, Epidemiological and Laboratory Features of Invasive Candida parapsilosis Complex Infections in a Brazilian Pediatric Reference Hospital during the COVID-19 Pandemic. J Fungi (Basel) 2023; 9:844. [PMID: 37623615 PMCID: PMC10456047 DOI: 10.3390/jof9080844] [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: 06/01/2023] [Revised: 07/31/2023] [Accepted: 08/09/2023] [Indexed: 08/26/2023] Open
Abstract
The present study aimed to describe the clinical, epidemiological and laboratory characteristics of invasive candidiasis by C. parapsilosis complex (CPC) in a Brazilian tertiary pediatric hospital during the COVID-19 pandemic. Clinical samples were processed in the BACT/ALERT® 3D system or on agar plates. Definitive identification was achieved by MALDI-TOF MS. Antifungal susceptibility was initially analyzed by the VITEK 2 system (AST-YS08 card) and confirmed by the CLSI protocol. Patient data were collected from the medical records using a structured questionnaire. CPC was recovered from 124 patients over an 18-month period, as follows: C. parapsilosis (83.87%), C. orthopsilosis (13.71%) and C. metapsilosis (2.42%). Antifungal resistance was not detected. The age of the patients with invasive CPC infections ranged from <1 to 18 years, and most of them came from oncology-related sectors, as these patients were more affected by C. parapsilosis. C. orthopsilosis infections were significantly more prevalent in patients from critical care units. Invasive infections caused by different pathogens occurred in 75 patients up to 30 days after the recovery of CPC isolates. Overall, 23 (18.55%) patients died within 30 days of CPC diagnosis. Catheter removal and antifungal therapy were important measures to prevent mortality. COVID-19 coinfection was only detected in one patient.
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Affiliation(s)
- Paulo Henrique Peixoto
- Department of Pathology and Legal Medicine, Federal University of Ceará, Fortaleza 60430-160, Brazil; (P.H.P.); (M.L.S.); (F.V.P.); (B.d.S.); (E.M.); (D.d.O.); (G.M.G.); (D.C.-B.)
| | - Maria Laína Silva
- Department of Pathology and Legal Medicine, Federal University of Ceará, Fortaleza 60430-160, Brazil; (P.H.P.); (M.L.S.); (F.V.P.); (B.d.S.); (E.M.); (D.d.O.); (G.M.G.); (D.C.-B.)
| | - Fernando Victor Portela
- Department of Pathology and Legal Medicine, Federal University of Ceará, Fortaleza 60430-160, Brazil; (P.H.P.); (M.L.S.); (F.V.P.); (B.d.S.); (E.M.); (D.d.O.); (G.M.G.); (D.C.-B.)
| | - Bruno da Silva
- Department of Pathology and Legal Medicine, Federal University of Ceará, Fortaleza 60430-160, Brazil; (P.H.P.); (M.L.S.); (F.V.P.); (B.d.S.); (E.M.); (D.d.O.); (G.M.G.); (D.C.-B.)
| | - Edlâny Milanez
- Department of Pathology and Legal Medicine, Federal University of Ceará, Fortaleza 60430-160, Brazil; (P.H.P.); (M.L.S.); (F.V.P.); (B.d.S.); (E.M.); (D.d.O.); (G.M.G.); (D.C.-B.)
| | - Denis de Oliveira
- Department of Pathology and Legal Medicine, Federal University of Ceará, Fortaleza 60430-160, Brazil; (P.H.P.); (M.L.S.); (F.V.P.); (B.d.S.); (E.M.); (D.d.O.); (G.M.G.); (D.C.-B.)
| | - Aldaíza Ribeiro
- Albert Sabin Children Hospital, Fortaleza 60410-794, Brazil;
| | - Henrique de Almeida
- Department of Tropical Medicine, Federal University of Pernambuco, Recife 50670-901, Brazil; (H.d.A.); (R.L.-N.)
| | - Reginaldo Lima-Neto
- Department of Tropical Medicine, Federal University of Pernambuco, Recife 50670-901, Brazil; (H.d.A.); (R.L.-N.)
| | - Glaucia Morgana Guedes
- Department of Pathology and Legal Medicine, Federal University of Ceará, Fortaleza 60430-160, Brazil; (P.H.P.); (M.L.S.); (F.V.P.); (B.d.S.); (E.M.); (D.d.O.); (G.M.G.); (D.C.-B.)
| | - Débora Castelo-Branco
- Department of Pathology and Legal Medicine, Federal University of Ceará, Fortaleza 60430-160, Brazil; (P.H.P.); (M.L.S.); (F.V.P.); (B.d.S.); (E.M.); (D.d.O.); (G.M.G.); (D.C.-B.)
| | - Rossana Cordeiro
- Department of Pathology and Legal Medicine, Federal University of Ceará, Fortaleza 60430-160, Brazil; (P.H.P.); (M.L.S.); (F.V.P.); (B.d.S.); (E.M.); (D.d.O.); (G.M.G.); (D.C.-B.)
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Gautam S, Das S, Singh PK, Rai G, Jain C, Saha R, Singh NP, Gomber S, Eltayeb R, Dar SA. Predictors of Candidemia during Febrile Episode in Lymphoreticular Malignancy Affecting Paediatric Population. Diagnostics (Basel) 2023; 13:diagnostics13091638. [PMID: 37175029 PMCID: PMC10177753 DOI: 10.3390/diagnostics13091638] [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: 03/15/2023] [Revised: 05/03/2023] [Accepted: 05/04/2023] [Indexed: 05/15/2023] Open
Abstract
Limited studies on candidemia in malignancy in the paediatric population from developing countries show a high incidence, high morbidity and a unique epidemiology as compared to developed nations. Our prospective observational study aimed to explore the prevalence of invasive candidiasis, especially candidemia, in febrile paediatric patients with lymphoreticular malignancy. A sample size of 49 children, with 100 recorded febrile episodes was studied. The relevance of candida colonization and mannan antigen detection as indicators of impending candidemia was evaluated. Genotypic identification of the yeast isolates was followed by sequence analysis using the NCBI-BLAST program, and the generation of the phylogenetic tree using MEGA 6.0 software. We observed a 5% prevalence of candidemia among febrile paediatric patients with lymphoreticular malignancy, predominantly caused by non-albicans candida. Colonization at multiple anatomical sites decreased from day 1 to day 8 of febrile episodes. Significant candida colonization (colonization index ≥0.5) was seen in a larger proportion of candidemia patients on day 1 and day 4 (p < 0.001) displaying a definite association between the two. The receiver operator characteristic (ROC) curve analysis for mannan antigen level revealed a cut-off of ≥104.667 pg/mL, suitable for predicting candidemia with a sensitivity of 100%, specificity of 92% and area under ROC value of 0.958 (95% CI: 0.915-1; p < 0.001). A phylogenetic tree with three population groups, clade 1, 2 and 3, consisting of Candida auris (1), Candida tropicalis (2) and Candida parapsilosis (2), respectively, was generated. The diagnosis of candidemia based on mannan antigen detection gives early results and has high negative predictive values. It can be combined with other biomarkers to increase sensitivity, specificity and positive predictive value.
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Affiliation(s)
- Suchita Gautam
- Department of Microbiology, University College of Medical Sciences (University of Delhi) & GTB Hospital, Delhi 110095, India
| | - Shukla Das
- Department of Microbiology, University College of Medical Sciences (University of Delhi) & GTB Hospital, Delhi 110095, India
| | - Praveen Kumar Singh
- Department of Microbiology, University College of Medical Sciences (University of Delhi) & GTB Hospital, Delhi 110095, India
| | - Gargi Rai
- Department of Microbiology, University College of Medical Sciences (University of Delhi) & GTB Hospital, Delhi 110095, India
| | - Charu Jain
- Department of Microbiology, University College of Medical Sciences (University of Delhi) & GTB Hospital, Delhi 110095, India
| | - Rumpa Saha
- Department of Microbiology, University College of Medical Sciences (University of Delhi) & GTB Hospital, Delhi 110095, India
| | - Narendra Pal Singh
- Department of Microbiology, University College of Medical Sciences (University of Delhi) & GTB Hospital, Delhi 110095, India
| | - Sunil Gomber
- Department of Paediatrics, University College of Medical Sciences (University of Delhi) & GTB Hospital, Delhi 110095, India
| | - Raga Eltayeb
- Department of Pathology, College of Medicine, Jazan University, Jazan 45142, Saudi Arabia
| | - Sajad Ahmad Dar
- Department of Microbiology, University College of Medical Sciences (University of Delhi) & GTB Hospital, Delhi 110095, India
- Research and Scientific Studies Unit, College of Nursing, Jazan University, Jazan 45142, Saudi Arabia
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Kahan Y, Tope SG, Ovadia A, Shpring A, Shatzman-Steuerman R, Sherman G, Barkai G, Mandelberg A, Armoni-Domany K, Tasher D. Risk Factors and Characteristics of Candidemia After Cardiac Surgery in Pediatric Patients in Central Israel. Pediatr Infect Dis J 2023; 42:368-373. [PMID: 36854105 DOI: 10.1097/inf.0000000000003847] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/02/2023]
Abstract
BACKGROUND Candidemia is a serious complication in pediatric patients with congenital heart defects (CHD) after cardiac surgery. Information about the epidemiology, clinical characteristics and risk factors for candidemia in this vulnerable population remains limited. METHODS This retrospective case-control study was conducted in 2 pediatric intensive care units between 2004 and 2019. All patients <18 years old who developed candidemia following cardiac surgery were included. Each case was matched with 2 control patients based on age and date of surgery. Multivariable logistic regression analysis was conducted to determine the risk factors for postoperative candidemia. RESULTS Thirty-five candidemia cases were identified and matched to 70 control cases. The incidence of candidemia was 6.3 episodes per 1000 admissions. The median age for candidemia cases was 4 months. The attributable mortality was 28.5%. The predominant (54%) pathogens isolated were non- albicans Candida species, of which C. parapsilosis isolates demonstrated high resistance to fluconazole (70%). Independent risk factors associated with candidemia included cumulative antibiotic exposure for ≥4 days [OR: -4.3; 95% confidence interval (CI): 1.3-14.6; P = 0.02], the need for total parenteral nutrition or peritoneal dialysis (OR: -6.1; 95% CI: 2-18.8; P = 0.001), male sex (OR: 6.2; 95% CI: 1.9-20.3; P = 0.002) and delayed sternal closure≥2 days (OR: -3.2; 95% CI: 1-11.2; P = 0.05). CONCLUSIONS Postoperative candidemia in children with CHD is an uncommon but severe complication. Our study revealed an unexpectedly high frequency of fluconazole-resistant C. parapsilosis as the main cause of non- albicans candidemia. In addition to confirming previously recognized risk factors, our results reveal new potential risk factors such as delayed sternal closure and male sex.
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Affiliation(s)
- Yaara Kahan
- Pediatric Infectious Diseases Unit, Edith Wolfson Medical Center, Holon, Israel
- Pediatric Infectious Disease Unit, Edmond and Lily Safra Children's Hospital, Sheba Medical Center, Tel-Hashomer, Israel
| | - Samantha G Tope
- Pediatric Infectious Disease Unit, Edmond and Lily Safra Children's Hospital, Sheba Medical Center, Tel-Hashomer, Israel
| | - Adi Ovadia
- Pediatric Infectious Disease Unit, Edmond and Lily Safra Children's Hospital, Sheba Medical Center, Tel-Hashomer, Israel
- Department of Pediatrics, Edith Wolfson Medical Center, Holon, Israel
| | - Adi Shpring
- Pediatric Infectious Disease Unit, Edmond and Lily Safra Children's Hospital, Sheba Medical Center, Tel-Hashomer, Israel
- Department of Pediatrics, Edith Wolfson Medical Center, Holon, Israel
| | - Rachel Shatzman-Steuerman
- Pediatric Infectious Disease Unit, Edmond and Lily Safra Children's Hospital, Sheba Medical Center, Tel-Hashomer, Israel
| | - Gilad Sherman
- Pediatric Infectious Disease Unit, Edmond and Lily Safra Children's Hospital, Sheba Medical Center, Tel-Hashomer, Israel
| | - Galia Barkai
- Pediatric Infectious Disease Unit, Edmond and Lily Safra Children's Hospital, Sheba Medical Center, Tel-Hashomer, Israel
| | - Avigdor Mandelberg
- Pediatric Infectious Disease Unit, Edmond and Lily Safra Children's Hospital, Sheba Medical Center, Tel-Hashomer, Israel
- Department of Pediatrics, Edith Wolfson Medical Center, Holon, Israel
| | - Keren Armoni-Domany
- Pediatric Infectious Disease Unit, Edmond and Lily Safra Children's Hospital, Sheba Medical Center, Tel-Hashomer, Israel
- Department of Pediatrics, Edith Wolfson Medical Center, Holon, Israel
| | - Diana Tasher
- Pediatric Infectious Diseases Unit, Edith Wolfson Medical Center, Holon, Israel
- Pediatric Infectious Disease Unit, Edmond and Lily Safra Children's Hospital, Sheba Medical Center, Tel-Hashomer, Israel
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Liu SH, Mitchell H, Nasser Al-Rawahi G. Epidemiology and associated risk factors for candidemia in a Canadian tertiary paediatric hospital: An 11-year review. JOURNAL OF THE ASSOCIATION OF MEDICAL MICROBIOLOGY AND INFECTIOUS DISEASE CANADA 2023; 8:29-39. [PMID: 37008577 PMCID: PMC10052903 DOI: 10.3138/jammi-2022-0021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Revised: 09/12/2022] [Accepted: 09/14/2022] [Indexed: 03/30/2023]
Abstract
Background: Candidemia represents a significant cause of morbidity and mortality in children. We examined the epidemiology and associated risk factors of candidemia at a Canadian tertiary care paediatric hospital over an 11-year period. Methods: A retrospective chart review was conducted on children with positive blood culture for Candida species between January 1, 2007 and December 31, 2018. Patient demographics, previously described candidemia risk factors, Candida species, follow-up investigations, interventions, and outcome data were included in the analysis. Results: Sixty-one candidemia episodes were reported with an overall incidence rate of 5.1 cases per 10,000 patient admissions. Of the 66 species identified, the most common was Candida albicans (53%, 35), followed by Candida parapsilosis (18%, 12), and Candida glabrata (8%, 5). Mixed candidemia was noted in 8% (5/61) of episodes. The most common risk factors included presence of central venous catheter (95%, 58/61) and receipt of antibiotics in the last 30 days (92%, 56/61). Majority of patients received abdominal imaging (89%, 54/61), ophthalmology consult (84%, 51/61), and echocardiogram (70%, 43/61), regardless of age. Line removal was performed in 81% (47/58) of cases. Evidence of disseminated fungal disease on abdominal imaging was observed in 11% (6/54) of patients, all in non-neonates but with risk factors including immunosuppression and gastrointestinal abnormalities. The overall 30-day case fatality rate was 8% (5/61). Conclusions: C. albicans was the most commonly isolated species. Disseminated candidiasis was demonstrated mainly on abdominal imaging in patients with relevant risk factors, including immunosuppression and gastrointestinal abnormalities.
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Affiliation(s)
- Suefay Harumi Liu
- Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Hana Mitchell
- Department of Pediatrics, Division of Infectious Diseases, BC Children's Hospital and BC Women's Hospital & Health Centre, Vancouver, British Columbia, Canada
| | - Ghada Nasser Al-Rawahi
- Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, British Columbia, Canada
- Correspondence: Ghada N Al-Rawahi, Department of Pathology and Laboratory Medicine, University of British Columbia, G105-Koerner Pavilion, 2211 Wesbrook Mall UBC Hospital, Vancouver, British Columbia V6T 2B5 Canada. Telephone: +968-72758585. E-mail:
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KORULMAZ A, ALAKAYA M, ARSLANKOYLU AE, KAYA S, ERDOGAN S, OZGUR D, OTAG ZF. Distribution of candida species and risk factors for invasive candidiasis. EGE TIP DERGISI 2022. [DOI: 10.19161/etd.1209148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Aim: The aim of this study was to investigate the Candida species isolated from the clinical samples of patients in the pediatric intensive care unit and to determine the risk factors for invasive candidiasis.
Materials and Methods: Patients with Candida species detected in clinical samples between January 2013 and December 2018 were included in this study. The demographic characteristics of the patients, the use of broad-spectrum antibiotics and immunosuppressive drugs, underlying diseases, blood transfusions, history of surgical operations, whether there is bacterial growth with Candida species in the same clinical sample, parenteral nutrition and invasive interventions were retrospectively analyzed and their relationship with invasive candidiasis was investigated.
Results: A total of 91 patients were included in the study. The mean age was 72.3 ± 70.1 months. Among the patients 48.4% had Candida albicans while 51.6% had non-albicans Candida. Candida parapsilosis (n = 18, 19.8%) and Candida tropicalis (n = 14, 15.4%) were the most common non-albicans Candida species. The most common antifungal treatment was fluconazole (n = 34, 59.6%). There was no statistically significant relationship between invasive candidiasis and the underlying disease, central venous and / or urinary catheter, broad-spectrum antibiotic, corticosteroid, gender and surgical operation (p> 0.05). On the other hand, there was a statistically significant relationship between invasive candidiasis and parenteral nutrition, blood transfusion and bacterial growth with Candida species in the same clinical sample (p <0.05).
Conclusions: Non-albicans Candida species are more common than Candida albicans in the pediatric intensive care units. Candida parapsilosis is the most common among non-albicans Candida species. Parenteral nutrition, blood transfusion and bacterial growth with Candida species in the same clinical sample increased the risk of invasive candidiasis.
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Affiliation(s)
- Ali KORULMAZ
- Mersin University Faculty of Medicine, Department of Pediatric Intensive Care Unit, Mersin, Türkiye
| | - Mehmet ALAKAYA
- Mersin University Faculty of Medicine, Department of Pediatric Intensive Care Unit, Mersin, Türkiye
| | - Ali Ertug ARSLANKOYLU
- Mersin University Faculty of Medicine, Department of Pediatric Intensive Care Unit, Mersin, Türkiye
| | - Sadik KAYA
- Mersin University Faculty of Medicine, Department of Pediatric Intensive Care Unit, Mersin, Türkiye
| | - Semra ERDOGAN
- Mersin University Faculty of Medicine, Department of Biostatistics, Mersin, Türkiye
| | - Didem OZGUR
- Mersin University Faculty of Medicine, Department of Microbiology, Mersin, Türkiye
| | - Zehra Feza OTAG
- Mersin University Faculty of Medicine, Department of Microbiology, Mersin, Türkiye
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10
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Bassetti M, Giacobbe DR, Vena A, Esposito S. An overview of micafungin as a treatment option for invasive candidiasis in pediatric patients younger than 4 months old. Expert Opin Pharmacother 2022; 23:1987-1993. [DOI: 10.1080/14656566.2022.2147824] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Matteo Bassetti
- Infectious Diseases Unit, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
- Department of Health Sciences (DISSAL), University of Genoa, Genoa, Italy
| | - Daniele Roberto Giacobbe
- Infectious Diseases Unit, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
- Department of Health Sciences (DISSAL), University of Genoa, Genoa, Italy
| | - Antonio Vena
- Infectious Diseases Unit, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
- Department of Health Sciences (DISSAL), University of Genoa, Genoa, Italy
| | - Susanna Esposito
- Pediatric Clinic, Department of Medicine and Surgery, University of Parma, Parma, Italy
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11
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Reda NM, Hassan RM, Salem ST, Yousef RHA. Prevalence and species distribution of Candida bloodstream infection in children and adults in two teaching university hospitals in Egypt: first report of Candida kefyr. Infection 2022; 51:389-395. [PMID: 36018493 PMCID: PMC10042939 DOI: 10.1007/s15010-022-01888-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2022] [Accepted: 07/12/2022] [Indexed: 11/28/2022]
Abstract
BACKGROUND Candidemia is a pervasive problem associated with significant morbidity and mortality in health care settings. This study aimed to determine the changing distribution of Candida species and the emergence of uncommon species. METHODS This was a cross-sectional study performed in two Cairo University hospitals between 2019 and 2020. All Candida species isolates recovered from blood cultures of adults and pediatrics patients admitted to the hospitals were included. Candida isolates were identified by chromogenic Candida agar and Vitek2 YST identification card. Candida kefyr was confirmed by chip array. RESULTS Candida species were responsible for 1.6% of bloodstream infections in adults and 10.8% in pediatric patients. C. albicans was the most prevalent species representing 27.8% in adults and 48.3% in pediatrics. Non-albicans species (NAC) represented the most isolated Candida species among adults and pediatrics (72.2% and 51.6%, respectively) with the predominance of C. tropicalis (27.8% and 22.5%, respectively) followed by C. parapsilosis (16.7% and 10.8%, respectively). The uncommon Candida, which is Candida species other than C. albicans, C. parapsilosis, C. tropicalis, C. glabrata, and C. krusei, represents 16.6% and 14% of all candidemia in adults and pediatrics, respectively. Only one of each of C. lusitaniae, C. utilis, and C. kefyr were detected in adults. C. lusitaniae was the most frequently recovered uncommon Candida among pediatrics resulting in 6.4% of candidemia followed by C. famata (4.3%), C. utilis (2.2%), and C. kefyr (1.1%). CONCLUSIONS C. albicans is still the primary species isolated from pediatrics and adults with candidemia despite the considerable shift to the non-albicans species. C. tropicalis and C. parapsilosis are the most prevalent NAC. The increased prevalence of uncommon Candida species is alarming and necessitates a prompt stewardship program.
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Affiliation(s)
- Nashwa Mohamed Reda
- Clinical and Chemical Pathology Department, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Reem Mostafa Hassan
- Clinical and Chemical Pathology Department, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Sherifa Tarek Salem
- Clinical and Chemical Pathology Department, Faculty of Medicine, Cairo University, Cairo, Egypt.
| | - Reham Hamed A Yousef
- Clinical and Chemical Pathology Department, Faculty of Medicine, Cairo University, Cairo, Egypt
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12
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Chediak Higashi syndrome with acute kidney injury: Answers. Pediatr Nephrol 2022; 37:1317-1318. [PMID: 35041039 DOI: 10.1007/s00467-021-05414-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2021] [Accepted: 12/09/2021] [Indexed: 10/19/2022]
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13
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Chen YN, Hsu JF, Chu SM, Lai MY, Lin C, Huang HR, Yang PH, Chiang MC, Tsai MH. Clinical and Microbiological Characteristics of Neonates with Candidemia and Impacts of Therapeutic Strategies on the Outcomes. J Fungi (Basel) 2022; 8:jof8050465. [PMID: 35628721 PMCID: PMC9148079 DOI: 10.3390/jof8050465] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2022] [Revised: 04/27/2022] [Accepted: 04/27/2022] [Indexed: 11/28/2022] Open
Abstract
Neonatal candidemia is associated with significant morbidities and a high mortality rate. We aimed to investigate the clinical characteristics of Candida bloodstream infections in neonates and the impact of therapeutic strategies on the outcomes. We identified all the neonates with candidemia from a medical center in Taiwan over an 18-year period (2003−2021) and analyzed them. Clinical isolates were confirmed by DNA sequencing, and antifungal susceptibility testing was performed. The prognostic factors associated with clinical treatment failure (30-day, all-cause mortality and persistent candidemia > 72 h after antifungal agents) and in-hospital mortality were analyzed using logistic regression modeling. A total of 123 neonates with 139 episodes of candidemia were included in the study. The median (IQR) gestational age and birth weight of the neonates with candidemia were 29.0 (26.0−35.0) weeks and 1104.0 (762.0−2055) g, respectively. The most common Candida spp. was Candida albicans (n = 57, 41.0%), followed by C. parapsilosis (n = 44, 31.7%), Candida guilliermondii (n = 12, 8.6%), and C. glabrata (n = 11, 7.9%). The overall susceptibility to fluconazole was 81.3%, and the resistant rates against other antifungal agents were less than 3%. The cumulative mortality rate at 7 and 30 days after the first episode of candidemia was 11.3% and 32.3%, respectively. The overall in-hospital mortality rate was 42.3%. The treatment outcomes did not change over the study period and were not affected by delayed initiation of antifungal agents. Multivariate analysis showed that delayed catheter removal (odds ratio [OR], 5.54; 95% confidence interval [CI]: 1.93−15.86, p = 0.001), septic shock (OR, 7.88; 95% CI: 2.83−21.93, p < 0.001), and multiple chronic comorbidities (OR, 8.71; 95% CI: 1.82−41.81, p = 0.007) were independently associated with the final in-hospital mortality. We concluded that the overall mortality of neonatal candidemia has remained consistently high over the past decade. Prompt early catheter removal and an aggressive treatment strategy for neonatal candidemia with septic shock would be critical to improving patient outcomes.
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Affiliation(s)
- Yu-Ning Chen
- Division of Pediatric Neonatology, Department of Pediatrics, Chang Gung Memorial Hospital, Taoyuan 333, Taiwan; (Y.-N.C.); (J.-F.H.); (S.-M.C.); (M.-Y.L.); (H.-R.H.); (M.-C.C.)
- College of Medicine, Chang Gung University, Taoyuan 333, Taiwan; (C.L.); (P.-H.Y.)
| | - Jen-Fu Hsu
- Division of Pediatric Neonatology, Department of Pediatrics, Chang Gung Memorial Hospital, Taoyuan 333, Taiwan; (Y.-N.C.); (J.-F.H.); (S.-M.C.); (M.-Y.L.); (H.-R.H.); (M.-C.C.)
- College of Medicine, Chang Gung University, Taoyuan 333, Taiwan; (C.L.); (P.-H.Y.)
| | - Shih-Ming Chu
- Division of Pediatric Neonatology, Department of Pediatrics, Chang Gung Memorial Hospital, Taoyuan 333, Taiwan; (Y.-N.C.); (J.-F.H.); (S.-M.C.); (M.-Y.L.); (H.-R.H.); (M.-C.C.)
- College of Medicine, Chang Gung University, Taoyuan 333, Taiwan; (C.L.); (P.-H.Y.)
| | - Mei-Yin Lai
- Division of Pediatric Neonatology, Department of Pediatrics, Chang Gung Memorial Hospital, Taoyuan 333, Taiwan; (Y.-N.C.); (J.-F.H.); (S.-M.C.); (M.-Y.L.); (H.-R.H.); (M.-C.C.)
- College of Medicine, Chang Gung University, Taoyuan 333, Taiwan; (C.L.); (P.-H.Y.)
| | - Chih Lin
- College of Medicine, Chang Gung University, Taoyuan 333, Taiwan; (C.L.); (P.-H.Y.)
- Department of Laboratory Medicine, Chang Gung Memorial Hospital at Linkou, Taoyuan 333, Taiwan
- Division of Neonatology, Department of Pediatrics, Chang Gung Memorial Hospital, Keelung 204, Taiwan
| | - Hsuan-Rong Huang
- Division of Pediatric Neonatology, Department of Pediatrics, Chang Gung Memorial Hospital, Taoyuan 333, Taiwan; (Y.-N.C.); (J.-F.H.); (S.-M.C.); (M.-Y.L.); (H.-R.H.); (M.-C.C.)
- College of Medicine, Chang Gung University, Taoyuan 333, Taiwan; (C.L.); (P.-H.Y.)
| | - Peng-Hong Yang
- College of Medicine, Chang Gung University, Taoyuan 333, Taiwan; (C.L.); (P.-H.Y.)
- Department of Pediatrics, Chang Gung Memorial Hospital, Chiayi 613, Taiwan
| | - Ming-Chou Chiang
- Division of Pediatric Neonatology, Department of Pediatrics, Chang Gung Memorial Hospital, Taoyuan 333, Taiwan; (Y.-N.C.); (J.-F.H.); (S.-M.C.); (M.-Y.L.); (H.-R.H.); (M.-C.C.)
- College of Medicine, Chang Gung University, Taoyuan 333, Taiwan; (C.L.); (P.-H.Y.)
| | - Ming-Horng Tsai
- College of Medicine, Chang Gung University, Taoyuan 333, Taiwan; (C.L.); (P.-H.Y.)
- Division of Neonatology and Pediatric Hematology/Oncology, Department of Pediatrics, Chang Gung Memorial Hospital, Yunlin 638, Taiwan
- Correspondence: ; Tel.: +886-5-691-5151 (ext. 2879); Fax: +886-5-691-3222
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Epidemiology of Fungal Colonization in Children Treated at the Department of Oncology and Hematology: Single-Center Experience. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19042485. [PMID: 35206670 PMCID: PMC8872470 DOI: 10.3390/ijerph19042485] [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: 10/30/2021] [Revised: 02/01/2022] [Accepted: 02/07/2022] [Indexed: 12/07/2022]
Abstract
Oncological patients are especially predisposed to fungal infections due to multiple risk factors and immunocompromising treatment. Epidemiological research regarding pediatric oncologic patients is still insufficient, and existing data are difficult to generalize on different populations. Therefore, we aimed to analyze fungal infections and fungal epidemiology in the Department of Oncology and Hematology of the University Children’s Hospital in Krakow with help from the Clinical Microbiology Department. During the chosen period of 2005 and 2015–2020, 2342 tests were performed in our ward on 847 patients. Analyzed samples were divided into five source groups. The amount of patients with positive test results was 62.5%. The year with the highest detection level was 2005. The most frequent pathogen was Candida albicans, with a significant decrease in tendency. An increase in non-albicans species was observed. Candida parapsilosis was not frequently observed compared to similar studies. We noticed an increase in positive results from the urinary tract material. Our results confirmed that fungal infections are still an issue, and they may indicate the efficacy of prophylaxis. The majority of our results are consistent with the literature, yet we managed to emphasize data unique to our patients’ population. Our findings are helpful in clinical work and for further studies in our center.
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Chen WC, Chen PY, Yang SC, Yen TY, Lu CY, Chen JM, Lee PI, Chang LY, Chen YC, Huang LM. Comparisons of the clinical and mycological characteristics of pediatric candidemia. J Formos Med Assoc 2021; 121:1668-1679. [PMID: 34876342 DOI: 10.1016/j.jfma.2021.11.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Revised: 09/17/2021] [Accepted: 11/17/2021] [Indexed: 01/14/2023] Open
Abstract
BACKGROUND/PURPOSE Invasive candidiasis is a severe infectious disease that could lead to mortality in critically ill children. METHODS We collected data regarding demographics, underlying diseases, predisposing factors, outcomes for pediatric patients with candidemia at a medical centre in Taiwan from 2011 to 2017. RESULTS Fifty-eight patients with 60 candidemia episodes were diagnosed. The 3 most common species were Candida albicans (42%), Candida parapsilosis (25%) and Candida tropicalis (23%). C. parapsilosis predominantly infected infants and neonates (median age: 0.8 years, range: 0.1-14.5). Cases with C. tropicalis had significantly higher rates of multidrug resistance (p = 0.011) and disseminated candidiasis (p = 0.025) compared with other cases. The all-cause mortality rate was 43%, and the candidemia-related mortality rate was 29%. Pediatric sequential organ failure assessment score >8 [adjusted odds ratio (aOR) 66.2, 95% CI 4.03-1088.5] and posaconazole resistance (aOR 33.57, 95% CI 1.61-700.3) were the most significant risk factors associated with candidemia-related mortality, whereas treatment with effective antifungal agents within 48 h (aOR 0.07, 95% CI 0.01-0.9) was the only significant protective factor. CONCLUSIONS Candidemia-related mortality was related to azole resistance; therefore, empirical therapy with echinocandin or amphotericin B is recommended pending species and susceptibility results.
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Affiliation(s)
- Wan-Chen Chen
- Department of Pediatrics, National Taiwan University Hospital, College of Medicine, National Taiwan University, Taipei, Taiwan; Department of Pediatrics, Changhua Christian Children's Hospital, Changhua City, Taiwan
| | - Pao-Yu Chen
- Division of Infectious Disease, Department of Internal Medicine, National Taiwan University Hospital, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Shun-Chen Yang
- Department of Pediatrics, Changhua Christian Children's Hospital, Changhua City, Taiwan
| | - Ting-Yu Yen
- Department of Pediatrics, National Taiwan University Hospital, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Chun-Yi Lu
- Department of Pediatrics, National Taiwan University Hospital, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Jong-Min Chen
- Department of Pediatrics, National Taiwan University Hospital, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Ping-Ing Lee
- Department of Pediatrics, National Taiwan University Hospital, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Luan-Ying Chang
- Department of Pediatrics, National Taiwan University Hospital, College of Medicine, National Taiwan University, Taipei, Taiwan.
| | - Yee-Chun Chen
- Division of Infectious Disease, Department of Internal Medicine, National Taiwan University Hospital, College of Medicine, National Taiwan University, Taipei, Taiwan.
| | - Li-Min Huang
- Department of Pediatrics, National Taiwan University Hospital, College of Medicine, National Taiwan University, Taipei, Taiwan
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Flores-Maldonado O, González GM, Andrade A, Montoya A, Treviño-Rangel R, Silva-Sánchez A, Becerril-García MA. Dissemination of Candida auris to deep organs in neonatal murine invasive candidiasis. Microb Pathog 2021; 161:105285. [PMID: 34774701 DOI: 10.1016/j.micpath.2021.105285] [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: 09/24/2021] [Revised: 11/03/2021] [Accepted: 11/04/2021] [Indexed: 10/19/2022]
Abstract
Candida auris is an emerging multidrug resistant fungal pathogen, which represents a major challenge for newborns systemic infections worldwide. Management of C. auris infections is complicated due to its intrinsic antifungal resistance and the limited information available on its pathogenesis, particularly during neonatal period. In this study, we developed a murine model of C. auris neonatal invasive infection. C. auris dissemination was evaluated by fungal burden and histopathological analysis of lung, brain, liver, kidney, and spleen at different time intervals. We found fungal cells in all the analyzed tissues, neonatal liver and brain were the most susceptible tissues to fungal invasion. This model will help to better understand pathogenesis mechanisms and facilitate strategies for control and prevention of C. auris infections in newborns.
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Affiliation(s)
- Orlando Flores-Maldonado
- Departamento de Microbiología, Universidad Autónoma de Nuevo León, Facultad de Medicina y Hospital Universitario "Dr. José Eleuterio González", Av. Francisco I. Madero, Mitras Centro, 64460, Monterrey, Mexico
| | - Gloria M González
- Departamento de Microbiología, Universidad Autónoma de Nuevo León, Facultad de Medicina y Hospital Universitario "Dr. José Eleuterio González", Av. Francisco I. Madero, Mitras Centro, 64460, Monterrey, Mexico
| | - Angel Andrade
- Departamento de Microbiología, Universidad Autónoma de Nuevo León, Facultad de Medicina y Hospital Universitario "Dr. José Eleuterio González", Av. Francisco I. Madero, Mitras Centro, 64460, Monterrey, Mexico
| | - Alexandra Montoya
- Departamento de Microbiología, Universidad Autónoma de Nuevo León, Facultad de Medicina y Hospital Universitario "Dr. José Eleuterio González", Av. Francisco I. Madero, Mitras Centro, 64460, Monterrey, Mexico
| | - Rogelio Treviño-Rangel
- Departamento de Microbiología, Universidad Autónoma de Nuevo León, Facultad de Medicina y Hospital Universitario "Dr. José Eleuterio González", Av. Francisco I. Madero, Mitras Centro, 64460, Monterrey, Mexico
| | - Aarón Silva-Sánchez
- Division of Clinical Immunology and Rheumatology, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Miguel A Becerril-García
- Departamento de Microbiología, Universidad Autónoma de Nuevo León, Facultad de Medicina y Hospital Universitario "Dr. José Eleuterio González", Av. Francisco I. Madero, Mitras Centro, 64460, Monterrey, Mexico.
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Moin S, Farooqi J, Rattani S, Nasir N, Zaka S, Jabeen K. C. auris and non-C. auris candidemia in hospitalized adult and pediatric COVID-19 patients; single center data from Pakistan. Med Mycol 2021; 59:1238-1242. [PMID: 34625790 DOI: 10.1093/mmy/myab057] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2021] [Revised: 07/12/2021] [Accepted: 09/24/2021] [Indexed: 12/22/2022] Open
Abstract
We compared candidemia due to Candida auris and other non-C.auris cases in hospitalized COVID-19 patients over a period of nine months at our institution. Candidemia cases in all admitted patients (with or without COVID-19) from April-December 2020 were identified. Electronic records were accessed to record clinical data of COVID-19 patients with candidemia. For statistical analysis, independent samples Mann-Whitney U test was used for continuous and Fisher's exact test was used for categorical variables.A total of 26 candidemia cases (four C.auris, 22 non-C.auris) in 2438 admitted COVID-19 (10.7 per 1000 admissions) and 59 candidemia cases (six C.auris, 53 non-C.auris) in admitted non-COVID patients (8.2 per 1000 admission) were identified. The proportion of C.auris candidemia in COVID-19 and non-COVID-19 patients was 15.4% and 10% respectively. 4/26 of COVID-19 candidemia patients were aged ≤ 15 years (10 months-15 years). Comparison of C.auris and non-C.auris candidemia cases reveal significant difference in prior antifungal exposure, present in 100% C.auris candidemia versus 27% non-C.auris candidemia patients (p-value 0.014). Although not statistically significant, C.auris candidemia patients had a longer stay in hospital before candidemia (20 vs 9 days), higher isolation rate of multidrug resistant bacteria (100% vs 50%), increased rate of prior colonization of Candida species (50% vs 14%) and lower mean beta-d-glucan levels (48.73 pg/mL vs. 138.146 pg/mL). Both C.auris and non-C.auris COVID-19 patients had similar mortality rate (67% vs 65%). A significant number of critically ill COVID-19 patients developed candidemia in our study highlighting the need for prompt diagnosis and management. LAY SUMMARY 26 candidemia cases (4 Candida auris;22 non-C.auris) in COVID-19 patients (April-December 2020) are reported from Pakistan. Compared to non-C.auris, C.auris candidemia patients had higher prior antifungal exposure, longer hospital stay, higher MDR bacteria and increased rate of Candida colonization.
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Affiliation(s)
- Safia Moin
- Department of Pathology and Laboratory Medicine, Aga Khan University, Karachi, Pakistan
| | - Joveria Farooqi
- Department of Pathology and Laboratory Medicine, Aga Khan University, Karachi, Pakistan
| | - Salima Rattani
- Department of Pathology and Laboratory Medicine, Aga Khan University, Karachi, Pakistan
| | - Nosheen Nasir
- Department of Medicine, Aga Khan University, Karachi, Pakistan
| | - Sadaf Zaka
- Department of Pathology and Laboratory Medicine, Aga Khan University, Karachi, Pakistan
| | - Kauser Jabeen
- Department of Pathology and Laboratory Medicine, Aga Khan University, Karachi, Pakistan
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Flores-Maldonado OE, González GM, Andrade-Torres Á, Treviño-Rangel R, Donis-Maturano L, Silva-Sánchez A, Hernández-Bello R, Montoya A, Salazar-Riojas R, Romo-González C, Becerril-García MA. Distinct innate immune responses between sublethal and lethal models of disseminated candidiasis in newborn BALB/c mice. Microb Pathog 2021; 158:105061. [PMID: 34157411 DOI: 10.1016/j.micpath.2021.105061] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Revised: 06/04/2021] [Accepted: 06/14/2021] [Indexed: 12/14/2022]
Abstract
Invasive candidiasis is associated with a high incidence and mortality rates in infants, especially in preterm newborns. The immunopathogenesis of the mycosis during the neonatal period is poorly understood. Although several in vivo models exist to study invasive candidiasis, the majority of studies employ distinct routes of infection and use 2 to 6 day-old mice that could be less comparable in studying candidiasis in preterm infants. In this study, by using 0-days-old mice we developed a new neonatal murine model of intravenous Candida albicans infection. Using different inoculums of Candida albicans we evaluated survival, dissemination of the fungus, frequency of CD45+ cells, and cytokine production in the liver, brain, and kidneys of newborn and adult BALB/c mice. Unexpectedly, the newborn mice infected with a low inoculum (1×105 cfu per mouse) of Candida albicans survive to the infection. Compared to adult mice, the liver and brain of newborn animals had the greatest fungal burden, fungal invasion and leukocyte infiltrate. A moderate production of TNFα, IL-1β, IL-6 and IFNγ was detected in tissues of newborn mice infected with a non-lethal inoculum of Candida albicans. In contrast, overproduction of TNFα, IL-1β, IL-6 and IL-10 was determined when injecting with a lethal inoculum. In agreement, flow cytometry of brain and liver showed an inoculum-dependent CD45+ leukocyte infiltration in newborn mice infected with Candida albicans. Overall, our data shows that Candida albicans infection in newborn mice affects mainly the brain and liver and a 2-fold increase of the inoculum rapidly becomes lethal probably due to massive fungal invasion and exacerbated CD45+ leukocyte infiltrate and cytokine production. This study is the first analysis of innate immune responses in different tissues during early neonatal disseminated candidiasis.
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Affiliation(s)
- Orlando E Flores-Maldonado
- Departamento de Microbiología, Universidad Autónoma de Nuevo León, Facultad de Medicina y Hospital Universitario "Dr. José Eleuterio González", Av. Francisco I. Madero, Mitras Centro, 64460, Monterrey, México
| | - Gloria M González
- Departamento de Microbiología, Universidad Autónoma de Nuevo León, Facultad de Medicina y Hospital Universitario "Dr. José Eleuterio González", Av. Francisco I. Madero, Mitras Centro, 64460, Monterrey, México
| | - Ángel Andrade-Torres
- Departamento de Microbiología, Universidad Autónoma de Nuevo León, Facultad de Medicina y Hospital Universitario "Dr. José Eleuterio González", Av. Francisco I. Madero, Mitras Centro, 64460, Monterrey, México
| | - Rogelio Treviño-Rangel
- Departamento de Microbiología, Universidad Autónoma de Nuevo León, Facultad de Medicina y Hospital Universitario "Dr. José Eleuterio González", Av. Francisco I. Madero, Mitras Centro, 64460, Monterrey, México
| | - Luis Donis-Maturano
- Unidad de Investigación en Biomedicina (UBIMED), Universidad Nacional Autónoma de México, Facultad de Estudios Superiores (FES)-Iztacala, Estado de México, México
| | - Aarón Silva-Sánchez
- Division of Clinical Immunology and Rheumatology, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Romel Hernández-Bello
- Departamento de Microbiología, Universidad Autónoma de Nuevo León, Facultad de Medicina y Hospital Universitario "Dr. José Eleuterio González", Av. Francisco I. Madero, Mitras Centro, 64460, Monterrey, México
| | - Alexandra Montoya
- Departamento de Microbiología, Universidad Autónoma de Nuevo León, Facultad de Medicina y Hospital Universitario "Dr. José Eleuterio González", Av. Francisco I. Madero, Mitras Centro, 64460, Monterrey, México
| | - Rosario Salazar-Riojas
- Servicio de Hematología, Universidad Autónoma de Nuevo León, Facultad de Medicina y Hospital Universitario "Dr. José Eleuterio González", Av. Francisco I. Madero, Mitras Centro, 64460, Monterrey, México
| | - Carolina Romo-González
- Laboratorio de Bacteriología Experimental, Instituto Nacional de Pediatría (INP). Ciudad de México, México
| | - Miguel A Becerril-García
- Departamento de Microbiología, Universidad Autónoma de Nuevo León, Facultad de Medicina y Hospital Universitario "Dr. José Eleuterio González", Av. Francisco I. Madero, Mitras Centro, 64460, Monterrey, México.
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Tan J, Song Y, Liu W, Wang X, Zhang J, Chen W, Li R, Liu W. Molecular genotyping of Candida albicans isolated from different sites may trace the etiological infection routes: Observation in China. Mycoses 2021; 64:841-850. [PMID: 34051012 DOI: 10.1111/myc.13327] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2020] [Revised: 05/22/2021] [Accepted: 05/24/2021] [Indexed: 12/23/2022]
Abstract
BACKGROUND Invasive candidiasis is a growing concern worldwide, especially in immunocompromised patients, including ICU patients. OBJECTIVES As Candida albicans is the leading cause of candidaemia, it is important to investigate the evolution of C. albicans in patients with candidaemia. METHODS We analysed 238 strains of C. albicans isolated from different body sites. Antifungal susceptibility testing, CAI loci genotyping and multilocus sequence typing (MLST) of all isolates were performed. The relationships among the total isolates that differed in sequence at only one of the seven housekeeping gene loci were analysed using eBURST. RESULTS Multilocus sequence typing analysis in 238 isolates by combining seven housekeeping alleles revealed 175 diploid sequence types, in which 84 were newly identified. eBURST analysis for these data recognised 19 clonal complexes (CCs) and 79 singletons. Besides, seventy-three CAI genotypes were identified. Blood isolates showed maximum genotypes (49), and the dominant genotypes were CAI 17-21 and CAI 21-21. Oral isolates possessed 25 CAI genotypes, and the dominant genotypes were CAI 17-21 and CAI 21-21 as well. Since isolates with CAI allele numbers <30 showed easier transmission, CAI 17-21 and CAI 21-21 were the most frequently transmitted. Finally, the CAI genotypes were classified into six groups. CONCLUSIONS This work revealed the oral and blood strains isolated from the patients with candidaemia in ICU shared the identical dominant CAI genotypes. Our data expanded the C. albicans MLST database and helped with understanding the evolution and spread of invasive candidiasis.
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Affiliation(s)
- Jingwen Tan
- 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.,Department of Medical Mycology, Shanghai Skin Disease Hospital, Tongji University School of Medicine, Shanghai, 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
| | - Weixia Liu
- 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.,Department of Dermatology, Heping Hospital Affiliated to Changzhi Medical College, Changzhi, China
| | - Xuejie 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.,Dongcheng Management Center for Community Health Service, Beijing, China
| | - Jinqing Zhang
- 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.,Department of Dermatology, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
| | - Wei Chen
- 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
| | - 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
| | - Wei Liu
- 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
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20
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Patterson JW, Comeau JL, Khan N, Kulkarni K. A case of disseminated Candida krusei infection in a child with acute myeloid leukemia. PEDIATRIC HEMATOLOGY ONCOLOGY JOURNAL 2021. [DOI: 10.1016/j.phoj.2020.12.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
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21
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Pediatric and Neonatal Invasive Candidiasis: Species Distribution and Mortality Rate in a Thai Tertiary Care Hospital. Pediatr Infect Dis J 2021; 40:96-102. [PMID: 33021588 DOI: 10.1097/inf.0000000000002912] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
BACKGROUND Invasive candidiasis (IC) is a serious infection among children with underlying medical conditions. A shift from C. albicans to non-albicans Candida has been observed worldwide. This study aims to identify species of Candida and factors associated with the overall 30-day mortality rate. METHODS A retrospective chart review was conducted among children with culture-confirmed IC from birth to 15 years of age at King Chulalongkorn Memorial Hospital, Thailand. Multivariate Cox regression analysis was performed to determine associated factors with 30-day mortality. RESULTS From 2003 to 2019, 102 episodes of IC in pediatric group with a median age of 16 months (interquartile range 4-65) and 12 episodes of IC in neonatal group with a median age of 18 days (interquartile range 12-22). The species distribution were Candida albicans (35%), Candida parapsilosis (26%), Candida tropicalis (22%), Candida glabrata (6%) and other/unspecified species (11%). Antifungal treatment was given in 88% (67% Amphotericin B deoxycholate, 28% Fluconazole). Overall 30-day mortality rates were 28.5% [95% confidence interval (CI) 20.8%-38.4%] and 8.3% (95% CI 1.2%-46.1%) in pediatrics and neonates, respectively. Mortality rate among the neutropenic group was significantly higher than non-neutropenic group (46.4% vs. 20.6%, P = 0.005). Factors associated with 30-day mortality in pediatric IC were shock [adjusted hazard ratio (aHR) 4.2; 95% CI 1.8-9.4], thrombocytopenia (aHR 7.7; 95% CI 1.8-33.9) and no antifungal treatment (aHR 4.6; 95% CI 1.7-12.1). CONCLUSIONS Two-third of children with IC were diagnosed with non-albicans Candida. Children with high mortality rate included those with neutropenia, presented with shock or thrombocytopenia, such that the proper empiric antifungal treatment is recommended.
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Chen B, Xie Y, Zhang N, Li W, Liu C, Li D, Bian S, Jiang Y, Yang Z, Li R, Feng Y, Zhang X, Shi D. Evaluation of Droplet Digital PCR Assay for the Diagnosis of Candidemia in Blood Samples. Front Microbiol 2021; 12:700008. [PMID: 34603226 PMCID: PMC8480469 DOI: 10.3389/fmicb.2021.700008] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2021] [Accepted: 07/26/2021] [Indexed: 12/14/2022] Open
Abstract
Numerous studies have shown that droplet digital PCR (ddPCR) is a promising tool for the diagnosis of pathogens, especially in samples with low concentrations of pathogenic DNA. An early diagnosis of candidemia is critical for the effective treatment of patients. In this study, we evaluated the sensitivity and specificity of ddPCR assay for Candida DNA detection both in vitro by mixing fungal cells with human blood and in vivo by analyzing blood samples from infected mice and patients with suspected candidemia. The results showed that ddPCR assay could detect a minimum of 4.5 DNA copies per reaction in blood samples. ddPCR showed higher sensitivity and specificity for Candida DNA detection than traditional culture and quantitative PCR (qPCR) methods and also exhibited significantly better positive and negative predictive values than the culture and qPCR methods that were commonly used in clinical practice. Hence, our study demonstrates that ddPCR assay is a promising method for the timely diagnosis of candidemia and could be useful for monitoring the treatment of candidemia.
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Affiliation(s)
- Biao Chen
- The Laboratory of Medical Mycology, Jining No. 1 People's Hospital, Jining, China
- Postdoctoral Mobile Station of Shandong University of Traditional Chinese Medicine, Jinan, China
| | - Yingguang Xie
- Intensive Care Unit, Jining No. 1 People’s Hospital, Jining, China
| | - Ning Zhang
- The Laboratory of Medical Mycology, Jining No. 1 People's Hospital, Jining, China
| | - Wenqiang Li
- Intensive Care Unit, Jining No. 1 People’s Hospital, Jining, China
| | - Chen Liu
- The Laboratory of Medical Mycology, Jining No. 1 People's Hospital, Jining, China
| | - Dongmei Li
- Department of Microbiology and Immunology, Georgetown University Medical Center, Washington, DC, United States
| | - Shaodong Bian
- The Laboratory of Medical Mycology, Jining No. 1 People's Hospital, Jining, China
| | - Yufeng Jiang
- Postdoctoral Mobile Station of Shandong University of Traditional Chinese Medicine, Jinan, China
- Clinical Laboratory, Jining No. 1 People’s Hospital, Jining, China
| | - Zhiya Yang
- The Laboratory of Medical Mycology, Jining No. 1 People's Hospital, Jining, China
| | - Renzhe Li
- Clinical Laboratory, Jining No. 1 People’s Hospital, Jining, China
| | - Yahui Feng
- Clinical Medicine College, Jining Medical College, Jining, China
| | - Xiaojie Zhang
- Postdoctoral Mobile Station of Shandong University of Traditional Chinese Medicine, Jinan, China
- Xiaojie Zhang,
| | - Dongmei Shi
- The Laboratory of Medical Mycology, Jining No. 1 People's Hospital, Jining, China
- Department of Dermatology, Jining No. 1 People’s Hospital, Jining, China
- *Correspondence: Dongmei Shi,
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23
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Piqueras AI, Rubio T, Lopez-Medina EM, Gimeno A, Modesto V, Cantón E, Pemán J. Recent changes in candidemia trends in a tertiary hospital (2011-2018). Rev Iberoam Micol 2020; 37:87-93. [PMID: 33279388 DOI: 10.1016/j.riam.2020.09.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2020] [Revised: 08/04/2020] [Accepted: 09/22/2020] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND The epidemiology of candidemia has changed over the last decades and varies widely among geographic areas. AIMS We examined in children (aged 0-14) with candidemia the trends in the incidence rate of this infection, as well as the clinical characteristics of the patients, in order to optimize the prognosis and the control measures of this serious disease. METHODS A retrospective cohort study of candidemia in the period 2011-2018 in the neonatal intensive care unit (NICU), pediatric ICU (PICU) and pediatric wards of a tertiary hospital, was conducted. The clinical course, Candida species isolated, antifungal susceptibility, outcome and incidence rates were analyzed and compared. RESULTS We diagnosed 68 episodes of candidemia in 62 children, 48% occurred in the NICU, 31% in the PICU and 21% in pediatric wards. Candida albicans was the most frequent species isolated in NICU infants (53%), and Candida parapsilosis predominated among PICU patients (59%) and pediatric wards (50%). One third of NICU infants had invasive candidiasis (IC), most of them having extremely low birth weight (ELBW) (35%). All isolates were susceptible to the antifungal administered. Over time, the incidence of candidemia decreased in the PICU (from 2.2 to 0.3 episodes/1000 patient-days, OR=0.6; 95%CI 0.5-0.8), whereas in the NICU and in the wards remained stable. Mortality occurred mostly in NICU patients (26%), predominated in ELBW infants and did not change over time. CONCLUSIONS The higher incidence and mortality of candidemia and IC observed in preterm infants requires a continuous evaluation of practices and diagnostic methods which will allow improving the prognosis of this most vulnerable population.
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Affiliation(s)
- Ana I Piqueras
- Pediatric Infectious Diseases, University & Polytechnic Hospital La Fe, Valencia, Spain; Health Research Institute La Fe, Valencia, Spain.
| | - Thomas Rubio
- Infectious Diseases, Georgetown University, Washington DC, USA
| | - Eva M Lopez-Medina
- Pediatric Infectious Diseases, University & Polytechnic Hospital La Fe, Valencia, Spain
| | - Ana Gimeno
- Division of Neonatology, University & Polytechnic Hospital La Fe, Spain
| | - Vicent Modesto
- Pediatric Intensive Care Unit, University & Polytechnic Hospital La Fe, Spain
| | - Emilia Cantón
- Pediatric Intensive Care Unit, University & Polytechnic Hospital La Fe, Spain
| | - Javier Pemán
- Health Research Institute La Fe, Valencia, Spain; Microbiology Department, University & Polytechnic Hospital La Fe, Spain
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Candidemia in Children with Malignancies: Report from the Infection Working Group of the Hellenic Society of Pediatric Hematology-Oncology. J Fungi (Basel) 2020; 6:jof6040276. [PMID: 33182837 PMCID: PMC7712277 DOI: 10.3390/jof6040276] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2020] [Revised: 11/06/2020] [Accepted: 11/09/2020] [Indexed: 01/22/2023] Open
Abstract
Candidemia is an important cause of morbidity and mortality especially in immunocompromised and hospitalized patients. We retrospectively collected data of candidemia cases that occurred in the seven Hematology-Oncology Departments/Units of Greece and the Stem Cell Transplant Unit between 2015 and 2019. In total, 19 episodes of candidemia in 19 patients were recorded. The majority of the patients (78.9%) had at least one risk factor for candidemia. The most frequent risk factors associated with candidemia observed in our patients were prolonged duration of hospitalization (30 days, range 1–141), presence of a central venous catheter at diagnosis of candidemia (73.7%) and antibiotics use during the last two weeks (84.2%). Candida parapsilosis was the most common species isolated accounting for 42.1%, followed by C. albicans (26.3%) and C. famata (15.8%). Nearly all of the patients (84.2%) received antifungal monotherapy with liposomal amphotericin B or echinocandins. The central venous catheter was removed in 78.6% of patients and the median time between the first positive blood culture and catheter removal was 3 days (range 1–9). Mortality at 28 days was 26.3%. In conclusion, a predominance of non-albicans species was observed in our study in conformity with the global trend.
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Zeng Z, Tian G, Ding Y, Yang K, Deng J, Liu J. Epidemiology, antifungal susceptibility, risk factors and mortality of invasive candidiasis in neonates and children in a tertiary teaching hospital in Southwest China. Mycoses 2020; 63:1164-1174. [PMID: 32687642 DOI: 10.1111/myc.13146] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2020] [Revised: 07/11/2020] [Accepted: 07/13/2020] [Indexed: 12/29/2022]
Abstract
BACKGROUND Invasive candidiasis (IC) is a major cause of morbidity and mortality in neonates and children; however, little information on the epidemiology of IC in paediatric patients in China is available. METHODS A 7-year retrospective study was conducted to analyse the prevalence, species distributions, antifungal susceptibility, risk factors and mortality among paediatric inpatients with IC in a regional tertiary teaching hospital in Southwest China. RESULTS A total of 86 paediatric inpatients with IC during the seven-year study period were identified, with a mean annual incidence of 1.04 cases per 1000 admissions and a neonatal incidence of 2.72 cases per 1000 admissions. The species distributions of Candida albicans and non-albicans Candida were 48.8% and 51.2%, respectively. The total resistance rates to fluconazole (FCA), itraconazole (ITR) and voriconazole (VRC) were 8.1%, 26.7% and 14.0%, respectively. Age, length of hospital stay, respiratory dysfunction, hospitalisation duration > 30 days and IC due to C albicans and Candida glabrata were associated with neonatal mortality (P < 0.05) according to univariate analyses. Respiratory dysfunction [odds ratio (OR), 50.03; 95% confidence interval (CI), 3.47-721.44; P = 0.004] was the only independent predictor of neonatal mortality. The overall mortality rate was 8.1%, and only neonatal IC patients died, with a neonatal mortality rate of 13.0%. CONCLUSIONS This report shows that the incidence and mortality of IC among neonatal patients warrants increased attention in Southwest China. Clinical interventions should be actively applied to reduce the incidence and mortality of neonatal infection. Fluconazole was a reasonable choice for the treatment of IC prior to species identification.
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Affiliation(s)
- Zhangrui Zeng
- Department of Laboratory Medicine, Affiliated Hospital of Southwest Medical University, Luzhou, China
| | - Gang Tian
- Department of Laboratory Medicine, Affiliated Hospital of Southwest Medical University, Luzhou, China
| | - Yinhuan Ding
- Department of Laboratory Medicine, Affiliated Hospital of Southwest Medical University, Luzhou, China
| | - Kui Yang
- Department of Laboratory Medicine, Affiliated Hospital of Southwest Medical University, Luzhou, China
| | - Jian Deng
- Department of Laboratory Medicine, Affiliated Hospital of Southwest Medical University, Luzhou, China
| | - Jinbo Liu
- Department of Laboratory Medicine, Affiliated Hospital of Southwest Medical University, Luzhou, China
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Song Y, Chen X, Yan Y, Wan Z, Liu W, Li R. Prevalence and Antifungal Susceptibility of Pathogenic Yeasts in China: A 10-Year Retrospective Study in a Teaching Hospital. Front Microbiol 2020; 11:1401. [PMID: 32719663 PMCID: PMC7347963 DOI: 10.3389/fmicb.2020.01401] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2020] [Accepted: 05/29/2020] [Indexed: 12/29/2022] Open
Abstract
To determine the dynamic changes of pathogenic yeast prevalence and antifungal susceptibility patterns in tertiary hospitals in China, we analyzed 527 yeast isolates preserved in the Research Center for Medical Mycology at Peking University, Beijing, China, between Jan 2010 and Dec 2019 and correctly identified 19 yeast species by matrix-assisted laser desorption ionization time-of-flight mass spectrometry (MALDI-TOF-MS) and ribosomal DNA sequencing. Antifungal susceptibility testing was performed following a Sensititre YeastOne colorimetric microdilution panel with nine clinically available antifungals. The Clinical and Laboratory Standards Institute (CLSI)-approved standard M27-A3 (S4) and newly revised clinical breakpoints or species-specific and method-specific epidemiological cutoff values were used for the interpretation of susceptibility test data. In this study, although Candida albicans was the predominant single species, non-C. albicans species constituted >50% of isolates in 6 out of 10 years, and more rare species were present in the recent 5 years. The non-C. albicans species identified most frequently were Candida parapsilosis sensu stricto, Candida tropicalis, and Candida glabrata. The prevalence of fluconazole and voriconazole resistance in the C. parapsilosis sensu stricto population was <3%, but C. tropicalis exhibited decreased susceptibility to fluconazole (42, 57.5%) and voriconazole (31, 42.5%), and 22 (30.1%) C. tropicalis isolates exhibited wild-type minimum inhibitory concentrations (MICs) to posaconazole. Furthermore, fluconazole and voriconazole cross-resistance prevalence in C. tropicalis was 19 (26.1%). The overall prevalence of fluconazole resistance in the C. glabrata population was 14 (26.9%), and prevalence of isolates exhibiting voriconazole non-wild-type MICs was 33 (63.5%). High-level echinocandin resistance was mainly observed in C. glabrata, and the prevalence rates of isolate resistance to anidulafungin, micafungin, and caspofungin were 5 (9.6%), 5 (9.6%), and 4 (7.7%), respectively. Moreover, one C. glabrata isolate showed multidrug resistant to azoles, echinocandins, and flucytosine. Overall, the 10-year surveillance study showed the increasing prevalence of non-C. albicans species over time; the emergence of azole resistance in C. tropicalis and multidrug resistance in C. glabrata over the years reinforced the need for epidemiological surveillance and monitoring.
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Affiliation(s)
- Yinggai Song
- Department of Dermatology and Venereology, Peking University First Hospital, Beijing, China.,Research Center for Medical Mycology, Peking University, Beijing, China.,National Clinical Research Center for Skin and Immune Diseases, Beijing, China
| | - Xianlian Chen
- Department of Laboratory Medicine, The First Affiliated Hospital of Zunyi Medical University, Zunyi, China
| | - Yan Yan
- Department of Laboratory Medicine, Peking University First Hospital, Beijing, China
| | - Zhe Wan
- Department of Dermatology and Venereology, Peking University First Hospital, Beijing, China.,Research Center for Medical Mycology, Peking University, Beijing, China.,National Clinical Research Center for Skin and Immune Diseases, Beijing, China
| | - Wei Liu
- Department of Dermatology and Venereology, Peking University First Hospital, Beijing, China.,Research Center for Medical Mycology, Peking University, Beijing, China.,National Clinical Research Center for Skin and Immune Diseases, Beijing, China
| | - Ruoyu Li
- Department of Dermatology and Venereology, Peking University First Hospital, Beijing, China.,Research Center for Medical Mycology, Peking University, Beijing, China.,National Clinical Research Center for Skin and Immune Diseases, Beijing, China
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Ambreen G, Rehman A, Hussain K, Sohail M, Javed S, Shamim S, Ali U, Ahmad K, Rizvi A. Neonatal fluid and electrolytes profile effect on amphotericin B associated nephrotoxicity in neonatal tertiary care unit of Karachi-Pakistan. Expert Opin Drug Saf 2020; 19:1209-1217. [PMID: 32544349 DOI: 10.1080/14740338.2020.1781813] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
OBJECTIVES Amphotericin-B (d-AmB) has a broader anti-fungal spectrum and is used for neonatal invasive-fungal-infections especially invasive-candidiasis (IC). To prevent d-AmB-induced nephrotoxicity, renal protective effect of fluid and electrolyte management has been established among adults; in this study, the authors determined this effect among neonates. METHODS In this retrospective cohort study, the authors reviewed neonatal medical records, admitted to neonatal intensive care unit and received d-AmB therapy. Patients were divided into, renal-insufficiency-group (RIG) and the non-renal-insufficiency-group (NIG). RESULTS A total of 90 cases were analyzed, 41 composed RIG and 49 NIG. Renal insufficiency (RI) was developed on 1.7 (0.84) and 7.8 (1.21) days of d-AmB therapy in 26 (63%) and 15 (37%) cases respectively. Bivariate and multivariate analysis demonstrate that >4 m Eq/kg/d sodium intake across all-time points was significantly (p < 0.0001) associated with reduced risk of RI [(phase-I: AOR: 0.96; 95% CI: 0.91-0.99), (phase-II: AOR: 0.84; 95% CI: 0.68-0.92) and (phase-III: AOR: 0.90; 95% CI: 0.86-0.95)]. While adequate fluid intake reduced the likelihood of RI if started before and initial 2 days of d-AmB therapy. CONCLUSIONS Adequate hydration before and 48 hours after d-AmB therapy and >4 mEq/kg/day sodium intake before and through d-AmB therapy may protect neonatal RI.
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Affiliation(s)
- Gul Ambreen
- Department of Pharmacy, Aga Khan University Hospital , Karachi, Pakistan
| | - Arshalooz Rehman
- Department of Paediatrics and Child Health, Aga Khan University Hospital , Karachi, Pakistan
| | - Kashif Hussain
- Department of Pharmacy, Aga Khan University Hospital , Karachi, Pakistan
| | - Mehreen Sohail
- Department of Pharmacy, Aga Khan University Hospital , Karachi, Pakistan
| | - Saba Javed
- Department of Pharmacy, Aga Khan University Hospital , Karachi, Pakistan
| | - Syed Shamim
- Department of Pharmacy, Aga Khan University Hospital , Karachi, Pakistan
| | - Umer Ali
- Department of Pharmacy, Aga Khan University Hospital , Karachi, Pakistan
| | - Khalil Ahmad
- Department of Paediatrics and Child Health, Aga Khan University Hospital , Karachi, Pakistan
| | - Arjumand Rizvi
- Department of Paediatrics and Child Health, Aga Khan University Hospital , Karachi, Pakistan
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Ahangarkani F, Shokohi T, Rezai MS, Ilkit M, Mahmoodi Nesheli H, Karami H, Tamaddoni A, Alizadeh-Navaei R, Khodavaisy S, Meis JF, Badali H. Epidemiological features of nosocomial candidaemia in neonates, infants and children: A multicentre study in Iran. Mycoses 2020; 63:382-394. [PMID: 31985076 DOI: 10.1111/myc.13053] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2019] [Revised: 01/12/2020] [Accepted: 01/20/2020] [Indexed: 02/05/2023]
Abstract
Nosocomial bloodstream candidaemia is a life-threatening fungal infection with high morbidity and mortality, especially among paediatric patients undergoing intensive immunosuppressive therapy. Limited data on the epidemiology of candidaemia and susceptibility profiles are available for Iran. To characterise candidaemia epidemiology, comorbidity risk factors, species distribution, and antifungal susceptibility profiles among paediatric patients in Iran. This observational cross-sectional study enrolled 26 189 patients <18 years old at three reference paediatric hospitals in Mazandaran and Tehran over 2 years. Blood samples from patients with suspected fungal bloodstream infection were analysed using the BACTEC culture system. Fungal isolates were identified using matrix-assisted laser desorption ionisation time-of-flight mass spectrometry (MALDI-TOF) and DNA sequencing. Antifungal susceptibility testing was performed using the Clinical and Laboratory Standards Institute broth microdilution guideline. We observed 109 episodes of nosocomial candidaemia in paediatric patients with or without immunosuppressive therapy. The most common healthcare-associated factor was central vascular catheter use (97%). The all-cause mortality rate was 40%, of which 48% was attributable to candidaemia. While Candida albicans was the most frequent causative agent (49%), emerging and uncommon Candida species were also isolated. Candidaemia mortality by non-albicans Candida species was significantly higher than that by C. albicans (P < .05). All fluconazole-resistant species were non-albicans Candida species. Uncommon Candida species with reduced susceptibility to antifungals are emerging as major agents of nosocomial candidaemia in high-risk paediatric patients in Iran. Appropriate source control, antifungal regimens and improved antifungal stewardship are warranted for managing and decreasing the burden of nosocomial candidaemia.
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Affiliation(s)
- Fatemeh Ahangarkani
- Student Research Committee, Mazandaran University of Medical Sciences, Sari, Iran
- Invasive Fungi Research Center, Mazandaran University of Medical Sciences, Sari, Iran
| | - Tahereh Shokohi
- Invasive Fungi Research Center, Mazandaran University of Medical Sciences, Sari, Iran
- Department of Medical Mycology, School of Medicine, Mazandaran University of Medical Sciences, Sari, Iran
| | - Mohammad Sadegh Rezai
- Pediatric Infectious Diseases Research Center, Mazandaran University of Medical Sciences, Sari, Iran
| | - Macit Ilkit
- Division of Mycology, Department of Microbiology, Faculty of Medicine, University of Çukurova, Adana, Turkey
| | - Hassan Mahmoodi Nesheli
- Non-Communicable Pediatrics Disease Research Center, Babol University of Medical Sciences, Babol, Iran
| | - Hossein Karami
- Thalassemia Research Center, Hemoglobinopathy Institute, Mazandaran University of Medical Sciences, Sari, Iran
| | - Ahmad Tamaddoni
- Non-Communicable Pediatrics Disease Research Center, Babol University of Medical Sciences, Babol, Iran
| | - Reza Alizadeh-Navaei
- Gastrointestinal Cancer Research Center, Mazandaran University of Medical Sciences, Sari, Iran
| | - Sadegh Khodavaisy
- Department of Medical Parasitology and Mycology, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Jacques F Meis
- Department of Medical Microbiology and Infectious Diseases, Canisius-Wilhelmina Hospital (CWZ), Nijmegen, the Netherlands
- Centre of Expertise in Mycology Radboudumc /CWZ, Nijmegen, the Netherlands
| | - Hamid Badali
- Invasive Fungi Research Center, Mazandaran University of Medical Sciences, Sari, Iran
- Department of Medical Mycology, School of Medicine, Mazandaran University of Medical Sciences, Sari, Iran
- Fungus Testing Laboratory, Department of Pathology and Laboratory Medicine, University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
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Abstract
BACKGROUND Data on Candida bloodstream infections in pediatric patients in Europe are limited. We performed a retrospective multicenter European study of the epidemiology and outcome of neonatal and pediatric candidemia. MATERIAL AND METHODS All first positive blood cultures from patients ≤ 18 years of age with candidemia were registered. Patients' demographic and clinical characteristics and causative Candida species were collected and analyzed. Regression analysis was used to identify factors independently associated with mortality. RESULTS One thousand three hundred ninety-five episodes of candidemia (57.8% male) were reported from 23 hospitals in 10 European countries. Of the 1395 episodes, 36.4% occurred in neonates (≤ 44 weeks postmenstrual age), 13.8% in infants (> 44 weeks postmenstrual age to 1 year) and 49.8% in children and adolescents. Candida albicans (52.5%) and Candida parapsilosis (28%) were the predominant species. A higher proportion of candidemia caused by C. albicans was observed among neonatal patients (60.2%) with highest rates of C. parapsilosis seen among infants (42%). Children admitted to hematology-oncology wards presented the highest rates of non-albicans Candida species. Candidemia because of C. albicans was more frequent than non-albicans Candida in Northern versus Southern Europe (odds ratio, 2.3; 95% confidence interval, 1.8-2.9; P < 0.001). The all-cause mortality at 30 days was 14.4%. All-cause mortality was higher among patients admitted to the neonatal or pediatric intensive care units than other wards. Over time, no significant changes in species distribution were observed. CONCLUSIONS This first multicenter European study shows unique characteristics of the epidemiology of pediatric candidemia. The insights obtained from this study will be useful to guide clinical management and antifungal stewardship.
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Wang K, Luo Y, Zhang W, Xie S, Yan P, Liu Y, Li Y, Ma X, Xiao K, Fu H, Cai J, Xie L. Diagnostic value of Candida mannan antigen and anti-mannan IgG and IgM antibodies for Candida infection. Mycoses 2019; 63:181-188. [PMID: 31755600 DOI: 10.1111/myc.13035] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2019] [Revised: 11/16/2019] [Accepted: 11/18/2019] [Indexed: 12/18/2022]
Abstract
OBJECTIVE To assess the diagnostic value of serum Candida mannan antigen (MN) and anti-mannan IgG and IgM antibodies for candidiasis. METHODS This study was a prospective cohort study. Clinical data and venous blood samples from 23 medical centres in Beijing, China were collected between 1 January 2017 and 31 December 2018. All collected specimens were tested within one week for serum Candida MN and IgG and IgM antibodies using an ELISA kit. RESULTS A total of 452 patients were enrolled, including 188 patients in the Candida exposure groups (56 patients with Candida bloodstream infection, 69 patients with Candida-positive tracheal aspirate cultures and 63 patients with Candida-positive urine cultures) and 264 patients in the control groups (212 healthy controls and 52 patients with bacteraemia). The receiver operating characteristic (ROC) curve of the 56 patients with Candida bloodstream infection and 212 healthy controls showed that serum MN and IgG had good diagnostic value. The area under the ROC curve (AUC) values were 0.812 (95% CI, 0.750-0.873) and 0.866 (95% CI, 0.808-0.924), respectively, wherein the MN specificity and sensitivity were 86.79% and 60.71%, and the IgG were 84.43% and 80.36%, respectively. The AUC of the combination of serum MN and IgG was 0.871(95% CI, 0.813-0.929), and the specificity and sensitivity were 93.87% and 57.14%. CONCLUSIONS The serum levels of Candida MN and its IgG antibody have diagnostic value for Candida bloodstream infection, and combination of MN and IgG can improve diagnostic specificity and may provide a new approach for diagnosis of candidaemia.
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Affiliation(s)
- Kaifei Wang
- Department of Pulmonary & Critical Care Medicine, Chinese PLA General Hospital, Beijing, China
| | - Yanping Luo
- Center for Clinical Laboratory Medicine, PLA General Hospital, Beijing, China
| | - Wei Zhang
- Department of Pulmonary & Critical Care Medicine, Chinese PLA General Hospital, Beijing, China
| | - Sheling Xie
- Department of Pulmonary & Critical Care Medicine, Chinese PLA General Hospital, Beijing, China
| | - Peng Yan
- Department of Pulmonary & Critical Care Medicine, Chinese PLA General Hospital, Beijing, China
| | - Yang Liu
- Department of Pulmonary & Critical Care Medicine, Chinese PLA General Hospital, Beijing, China
| | - Yanqin Li
- Department of Pulmonary & Critical Care Medicine, Chinese PLA General Hospital, Beijing, China
| | - Xiuqing Ma
- Department of Pulmonary & Critical Care Medicine, Chinese PLA General Hospital, Beijing, China
| | - Kun Xiao
- Department of Pulmonary & Critical Care Medicine, Chinese PLA General Hospital, Beijing, China
| | - Han Fu
- Department of Pulmonary & Critical Care Medicine, Chinese PLA General Hospital, Beijing, China
| | - Jinyu Cai
- Nankai University School of Medicine, Tianjin, China
| | - Lixin Xie
- Department of Pulmonary & Critical Care Medicine, Chinese PLA General Hospital, Beijing, China
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Noni M, Stathi A, Vaki I, Velegraki A, Zachariadou L, Michos A. Changing Epidemiology of Invasive Candidiasis in Children during a 10-Year Period. J Fungi (Basel) 2019; 5:jof5010019. [PMID: 30813283 PMCID: PMC6462917 DOI: 10.3390/jof5010019] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2018] [Revised: 02/15/2019] [Accepted: 02/21/2019] [Indexed: 11/16/2022] Open
Abstract
Candida species are a common cause of invasive infection in neonates and children. The aim of our study was to evaluate the epidemiology and microbiology of invasive candidiasis (IC) in the largest tertiary Greek pediatric hospital during a 10-year period. A retrospective cohort study was performed from January 2008 to December 2017. Identification of species and antifungal susceptibility testing was performed according to the Clinical and Laboratory Standards Institute (CLSI) methodology. During the study period, 178 cases of IC were recorded. The tissue distribution included blood (87.1%), cerebrospinal (7.9%), peritoneal (3.9%) and pleural fluids (1.1%). Candida albicans and Candida parapsilosis (sensu lato) were the most frequently isolated species (47.8% and 28.7% respectively). From period 2008⁻2012 to period 2013⁻2017, a significant decrease in IC rates was detected (0.21 cases/1000 hospitalization days VS 0.11 cases/1000 hospitalization days, P = 0.040), while median minimum inhibitory concentrations (MICs) of amphotericin B were significantly increased for both C. albicans and C. parapsilosis (sl) (P = 0.037 and P = 0.004 respectively). The decrease in IC rates may reflect the increased awareness as well as the effective infection control initiatives and antifungal interventions. However, the significant increase in the MICs for amphotericin B and echinocandins such as caspofungin, raises concerns about their common use as first-line treatment. Epidemiologic monitoring is, therefore, critically important in order to evaluate and optimize therapeutic protocols for IC in pediatric populations.
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Affiliation(s)
- Maria Noni
- First Department of Pediatrics, Division of Infectious Diseases, "Aghia Sophia" Children's Hospital, National and Kapodistrian University of Athens, 115 27 Athens, Greece.
| | - Angeliki Stathi
- Department of Microbiology, "Aghia Sophia" Children's Hospital, 115 27 Athens, Greece.
| | - Ilia Vaki
- First Department of Pediatrics, Division of Infectious Diseases, "Aghia Sophia" Children's Hospital, National and Kapodistrian University of Athens, 115 27 Athens, Greece.
| | - Aristea Velegraki
- Department of Microbiology, School of Medicine, National and Kapodistrian University of Athens, 115 27 Athens, Greece.
| | - Levantia Zachariadou
- Department of Microbiology, "Aghia Sophia" Children's Hospital, 115 27 Athens, Greece.
| | - Athanasios Michos
- First Department of Pediatrics, Division of Infectious Diseases, "Aghia Sophia" Children's Hospital, National and Kapodistrian University of Athens, 115 27 Athens, Greece.
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Xie J, Zhu L, Zhu T, Jian Y, Ding Y, Zhou M, Feng X. Vitamin D-supplemented yogurt drink reduces Candida infections in a paediatric intensive care unit: a randomised, placebo-controlled clinical trial. J Hum Nutr Diet 2019; 32:512-517. [PMID: 30773722 DOI: 10.1111/jhn.12634] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND The prevalence of Candida infections in paediatric intensive care units (PICUs) has dramatically increased as a result of resistance to conventional anti-fungal treatments. Because vitamin D has been shown to exhibit fungicidal activity against Candida infection in an in vitro antimicrobial screening, we aimed to investigate the effect of vitamin D on Candida infections in the PICU. METHODS Four hundred sixteen eligible children aged between 12 months to 5 years old admitted to the PICU, who were on broad-spectrum antibiotic therapy, participated in the study. Patients were randomly assigned to two study groups, receiving a plain yogurt drink (placebo group) or supplemented with 300 IU day-1 vitamin D (VD group). Primary outcome was defined as the incidences of Candida colonisation (Candida isolated from rectal swab) 14 days after enrollment. Secondary outcome measures were Candida growth in blood (candidaemia) and urine (candiduria). RESULTS The prevalence of candiduria as well as candidaemia was significantly lower in the VD-treated group (26 cases) than in the placebo group (62 cases). The mean (SD) length of PICU stay was obviously lowered in the VD group [11.8 (1.2) days] compared to the placebo group [15.2 (2.3 days)], whereas cases of patient death were similar between the two groups. CONCLUSIONS Supplementation of vitamin D effectively reduces infections of Candida in children who were critically ill and on broad-spectrum antibiotic treatment.
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Affiliation(s)
- J Xie
- Nursing Department, Wuxi Children's Hospital, Wuxi, China
| | - L Zhu
- Nursing Department, Wuxi Children's Hospital, Wuxi, China
| | - T Zhu
- Nursing Department, Wuxi Children's Hospital, Wuxi, China
| | - Y Jian
- Nursing Department, Wuxi Children's Hospital, Wuxi, China
| | - Y Ding
- Nursing Department, Wuxi Children's Hospital, Wuxi, China
| | - M Zhou
- Nursing Department, Wuxi Children's Hospital, Wuxi, China
| | - X Feng
- Nursing Department, Wuxi Children's Hospital, Wuxi, China
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Invasive Candidiasis in Infants and Children: Recent Advances in Epidemiology, Diagnosis, and Treatment. J Fungi (Basel) 2019; 5:jof5010011. [PMID: 30678324 PMCID: PMC6463055 DOI: 10.3390/jof5010011] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2018] [Revised: 01/10/2019] [Accepted: 01/17/2019] [Indexed: 02/07/2023] Open
Abstract
This paper reviews recent advances in three selected areas of pediatric invasive candidiasis: epidemiology, diagnosis, and treatment. Although the epidemiological trends of pediatric invasive candidiasis illustrate a declining incidence, this infection still carries a heavy burden of mortality and morbidity that warrants a high index of clinical suspicion, the need for rapid diagnostic systems, and the early initiation of antifungal therapy. The development of non-culture-based technologies, such as the T2Candida system and (1→3)-β-d-glucan detection assay, offers the potential for early laboratory detection of candidemia and CNS candidiasis, respectively. Among the complications of disseminated candidiasis in infants and children, hematogenous disseminated Candida meningoencephalitis (HCME) is an important cause of neurological morbidity. Detection of (1→3)-β-d-glucan in cerebrospinal fluid serves as an early diagnostic indicator and an important biomarker of therapeutic response. The recently reported pharmacokinetic data of liposomal amphotericin B in children demonstrate dose–exposure relationships similar to those in adults. The recently completed randomized clinical trial of micafungin versus deoxycholate amphotericin B in the treatment of neonatal candidemia provides further safety data for an echinocandin in this clinical setting.
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Hadžić D, Skokić F, Brkić S, Saračević A. Clinical and laboratory characteristics of Neonatal Candida sepsis. SANAMED 2019. [DOI: 10.24125/sanamed.v14i3.364] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
Introduction: Steady progress in intensive treatment worldwide has increased the survival of immature neonates, but with multiple invasive procedures, which has increased the risk of infection and, consequently, fungal sepsis. Candida is the dominant cause, with the rise of resistant non-albicans species. The mortality rate is high and requires timely suspicion and adequate treatment to counteract fatal outcomes. Objectives:To analyze the clinical and laboratory characteristics of Candida sepsis, compared to bacterial sepsis, in neonates treated in the neonatal intensive care unit. Methods: A retrospective cohort study conducted at the Intensive care unit of Pediatric Clinic Tuzla over a three-year period (2016-2018) analyzed the clinical and laboratory characteristics of neonates with Candida sepsis, evidenced by positive blood culture. The control group was neonates treated at the same time for proven bacterial sepsis. Statistical analysis applied standard methods, and the research was approved by the Ethics Committee of the institution. Results: Out of the total 921 neonates treated over a three-year period, culture-confirmed Candida sepsis was found in 48 (5.2%). Prematurity and low birth weight were the most significant risk factors and affected neonates had a more difficult clinical presentation, more receiving parenteral nutrition, mechanical ventilation, intravenous gamma globulin, and longer intensive treatment. Candida sepsis manifested mainly as late-onset. Laboratory abnormalities mainly included CRP elevation, anemia, leukocyte count deviations, and thrombocytopenia. There was no difference in mortality, 44 neonates recovered (91.7%), while 4 (8.3%) died. Antifungal therapy lasted 20.6 ± 6 days, and intensive treatment 38.2 ± 23.2 days, and was significantly longer compared to the control. All isolates were Candida species without in vitro resistance. In 8 neonates (16.7%) treatment complications were recorded. Conclusions: Neonatal Candida sepsis endangers life, complicates treatment, increases costs and mortality rate. Recovery depends on timely suspicion, adequate treatment, and supervision. Antifungal susceptibility is also important and requires monitoring of local epidemiological dynamics.
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Xie J, Zhu L, Zhu T, Jian Y, Ding Y, Zhou M, Feng X. Zinc supplementation reduces Candida infections in pediatric intensive care unit: a randomized placebo-controlled clinical trial. J Clin Biochem Nutr 2018; 64:170-173. [PMID: 30936630 PMCID: PMC6436042 DOI: 10.3164/jcbn.18-74] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2018] [Accepted: 09/18/2018] [Indexed: 11/26/2022] Open
Abstract
Resistance to anti-fungal drugs has become the main cause for increasing incidence rate of Candida infections in pediatric intensive care units (PICU). Zinc supplementation has been shown to exhibit beneficial effects on many pediatric illnesses. This study aimed to investigate the efficacy of zinc supplementation on prevalence of candidemia and candiduria infections in PICU. 724 eligible children between 1 to 5 years old admitted in PICU were randomly assigned into either zinc supplementation group or placebo group. Primary endpoints were the number of Candida infections, length of PICU stay and cases of patient death 14 days after enrollment. Secondary endpoints were the incidence rates of candidemia and candiduria. The incidences of candiduria and candidemia were significantly lower in the zinc group than the placebo group. The length of PICU stay and cases of patient death were obviously lowered in the zinc group compared to the placebo group. In conclusion, zinc supplementation shows beneficial clinical efficacy in reducing Candida infections among PICU patients on broad-spectrum antibiotics with critical illnesses.
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Affiliation(s)
- Jun Xie
- Nursing Department, Wuxi Children's Hospital, Wuxi 214023, P. R. China
| | - Lihong Zhu
- Nursing Department, Wuxi Children's Hospital, Wuxi 214023, P. R. China
| | - Tingli Zhu
- Nursing Department, Wuxi Children's Hospital, Wuxi 214023, P. R. China
| | - Ying Jian
- Nursing Department, Wuxi Children's Hospital, Wuxi 214023, P. R. China
| | - Ye Ding
- Nursing Department, Wuxi Children's Hospital, Wuxi 214023, P. R. China
| | - Min Zhou
- Nursing Department, Wuxi Children's Hospital, Wuxi 214023, P. R. China
| | - Xiaoyan Feng
- Nursing Department, Wuxi Children's Hospital, Wuxi 214023, P. R. China
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McCarthy MW, Walsh TJ. Candidemia in the cancer patient: diagnosis, treatment, and future directions. Expert Rev Anti Infect Ther 2018; 16:849-854. [PMID: 30322269 DOI: 10.1080/14787210.2018.1536546] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
INTRODUCTION The presence of Candida species in the blood is known as candidemia and may constitute a medical emergency for patients with cancer. Despite advances in diagnosis and treatment of this fungal infection, mortality remains unacceptably high. Areas covered: This paper reviews recent advances in molecular diagnostics to detect species of Candida as well as novel antifungal agents that have been developed to address candidiasis. We also review prophylaxis strategies to prevent candidiasis in high-risk cancer patients. Expert commentary: We draw from our own experiences treating candidemia in the cancer patient and review novel diagnostic strategies involving molecular resonance and mass spectroscopy. We also explore novel chemoprophylaxis and treatment options, including new drugs such as rezafungin and SCY-078. We also look ahead, to examine how this condition will be managed in the years ahead.
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Affiliation(s)
- Matthew W McCarthy
- a Division of General Internal Medicine , New York-Presbyterian Hospital, Weill Cornell Medical College , New York , NY , USA
| | - Thomas J Walsh
- b Transplantation-Oncology Infectious Diseases Program, Medical Mycology Research Laboratory, Pediatrics, and Microbiology & Immunology , Weill Cornell Medical Center , New York , NY , USA
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