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Araujo JM, de Almeida Junior JN, Magri MMC, Costa SF, Guimarães T. Guideline Adherence and Outcomes of Patients with Candidemia in Brazil. J Fungi (Basel) 2024; 10:282. [PMID: 38667953 PMCID: PMC11051107 DOI: 10.3390/jof10040282] [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: 03/06/2024] [Revised: 04/08/2024] [Accepted: 04/08/2024] [Indexed: 04/28/2024] Open
Abstract
Candidemia is a significant cause of mortality among hospitalized patients, both worldwide and in Brazil. Prompt and appropriate treatment are essential to mitigate mortality, and clinical practice guidelines aim to optimize patient care based on the best scientific evidence. This study aims to examine the management of candidemia, assessing adherence to the guidelines of the Brazilian Society of Infectious Diseases in a single center located at São Paulo, Brazil. All adult patients hospitalized from 2016 to 2018 who presented one positive blood culture for Candida spp. were included. Electronic medical records were retrospectively reviewed to collect information relevant to the treatment for candidemia, in order to assess the adherence to the Brazilian guideline for the management of candidemia in relation to nine defined outcomes, and we correlated those findings with 30-day mortality by using uni- and multivariate analyses. A total of 115 patients were included; 68 patients (59.1%) were male, with a mean age of 55 years. C. albicans, C. tropicalis and C. glabrata were the most prevalent species. In total, 80 patients (69.5%) received antifungal treatment. The adherence to Brazilian guideline recommendations was determined as described in the following: initial treatment with echinocandin in 48 (60%); step-down to fluconazole in 21 (26.2%); collection of first control blood culture in 43 (58.9%); collection of second control blood culture, if the first one had been positive, in 14 (73.6%); treatment for 14 days after the first negative blood culture in 53 (65.4%); central venous catheter (CVC) removal in 66 (82.5%); CVC removal if the first control blood culture had been positive in 17 (89.4%); performance of a transthoracic echocardiogram in 51 (63.7%) and performance of a fundoscopy in 59 (73.7%). Univariate analysis showed that CVC removal and initial echinocandin therapy were more prevalent in the surviving group, but with no statistically significant difference. On the other hand, step-down to fluconazole demonstrated higher survival rate in the multivariate analysis OR 0.15 (95% CI 0.03-0.8); p = 0.02. The analysis of these nine recommendations demonstrates that it is necessary to improve adherence to specific recommendations and also disseminate strategies of the initial use of echinocandin as the drug of choice and addressing length of treatment and follow-up and complementary exams. Our study provides reassurance that the step-down to fluconazole is safe and may be recommended, if the preexisting conditions are present.
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Affiliation(s)
- Jordana Machado Araujo
- Infection Control Department, Hospital das Clínicas, University of São Paulo, São Paulo 05403-900, Brazil;
| | | | - Marcello Mihailenko Chaves Magri
- Infectious Diseases Department, Hospital das Clínicas, University of São Paulo, São Paulo 05403-900, Brazil; (M.M.C.M.); (S.F.C.)
| | - Silvia Figueiredo Costa
- Infectious Diseases Department, Hospital das Clínicas, University of São Paulo, São Paulo 05403-900, Brazil; (M.M.C.M.); (S.F.C.)
| | - Thaís Guimarães
- Infection Control Department, Hospital das Clínicas, University of São Paulo, São Paulo 05403-900, Brazil;
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Lee YS, Chen X, Widiyanto TW, Orihara K, Shibata H, Kajiwara S. Curcumin affects function of Hsp90 and drug efflux pump of Candida albicans. Front Cell Infect Microbiol 2022; 12:944611. [PMID: 36237434 PMCID: PMC9551236 DOI: 10.3389/fcimb.2022.944611] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2022] [Accepted: 09/07/2022] [Indexed: 11/13/2022] Open
Abstract
Candida albicans is a pathogenic yeast that causes candidiasis in immunocompromised patients. The overuse of antifungal drugs has led to the development of resistance to such drugs by this fungus, which is a major challenge in antifungal chemotherapy. One approach to this problem involves the utilization of new natural products as an alternative source of antifungals. Curcumin, one such natural product, has been widely studied as a drug candidate and is reported to exhibit antifungal activity against C. albicans. Although studies of the mechanism of curcumin against human cancer cells have shown that it inhibits heat shock protein 90 (Hsp90), little is known about its function against C. albicans. In this paper, using a doxycycline-mediated HSP90 strain and an HSP90-overexpressing strain of C. albicans, we demonstrated that the curcumin triggered a decrease in Hsp90 by affecting it at the post-transcriptional level. This also led to the downregulation of HOG1 and CDR1, resulting in a reduction of the stress response and efflux pump activity of C. albicans. However, the inhibition of HSP90 by curcumin was not due to the inhibition of transcription factors HSF1 or AHR1. We also found that curcumin can not only decrease the transcriptional expression of CDR1, but also inhibit the efflux pump activity of Cdr1. Hence, we conclude that disruption of HSP90 by curcumin could impair cell growth, stress responses and efflux pump activity of C. albicans.
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Affiliation(s)
- Yean Sheng Lee
- School of Life Science and Technology, Tokyo Institute of Technology, Yokohama, Japan
| | - Xinyue Chen
- School of Life Science and Technology, Tokyo Institute of Technology, Yokohama, Japan
| | | | - Kanami Orihara
- School of Life Science and Technology, Tokyo Institute of Technology, Yokohama, Japan
| | | | - Susumu Kajiwara
- School of Life Science and Technology, Tokyo Institute of Technology, Yokohama, Japan
- *Correspondence: Susumu Kajiwara,
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Prognostic factors of Candida spp. bloodstream infection in adults: A nine-year retrospective cohort study across tertiary hospitals in Brazil and Spain. LANCET REGIONAL HEALTH. AMERICAS 2021; 6:100117. [PMID: 36777889 PMCID: PMC9904028 DOI: 10.1016/j.lana.2021.100117] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Background Mortality rates among adults with candidemia vary widely in different geographical settings. Studies directly comparing epidemiology and clinical practices between countries are scarce and could bring insights into improving clinical outcomes. Methods Retrospective cohort including adults with candidemia diagnosed in five tertiary hospitals from Brazil and Spain between 2010-2018. Adequate therapeutic management included appropriate antifungal therapy and central-venous-catheter (CVC) removal within 48 h of fungemia. Primary endpoints were mortality rates at 14 and 30 days. Secondary endpoints were prognostic factors associated with 30-day mortality. Findings Overall, 720 patients were included, being 323 from Spain. Spanish patients received echinocandins more often (52·5% vs. 39·3%, p = 0.001), initiated antifungals earlier [2 (0-7) vs. 2 days (0-16), p<0.001], and had faster CVC-removal [1 (0-42) vs. 2 days (0-38), p = 0.012]. Mortality was higher among Brazilians at 14 days (35·8% vs. 20·1%, p<0.001), and at 30 days (51·9% vs. 31·6%, p < 0.001). Factors associated with mortality included: age [OR 1·02, 95%CI (1·008-1·032), p = 0·001], neutropenia [OR 3·24, 95%CI (1·594-6·585), p = 0·001], chronic pulmonary disease [OR 2·26, 95%CI (1·495-3·436), p < 0·001], corticosteroids [OR 1·45, 95%CI (1·018-2·079), p = 0·039], Pitt-Score>1 [OR 2·56, 95%CI (1·776-3·690), p < 0·001], and inadequate therapeutic management [OR 2·84, 95%CI (1·685-4·800), p < 0·001]. Being from Spain [OR 0·51, 95%CI (0·359-0·726), p < 0·001] and C. parapsilosis [OR 0·36, 95%CI (0·233-0·568), p < 0·001] were protective. Interpretation Higher mortality rates were observed in Brazil. Factors associated with 30-day mortality included mainly epidemiological characteristics and inadequate therapeutic management. Thus, effective and prompt antifungals combined with CVC-removal still need to be emphasized in order to improve the prognosis of adults with candidemia. Funding Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP 2017/02203-7); CAPES Foundation (PDSE 88881.187981/2018-01).
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Mind the gaps: challenges in the clinical management of invasive candidiasis in critically ill patients. Curr Opin Infect Dis 2021; 33:441-448. [PMID: 33044240 DOI: 10.1097/qco.0000000000000684] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
PURPOSE OF REVIEW Strict adherence to clinical practice guidelines is recognized to improve outcomes but the inconvenient truth is that only a small subset of what is done in medicine has been tested in appropriate, well designed studies. In this article, we aim to review controversial aspects of the clinical management of invasive candidiasis recommended by guidelines. RECENT FINDINGS Despite still being recommended by guidelines, we fail to identify a single randomized clinical trial documenting that the use of antifungal drugs in high-risk critically ill patients without microbiologic documentation of Candida infection decreases mortality. Regarding deep-seated Candida infections, most cohort studies of patients with candidemia found less than 5% of patients developed endophthalmitis and endocarditis. In this scenario, it is reasonable to reconsider routine universal screening of both complications in candidemic patients. Finally, a large number of studies have shown that critically ill patients usually have lower echinocandin exposure when compared with other populations. We need more data on the clinical relevance of this finding. SUMMARY We need robust studies to validate new strategies for the clinical management of candidemia in ICU, including: the use of fungal biomarkers in the early initiation or interruption of antifungal therapy in high-risk patients to replace the conventional empirical antifungal therapy driven by predictive rules; validation of targeted screening of eye infection and endocarditis with the aid of fungal biomarkers only in high-risk patients; we should clarify if higher doses of candins are necessary to treat invasive candidiasis in critically ill patients, especially in the case of intra-abdominal infections where drug penetration is suboptimal.
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Timing for Step-Down Therapy of Candidemia in Non-Neutropenic Patients: An International Multi-Center Study. Mediterr J Hematol Infect Dis 2021; 13:e2021031. [PMID: 34007419 PMCID: PMC8114892 DOI: 10.4084/mjhid.2021.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Accepted: 04/09/2021] [Indexed: 11/29/2022] Open
Abstract
Background Candida bloodstream infection (BSI) remains one of the leading causes of BSI in critically ill and immunosuppressed cancer patients. In light of the changing epidemiology and rising resistant species, duration of treatment and appropriate timing of stepdown therapy from intravenous (IV) to oral antifungal agents are crucial for utmost disease control and overall survival. Method We performed a multicenter retrospective study, with 119 non-neutropenic patients enrolled from four different medical institutions in Brazil, Lebanon, Spain and the United States, to assess the duration of IV therapy and appropriate time to step-down to oral therapy in adult patients, 14 years of age and older, with documented candidemia. The analysis was done using the statistical program R and SAS v9.4. Descriptive statistics are presented as frequencies and tables and the Fisher exact test was used to test the association between the categorical variables: organism, cancer, country, antifungal drug and duration of therapy, and time of step-down. Results Candida albicans contributed to 45% of bloodstream infection versus 55% of infection caused by Candida non-albicans. The three most common Candida non-albicans are: Candida glabrata 24%, Candida parapsilosis 13% and Candida tropicalis 8%. Most (57%) of the patients were admitted to ICU, whereas 52% had underlying malignancy. Multivariate analysis showed that a stay at ICU or an underlying cancer requiring chemotherapy were independently associated with failure and death (p <0.001). The average total duration of therapy was 14 days in all patients and 16 days in those who responded and survived. Forty-five patients were stepped down to either fluconazole and/or voriconazole in association with clinical and microbiologic resolution of the candidemia. The average (and median) day of step-down was 5 days. Patients who had a stepdown had more favorable outcomes (78% survival) as compared to those with no stepdown (56% survival) (P = 0.022). However, the 20 patients who received 1–4 days of first IV treatment before a stepdown to oral azoles had a comparable outcome (20% mortality) to the 25 patients who received >5 days of treatment (24% mortality - p = 0.75). Conclusion Our data support the IDSA guidelines in that the total duration of treatment for candidemia should be at least 14 days after a negative blood culture. However, in non-neutropenic cancer patients with candidemia, a step-down to oral azole therapy can safely take place early (within 4 days of initiating IV therapy) as long as the patient had clinical and microbiologic resolution of the bloodstream infections.
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Cornely FB, Cornely OA, Salmanton‐García J, Koehler FC, Koehler P, Seifert H, Wingen‐Heimann S, Mellinghoff SC. Attributable mortality of candidemia after introduction of echinocandins. Mycoses 2020; 63:1373-1381. [DOI: 10.1111/myc.13177] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2020] [Accepted: 08/26/2020] [Indexed: 01/02/2023]
Affiliation(s)
- Florian B. Cornely
- Department I of Internal Medicine Faculty of Medicine and University Hospital Cologne Excellence Center for Medical Mycology (ECMM) University of Cologne Cologne Germany
- Medical University of Varna Varna Bulgaria
| | - Oliver A. Cornely
- Department I of Internal Medicine Faculty of Medicine and University Hospital Cologne Excellence Center for Medical Mycology (ECMM) University of Cologne Cologne Germany
- Faculty of Medicine and University Hospital Cologne Chair Translational Research Cologne Excellence Cluster on Cellular Stress Responses in Aging‐Associated Diseases (CECAD) University of Cologne Cologne Germany
- Clinical Trial Centre Cologne (ZKS Köln) University of Cologne Cologne Germany
- German Center for Infection Research (DZIF)Partner Site Bonn‐Cologne Cologne Germany
| | - Jon Salmanton‐García
- Department I of Internal Medicine Faculty of Medicine and University Hospital Cologne Excellence Center for Medical Mycology (ECMM) University of Cologne Cologne Germany
- Faculty of Medicine and University Hospital Cologne Chair Translational Research Cologne Excellence Cluster on Cellular Stress Responses in Aging‐Associated Diseases (CECAD) University of Cologne Cologne Germany
| | - Felix C. Koehler
- Faculty of Medicine and University Hospital Cologne Chair Translational Research Cologne Excellence Cluster on Cellular Stress Responses in Aging‐Associated Diseases (CECAD) University of Cologne Cologne Germany
- Department II of Internal Medicine Faculty of Medicine and University Hospital Cologne Center for Molecular Medicine Cologne University of Cologne Cologne Germany
| | - Philipp Koehler
- Department I of Internal Medicine Faculty of Medicine and University Hospital Cologne Excellence Center for Medical Mycology (ECMM) University of Cologne Cologne Germany
- Faculty of Medicine and University Hospital Cologne Chair Translational Research Cologne Excellence Cluster on Cellular Stress Responses in Aging‐Associated Diseases (CECAD) University of Cologne Cologne Germany
| | - Harald Seifert
- German Center for Infection Research (DZIF)Partner Site Bonn‐Cologne Cologne Germany
- Institute for Medical Microbiology, Immunology and Hygiene University of Cologne Cologne Germany
| | - Sebastian Wingen‐Heimann
- Faculty of Medicine and University Hospital Cologne Chair Translational Research Cologne Excellence Cluster on Cellular Stress Responses in Aging‐Associated Diseases (CECAD) University of Cologne Cologne Germany
- FOM University of Applied Sciences Cologne Germany
| | - Sibylle C. Mellinghoff
- Department I of Internal Medicine Faculty of Medicine and University Hospital Cologne Excellence Center for Medical Mycology (ECMM) University of Cologne Cologne Germany
- Faculty of Medicine and University Hospital Cologne Chair Translational Research Cologne Excellence Cluster on Cellular Stress Responses in Aging‐Associated Diseases (CECAD) University of Cologne Cologne Germany
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Bouza E, Almirante B, García Rodríguez J, Garnacho-Montero J, Salavert M, Muñoz P, Sanguinetti M. Biomarkers of fungal infection: Expert opinion on the current situation. REVISTA ESPANOLA DE QUIMIOTERAPIA 2019. [PMID: 31729203 PMCID: PMC6987620 DOI: 10.37201/req/2260.2019] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
The introduction of non-culture-based diagnostic techniques is revolutionizing the world of microbiological diagnosis and infection assessment. Fungi are no exception, and the introduction of biomarkers has opened up enormous expectations for better management of these entities. Biomarkers are diverse, their targets are also diverse and their evaluation has been done preferably in an individualized use and with deficient designs. Less is known about the value of the combined use of biomarkers and the impact of the negativity of two or more biomarkers on antifungal treatment decisions has been poorly studied. Given the paucity of prospective, randomized and definitive studies, we have convened experts from different fields, with an interest in invasive fungal infections, to answer some questions about the current relevant use of fungal biomarkers. This document summarizes the answers of these experts to the different questions.
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Affiliation(s)
- E Bouza
- Emilio Bouza, Instituto de Investigación Sanitaria Gregorio Marañón, Servicio de Microbiología Clínica y E. Infecciosas, C/ Dr. Esquerdo, 46, 28007 Madrid, Spain.
| | | | | | | | | | - P Muñoz
- Patricia Muñoz, Servicio de Microbiología Clínica y Enfermedades Infecciosas, Hospital General Universitario Gregorio Marañón, C/ Dr. Esquerdo, 46, 28007 Madrid, Spain.
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de Medeiros MAP, de Melo APV, Bento ADO, de Souza LBFC, Neto FDAB, Garcia JBL, Zuza-Alves DL, Francisco EC, Melo ASDA, Chaves GM. Epidemiology and prognostic factors of nosocomial candidemia in Northeast Brazil: A six-year retrospective study. PLoS One 2019; 14:e0221033. [PMID: 31437188 PMCID: PMC6705852 DOI: 10.1371/journal.pone.0221033] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2019] [Accepted: 07/29/2019] [Indexed: 12/21/2022] Open
Abstract
Candidemia has been considered a persistent public health problem with great impact on hospital costs and high mortality. We aimed to evaluate the epidemiology and prognostic factors of candidemia in a tertiary hospital in Northeast Brazil from January 2011 to December 2016. Demographic and clinical data of patients were retrospectively obtained from medical records and antifungal susceptibility profiling was performed using the broth microdilution method. A total of 68 episodes of candidemia were evaluated. We found an average incidence of 2.23 episodes /1000 admissions and a 30-day mortality rate of 55.9%. The most prevalent species were Candida albicans (35.3%), Candida tropicalis (27.4%), Candida parapsilosis (21.6%) and Candida glabrata (11.8%). Higher mortality rates were observed in cases of candidemia due to C. albicans (61.1%) and C. glabrata (100%), especially when compared to C. parapsilosis (27.3%). Univariate analysis revealed some variables which significantly increased the probability of death: older age (P = 0.022; odds ratio [OR] = 1.041), severe sepsis (P < 0.001; OR = 8.571), septic shock (P = 0.035; OR = 3.792), hypotension (P = 0.003; OR = 9.120), neutrophilia (P = 0.046; OR = 3.080), thrombocytopenia (P = 0.002; OR = 6.800), mechanical ventilation (P = 0.009; OR = 8.167) and greater number of surgeries (P = 0.037; OR = 1.920). Multivariate analysis showed that older age (P = 0.040; OR = 1.055), severe sepsis (P = 0.009; OR = 9.872) and hypotension (P = 0.031; OR = 21.042) were independently associated with worse prognosis. There was no resistance to amphotericin B, micafungin or itraconazole and a low rate of resistance to fluconazole (5.1%). However, 20.5% of the Candida isolates were susceptible dose-dependent (SDD) to fluconazole and 7.7% to itraconazole. In conclusion, our results could assist in the adoption of strategies to stratify patients at higher risk for developing candidemia and worse prognosis, in addition to improve antifungal management.
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Affiliation(s)
- Mariana Araújo Paulo de Medeiros
- Laboratory of Medical and Molecular Mycology, Department of Clinical and Toxicological Analysis, Federal University of Rio Grande do Norte, Natal city, Rio Grande do Norte State, Brazil
| | - Ana Patrícia Vieira de Melo
- Laboratory of Medical and Molecular Mycology, Department of Clinical and Toxicological Analysis, Federal University of Rio Grande do Norte, Natal city, Rio Grande do Norte State, Brazil
| | - Aurélio de Oliveira Bento
- Laboratory of Medical and Molecular Mycology, Department of Clinical and Toxicological Analysis, Federal University of Rio Grande do Norte, Natal city, Rio Grande do Norte State, Brazil
| | - Luanda Bárbara Ferreira Canário de Souza
- Laboratory of Medical and Molecular Mycology, Department of Clinical and Toxicological Analysis, Federal University of Rio Grande do Norte, Natal city, Rio Grande do Norte State, Brazil
| | - Francisco de Assis Bezerra Neto
- Laboratory of Medical and Molecular Mycology, Department of Clinical and Toxicological Analysis, Federal University of Rio Grande do Norte, Natal city, Rio Grande do Norte State, Brazil
| | - Jarmilla Bow-Ltaif Garcia
- Laboratory of Medical and Molecular Mycology, Department of Clinical and Toxicological Analysis, Federal University of Rio Grande do Norte, Natal city, Rio Grande do Norte State, Brazil
| | - Diana Luzia Zuza-Alves
- Laboratory of Medical and Molecular Mycology, Department of Clinical and Toxicological Analysis, Federal University of Rio Grande do Norte, Natal city, Rio Grande do Norte State, Brazil
| | - Elaine Cristina Francisco
- Special Mycology Laboratory, Department of Medicine, Federal University of Sao Paulo, São Paulo City, São Paulo State, Brazil
| | - Analy Salles de Azevedo Melo
- Special Mycology Laboratory, Department of Medicine, Federal University of Sao Paulo, São Paulo City, São Paulo State, Brazil
| | - Guilherme Maranhão Chaves
- Laboratory of Medical and Molecular Mycology, Department of Clinical and Toxicological Analysis, Federal University of Rio Grande do Norte, Natal city, Rio Grande do Norte State, Brazil
- * E-mail:
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Poves-Alvarez R, Cano-Hernández B, Muñoz-Moreno MF, Balbás-Alvarez S, Román-García P, Gómez-Sánchez E, Martínez-Rafael B, Gómez-Pesquera E, Lorenzo-López M, Alvarez-Fuente E, de la Varga O, Flores M, Eiros JM, Tamayo E, Heredia-Rodríguez M. Impact of empirical treatment with antifungal agents on survival of patients with candidemia. REVISTA ESPANOLA DE QUIMIOTERAPIA : PUBLICACION OFICIAL DE LA SOCIEDAD ESPANOLA DE QUIMIOTERAPIA 2019; 32:6-14. [PMID: 30499639 PMCID: PMC6372967] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
OBJECTIVE The objective of this study was to evaluate the impact of echinocandins and fluconazole) on mortality 7 and 30 days after candidemia onset and overall in-hospital mortality), in patients with candidemia at a Spanish tertiary hospital. METHODS A retrospective study was conducted that enrolled all non-neutropenic adult patients diagnosed with candidemia at Hospital Clínico Universitario de Valladolid between 2007 and 2016. A total of 179 patients were evaluated, they were divided into two sub-groups: surviving patients (n = 92) and non-surviving patients (n = 87). RESULTS The 7-day mortality was 25,1% (45), 30-day mortality was 46,9% (84), and overall in-hospital mortality was 48,6% (87). 40.8% of patients received no antifungal treatment (43.8% of surviving patients and 37.8% of non-surviving patients; p=0.15). A total of 106 (59.2%) patients were treated, of which 90 patients (50.3%) received empiric treatment. 19.6% and 47.8% of surviving patients were treated with echinocandins and fluconazole, respectively. By contrast, of non-surviving patients, 31.0% were treated with echinocandins and 47.1% received fluconazole. Survival for the first 7 days was significantly higher in treated with antifungal agents (log-rank = 0.029), however, there were not significant differences in 30-day survival. Factors linked to a significant increase in overall in-hospital mortality were age (OR 1.040), septic shock (OR 2.694) and need for mechanical ventilation > 48 h (OR 2.812). CONCLUSIONS Patients who received antifungal treatment, regardless of whether they received fluconazole or echinocandins, had a significantly lower mortality rate after 7 days than untreated patients, although no significant differences in 30-day mortality were seen.
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Affiliation(s)
- Rodrigo Poves-Alvarez
- Anesthesiology and Surgical Critical Care Department, Hospital Clínico Universitario de Valladolid, Spain,Group of Biomedical Research in Critical Care Medicine (BioCritic), Hospital Clínico Universitario de Valladolid, Spain
| | - Beatriz Cano-Hernández
- Anesthesiology and Surgical Critical Care Department, Hospital Clínico Universitario de Valladolid, Spain,Group of Biomedical Research in Critical Care Medicine (BioCritic), Hospital Clínico Universitario de Valladolid, Spain
| | | | - Sara Balbás-Alvarez
- Anesthesiology and Surgical Critical Care Department, Hospital Clínico Universitario de Valladolid, Spain,Group of Biomedical Research in Critical Care Medicine (BioCritic), Hospital Clínico Universitario de Valladolid, Spain
| | - Patricia Román-García
- Anesthesiology and Surgical Critical Care Department, Hospital Clínico Universitario de Valladolid, Spain,Group of Biomedical Research in Critical Care Medicine (BioCritic), Hospital Clínico Universitario de Valladolid, Spain
| | - Esther Gómez-Sánchez
- Anesthesiology and Surgical Critical Care Department, Hospital Clínico Universitario de Valladolid, Spain,Group of Biomedical Research in Critical Care Medicine (BioCritic), Hospital Clínico Universitario de Valladolid, Spain
| | - Beatriz Martínez-Rafael
- Anesthesiology and Surgical Critical Care Department, Hospital Clínico Universitario de Valladolid, Spain,Group of Biomedical Research in Critical Care Medicine (BioCritic), Hospital Clínico Universitario de Valladolid, Spain
| | - Estefanía Gómez-Pesquera
- Anesthesiology and Surgical Critical Care Department, Hospital Clínico Universitario de Valladolid, Spain,Group of Biomedical Research in Critical Care Medicine (BioCritic), Hospital Clínico Universitario de Valladolid, Spain
| | - Mario Lorenzo-López
- Anesthesiology and Surgical Critical Care Department, Hospital Clínico Universitario de Valladolid, Spain,Group of Biomedical Research in Critical Care Medicine (BioCritic), Hospital Clínico Universitario de Valladolid, Spain
| | - Elisa Alvarez-Fuente
- Anesthesiology and Surgical Critical Care Department, Hospital Clínico Universitario de Valladolid, Spain,Group of Biomedical Research in Critical Care Medicine (BioCritic), Hospital Clínico Universitario de Valladolid, Spain
| | - Olga de la Varga
- Anesthesiology and Surgical Critical Care Department, Hospital Clínico Universitario de Valladolid, Spain,Group of Biomedical Research in Critical Care Medicine (BioCritic), Hospital Clínico Universitario de Valladolid, Spain
| | - Miguel Flores
- Anesthesiology and Surgical Critical Care Department, Hospital Clínico Universitario de Valladolid, Spain,Group of Biomedical Research in Critical Care Medicine (BioCritic), Hospital Clínico Universitario de Valladolid, Spain
| | - José María Eiros
- Group of Biomedical Research in Critical Care Medicine (BioCritic), Hospital Clínico Universitario de Valladolid, Spain,Department of Microbiology, Faculty of Medicine, University of Valladolid, Spain
| | - Eduardo Tamayo
- Anesthesiology and Surgical Critical Care Department, Hospital Clínico Universitario de Valladolid, Spain,Group of Biomedical Research in Critical Care Medicine (BioCritic), Hospital Clínico Universitario de Valladolid, Spain
| | - María Heredia-Rodríguez
- Anesthesiology and Surgical Critical Care Department, Hospital Clínico Universitario de Valladolid, Spain,Group of Biomedical Research in Critical Care Medicine (BioCritic), Hospital Clínico Universitario de Valladolid, Spain
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Sadeghi G, Ebrahimi-Rad M, Mousavi SF, Shams-Ghahfarokhi M, Razzaghi-Abyaneh M. Emergence of non-Candida albicans species: Epidemiology, phylogeny and fluconazole susceptibility profile. J Mycol Med 2018; 28:51-58. [PMID: 29366545 DOI: 10.1016/j.mycmed.2017.12.008] [Citation(s) in RCA: 46] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2017] [Revised: 12/05/2017] [Accepted: 12/15/2017] [Indexed: 01/19/2023]
Abstract
OBJECTIVE Non-Candida albicans (NCA) species now account for a significant part of clinical candidiasis worldwide. In the present study, epidemiology and antifungal susceptibility profile of NCA isolated from various forms of candidiasis were studied with special focus on their phylogenetic relationship by ITS sequencing. PATIENTS AND METHODS Seventy-nine NCA isolates were isolated from skin and nail scrapings (67.0%), vaginal discharges (8.8%), blood (8.8%), sputa (5.0%), urine (5.0%), oral swabs (2.6%), biopsy and eye tumor, each (1.4%). These isolates were identified by morphological, biochemical and molecular (ITS sequencing) techniques. In vitro antifungal susceptibility of the isolates to fluconazole (FCZ) was tested according to the CLSI method (M27-S4). RESULTS Among a total number of 79 cases of proven NCA infections, C. parapsilosis (36.8%) was the most prevalent species followed by C. glabrata (32.9%), C. orthopsilosis (11.4%), C. tropicalis (8.9%), C. krusei (5.0%) and C. guilliermondii (5.0%). The susceptibility to FCZ was assessed for C. parapsilosis (96.5%), C. orthopsilosis (88.9%), C. tropicalis (85.7%) and C. guilliermondii (50.0%). C. glabrata and C. krusei isolates were not susceptible to FCZ. NCA species were distributed in various phylogenetic clades including C. glabrata (1), C. tropicalis (3), C. parapsilosis (6) and C. orthopsilosis, C. krusei and C. guilliermondii (each 2). CONCLUSION C. parapsilosis and C. glabrata were the most predominant NCA species involve in the etiology of candidiasis. C. orthopsilosis was reported from superficial candidiasis. Taken together, our results further substantiate the increasing importance of the involvement of NCA species in the etiology of candidiasis.
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Affiliation(s)
- G Sadeghi
- Department of Medical Mycology, Pasteur Institute of Iran, 1316943551 Tehran, Iran
| | - M Ebrahimi-Rad
- Department of Biochemistry, Pasteur Institute of Iran, 1316943551 Tehran, Iran
| | - S F Mousavi
- Department of Microbiology, Pasteur Institute of Iran, 1316943551 Tehran, Iran
| | - M Shams-Ghahfarokhi
- Department of Medical Mycology, Faculty of Medical Sciences, Tarbiat Modares University, 14115-331 Tehran, Iran
| | - M Razzaghi-Abyaneh
- Department of Medical Mycology, Pasteur Institute of Iran, 1316943551 Tehran, Iran.
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11
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Castro LL, Schütze M, Bücker DH, Vasconcellos LDS. Prevalence of fungemia in a tertiary hospital: Analysis of the last decade. Rev Assoc Med Bras (1992) 2017; 62:315-9. [PMID: 27437675 DOI: 10.1590/1806-9282.62.04.315] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2014] [Accepted: 11/03/2014] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION The prevalence of nosocomial fungemia has increased worldwide, and mortality caused by this disease is high. OBJECTIVE To assess progress in the last decade, and the prevalence and profile of fungal agents isolated in blood cultures performed in a tertiary university hospital. METHOD All the results of blood cultures processed at Hospital das Clínicas, Universidade Federal de Minas Gerais (HC-UFMG), in the time intervals 2001-2003 and 2011-2013 were analyzed retrospectively. For each three-year period, the number of collected blood cultures, the overall positivity rate and the percentage of fungemia were recorded. In addition, all identified fungal species were cataloged. All blood samples were incubated in the BacT/ALERT® (bioMérieux) automation system. RESULTS In 2001-2003, 34,822 samples were evaluated, with 5,510 (15.8%) positive results. In 2011-2013, the number of blood cultures processed increased to 55,052 samples, with 4,873 (8.9%) positive results. There was an increase in the number of positive cultures for fungi in the analyzed period (2001-2003: 4.16%; 2011-2013: 5.95%; p<0.001). Among the agents, candidemias were predominant, especially those caused by non-albicans Candida species (2001-2003: 57.64%; 2011-2013: 65.17%; p<0.05). There was also an increase in fungemia caused by other genera (2001-2003: 2.62%; 2011-2013: 4.48%; p<0.01). CONCLUSION There was an increase in the prevalence of fungemia in the last decade at HC-UFMG. Although candidemias have been responsible for most of the cases, there has been an increase in fungemias caused by other species.
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Affiliation(s)
- Luísa Lima Castro
- MD from Faculdade de Medicina, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, MG, Brazil
| | - Manuel Schütze
- MD from Faculdade de Medicina, UFMG. MSc in Molecular Medicine from UFMG, Belo Horizonte, MG, Brazil
| | - Daniel Henrique Bücker
- Biologist, degree from Universidade Federal de Rondônia. MSc in Genetics from UFMG. Employee of the Laboratory Medicine Service at Hospital das Clínicas, UFMG, Belo Horizonte, MG, Brazil
| | - Leonardo de Souza Vasconcellos
- MSc and PhD in Medicine from UFMG. Adjunct Professor, Department of Complementary Propedeutics, Faculdade de Medicina, UFMG. MD, Clinical Pathologist, Belo Horizonte, MG, Brazil
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12
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Fu J, Wang X, Wei B, Jiang Y, Chen J. Risk factors and clinical analysis of candidemia in very-low-birth-weight neonates. Am J Infect Control 2016; 44:1321-1325. [PMID: 27566876 DOI: 10.1016/j.ajic.2016.03.026] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2015] [Revised: 03/18/2016] [Accepted: 03/18/2016] [Indexed: 10/21/2022]
Abstract
BACKGROUND Candidemia is the third leading cause of morbidity and mortality in preterm or very-low-birth-weight infants. The incidence and risk factors of candidemia in this population are poorly known in western China. METHODS A case-control retrospective study of candidemia was conducted from January 2012-November 2015 in the Liuzhou Maternity and Child Healthcare Hospital. Data were analyzed by univariate analysis and multivariate logistic regression. RESULTS Forty-eight confirmed cases of candidemia were identified during the study period, indicating an incidence of 106.9 per 1,000 admissions of very-low-birth-weight infants. Candida albicans was the most common pathogen and was isolated in 39.6% of infants with candidemia. The mortality rate of the case group was 10.4% versus 2.1% in the control group (P = .128). The multivariable logistic regression model identified that carbapenem use (odds ratio [OR], 11.39; 95% confidence interval [CI], 3.28-39.54), total parenteral nutrition (OR, 10.16; 95% CI, 2.25-45.94), and prolonged hospitalization (OR, 1.04; 95% CI, 1.01-1.07) were all associated with the risk of developing neonatal candidemia. CONCLUSION Very-low-birth-weight infants are at a significantly high risk of developing candidemia. The local neonatal intensive care unit management teams should effectively focus on decreasing the overall use of carbapenems, improving catheter care, removing catheters early, and shortening hospitalizations to reduce the incidence of candidemia.
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13
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Ferrer R, Zaragoza R, Rodríguez AH, Maseda E, Llinares P, Grau S, Álvarez-Lerma F, Quindós G, Salavert M, Huarte R. EPICO 3.0. Management of non-neutropenic patients in medical wards. Rev Iberoam Micol 2016; 33:216-223. [PMID: 27769740 DOI: 10.1016/j.riam.2016.06.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2016] [Revised: 06/16/2016] [Accepted: 06/17/2016] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Although the management of invasive fungal infection (IFI) has improved, a number of controversies persist regarding the approach to invasive fungal infection in non-neutropenic medical ward patients. AIMS To identify the essential clinical knowledge to elaborate a set of recommendations with a high level of consensus necessary for the management of IFI in non-neutropenic medical ward patients. METHODS A prospective, Spanish questionnaire, which measures consensus through the Delphi technique, was anonymously answered and e-mailed by 30 multidisciplinary national experts, all specialists (intensivists, anesthesiologists, microbiologists, pharmacologists and specialists in infectious diseases) in IFI and belonging to six scientific national societies. They responded to five questions prepared by the coordination group after a thorough review of the literature published in the last few years. For a category to be selected, the level of agreement among the experts in each category had to be equal to or greater than 70%. In a second round, 73 specialists attended a face-to-face meeting held after extracting the recommendations from the chosen topics, and validated the pre-selected recommendations and derived algorithm. RESULTS The following recommendations were validated and included in the algorithm: 1. several elements were identified as risk factors for invasive candidiasis (IC) in non-hematologic medical patients; 2. no agreement on the use of the colonization index to decide whether prescribing an early antifungal treatment to stable patients (no shock), with sepsis and no other evident focus and IC risk factors; 3. agreement on the use of the Candida Score to decide whether prescribing early antifungal treatment to stable patients (no shock) with sepsis and no other evident focus and IC risk factors; 4. agreement on initiating early antifungal treatment in stable patients (no shock) with a colonization index>0.4, sepsis with no other evident focus and IC risk factors; 5. agreement on the performance of additional procedures in stable patients (no shock) with sepsis and no other evident focus, IC risk factors, without colonization index>0.4, but with a high degree of suspicion. CONCLUSIONS Based on the expert's recommendations, an algorithm for the management of non-neutropenic medical patients was constructed and validated. This algorithm may be useful to support bedside prescription.
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Affiliation(s)
- Ricardo Ferrer
- Intensive Care Department, Vall d'Hebron University Hospital. Shock, organ dysfunction and Resuscitation Research Group (SODIR), VHIR, Barcelona, Spain.
| | - Rafael Zaragoza
- Intensive Care Medicine Service, Dr. Peset University Hospital, Valencia, Spain
| | | | - Emilio Maseda
- Anesthesiology Service, La Paz University Hospital, Madrid, Spain
| | - Pedro Llinares
- Infectious Diseases Service, A Coruña University Complex Hospital, A Coruña, Spain
| | - Santiago Grau
- Pharmacy Service, Hospital del Mar, Barcelona, Spain
| | | | - Guillermo Quindós
- Microbiology Service, Faculty of Medicine and Dentistry, Basque Country University, Spain
| | - Miguel Salavert
- Infectious Diseases Service, Hospital La Fe, Valencia, Spain
| | - Rafael Huarte
- Pharmacy Service, Miguel Servet University Hospital, Zaragoza, Spain
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Razzaghi R, Momen-Heravi M, Erami M, Nazeri M. Candidemia in patients with prolonged fever in Kashan, Iran. Curr Med Mycol 2016; 2:20-26. [PMID: 28681025 PMCID: PMC5490286 DOI: 10.18869/acadpub.cmm.2.3.20] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Abstract
Background and Purpose: Candida species are considered a common cause of fungal blood stream infections, which are associated with considerable mortality and morbidity rates, especially in the admitted and immunocompromised patients. Despite the increase in new and available antifungal agents, the emergence of resistant strains is growing. Regarding this, the aim of the present study was to assess the fungal epidemiology of candidemia and the antifungal susceptibility patterns against five current antifungal agents among the patients with prolonged fever, who were admitted to Beheshti Educational Hospital, Kashan, Iran. Materials and Methods: This cross-sectional study was conducted on 253 hospitalized patients with prolonged fever despite receiving broad-spectrum antibiotic therapy. Blood samples were collected aseptically, and then cultured using an automated blood culture system and conventional broth culture bottle. Candida isolates were identified at species level using morphological and physiological properties and produced color on the CHROMagar Candida. Furthermore, the antifungal susceptibility testing was performed using (CLSI M27-A3 and CLSI M27-S4) broth microdilution methods. Results: The most positive cultures were detected by the automated blood culture system. C.albicans (%50) was the most prevalent species, followed by C. glabrata (%40), and C. parapsilosis, (%10) respectively .The mortality rate was high (%60) and most patients with candidemia were admitted to the Intensive Care Unit and Neonatal Intensive Care Unit. All isolates were susceptible to amphotericin B, while the highest resistance belonged to caspofungin. Conclusion: In this study, high resistance was reported, especially for caspofungin, which can be regarded as the emergence of caspofungin-resistant strains. Regarding this, the establishment of a surveillance and prevention program for the reduction of the emergence of resistant species is necessary.
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Affiliation(s)
- R Razzaghi
- Department of Infectious Diseases, Faculty of Medicine, Kashan University of Medical Sciences, Kashan, Iran
| | - M Momen-Heravi
- Department of Infectious Diseases, Faculty of Medicine, Kashan University of Medical Sciences, Kashan, Iran
| | - M Erami
- Beheshti Hospital, Kashan University of Medical Sciences, Kashan, Iran
| | - M Nazeri
- Department of Medical Parasitology and Mycology, Faculty of Medicine, Kashan University of Medical Sciences, Kashan, Iran
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15
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Menezes RDP, Borges AS, Araujo LBD, Pedroso RDS, Röder DVDDB. RELATED FACTORS FOR COLONIZATION BY Candida SPECIES IN THE ORAL CAVITY OF HIV-INFECTED INDIVIDUALS. Rev Inst Med Trop Sao Paulo 2016; 57:413-9. [PMID: 26603229 PMCID: PMC4660451 DOI: 10.1590/s0036-46652015000500008] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2014] [Accepted: 02/03/2015] [Indexed: 11/22/2022] Open
Abstract
UNLABELLED The colonization of the oral cavity is a prerequisite to the development of oropharyngeal candidiasis. AIMS The aims of this study were: to evaluate colonization and quantify Candida spp. in the oral cavity; to determine the predisposing factors for colonization; and to correlate the levels of CD4+ cells and viral load with the yeast count of colony forming units per milliliter (CFU/mL) in HIV-positive individuals treated at a University Hospital. Saliva samples were collected from 147 HIV patients and were plated on Sabouraud Dextrose Agar (SDA) and chromogenic agar, and incubated at 30 ºC for 72 h. Colonies with similar morphology in both media were counted and the result expressed in CFU/mL. RESULTS Of the 147 HIV patients, 89 had positive cultures for Candida spp., with a total of 111 isolates, of which C. albicans was the most frequent species (67.6%), and the mean of colonies counted was 8.8 × 10³ CFU/mL. The main predisposing factors for oral colonization by Candida spp. were the use of antibiotics and oral prostheses. The use of reverse transcriptase inhibitors appears to have a greater protective effect for colonization. A low CD4+ T lymphocyte count is associated with a higher density of yeast in the saliva of HIV patients.
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16
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Sánchez-Fresneda R, Guirao-Abad JP, Martinez-Esparza M, Maicas S, Valentín E, Argüelles JC. Homozygous deletion of ATC1 and NTC1 genes in Candida parapsilosis abolishes trehalase activity and affects cell growth, sugar metabolism, stress resistance, infectivity and biofilm formation. Fungal Genet Biol 2015; 85:45-57. [PMID: 26529381 DOI: 10.1016/j.fgb.2015.10.007] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2015] [Revised: 10/26/2015] [Accepted: 10/31/2015] [Indexed: 12/16/2022]
Abstract
A double homozygous atc1Δ/atc1Δ/ntc1Δ/ntc1Δ mutant (atc1Δ/ntc1Δ KO) was constructed in the pathogen opportunistic yeast Candida parapsilosis by disruption of the two chromosomal alleles coding for NTC1 gene (encoding a neutral trehalase) in a Cpatc1Δ/atc1Δ background (atc1Δ KO strain, deficient in acid trehalase). The Cpatc1Δ/ntc1Δ KO mutant failed to counteract the inability of Cpatc1Δ cells to metabolize exogenous trehalose and showed a similar growth pattern on several monosaccharides and disaccharides. However, upon prolonged incubation in either rich medium (YPD) or nutrient-starved medium the viability of Cpatc1Δ cells exhibited a sensitive phenotype, which was augmented by further CpNTC1/NTC1 disruption. Furthermore, Cpatc1Δ/ntc1Δ KO cells had difficulty in resuming active growth in fresh YPD. This homozygous mutant also lacked any in vitro measurable trehalase activity, whether acid or neutral, suggesting that a single gene codes for each enzyme. By contrast, in Cpatc1Δ/ntc1Δ KO strain the resistance to oxidative and heat stress displayed by atc1Δ mutant was suppressed. Cpatc1Δ/ntc1Δ KO cells showed a significant decrease in virulence as well as in the capacity to form biofilms. These results point to a major role for acid trehalase (Atc1p) in the pathobiology of C. parapsilosis, whereas the activity of neutral trehalase can only partially counteract Atc1p deficiency. They also support the use of ATC1 and NTC1 genes as interesting antifungal targets.
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Affiliation(s)
- Ruth Sánchez-Fresneda
- Área de Microbiología, Facultad de Biología, Universidad de Murcia, 30100 Murcia, Spain; IMIB-Arrixaca, Spain; Departamento de Microbiología y Ecología, Facultad de Farmacia, Universidad de Valencia, 46100 Burjassot, Valencia, Spain
| | - José P Guirao-Abad
- Área de Microbiología, Facultad de Biología, Universidad de Murcia, 30100 Murcia, Spain; IMIB-Arrixaca, Spain
| | - María Martinez-Esparza
- Departamento de Bioquímica, Biología Molecular (B) e Inmunología, Facultad de Medicina, Universidad de Murcia, 30100 Murcia, Spain; IMIB-Arrixaca, Spain
| | - Sergi Maicas
- Departamento de Microbiología y Ecología, Facultad de Biología, Universidad de Valencia, 46100 Burjassot, Valencia, Spain
| | - Eulogio Valentín
- Departamento de Microbiología y Ecología, Facultad de Farmacia, Universidad de Valencia, 46100 Burjassot, Valencia, Spain
| | - Juan-Carlos Argüelles
- Área de Microbiología, Facultad de Biología, Universidad de Murcia, 30100 Murcia, Spain; IMIB-Arrixaca, Spain.
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17
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Epidemiology, clinical characteristics, and outcome of candidemia in a tertiary referral center in Italy from 2010 to 2014. Infection 2015; 44:205-13. [DOI: 10.1007/s15010-015-0845-z] [Citation(s) in RCA: 67] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2015] [Accepted: 09/15/2015] [Indexed: 12/26/2022]
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18
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Fernández-Ruiz M, Puig-Asensio M, Guinea J, Almirante B, Padilla B, Almela M, Díaz-Martín A, Rodríguez-Baño J, Cuenca-Estrella M, Aguado JM. Candida tropicalis bloodstream infection: Incidence, risk factors and outcome in a population-based surveillance. J Infect 2015; 71:385-94. [DOI: 10.1016/j.jinf.2015.05.009] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2014] [Revised: 04/06/2015] [Accepted: 05/16/2015] [Indexed: 11/29/2022]
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19
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Alp S, Arikan-Akdagli S, Gulmez D, Ascioglu S, Uzun O, Akova M. Epidemiology of candidaemia in a tertiary care university hospital: 10-year experience with 381 candidaemia episodes between 2001 and 2010. Mycoses 2015; 58:498-505. [DOI: 10.1111/myc.12349] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2014] [Revised: 02/06/2015] [Accepted: 03/26/2015] [Indexed: 01/02/2023]
Affiliation(s)
- Sehnaz Alp
- Faculty of Medicine; Department of Infectious Diseases and Clinical Microbiology; Hacettepe University; Ankara Turkey
| | - Sevtap Arikan-Akdagli
- Faculty of Medicine; Department of Medical Microbiology; Hacettepe University; Ankara Turkey
| | - Dolunay Gulmez
- Faculty of Medicine; Department of Medical Microbiology; Hacettepe University; Ankara Turkey
| | - Sibel Ascioglu
- Faculty of Medicine; Department of Infectious Diseases and Clinical Microbiology; Hacettepe University; Ankara Turkey
| | - Omrum Uzun
- Faculty of Medicine; Department of Infectious Diseases and Clinical Microbiology; Hacettepe University; Ankara Turkey
| | - Murat Akova
- Faculty of Medicine; Department of Infectious Diseases and Clinical Microbiology; Hacettepe University; Ankara Turkey
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Galán F, García-Agudo L, Guerrero I, Marín P, García-Tapia A, García-Martos P, Rodríguez-Iglesias M. Evaluación de la espectrometría de masas en la identificación de levaduras de interés clínico. Enferm Infecc Microbiol Clin 2015; 33:372-8. [DOI: 10.1016/j.eimc.2014.10.003] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2014] [Revised: 07/29/2014] [Accepted: 10/01/2014] [Indexed: 10/24/2022]
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21
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De Rosa FG, Corcione S, Filippini C, Raviolo S, Fossati L, Montrucchio C, Aldieri C, Petrolo A, Cavallo R, Di Perri G. The Effect on mortality of fluconazole or echinocandins treatment in candidemia in internal medicine wards [corrected]. PLoS One 2015; 10:e0125149. [PMID: 25938486 PMCID: PMC4418611 DOI: 10.1371/journal.pone.0125149] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2015] [Accepted: 03/09/2015] [Indexed: 11/18/2022] Open
Abstract
The incidence of candidemia has increased over the past two decades, with an increased number of cases in Internal Medicine and a prevalence ranging from 24% to 57%. This single-center retrospective study was performed to evaluate the epidemiology and the risk factors associated with mortality of candidemia in patients admitted to Internal Medicine wards (IMWs) of the City of Health and Sciences, Molinette Hospital, Turin, from January 2004 to December 2012. For each patient, demographic, clinical and microbiological data were collected. A case of candidemia was defined as a patient with at least one blood culture positive for Candida spp. Amongst 670 episodes of candidemia, 274 (41%) episodes occurred in IMWs. The mortality was 39% and was associated at multivariate analysis with sepsis, cirrhosis and neurologic diseases, whilst removal of central venous catheter ≤48h was significantly associated with survival. In the 77 patients treated with early antifungal therapy the mortality was 29% and was not significantly different with caspofungin or fluconazole, whilst in patients with definitive therapy the mortality was significantly lower with echinocandins compared to fluconazole (11.7% Vs. 39%; p=0.0289), a finding confirmed by multivariate analysis. The mortality was significantly associated with sepsis, cirrhosis and neurologic diseases, whilst CVC removal ≤48h was associated with survival. In patients with early therapy, fluconazole or caspofungin were equally effective. However, echinocandins were significantly more effective as definitive treatment, a finding not explained by differences in treatment delays. Further studies are needed to understand the full potential of these different therapeutic strategies in IMWs.
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Affiliation(s)
- Francesco G. De Rosa
- Department of Medical Sciences, Infectious Diseases at Amedeo di Savoia Hospital, University of Turin, Turin, Italy
- * E-mail:
| | - Silvia Corcione
- Department of Medical Sciences, Infectious Diseases at Amedeo di Savoia Hospital, University of Turin, Turin, Italy
| | - Claudia Filippini
- Department of Anesthesia and Critical Care, City of Health and Sciences, Molinette Hospital, University of Turin, Turin, Italy
| | - Stefania Raviolo
- Department of Medical Sciences, Infectious Diseases at Amedeo di Savoia Hospital, University of Turin, Turin, Italy
| | - Lucina Fossati
- Department of Public Health and Pediatric Sciences, Laboratory of Microbiology and Virology, City of Health and Sciences, Molinette, University of Turin, Turin, Italy
| | - Chiara Montrucchio
- Department of Medical Sciences, Infectious Diseases at Amedeo di Savoia Hospital, University of Turin, Turin, Italy
| | - Chiara Aldieri
- Department of Medical Sciences, Infectious Diseases at Amedeo di Savoia Hospital, University of Turin, Turin, Italy
| | - Alessia Petrolo
- Department of Medical Sciences, Infectious Diseases at Amedeo di Savoia Hospital, University of Turin, Turin, Italy
| | - Rossana Cavallo
- Department of Public Health and Pediatric Sciences, Laboratory of Microbiology and Virology, City of Health and Sciences, Molinette, University of Turin, Turin, Italy
| | - Giovanni Di Perri
- Department of Medical Sciences, Infectious Diseases at Amedeo di Savoia Hospital, University of Turin, Turin, Italy
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Karadag-Oncel E, Kara A, Ozsurekci Y, Arikan-Akdagli S, Cengiz AB, Ceyhan M, Gur D, Celik M, Ozkaya-Parlakay A. Candidaemia in a paediatric centre and importance of central venous catheter removal. Mycoses 2015; 58:140-8. [DOI: 10.1111/myc.12288] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2014] [Revised: 11/30/2014] [Accepted: 12/11/2014] [Indexed: 12/26/2022]
Affiliation(s)
- Eda Karadag-Oncel
- Pediatric Infectious Disease Unit; Department of Pediatrics; Hacettepe University Faculty of Medicine; Ankara Turkey
| | - Ates Kara
- Pediatric Infectious Disease Unit; Department of Pediatrics; Hacettepe University Faculty of Medicine; Ankara Turkey
| | - Yasemin Ozsurekci
- Pediatric Infectious Disease Unit; Department of Pediatrics; Hacettepe University Faculty of Medicine; Ankara Turkey
| | - Sevtap Arikan-Akdagli
- Department of Medical Microbiology; Hacettepe University Faculty of Medicine; Ankara Turkey
| | - Ali Bulent Cengiz
- Pediatric Infectious Disease Unit; Department of Pediatrics; Hacettepe University Faculty of Medicine; Ankara Turkey
| | - Mehmet Ceyhan
- Pediatric Infectious Disease Unit; Department of Pediatrics; Hacettepe University Faculty of Medicine; Ankara Turkey
| | - Deniz Gur
- Department of Medical Microbiology; Hacettepe University Faculty of Medicine; Ankara Turkey
| | - Melda Celik
- Pediatric Infectious Disease Unit; Department of Pediatrics; Hacettepe University Faculty of Medicine; Ankara Turkey
| | - Aslinur Ozkaya-Parlakay
- Pediatric Infectious Disease Unit; Department of Pediatrics; Hacettepe University Faculty of Medicine; Ankara Turkey
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23
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Sentinel surveillance of invasive candidiasis in Spain: epidemiology and antifungal susceptibility. Diagn Microbiol Infect Dis 2015; 81:34-40. [DOI: 10.1016/j.diagmicrobio.2014.05.021] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2013] [Revised: 05/24/2014] [Accepted: 05/27/2014] [Indexed: 12/31/2022]
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24
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Ramirez-Garcia A, Rementeria A, Aguirre-Urizar JM, Moragues MD, Antoran A, Pellon A, Abad-Diaz-de-Cerio A, Hernando FL. Candida albicans and cancer: Can this yeast induce cancer development or progression? Crit Rev Microbiol 2014; 42:181-93. [PMID: 24963692 DOI: 10.3109/1040841x.2014.913004] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
There is currently increasing concern about the relation between microbial infections and cancer. More and more studies support the view that there is an association, above all, when the causal agents are bacteria or viruses. This review adds to this, summarizing evidence that the opportunistic fungus Candida albicans increases the risk of carcinogenesis and metastasis. Until recent years, Candida spp. had fundamentally been linked to cancerous processes as it is an opportunist pathogen that takes advantage of the immunosuppressed state of patients particularly due to chemotherapy. In contrast, the most recent findings demonstrate that C. albicans is capable of promoting cancer by several mechanisms, as described in the review: production of carcinogenic byproducts, triggering of inflammation, induction of Th17 response and molecular mimicry. We underline the need not only to control this type of infection during cancer treatment, especially given the major role of this yeast species in nosocomial infections, but also to find new therapeutic approaches to avoid the pro-tumor effect of this fungal species.
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Affiliation(s)
| | | | | | | | | | - Aize Pellon
- a Department of Immunology, Microbiology, and Parasitology
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Fernández-Ruiz M, Aguado JM, Almirante B, Lora-Pablos D, Padilla B, Puig-Asensio M, Montejo M, García-Rodríguez J, Pemán J, Ruiz Pérez de Pipaón M, Cuenca-Estrella M, Padilla B, Muñoz P, Guinea J, Paño Pardo JR, García-Rodríguez J, Cerrada CG, Fortún J, Martín P, Gómez E, Ryan P, Campelo C, de los Santos Gil I, Buendía V, Gorricho BP, Alonso M, Sanz FS, Aguado JM, Merino P, Romo FG, Gorgolas M, Gadea I, Losa JE, Delgado-Iribarren A, Ramos A, Romero Y, Romero IS, Zaragoza O, Cuenca-Estrella M, Rodriguez-Baño J, Suarez AI, Loza A, Aller García AI, Martín-Mazuelos E, de Pipaón MRP, Garnacho J, Ortiz C, Chávez M, Maroto FL, Salavert M, Pemán J, Blanquer J, Navarro D, Camarena JJ, Zaragoza R, Abril V, Gimeno C, Hernáez S, Ezpeleta G, Bereciartua E, Hernández Almaraz JL, Montejo M, Rivas RA, Ayarza R, Ma Planes A, Ruiz Camps I, Almirante B, Mensa J, Almela M, Gurgui M, Sánchez-Reus F, Martinez-Montauti J, Sierra M, Horcajada JP, Sorli L, Gómez J, Gené A, Urrea M, Valerio M, Díaz-Martín A, Puchades F, Mularoni A. Initial Use of Echinocandins Does Not Negatively Influence Outcome in Candida parapsilosis Bloodstream Infection: A Propensity Score Analysis. Clin Infect Dis 2014; 58:1413-21. [DOI: 10.1093/cid/ciu158] [Citation(s) in RCA: 94] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Identification and differentiation of Candida parapsilosis complex species by use of exon-primed intron-crossing PCR. J Clin Microbiol 2014; 52:1758-61. [PMID: 24622093 DOI: 10.1128/jcm.00105-14] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
The Candida parapsilosis complex is composed of Candida parapsilosis sensu stricto, Candida orthopsilosis, Candida metapsilosis, and the closely related species Lodderomyces elongisporus. An exon-primed intron-crossing PCR assay was developed here to distinguish the members of the species complex on the basis of the distinct sizes of amplicons, and Candida orthopsilosis and Candida metapsilosis were further discriminated by restriction enzyme analysis.
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Echinocandins in the treatment of candidaemia and invasive candidiasis: clinical and economic perspectives. Int J Antimicrob Agents 2014; 43:207-14. [DOI: 10.1016/j.ijantimicag.2013.08.010] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2013] [Accepted: 08/23/2013] [Indexed: 12/29/2022]
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Németh T, Tóth A, Hamari Z, Falus A, Éder K, Vágvölgyi C, Guimaraes AJ, Nosanchuk JD, Gácser A. Transcriptome profile of the murine macrophage cell response to Candida parapsilosis. Fungal Genet Biol 2014; 65:48-56. [PMID: 24530442 DOI: 10.1016/j.fgb.2014.01.006] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2013] [Revised: 01/17/2014] [Accepted: 01/29/2014] [Indexed: 12/20/2022]
Abstract
Candida parapsilosis is a human fungal pathogen with increasing global significance. Understanding how macrophages respond to C. parapsilosis at the molecular level will facilitate the development of novel therapeutic paradigms. The complex response of murine macrophages to infection with C. parapsilosis was investigated at the level of gene expression using an Agilent mouse microarray. We identified 155 and 511 differentially regulated genes at 3 and 8h post-infection, respectively. Most of the upregulated genes encoded molecules involved in immune response and inflammation, transcription, signaling, apoptosis, cell cycle, electron transport and cell adhesion. Typical of the classically activated macrophages, there was significant upregulation of genes coordinating the production of inflammatory cytokines such as TNF, IL-1 and IL-15. Further, we used both primary murine macrophages and macrophages differentiated from human peripheral mononuclear cells to confirm the upregulation of the TNF-receptor family member TNFRSF9 that is associated with Th1 T-helper cell responses. Additionally, the microarray data indicate significant differences between the response to C. parapsilosis infection and that of C. albicans.
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Affiliation(s)
- Tibor Németh
- Department of Microbiology, University of Szeged, Közép fasor 52, H-6726 Szeged, Hungary
| | - Adél Tóth
- Department of Microbiology, University of Szeged, Közép fasor 52, H-6726 Szeged, Hungary
| | - Zsuzsanna Hamari
- Department of Microbiology, University of Szeged, Közép fasor 52, H-6726 Szeged, Hungary
| | - András Falus
- Department of Genetics, Cell- and Immunobiology, Semmelweis University, Nagyvárad tér 4, 1089 Budapest, Hungary
| | - Katalin Éder
- Department of Genetics, Cell- and Immunobiology, Semmelweis University, Nagyvárad tér 4, 1089 Budapest, Hungary
| | - Csaba Vágvölgyi
- Department of Microbiology, University of Szeged, Közép fasor 52, H-6726 Szeged, Hungary
| | - Allan J Guimaraes
- Department of Microbiology and Immunology, Albert Einstein College of Medicine, 1300 Morris Park Ave, New York, NY 10461, USA
| | - Joshua D Nosanchuk
- Department of Microbiology and Immunology, Albert Einstein College of Medicine, 1300 Morris Park Ave, New York, NY 10461, USA
| | - Attila Gácser
- Department of Microbiology, University of Szeged, Közép fasor 52, H-6726 Szeged, Hungary.
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Abstract
The number of immunosuppressive patients has increased significantly in recent years. These patients are at risk for opportunistic infections, especially fungal infections. Candidiasis is one of the most frequent fungal infections determined in these immunosuppressive patients and its epidemiology has changed over the last two decades. Recently, new antifungal agents and new therapy strategies such as antifungal prophylaxis, secondary prophylaxis, and preemptive therapy have come into use. These changes resulted in the alteration of Candida species causing invasive infections. The incidence of Candida albicans was decreased in many countries, especially among patients with immunosuppressive disorders, while the incidence of species other than C. albicans was increased. In this review, incidence, risk factors, and species distribution of invasive candidiasis are discussed.
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Affiliation(s)
- Nur Yapar
- Department of Infectious Diseases and Clinical Microbiology, Faculty of Medicine, Dokuz Eylül University, İzmir, Turkey
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Vogiatzi L, Katragkou A, Roilides E. Antifungal Prophylaxis in the Pediatric Intensive Care Unit. CURRENT FUNGAL INFECTION REPORTS 2013. [DOI: 10.1007/s12281-013-0154-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Quindós G. Epidemiology of candidaemia and invasive candidiasis. A changing face. Rev Iberoam Micol 2013; 31:42-8. [PMID: 24270071 DOI: 10.1016/j.riam.2013.10.001] [Citation(s) in RCA: 125] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2013] [Revised: 09/09/2013] [Accepted: 10/01/2013] [Indexed: 12/11/2022] Open
Abstract
Invasive candidiasis is a leading cause of mortality. Candidaemia is the most common clinical presentation of invasive candidiasis but more that 30% of these infections do not yield positive blood cultures. Candida albicans remains the predominant aetiology, accounting for 50% of all cases. However, there has been an epidemiological shift in the last decades. Some species of Candida different to C. albicans have emerged as an important cause of severe candidaemia as they can exhibit resistance to fluconazole and other antifungal agents. Moreover, there is a different distribution of non C. albicans Candida species in relationship to patients' and hospital characteristics. Thus, Candida parapsilosis has been associated to candidaemia in neonates and young adults. This species usually has an exogenously origin and contaminates medical devices, causing central venous catheter-associated candidaemias. Candida glabrata, Candida tropicalis and Candida krusei are isolated in blood cultures from older patients (>65 years) with important risk factors, such as major abdominal surgery, solid tumours and haematologic malignancies, transplants, and/or prolonged treatment with corticoids. Moreover, important geographical differences in the distribution of the Candida species different to C. albicans causing invasive candidiasis have been reported: C. parapsilosis predominates in Australia, Latin America and Mediterranean countries of Africa, Asia and Europe. In contrast, C. glabrata has an important aetiological role in USA and Central and Northern Europe. Finally, an important and worrying issue is that mortality due to invasive candidiasis remains unacceptably high. This manuscript is part of the series of works presented at the "V International Workshop: Molecular genetic approaches to the study of human pathogenic fungi" (Oaxaca, Mexico, 2012).
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Affiliation(s)
- Guillermo Quindós
- Departamento de Inmunología, Microbiología y Parasitología, UFI11/25 (Microbios y Salud), Facultad de Medicina y Odontología, Universidad del País Vasco/Euskal Herriko Unibertsitatea, Bilbao, Spain.
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Hoffmann-Santos HD, Paula CR, Yamamoto ACA, Tadano T, Hahn RC. Six-year trend analysis of nosocomial candidemia and risk factors in two intensive care hospitals in Mato Grosso, midwest region of Brazil. Mycopathologia 2013; 176:409-15. [PMID: 24113801 DOI: 10.1007/s11046-013-9705-5] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2013] [Accepted: 09/16/2013] [Indexed: 10/26/2022]
Abstract
We conducted this cross-sectional retrospective study using clinical and laboratory data from two tertiary hospitals in Cuiabá, Mato Grosso, Brazil, in order to explore the risk factors and estimate mortality, prevalence and lethality of candidemia between 2006 and 2011. A total of 130 episodes of candidemia were identified. The prevalence of candidemia was 1.8 per 1,000 admissions, the mortality rate was 0.9 per 1,000 admissions, and the lethality was 49.2 %. The main agent in this population was Candida parapsilosis (n = 50), followed by C. albicans (n = 45). Comparison between the numbers of episodes in the two triennia revealed that the non-albicans group grew by 48.2 %. The distribution of yeast species of Candida per hospital unit revealed that C. albicans was more prevalent than C. parapsilosis in the adult ICU and C. parapsilosis was more prevalent than C. albicans in the neonatal ICU. Patients remained hospitalized for an average of 53.5 days. Central venous catheters, parenteral nutrition and age were the variables that proved to be independent in the multivariate analysis and that maintained a statistically significant association with the incidence of death in patients with candidemia. The annual prevalence of candidemia showed a significant increase in the second triennium (2009-2011) compared with the first (2006-2008) probably due to increased exposure to risk factors: central venous catheter, H2 blockers, nutrition parenteral corticosteroids and mean hospital duration.
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Affiliation(s)
- Hugo Dias Hoffmann-Santos
- Laboratório de Micologia, Faculdade de Medicina, Universidade Federal de Mato Grosso, Av. Fernando Correa da Costa, No. 2367, bairro Boa Esperança, Cuiabá, MT, CEP 78060-900, Brazil
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Epidemiology, species distribution, antifungal susceptibility, and outcome of candidemia across five sites in Italy and Spain. J Clin Microbiol 2013; 51:4167-72. [PMID: 24108614 DOI: 10.1128/jcm.01998-13] [Citation(s) in RCA: 161] [Impact Index Per Article: 14.6] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Abstract
Candidemia has become an important bloodstream infection that is frequently associated with high rates of mortality and morbidity, and its growing incidence is related to complex medical and surgical procedures. We conducted a multicenter study in five tertiary care teaching hospitals in Italy and Spain and evaluated the epidemiology, species distribution, antifungal susceptibilities, and outcomes of candidemia episodes. In the period of 2008 to 2010, 995 episodes of candidemia were identified in these hospitals. The overall incidence of candidemia was 1.55 cases per 1,000 admissions and remained stable during the 3-year analysis. Candida albicans was the leading agent of infection (58.4%), followed by Candida parapsilosis complex (19.5%), Candida tropicalis (9.3%), and Candida glabrata (8.3%). The majority of the candidemia episodes were found in the internal medicine department (49.6%), followed by the surgical ward, the intensive care unit (ICU), and the hemato-oncology ward. Out of 955 patients who were eligible for evaluation, 381 (39.9%) died within 30 days from the onset of candidemia. Important differences in the 30-day mortality rates were noted between institutions: the lowest mortality rate was in the Barcelona hospital, and the highest rate was in the Udine hospital (33.6% versus 51%, respectively; P = 0.0005). Overall, 5.1% of the 955 isolates tested were resistant or susceptible dose dependent (SDD) to fluconazole, with minor differences between the hospitals in Italy and Spain (5.7% versus 3.5%, respectively; P = 0.2). Higher MICs for caspofungin were found, especially with C. parapsilosis complex (MIC90, 1 μg/ml). Amphotericin B had the lowest MICs. This report shows that candidemia is a significant source of morbidity in Europe, causing a substantial burden of disease and mortality.
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Vogiatzi L, Ilia S, Sideri G, Vagelakoudi E, Vassilopoulou M, Sdougka M, Briassoulis G, Papadatos I, Kalabalikis P, Sianidou L, Roilides E. Invasive candidiasis in pediatric intensive care in Greece: a nationwide study. Intensive Care Med 2013; 39:2188-95. [PMID: 23942859 DOI: 10.1007/s00134-013-3057-y] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2013] [Accepted: 08/01/2013] [Indexed: 12/28/2022]
Abstract
PURPOSE To record the practices for prevention and management of invasive candidiasis in the PICU and investigate the epidemiology of candidiasis and its outcome nationwide. METHODS A multicenter national study among PICUs throughout Greece. A questionnaire referring to local practices of prevention and management of candidemia was filled in, and a retrospective study of episodes that occurred during 5 years was conducted in all seven Greek PICUs. RESULTS Clinical practices regarding surveillance cultures, catheter replacement protocols and antibiotic use were similar, although the case mix differed. In all PICUs prophylactic antifungal treatment was administered in transplant and neutropenic oncology patients. Discrepancy existed between PICUs concerning the first-line antifungal agents and treatment duration of candidemia. Twenty-two candidemias were nationally recorded between 2005 and 2009 with a median incidence of 6.4 cases/1,000 admissions. Median age was 8.2 (0.3-16.6) years. Candida albicans was isolated in 45.4 % of episodes followed by Candida parapsilosis (22.7 %). Common findings were presence of central venous and urinary catheters as well as mechanical ventilation and administration of antibiotics with anti-anaerobic activity in almost all patients with candidemia. Total parenteral nutrition was administered to five (22.7 %) patients. Most of the patients had a chronic underlying disease; five were oncology patients, and two-thirds of those with candidemia were colonized with Candida spp. Lipid amphotericin B formulations were the predominant therapeutic choice (54.5 %). Thirty-day mortality was 18.2 %. CONCLUSION This first national study adds information to the epidemiology of candidemia in critically ill children. In these special patients, candidemia has a relatively low incidence and tends toward non-albicans Candida preponderance.
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Affiliation(s)
- L Vogiatzi
- PICU, Hippokration Hospital, Thessaloniki, Greece
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Pemán J, Zaragoza R. [Towards an early diagnosis of invasive candidiasis in the critically ill patient]. Rev Iberoam Micol 2013; 29:71-5. [PMID: 22463780 DOI: 10.1016/j.riam.2012.03.002] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
The management of invasive fungal infections in critically ill patients, from diagnosis to selection of the therapeutic protocol, is often a challenge. Early diagnosis and treatment are associated with a better prognosis, but apart from cases with positive cultures from blood or fluid/tissue biopsy, diagnosis is neither sensitive nor specific, and there is a need for specific markers in these diseases. Serodiagnostic assays such as mannan antigen, mannan antibodies, Candida albicans germ-tube antibodies or (1→3)-β-D-glucan detection, and molecular techniques for the detection of fungal-specific DNA have been developed with promising results in critical care settings. One of the main features in diagnosis is the evaluation of risk factors for infection, which will identify patients in need of preemptive or empirical treatment. Clinical scores were built from those risk factors. The combination of prediction rules and non-culture microbiological tools could be currently be the key to improving the diagnosis and prognosis of invasive fungal infections in critically ill patients.
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Affiliation(s)
- Javier Pemán
- Servicio de Microbiología, Hospital Universitario y Politécnico La Fe, Valencia, España.
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Mikulska M, Del Bono V, Ratto S, Viscoli C. Occurrence, presentation and treatment of candidemia. Expert Rev Clin Immunol 2013; 8:755-65. [PMID: 23167687 DOI: 10.1586/eci.12.52] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Candida is one of the most common causes of nosocomial bloodstream infections. Candidemia is not confined to hematological patients, intensive care units or abdominal surgery wards, but it is remarkably frequent in the internal medicine setting. High mortality associated with candidemia can be reduced by prompt, appropriate antifungal therapy. The epidemiology of species has been shifting toward non-albicans strains. Significant improvements in nonculture-based diagnostic methods, such as serological markers, have been made in recent years, and novel diagnostic techniques should be further studied to enable early pre-emptive therapy. Treatment guidelines indicate that echinocandins are at present the best choice for patients who are severely ill or possibly infected with fluconazole-resistant strains.
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Affiliation(s)
- Małgorzata Mikulska
- Division of Infectious Diseases, Department of Health Science, University of Genoa, Genoa, Italy
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A 1-year prospective survey of candidemia in Italy and changing epidemiology over one decade. Infection 2013; 41:655-62. [DOI: 10.1007/s15010-013-0455-6] [Citation(s) in RCA: 75] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2012] [Accepted: 03/20/2013] [Indexed: 10/27/2022]
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Lai CC, Chu CC, Wang CY, Tsai HY, Cheng A, Lee YC, Huang YT, Liao CH, Hsueh PR. Association between incidence of candidaemia and consumption of antifungal agents at a medical centre in Taiwan. Int J Antimicrob Agents 2012; 40:349-53. [DOI: 10.1016/j.ijantimicag.2012.05.024] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2012] [Revised: 05/25/2012] [Accepted: 05/28/2012] [Indexed: 12/18/2022]
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Garcia-Effron G, Canton E, Pemán J, Dilger A, Romá E, Perlin DS. Epidemiology and echinocandin susceptibility of Candida parapsilosis sensu lato species isolated from bloodstream infections at a Spanish university hospital. J Antimicrob Chemother 2012; 67:2739-48. [PMID: 22868644 DOI: 10.1093/jac/dks271] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVES The aims of this work were to study the epidemiological profiles, differences in echinocandin susceptibilities and clinical relevance of the Candida parapsilosis sensu lato species isolated from proven fungaemia cases at La Fe University Hospital of Valencia (Spain) from 1995 to 2007. RESULTS The prevalence of these species was: C. parapsilosis sensu stricto, 74.4%; Candida orthopsilosis, 23.54%; and Candida metapsilosis, 2.05%. The incidence of the species complex as agents of fungaemia remained stationary until 2005 and doubled in 2006. The incidence of C. orthopsilosis showed an increasing trend during the study period, while C. parapsilosis sensu stricto incidence diminished. Also, an important epidemiological change was observed starting in 2004, when 86.5% of the C. parapsilosis sensu lato strains were found in adult patients, while before that year only 13.5% of the isolates were found in this population. CONCLUSIONS Echinocandin drug susceptibility testing using the CLSI M27-A3 document showed a wide range of MIC values (0.015-4 mg/L), with micafungin being the most potent in vitro inhibitor followed by anidulafungin and caspofungin (MIC geometric mean of 0.68, 0.74 and 0.87 mg/L, respectively). C. metapsilosis was the most susceptible species of the complex to anidulafungin and micafungin in vitro (MIC(50) for anidulafungin and micafungin: 0.06 mg/L), while there were no differences between C. parapsilosis sensu lato species when caspofungin MIC(50)s were compared (MIC(50) 1.00 mg/L). Differences in caspofungin in vitro susceptibility were observed between the different clinical service departments of La Fe Hospital.
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Emerging trends in candidemia: A higher incidence but a similar outcome. J Infect 2012; 65:64-70. [DOI: 10.1016/j.jinf.2012.02.011] [Citation(s) in RCA: 55] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2011] [Revised: 02/19/2012] [Accepted: 02/20/2012] [Indexed: 11/19/2022]
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Garnacho-Montero J, Díaz-Martín A, Ruiz-Pérez De Piappón M, García-Cabrera E. [Invasive fungal infection in critically ill patients]. Enferm Infecc Microbiol Clin 2012; 30:338-43. [PMID: 22503211 DOI: 10.1016/j.eimc.2012.02.011] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2012] [Revised: 02/14/2012] [Accepted: 02/15/2012] [Indexed: 12/17/2022]
Abstract
The most common organism implicated in fungal infections in the critically ill patients is Candida spp. C. albicans continues to be the species that causes the largest number of invasive candidiasis. In critically ill patients, Candida spp. are frequently isolated in non-sterile sites. Candida colonization is documented in nearly 60% of non-neutropenic critically ill patients staying more than one week in the ICU. However, only 5% of colonized patients will develop invasive candidiasis. The diagnosis of invasive non-candidemic candidiasis remains elusive in the majority of the patients. Candida in a blood culture should never be viewed as a contaminant and should always prompt treatment initiation. Patients with multifocal colonization with a Candida score >3 should also receive antifungal therapy. Fluconazole is reserved for non-severely ill patients without recent exposure to azoles. The use of an echinocandin is recommended for hemodynamically unstable patients or with a history of recent fluconazole exposure.
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Affiliation(s)
- José Garnacho-Montero
- Unidad de Gestión Clínica de Cuidados Críticos y Urgencias, Hospital Universitario Virgen del Rocío, Sevilla, España.
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Ruhnke M, Paiva JA, Meersseman W, Pachl J, Grigoras I, Sganga G, Menichetti F, Montravers P, Auzinger G, Dimopoulos G, Borges Sá M, Miller PJ, Marček T, Kantecki M. Anidulafungin for the treatment of candidaemia/invasive candidiasis in selected critically ill patients. Clin Microbiol Infect 2012; 18:680-7. [PMID: 22404732 PMCID: PMC3510306 DOI: 10.1111/j.1469-0691.2012.03784.x] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
A prospective, multicentre, phase IIIb study with an exploratory, open-label design was conducted to evaluate efficacy and safety of anidulafungin for the treatment of candidaemia/invasive candidiasis (C/IC) in specific ICU patient populations. Adult ICU patients with confirmed C/IC meeting ≥1 of the following criteria were enrolled: post-abdominal surgery, solid tumour, renal/hepatic insufficiency, solid organ transplant, neutropaenia, and age ≥65 years. Patients received anidulafungin (200 mg on day 1, 100 mg/day thereafter) for 10–42 days, optionally followed by oral voriconazole/fluconazole. The primary efficacy endpoint was global (clinical and microbiological) response at the end of all therapy (EOT). Secondary endpoints included global response at the end of intravenous therapy (EOIVT) and at 2 and 6 weeks post-EOT, survival at day 90, and incidence of adverse events (AEs). The primary efficacy analysis was performed in the modified intent-to-treat (MITT) population, excluding unknown/missing responses. The safety and MITT populations consisted of 216 and 170 patients, respectively. The most common pathogens were Candida albicans (55.9%), C. glabrata (14.7%) and C. parapsilosis (10.0%). Global success was 69.5% (107/154; 95% CI, 61.6–76.6) at EOT, 70.7% (111/157) at EOIVT, 60.2% (77/128) at 2 weeks post-EOT, and 50.5% (55/109) at 6 weeks post-EOT. When unknown/missing responses were included as failures, the respective success rates were 62.9%, 65.3%, 45.3% and 32.4%. Survival at day 90 was 53.8%. Treatment-related AEs occurred in 33/216 (15.3%) patients, four (1.9%) of whom had serious AEs. Anidulafungin was effective, safe and well tolerated for the treatment of C/IC in selected groups of ICU patients.
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Affiliation(s)
- M Ruhnke
- Department of Medicine, Charité University Hospital, Berlin, Germany.
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Dóczi I, Pető Z, Fodor E, Bereczki L, Nagy E, Hajdú E. Evaluation of fungaemia infections in a Hungarian university hospital between 1996 and 2009. Acta Microbiol Immunol Hung 2012; 59:29-41. [PMID: 22510285 DOI: 10.1556/amicr.59.2012.1.4] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
The incidence of Candida species causing bloodstream infections in the University Hospital of Szeged, Hungary, between 1996 and 2009, and the susceptibilities of these isolates to antifungal agents were evaluated.Automated blood culture systems (Vital, bioMérieux, Marcy-l'Etoile, France; and BACTEC 9120, Becton-Dickinson Diagnostic Systems, Sparks, USA) were used. The in vitro susceptibilities of the yeast isolates to antifungal agents were determined by the Etest method (AB Biodisk, Solna, Sweden).Bloodstream infections were caused by yeast strains in 231 cases during this period, and 226 Candida strains were cultured from 216 candidaemia patients. Bloodstream infections caused by multiple Candida spp. were diagnosed almost every year. Of the 216 patients, 67 were children; and 55 infants needed intensive care. In 2005, C. glabrata caused an increase in the incidence of invasive fungal infections in the Neonatal Intensive Care Unit. The PFGE analysis of 12 isolates distinguished 4 different karyotypes. The incidence of bloodstream infections caused by fungi did not change during the 14-year study period. The most frequent species cultured from blood samples were C. albicans and C. glabrata. The incidence of resistant isolates remained constant. The local trends of fungaemia must be monitored and compared with global reports.
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Affiliation(s)
- Ilona Dóczi
- 1 University of Szeged Institute of Clinical Microbiology Szeged Hungary
| | - Zoltán Pető
- 2 University of Szeged Institute of Anaesthesiology and Intensive Care Szeged Hungary
| | - Eleonóra Fodor
- 1 University of Szeged Institute of Clinical Microbiology Szeged Hungary
| | - László Bereczki
- 1 University of Szeged Institute of Clinical Microbiology Szeged Hungary
| | - Elisabeth Nagy
- 1 University of Szeged Institute of Clinical Microbiology Szeged Hungary
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Cateau E, Cognee AS, Tran TC, Vallade E, Garcia M, Belaz S, Kauffmann-Lacroix C, Rodier MH. Impact of yeast-bacteria coinfection on the detection of Candida sp. in an automated blood culture system. Diagn Microbiol Infect Dis 2012; 72:328-31. [PMID: 22306352 DOI: 10.1016/j.diagmicrobio.2011.12.012] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2011] [Revised: 12/16/2011] [Accepted: 12/19/2011] [Indexed: 12/29/2022]
Abstract
Invasive candidiasis remains a major cause of morbidity and mortality. It is now well known that an early diagnosis contributes to the patients' outcome. Blood cultures, which are the first-line test in case of bloodstream infection suspicion, can be carried out using fungus-selective medium (containing antibiotics) or standard microorganism medium allowing both bacterial and fungal growth. Some patients can suffer from polymicrobial sepsis involving bacteria and yeasts, so we decided to investigate in blood cultures the influence of the presence of bacteria on fungal development. Simulated blood cultures were performed using Candida albicans or C. glabrata coincubated with Escherichia coli or Staphylococcus aureus at different concentrations. The results showed that, in a standard microorganism medium, bacterial growth could hide the fungal development. Thus, in patients at risk of invasive candidiasis, the use of a specific fungal medium could improve the diagnosis and allow an earlier efficient antifungal treatment.
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Affiliation(s)
- Estelle Cateau
- Laboratoire de Parasitologie et Mycologie Médicale, CHU la Miletrie, Poitiers, France.
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Pemán J, Salavert M. Epidemiología general de la enfermedad fúngica invasora. Enferm Infecc Microbiol Clin 2012; 30:90-8. [DOI: 10.1016/j.eimc.2011.09.004] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2011] [Accepted: 09/05/2011] [Indexed: 10/15/2022]
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Zirkel J, Klinker H, Kuhn A, Abele-Horn M, Tappe D, Turnwald D, Einsele H, Heinz WJ. Epidemiology ofCandidablood stream infections in patients with hematological malignancies or solid tumors. Med Mycol 2012; 50:50-5. [DOI: 10.3109/13693786.2011.587211] [Citation(s) in RCA: 51] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Negri M, Silva S, Henriques M, Oliveira R. Insights into Candida tropicalis nosocomial infections and virulence factors. Eur J Clin Microbiol Infect Dis 2011; 31:1399-412. [PMID: 22037823 DOI: 10.1007/s10096-011-1455-z] [Citation(s) in RCA: 80] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2011] [Accepted: 10/08/2011] [Indexed: 12/31/2022]
Abstract
Candida tropicalis is considered the first or the second non-Candida albicans Candida (NCAC) species most frequently isolated from candidosis, mainly in patients admitted in intensive care units (ICUs), especially with cancer, requiring prolonged catheterization, or receiving broad-spectrum antibiotics. The proportion of candiduria and candidemia caused by C. tropicalis varies widely with geographical area and patient group. Actually, in certain countries, C. tropicalis is more prevalent, even compared with C. albicans or other NCAC species. Although prophylactic treatments with fluconazole cause a decrease in the frequency of candidosis caused by C. tropicalis, it is increasingly showing a moderate level of fluconazole resistance. The propensity of C. tropicalis for dissemination and the high mortality associated with its infections might be strongly related to the potential of virulence factors exhibited by this species, such as adhesion to different host surfaces, biofilm formation, infection and dissemination, and enzymes secretion. Therefore, the aim of this review is to outline the present knowledge on all the above-mentioned C. tropicalis virulence traits.
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Affiliation(s)
- M Negri
- Institute for Biotechnology and Bioengineering (IBB), Centre of Biological Engineering, Universidade do Minho, Campus de Gualtar, 4710-057, Braga, Portugal
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Bassetti M, Taramasso L, Nicco E, Molinari MP, Mussap M, Viscoli C. Epidemiology, species distribution, antifungal susceptibility and outcome of nosocomial candidemia in a tertiary care hospital in Italy. PLoS One 2011; 6:e24198. [PMID: 21935385 PMCID: PMC3174155 DOI: 10.1371/journal.pone.0024198] [Citation(s) in RCA: 156] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2011] [Accepted: 08/02/2011] [Indexed: 11/28/2022] Open
Abstract
Candida is an important cause of bloodstream infections (BSI), causing significant mortality and morbidity in health care settings. From January 2008 to December 2010 all consecutive patients who developed candidemia at San Martino University Hospital, Italy were enrolled in the study. A total of 348 episodes of candidaemia were identified during the study period (January 2008–December 2010), with an incidence of 1,73 episodes/1000 admissions. Globally, albicans and non-albicans species caused around 50% of the cases each. Non-albicans included Candida parapsilosis (28.4%), Candida glabrata (9.5%), Candida tropicalis (6.6%), and Candida krusei (2.6%). Out of 324 evaluable patients, 141 (43.5%) died within 30 days from the onset of candidemia. C. parapsilosis candidemia was associated with the lowest mortality rate (36.2%). In contrast, patients with C. krusei BSI had the highest mortality rate (55.5%) in this cohort. Regarding the crude mortality in the different units, patients in Internal Medicine wards had the highest mortality rate (54.1%), followed by patients in ICU and Hemato-Oncology wards (47.6%). This report shows that candidemia is a significant source of morbidity in Italy, with a substantial burden of disease, mortality, and likely high associated costs. Although our high rates of candidemia may be related to high rates of BSI in general in Italian public hospitals, reasons for these high rates are not clear and warrant further study. Determining factors associated with these high rates may lead to identifying measures that can help to prevent disease.
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Affiliation(s)
- Matteo Bassetti
- Infectious Diseases Division, Santa Maria Misericordia University Hospital, Udine, Italy.
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49
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Why Should the
Journal of Clinical Microbiology
Apologize for Publishing a Paper Plagiarized from Its Archives? J Clin Microbiol 2011; 49:3109-10; author reply 3112. [DOI: 10.1128/jcm.00881-11] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Abstract
The epidemiology of Candida infections has changed over the last two decades: The number of patients suffering from such infections has increased dramatically and the Candida species involved have become more numerous as Candida albicans is replaced as an infecting agent by various non-C. albicans species (NAC). At the same time, additional antifungal agents have become available. The different Candida species may vary in their susceptibility for these various antifungals. This draws more attention to in vitro susceptibility testing. Unfortunately, several different test methods exist that may deliver different results. Moreover, clinical breakpoints (CBP) that classify test results into susceptible, intermediate and resistant are controver- sial between CLSI and EUCAST. Therefore, clinicians should be aware that interpretations may vary with the test system being followed by the microbiological laboratory. Thus, knowledge of actual MIC values and pharmacokinetic properties of individual antifungal agents is important in delivering appropriate therapy to patients
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Affiliation(s)
- C Rodloff
- Institut für Medizinische Mikrobiologie, und Infektionsepidemiologie, Universitätsklinikum Leipzig, Liebigstr, Germany.
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