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Kalra S, Tanwar S, Bari VK. Overexpression of PDR16 Confers Amphotericin B Resistance in a PMP3-Dependent Manner in Yeast Saccharomyces cerevisiae. Microb Drug Resist 2024; 30:279-287. [PMID: 38727600 DOI: 10.1089/mdr.2024.0008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/20/2024] Open
Abstract
Invasive fungal infections in humans with compromised immune systems are the primary cause of morbidity and mortality, which is becoming more widely acknowledged. Amphotericin B (AmB) is one of the antifungal drugs used to treat such infections. AmB binds with plasma membrane ergosterol, inducing cellular ions to leak and causing cell death. Reduction in ergosterol content and modification of cell walls have been described as AmB resistance mechanisms. In addition, when the sphingolipid level is decreased, the cell becomes more susceptible to AmB. Previously, PDR16, a gene that encodes phosphatidylinositol transfer protein in Saccharomyces cerevisiae, was shown to enhance AmB resistance upon overexpression. However, the mechanism of PDR16-mediated AmB resistance is not clear. Here, in this study, it was discovered that a plasma membrane proteolipid 3 protein encoded by PMP3 is essential for PDR16-mediated AmB resistance. PDR16-mediated AmB resistance does not depend on ergosterol, but a functional sphingolipid biosynthetic pathway is required. Additionally, PMP3-mediated alteration in membrane integrity abolishes PDR16 mediated AmB resistance, confirming the importance of PMP3 in the PDR16 mediated AmB resistance.
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Affiliation(s)
- Sapna Kalra
- Department of Biochemistry, School of Basic Sciences, Central University of Punjab, Bathinda, India
| | - Sunita Tanwar
- Department of Biochemistry, School of Basic Sciences, Central University of Punjab, Bathinda, India
| | - Vinay Kumar Bari
- Department of Biochemistry, School of Basic Sciences, Central University of Punjab, Bathinda, India
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Ahmady L, Gothwal M, Mukkoli MM, Bari VK. Antifungal drug resistance in Candida: a special emphasis on amphotericin B. APMIS 2024; 132:291-316. [PMID: 38465406 DOI: 10.1111/apm.13389] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Accepted: 02/12/2024] [Indexed: 03/12/2024]
Abstract
Invasive fungal infections in humans caused by several Candida species, increased considerably in immunocompromised or critically ill patients, resulting in substantial morbidity and mortality. Candida albicans is the most prevalent species, although the frequency of these organisms varies greatly according to geographic region. Infections with C. albicans and non-albicans Candida species have become more common, especially in the past 20 years, as a result of aging, immunosuppressive medication use, endocrine disorders, malnourishment, extended use of medical equipment, and an increase in immunogenic diseases. Despite C. albicans being the species most frequently associated with human infections, C. glabrata, C. parapsilosis, C. tropicalis, and C. krusei also have been identified. Several antifungal drugs with different modes of action are approved for use in clinical settings to treat fungal infections. However, due to the common eukaryotic structure of humans and fungi, only a limited number of antifungal drugs are available for therapeutic use. Furthermore, drug resistance in Candida species has emerged as a result of the growing use of currently available antifungal drugs against fungal infections. Amphotericin B (AmB), a polyene class of antifungal drugs, is mainly used for the treatment of serious systemic fungal infections. AmB interacts with fungal plasma membrane ergosterol, triggering cellular ion leakage via pore formation, or extracting the ergosterol from the plasma membrane inducing cellular death. AmB resistance is primarily caused by changes in the content or structure of ergosterol. This review summarizes the antifungal drug resistance exhibited by Candida species, with a special focus on AmB.
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Affiliation(s)
- Lailema Ahmady
- Department of Biochemistry, School of Basic Sciences, Central University of Punjab, Bathinda, India
| | - Manisha Gothwal
- Department of Biochemistry, School of Basic Sciences, Central University of Punjab, Bathinda, India
| | | | - Vinay Kumar Bari
- Department of Biochemistry, School of Basic Sciences, Central University of Punjab, Bathinda, India
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Cai W, Ruan Q, Li J, Lin L, Xi L, Sun J, Lu S. Fungal Spectrum and Susceptibility Against Nine Antifungal Agents in 525 Deep Fungal Infected Cases. Infect Drug Resist 2023; 16:4687-4696. [PMID: 37484904 PMCID: PMC10362860 DOI: 10.2147/idr.s403863] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Accepted: 06/30/2023] [Indexed: 07/25/2023] Open
Abstract
Background Deep fungal infection has become an important cause of infection and death in hospitalized patients, and this has worsened with increasing antifungal drug resistance. Objective A 3-year retrospective study was conducted to investigate the clinical characteristics, pathogen spectrum, and drug resistance of deep fungal infection in a regional hospital of Guangzhou, China. Methods Non-duplicate fungi isolates recovered from blood and other sterile body fluids of in-patients of the clinical department were identified using biochemical tests of pure culture with the API20C AUX and CHROMagar medium. Antifungal susceptibilities were determined by Sensititre YeastOne® panel trays. Results In this study, 525 patients (283 female, 242 male) with deep fungal infection were included, half of them were elderly patients (≥60 years) (54.67%, n=286). A total of 605 non-repetitive fungi were finally isolated from sterile samples, of which urine specimens accounted for 66.12% (n=400). Surgery, ICU, and internal medicine were the top three departments that fungi were frequently detected. The mainly isolated fungal species were Candida albicans (43.97%, n=266), Candida glabrata (20.00%, n=121), and Candida tropicalis (17.02%, n=103), which contributed to over 80% of fungal infection. The susceptibility of the Candida spp. to echinocandins, 5-fluorocytosine, and amphotericin B remained above 95%, while C. glabrata and C. tropicalis to itraconazole were about 95%, and the dose-dependent susceptibility of C. glabrata to fluconazole was more than 90%. The echinocandins had no antifungal activity against Trichosporon asahi in vitro (MIC90>8 μg/mL), but azole drugs were good, especially voriconazole and itraconazole (MIC90 = 0.25 μg/mL). Conclusion The main causative agents of fungal infection were still the genus of Candida. Echinocandins were the first choice for clinical therapy of Candida infection, followed with 5-fluorocytosine and amphotericin B. Azole antifungal agents should be used with caution in Candida glabrata and Candida tropicalis infections.
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Affiliation(s)
- Wenying Cai
- Department of Dermatology and Venereology, Sun Yat-sen Memorial Hospital of Sun Yat-Sen University, Guangzhou, People’s Republic of China
| | - Qianqian Ruan
- Guangdong Provincial Institute of Public Health, Guangzhou, People’s Republic of China
- Guangdong Provincial Center for Disease Control and Prevention, Guangzhou, People’s Republic of China
- School of Public Health, Sun Yat-sen University, Guangzhou, People’s Republic of China
| | - Jiahao Li
- Department of Dermatology and Venereology, Sun Yat-sen Memorial Hospital of Sun Yat-Sen University, Guangzhou, People’s Republic of China
| | - Li Lin
- Department of Dermatology and Venereology, Sun Yat-sen Memorial Hospital of Sun Yat-Sen University, Guangzhou, People’s Republic of China
| | - Liyan Xi
- Department of Dermatology and Venereology, Sun Yat-sen Memorial Hospital of Sun Yat-Sen University, Guangzhou, People’s Republic of China
- Dermatology Hospital, Southern Medical University, Guangzhou, People’s Republic of China
| | - Jiufeng Sun
- Guangdong Provincial Institute of Public Health, Guangzhou, People’s Republic of China
- Guangdong Provincial Center for Disease Control and Prevention, Guangzhou, People’s Republic of China
| | - Sha Lu
- Department of Dermatology and Venereology, Sun Yat-sen Memorial Hospital of Sun Yat-Sen University, Guangzhou, People’s Republic of China
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Codreanu SI, Ciurea CN. Candida spp. DNA Extraction in the Age of Molecular Diagnosis. Microorganisms 2023; 11:microorganisms11040818. [PMID: 37110241 PMCID: PMC10143247 DOI: 10.3390/microorganisms11040818] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Revised: 03/16/2023] [Accepted: 03/21/2023] [Indexed: 04/29/2023] Open
Abstract
The standard procedure for the detection of candidemia is blood culture, a method that might require 3-5 days for a positive result. Compared with culturing, molecular diagnosis techniques can provide faster diagnosis. The current paper aimed to present the main strengths and constraints of current molecular techniques for Candida spp. DNA extraction, analyzing their efficiency from a time, price, and ease of usage point of view. A comprehensive search was conducted using the PubMed NIH database for peer-reviewed full-text articles published before October 2022. The studies provided adequate data on the diagnosis of the infection with the Candida spp. DNA extraction is a relevant step in yielding pure qualitative DNA to be amplified in molecular diagnostic techniques. The most used fungal DNA extraction strategies are: mechanical (bead beating, ultrasonication, steel-bullet beating), enzymatic (proteinase K, lysozyme, lyticase), and chemical extraction (formic acid, liquid nitrogen, ammonium chloride). More clinical studies are needed to formulate adequate guidelines for fungal DNA extraction as the current paper highlighted discrepancies in the reported outcome.
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Affiliation(s)
- Smaranda Ioana Codreanu
- Faculty of Medicine, "George Emil Palade" University of Medicine, Pharmacy, Sciences and Technology of Târgu Mures, 38 Gheorghe Marinescu Street, 540139 Târgu Mures, Romania
| | - Cristina Nicoleta Ciurea
- Department of Microbiology, Faculty of Medicine, "George Emil Palade" University of Medicine, Pharmacy, Sciences and Technology of Târgu Mures, 38 Gheorghe Marinescu Street, 540139 Târgu Mures, Romania
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Sedono R, Adisasmita A, Djuwita R, Sjaaf A, Nadjib M, Syarif S, Alisjahbana B, Karuniawati A, Wahyuningsih R. Risk Factors for development of invasive candidiasis in critically ill patients: A prospective observational study in intensive care unit of a tertiary hospital. BALI JOURNAL OF ANESTHESIOLOGY 2023. [DOI: 10.4103/bjoa.bjoa_255_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/06/2023] Open
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Trivedi AA, Yang JY, Johnston J, Sori A. Septic shock due to candida and disseminated herpes simplex virus-1 (HSV1) after elective spinal surgery in an immunocompromised patient with chronic HSV1 infection. J Surg Case Rep 2022; 2022:rjac273. [PMID: 35702262 PMCID: PMC9187346 DOI: 10.1093/jscr/rjac273] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Accepted: 05/22/2022] [Indexed: 01/18/2023] Open
Abstract
Herpes simplex virus is an infection that can result in a variety of symptoms ranging from blistering or ulcers to severe, systemic manifestations. We report a case of patient who underwent elective spinal surgery and developed invasive herpes as well as candidiasis postoperatively without any direct evidence of immunosuppression.
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Affiliation(s)
| | - James Y Yang
- St. Joseph’s University Medical Center , Paterson, NJ, USA
| | | | - Alan Sori
- St. Joseph’s University Medical Center , Paterson, NJ, USA
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Schumann J, Johanns U, Ahmad-Nejad P, Ghebremedhin B, Woebker G. The Impact of the FilmArray-Based Detection of Microbial Pathogens from Positive Blood Culture Vials on the Time to Optimal Antimicrobial Regimen in Intensive Care Units of the Helios University Clinic Wuppertal, Germany. J Clin Med 2021; 10:jcm10245880. [PMID: 34945183 PMCID: PMC8704407 DOI: 10.3390/jcm10245880] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2021] [Revised: 12/10/2021] [Accepted: 12/12/2021] [Indexed: 11/16/2022] Open
Abstract
The role of empirical therapy and time to first effective treatment, including the antimicrobial stewardship program, are decisive in patients presenting with bloodstream infections (BSI). The FilmArray® Blood Culture Identification Panel (FA BCID 1.0) detects 24 bacterial and fungal pathogens as well as 3 resistance genes from positive blood cultures in approximately 70 min. In this paper, we evaluate the impact of the additional FA BCID analysis on the time to an optimal antimicrobial therapy and on the length of stay in the ICU, ICU mortality, and PCT level reduction. This retro-/prospective trial was conducted in BSI patients in the ICU at a German tertiary care hospital. A total of 179 individual patients with 200 episodes of BSI were included in the prospective intervention group, and 150 patients with 170 episodes of BSI in the retrospective control group. In the intervention group, BSI data were analyzed including the MALDI-TOF MS (matrix assisted laser desorption ionization time-of-flight mass spectrometry) and FA BCID results from January 2019 to August 2020; the data from the control group, including the MALDI-TOF results, were collected retrospectively from the year 2018. The effective and appropriate antimicrobial regimen occurred in a median of 17 hours earlier in the intervention versus control group (p = 0.071). Furthermore, changes in the antimicrobial regimens of the intervention group that did not immediately lead to an optimal therapy occurred significantly earlier by a median of 24 hours (p = 0.029). Surrogate markers, indicating an earlier recovery of the patients from the intervention group, such as length of stay at the ICU, duration of mechanical ventilation, or an earlier reduction in PCT level, were not significantly affected. However, mortality did not differ between the patient groups. A postulated reduction of the antimicrobial therapy, in those cases in which coagulase-negative Staphylococcus species were identified, did occur in the control group, but not in the intervention group (p = 0.041). The implementation of FA BCID into the laboratory workflow can improve patient care by optimizing antimicrobial regimen earlier in BSI patients as it provides rapid and accurate results for key pathogens associated with BSI, as well as important antimicrobial resistance markers, e.g., mecA or vanA.
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Affiliation(s)
- Jannik Schumann
- Center for Clinical and Translational Research (CCTR), Institute for Medical Laboratory Diagnostics, Helios University Hospital Wuppertal, Witten/Herdecke University, 42283 Wuppertal, Germany; (J.S.); (P.A.-N.); (B.G.)
| | - Ulrike Johanns
- Clinic for Intensive Care Medicine, Helios University Hospital Wuppertal, Witten/Herdecke University, 42283 Wuppertal, Germany;
| | - Parviz Ahmad-Nejad
- Center for Clinical and Translational Research (CCTR), Institute for Medical Laboratory Diagnostics, Helios University Hospital Wuppertal, Witten/Herdecke University, 42283 Wuppertal, Germany; (J.S.); (P.A.-N.); (B.G.)
| | - Beniam Ghebremedhin
- Center for Clinical and Translational Research (CCTR), Institute for Medical Laboratory Diagnostics, Helios University Hospital Wuppertal, Witten/Herdecke University, 42283 Wuppertal, Germany; (J.S.); (P.A.-N.); (B.G.)
| | - Gabriele Woebker
- Clinic for Intensive Care Medicine, Helios University Hospital Wuppertal, Witten/Herdecke University, 42283 Wuppertal, Germany;
- Correspondence: ; Tel.: +49-(0)-202-896-2720; Fax: +49-(0)-202-896-2718
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Geersing TH, Franssen EJF, Spronk PE, van Kan HJM, den Reijer M, van der Voort PHJ. Nephrotoxicity of continuous amphotericin B in critically ill patients with abdominal sepsis: a retrospective analysis with propensity score matching. J Antimicrob Chemother 2021; 77:246-252. [PMID: 34613383 DOI: 10.1093/jac/dkab372] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Accepted: 09/14/2021] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Continuous infusion of conventional amphotericin B (CCAB) is used in ICUs for pre-emptive treatment of invasive fungal infections. Amphotericin B has previously been associated with nephrotoxicity. OBJECTIVES To investigate if CCAB with therapeutic drug monitoring (TDM) results in renal impairment over time in critically ill patients with abdominal sepsis. PATIENTS AND METHODS The study was conducted at mixed medical-surgical ICUs of two large teaching hospitals in the Netherlands. Consecutive patients who were treated on the ICUs between 2006 and 2019 for abdominal sepsis, with or without CCAB, were included. CCAB dosing was guided by TDM. Serum creatinine concentrations and renal failure scores of patients with CCAB treatment were compared with those without CCAB treatment. Excluded were: (i) patients treated with CCAB for less than 72 h; and (ii) patients with renal replacement therapy. RESULTS A total of 319 patients were included (185 treated with CCAB and 134 controls). A multiple linear regression model showed that the serum creatinine concentration was independent of CCAB treatment (β = -0.023; 95% CI = -12.2 to 7.2; P = 0.615). Propensity score matching resulted in 134 pairs of CCAB-treated and non-treated patients. Again, the analysis of these pairs showed that the cumulative CCAB dose was not associated with serum creatinine concentration during intensive care treatment (β = 0.299; 95% CI = -0.38 to 0.98; P = 0.388). CONCLUSIONS CCAB with TDM did not result in renal impairment over time in critically ill patients with abdominal sepsis.
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Affiliation(s)
- T H Geersing
- Department of Clinical Pharmacy, OLVG, Amsterdam, The Netherlands
| | - E J F Franssen
- Department of Clinical Pharmacy, OLVG, Amsterdam, The Netherlands
| | - P E Spronk
- Department of Intensive Care Medicine, Gelre Hospitals Apeldoorn, Apeldoorn, The Netherlands
| | - H J M van Kan
- Department of Clinical Pharmacy, Gelre Hospitals Apeldoorn, Apeldoorn, The Netherlands
| | - M den Reijer
- Department of Clinical Microbiology & Infection Prevention, Gelre Hospitals Apeldoorn, Apeldoorn, The Netherlands
| | - P H J van der Voort
- Department of Critical Care, University Medical Center Groningen, University of Groningen, The Netherlands.,TIAS School for Business and Society, Tilburg University, Tilburg, The Netherlands
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Li J, Jin ZH, Li JS, Su LY, Wang YX, Zhang Y, Qin DM, Rao GX, Wang RR. Activity of Compound Agrimony Enteritis Capsules against invasive candidiasis: Exploring the differences between traditional Chinese medicine prescriptions and its main components in the treatment of diseases. JOURNAL OF ETHNOPHARMACOLOGY 2021; 277:114201. [PMID: 34015365 DOI: 10.1016/j.jep.2021.114201] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/14/2021] [Revised: 04/27/2021] [Accepted: 05/07/2021] [Indexed: 06/12/2023]
Abstract
ETHNOPHARMACOLOGICAL RELEVANCE Compound Agrimony Enteritis Capsules (FFXHC) is an ethnomedicine derived from Yi Nationality Herbal Medicine for the treatment of enteritis. We found that compared to berberine hydrochloride (BBR), a component of this medicine, FFXHC was more efficacious in the mouse model of IC mice in significantly alleviating lung and intestinal lesions. " Our study provides a novel perspective into the pharmacological mechanism of action of the ethnic compound FFXHC. AIM OF THE STUDY To determine the underlying mechanism of the superiority of FFXHC over BBR in IC. MATERIALS AND METHODS The susceptibility of Candida albicans to FFXHC was evaluated in vitro. The mouse model of IC was established and the survival rate, weight change, the number of organ colonies, and immune organ coefficient of the mice were determined, the effect of FFXHC on the immune function of mice, including changes in the number of immune cells, levels of the related inflammatory cytokines (INF-γ, TNF-α, MCP-1, IL-6, and IL-17A), and the antimicrobial peptide, LL-37 (CRAMP in mice), were determined. Mice feces were collected and changes in the intestinal microecology were studied. RESULTS Our findings indicated that FFXHC was not active against Candida albicans and did not restore the sensitivity of the resistant strain in vitro; however, it had a therapeutic effect that improve survival rate on mice with IC. The number of lymphocytes and neutrophils of mice with IC treated with FFXHC increased significantly. The intestinal microecology of mice was restored and the abundance of the probiotic Bacteroides was increased, which further stimulated the production of the antimicrobial peptide, LL-37, which is required for acquired immunity. Furthermore, the levels of Th cell-related cytokines, including INF-γ, TNF-α, and IL-17A were significantly increased, whereas those of the proinflammatory cytokines, IL-6 and MCP-1, decreased. With the activation of acquired immunity, the immune function of mice was restored, the body weight and survival rate of mice improved considerably, the coefficients of the thymus and spleen increased, and the number of fungal colonies in the lung and kidney decreased. CONCLUSIONS FFXHC could eliminate fungi by increasing the relative abundance of probiotics in Bacteroides and the number of neutrophils, thereby promoting the production of CRAMP and resulting in a fungicidal effect, leading to acquired immunity. Although BBR has an antifungal effect, we found that it was not as effective as FFXHC.
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Affiliation(s)
- Jun Li
- College of Chinese Materia Medica, Yunnan University of Traditional Chinese Medicine, Kunming, 650500, China; Engineering Laboratory for National Health Theory and Product of Yunnan Province, Yunnan University of Chinese Medicine, Kunming, 650500, China
| | - Ze-Hua Jin
- College of Chinese Materia Medica, Yunnan University of Traditional Chinese Medicine, Kunming, 650500, China; State Key Laboratory of Component-based Chinese Medicine, Tianjin University of Traditional Chinese Medicine, Tianjin, 301617, China
| | - Jia-Sheng Li
- College of Chinese Materia Medica, Yunnan University of Traditional Chinese Medicine, Kunming, 650500, China; Engineering Laboratory for National Health Theory and Product of Yunnan Province, Yunnan University of Chinese Medicine, Kunming, 650500, China
| | - Liu-Yan Su
- College of Chinese Materia Medica, Yunnan University of Traditional Chinese Medicine, Kunming, 650500, China; Engineering Laboratory for National Health Theory and Product of Yunnan Province, Yunnan University of Chinese Medicine, Kunming, 650500, China
| | - Ying-Xian Wang
- College of Chinese Materia Medica, Yunnan University of Traditional Chinese Medicine, Kunming, 650500, China; Engineering Laboratory for National Health Theory and Product of Yunnan Province, Yunnan University of Chinese Medicine, Kunming, 650500, China
| | - Yi Zhang
- College of Chinese Materia Medica, Yunnan University of Traditional Chinese Medicine, Kunming, 650500, China; Engineering Laboratory for National Health Theory and Product of Yunnan Province, Yunnan University of Chinese Medicine, Kunming, 650500, China
| | - Ding-Mei Qin
- College of Chinese Materia Medica, Yunnan University of Traditional Chinese Medicine, Kunming, 650500, China; Engineering Laboratory for National Health Theory and Product of Yunnan Province, Yunnan University of Chinese Medicine, Kunming, 650500, China
| | - Gao-Xiong Rao
- College of Chinese Materia Medica, Yunnan University of Traditional Chinese Medicine, Kunming, 650500, China; Engineering Laboratory for National Health Theory and Product of Yunnan Province, Yunnan University of Chinese Medicine, Kunming, 650500, China.
| | - Rui-Rui Wang
- College of Chinese Materia Medica, Yunnan University of Traditional Chinese Medicine, Kunming, 650500, China; Engineering Laboratory for National Health Theory and Product of Yunnan Province, Yunnan University of Chinese Medicine, Kunming, 650500, China.
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Soulountsi V, Schizodimos T, Kotoulas SC. Deciphering the epidemiology of invasive candidiasis in the intensive care unit: is it possible? Infection 2021; 49:1107-1131. [PMID: 34132989 DOI: 10.1007/s15010-021-01640-7] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2021] [Accepted: 06/08/2021] [Indexed: 12/12/2022]
Abstract
Invasive candidiasis (IC) has emerged in the last decades as an important cause of morbidity, mortality, and economic load in the intensive care unit (ICU). The epidemiology of IC is still a difficult and unsolved enigma for the literature. Accurate estimation of the true burden of IC is difficult due to variation in definitions and limitations inherent to available case-finding methodologies. Candidemia and intra-abdominal candidiasis (IAC) are the two predominant types of IC in ICU. During the last two decades, an increase in the incidence of candidemia has been constantly reported particularly in the expanding populations of elderly or immunosuppressed patents, with a parallel change in Candida species (spp.) distribution worldwide. Epidemiological shift in non-albicans spp. has reached worrisome trends. Recently, a novel, multidrug-resistant Candida spp., Candida auris, has globally emerged as a nosocomial pathogen causing a broad range of healthcare-associated invasive infections. Epidemiological profile of IAC remains imprecise. Though antifungal drugs are available for Candida infections, mortality rates continue to be high, estimated to be up to 50%. Increased use of fluconazole and echinocandins has been associated with the emergence of resistance to these drugs, which affects particularly C. albicans and C. glabrata. Crucial priorities for clinicians are to recognize the epidemiological trends of IC as well as the emergence of resistance to antifungal agents to improve diagnostic techniques and strategies, develop international surveillance networks and antifungal stewardship programmes for a better epidemiological control of IC.
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Affiliation(s)
- Vasiliki Soulountsi
- Department of Intensive Care Medicine, George Papanikolaou General Hospital, Thessaloniki, Greece.
| | - Theodoros Schizodimos
- Department of Intensive Care Medicine, George Papanikolaou General Hospital, Thessaloniki, Greece
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11
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Logan C, Martin-Loeches I, Bicanic T. Invasive candidiasis in critical care: challenges and future directions. Intensive Care Med 2020; 46:2001-2014. [PMID: 32990778 DOI: 10.1007/s00134-020-06240-x] [Citation(s) in RCA: 60] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Accepted: 09/01/2020] [Indexed: 12/19/2022]
Abstract
Invasive candidiasis is the most common critical care-associated fungal infection with a crude mortality of ~ 40-55%. Important factors contributing to risk of invasive candidiasis in ICU include use of broad-spectrum antimicrobials, immunosuppressive drugs, and total parenteral nutrition alongside iatrogenic interventions which breach natural barriers to infection [vascular catheters, renal replacement therapy, extracorporeal membrane oxygenation (ECMO), surgery]. This review discusses three key challenges in this field. The first is the shift in Candida epidemiology across the globe to more resistant non-albicans species, in particular, the emergence of multi-resistant Candida glabrata and Candida auris, which pose significant treatment and infection control challenges in critical care. The second challenge lies in the timely and appropriate initiation and discontinuation of antifungal therapy. Early antifungal strategies (prophylaxis, empirical and pre-emptive) using tools such as the Candida colonisation index, clinical prediction rules and fungal non-culture-based tests have been developed: we review the evidence on implementation of these tools in critical care to aid clinical decision-making around the prescribing and cessation of antifungal therapy. The third challenge is selection of the most appropriate antifungal to use in critical care patients. While guidelines exist to aid choice, this heterogenous and complex patient group require a more tailored approach, particularly in cases of acute kidney injury, liver impairment and for patients supported by extracorporeal membrane oxygenation. We highlight key research priorities to overcome these challenges in the future.
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Affiliation(s)
- C Logan
- Institute of Infection and Immunity, St George's University of London, London, UK
- Clinical Infection Unit, St George's University Hospital, London, UK
| | - I Martin-Loeches
- Multidisciplinary Intensive Care Research Organization (MICRO), St. James's Hospital/Trinity College, Dublin, Ireland.
- Hospital Clinic, Universidad de Barcelona, CIBERes, Barcelona, Spain.
| | - T Bicanic
- Institute of Infection and Immunity, St George's University of London, London, UK
- Clinical Infection Unit, St George's University Hospital, London, UK
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12
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Ryan LK, Hise AG, Hossain CM, Ruddick W, Parveen R, Freeman KB, Weaver DG, Narra HP, Scott RW, Diamond G. A Novel Immunocompetent Mouse Model for Testing Antifungal Drugs Against Invasive Candida albicans Infection. J Fungi (Basel) 2020; 6:E197. [PMID: 33007818 PMCID: PMC7712810 DOI: 10.3390/jof6040197] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2020] [Revised: 09/22/2020] [Accepted: 09/28/2020] [Indexed: 12/12/2022] Open
Abstract
Disseminated infection by Candida species represents a common, often life-threatening condition. Increased resistance to current antifungal drugs has led to an urgent need to develop new antifungal drugs to treat this pathogen. However, in vivo screening of candidate antifungal compounds requires large numbers of animals and using immunosuppressive agents to allow for fungal dissemination. To increase the efficiency of screening, to use fewer mice, and to remove the need for immunosuppressive agents, which may interfere with the drug candidates, we tested the potential for a novel approach using in vivo imaging of a fluorescent strain of Candida albicans, in a mouse strain deficient in the host defense peptide, murine β-defensin 1 (mBD-1). We developed a strain of C. albicans that expresses red fluorescent protein (RFP), which exhibits similar infectivity to the non-fluorescent parent strain. When this strain was injected into immunocompetent mBD-1-deficient mice, we observed a non-lethal disseminated infection. Further, we could quantify its dissemination in real time, and observe the activity of an antifungal peptide mimetic drug by in vivo imaging. This novel method will allow for the rapid in vivo screening of antifungal drugs, using fewer mice, and increase the efficiency of testing new antifungal agents.
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Affiliation(s)
- Lisa K. Ryan
- Division of Infectious Disease and Global Medicine, Department of Medicine, University of Florida College of Medicine, Gainesville, FL 32610, USA;
| | - Amy G Hise
- Department of Pathology, Case Western Reserve University School of Medicine, Cleveland, OH 44106, USA;
- Medicine Service, Louis Stokes Cleveland VA Medical Center, Cleveland, OH 44106, USA
| | - Chowdhury Mobaswar Hossain
- Department of Oral Biology, University of Florida College of Dentistry, Gainesville, FL 32610, USA; (C.M.H.); (W.R.); (R.P.)
| | - William Ruddick
- Department of Oral Biology, University of Florida College of Dentistry, Gainesville, FL 32610, USA; (C.M.H.); (W.R.); (R.P.)
| | - Rezwana Parveen
- Department of Oral Biology, University of Florida College of Dentistry, Gainesville, FL 32610, USA; (C.M.H.); (W.R.); (R.P.)
| | - Katie B. Freeman
- Fox Chase Chemical Diversity Center, Inc., Pennsylvania Biotechnology Center, Doylestown, PA 18902, USA; (K.B.F.); (D.G.W.); (R.W.S.)
| | - Damian G. Weaver
- Fox Chase Chemical Diversity Center, Inc., Pennsylvania Biotechnology Center, Doylestown, PA 18902, USA; (K.B.F.); (D.G.W.); (R.W.S.)
| | - Hema P. Narra
- Department of Pathology, University of Texas Medical Branch, Galveston, TX 77555, USA;
| | - Richard W. Scott
- Fox Chase Chemical Diversity Center, Inc., Pennsylvania Biotechnology Center, Doylestown, PA 18902, USA; (K.B.F.); (D.G.W.); (R.W.S.)
| | - Gill Diamond
- Department of Oral Biology, University of Florida College of Dentistry, Gainesville, FL 32610, USA; (C.M.H.); (W.R.); (R.P.)
- Department of Oral Immunology and Infectious Diseases, University of Louisville School of Dentistry, Louisville, KY 40902, USA
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Maurel V, Denis B, Camby M, Jeanne M, Cornesse A, Glavnik B, Alanio A, Rousseau AF, Lefloch R, Lagrange-Xelot M, Textoris J, Wiramus S, de Tymowski C, Legrand M. Outcome and characteristics of invasive fungal infections in critically ill burn patients: A multicenter retrospective study. Mycoses 2020; 63:535-542. [PMID: 32077536 DOI: 10.1111/myc.13068] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2019] [Revised: 02/16/2020] [Accepted: 02/18/2020] [Indexed: 12/21/2022]
Abstract
BACKGROUND Characteristics and outcome of invasive fungal infection (IFI) in critically ill burn patients have been poorly explored. OBJECTIVES We report the factors associated with 90-day mortality in a multicentre retrospective European study. PATIENTS/METHODS All burn patients with confirmed IFI admitted between 1 January 2010 to 31 December 2015 in 10 centres in France and Belgium were included. RESULTS Ninety-four patients were enrolled with 110 cases of IFIs: 79 (71.8%) were yeasts IFI and 31 (28.2%) filamentous IFI. Incidence was 1% among admitted patients. The 90-day mortality was 37.2% for all IFIs combined, 52% for filamentous infection and 31.9% for yeast infection. Patients with more than one IFI had a higher 90-day mortality than patients with only one episode (61.5% vs 33.5% (P = .006)). In multivariate analysis, higher Simplified Acute Physiology Score II (OR = 1.05 (95% CI: 1.02-1.09) P = .003), bacterial co-infection (OR = 3.85 (95% CI: 1.23-12.01), P = .014) and use of skin allografts at the time of IFI diagnosis (OR = 3.87 (95% CI: 1.31-11.42), P = .021) were associated with 90-day mortality. CONCLUSIONS Although rare, invasive fungal infections remain associated with poor outcome in burn patients. Bacterial co-infection and presence of allograft were potentially modifiable factors independently associated with outcome.
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Affiliation(s)
- Véronique Maurel
- Department of Anesthesiology and Critical Care and Burn Unit, AP-HP, St-Louis Hospital, Paris, France
| | - Blandine Denis
- Department of Infectious Diseases, AP-HP, St-Louis Hospital, Paris, France
| | - Matthieu Camby
- Department of Anesthesiology and Critical Care and Burn Unit, AP-HP, St-Louis Hospital, Paris, France
| | - Mathieu Jeanne
- Department of Anesthesiology and Intensive Care, CHU Lille, Lille, France
| | - Aline Cornesse
- Department of Anesthesiology and Critical Care and Burn Unit, CHU Toulouse, Toulouse, France
| | - Boris Glavnik
- Department of Anesthesiology and Critical Care and Burn Unit, Mercy Hospital, Metz, France
| | - Alexandre Alanio
- Molecular Mycology Unit, Institut Pasteur, CNRS, UMR2000, Paris, France.,Laboratoire de Parasitologie-Mycologie, Groupe Hospitalier Saint-Louis-Lariboisière-Fernand-Widal, Hôpital Saint-Louis, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France.,Sorbonne Paris Cité, Université Paris Diderot, Paris, France
| | | | - Ronan Lefloch
- Burn Intensive Care Unit, CHU Nantes, Nantes, France
| | | | - Julien Textoris
- Department of Anesthesiology and Intensive Care, Edouard Herriot Hospital, Hospices Civils de Lyon, Lyon, France.,EA7426 P13 "Pathophysiology of Injury-Induced Immunosuppression", Hospices Civils de Lyon, bioMérieux, Université Claude Bernard Lyon-1, Lyon, France
| | - Sandrine Wiramus
- Department of Anesthesiology and Critical Care and Burn Unit, AP-HM, Conception Hospital, Marseille, France
| | - Christian de Tymowski
- Department of Anesthesiology and Critical Care and Burn Unit, AP-HP, St-Louis Hospital, Paris, France
| | - Matthieu Legrand
- Department of Anesthesiology and Critical Care and Burn Unit, AP-HP, St-Louis Hospital, Paris, France.,Sorbonne Paris Cité, Université Paris Diderot, Paris, France.,UMR INSERM 942, Institut National de la Santé et de la Recherche Médicale (INSERM), F-CRIN INI-CRCT Network, Paris, France
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14
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Cortegiani A, Einav S. Being candid about Candida airway colonization and clinical outcomes: What can we really learn from unadjusted associations? Am J Infect Control 2020; 48:587-588. [PMID: 32173124 DOI: 10.1016/j.ajic.2020.01.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2020] [Accepted: 01/31/2020] [Indexed: 10/24/2022]
Affiliation(s)
- Andrea Cortegiani
- Section of Anesthesia, Analgesia, Intensive Care and Emergency, Department of Surgical, Oncological and Oral Science (Di.Chir.On.S.), Policlinico Paolo Giaccone, University of Palermo, Palermo, Italy.
| | - Sharon Einav
- Intensive Care Unit, Shaare Zedek Medical Medical Centre, Jerusalem, Israel; Hebrew University Faculty of Medicine, Jerusalem, Israel
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15
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Puel A. Human inborn errors of immunity underlying superficial or invasive candidiasis. Hum Genet 2020; 139:1011-1022. [PMID: 32124012 DOI: 10.1007/s00439-020-02141-7] [Citation(s) in RCA: 53] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2019] [Accepted: 02/18/2020] [Indexed: 12/24/2022]
Abstract
Candida species, including C. albicans in particular, can cause superficial or invasive disease, often in patients with known acquired immunodeficiencies or iatrogenic conditions. The molecular and cellular basis of these infections in patients with such risk factors remained largely elusive, until the study of inborn errors of immunity clarified the basis of the corresponding inherited and "idiopathic" infections. Superficial candidiasis, also known as chronic mucocutaneous candidiasis (CMC), can be caused by inborn errors of IL-17 immunity. Invasive candidiasis can be caused by inborn errors of CARD9 immunity. In this chapter, we review both groups of inborn errors of immunity, and discuss the contribution of these studies to the deciphering of the critical mechanisms of anti-Candida immunity in patients with other conditions.
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Affiliation(s)
- Anne Puel
- Laboratory of Human Genetics of Infectious Diseases, INSERM U1163, Necker Hospital for Sick Children, Necker Branch, 75015, Paris, France. .,Imagine Institute, Paris University, 75015, Paris, France. .,St. Giles Laboratory of Human Genetics of Infectious Diseases, The Rockefeller University, Rockefeller Branch, New York, NY, 10065, USA.
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16
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C-reactive protein and albumin kinetics before community-acquired bloodstream infections - a Danish population-based cohort study. Epidemiol Infect 2020; 148:e38. [PMID: 32100658 PMCID: PMC7058655 DOI: 10.1017/s0950268820000291] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
Early changes in biomarker levels probably occur before bloodstream infection (BSI) is diagnosed. However, this issue has not been fully addressed. We aimed at evaluating the kinetics of C-reactive protein (CRP) and plasma albumin (PA) in the 30 days before community-acquired (CA) BSI diagnosis. From a population-based BSI database we identified 658 patients with at least one measurement of CRP or PA from day −30 (D–30) through day −1 (D–1) before the day of CA-BSI (D0) and a measurement of the same biomarker at D0 or D1. Amongst these, 502 had both CRP and PA measurements which fitted these criteria. CRP and PA concentrations began to change inversely some days before CA-BSI diagnosis, CRP increasing by day −3.1 and PA decreasing by day −1.3. From D–30 to D–4, CRP kinetics (expressed as slopes – rate of concentration change per day) was −1.5 mg/l/day. From D–3 to D1, the CRP slope increased to 36.3 mg/l/day. For albumin, the slope between D–30 to D–2 was 0.1 g/l/day and changed to −1.8 g/l/day between D–1 and D1. We showed that biomarker levels begin to change some days before the CA-BSI diagnosis, CRP 3.1 days and PA 1.3 days before.
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17
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Guinea J, Arendrup MC, Cantón R, Cantón E, García-Rodríguez J, Gómez A, de la Pedrosa EGG, Hare RK, Orden B, Sanguinetti M, Pemán J, Posteraro B, Ruiz-Gaitán A, Parisi G, Da Matta DA, Colombo AL, Sánchez-Carrillo C, Reigadas E, Muñoz P, Escribano P. Genotyping Reveals High Clonal Diversity and Widespread Genotypes of Candida Causing Candidemia at Distant Geographical Areas. Front Cell Infect Microbiol 2020; 10:166. [PMID: 32432048 PMCID: PMC7214738 DOI: 10.3389/fcimb.2020.00166] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2019] [Accepted: 03/30/2020] [Indexed: 12/16/2022] Open
Abstract
The objectives of this study were to gain further insight on Candida genotype distribution and percentage of clustered isolates between hospitals and to identify potential clusters involving different hospitals and cities. We aim to genotype Candida spp. isolates causing candidemia in patients admitted to 16 hospitals in Spain, Italy, Denmark, and Brazil. Eight hundred and eighty-four isolates (Candida albicans, n = 534; C. parapsilosis, n = 282; and C. tropicalis, n = 68) were genotyped using species-specific microsatellite markers. CDC3, EF3, HIS3, CAI, CAIII, and CAVI were used for C. albicans, Ctrm1, Ctrm10, Ctrm12, Ctrm21, Ctrm24, and Ctrm28 for C. tropicalis, and CP1, CP4a, CP6, and B for C. parapsilosis. Genotypes were classified as singletons (genotype only found once) or clusters (same genotype infecting two or more patients). Clusters were defined as intra-hospital (involving patients admitted to a single hospital), intra-ward (involving patients admitted to the same hospital ward) or widespread (involving patients admitted to different hospitals). The percentage of clusters and the proportion of patients involved in clusters among species, genotypic diversity and distribution of genetic diversity were assessed. Seven hundred and twenty-three genotypes were detected, 78 (11%) being clusters, most of which (57.7%; n = 45/78) were intra-hospital clusters including intra-ward ones (42.2%; n = 19/45). The proportion of clusters was not statistically different between species, but the percentage of patients in clusters varied among hospitals. A number of genotypes (7.2%; 52/723) were widespread (found at different hospitals), comprising 66.7% (52/78) of clusters, and involved patients at hospitals in the same city (n = 21) or in different cities (n = 31). Only one C. parapsilosis cluster was a widespread genotype found in all four countries. Around 11% of C. albicans and C. parapsilosis isolates causing candidemia are clusters that may result from patient-to-patient transmission, widespread genotypes commonly found in unrelated patients, or insufficient microsatellite typing genetic discrimination.
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Affiliation(s)
- Jesús Guinea
- Clinical Microbiology and Infectious Diseases, Hospital General Universitario Gregorio Marañón, Madrid, Spain
- Instituto de Investigación Sanitaria Gregorio Marañón, Universidad Complutense de Madrid, Madrid, Spain
- CIBER de Enfermedades Respiratorias (CIBERES CB06/06/0058), Madrid, Spain
- *Correspondence: Jesús Guinea
| | - Maiken C. Arendrup
- Unit of Mycology, Statens Serum Institut, Copenhagen, Denmark
- Department of Clinical Microbiology, Rigshospitalet, Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Rafael Cantón
- Servicio de Microbiología. Hospital Ramón y Cajal, Madrid and Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), Madrid, Spain
- Red Española de Investigación en Patología Infecciosa (REIPI), Instituto de Salud Carlos III, Madrid, Spain
| | - Emilia Cantón
- Instituto de Investigación Sanitaria La Fe, Universidad de Valencia, Valencia, Spain
| | | | - Ana Gómez
- Clinical Microbiology and Infectious Diseases, Hospital General Universitario Gregorio Marañón, Madrid, Spain
- Instituto de Investigación Sanitaria Gregorio Marañón, Universidad Complutense de Madrid, Madrid, Spain
| | - Elia Gómez G. de la Pedrosa
- Servicio de Microbiología. Hospital Ramón y Cajal, Madrid and Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), Madrid, Spain
| | - Rasmus K. Hare
- Unit of Mycology, Statens Serum Institut, Copenhagen, Denmark
| | - Beatriz Orden
- Department of Clinical Microbiology, Hospital Puerta de Hierro-Majadahonda, Madrid, Spain
| | - Maurizio Sanguinetti
- Dipartimento di Scienze di Laboratorio e Infettivologiche, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Javier Pemán
- Instituto de Investigación Sanitaria La Fe, Universidad de Valencia, Valencia, Spain
- Department of Clinical Microbiology, Hospital Universitario y Politécnico La Fe, Valencia, Spain
| | - Brunella Posteraro
- Dipartimento di Scienze Gastroenterologiche, Endocrino-Metaboliche e Nefro-Urologiche, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Alba Ruiz-Gaitán
- Instituto de Investigación Sanitaria La Fe, Universidad de Valencia, Valencia, Spain
| | - Gabriella Parisi
- Department of Clinical Microbiology, Azienda Ospedaliera San Camillo-Forlanini, Rome, Italy
| | | | - Arnaldo L. Colombo
- Special Mycology Laboratory, Universida de Federalde São Paulo, São Paulo, Brazil
| | - Carlos Sánchez-Carrillo
- Clinical Microbiology and Infectious Diseases, Hospital General Universitario Gregorio Marañón, Madrid, Spain
- Instituto de Investigación Sanitaria Gregorio Marañón, Universidad Complutense de Madrid, Madrid, Spain
- CIBER de Enfermedades Respiratorias (CIBERES CB06/06/0058), Madrid, Spain
| | - Elena Reigadas
- Clinical Microbiology and Infectious Diseases, Hospital General Universitario Gregorio Marañón, Madrid, Spain
- Instituto de Investigación Sanitaria Gregorio Marañón, Universidad Complutense de Madrid, Madrid, Spain
- CIBER de Enfermedades Respiratorias (CIBERES CB06/06/0058), Madrid, Spain
| | - Patricia Muñoz
- Clinical Microbiology and Infectious Diseases, Hospital General Universitario Gregorio Marañón, Madrid, Spain
- Instituto de Investigación Sanitaria Gregorio Marañón, Universidad Complutense de Madrid, Madrid, Spain
- CIBER de Enfermedades Respiratorias (CIBERES CB06/06/0058), Madrid, Spain
- Medicine Department, Faculty of Medicine, Universidad Complutense de Madrid, Madrid, Spain
| | - Pilar Escribano
- Clinical Microbiology and Infectious Diseases, Hospital General Universitario Gregorio Marañón, Madrid, Spain
- Instituto de Investigación Sanitaria Gregorio Marañón, Universidad Complutense de Madrid, Madrid, Spain
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Paul S, Kannan I, Mohanram K. Extensive ERG11 mutations associated with fluconazole-resistant Candida albicans isolated from HIV-infected patients. Curr Med Mycol 2019; 5:1-6. [PMID: 31850389 PMCID: PMC6910709 DOI: 10.18502/cmm.5.3.1739] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
Background and Purpose: Azoles are preferred antifungal agents given their inexpensiveness, limited toxicity, and potentiality of oral administration. However, the extensive use of prophylactic azole therapy for chronic infections, especially in immunocompromised patients, has led to an increase in azole resistance, thereby rising health care costs. Fluconazole resistance is associated with poor clinical outcomes and the emergence of new infections. The present study aimed to investigate the mutations of ERG11 gene in fluconazole-resistant Candida albicans isolates. Materials and Methods: This study was conducted on 80 clinical samples collected from HIV-infected patients with suspected candidiasis in Tagore Medical College Hospital and Government Hospital of Thoracic Medicine, Chennai, India, for a period of 18 months (May 2016-December 2017). The antifungal susceptibility pattern was determined by agar diffusion and broth dilution techniques as per the Clinical and Laboratory Standards Institute guidelines. The ERG11 gene of the known fluconazole-resistant strains of C. albicans was amplified by polymerase chain reaction (PCR). In addition, the samples were subjected to sequencing and mutation analysis. Results: A total of 60 Candida species were isolated from HIV patients and were speciated using standard, conventional, and molecular methods. Candida albicans comprised 28.3% (n=17) of the Candida isolates, 59% (n=10) of which were resistant to fluconazole. Sequencing of the amplified product of ERG11C. albicans gene isolates showed that they were highly mutated and included many nonsense mutations which were not reported earlier. Conclusion: The molecular characterization of ERG11 gene showed many missense and nonsense mutations. Such mutations, which were unique to the geographical area under investigation, could be concluded to account for the development of resistance to fluconazole.
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Affiliation(s)
- Sony Paul
- Department of Microbiology, Tagore Medical College and Hospital, Rathinamangalam, Chennai, India
| | - Iyanar Kannan
- Department of Microbiology, Tagore Medical College and Hospital, Rathinamangalam, Chennai, India
| | - Kalyani Mohanram
- Department of Microbiology, Saveetha Medical College and Hospital, Chennai, India
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19
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Nieto M, Robles JC, Causse M, Gutiérrez L, Cruz Perez M, Ferrer R, Xercavins M, Herrero E, Sirvent E, Fernández C, Anguita P, Merino P. Polymerase Chain Reaction Versus Blood Culture to Detect Candida Species in High-Risk Patients with Suspected Invasive Candidiasis: The MICAFEM Study. Infect Dis Ther 2019; 8:429-444. [PMID: 31127539 PMCID: PMC6702528 DOI: 10.1007/s40121-019-0248-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2019] [Indexed: 11/25/2022] Open
Abstract
INTRODUCTION We evaluated the diagnostic reliability of serum polymerase chain reaction (PCR) versus blood culture, abdominal fluid or both (composite measure) in patients receiving empirical antifungal treatment for suspected invasive candidiasis. METHODS This observational, prospective, non-interventional, multicentre study in Spain enrolled 176 critically ill patients admitted to the intensive care unit. Separate blood samples for culture and serum PCR were taken before the start of antifungal therapy. Patient assessment was performed according to each site's usual clinical practice. The primary end point was concordance between serum PCR and blood culture. Secondary end points were concordance between serum PCR and a positive abdominal fluid sample or the composite measure. Quality indices included sensitivity, specificity, positive/negative predictive values (PPV/NPV) and kappa indices. RESULTS Among 175 evaluable patients, rates of Candida detection were similar for serum PCR (n = 16/175, 9.1%) versus blood culture (n = 14/175, 8.0%). Quality indices for serum PCR relative to blood culture were: sensitivity 21.4%; specificity 91.9%; PPV 18.8%; NPV 93.1%; kappa index 0.125. Thirty-two abdominal fluid samples were positive. Quality indices for serum PCR versus abdominal fluid were: sensitivity 31.3%; specificity 83.0%; PPV 15.6%; NPV 92.3%; kappa index 0.100. Quality indices for serum PCR versus the composite measure were: sensitivity 15.8%; specificity 92.7%; PPV 37.5%; NPV 79.9%; kappa index 0.107. CONCLUSION The sensitivity of serum PCR for Candida detection was low and the rate of concordance was low between serum PCR and the other diagnostic techniques used to identify Candida infections. Hospital-based diagnostic tests need optimising to improve outcomes in patients with suspected invasive candidiasis. FUNDING Astellas Pharma Inc.
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Affiliation(s)
| | | | | | | | | | - Ricard Ferrer
- Catlab-Hospital Universitari Mutua Terrassa, Barcelona, Spain
- Hospital Vall d´Hebron, Barcelona, Spain
| | | | | | - Elia Sirvent
- Hospital Universitario de Torrevieja, Alicante, Spain
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20
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Kashiha A, Setayesh N, Panahi Y, Ahmadi A, Soltany-Rezaee-Rad M, Najafi A, Rouini MR, Namipashaki A, Sahebkar A, Mojtahedzadeh M. Prevalence of candidemia and associated candida subtypes following severe sepsis in non-neutropenic critically ill patients. ACTA BIO-MEDICA : ATENEI PARMENSIS 2018; 89:193-202. [PMID: 29957751 PMCID: PMC6179014 DOI: 10.23750/abm.v89i2.5385] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/24/2016] [Accepted: 05/25/2016] [Indexed: 11/23/2022]
Abstract
Background: Invasive candidiasis management through the rapid initiation of appropriate antifungal therapy has been shown to be associated with the better prognosis, improved clinical outcome and reduced mortality in critically ill patients. Therefore, selection of an appropriate antifungal therapy should be based on the distribution of candida species and the pattern of antifungal resistance. This study aimed to assess the prevalence of candidemia and associated subtypes following severe sepsis in non-neutropenic critically ill patients. Methods: This study was a cross-sectional study that was conducted on severe sepsis patients stayed at least seven days in intensive care unit. Patients less than 18 years old, pregnant and breastfeeding patients, immunocompromised patients, neutropenic patients, patients with concurrent use of antifungal medicines and cytotoxic agents were excluded.To asses the candidemia, one mililiter of patients’ blood sample was collected. Sample analysis was performed by Real-Time PCR and high resolution melting curve analysis method. Results: Thirty-one critically ill patients were recruited in this study over 12-month period. Candidemia with a detection limit of 100 pg per 0.2 ml blood sample was not recognized in any of the included patients. Conclusion: The present result indicates low incidence of candidemia in the targeted intensive care units, but other factors such as small sample size, exclusion of patients with compromised immune system and the low fungal load at the time of sampling may also account for our observation. (www.actabiomedica.it)
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Affiliation(s)
- Arefeh Kashiha
- Faculty of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran.
| | - Neda Setayesh
- Department of Pharmaceutical Biotechnology and Pharmaceutical Biotechnology Research Center, Faculty of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran.
| | | | - Arezoo Ahmadi
- Department of Anesthesiology and Critical Care Medicine, Faculty of Medicine, Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran.
| | - Mohammad Soltany-Rezaee-Rad
- Department of Pharmaceutical Biotechnology and Pharmaceutical Biotechnology Research Center, Faculty of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran.
| | - Atabak Najafi
- Department of Anesthesiology and Critical Care Medicine, Faculty of Medicine, Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran.
| | - Mohammad Reza Rouini
- epartment of Pharmaceutics, Faculty of Pharmacy, Tehran University of Medical Sciences.
| | - Atefeh Namipashaki
- Department of Medical Biotechology, Faculty of Advanced Technologies in Medicine, Tehran University of Medical Sciences. Tehran, Iran.
| | | | - Mojtaba Mojtahedzadeh
- Clinical Pharmacy Department, Pharmaceutical Sciences Research Center, Tehran University of Medical Sciences, Tehran, Iran.
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21
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Hartl B, Zeller I, Manhart A, Selitsch B, Lass-Flörl C, Willinger B. A Retrospective Assessment of Four Antigen Assays for the Detection of Invasive Candidiasis Among High-Risk Hospitalized Patients. Mycopathologia 2018; 183:513-519. [PMID: 29356937 PMCID: PMC5958149 DOI: 10.1007/s11046-017-0238-1] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2017] [Accepted: 12/15/2017] [Indexed: 11/04/2022]
Abstract
Because of their high mortality rates and non-specific symptoms, invasive Candida infections pose a huge diagnostic and therapeutic challenge. In this study, we evaluated the three mannan antigen assays Platelia, Platelia Plus and Serion, and the (1-3)-β-D-glucan assay Fungitell in a group of high-risk (hematological and surgical) patients. Test results of 305 patients hospitalized at the Vienna General Hospital and the University Hospital of Innsbruck were retrospectively analyzed. We assessed the test accuracy by means of descriptive statistics. Nine (2.95%) patients were affected by invasive candidiasis (IC), and 25 (8.2%) patients had a probable/possible infection. The majority of patients (271; 88.9%) showed no signs of infection. The Platelia and Serion mannan assays had a low sensitivity (65% and 52%, respectively), but high specificity (98% for both tests). The newer version of the Platelia assay, the Platelia Plus, had a higher sensitivity (85%) but a lower specificity (89%). The sensitivity of the Fungitell assay was high (100%), while its specificity was low (58%). The positive predictive values were 0.48 for the Platelia and 0.41 for the Serion assay, 0.26 for the Platelia Plus and 0.09 for the Fungitell assay. Our limited, retrospective study suggests the efficacy of mannan assays as screening (Platelia Plus) and confirmatory (Serion) tests, while the Fungitell assay can be used to exclude invasive Candida infections.
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Affiliation(s)
- Barbara Hartl
- Department of Laboratory Medicine, Division of Clinical Microbiology, Medical University of Vienna, Währinger Gürtel 18-20/5P, A-1090, Vienna, Austria
- Skånes universitetssjukhus, Getingevägen 4, 222 41, Lund, Sweden
| | - Iris Zeller
- Department of Laboratory Medicine, Division of Clinical Microbiology, Medical University of Vienna, Währinger Gürtel 18-20/5P, A-1090, Vienna, Austria
| | - Angelika Manhart
- Department of Laboratory Medicine, Division of Clinical Microbiology, Medical University of Vienna, Währinger Gürtel 18-20/5P, A-1090, Vienna, Austria
- Courant Institute of Mathematical Sciences, New York University, 251 Mercer Street, New York, NY, 10012, USA
| | - Brigitte Selitsch
- Department of Laboratory Medicine, Division of Clinical Microbiology, Medical University of Vienna, Währinger Gürtel 18-20/5P, A-1090, Vienna, Austria
| | - Cornelia Lass-Flörl
- Division of Hygiene and Medical Microbiology, Medical University of Innsbruck, Schöpfstrasse 41, A-6020, Innsbruck, Austria
| | - Birgit Willinger
- Department of Laboratory Medicine, Division of Clinical Microbiology, Medical University of Vienna, Währinger Gürtel 18-20/5P, A-1090, Vienna, Austria.
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Al-Dorzi HM, Sakkijha H, Khan R, Aldabbagh T, Toledo A, Ntinika P, Al Johani SM, Arabi YM. Invasive Candidiasis in Critically Ill Patients: A Prospective Cohort Study in Two Tertiary Care Centers. J Intensive Care Med 2018; 35:542-553. [PMID: 29628014 PMCID: PMC7222290 DOI: 10.1177/0885066618767835] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Background: Invasive candidiasis is not uncommon in critically ill patients but has variable epidemiology and outcomes between intensive care units (ICUs). This study evaluated the epidemiology, characteristics, management, and outcomes of patients with invasive candidiasis at 6 ICUs of 2 tertiary care centers. Methods: This was a prospective observational study of all adults admitted to 6 ICUs in 2 different hospitals between August 2012 and May 2016 and diagnosed to have invasive candidiasis by 2 intensivists according to predefined criteria. The epidemiology of isolated Candida and the characteristics, management, and outcomes of affected patients were studied. Multivariable logistic regression analyses were performed to identify the predictors of non-albicans versus albicans infection and hospital mortality. Results: Invasive candidiasis was diagnosed in 162 (age 58.4 ± 18.9 years, 52.2% males, 82.1% medical admissions, and admission Acute Physiology and Chronic Health Evaluation II score 24.1 ± 8.4) patients at a rate of 2.6 cases per 100 ICU admissions. On the diagnosis day, the Candida score was 2.4 ± 0.9 in invasive candidiasis compared with 1.6 ± 0.9 in Candida colonization (P < .01). The most frequent species were albicans (38.3%), tropicalis (16.7%), glabrata (16%), and parapsilosis (13.6%). In patients with candidemia, antifungal therapy was started on average 1 hour before knowing the culture result (59.6% of therapy initiated after). Resistance to fluconazole, caspofungin, and amphotericin B occurred in 27.9%, 2.9%, and 3.1%, respectively. The hospital mortality was 58.6% with no difference between albicans and non-albicans infections (61.3% and 54.9%, respectively; P = .44). The independent predictors of mortality were renal replacement therapy after invasive candidiasis diagnosis (odds ratio: 5.42; 95% confidence interval: 2.16-13.56) and invasive candidiasis leading/contributing to ICU admission versus occurring during critical illness (odds ratio: 2.87; 95% confidence interval: 1.22-6.74). Conclusions: In critically ill patients with invasive candidiasis, non-albicans was responsible for most cases, and mortality was high (58.6%). Antifungal therapy was initiated after culture results in 60% suggesting low preclinical suspicion. Study registration: NCT01490684; registered in ClinicalTrials.gov on February 11, 2012.
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Affiliation(s)
- Hasan M Al-Dorzi
- Intensive Care Department, International Medical Research Center, College of Medicine, King Saud bin Abdulaziz, University for Health Sciences and King Abdullah Riyadh, Saudi Arabia
| | - Hussam Sakkijha
- Pulmonary and Critical Care Medicine Department, King Fahad Medical City, Riyadh, Saudi Arabia
| | - Raymond Khan
- Intensive Care Department, International Medical Research Center, College of Medicine, King Saud bin Abdulaziz, University for Health Sciences and King Abdullah Riyadh, Saudi Arabia
| | - Tarek Aldabbagh
- Intensive Care Department, International Medical Research Center, College of Medicine, King Saud bin Abdulaziz, University for Health Sciences and King Abdullah Riyadh, Saudi Arabia
| | - Aron Toledo
- King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
| | - Pendo Ntinika
- Research Center, King Fahad Medical City, Riyadh, Saudi Arabia
| | - Sameera M Al Johani
- Laboratory Medicine Department, College of Medicine, King Saud bin Abdulaziz, University for Health Sciences and King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
| | - Yaseen M Arabi
- Intensive Care Department, International Medical Research Center, College of Medicine, King Saud bin Abdulaziz, University for Health Sciences and King Abdullah Riyadh, Saudi Arabia
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23
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Shiradhone AB, Ingle SS, Zore AGB. Microenvironment Responsive Modulations in the Fatty Acid Content, Cell Surface Hydrophobicity, and Adhesion of Candida albicans Cells. J Fungi (Basel) 2018; 4:jof4020047. [PMID: 29642416 PMCID: PMC6024300 DOI: 10.3390/jof4020047] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2018] [Revised: 03/18/2018] [Accepted: 04/04/2018] [Indexed: 11/17/2022] Open
Abstract
Considering the significance in survival and virulence, we have made an attempt to understand modulations in the membrane and cell wall properties of Candida albicans hyphae induced by temperature (37 °C) and neutral pH and yeast form cells grown under low hydrostatic pressure (LHP). Our results suggest that cell surface hydrophobicity (CSH) and adhesion are dynamic properties determined largely by the microenvironment rather than morphological forms, citing the significance of variation in niche specific virulence. GC-MS analysis showed that 49 and 41 fatty acids modulated under hyphal form induced by temperature alone (37 °C) and neutral pH, respectively while that of 58 under yeast form cells under low hydrostatic pressure (LHP) (1800 Pa). Fatty acid and ergosterol data indicates that fluidity increases with increase in temperature (37 °C) and neutral pH i.e., saturated fatty acids and ergosterol decreases. Similarly, CSH and adhesion decrease in response to temperature (37 °C), pH 7, and LHP compared to controls, irrespective of morphological forms. In general, membranes were more rigid, and cell walls were more hydrophobic and adhesive in yeast form compared to hyphal form cells, except in case of yeast form cells grown under LHP. Yeast form cells grown under LHP are less hydrophobic and adhesive.
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Affiliation(s)
- Asha Bhujangrao Shiradhone
- Research Laboratory 1, School of Life Sciences, Swami Ramanand Teerth Marathwada University, Nanded431606, MS, India.
| | - Sujata S Ingle
- Research Laboratory 1, School of Life Sciences, Swami Ramanand Teerth Marathwada University, Nanded431606, MS, India.
| | - And Gajanan B Zore
- Research Laboratory 1, School of Life Sciences, Swami Ramanand Teerth Marathwada University, Nanded431606, MS, India.
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24
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Abstract
BACKGROUND Candida is a leading cause of infection in the intensive care unit. Colonization versus infection remains a challenge. A Candida Score (CS) of 3 or greater has been used to target antifungal therapy in surgical patients at risk of candidemia but has not been well evaluated in medical patients with sepsis. OBJECTIVES The aim of this study was to assess utility of the CS in detecting candidemia early in patients with sepsis. METHODS This was a secondary analysis of patients with sepsis (n = 77) who were followed up for development of new infections. Patients with known fungal infection at admission were excluded. Candida colonization was defined as Candida cultured from any baseline culture, except blood, as a part of routine clinical care. RESULTS Candidemia was detected in 8 of 77 participants (10.4%; 4 [15.4%] with a CS ≥3 and 4 [7.8%] with a CS <3). Demographic variables (age, race, sex) were similar among those who did and did not develop candidemia. Using the recommended CS of 3 or greater, sensitivity was (4/8) 50%, specificity was (47/69) 68.1%, positive predictive value was (4/26) 15.4%, and negative predictive value was (47/51) 92.2%. Baseline colonization was significantly higher among those who developed candidemia (50% vs 11.6%; P = .02), but no significant differences were observed among CS components or total scores. CONCLUSIONS Despite a relatively poor sensitivity, a reasonable specificity with a strong negative predictive value makes this tool a viable option for screening medically ill patients who may require antifungal agents. The CS should be evaluated in a larger, more inclusive, medical population.
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25
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Vasilyeva NV, Raush ER, Rudneva MV, Bogomolova TS, Taraskina AE, Fang Y, Zhang F, Klimko NN. Etiology of invasive candidosis agents in Russia: a multicenter epidemiological survey. Front Med 2018; 12:84-91. [PMID: 29335835 DOI: 10.1007/s11684-017-0612-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2017] [Accepted: 11/10/2017] [Indexed: 12/13/2022]
Abstract
A multicenter prospective epidemiological survey on the etiologic agents of invasive candidosis was conducted in Russia in the period of 2012-2014. Samples were collected from 284 patients with invasive candidosis and Candida species isolated by culture. The species were identified by DNA sequencing and MALDI-TOF massspectrometry. A total of 322 isolates were recovered, in which 96% of Сandida species belonged to six major species, namely, C. albicans (43.2%), C. parapsilosis (20.2%), C. glabrata (11.5%), C. tropicalis (9.6%), C. krusei (6.2%), and C. guilliermondii (5.3%). Most Candida species were isolated from blood samples (83.23%). Notably, the prevalence rate of C. albicans reduced from 52.38% to 32.79% (2012 vs. 2014) (P = 0.01) whereas that of non-C. albicans increased from 47.62% (2012) to 67.21% (2014) (P < 0.01). Species distribution differed among geographical regions; specifically, the prevalence rate of C. albicans as an etiologic agent of invasive candidosis in Siberian Federal region was significantly higher than that in other Federal regions. Results indicated a shift from C. albicans to non-C. albicans. Therefore, a detailed investigation on the contributing factors and appropriate treatment of invasive candidosis is needed.
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Affiliation(s)
- N V Vasilyeva
- Department of Medical Microbiology, North-Western State Medical University named after I.I. Mechnikov, St. Petersburg, 194291, Russia. .,Kashkin Research Institute of Medical Mycology, North-Western State Medical University named after I.I. Mechnikov, St. Petersburg, 194291, Russia. .,Sino-Russia Institute of Infection and Immunity, Department of Microbiology, Harbin Medical University, Harbin, 150086, China.
| | - E R Raush
- Department of Medical Microbiology, North-Western State Medical University named after I.I. Mechnikov, St. Petersburg, 194291, Russia
| | - M V Rudneva
- Kashkin Research Institute of Medical Mycology, North-Western State Medical University named after I.I. Mechnikov, St. Petersburg, 194291, Russia
| | - T S Bogomolova
- Department of Medical Microbiology, North-Western State Medical University named after I.I. Mechnikov, St. Petersburg, 194291, Russia.,Kashkin Research Institute of Medical Mycology, North-Western State Medical University named after I.I. Mechnikov, St. Petersburg, 194291, Russia
| | - A E Taraskina
- Kashkin Research Institute of Medical Mycology, North-Western State Medical University named after I.I. Mechnikov, St. Petersburg, 194291, Russia
| | - Yong Fang
- Sino-Russia Institute of Infection and Immunity, Department of Microbiology, Harbin Medical University, Harbin, 150086, China
| | - Fengmin Zhang
- Sino-Russia Institute of Infection and Immunity, Department of Microbiology, Harbin Medical University, Harbin, 150086, China
| | - N N Klimko
- Department of Clinical Mycology, Allergy and Immunology, North-Western State Medical University named after I.I. Mechnikov, St. Petersburg, 194291, Russia
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Choosing Optimal Antifungal Agents To Prevent Fungal Infections in Nonneutropenic Critically Ill Patients: Trial Sequential Analysis, Network Meta-analysis, and Pharmacoeconomic Analysis. Antimicrob Agents Chemother 2017; 61:AAC.00620-17. [PMID: 28993334 DOI: 10.1128/aac.00620-17] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2017] [Accepted: 10/05/2017] [Indexed: 01/18/2023] Open
Abstract
The use of antifungal interventions in critically ill patients prior to invasive fungal infection (IFI) being microbiologically confirmed and the preferred drug are still controversial. A systematic literature search was performed to identify randomized controlled trials (RCTs) that compared untargeted antifungal treatments applied to nonneutropenic critically ill patients. The primary outcomes were all-cause mortality and proven IFI rates. A random-effects model was used with trial sequential analyses (TSA), a network meta-analysis (NMA) was conducted to obtain indirect evidence, and a cost-effectiveness analysis using a decision-analytic model was completed from the patient perspective over a lifetime horizon. In total, 19 RCTs involving 2,556 patients (7 interventions) were included. Untargeted antifungal treatment did not significantly decrease the incidence of all-cause mortality (odds ratio [OR] = 0.89, 95% confidence interval [95%CI] = 0.70 to 1.14), but it did reduce the incidence of proven IFI (OR = 0.45, 95%CI = 0.29 to 0.71) relative to placebo/no intervention. The TSA showed that there was sufficient evidence supporting these findings. In the NMA, the only significant difference found for both primary outcomes was between fluconazole and placebo/no intervention in preventing proven IFI (OR = 0.35, 95%CI = 0.19 to 0.65). Based on drug and hospital costs in China, the incremental cost-effectiveness ratios per life-year saved for fluconazole, caspofungin, and micafungin relative to placebo/no intervention corresponded to US$889, US$9,994, and US$10,351, respectively. Untargeted antifungal treatment significantly reduced proven IFI rates in nonneutropenic critically ill patients but with no mortality benefits relative to placebo/no intervention. Among the well-tolerated antifungals, fluconazole remains the only one that is effective for IFI prevention and significantly cheaper than echinocandins.
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27
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Bondaryk M, Staniszewska M, Zielińska P, Urbańczyk-Lipkowska Z. Natural Antimicrobial Peptides as Inspiration for Design of a New Generation Antifungal Compounds. J Fungi (Basel) 2017; 3:E46. [PMID: 29371563 PMCID: PMC5715947 DOI: 10.3390/jof3030046] [Citation(s) in RCA: 79] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2017] [Revised: 08/16/2017] [Accepted: 08/22/2017] [Indexed: 12/16/2022] Open
Abstract
Invasive fungal infections are associated with high mortality rates, despite appropriate antifungal therapy. Limited therapeutic options, resistance development and the high mortality of invasive fungal infections brought about more concern triggering the search for new compounds capable of interfering with fungal viability and virulence. In this context, peptides gained attention as promising candidates for the antimycotics development. Variety of structural and functional characteristics identified for various natural antifungal peptides makes them excellent starting points for design novel drug candidates. Current review provides a brief overview of natural and synthetic antifungal peptides.
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Affiliation(s)
- Małgorzata Bondaryk
- National Institute of Public Health-National Institute of Hygiene, Chocimska 24, 00-791 Warsaw, Poland.
| | - Monika Staniszewska
- National Institute of Public Health-National Institute of Hygiene, Chocimska 24, 00-791 Warsaw, Poland.
| | - Paulina Zielińska
- Institute of Organic Chemistry, Polish Academy of Sciences, 01-224 Warsaw, Poland.
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28
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Menzel LP, Chowdhury HM, Masso-Silva JA, Ruddick W, Falkovsky K, Vorona R, Malsbary A, Cherabuddi K, Ryan LK, DiFranco KM, Brice DC, Costanzo MJ, Weaver D, Freeman KB, Scott RW, Diamond G. Potent in vitro and in vivo antifungal activity of a small molecule host defense peptide mimic through a membrane-active mechanism. Sci Rep 2017; 7:4353. [PMID: 28659617 PMCID: PMC5489528 DOI: 10.1038/s41598-017-04462-6] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2016] [Accepted: 05/17/2017] [Indexed: 12/28/2022] Open
Abstract
Lethal systemic fungal infections of Candida species are increasingly common, especially in immune compromised patients. By in vitro screening of small molecule mimics of naturally occurring host defense peptides (HDP), we have identified several active antifungal molecules, which also exhibited potent activity in two mouse models of oral candidiasis. Here we show that one such compound, C4, exhibits a mechanism of action that is similar to the parent HDP upon which it was designed. Specifically, its initial interaction with the anionic microbial membrane is electrostatic, as its fungicidal activity is inhibited by cations. We observed rapid membrane permeabilization to propidium iodide and ATP efflux in response to C4. Unlike the antifungal peptide histatin 5, it did not require energy-dependent transport across the membrane. Rapid membrane disruption was observed by both fluorescence and electron microscopy. The compound was highly active in vitro against numerous fluconazole-resistant clinical isolates of C. albicans and non-albicans species, and it exhibited potent, dose-dependent activity in a mouse model of invasive candidiasis, reducing kidney burden by three logs after 24 hours, and preventing mortality for up to 17 days. Together the results support the development of this class of antifungal drug to treat invasive candidiasis.
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Affiliation(s)
- Lorenzo P Menzel
- Department of Oral Biology, University of Florida, Gainesville, FL, 32610, USA
| | | | - Jorge Adrian Masso-Silva
- Graduate School of Biomedical Sciences, New Jersey Medical School, Rutgers, Newark, NJ, 07101, USA
| | - William Ruddick
- Department of Oral Biology, University of Florida, Gainesville, FL, 32610, USA
| | - Klaudia Falkovsky
- Department of Oral Biology, New Jersey Dental School, Rutgers, Newark, NJ, 07101, USA
| | - Rafael Vorona
- Department of Oral Biology, University of Florida, Gainesville, FL, 32610, USA
| | - Andrew Malsbary
- Department of Oral Biology, New Jersey Dental School, Rutgers, Newark, NJ, 07101, USA
| | - Kartikeya Cherabuddi
- Division of Infectious Diseases and Global Medicine, Department of Medicine, University of Florida College of Medicine, Gainesville, FL, 32610, USA
| | - Lisa K Ryan
- Division of Infectious Diseases and Global Medicine, Department of Medicine, University of Florida College of Medicine, Gainesville, FL, 32610, USA
| | - Kristina M DiFranco
- Department of Oral Biology, University of Florida, Gainesville, FL, 32610, USA
| | - David C Brice
- Department of Oral Biology, University of Florida, Gainesville, FL, 32610, USA
| | | | - Damian Weaver
- Fox Chase Chemical Diversity Center, Doylestown, PA, USA
| | | | | | - Gill Diamond
- Department of Oral Biology, University of Florida, Gainesville, FL, 32610, USA.
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29
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Armaganidis A, Nanas S, Antoniadou E, Mandragos K, Liakou K, Koutsoukou A, Baltopoulos G, Nakos G, Kounougeri A, Ganas K, Prekates A, Kompoti M, Georgopoulos D, Pneumatikos I, Zakynthinos E. Clinical factors affecting costs in patients receiving systemic antifungal therapy in intensive care units in Greece: Results from the ESTIMATOR study. Mycoses 2017; 60:454-461. [PMID: 28425571 DOI: 10.1111/myc.12616] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2016] [Revised: 02/16/2017] [Accepted: 02/17/2017] [Indexed: 11/30/2022]
Abstract
Invasive fungal infections are common in intensive care units (ICUs) but there is a great variability in factors affecting costs of different antifungal treatment strategies in clinical practice. To determine factors affecting treatment cost in adult ICU patients with or without documented invasive fungal infection receiving systemic antifungal therapy (SAT) we have performed a prospective, multicentre, observational study enrolling patients receiving SAT in participating ICUs in Greece. During the study period, 155 patients received SAT at 14 participating ICUs: 37 (23.9%) for proven fungal infection before treatment began, 10 (6.5%) prophylactically, 77 (49.7%) empirically and 31 (20.0%) pre-emptively; 66 patients receiving early SAT (55.9%) were subsequently confirmed to have proven infection with Candida spp. (eight while on treatment). The most frequently used antifungal drugs were echinocandins (89/155; 57.4%), fluconazole (31/155; 20%) and itraconazole (20/155; 12.9%). Mean total cost per patient by SAT strategy was €20 458 (proven), €15 054 (prophylaxis), €23 594 (empiric) and €22 184 (pre-emptive). Factors associated with significantly increased cost were initial treatment failure, length of stay (LOS) in ICU before starting SAT (i.e. from admission until treatment start), fever and proven candidaemia (all P≤.05). CONCLUSION Early administration of antifungal drugs was not a substantial component of total hospital costs. However, there was a significant adverse impact on costs with increasing LOS in febrile patients in ICU for whom diagnosis of fungaemia was delayed before starting SAT, and with initial treatment failure. Awareness of potential candidaemia and initiation of pre-emptive or empirical strategy as early appropriate treatment may improve ICU patient outcomes while reducing direct medical costs.
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Affiliation(s)
- A Armaganidis
- Second Critical Care Department, ATTIKON University Hospital, National and Kapodistrian University of Athens Medical School, Athens, Greece
| | - S Nanas
- First Critical Care Department, General Hospital of Athens "Evangelismos", National and Kapodistrian University of Athens Medical School, Athens, Greece
| | - E Antoniadou
- Intensive Care Unit, "G. Gennimatas" General Hospital, Thessaloniki, Greece
| | - K Mandragos
- Intensive Care Unit, "Korgialenio Benakio" Red Cross General Hospital, Athens, Greece
| | - K Liakou
- Medical Department, Astellas Pharma, Athens, Greece
| | - A Koutsoukou
- Intensive Care Unit, 1st Department of Respiratory Diseases, Sotiria Chest Hospital, National and Kapodistrian University of Athens Medical School, Athens, Greece
| | - G Baltopoulos
- Athens University Faculty of Nursing, ICU "Agioi Anargyroi" Hospital of Kifissia, Athens, Greece
| | - G Nakos
- Intensive Care Unit, University Hospital of Ioannina, Ioannina, Greece
| | - A Kounougeri
- Intensive Care Unit, Konstantopoulio General Hospital "Agia Olga", Athens, Greece
| | - K Ganas
- Intensive Care Unit, General Hospital of Nikaia "Agios Panteleimonas", Piraeus, Greece
| | - A Prekates
- Intensive Care Unit, Tzaneio General Hospital, Piraeus, Greece
| | - M Kompoti
- Intensive Care Unit, General Hospital of Eleusis "Thriassion", Athens, Greece
| | - D Georgopoulos
- Intensive Care Unit, University Hospital of Heraklion, Crete, Greece
| | - I Pneumatikos
- Department of Intensive Care Medicine, University Hospital of Alexandroupolis, Alexandroupoli, Greece
| | - E Zakynthinos
- Department of Critical Care, University Hospital of Larissa, Larissa, Greece
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30
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Candida albicans Germ-Tube Antibody: Evaluation of a New Automatic Assay for Diagnosing Invasive Candidiasis in ICU Patients. Mycopathologia 2017; 182:645-652. [PMID: 28378240 DOI: 10.1007/s11046-017-0125-9] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2016] [Accepted: 02/20/2017] [Indexed: 01/05/2023]
Abstract
Testing for Candida albicans germ-tube antibody IFA IgG assay (CAGTA) is used to detect invasive candidiasis infection. However, most suitable assays lack automation and rapid single-sample testing. The CAGTA assay was adapted in an automatic monotest system (invasive candidiasis [CAGTA] VirClia® IgG monotest (VirClia®), a chemiluminescence assay with ready-to-use reagents that provides a rapid objective result. CAGTA assay was compared with the monotest automatic VirClia® assay in order to establish the diagnostic reliability, accuracy, and usefulness of this method. A prospective study with 361 samples from 179 non-neutropenic critically ill adults patients was conducted, including 21 patients with candidemia, 18 with intra-abdominal candidiasis, 84 with Candida spp. colonization, and 56 with culture-negative samples, as well as samples from ten healthy subjects. Overall agreement between the two assays (CAGTA and VirCLIA) was 85.3%. These assays were compared with the gold-standard method to determine the sensitivity, specificity as well as positive and negative predictive values. In patients with candidemia, values for CAGTA and VirCLIA assays were 76.2 versus 85.7%, 80.3 versus 75.8%, 55.2 versus 52.9%, and 91.4 versus 94.3%, respectively. The corresponding values in patients with intra-abdominal candidiasis were 61.1 versus 66.7%, 80.3 versus 75.8%, 45.8 versus 42.9%, and 88.3 versus 89.3%, respectively. No differences were found according to the species of Candida isolated in culture, except for Candida albicans and C. parapsilosis, for which VirClia® was better than CAGTA. According to these results, the automated VirClia® assay was a reliable, rapid, and very easy to perform technique as tool for the diagnosis invasive candidiasis.
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31
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A prospective study of fungal biomarkers to improve management of invasive fungal diseases in a mixed specialty critical care unit. J Crit Care 2017; 40:119-127. [PMID: 28384600 DOI: 10.1016/j.jcrc.2017.03.025] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2016] [Revised: 03/03/2017] [Accepted: 03/29/2017] [Indexed: 01/11/2023]
Abstract
PURPOSE The diagnosis of invasive fungal diseases (IFD) in critical care patients (CrCP) is difficult. The study investigated the performance of a set of biomarkers for diagnosis of IFD in a mixed specialty critical care unit (CrCU). METHODS A prospective observational study in patients receiving critical care for ≥7days was performed. Serum samples were tested for the presence of: (1-3) - β-d-glucan (BDG), galactomannan (GM), and Aspergillus fumigatus DNA. GM antigen detection was also performed on bronchoalveolar lavage (BAL) samples. The patients were classified using published definitions for IFD and a diagnostic algorithm for invasive pulmonary aspergillosis. Performance parameters of the assays were determined. RESULTS In patients with proven and probable IFD, the sensitivity, specificity, PPV and NPV of a single positive BDG were 63%, 83%, 65% and 83% respectively. Specificity increased to 86% with 2 consecutive positive results. The mean BDG value of patients with proven and probable IFD was significantly higher compared to those with fungal colonization and no IFD (p value<0.0001). CONCLUSION New diagnostic criteria which incorporate these biomarkers, in particular BDG, and host factors unique to critical care patients should enhance diagnosis of IFD and positively impact antifungal stewardship programs.
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32
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Osthoff M, Khanna N, Siegemund M. The EMPIRICUS trial-the final nail in the coffin of empirical antifungal therapy in the intensive care unit? J Thorac Dis 2017; 9:E269-E273. [PMID: 28449517 DOI: 10.21037/jtd.2017.02.78] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Michael Osthoff
- Division of Infectious Diseases & Hospital Epidemiology, University Hospital Basel, Basel, Switzerland
| | - Nina Khanna
- Division of Infectious Diseases & Hospital Epidemiology, University Hospital Basel, Basel, Switzerland
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Motoa G, Muñoz JS, Oñate J, Pallares CJ, Hernández C, Villegas MV. Epidemiology of Candida isolates from Intensive Care Units in Colombia from 2010 to 2013. Rev Iberoam Micol 2016; 34:17-22. [PMID: 27810262 DOI: 10.1016/j.riam.2016.02.006] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2015] [Revised: 11/25/2015] [Accepted: 02/12/2016] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND The frequency of Candida isolates as a cause of hospital infections has risen in recent years, leading to high rates of morbidity and mortality. The knowledge of the epidemiology of those hospital acquired fungal infections is essential to implement an adequate antifungal therapy. AIMS To describe the epidemiology of Candida infections in Intensive Care Units (ICUs) from a surveillance network in Colombia. METHODS Information was collected from the microbiology laboratories of 20 tertiary healthcare institutions from 10 Colombian cities using the Whonet® software version 5.6. A general descriptive analysis of Candida species and susceptibility profiles focusing on fluconazole and voriconazole was completed between 2010 and 2013, including a sub-analysis of healthcare associated infections (HAIs) during the last year. RESULTS Candida isolates made up 94.5% of the 2680 fungal isolates considered, with similar proportions for Candida albicans and non-C. albicans Candida species (48.3% and 51.7%, respectively). Among the latter, Candida tropicalis (38.6%) and Candida parapsilosis (28.5%) were the most frequent species. Of note, among the blood isolates C. albicans was not the main species. Most of the species isolated were susceptible to fluconazole and voriconazole. From the HAIs reported, 25.5% were caused by Candida; central line-associated bloodstream infection was the most common HAI (58.8%). There were no statistically significant differences regarding length of hospital stay and device days among HAIs. CONCLUSIONS In ICUs of Colombia, non-C. albicans Candida species are as frequent as C. albicans, except in blood samples where non-C. albicans Candida isolates predominate. Further studies are needed to evaluate Candida associated risk factors and to determine its clinical impact.
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Affiliation(s)
- Gabriel Motoa
- Centro Internacional de Entrenamiento e Investigaciones Médicas (CIDEIM), Cali, Colombia
| | - Juan Sebastián Muñoz
- Centro Internacional de Entrenamiento e Investigaciones Médicas (CIDEIM), Cali, Colombia
| | - José Oñate
- Centro Internacional de Entrenamiento e Investigaciones Médicas (CIDEIM), Cali, Colombia; Department of Internal Medicine, School of Medicine, Universidad del Valle, Cali, Colombia; Centro Medico Imbanaco, Cali, Colombia
| | | | - Cristhian Hernández
- Centro Internacional de Entrenamiento e Investigaciones Médicas (CIDEIM), Cali, Colombia
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Polvi EJ, Averette AF, Lee SC, Kim T, Bahn YS, Veri AO, Robbins N, Heitman J, Cowen LE. Metal Chelation as a Powerful Strategy to Probe Cellular Circuitry Governing Fungal Drug Resistance and Morphogenesis. PLoS Genet 2016; 12:e1006350. [PMID: 27695031 PMCID: PMC5047589 DOI: 10.1371/journal.pgen.1006350] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2016] [Accepted: 09/08/2016] [Indexed: 01/01/2023] Open
Abstract
Fungal pathogens have evolved diverse strategies to sense host-relevant cues and coordinate cellular responses, which enable virulence and drug resistance. Defining circuitry controlling these traits opens new opportunities for chemical diversity in therapeutics, as the cognate inhibitors are rarely explored by conventional screening approaches. This has great potential to address the pressing need for new therapeutic strategies for invasive fungal infections, which have a staggering impact on human health. To explore this approach, we focused on a leading human fungal pathogen, Candida albicans, and screened 1,280 pharmacologically active compounds to identify those that potentiate the activity of echinocandins, which are front-line therapeutics that target fungal cell wall synthesis. We identified 19 compounds that enhance activity of the echinocandin caspofungin against an echinocandin-resistant clinical isolate, with the broad-spectrum chelator DTPA demonstrating the greatest synergistic activity. We found that DTPA increases susceptibility to echinocandins via chelation of magnesium. Whole genome sequencing of mutants resistant to the combination of DTPA and caspofungin identified mutations in the histidine kinase gene NIK1 that confer resistance to the combination. Functional analyses demonstrated that DTPA activates the mitogen-activated protein kinase Hog1, and that NIK1 mutations block Hog1 activation in response to both caspofungin and DTPA. The combination has therapeutic relevance as DTPA enhanced the efficacy of caspofungin in a mouse model of echinocandin-resistant candidiasis. We found that DTPA not only reduces drug resistance but also modulates morphogenesis, a key virulence trait that is normally regulated by environmental cues. DTPA induced filamentation via depletion of zinc, in a manner that is contingent upon Ras1-PKA signaling, as well as the transcription factors Brg1 and Rob1. Thus, we establish a new mechanism by which metal chelation modulates morphogenetic circuitry and echinocandin resistance, and illuminate a novel facet to metal homeostasis at the host-pathogen interface, with broad therapeutic potential. Invasive fungal infections pose a serious threat to human health worldwide, with Candida albicans being a leading fungal pathogen. Mortality is in part due to the limited arsenal of effective antifungals, with drug resistance on the rise. The echinocandins, which target the fungal cell wall, are the newest class of antifungal, and echinocandin resistance has already emerged. Here, we screened a library of 1,280 pharmacologically active compounds to identify those that potentiate echinocandin activity against an echinocandin-resistant isolate. The lead compound was a chelator, DTPA, which affects resistance by depleting magnesium. Genome sequencing of mutants resistant to the combination of DTPA and echinocandin revealed mutations in the gene encoding Nik1, which signals upstream of the Hog1 stress response pathway. We established that DTPA acts through Nik1 to modulate Hog1 signaling and enhance echinocandin activity, and that this combination has therapeutic benefits in a murine model of candidiasis. We also discovered that DTPA modulates C. albicans morphogenesis, a key virulence trait. DTPA induced filamentation by chelating zinc, in a manner that is contingent upon core filamentation pathways and specialized circuitry. Thus, we establish novel roles for metal homeostasis in C. albicans pathogenesis, thereby illuminating new therapeutic strategies for life-threatening infectious disease.
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Affiliation(s)
- Elizabeth J. Polvi
- Department of Molecular Genetics, University of Toronto, Toronto, Ontario, Canada
| | - Anna F. Averette
- Department of Molecular Genetics and Microbiology, Medicine, and Pharmacology and Cancer Biology, Duke University Medical Center, Durham, North Carolina, United States of America
| | - Soo Chan Lee
- Department of Molecular Genetics and Microbiology, Medicine, and Pharmacology and Cancer Biology, Duke University Medical Center, Durham, North Carolina, United States of America
- Department of Biology, University of Texas at San Antonio, San Antonio, Texas, United States of America
| | - Taeyup Kim
- Department of Molecular Genetics and Microbiology, Medicine, and Pharmacology and Cancer Biology, Duke University Medical Center, Durham, North Carolina, United States of America
| | - Yong-Sun Bahn
- Department of Biochemistry, College of Life Science and Biotechnology, Yonsei University, Seoul, Republic of Korea
| | - Amanda O. Veri
- Department of Molecular Genetics, University of Toronto, Toronto, Ontario, Canada
| | - Nicole Robbins
- Department of Molecular Genetics, University of Toronto, Toronto, Ontario, Canada
| | - Joseph Heitman
- Department of Molecular Genetics and Microbiology, Medicine, and Pharmacology and Cancer Biology, Duke University Medical Center, Durham, North Carolina, United States of America
| | - Leah E. Cowen
- Department of Molecular Genetics, University of Toronto, Toronto, Ontario, Canada
- * E-mail:
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van der Geest PJ, Hunfeld NGM, Ladage SE, Groeneveld ABJ. Micafungin versus anidulafungin in critically ill patients with invasive candidiasis: a retrospective study. BMC Infect Dis 2016; 16:490. [PMID: 27634140 PMCID: PMC5025542 DOI: 10.1186/s12879-016-1825-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2016] [Accepted: 09/09/2016] [Indexed: 11/25/2022] Open
Abstract
Background In critically ill patients the incidence of invasive fungal infections caused by Candida spp. has increased remarkably. Echinocandins are recommended as initial treatment for invasive fungal infections. The safety and efficacy of micafungin compared to caspofungin is similar, but no comparison is made between anidulafungin and micafungin concerning safety and efficacy. We therefore performed a retrospective study to assess these aspects in critically ill patients with invasive candidiasis. Methods All patients in the intensive care unit (ICU) with invasive candidiasis, who were only treated with anidulafungin or micafungin, between January 2012 and December 2014 were retrospectively included. Baseline demographic characteristics, infection characteristics and patient courses were assessed. Results A total of 63 patients received either anidulafungin (n = 30) or micafungin (n = 33) at the discretion of the attending intensivist. Baseline characteristics were comparable between the two groups, suggesting similar risk for developing invasive candidiasis. Patients with invasive candidiasis and liver failure were more often treated with anidulafungin than micafungin. Response rates were similar for both groups. No difference was observed in 28-day mortality, but 90-day mortality was higher in patients on anidulafungin. Multivariable cox regression analysis showed that age and serum bilirubin were the best parameters for the prediction of 90-day mortality, whereas APACHE II, Candida score and antifungal therapy did not contribute (P > 0.05). None of the patients developed impaired liver function related to antifungal use and no differences were seen in prothrombin time, serum transaminases and bilirubin levels between the groups, after exclusion of patients with liver injury or failure. Conclusion Micafungin can be safely and effectively used in critically ill patients with invasive candidiasis. The observed increased 90-day mortality with anidulafungin can be explained by intensivists unnecessarily avoiding micafungin in patients with liver injury and failure.
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Affiliation(s)
- Patrick J van der Geest
- Department of Intensive Care Medicine, Erasmus University Medical Center, 's Gravendijkwal 230, 3015 CE, Rotterdam, The Netherlands.
| | - Nicole G M Hunfeld
- Department of Intensive Care Medicine, Erasmus University Medical Center, 's Gravendijkwal 230, 3015 CE, Rotterdam, The Netherlands.,Department of Pharmacy, Erasmus University Medical Center, 's Gravendijkwal 230, Rotterdam, 3015 CE, The Netherlands
| | - Sophie E Ladage
- Department of Intensive Care Medicine, Erasmus University Medical Center, 's Gravendijkwal 230, 3015 CE, Rotterdam, The Netherlands
| | - A B Johan Groeneveld
- Department of Intensive Care Medicine, Erasmus University Medical Center, 's Gravendijkwal 230, 3015 CE, Rotterdam, The Netherlands
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Abstract
Candida albicans is a fungal species that is part of the normal human microbiota and also an opportunistic pathogen capable of causing mucosal and systemic infections. C. albicans cells proliferate in a planktonic (suspension) state, but they also form biofilms, organized and tightly packed communities of cells attached to a solid surface. Biofilms colonize many niches of the human body and persist on implanted medical devices, where they are a major source of new C. albicans infections. Here, we used an unbiased and global substrate-profiling approach to discover proteolytic activities produced specifically by C. albicans biofilms, compared to planktonic cells, with the goal of identifying potential biofilm-specific diagnostic markers and targets for therapeutic intervention. This activity-based profiling approach, coupled with proteomics, identified Sap5 (Candidapepsin-5) and Sap6 (Candidapepsin-6) as major biofilm-specific proteases secreted by C. albicans. Fluorogenic peptide substrates with selectivity for Sap5 or Sap6 confirmed that their activities are highly upregulated in C. albicans biofilms; we also show that these activities are upregulated in other Candida clade pathogens. Deletion of the SAP5 and SAP6 genes in C. albicans compromised biofilm development in vitro in standard biofilm assays and in vivo in a rat central venous catheter biofilm model. This work establishes secreted proteolysis as a promising enzymatic marker and potential therapeutic target for Candida biofilm formation. Biofilm formation by the opportunistic fungal pathogen C. albicans is a major cause of life-threatening infections. This work provides a global characterization of secreted proteolytic activity produced specifically by C. albicans biofilms. We identify activity from the proteases Sap5 and Sap6 as highly upregulated during C. albicans biofilm formation and develop Sap-cleavable fluorogenic substrates that enable the detection of biofilms from C. albicans and also from additional pathogenic Candida species. Furthermore, SAP5 and SAP6 deletions confirm that both proteases are required for proper biofilm development in vitro and in vivo. We propose that secreted proteolysis is a promising marker for the diagnosis and potential therapeutic targeting of Candida biofilm-associated infections.
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Rajendran R, Sherry L, Deshpande A, Johnson EM, Hanson MF, Williams C, Munro CA, Jones BL, Ramage G. A Prospective Surveillance Study of Candidaemia: Epidemiology, Risk Factors, Antifungal Treatment and Outcome in Hospitalized Patients. Front Microbiol 2016; 7:915. [PMID: 27379047 PMCID: PMC4910670 DOI: 10.3389/fmicb.2016.00915] [Citation(s) in RCA: 52] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2016] [Accepted: 05/27/2016] [Indexed: 01/12/2023] Open
Abstract
This study provide an up-to-date overview of the epidemiology and risk factors for Candida bloodstream infection in Scotland in 2012/2013, and the antifungal susceptibility of isolates from blood cultures from 11 National Health Service boards within Scotland. Candida isolates were identified by chromogenic agar and confirmed by MALDI–TOF methods. Survival and associated risk factors for patients stratified as albicans and non-albicans cases were assessed. Information on the spectrum of antifungals used was collected and summarized. The isolates sensitivity to different antifungals was tested by broth microdilution method and interpreted according to CLSI/EUCAST guidelines. Forty one percent of candidaemia cases were associated with Candida albicans, followed by C. glabrata (35%), C. parapsilosis (11.5%), and remainder with other Candida spp. C. albicans and C. glabrata infections were associated with 20.9 and 16.3% mortality, respectively. Survival of patients with C. albicans was significantly lower compared to non-C. albicans and catheter line removal in C. albicans patients significantly increases the survival days. Predisposing factors such as total parenteral nutrition, and number of days on mechanical ventilation or in intensive care, were significantly associated with C. albicans infections. Fluconazole was used extensively (64.5%) for treating candidaemia cases followed by echinocandins (33.8%). Based on CLSI breakpoints, MIC test found no resistance to any antifungals tested except 5.26% fluconazole resistance among C. glabrata isolates. Moreover, by comparing to EUCAST breakpoints we found 3.95% of C. glabrata isolates were resistant to anidulafungin. We have observed a shift in Candida spp. with an increasing isolation of C. glabrata. Delay and choice of antifungal treatment are associated with poor clinical outcomes.
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Affiliation(s)
- Ranjith Rajendran
- School of Medicine, College of Medical, Veterinary and Life Sciences, University of Glasgow Glasgow, UK
| | - Leighann Sherry
- School of Medicine, College of Medical, Veterinary and Life Sciences, University of Glasgow Glasgow, UK
| | | | | | | | | | - Carol A Munro
- Aberdeen Fungal Group, University of Aberdeen Aberdeen, UK
| | - Brian L Jones
- Microbiology Department, Glasgow Royal Infirmary Glasgow, UK
| | - Gordon Ramage
- School of Medicine, College of Medical, Veterinary and Life Sciences, University of Glasgow Glasgow, UK
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Calandra T, Roberts JA, Antonelli M, Bassetti M, Vincent JL. Diagnosis and management of invasive candidiasis in the ICU: an updated approach to an old enemy. CRITICAL CARE : THE OFFICIAL JOURNAL OF THE CRITICAL CARE FORUM 2016; 20:125. [PMID: 27230564 PMCID: PMC4882871 DOI: 10.1186/s13054-016-1313-6] [Citation(s) in RCA: 65] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Invasive fungal infections, particularly those caused by Candida species, are not uncommon in critically ill patients and are associated with considerable morbidity and mortality. Diagnosis and management of these infections can be challenging. In this review, we will briefly discuss recent epidemiological data on invasive candidiasis and current diagnostic approaches before concentrating on antifungal treatments.
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Affiliation(s)
- Thierry Calandra
- Infectious Diseases Service, Centre Hospitalier Universitaire Vaudois, University of Lausanne, Rue du Bugnon 46, 1011, Lausanne, Switzerland
| | - Jason A Roberts
- Burns, Trauma and Critical Care Research Centre, The University of Queensland, Royal Brisbane and Women's Hospital, Butterfield Street, 4029 Herston, Brisbane, Australia
| | - Massimo Antonelli
- Department of Anesthesiology and Intensive Care Medicine, Catholic University of Rome, A. Gemelli University Hospital, Largo A. Gemelli 8, 00168, Rome, Italy
| | - Matteo Bassetti
- Infectious Diseases Division, Santa Maria Misericordia University Hospital, Piazzale Santa MAria della Misericordia 15, 33100, Udine, Italy
| | - Jean-Louis Vincent
- Department of Intensive Care, Erasme Hospital, Université libre de Bruxelles, Route de Lennik 808, 1070, Brussels, Belgium.
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Souza MN, Ortiz SO, Mello MM, Oliveira FDM, Severo LC, Goebel CS. COMPARISON BETWEEN FOUR USUAL METHODS OF IDENTIFICATION OF Candida SPECIES. Rev Inst Med Trop Sao Paulo 2016; 57:281-7. [PMID: 26422150 PMCID: PMC4616911 DOI: 10.1590/s0036-46652015000400002] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
Infection by Candidaspp. is associated with high mortality rates, especially when treatment is not appropriate and/or not immediate. Therefore, it is necessary to correctly identify the genus and species of Candida. The aim of this study was to compare the identification of 89 samples of Candida spp. by the manual methods germ tube test, auxanogram and chromogenic medium in relation to the ID 32C automated method. The concordances between the methods in ascending order, measured by the Kappa index were: ID 32C with CHROMagar Candida(κ = 0.38), ID 32C with auxanogram (κ = 0.59) and ID 32C with germ tube (κ = 0.9). One of the species identified in this study was C. tropicalis,which demonstrated a sensitivity of 46.2%, a specificity of 95.2%, PPV of 80%, NPV of 81.1%, and an accuracy of 80.9% in tests performed with CHROMagar Candida;and a sensitivity of 76.9%, a specificity of 96.8%, PPV of 90.9%, NPV of 91%, and an accuracy of 91% in the auxanogram tests. Therefore, it is necessary to know the advantages and limitations of methods to choose the best combination between them for a fast and correct identification of Candidaspecies.
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Affiliation(s)
| | | | | | | | - Luiz Carlos Severo
- Irmandade Santa Casa de Misericórdia de Porto Alegre, Porto Alegre, RS, BR
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Singh G, Pitoyo CW, Aditianingsih D, Rumende CM. Risk factors for early invasive fungal disease in critically ill patients. Indian J Crit Care Med 2016; 20:633-639. [PMID: 27994377 PMCID: PMC5144524 DOI: 10.4103/0972-5229.194007] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND The incidence of invasive fungal disease (IFD) is increasing worldwide in the past two to three decades. Critically ill patients in Intensive Care Units are more vulnerable to fungal infection. Early detection and treatment are important to decrease morbidity and mortality in critically ill patients. OBJECTIVE Our study aimed to assess factors associated with early IFD in critically ill patients. MATERIALS AND METHODS This prospective cohort study was conducted in critically ill patients, from March to September 2015. Total number of patients (74) in this study was drawn based on one of the risk factors (human immunodeficiency virus). Specimens were collected on day 5-7 of hospitalization. Multivariate analysis with logistic regression was performed for factors, with P < 0.25 in bivariate analysis. RESULTS Two hundred and six patients were enrolled in this study. Seventy-four patients were with IFD, majority were males (52.7%), mean age was 58 years (range 18-79), mean Leon's score was 3 (score range 2-5), majority group was nonsurgical/nontrauma (72.9%), and mean fungal isolation was positive on day 5. Candida sp. (92.2%) is the most frquently isolated fungal infection. Urine culture yielded the highest number of fungal isolates (70.1%). Mortality rate in this study was 50%. In multivariate analysis, diabetes mellitus (DM) (P = 0.018, odds ratio 2.078, 95% confidence interval 1.135-3.803) was found as an independent factor associated with early IFD critically ill patients. CONCLUSION DM is a significant factor for the incidence of early IFD in critically ill patients.
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Affiliation(s)
- Gurmeet Singh
- Department of Internal Medicine, Respirology and Critical Illness Division, Faculty of Medicine, Universitas Indonesia/Cipto Mangunkusumo Hospital, Jakarta, Indonesia
| | - Ceva Wicaksono Pitoyo
- Department of Internal Medicine, Respirology and Critical Illness Division, Faculty of Medicine, Universitas Indonesia/Cipto Mangunkusumo Hospital, Jakarta, Indonesia
| | - Dita Aditianingsih
- Department of Anesthesiology and Intensive Care, Faculty of Medicine, Universitas Indonesia/Cipto Mangunkusumo Hospital, Jakarta, Indonesia
| | - Cleopas Martin Rumende
- Department of Internal Medicine, Respirology and Critical Illness Division, Faculty of Medicine, Universitas Indonesia/Cipto Mangunkusumo Hospital, Jakarta, Indonesia
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van der Geest PJ, Rijnders BJA, Vonk AG, Groeneveld ABJ. Echinocandin to fluconazole step-down therapy in critically ill patients with invasive, susceptible Candida albicans infections. Mycoses 2015; 59:179-85. [PMID: 26707572 DOI: 10.1111/myc.12450] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2015] [Revised: 10/24/2015] [Accepted: 11/22/2015] [Indexed: 01/24/2023]
Abstract
Invasive Candida spp. infections are increasingly diagnosed in critically ill patients. For initial treatment, an echinocandin is recommended with a possible step-down to fluconazole when the patients' condition is improving and the isolate appears susceptible, but there are no data to support such policy. We studied the safety and efficacy of step-down therapy in critically ill patients with culture proven deep seated or bloodstream infections by C. albicans susceptible to fluconazole. All patients admitted into the intensive care unit from January 2010 to December 2014, who had a culture proven invasive C. albicans infection and received initial treatment with an echinocandin for at least 4 days were included. Data on patient characteristics, treatment and vital outcomes were assessed. Of the 56 patients, 32 received step-down fluconazole therapy, at median day 5, whereas the echinocandin was continued in the other 24. No differences where seen in baseline characteristics or risk factors for invasive C. albicans infection between the two groups. Response rates were similar and no difference where seen in 28-day or 90-day mortality between the groups. Step-down therapy to fluconazole may be safe and effective in critically ill patients with invasive infections by C. albicans, susceptible to fluconazole, who have clinically improved as early as 4 days after start of treatment with an echinocandin.
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Affiliation(s)
| | - Bart J A Rijnders
- Department of Medical Microbiology and Infectious Diseases, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Alieke G Vonk
- Department of Medical Microbiology and Infectious Diseases, Erasmus Medical Center, Rotterdam, The Netherlands
| | - A B Johan Groeneveld
- Department of Intensive Care Medicine, Erasmus Medical Center, Rotterdam, The Netherlands
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Hankovszky P, Társy D, Öveges N, Molnár Z. Invasive Candida Infections in the ICU: Diagnosis and Therapy. ACTA ACUST UNITED AC 2015; 1:129-139. [PMID: 29967821 DOI: 10.1515/jccm-2015-0025] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2015] [Accepted: 09/15/2015] [Indexed: 11/15/2022]
Abstract
Invasive fungal infections have become a serious problem in the critically ill. One of the main reasons is the development of an immunocompromised condition. The most frequently found pathogens are Candida species. In order to provide adequate treatment, understanding this potentially life-threatening infection is mandatory. The aim of this summary is to view Candida infections from a different perspective and to give an overview on epidemiology, the range of pathophysiology from colonization to the invasive infections, and its impact on mortality. New therapeutic options will also be discussed and how these relate to current guidelines. Finally, the key issue of the choice of anti-fungal agents will be evaluated.
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Affiliation(s)
- Péter Hankovszky
- Department of Anaesthesiology and Intensive Therapy, University of Szeged, Albert Szent-Györgyi Health Center, Szeged, Hungary
| | - Domokos Társy
- Department of Anaesthesiology and Intensive Therapy, University of Szeged, Albert Szent-Györgyi Health Center, Szeged, Hungary
| | - Nándor Öveges
- Department of Anaesthesiology and Intensive Therapy, University of Szeged, Albert Szent-Györgyi Health Center, Szeged, Hungary
| | - Zsolt Molnár
- Department of Anaesthesiology and Intensive Therapy, University of Szeged, Albert Szent-Györgyi Health Center, Szeged, Hungary
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Knitsch W, Vincent JL, Utzolino S, François B, Dinya T, Dimopoulos G, Özgüneş İ, Valía JC, Eggimann P, León C, Montravers P, Phillips S, Tweddle L, Karas A, Brown M, Cornely OA. A randomized, placebo-controlled trial of preemptive antifungal therapy for the prevention of invasive candidiasis following gastrointestinal surgery for intra-abdominal infections. Clin Infect Dis 2015; 61:1671-8. [PMID: 26270686 PMCID: PMC4643488 DOI: 10.1093/cid/civ707] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2015] [Accepted: 08/07/2015] [Indexed: 01/05/2023] Open
Abstract
Patients undergoing emergency gastrointestinal surgery for intra-abdominal infection are at high risk for invasive candidiasis. This exploratory clinical trial could not provide evidence that a preemptive antifungal treatment strategy was effective in this patient group. Background. Patients undergoing emergency gastrointestinal surgery for intra-abdominal infection are at risk of invasive candidiasis (IC) and candidates for preemptive antifungal therapy. Methods. This exploratory, randomized, double-blind, placebo-controlled trial assessed a preemptive antifungal approach with micafungin (100 mg/d) in intensive care unit patients requiring surgery for intra-abdominal infection. Coprimary efficacy variables were the incidence of IC and the time from baseline to first IC in the full analysis set; an independent data review board confirmed IC. An exploratory biomarker analysis was performed using logistic regression. Results. The full analysis set comprised 124 placebo- and 117 micafungin-treated patients. The incidence of IC was 8.9% for placebo and 11.1% for micafungin (difference, 2.24%; [95% confidence interval, −5.52 to 10.20]). There was no difference between the arms in median time to IC. The estimated odds ratio showed that patients with a positive (1,3)-β-d-glucan (ßDG) result were 3.66 (95% confidence interval, 1.01–13.29) times more likely to have confirmed IC than those with a negative result. Conclusions. This study was unable to provide evidence that preemptive administration of an echinocandin was effective in preventing IC in high-risk surgical intensive care unit patients with intra-abdominal infections. This may have been because the drug was administered too late to prevent IC coupled with an overall low number of IC events. It does provide some support for using ßDG to identify patients at high risk of IC. Clinical Trials Registration. NCT01122368.
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Affiliation(s)
- Wolfgang Knitsch
- Department of General, Visceral and Transplantation Surgery, Hanover Medical School
| | - Jean-Louis Vincent
- Department of Intensive Care Erasme Hospital, Université Libre de Bruxelles, Brussels, Belgium
| | - Stefan Utzolino
- Department of General and Visceral Surgery, University of Freiburg, Freiburg im Breisgau
| | - Bruno François
- Inserm CIC 1435/Medical-Surgical Intensive Care Unit, Centre Hospitalier Universitaire Dupuytren, Limoges
| | - Tamás Dinya
- Institute of Surgery, University of Debrecen, Hungary
| | - George Dimopoulos
- 2nd Intensive Care Department, University Hospital Attikon, Athens, Greece
| | - İlhan Özgüneş
- Department of Clinical Microbiology and Infectious Diseases, Eskisehir Osmangazi University Faculty of Medicine, Turkey
| | - Juan Carlos Valía
- Servicio de Anestesia y Reanimación, Hospital General Universitario, Valencia
| | - Philippe Eggimann
- Adult Intensive Care Service, Department of Interdisciplinary Centers and Logistics, Centre Hospitalier Universitaire Vaudois and University of Lausanne, Switzerland
| | - Cristóbal León
- Intensive Care Unit, Valme University Hospital, University of Seville, Spain
| | - Philippe Montravers
- Département d'Anesthésie Réanimation Chirurgicale, Centre Hospitalier Universitaire Bichat Claude Bernard and University Denis Diderot Sorbonne Cité, Paris, France
| | | | | | - Andreas Karas
- Astellas Pharma EMEA Medical Affairs, Chertsey, United Kingdom
| | - Malcolm Brown
- Astellas Pharma Global Medical Affairs, Northbrook, Illinois
| | - Oliver A Cornely
- Department I of Internal Medicine, Clinical Trials Centre Cologne, German Centre for Infection Research, and Cologne Excellence Custer on Cellular Stress Responses in Aging-Associated Diseases, University of Cologne, Germany
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Mattsby-Baltzer I, Pinel C, Yugueros Marcos J, Kondori N, Potton L, Thiebaut-Bertrand A, Pelloux H, Cornet M. IgG1 anti-cell wall and IgG2 anti-phosphopeptidomannan antibodies in the diagnosis of invasive candidiasis and heavy Candida colonization. Med Mycol 2015; 53:725-35. [PMID: 26162476 DOI: 10.1093/mmy/myv037] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2015] [Accepted: 04/28/2015] [Indexed: 02/07/2023] Open
Abstract
We conducted a retrospective study to evaluate the usefulness of immunoglobulin G (IgG) subclasses against Candida cell wall fragments (CW) and phosphopeptidomannan (PPM) for the diagnosis of invasive candidiasis (IC). We analyzed 54 patients with IC (n = 19), Candida heavy colonization (HC; n = 16), and controls (no IC or HC, n = 19).In nonneutropenic patients (n = 47), the sensitivity and specificity values of IgG1 anti-CW and IgG2 anti-PPM in IC were 88%, 59%, and 88%, 94%, respectively. The areas under the receiver operating characteristic curves were 0.69 (0.51-0.88) and 0.901 (0.78-1.02), respectively. IgG1 mean values (arbitrary units) and 95% confidence interval were 46 (20-71), 42 (-0.38 to 84) and 20 (8.3-32) in IC, HC, and in controls, respectively, and discriminated IC but not HC from controls (P = .032, and P = .77, respectively). IgG2 mean values were 26 (9.2-42), 19 (4.4-33), and 3.2 (0.28-6.6) in IC, HC, and in controls, respectively, and discriminated both IC and HC from controls (P < .0001 and P = .035, respectively) but did not separate IC from HC (P = .2). IgG2 showed positivity as early as one day after the IC diagnosis. Antibodies were detected in only two out of a total of seven neutropenic patients.For both IC and HC patients, the diagnostic performance of IgG2 anti-PPM was better than the one of IgG1 anti-CW. In nonneutropenic patients, IgG2 anti-PPM accurately identified not only IC patients but also HC patients at high risk for IC. This marker may help clinicians in the initiation of early preemptive therapy.
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Affiliation(s)
- Inger Mattsby-Baltzer
- Department of Infectious Diseases, Institute of Biomedicine, University of Gothenburg, Gothenburg, Sweden Sahlgrenska University Hospital, Clinical Microbiology, Gothenburg
| | - Claudine Pinel
- Centre Hospitalier Universitaire de Grenoble, CHUG, Laboratoire de Parasitologie-Mycologie, Grenoble, France Université Joseph Fourier, Grenoble, France
| | | | - Nahid Kondori
- Sahlgrenska University Hospital, Clinical Microbiology, Gothenburg
| | - Leila Potton
- CHUG, Service de Réanimation Médicale, Grenoble, France
| | | | - Hervé Pelloux
- Centre Hospitalier Universitaire de Grenoble, CHUG, Laboratoire de Parasitologie-Mycologie, Grenoble, France Université Joseph Fourier, Grenoble, France
| | - Muriel Cornet
- Centre Hospitalier Universitaire de Grenoble, CHUG, Laboratoire de Parasitologie-Mycologie, Grenoble, France Université Joseph Fourier, Grenoble, France
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Bilir SP, Ferrufino CP, Pfaller MA, Munakata J. The economic impact of rapid Candida species identification by T2Candida among high-risk patients. Future Microbiol 2015; 10:1133-44. [DOI: 10.2217/fmb.15.29] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
ABSTRACT Introduction: This study estimates the cost–effectiveness and hospital budget impact of rapid candidemia identification using T2Candida, a novel diagnostic panel with same-day species-specific results. Materials & Methods: A 1-year decision-tree model estimates hospital costs (2013 US$) and effects (candidemia-related deaths) for faster diagnostics versus blood culture (BC), accounting for disease prevalence, distribution of Candida species, test characteristics (sensitivity/specificity/time to result), antifungal medication and differential length-of-stay and mortality by appropriate treatment timing. Results: The model estimates a hospital with 5100 annual high-risk patients could possibly save $5,858,448 with T2Candida versus BC, a 47.6% decrease in candidemia diagnosis and treatment budget ($1149/patient tested), while averting 60.6% of candidemia-related mortality. Conclusion: Hospitals may observe lower candidemia-related inpatient costs and mortality with rapid Candida diagnosis.
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Affiliation(s)
- Sara Pinar Bilir
- Health Economics & Outcomes Research, 425 Market Street, 7th Floor, IMS Health, San Francisco, CA 94105, USA
| | - Cheryl P Ferrufino
- Health Economics & Outcomes Research, 425 Market Street, 7th Floor, IMS Health, San Francisco, CA 94105, USA
| | - Michael A Pfaller
- T2Biosystems, 101 Hartwell Ave, Lexington, MA 02421, USA
- University of Iowa College of Medicine & College of Public Health, Iowa City, IA 52242, USA
| | - Julie Munakata
- Health Economics & Outcomes Research, 425 Market Street, 7th Floor, IMS Health, San Francisco, CA 94105, USA
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Bassetti M, Leon C, Timsit JF. Are prophylactic antifungals in highly colonized patients safe and effective? Intensive Care Med 2015; 41:1336-9. [PMID: 26077079 DOI: 10.1007/s00134-015-3888-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2015] [Accepted: 05/15/2015] [Indexed: 12/20/2022]
Affiliation(s)
- Matteo Bassetti
- Infectious Diseases Division, Santa Maria Misericordia University Hospital, Piazzale Santa Maria Della Misericordia 15, 33100, Udine, Italy,
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Polvi EJ, Li X, O’Meara TR, Leach MD, Cowen LE. Opportunistic yeast pathogens: reservoirs, virulence mechanisms, and therapeutic strategies. Cell Mol Life Sci 2015; 72:2261-87. [PMID: 25700837 PMCID: PMC11113693 DOI: 10.1007/s00018-015-1860-z] [Citation(s) in RCA: 49] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2014] [Revised: 02/06/2015] [Accepted: 02/11/2015] [Indexed: 12/21/2022]
Abstract
Life-threatening invasive fungal infections are becoming increasingly common, at least in part due to the prevalence of medical interventions resulting in immunosuppression. Opportunistic fungal pathogens of humans exploit hosts that are immunocompromised, whether by immunosuppression or genetic predisposition, with infections originating from either commensal or environmental sources. Fungal pathogens are armed with an arsenal of traits that promote pathogenesis, including the ability to survive host physiological conditions and to switch between different morphological states. Despite the profound impact of fungal pathogens on human health worldwide, diagnostic strategies remain crude and treatment options are limited, with resistance to antifungal drugs on the rise. This review will focus on the global burden of fungal infections, the reservoirs of these pathogens, the traits of opportunistic yeast that lead to pathogenesis, host genetic susceptibilities, and the challenges that must be overcome to combat antifungal drug resistance and improve clinical outcome.
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Affiliation(s)
- Elizabeth J. Polvi
- Department of Molecular Genetics, University of Toronto, 1 King’s College Circle, Medical Sciences Building, Room 4368, Toronto, ON M5S 1A8 Canada
| | - Xinliu Li
- Department of Molecular Genetics, University of Toronto, 1 King’s College Circle, Medical Sciences Building, Room 4368, Toronto, ON M5S 1A8 Canada
| | - Teresa R. O’Meara
- Department of Molecular Genetics, University of Toronto, 1 King’s College Circle, Medical Sciences Building, Room 4368, Toronto, ON M5S 1A8 Canada
| | - Michelle D. Leach
- Department of Molecular Genetics, University of Toronto, 1 King’s College Circle, Medical Sciences Building, Room 4368, Toronto, ON M5S 1A8 Canada
- Aberdeen Fungal Group, Institute of Medical Sciences, School of Medical Sciences, University of Aberdeen, Foresterhill, Aberdeen, UK
| | - Leah E. Cowen
- Department of Molecular Genetics, University of Toronto, 1 King’s College Circle, Medical Sciences Building, Room 4368, Toronto, ON M5S 1A8 Canada
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Eggimann P, Que YA, Revelly JP, Pagani JL. Preventing invasive candida infections. Where could we do better? J Hosp Infect 2015; 89:302-8. [DOI: 10.1016/j.jhin.2014.11.006] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2014] [Accepted: 11/20/2014] [Indexed: 12/29/2022]
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Arnould JF, Le Floch R. [Not Available]. ANNALS OF BURNS AND FIRE DISASTERS 2015; 28:21-8. [PMID: 26668558 PMCID: PMC4665176] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 11/27/2014] [Accepted: 03/11/2015] [Indexed: 06/05/2023]
Abstract
Local or general fungal infection remain a very serious event in burns. Burns have numerous risk factors for such, infections associated with depressed immunity. Candida, Aspergillus and mucor fungi prevail in wound infections. The two latest are especially serious and impairing. Diagnosis is based on anatomo-pathological and mycological examination of skin samples. Treatment is mainly surgical. Medical therapy depends on antifungal susceptibility. Most fungemias are candidemias. Diagnosis is difficult and often based on clinical suspicion. Treatment uses echinocandin and fluconazole.
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Affiliation(s)
- JF. Arnould
- Service de Réanimation Chirurgicale et des brûlés, CHU Nantes, France
| | - R. Le Floch
- Service de Réanimation Chirurgicale et des brûlés, CHU Nantes, France
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Timsit JF, Chemam S, Bailly S. Empiric/pre-emptive anti-Candida therapy in non-neutropenic ICU patients. F1000PRIME REPORTS 2015; 7:21. [PMID: 25750739 PMCID: PMC4335794 DOI: 10.12703/p7-21] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
The potential of the systemic antifungal treatment of non-immunocompromised patients with sepsis, extra-digestive Candida colonization and multiple organ failure is unknown, although it represents three out of four antifungal treatments prescribed in intensive care units. It may allow an early treatment of invasive fungal infection at incubation phase, but exposes patients to unnecessary antifungal treatments with subsequent costs and antifungal selection pressure. As early diagnostic tests for invasive candidiasis are still considered insufficient, the potential of this strategy needs to be demonstrated by a randomized controlled trial. Such a trial is currently ongoing.
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Affiliation(s)
- Jean-François Timsit
- INSERMIAME, UMR 1137, F-75018 ParisFrance
- Paris Diderot UniversityIAME, UMR 1137, Sorbonne Paris Cité, F-75018 ParisFrance
- AP-HP, Bichat Hospital, medical and infectious diseases ICUF-75018 ParisFrance
| | - Sarah Chemam
- AP-HP, Bichat Hospital, medical and infectious diseases ICUF-75018 ParisFrance
| | - Sébastien Bailly
- INSERMIAME, UMR 1137, F-75018 ParisFrance
- Paris Diderot UniversityIAME, UMR 1137, Sorbonne Paris Cité, F-75018 ParisFrance
- Joseph Fourier (Grenoble 1) University, Albert Bonniot instituteU 823, Grenoble, F-38000France
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