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Aydin S, Derin O, Sahin M, Dinleyici R, Yilmaz M, Ceylan B, Tosun AI, Ozturk R, Mert A. Epidemiology of nosocomial candidemia, mortality and antifungal resistance, 7-year experience, in Turkey. Jpn J Infect Dis 2022; 75:597-603. [PMID: 35908875 DOI: 10.7883/yoken.jjid.2022.181] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Candidemia is an important clinical condition that prolongs the period of hospitalization and increases morbidity, mortality, and hospital costs. In this retrospective study, we aimed to evaluate the epidemiological and microbiological characteristics of patients with candidemia, between January 2013 and December 2019. Two hundred forty-one candidemia episodes were observed in the 230 patients, of whom 45% were female. The median age was 63 and 53.9% of the episodes were in the ICU. Frequently observed predisposing factors for candidemia included the use of antibiotics (71.3%), urinary catheterization (56.3%), Central venous catheter placement (50.3%), total parenteral nutrition (47.9%), solid-organ malignancy (46%), a surgical intervention (48.6%), chemotherapy (37%), steroid treatment (25.5%). The crude mortality rate was 52.7%. A significant difference was found between survivors and non-survivors (p = 0.007) with the Charlson comorbidity index. However, no statistically significant association was found between mortality and age, sex, surgical intervention, catheter-related candidemia, or Candida spp. The most frequently isolated Candida spp. was C. albicans (51%). Overall resistance to fluconazole, voriconazole, caspofungin, micafungin and flucytosine was 3.7%, 0%, 2.5%, 1.8%,1.8%, respectively. Consequently, there is a need for tests that yield higher success rates and rapid in diagnosis candidemia and local epidemiological data for antifungal resistance.
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Affiliation(s)
- Selda Aydin
- Department of Infectious Diseases and Clinical Microbiology, Istanbul Medipol University, School of Medicine, Turkey
| | - Okan Derin
- Department of Infectious Diseases and Clinical Microbiology, University of Health Science Turkey, Sisli Hamidiye Etfal Training and Research Hospital, Turkey
| | - Meyha Sahin
- Department of Infectious Diseases and Clinical Microbiology, Istanbul Medipol University, School of Medicine, Turkey
| | - Rumeysa Dinleyici
- Department of Clinical Pharmacy, Istanbul Medipol University, School of Pharmacy, Turkey
| | - Mesut Yilmaz
- Department of Infectious Diseases and Clinical Microbiology, Istanbul Medipol University, School of Medicine, Turkey
| | - Bahadır Ceylan
- Department of Infectious Diseases and Clinical Microbiology, Istanbul Medipol University, School of Medicine, Turkey
| | - Ayse Istanbullu Tosun
- Department of Medical Microbiology; Istanbul Medipol University School of Medicine, Turkey
| | - Recep Ozturk
- Department of Infectious Diseases and Clinical Microbiology, Istanbul Medipol University, School of Medicine, Turkey
| | - Ali Mert
- Department of Internal Medicine, Istanbul Medipol University, School of Medicine, Turkey
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2
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Chang YC, Chen JS, Yin CH, Shin-Jung Lee S, Chen WC. Candidemia in hospitalized cirrhotic patients with bloodstream infection: A retrospective analysis and brief summary of published studies. J Chin Med Assoc 2022; 85:295-303. [PMID: 35259132 DOI: 10.1097/jcma.0000000000000695] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Candidemia is a life-threatening condition; however, the predictive markers for candidemia and mortality are inadequate in cirrhotic patients. This study was conducted to propose candidate predictors for the occurrence of candidemia and 30-day mortality in hospitalized cirrhotic patients with bloodstream infection (BSI) and review the related literature. METHODS Cirrhotic patients with BSI between January 2011 and March 2020 were screened from the databank of a medical center and eligible patients were enrolled. Patients were separated into candidemia and bacteremia groups according to the results of blood cultures. Baseline characteristics, clinical presentation, and biochemistry data were collected at this time, as were microbiological data, medical management, use of antimicrobial agents, and outcome of the patients. The parameters and 30-day mortality were compared between candidemia and bacteremia groups. A combination of the MeSH terms and text terms related to candidemia and cirrhosis was searched in the electronic databases. RESULTS Four hundred and sixty cirrhotic patients with BSI were enrolled. Thirty-five patients with candidemia (7.6%) were identified. Nosocomial infection, intensive care unit (ICU) admission, antibiotics exposure ≥14 days, white cell count >10 K/mm3, and model for end-stage liver disease (MELD) score >24 were associated with candidemia. The 30-day mortality was 65.7% in the candidemia group and 37.9% in the bacteremia group (p = 0.001). Nosocomial infection, ICU admission, hepatoma, hepatic encephalopathy, international normalized ratio ≥1.2, platelet ≤150 K/mm3, estimated glomerular filtration rate <60 mL/min/1.73m2, and MELD score >24 were associated with 30-day mortality. Six studies were identified. The results were consistent with our findings regarding low incidence of candidemia, and relevant risk factors are listed. CONCLUSION Candidemia had low incidence but high mortality in hospitalized cirrhotic patients with BSI. New predictors were proposed for the occurrence of candidemia and 30-day mortality in these patients.
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Affiliation(s)
- Yu-Chen Chang
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan, ROC
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
| | - Jin-Shuen Chen
- Division of Nephrology, Department of Internal Medicine, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan, ROC
| | - Chun-Hao Yin
- Department of Medical Education and Research, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan, ROC
| | - Susan Shin-Jung Lee
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
- Division of Infectious Disease, Department of Internal Medicine, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan, ROC
| | - Wen-Chi Chen
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan, ROC
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
- Institute of Biomedical Sciences, College of Science, National Sun Yat-Sen University, Kaohsiung, Taiwan, ROC
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Mareković I, Pleško S, Rezo Vranješ V, Herljević Z, Kuliš T, Jandrlić M. Epidemiology of Candidemia: Three-Year Results from a Croatian Tertiary Care Hospital. J Fungi (Basel) 2021; 7:267. [PMID: 33807486 PMCID: PMC8065499 DOI: 10.3390/jof7040267] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2021] [Revised: 03/24/2021] [Accepted: 03/29/2021] [Indexed: 12/15/2022] Open
Abstract
Invasive candidosis is the most common invasive fungal infection in hospitalized patients and is associated with a high mortality rate. This is the first study from a Croatian tertiary care hospital describing epidemiology, risk factors and species distribution in patients with candidemia. A three-year retrospective observational study, from 2018 to 2020, was performed at the University Hospital Centre Zagreb, Zagreb, Croatia. A total of 160 patients with candidemia (n = 170 isolates) were enrolled. Candidemia incidence increased from 0.47 to 0.69 per 1000 admissions in 2018 and 2020, respectively. Ninety-five patients (58.38%) were in the intensive care unit. The main risk factors for candidemia were central venous catheter (CVC) (84.38%), previous surgical procedure (56.88%) and invasive mechanical ventilation (42.50%). Candida albicans was identified in 43.53% of isolates, followed by C. parapsilosis (31.76%) and C. glabrata (12.36%), C. krusei (5.29%), C. tropicalis (2.35%) and C. lusitaniae (2.35%). The study discovered a shift to non-albicansCandida species, particularly C. parapsilosis, and made it possible to determine the main tasks we should focus on to prevent candidemia in the hospital, these being mainly infection control measures directed towards prevention of catheter-related bloodstream infections, specifically comprising hand hygiene and CVC bundles of care. The potential benefit of fluconazole prophylaxis in certain populations of surgical patients could also be considered.
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Affiliation(s)
- Ivana Mareković
- Department of Clinical and Molecular Microbiology, University Hospital Centre Zagreb, School of Medicine University of Zagreb, 10000 Zagreb, Croatia; (S.P.); (V.R.V.); (Z.H.); (M.J.)
| | - Sanja Pleško
- Department of Clinical and Molecular Microbiology, University Hospital Centre Zagreb, School of Medicine University of Zagreb, 10000 Zagreb, Croatia; (S.P.); (V.R.V.); (Z.H.); (M.J.)
| | - Violeta Rezo Vranješ
- Department of Clinical and Molecular Microbiology, University Hospital Centre Zagreb, School of Medicine University of Zagreb, 10000 Zagreb, Croatia; (S.P.); (V.R.V.); (Z.H.); (M.J.)
| | - Zoran Herljević
- Department of Clinical and Molecular Microbiology, University Hospital Centre Zagreb, School of Medicine University of Zagreb, 10000 Zagreb, Croatia; (S.P.); (V.R.V.); (Z.H.); (M.J.)
| | - Tomislav Kuliš
- Department of Urology, University Hospital Centre Zagreb, School of Medicine University of Zagreb, 10000 Zagreb, Croatia;
| | - Marija Jandrlić
- Department of Clinical and Molecular Microbiology, University Hospital Centre Zagreb, School of Medicine University of Zagreb, 10000 Zagreb, Croatia; (S.P.); (V.R.V.); (Z.H.); (M.J.)
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Preparation and In Vitro Evaluation of Alginate Microparticles Containing Amphotericin B for the Treatment of Candida Infections. Int J Biomater 2020; 2020:2514387. [PMID: 32802065 PMCID: PMC7416289 DOI: 10.1155/2020/2514387] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2020] [Revised: 07/03/2020] [Accepted: 07/17/2020] [Indexed: 01/08/2023] Open
Abstract
Invasive candidiasis (IC) remains as a major cause of morbidity and mortality in critically ill patients. Amphotericin B (AmB) is one of the most effective antifungal agents commonly used to treat this infection. However, it induces severe side effects such as nephrotoxicity, cardiac alterations, nausea, fever, and liver damage. The utilization of drug delivery systems has been explored to overcome these limitations. Several AmB lipid formulations have been developed and are currently available in the market. Although they have the ability to reduce the main side effects of free AmB, their high cost, necessity of repeated intravenous injections for successful treatment, and incidence of pulmonary toxicity have limited their use. In the last decades, alginate has gained significant interest in drug delivery applications as a cost-effective strategy to improve the safety and therapeutic effect of toxic drugs. In this work, the clinically relevant drug AmB was encapsulated into alginate microparticles using the emulsification/external gelation method. We hypothesize that this synthesis strategy may positively impact the antifungal efficacy of AmB-loaded MCPs toward Candida albicans cells while reducing the toxicity in human lung cells. To prove this hypothesis, the ability of the microplatform to disrupt the cellular membrane potential was tested and its antifungal effectiveness toward Candida albicans cells was evaluated using the cell counting and plate count methods. Moreover, the toxicity of the microplatform in human lung cells was evaluated using CellTiter 96® AQueous cell viability assay and qualitative diffusion analysis of acridine orange. Our results demonstrated that the platform developed in this work was able to induce antifungal toxicity against Candida albicans yeast cells at the same level of free AmB with minimal toxicity to lung cells, which is one of the main side effects induced by commercial drug delivery systems containing AmB. Overall, our data provides convincing evidence about the effectiveness of the alginate-based microplatform toward Candida albicans cells. In addition, this vehicle may not require several infusions for a successful treatment while reducing the pulmonary toxic effect induced by commercial lipid formulations.
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5
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Song Y, Chen X, Yan Y, Wan Z, Liu W, Li R. Prevalence and Antifungal Susceptibility of Pathogenic Yeasts in China: A 10-Year Retrospective Study in a Teaching Hospital. Front Microbiol 2020; 11:1401. [PMID: 32719663 PMCID: PMC7347963 DOI: 10.3389/fmicb.2020.01401] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2020] [Accepted: 05/29/2020] [Indexed: 12/29/2022] Open
Abstract
To determine the dynamic changes of pathogenic yeast prevalence and antifungal susceptibility patterns in tertiary hospitals in China, we analyzed 527 yeast isolates preserved in the Research Center for Medical Mycology at Peking University, Beijing, China, between Jan 2010 and Dec 2019 and correctly identified 19 yeast species by matrix-assisted laser desorption ionization time-of-flight mass spectrometry (MALDI-TOF-MS) and ribosomal DNA sequencing. Antifungal susceptibility testing was performed following a Sensititre YeastOne colorimetric microdilution panel with nine clinically available antifungals. The Clinical and Laboratory Standards Institute (CLSI)-approved standard M27-A3 (S4) and newly revised clinical breakpoints or species-specific and method-specific epidemiological cutoff values were used for the interpretation of susceptibility test data. In this study, although Candida albicans was the predominant single species, non-C. albicans species constituted >50% of isolates in 6 out of 10 years, and more rare species were present in the recent 5 years. The non-C. albicans species identified most frequently were Candida parapsilosis sensu stricto, Candida tropicalis, and Candida glabrata. The prevalence of fluconazole and voriconazole resistance in the C. parapsilosis sensu stricto population was <3%, but C. tropicalis exhibited decreased susceptibility to fluconazole (42, 57.5%) and voriconazole (31, 42.5%), and 22 (30.1%) C. tropicalis isolates exhibited wild-type minimum inhibitory concentrations (MICs) to posaconazole. Furthermore, fluconazole and voriconazole cross-resistance prevalence in C. tropicalis was 19 (26.1%). The overall prevalence of fluconazole resistance in the C. glabrata population was 14 (26.9%), and prevalence of isolates exhibiting voriconazole non-wild-type MICs was 33 (63.5%). High-level echinocandin resistance was mainly observed in C. glabrata, and the prevalence rates of isolate resistance to anidulafungin, micafungin, and caspofungin were 5 (9.6%), 5 (9.6%), and 4 (7.7%), respectively. Moreover, one C. glabrata isolate showed multidrug resistant to azoles, echinocandins, and flucytosine. Overall, the 10-year surveillance study showed the increasing prevalence of non-C. albicans species over time; the emergence of azole resistance in C. tropicalis and multidrug resistance in C. glabrata over the years reinforced the need for epidemiological surveillance and monitoring.
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Affiliation(s)
- Yinggai Song
- Department of Dermatology and Venereology, Peking University First Hospital, Beijing, China.,Research Center for Medical Mycology, Peking University, Beijing, China.,National Clinical Research Center for Skin and Immune Diseases, Beijing, China
| | - Xianlian Chen
- Department of Laboratory Medicine, The First Affiliated Hospital of Zunyi Medical University, Zunyi, China
| | - Yan Yan
- Department of Laboratory Medicine, Peking University First Hospital, Beijing, China
| | - Zhe Wan
- Department of Dermatology and Venereology, Peking University First Hospital, Beijing, China.,Research Center for Medical Mycology, Peking University, Beijing, China.,National Clinical Research Center for Skin and Immune Diseases, Beijing, China
| | - Wei Liu
- Department of Dermatology and Venereology, Peking University First Hospital, Beijing, China.,Research Center for Medical Mycology, Peking University, Beijing, China.,National Clinical Research Center for Skin and Immune Diseases, Beijing, China
| | - Ruoyu Li
- Department of Dermatology and Venereology, Peking University First Hospital, Beijing, China.,Research Center for Medical Mycology, Peking University, Beijing, China.,National Clinical Research Center for Skin and Immune Diseases, Beijing, China
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6
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Arslan F, Caskurlu H, Sarı S, Dal HC, Turan S, Sengel BE, Gul F, Yesilbag Z, Eren G, Temel S, Alp E, Gol Serin B, Kose S, Calık S, Tuncel ZT, Senbayrak S, Sarı A, Karagoz G, Tomruk SG, Sen B, Hizarci B, Vahaboglu H. Risk factors for noncatheter-related Candida bloodstream infections in intensive care units: A multicenter case-control study. Med Mycol 2020; 57:668-674. [PMID: 30496520 DOI: 10.1093/mmy/myy127] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2018] [Revised: 10/24/2018] [Accepted: 11/03/2018] [Indexed: 01/05/2023] Open
Abstract
Candida bloodstream infections are associated with high mortality among critically ill patients in intensive care units (ICUs). Studies that explore the risk factors for candidemia may support better patient care in intensive care units. We conducted a retrospective, multicenter case-control study to investigate the risk factors for noncatheter-related Candida bloodstream infections (CBSI) in adult ICUs. Participants selected controls randomly on a 1:1 basis among all noncase patients stayed during the same period in ICUs. Data on 139 cases and 140 controls were deemed eligible. Among the controls, 69 patients died. The stratified Fine-Gray model was used to estimate the subdistribution Hazard ratios. The subdistribution hazards and 95% confidence intervals for final covariates were as follows: prior exposure to antimycotic agents, 2.21 (1.56-3.14); prior exposure to N-acetylcysteine, 0.11 (0.03-0.34) and prior surgical intervention, 1.26 (0.76-2.11). Of the patients, those exposed to antimycotic drugs, 87.1% (54/62) had breakthrough candidemia. Serious renal, hepatic, or hematologic side effects were comparable between patients those exposed and not-exposed to systemic antimycotic drugs. Untargeted administration of antimycotic drugs did not improve survival among candidemic patients (not-exposed, 63.6% [49/77]; exposed % 66.1 [41/62]; P = .899). This study documented that exposure to an antifungal agent is associated with increased the risk of subsequent development of CBSIs among nonneutropenic adult patients admitted to the ICU. Only two centers regularly prescribed N-acetylcysteine. Due to the limited number of subjects, we interpreted the positive effect of N-acetylcysteine on the absolute risk of CBSIs with caution.
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Affiliation(s)
- Ferhat Arslan
- Department of Infectious Diseases and Clinical Microbiology, Faculty of Medicine, Istanbul Medeniyet University, Istanbul, Turkey
| | - Hulya Caskurlu
- Department of Infectious Diseases and Clinical Microbiology, Faculty of Medicine, Istanbul Medeniyet University, Istanbul, Turkey
| | - Sema Sarı
- Department of Intensive Care, Health Sciences University, Turkiye Yuksek Ihtisas Training and Research Hospital, Ankara, Turkey
| | - Hayriye Cankar Dal
- Department of Intensive Care, Health Sciences University, Turkiye Yuksek Ihtisas Training and Research Hospital, Ankara, Turkey
| | - Sema Turan
- Department of Intensive Care, Health Sciences University, Turkiye Yuksek Ihtisas Training and Research Hospital, Ankara, Turkey
| | - Buket Erturk Sengel
- Department of Infectious Diseases and Clinical Microbiology, Marmara University Faculty of Medicine, İstanbul, Turkey
| | - Fethi Gul
- Department of Anesthesiology and Reanimation, Marmara University Faculty of Medicine, İstanbul, Turkey
| | - Zuhal Yesilbag
- Department of Infectious Diseases and Clinical Microbiology, Health Sciences University, Bakirkoy Dr. Sadi Konuk Education and Research Hospital, Istanbul, Turkey
| | - Gulay Eren
- Department of Anesthesiology and Reanimation, Health Sciences University, Bakirkoy Dr. Sadi Konuk Education and Research Hospital, Istanbul
| | - Sahin Temel
- Department of Anesthesiology and Reanimation, Faculty of Medicine, Erciyes University, Kayseri, Turkey
| | - Emine Alp
- Department of Infectious Diseases and Clinical Microbiology, Faculty of Medicine, Erciyes University, Kayseri, Turkey
| | - Basak Gol Serin
- Department of Infectious Diseases and Clinical Microbiology, Health Sciences University, İzmir Tepecik Training and Research Hospital, Izmir, Turkey
| | - Sukran Kose
- Department of Infectious Diseases and Clinical Microbiology, Health Sciences University, İzmir Tepecik Training and Research Hospital, Izmir, Turkey
| | - Sebnem Calık
- Department of Infectious Diseases and Clinical Microbiology, Health Sciences University, İzmir Bozyaka Training and Research Hospital, İzmir, Turkey
| | - Zeki Tekgul Tuncel
- Department of Anesthesiology and Reanimation, Health Sciences University, İzmir Bozyaka Training and Research Hospital, İzmir, Turkey
| | - Seniha Senbayrak
- Department of Infectious Diseases and Clinical Microbiology, Health Sciences University, Haydarpasa Numune Training and Research Hospital, Istanbul, Turkey
| | - Ahmet Sarı
- Department of Anesthesiology and Reanimation, Health Sciences University, Haydarpasa Numune Training and Research Hospital, Istanbul, Turkey
| | - Gul Karagoz
- Department of Infectious Diseases and Clinical Microbiology, Umraniye Training and Research Hospital, Istanbul, Turkey
| | - Senay Goksu Tomruk
- Department of Anesthesiology and Reanimation, Umraniye Training and Research Hospital, Istanbul, Turkey
| | - Betul Sen
- Department of Anesthesiology and Reanimation, Faculty of Medicine, Istanbul Medeniyet University, Istanbul, Turkey
| | - Burcu Hizarci
- Department of Anesthesiology and Reanimation, Faculty of Medicine, Istanbul Medipol University, Istanbul, Turkey
| | - Haluk Vahaboglu
- Department of Infectious Diseases and Clinical Microbiology, Faculty of Medicine, Istanbul Medeniyet University, Istanbul, Turkey
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Abstract
In Colombia, especially in intensive care units, candidemia is a frequent cause of infection, accounting for 88% of fungal infections in hospitalized patients, with mortality ranging from 36% to 78%. Its incidence in Colombia is higher than that reported in developed countries and even higher than in other Latin American countries. First, the patient’s risk factors should be considered, and then clinical characteristics should be assessed. Finally, microbiological studies are recommended and if the evidence supports its use, molecular testing.
In general, American, Latin American, and European guides place the echinocandins as the first-line treatment for candidemia and differ in the use of fluconazole based on evidence, disease severity, previous exposure to azoles, and prevalence of Candida non-albicans. Taking into account the high incidence of this disease in our setting, it should be looked for in patients with risk factors to start a prompt empirical anti-fungal treatment.
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8
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Morbidity and mortality of candidaemia in Europe: an epidemiologic meta-analysis. Clin Microbiol Infect 2019; 25:1200-1212. [DOI: 10.1016/j.cmi.2019.04.024] [Citation(s) in RCA: 101] [Impact Index Per Article: 20.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2019] [Revised: 04/15/2019] [Accepted: 04/18/2019] [Indexed: 01/30/2023]
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de Medeiros MAP, de Melo APV, Bento ADO, de Souza LBFC, Neto FDAB, Garcia JBL, Zuza-Alves DL, Francisco EC, Melo ASDA, Chaves GM. Epidemiology and prognostic factors of nosocomial candidemia in Northeast Brazil: A six-year retrospective study. PLoS One 2019; 14:e0221033. [PMID: 31437188 PMCID: PMC6705852 DOI: 10.1371/journal.pone.0221033] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2019] [Accepted: 07/29/2019] [Indexed: 12/21/2022] Open
Abstract
Candidemia has been considered a persistent public health problem with great impact on hospital costs and high mortality. We aimed to evaluate the epidemiology and prognostic factors of candidemia in a tertiary hospital in Northeast Brazil from January 2011 to December 2016. Demographic and clinical data of patients were retrospectively obtained from medical records and antifungal susceptibility profiling was performed using the broth microdilution method. A total of 68 episodes of candidemia were evaluated. We found an average incidence of 2.23 episodes /1000 admissions and a 30-day mortality rate of 55.9%. The most prevalent species were Candida albicans (35.3%), Candida tropicalis (27.4%), Candida parapsilosis (21.6%) and Candida glabrata (11.8%). Higher mortality rates were observed in cases of candidemia due to C. albicans (61.1%) and C. glabrata (100%), especially when compared to C. parapsilosis (27.3%). Univariate analysis revealed some variables which significantly increased the probability of death: older age (P = 0.022; odds ratio [OR] = 1.041), severe sepsis (P < 0.001; OR = 8.571), septic shock (P = 0.035; OR = 3.792), hypotension (P = 0.003; OR = 9.120), neutrophilia (P = 0.046; OR = 3.080), thrombocytopenia (P = 0.002; OR = 6.800), mechanical ventilation (P = 0.009; OR = 8.167) and greater number of surgeries (P = 0.037; OR = 1.920). Multivariate analysis showed that older age (P = 0.040; OR = 1.055), severe sepsis (P = 0.009; OR = 9.872) and hypotension (P = 0.031; OR = 21.042) were independently associated with worse prognosis. There was no resistance to amphotericin B, micafungin or itraconazole and a low rate of resistance to fluconazole (5.1%). However, 20.5% of the Candida isolates were susceptible dose-dependent (SDD) to fluconazole and 7.7% to itraconazole. In conclusion, our results could assist in the adoption of strategies to stratify patients at higher risk for developing candidemia and worse prognosis, in addition to improve antifungal management.
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Affiliation(s)
- Mariana Araújo Paulo de Medeiros
- Laboratory of Medical and Molecular Mycology, Department of Clinical and Toxicological Analysis, Federal University of Rio Grande do Norte, Natal city, Rio Grande do Norte State, Brazil
| | - Ana Patrícia Vieira de Melo
- Laboratory of Medical and Molecular Mycology, Department of Clinical and Toxicological Analysis, Federal University of Rio Grande do Norte, Natal city, Rio Grande do Norte State, Brazil
| | - Aurélio de Oliveira Bento
- Laboratory of Medical and Molecular Mycology, Department of Clinical and Toxicological Analysis, Federal University of Rio Grande do Norte, Natal city, Rio Grande do Norte State, Brazil
| | - Luanda Bárbara Ferreira Canário de Souza
- Laboratory of Medical and Molecular Mycology, Department of Clinical and Toxicological Analysis, Federal University of Rio Grande do Norte, Natal city, Rio Grande do Norte State, Brazil
| | - Francisco de Assis Bezerra Neto
- Laboratory of Medical and Molecular Mycology, Department of Clinical and Toxicological Analysis, Federal University of Rio Grande do Norte, Natal city, Rio Grande do Norte State, Brazil
| | - Jarmilla Bow-Ltaif Garcia
- Laboratory of Medical and Molecular Mycology, Department of Clinical and Toxicological Analysis, Federal University of Rio Grande do Norte, Natal city, Rio Grande do Norte State, Brazil
| | - Diana Luzia Zuza-Alves
- Laboratory of Medical and Molecular Mycology, Department of Clinical and Toxicological Analysis, Federal University of Rio Grande do Norte, Natal city, Rio Grande do Norte State, Brazil
| | - Elaine Cristina Francisco
- Special Mycology Laboratory, Department of Medicine, Federal University of Sao Paulo, São Paulo City, São Paulo State, Brazil
| | - Analy Salles de Azevedo Melo
- Special Mycology Laboratory, Department of Medicine, Federal University of Sao Paulo, São Paulo City, São Paulo State, Brazil
| | - Guilherme Maranhão Chaves
- Laboratory of Medical and Molecular Mycology, Department of Clinical and Toxicological Analysis, Federal University of Rio Grande do Norte, Natal city, Rio Grande do Norte State, Brazil
- * E-mail:
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10
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Hesstvedt L, Gaustad P, Müller F, Torp Andersen C, Brunborg C, Mylvaganam H, Leiva RA, Berdal JE, Egil Ranheim T, Johnsen BO, Falch BM, Grimnes G, Skogen V, Haarr E, Sandmo Lyngøy A, Wik Larssen K, Hannula R, Åsheim Hansen B, Nordøy I. The impact of age on risk assessment, therapeutic practice and outcome in candidemia. Infect Dis (Lond) 2019; 51:425-434. [PMID: 31010380 DOI: 10.1080/23744235.2019.1595709] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND In Norway, the epidemiological situation of candidemia is followed closely. We have previously demonstrated the highest incidence of candidemia in elderly >65 years of age. However, knowledge of other aspects of this infection is lacking. OBJECTIVE The aim of this nationwide, retrospective study was to examine risk factors, therapeutic practice and outcome in adult candidemia patients according to age. METHODS We retrieved data from medical records from patients who developed candidemia in Norway between 1 January 2008 and 31 December 2012. Data were analyzed according to age, younger patients being between 18 and 65 years, elderly being ≥65 years of age. RESULTS From 771 eligible patients, 738 patients (95.7%) were included (58% men, mean age 65.2 years, 58.1% being ≥65 years). Exposure to health-care related risk factors for candidemia were significantly more common in the younger patients (neutropenia, central venous catheter, mechanical ventilation and chemotherapy) who received empirical treatment more often than the elderly (29.8% vs. 21.7%, p = .01). More elderly did not received any antifungal therapy (27.3% vs 16.8%, p < 0001) and had higher mortality compared to younger patients (45.5% vs 23.9%, p < .0001). In the study population, mortality was higher with age (per 10-years increase, OR 1.43;1.28-1.59, p < 0.0001), in patients not receiving targeted therapy (OR 2.5; CI 1.82-3.36, p < .0001) or any therapy at all (OR 4.64; 3.23-6.68, p < .0001). CONCLUSIONS Risk factors for candidemia, treatment and outcome differed significantly according to age. Given the increasing numbers of elderly, scrutiny on our clinical practice is warranted.
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Affiliation(s)
- Liv Hesstvedt
- a Research Institute for Internal Medicine, Oslo University Hospital, Rikshospitalet , Oslo , Norway.,b Department of Microbiology , Oslo University Hospital, Rikshospitalet , Oslo , Norway
| | - Peter Gaustad
- b Department of Microbiology , Oslo University Hospital, Rikshospitalet , Oslo , Norway.,c Norwegian Mycological Reference Laboratory, Oslo University Hospital , Oslo , Norway.,d Institute of Clinical Medicine, Faculty of Medicine, University of Oslo , Oslo , Norway
| | - Fredrik Müller
- c Norwegian Mycological Reference Laboratory, Oslo University Hospital , Oslo , Norway.,d Institute of Clinical Medicine, Faculty of Medicine, University of Oslo , Oslo , Norway
| | - Cecilie Torp Andersen
- b Department of Microbiology , Oslo University Hospital, Rikshospitalet , Oslo , Norway.,c Norwegian Mycological Reference Laboratory, Oslo University Hospital , Oslo , Norway
| | - Cathrine Brunborg
- e Oslo Centre for Biostatistics & Epidemiology, Oslo University Hospital , Oslo , Norway
| | - Haima Mylvaganam
- f Department of Microbiology , Haukeland University Hospital , Bergen , Norway
| | | | - Jan Erik Berdal
- h Department of Infectious Diseases , Akershus University Hospital , Lørenskog , Norway
| | - Trond Egil Ranheim
- i Department of Microbiology and Infection Control , Akershus University Hospital , Lørenskog , Norway
| | - Bjørn Odd Johnsen
- i Department of Microbiology and Infection Control , Akershus University Hospital , Lørenskog , Norway
| | - Birgit M Falch
- j Department of Microbiology , University Hospital of Northern Norway , Tromsø , Norway
| | - Gro Grimnes
- k Department of Infectious Diseases , University Hospital of Northern Norway , Tromsø , Norway
| | - Vegard Skogen
- k Department of Infectious Diseases , University Hospital of Northern Norway , Tromsø , Norway
| | - Elisebet Haarr
- l Department of Medical Microbiology , University Hospital of Stavanger , Stavanger , Norway
| | - Anita Sandmo Lyngøy
- m Department of Infectious Diseases , University Hospital of Stavanger , Stavanger , Norway
| | - Kjersti Wik Larssen
- n Department of Microbiology , Trondheim University Hospital , Trondheim , Norway
| | - Raisa Hannula
- o Department of Infectious Diseases , Trondheim University Hospital , Trondheim , Norway
| | - Bjørn Åsheim Hansen
- p Department of Infectious Diseases , Vestfold Hospital Trust , Tønsberg , Norway
| | - Ingvild Nordøy
- a Research Institute for Internal Medicine, Oslo University Hospital, Rikshospitalet , Oslo , Norway.,q Section of Clinical immunology and Infectious Diseases , Oslo University Hospital, Rikshospitalet , Oslo , Norway
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11
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Shao TY, Ang WXG, Jiang TT, Huang FS, Andersen H, Kinder JM, Pham G, Burg AR, Ruff B, Gonzalez T, Khurana Hershey GK, Haslam DB, Way SS. Commensal Candida albicans Positively Calibrates Systemic Th17 Immunological Responses. Cell Host Microbe 2019; 25:404-417.e6. [PMID: 30870622 PMCID: PMC6419754 DOI: 10.1016/j.chom.2019.02.004] [Citation(s) in RCA: 131] [Impact Index Per Article: 26.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2018] [Revised: 01/07/2019] [Accepted: 02/15/2019] [Indexed: 12/22/2022]
Abstract
Mucosal barriers are densely colonized by pathobiont microbes such as Candida albicans, capable of invasive disseminated infection. However, systemic infections occur infrequently in healthy individuals, suggesting that pathobiont commensalism may elicit host benefits. We show that intestinal colonization with C. albicans drives systemic expansion of fungal-specific Th17 CD4+ T cells and IL-17 responsiveness by circulating neutrophils, which synergistically protect against C. albicans invasive infection. Protection conferred by commensal C. albicans requires persistent fungal colonization and extends to other extracellular invasive pathogens such as Staphylococcus aureus. However, commensal C. albicans does not protect against intracellular influenza virus infection and exacerbates allergic airway inflammation susceptibility, indicating that positively calibrating systemic Th17 responses is not uniformly beneficial. Thus, systemic Th17 inflammation driven by CD4+ T cells responsive to tonic stimulation by commensal C. albicans improves host defense against extracellular pathogens, but with potentially harmful immunological consequences.
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Affiliation(s)
- Tzu-Yu Shao
- Division of Infectious Diseases, Center for Inflammation and Tolerance, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, OH 45229, USA; Division of Immunobiology, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, OH 45229, USA
| | - W X Gladys Ang
- Division of Infectious Diseases, Center for Inflammation and Tolerance, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, OH 45229, USA
| | - Tony T Jiang
- Division of Infectious Diseases, Center for Inflammation and Tolerance, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, OH 45229, USA; Division of Immunobiology, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, OH 45229, USA
| | - Felicia Scaggs Huang
- Division of Infectious Diseases, Center for Inflammation and Tolerance, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, OH 45229, USA
| | - Heidi Andersen
- Division of Infectious Diseases, Center for Inflammation and Tolerance, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, OH 45229, USA
| | - Jeremy M Kinder
- Division of Infectious Diseases, Center for Inflammation and Tolerance, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, OH 45229, USA
| | - Giang Pham
- Division of Infectious Diseases, Center for Inflammation and Tolerance, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, OH 45229, USA
| | - Ashley R Burg
- Division of Infectious Diseases, Center for Inflammation and Tolerance, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, OH 45229, USA
| | - Brandy Ruff
- Division of Asthma Research, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, OH 45229, USA
| | - Tammy Gonzalez
- Division of Immunobiology, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, OH 45229, USA
| | - Gurjit K Khurana Hershey
- Division of Asthma Research, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, OH 45229, USA
| | - David B Haslam
- Division of Infectious Diseases, Center for Inflammation and Tolerance, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, OH 45229, USA
| | - Sing Sing Way
- Division of Infectious Diseases, Center for Inflammation and Tolerance, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, OH 45229, USA.
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12
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Ahmadi NA, Davodi L. Candidemia after cardiac surgery in Tehran, Iran: A retrospective analysis of 424 cases at two medical centers. ALEXANDRIA JOURNAL OF MEDICINE 2018. [DOI: 10.1016/j.ajme.2017.11.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Affiliation(s)
- Nayeb Ali Ahmadi
- Proteomics Research Center, Faculty of Paramedical Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Leila Davodi
- Medical Diagnostic Laboratory, Lavasani hospital, Tehran, Iran
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13
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Nordøy I, Hesstvedt L, Torp Andersen C, Mylvaganam H, Kols NI, Falch BM, Tofteland S, Müller F, Denning DW. An Estimate of the Burden of Fungal Disease in Norway. J Fungi (Basel) 2018; 4:E29. [PMID: 29466284 PMCID: PMC5872332 DOI: 10.3390/jof4010029] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2018] [Revised: 02/18/2018] [Accepted: 02/19/2018] [Indexed: 12/12/2022] Open
Abstract
The aim of this study was to examine the burden of fungal disease in Norway, contributing to a worldwide effort to improve awareness of the needs for better diagnosis and treatment of such infections. We used national registers and actual data from the Departments of Microbiology from 2015 and estimated the incidence and/or prevalence of superficial, allergic and invasive fungal disease using published reports on specific populations at risk. One in 6 Norwegians suffered from fungal disease: Superficial skin infections (14.3%: 745,600) and recurrent vulvovaginal candidiasis in fertile women (6%: 43,123) were estimated to be the most frequent infections. Allergic fungal lung disease was estimated in 17,755 patients (341/100,000). Pneumocystis jirovecii was diagnosed in 262 patients (5/100,000), invasive candidiasis in 400 patients (7.7/100,000), invasive aspergillosis in 278 patients (5.3/100,000) and mucormycosis in 7 patients (0.1/100,000). Particular fungal infections from certain geographic areas were not observed. Overall, 1.79% of the population was estimated to be affected by serious fungal infections in Norway in 2015. Even though estimates for invasive infections are small, the gravity of such infections combined with expected demographic changes in the future emphasizes the need for better epidemiological data.
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Affiliation(s)
- Ingvild Nordøy
- Section for Clinical Immunology and Infectious Diseases, Oslo University Hospital, Rikshospitalet, 0372 Oslo, Norway.
- Research Institute for Internal Medicine, Oslo University Hospital, Rikshospitalet, 0372 Oslo, Norway.
| | - Liv Hesstvedt
- Research Institute for Internal Medicine, Oslo University Hospital, Rikshospitalet, 0372 Oslo, Norway.
- Department of Microbiology, Oslo University Hospital, 0372 Oslo, Norway.
| | | | - Haima Mylvaganam
- Department of Microbiology, Haukeland University Hospital, Bergen, 5021 Bergen, Norway.
| | | | - Birgit Margrethe Falch
- Department of Microbiology, University Hospital of Northern Norway, 9019 Tromsø, Norway.
| | - Ståle Tofteland
- Department of Microbiology, Sørlandet Hospital, 4615 Kristiansand, Norway.
| | - Fredrik Müller
- Department of Microbiology, Oslo University Hospital, 0372 Oslo, Norway.
- Department of Microbiology, Oslo University, 0371 Oslo, Norway.
| | - David William Denning
- National Aspergillosis Centre, Wythenshawe Hospital and The University of Manchester, Manchester M13 9PL, UK.
- Leading International Fungal Education (LIFE), Cheshire SK10 9AR, UK.
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14
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Guo LN, Xiao M, Cao B, Qu F, Zhan YL, Hu YJ, Wang XR, Liang GW, Gu HT, Qi J, Yuan H, Min R, Wang FY, Liu LJ, Wang HB, Jiang W, Duan XG, Xu WJ, Yu YH, Su JR, Zhang JZ, Nong JQ, Liu SM, Li J, Liu JT, Yue ZG, Yang D, Guo J, Zhao R, Zhang YN, Yang XM, Liu XQ, Hsueh PR, Xu YC. Epidemiology and antifungal susceptibilities of yeast isolates causing invasive infections across urban Beijing, China. Future Microbiol 2017; 12:1075-1086. [PMID: 28836465 DOI: 10.2217/fmb-2017-0036] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
AIM To investigate the species distribution and antifungal susceptibility profiles of yeast isolates causing invasive infections across Beijing. MATERIALS & METHODS A total of 1201 yeast isolates recovered from blood and other sterile body fluids were correctly identified by matrix-assisted laser desorption/ionization TOF MS supplemented by DNA sequencing. Antifungal susceptibility testing was performed according to the Clinical and Laboratory Standards Institute broth microdilution method. RESULTS Candida (95.5%) remained the most common yeast species isolated; Candida albicans (38.8%) and Candida parapsilosis (22.6%) were the leading species of candidemia. Azole resistances were mainly observed in Candida glabrata and Candida tropicalis isolates. CONCLUSION This study outlined the epidemiologic data of invasive yeast infections and highlighted the need for continuous monitoring of azole resistances among C. glabrata and C. tropicalis isolates in Beijing.
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Affiliation(s)
- Li-Na Guo
- Department of Clinical Laboratory, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing 100730, China
| | - Meng Xiao
- Department of Clinical Laboratory, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing 100730, China
| | - Bin Cao
- Department of Clinical Laboratory, Beijing Chaoyang Hospital, Capital Medical University, Beijing 100000, China
| | - Fen Qu
- Department of Clinical Laboratory, 302 Military Hospital of China, Peking University, Beijing 100039, China
| | - Yu-Liang Zhan
- Department of Clinical Laboratory, China-Japan Friendship Hospital, Peking University Health Science Center, Beijing University of Chinese Medicine, Beijing 100029, China
| | - Yun-Jian Hu
- Department of Clinical Laboratory, Beijing Hospital, Peking University, Beijing 100730, China
| | - Xin-Ru Wang
- Department of Clinical Laboratory, The General Hospital of PLA Rocket Force, Beijing 100088, China
| | - Guo-Wei Liang
- Department of Clinical Laboratory, Aerospace Center Hospital, Peking University, Beijing 100049, China
| | - Hai-Tong Gu
- Department of Clinical Laboratory, Beijing Tongren Hospital, Capital Medical University, Beijing 100730, China
| | - Jun Qi
- Department of Clinical Laboratory, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100021, China
| | - Hui Yuan
- Department of Clinical Laboratory, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart Lung & Blood Vessel Diseases, Beijing 100029, China
| | - Rong Min
- Department of Clinical Laboratory, Xuanwu Hospital, Capital Medical University, Beijing 100053, China
| | - Fei-Yan Wang
- Department of Clinical Laboratory, Fuwai Hospital, Chinese Academy of Medical Sciences, Beijing 100037, China
| | - Lin-Juan Liu
- Department of Clinical Laboratory, Peking University Cancer Hospital & Institute, Peking University, Beijing 100142, China
| | - Hai-Bin Wang
- Department of Clinical Laboratory, First Affiliated Hospital of Chinese PLA General Hospital, The Second Military Medical University, Beijing 100048, China
| | - Wei Jiang
- Department of Infection Control, First Affiliated Hospital of Chinese PLA General Hospital, The Second Military Medical University, Beijing 100048, China
| | - Xue-Guang Duan
- Department of Clinical Laboratory, Dongfang Hospital, Beijing University of Chinese Medicine, Beijing 100078, China
| | - Wen-Jian Xu
- Department of Clinical Laboratory, Children's Hospital, Capital institute of Pediatrics, Beijing 100020, China
| | - Yan-Hua Yu
- Department of Clinical Laboratory, Beijing YouAn Hospital, Capital Medical University, Beijing 100069, China
| | - Jian-Rong Su
- Department of Clinical Laboratory, Beijing Friendship Hospital, Capital Medical University, Beijing 100050, China
| | - Jian-Zhong Zhang
- State Key Laboratory of Infectious Disease Prevention & Control, Collaborative Innovation Centre for Diagnosis & Treatment of Infectious Diseases, National Institute for Communicable Disease Control & Prevention, Chinese Center for Disease Control & Prevention, Beijing 102206, China
| | - Jin-Qing Nong
- Department of Clinical Laboratory, Shougang Hospital, Peking University, Beijing 100144, China
| | - Shu-Mei Liu
- Department of Clinical Laboratory, FuXing Hospital, Capital Medical University, Beijing 100038, China
| | - Jun Li
- Department of Clinical Laboratory, Second Hospital of Armed Police Beijing Office, Jiangxi University of Traditional Chinese Medicine, Beijing 100037, China
| | - Jun-Ting Liu
- Department of Clinical Laboratory, FengTai Hospital, Capital Medical University, Beijing 100070, China
| | - Zhi-Gang Yue
- Department of Clinical Laboratory, China MeiTan General Hospital, North China Coal Medical University, Beijing 100028, China
| | - Duo Yang
- Department of Clinical Laboratory, Beijing ShiJiTan Hospital, Capital Medical University, Beijing 100038, China
| | - Jie Guo
- Department of Clinical Laboratory, Wangjing Hospital, China Academy of Chinese Medical Sciences, Beijing 100102, China
| | - Rui Zhao
- Department of Clinical Laboratory, State Grid Corporation of China Beijing Electric Power Hospital, Capital Medical University, Beijing 100073, China
| | - Ya-Nan Zhang
- Department of Clinical Laboratory, Beijing TianTan Hospital, Capital Medical University, Beijing 100050, China
| | - Xi-Ming Yang
- Department of Clinical Laboratory, DongZhiMen Hospital, Beijing University of Chinese Medicine, Beijing 100700, China
| | - Xiao-Qing Liu
- Department of Infectious Disease, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing 100730, China
| | - Po-Ren Hsueh
- Departments of Laboratory Medicine & Internal Medicine, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei 100, Taiwan
| | - Ying-Chun Xu
- Department of Clinical Laboratory, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing 100730, China
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15
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Vaquero-Herrero MP, Ragozzino S, Castaño-Romero F, Siller-Ruiz M, Sánchez González R, García-Sánchez JE, García-García I, Marcos M, Ternavasio-de la Vega HG. The Pitt Bacteremia Score, Charlson Comorbidity Index and Chronic Disease Score are useful tools for the prediction of mortality in patients with Candida
bloodstream infection. Mycoses 2017; 60:676-685. [DOI: 10.1111/myc.12644] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2017] [Revised: 05/02/2017] [Accepted: 05/22/2017] [Indexed: 11/29/2022]
Affiliation(s)
| | - Silvio Ragozzino
- Department of Internal Medicine; University Hospital of Salamanca; Salamanca Spain
- Institute of Biomedical Research of Salamanca (IBSAL); Salamanca Spain
| | | | - María Siller-Ruiz
- Department of Microbiology; University Hospital of Salamanca; Salamanca Spain
| | | | - José Elías García-Sánchez
- Department of Microbiology; University Hospital of Salamanca; Salamanca Spain
- Institute of Biomedical Research of Salamanca (IBSAL); Salamanca Spain
- University of Salamanca (USAL); Salamanca Spain
| | - Inmaculada García-García
- Department of Microbiology; University Hospital of Salamanca; Salamanca Spain
- Institute of Biomedical Research of Salamanca (IBSAL); Salamanca Spain
| | - Miguel Marcos
- Department of Internal Medicine; University Hospital of Salamanca; Salamanca Spain
- Institute of Biomedical Research of Salamanca (IBSAL); Salamanca Spain
- University of Salamanca (USAL); Salamanca Spain
| | - Hugo Guillermo Ternavasio-de la Vega
- Department of Internal Medicine; University Hospital of Salamanca; Salamanca Spain
- Institute of Biomedical Research of Salamanca (IBSAL); Salamanca Spain
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16
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Quesada C, Aceituno J, Suárez R, Mazariegos C. Fungemia Related to Parenteral Nutrition. CURRENT TROPICAL MEDICINE REPORTS 2017. [DOI: 10.1007/s40475-017-0120-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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17
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Vaezi A, Fakhim H, Khodavaisy S, Alizadeh A, Nazeri M, Soleimani A, Boekhout T, Badali H. Epidemiological and mycological characteristics of candidemia in Iran: A systematic review and meta-analysis. J Mycol Med 2017; 27:146-152. [PMID: 28318900 DOI: 10.1016/j.mycmed.2017.02.007] [Citation(s) in RCA: 55] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2017] [Revised: 01/30/2017] [Accepted: 02/17/2017] [Indexed: 10/20/2022]
Abstract
To date, there has been no comprehensive review of the epidemiology, risk factors, species distribution, and outcomes of candidemia in Iran. This study aimed to perform a systematic review and meta-analysis of all reported candidemia cases in Iran until December 2015. The review process occurred in three steps, namely a literature search, data extraction and statistical analyses. After a comprehensive literature search, we identified 55 cases. The mean age of patients was 46.80±24.30 years (range 1-81 years). The main risk factors for candidemia were surgery and burns (23.6%), followed by malignancies (20%), use of broad-spectrum antibiotics (18.2%), and diabetes (7.3%). Candida parapsilosis (n=17, 30.8%) was the leading agent, followed by Candida albicans (n=15, 27.3%), Candida glabrata (n=10, 18.2%), and Candida tropicalis (n=8, 14.5%). The frequencies of candidemia cases due to C. glabrata, C. parapsilosis, and C. albicans were significantly higher among patients aged>60, 21-40, and 41-60 years, respectively. Comparison of risk factors for candidemia by multiple logistic regression showed that one of the most important risk factors was surgery (OR: 4.245; 95% CI: 1.141-15.789; P=0.031). The outcome was recorded in only 19 cases and 13 of those patients (68.4%) expired. This study confirms that knowledge of the local epidemiology is important when conducting surveillance studies to prevent and control candidemia and will be of interest for antifungal stewardship.
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Affiliation(s)
- A Vaezi
- Student Research Committee, Mazandaran University of Medical Sciences, Sari, Iran; Department of Medical Mycology and Parasitology, School of Medicine, Mazandaran University of Medical Sciences, Sari, Iran
| | - H Fakhim
- Department of Medical Mycology and Parasitology, School of Medicine, Mazandaran University of Medical Sciences, Sari, Iran
| | - S Khodavaisy
- Department of Medical Mycology and Parasitology, Tehran University of Medical Sciences, Tehran, Iran
| | - A Alizadeh
- Department of Epidemiology and Reproductive Health, Reproductive Epidemiology Research Center, Royan Institute for Reproductive Biomedicine, ACECR, Tehran, Iran
| | - M Nazeri
- Department of Medical Parasitology and Mycology, Faculty of Medicine, Kashan University of Medical Sciences, Kashan, Iran
| | - A Soleimani
- Department of Anesthesiology, Faculty of Medicine, Mazandaran University of Medical Sciences, Sari, Iran
| | - T Boekhout
- Westerdijk Fungal Biodiversity Institute, Utrecht, The Netherlands; Institute of Biodiversity and Ecosystem Dynamics (IBED), University of Amsterdam, Amsterdam, The Netherlands
| | - H Badali
- Department of Medical Mycology and Parasitology, School of Medicine, Mazandaran University of Medical Sciences, Sari, Iran; Invasive Fungi Research Center (IFRC), School of Medicine, Mazandaran University of Medical Sciences, Sari, Iran.
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18
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Enoch DA, Yang H, Aliyu SH, Micallef C. The Changing Epidemiology of Invasive Fungal Infections. Methods Mol Biol 2017; 1508:17-65. [PMID: 27837497 DOI: 10.1007/978-1-4939-6515-1_2] [Citation(s) in RCA: 238] [Impact Index Per Article: 34.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Invasive fungal infections (IFI) are an emerging problem worldwide with invasive candidiasis and candidemia responsible for the majority of cases. This is predominantly driven by the widespread adoption of aggressive immunosuppressive therapy among certain patient populations (e.g., chemotherapy, transplants) and the increasing use of invasive devices such as central venous catheters (CVCs). The use of new immune modifying drugs has also opened up an entirely new spectrum of patients at risk of IFIs. While the epidemiology of candida infections has changed in the last decade, with a gradual shift from C. albicans to non-albicans candida (NAC) strains which may be less susceptible to azoles, these changes vary between hospitals and regions depending on the type of population risk factors and antifungal use. In certain parts of the world, the incidence of IFI is strongly linked to the prevalence of other disease conditions and the ecological niche for the organism; for instance cryptococcal and pneumocystis infections are particularly common in areas with a high prevalence of HIV disease. Poorly controlled diabetes is a major risk factor for invasive mould infections. Environmental factors and trauma also play a unique role in the epidemiology of mould infections, with well-described hospital outbreaks linked to the use of contaminated instruments and devices. Blastomycosis is associated with occupational exposure (e.g., forest rangers) and recreational activities (e.g., camping and fishing).The true burden of IFI is probably an underestimate because of the absence of reliable diagnostics and lack of universal application. For example, the sensitivity of most blood culture systems for detecting candida is typically 50 %. The advent of new technology including molecular techniques such as 18S ribosomal RNA PCR and genome sequencing is leading to an improved understanding of the epidemiology of the less common mould and dimorphic fungal infections. Molecular techniques are also providing a platform for improved diagnosis and management of IFI.Many factors affect mortality in IFI, not least the underlying medical condition, choice of therapy, and the ability to achieve early source control. For instance, mortality due to pneumocystis pneumonia in HIV-seronegative individuals is now higher than in seropositive patients. Of significant concern is the progressive increase in resistance to azoles and echinocandins among candida isolates, which appears to worsen the already significant mortality associated with invasive candidiasis. Mortality with mould infections approaches 50 % in most studies and varies depending on the site, underlying disease and the use of antifungal agents such as echinocandins and voriconazole. Nevertheless, mortality for most IFIs has generally fallen with advances in medical technology, improved care of CVCs, improved diagnostics, and more effective preemptive therapy and prophylaxis.
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Affiliation(s)
- David A Enoch
- National Infection Service, Public Health England, Cambridge Microbiology and Public Health Laboratory, Addenbrooke's Hospital, Box 236, Cambridge Biomedical Campus, Hills Road, Cambridge, CB2 0QW, UK.
| | - Huina Yang
- National Infection Service, Public Health England, Cambridge Microbiology and Public Health Laboratory, Addenbrooke's Hospital, Box 236, Cambridge Biomedical Campus, Hills Road, Cambridge, CB2 0QW, UK
| | - Sani H Aliyu
- National Infection Service, Public Health England, Cambridge Microbiology and Public Health Laboratory, Addenbrooke's Hospital, Box 236, Cambridge Biomedical Campus, Hills Road, Cambridge, CB2 0QW, UK
| | - Christianne Micallef
- National Infection Service, Public Health England, Cambridge Microbiology and Public Health Laboratory, Addenbrooke's Hospital, Box 236, Cambridge Biomedical Campus, Hills Road, Cambridge, CB2 0QW, UK
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Scudeller L, Bassetti M, Concia E, Corrao S, Cristini F, De Rosa FG, Del Bono V, Durante-Mangoni E, Falcone M, Menichetti F, Tascini C, Tumbarello M, Venditti M, Viale P, Viscoli C, Mazzone A. MEDical wards Invasive Candidiasis ALgorithms (MEDICAL):Consensus proposal for management. Eur J Intern Med 2016; 34:45-53. [PMID: 27495949 DOI: 10.1016/j.ejim.2016.07.007] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2016] [Revised: 07/06/2016] [Accepted: 07/08/2016] [Indexed: 01/27/2023]
Abstract
INTRODUCTION A majority of invasive Candida infections occur in medical wards; however, evidence for management in this setting is scarce and based primarily on the intensive care or surgical setting. On behalf of the Italian Society for Anti-Infective Therapy (SITA) and the Italian Federation of Associations of Hospital Doctors on Internal Medicine (FADOI), the MEDICAL group produced practical management algorithms for patients in internal medicine wards. METHODS The MEDICAL group panel, composed of 30 members from internal medicine, infectious disease, clinical pharmacology, clinical microbiology and clinical epidemiology, provided expert opinion through the RAND/UCLA method. RESULTS Seven clinical scenarios were constructed based on clinical severity and probability of invasive candidiasis. For each scenario, the appropriateness of 63 different diagnostic, imaging, management, or therapeutic procedures was determined in two Delphi rounds. The necessity for performing each appropriate procedure, was then determined in a third Delphi round. Results were summarized in algorithms. DISCUSSION The proposed algorithms provide internal medicine physicians and managers with an easy to interpret tool that is exhaustive, clear and suitable for adaption to individual local settings. Attention was paid to individual patient management and resource allocation.
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Affiliation(s)
- Luigia Scudeller
- Clinical Epidemiology Unit, Scientific Direction, IRCCS, Policlinico San Matteo Foundation, Pavia, Italy.
| | - Matteo Bassetti
- Infectious Diseases Division, Santa Maria della Misericordia University Hospital, Udine, Italy
| | - Ercole Concia
- Section of Infectious Diseases, Department of Pathology and Diagnostics, Azienda Ospedaliera Universitaria Integrata, Policlinico G B Rossi, Verona, Italy
| | - Salvatore Corrao
- Department of Internal Medicine, National Relevance Hospital Trust, ARNAS Civico, Di Cristina e Benfratelli, Palermo, Di.Bi.M.I.S., University of Palermo, Italy
| | - Francesco Cristini
- Infectious Diseases Unit, Teaching Hospital Policlinico S. Orsola-Malpighi Alma Mater Studiorum, University of Bologna, Bologna, Italy
| | | | - Valerio Del Bono
- Clinic of Infectious Diseases, IRCCS San Martino-IST, University of Genova, Genova, Italy
| | - Emanuele Durante-Mangoni
- Internal Medicine Section, Department of Cardiothoracic Sciences, and Division of Infectious and Transplant Medicine, Second University of Naples at Monaldi Hospital, Napoli, Italy
| | - Marco Falcone
- Department of Public Health and Infectious Diseases, Policlinico Umberto I, "Sapienza" University of Rome, Rome, Italy
| | | | - Carlo Tascini
- Infectious Disease Department, Cisanello Hospital, Pisa, Italy
| | - Mario Tumbarello
- Infectious Diseases Institute, Policlinico Gemelli, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Mario Venditti
- Department of Public Health and Infectious Diseases, Policlinico Umberto I, "Sapienza" University of Rome, Rome, Italy
| | - Pierluigi Viale
- Infectious Diseases Unit, Teaching Hospital Policlinico S. Orsola-Malpighi Alma Mater Studiorum, University of Bologna, Bologna, Italy
| | - Claudio Viscoli
- Clinic of Infectious Diseases, IRCCS San Martino-IST, University of Genova, Genova, Italy
| | - Antonino Mazzone
- Internal Medicine Department, Hospital of Legnano, Legnano, Italy
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Maxfield AZ, Korkmaz H, Gregorio LL, Busaba NY, Gray ST, Holbrook EH, Guo R, Bleier BS. General antibiotic exposure is associated with increased risk of developing chronic rhinosinusitis. Laryngoscope 2016; 127:296-302. [DOI: 10.1002/lary.26232] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2016] [Revised: 07/04/2016] [Accepted: 07/18/2016] [Indexed: 12/29/2022]
Affiliation(s)
- Alice Z. Maxfield
- Department of Otolaryngology; Massachusetts Eye and Ear Infirmary, Harvard Medical School; Boston Massachusetts U.S.A
| | - Hakan Korkmaz
- Department of Otorhinolaryngology; Ordu University Faculty of Medicine; Ordu Turkey
| | - Luciano L. Gregorio
- Department of Otolaryngology; Massachusetts Eye and Ear Infirmary, Harvard Medical School; Boston Massachusetts U.S.A
| | - Nicolas Y. Busaba
- Department of Otolaryngology; Massachusetts Eye and Ear Infirmary, Harvard Medical School; Boston Massachusetts U.S.A
| | - Stacey T. Gray
- Department of Otolaryngology; Massachusetts Eye and Ear Infirmary, Harvard Medical School; Boston Massachusetts U.S.A
| | - Eric H. Holbrook
- Department of Otolaryngology; Massachusetts Eye and Ear Infirmary, Harvard Medical School; Boston Massachusetts U.S.A
| | - Rong Guo
- Department of Biostatistics; Massachusetts Eye and Ear Infirmary, Harvard Medical School; Boston Massachusetts U.S.A
| | - Benjamin S. Bleier
- Department of Otolaryngology; Massachusetts Eye and Ear Infirmary, Harvard Medical School; Boston Massachusetts U.S.A
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Watkins RR, Mukherjee PK, Chandra J, Retuerto MA, Guidry C, Haller N, Paranjape C, Ghannoum MA. Admission to the Intensive Care Unit is Associated With Changes in the Oral Mycobiome. J Intensive Care Med 2016; 32:278-282. [PMID: 26893317 DOI: 10.1177/0885066615627757] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
A prospective exploratory study was conducted to characterize the oral mycobiome at baseline and determine whether changes occur after admission to the intensive care unit (ICU). We found that ICU admission is associated with alterations in the oral mycobiome, including an overall increase in Candida albicans.
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Affiliation(s)
- Richard R Watkins
- 1 Department of Internal Medicine, Northeast Ohio Medical University, Rootstown, OH, USA.,2 Division of Infectious Diseases, Akron General Medical Center, Akron, OH, USA
| | - Pranab K Mukherjee
- 3 Department of Dermatology, Center for Medical Mycology, University Hospitals Case Medical Center, Case Western Reserve University, Cleveland, OH, USA
| | - Jyotsna Chandra
- 3 Department of Dermatology, Center for Medical Mycology, University Hospitals Case Medical Center, Case Western Reserve University, Cleveland, OH, USA
| | - Mauricio A Retuerto
- 4 OHARA/ACTG Mycology Unit, Department of Dermatology, Case Western Reserve University, Cleveland, OH, USA
| | - Chrissy Guidry
- 5 Department of Surgery, Akron General Medical Center, Akron, OH, USA
| | - Nairmeen Haller
- 6 Department of Research, Akron General Medical Center, Akron, OH, USA
| | | | - Mahmoud A Ghannoum
- 7 Department of Dermatology, Center for Medical Microbiology, Case Western Reserve University School of Medicine, University Hospitals Case Medical Center, Cleveland, OH, USA
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Teodoro GR, Ellepola K, Seneviratne CJ, Koga-Ito CY. Potential Use of Phenolic Acids as Anti-Candida Agents: A Review. Front Microbiol 2015; 6:1420. [PMID: 26733965 PMCID: PMC4685070 DOI: 10.3389/fmicb.2015.01420] [Citation(s) in RCA: 101] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2015] [Accepted: 11/30/2015] [Indexed: 12/13/2022] Open
Abstract
There has been a sharp rise in the occurrence of Candida infections and associated mortality over the last few years, due to the growing body of immunocompromised population. Limited number of currently available antifungal agents, undesirable side effects and toxicity, as well as emergence of resistant strains pose a considerable clinical challenge for the treatment of candidiasis. Therefore, molecules that derived from natural sources exhibiting considerable antifungal properties are a promising source for the development of novel anti-candidal therapy. Phenolic compounds isolated from natural sources possess antifungal properties of interest. Particularly, phenolic acids have shown promising in vitro and in vivo activity against Candida species. However, studies on their mechanism of action alone or in synergism with known antifungals are still scarce. This review attempts to discuss the potential use, proposed mechanisms of action and limitations of the phenolic acids in anti-candidal therapy.
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Affiliation(s)
- Guilherme R Teodoro
- Oral Biopathology Graduate Program, São José dos Campos Institute of Science and Technology, Universidade Estadual Paulista São José dos Campos, Brazil
| | - Kassapa Ellepola
- Oral Sciences, Faculty of Dentistry, National University of Singapore Singapore, Singapore
| | - Chaminda J Seneviratne
- Oral Sciences, Faculty of Dentistry, National University of Singapore Singapore, Singapore
| | - Cristiane Y Koga-Ito
- Oral Biopathology Graduate Program, São José dos Campos Institute of Science and Technology, Universidade Estadual PaulistaSão José dos Campos, Brazil; Department of Environmental Engineering and Biopathology Graduate Program, São José dos Campos Institute of Science and Technology, Universidade Estadual PaulistaSão José dos Campos, Brazil
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24
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Quick Detection of FKS1 Mutations Responsible for Clinical Echinocandin Resistance in Candida albicans. J Clin Microbiol 2015; 53:2037-41. [PMID: 25878347 DOI: 10.1128/jcm.00398-15] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2015] [Accepted: 04/09/2015] [Indexed: 01/02/2023] Open
Abstract
A rapid molecular-based assay for the detection of the Candida albicans FKS1 gene mutations responsible for resistance to echinocandin drugs was designed and evaluated. The assay consisted of a multiplexed PCR set of 5 tubes able to detect the most commonly described resistance mechanism, including FKS1 hot spot 1 and hot spot 2 mutations. The performance and specificity of the assay was evaluated using a double-blinded panel of 50 C. albicans strains. The assay showed a sensitivity of 96% and was able to detect all homozygous mutants included in the collection of strains, demonstrating that it is a robust, quick, and labor-saving method that is suitable for a routine clinical diagnostic laboratory.
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