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Park JY, Yang KM, Kwak JY, Jung YT. Risk Factors for Invasive Candidiasis in Critically Ill Patients Who Underwent Emergency Gastrointestinal Surgery for Complicated Intra-Abdominal Infection. Surg Infect (Larchmt) 2024. [PMID: 38634791 DOI: 10.1089/sur.2023.333] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/19/2024] Open
Abstract
Background: Candida species account for approximately 15% of hospital-associated infections, causing fatal consequences, especially in critically ill patients. This study aimed to evaluate invasive candidiasis (IC) risk factors in critically ill patients undergoing surgery. Patients and Methods: We retrospectively reviewed the medical records of 583 patients who underwent emergency surgery for complicated intra-abdominal infections between January 2016 and December 2021. Patients were divided into two groups according to the presence or absence of IC during their hospital stay. IC was defined as culture-proven candidemia and intra-abdominal candidiasis. Results: This study included 373 patients for the final analysis, of whom 320 were discharged without IC (IC absent group) and 53 presented with IC (IC present group) during their hospital stay. The IC present group showed a higher in-hospital mortality rate (35.8 vs. 8.8%; p < 0.001), with 66.0% of the patients diagnosed within 10 days, whereas only 6.5% were diagnosed beyond 20 days after admission. Stomach (odds ratio [OR], 4.188; 95% confidence interval [CI], 1.204-14.561; p = 0.024) and duodenum (OR, 7.595; 95% CI, 1.934-29.832; p = 0.004) as infection origin, higher Acute Physiology and Chronic Health Evaluation II (APACHE II) score (OR, 1.097; 95% CI, 1.044-1.152; p < 0.001), and lower initial systolic blood pressure (OR, 0.983; 95% CI, 0.968-0.997; p = 0.018) were risk factors of IC after emergency gastrointestinal surgery. Conclusions: Patients who had stomach and duodenum as infection origin, higher APACHE II scores, and lower initial systolic blood pressure had a higher risk of developing IC during their hospital stay after emergency gastrointestinal surgery. Prophylactic antifungal agents can be carefully considered for critically ill patients with these features.
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Affiliation(s)
- Jung Yun Park
- Department of Surgery, Gangneung Asan Hospital, Gangneung, South Korea
| | - Kwan Mo Yang
- Department of Surgery, Gangneung Asan Hospital, Gangneung, South Korea
- Department of Surgery, University of Ulsan College of Medicine, Ulsan, South Korea
| | - Jae Young Kwak
- Department of Surgery, Gangneung Asan Hospital, Gangneung, South Korea
- Department of Surgery, University of Ulsan College of Medicine, Ulsan, South Korea
| | - Yun Tae Jung
- Department of Surgery, Gangneung Asan Hospital, Gangneung, South Korea
- Department of Surgery, University of Ulsan College of Medicine, Ulsan, South Korea
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Locke JB, Pillar CM, Castanheira M, Carvalhaes CG, Andes D, Aram JA, Andrzejewski C, Bartizal K, Das AF, Sandison T, Thompson GR, Pappas PG. Outcomes by Candida spp. in the ReSTORE Phase 3 trial of rezafungin versus caspofungin for candidemia and/or invasive candidiasis. Antimicrob Agents Chemother 2024:e0158423. [PMID: 38526046 DOI: 10.1128/aac.01584-23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2023] [Accepted: 02/16/2024] [Indexed: 03/26/2024] Open
Abstract
Rezafungin is a long-acting, intravenously administered echinocandin for the treatment of candidemia and invasive candidiasis (IC). Non-inferiority of rezafungin vs caspofungin for the treatment of adults with candidemia and/or IC was demonstrated in the Phase 3 ReSTORE study based on the primary endpoints of day 14 global cure and 30-day all-cause mortality. Here, an analysis of ReSTORE data evaluating efficacy outcomes by baseline Candida species is described. Susceptibility testing was performed for Candida species using the Clinical and Laboratory Standards Institute reference broth microdilution method. There were 93 patients in the modified intent-to-treat population who received rezafungin; 94 received caspofungin. Baseline Candida species distribution was similar in the two treatment groups; C. albicans (occurring in 41.9% and 42.6% of patients in the rezafungin and caspofungin groups, respectively), C. glabrata (25.8% and 26.6%), and C. tropicalis (21.5% and 18.1%) were the most common pathogens. Rates of global cure and mycological eradication at day 14 and day 30 all-cause mortality by Candida species were comparable in the rezafungin and caspofungin treatment groups and did not appear to be impacted by minimal inhibitory concentration (MIC) values for either rezafungin or caspofungin. Two patients had baseline isolates with non-susceptible MIC values (both in the rezafungin group: one non-susceptible to rezafungin and one to caspofungin, classified as intermediate); both were candidemia-only patients in whom rezafungin treatment was successful based on the day 30 all-cause mortality endpoint. This analysis of ReSTORE demonstrated the efficacy of rezafungin for candidemia and IC in patients infected with a variety of Candida species.
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Affiliation(s)
| | - Chris M Pillar
- Science and Operations, Microbiologics, Kalamazoo, Michigan, USA
| | | | | | - David Andes
- Department of Medicine, University of Wisconsin-Madison, Madison, Wisconsin, USA
| | - Jalal A Aram
- Medical Affairs, Melinta Therapeutics, LLC, Parsippany, New Jersey, USA
| | | | - Ken Bartizal
- Cidara Therapeutics, Inc., San Diego, California, USA
| | - Anita F Das
- Cidara Therapeutics, Inc., San Diego, California, USA
| | | | - George R Thompson
- Division of Infectious Diseases, Department of Internal Medicine and Department of Medical Microbiology and Immunology, University of California Davis Medical Center, Sacramento, California, USA
| | - Peter G Pappas
- Division of Infectious Diseases, Department of Internal Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA
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Sharma D, Vazquez JA. An evaluation of Rezafungin: the latest treatment option for adults with candidemia and invasive candidiasis. Expert Opin Pharmacother 2024:1-9. [PMID: 38497379 DOI: 10.1080/14656566.2024.2331775] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2024] [Accepted: 03/13/2024] [Indexed: 03/19/2024]
Abstract
INTRODUCTION Invasive fungal infections, especially candidemia and invasive candidiasis, continue to cause substantial morbidity and mortality. In addition, the emergence of drug-resistant Candida species, notably C. glabrata and C. auris, along with limitations in available treatments, highlights the urgent need for novel, effective antifungal agents. AREAS COVERED This review discusses the results of in vitro studies evaluating the spectrum and highlights the pharmacokinetic/pharmacodynamic properties. It also includes discussions on two key clinical studies that assess safety, tolerability, and efficacy. EXPERT OPINION Rezafungin has demonstrated comparable efficacy to other echinocandins in two clinical studies and exhibits in vitro activity against a broad range of Candida species and Aspergillus spp. It has a favorable safety profile with minimal side effects, and no drug interactions or effects on QT intervals. In contrast to other echinocandins, it demonstrates dose-dependent killing, a prolonged half-life, and low clearance make it suitable for once-weekly dosing, which is supported by clinical trials confirming its efficacy. Rezafungin offers a promising option for the outpatient management of difficult to treat fungal infections. It has become a valuable addition to the antifungal arsenal, with the potential to reduce hospital length of stay and hospitalization costs and combat drug-resistant Candida species.
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Affiliation(s)
- Divisha Sharma
- Division of infectious Disease, Department of Medicine, WellStar MCG Health, Augusta University, Augusta, GA, USA
| | - Jose A Vazquez
- Division of infectious Disease, Department of Medicine, WellStar MCG Health, Augusta University, Augusta, GA, USA
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4
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Smith HL, Bensman TJ, Mishra S, Li X, Dixon CA, Sheikh J, McMaster OG, Joshi A, Rubin DB, Goodwin A, Miller TJ, Danielsen ZY, Syed I, Shukla SJ, Iarikov D, Kim PW, Farley JJ. Regulatory Considerations in the Approval of Rezafungin (REZZAYO) for the Treatment of Candidemia and Invasive Candidiasis in Adults. J Infect Dis 2024:jiae146. [PMID: 38502709 DOI: 10.1093/infdis/jiae146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2023] [Revised: 03/08/2024] [Accepted: 03/14/2024] [Indexed: 03/21/2024] Open
Abstract
On March 22, 2023, the FDA approved rezafungin (REZZAYO) for the treatment of candidemia and invasive candidiasis in adults with limited or no alternative treatment options. Rezafungin is an echinocandin that supports weekly dosing, enabling outpatient parenteral treatment that potentially avoids the need for a central venous catheter. Approval of rezafungin was based on a single adequate and well-controlled phase 3 study designed with a Day 30 all-cause mortality primary endpoint and 20% noninferiority margin, which demonstrated that rezafungin is noninferior to the comparator echinocandin. Nonclinical studies of rezafungin in non-human primates identified a neurotoxicity safety signal; however, rezafungin's safety profile in the completed clinical studies was similar to other FDA-approved echinocandins. Here we describe the rationale for this approval and important considerations during the review process for a flexible development program intended to expedite the availability of antimicrobial therapies to treat serious infections in patients with limited treatment options.
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Affiliation(s)
- Heidi L Smith
- Division of Anti-Infectives, Office of Infectious Diseases, Office of New Drugs, Center for Drug Evaluation and Research (CDER), Food and Drug Administration (FDA), Silver Spring, Maryland, USA
| | - Timothy J Bensman
- Division of Infectious Disease Pharmacology, Office of Clinical Pharmacology, CDER, FDA, Silver Spring, Maryland, USA
| | - Shrimant Mishra
- Division of Anti-Infectives, Office of Infectious Diseases, Office of New Drugs, Center for Drug Evaluation and Research (CDER), Food and Drug Administration (FDA), Silver Spring, Maryland, USA
| | - Xianbin Li
- Division of Biometrics IV, Office of Biostatistics, Office of Translational Sciences, CDER, FDA, Silver Spring, Maryland, USA
| | - Cheryl A Dixon
- Division of Biometrics IV, Office of Biostatistics, Office of Translational Sciences, CDER, FDA, Silver Spring, Maryland, USA
| | - Jalal Sheikh
- Division of Anti-Infectives, Office of Infectious Diseases, Office of New Drugs, Center for Drug Evaluation and Research (CDER), Food and Drug Administration (FDA), Silver Spring, Maryland, USA
| | - Owen G McMaster
- Division of Pharmacology/Toxicology for Infectious Diseases, Office of Infectious Diseases, Office of New Drugs, CDER, FDA, Silver Spring, Maryland, USA
| | - Abhay Joshi
- Division of Infectious Disease Pharmacology, Office of Clinical Pharmacology, CDER, FDA, Silver Spring, Maryland, USA
| | - Daniel B Rubin
- Division of Biometrics IV, Office of Biostatistics, Office of Translational Sciences, CDER, FDA, Silver Spring, Maryland, USA
| | - Avery Goodwin
- Division of Anti-Infectives, Office of Infectious Diseases, Office of New Drugs, Center for Drug Evaluation and Research (CDER), Food and Drug Administration (FDA), Silver Spring, Maryland, USA
| | - Terry J Miller
- Division of Pharmacology/Toxicology for Infectious Diseases, Office of Infectious Diseases, Office of New Drugs, CDER, FDA, Silver Spring, Maryland, USA
| | - Zhixia Y Danielsen
- Division of Infectious Disease Pharmacology, Office of Clinical Pharmacology, CDER, FDA, Silver Spring, Maryland, USA
| | - Irum Syed
- DRT Strategies, Inc., Arlington, Virginia, USA
| | - Sunita J Shukla
- Office of Infectious Diseases, Office of New Drugs, CDER, FDA, Silver Spring, Maryland, USA
| | - Dmitri Iarikov
- Division of Anti-Infectives, Office of Infectious Diseases, Office of New Drugs, Center for Drug Evaluation and Research (CDER), Food and Drug Administration (FDA), Silver Spring, Maryland, USA
| | - Peter W Kim
- Division of Anti-Infectives, Office of Infectious Diseases, Office of New Drugs, Center for Drug Evaluation and Research (CDER), Food and Drug Administration (FDA), Silver Spring, Maryland, USA
| | - John J Farley
- Office of Infectious Diseases, Office of New Drugs, CDER, FDA, Silver Spring, Maryland, USA
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Azim A, Ahmed A. Diagnosis and management of invasive fungal diseases in non-neutropenic ICU patients, with focus on candidiasis and aspergillosis: a comprehensive review. Front Cell Infect Microbiol 2024; 14:1256158. [PMID: 38505289 PMCID: PMC10948617 DOI: 10.3389/fcimb.2024.1256158] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Accepted: 02/20/2024] [Indexed: 03/21/2024] Open
Abstract
Invasive fungal diseases pose a significant threat to non-neutropenic ICU patients, with Candida and Aspergillus infections being the most common. However, diagnosing these infections in the ICU population remains challenging due to overlapping clinical features, poor sensitivity of blood cultures, and invasive sampling requirements. The classical host criteria for defining invasive fungal disease do not fully apply to ICU patients, leading to missed or delayed diagnoses. Recent advancements have improved our understanding of invasive fungal diseases, leading to revised definitions and diagnostic criteria. However, the diagnostic difficulties in ICU patients remain unresolved, highlighting the need for further research and evidence generation. Invasive candidiasis is the most prevalent form of invasive fungal disease in non-neutropenic ICU patients, presenting as candidemia and deep-seated candidiasis. Diagnosis relies on positive blood cultures or histopathology, while non-culture-based techniques such as beta-D-glucan assay and PCR-based tests show promise. Invasive aspergillosis predominantly manifests as invasive pulmonary aspergillosis in ICU patients, often associated with comorbidities and respiratory deterioration in viral pneumonia. Diagnosis remains challenging due to poor sensitivity of blood cultures and difficulties in performing lung biopsies. Various diagnostic criteria have been proposed, including mycological evidence, clinical/radiological factors and expanded list of host factors. Non-culture-based techniques such as galactomannan assay and PCR-based tests can aid in diagnosis. Antifungal management involves tailored therapy based on guidelines and individual patient factors. The complexity of diagnosing and managing invasive fungal diseases in ICU patients underscore the importance of ongoing research and the need for updated diagnostic criteria and treatment approaches. Invasive fungal disease, Invasive fungal infection, Invasive candidiasis, Invasive aspergillosis, Antifungal drugs.
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Affiliation(s)
- Afzal Azim
- Department of Critical Care Medicine, Sanjay Gandhi Post Graduate Institute of Medical Sciences (SGPGI), Lucknow, India
| | - Armin Ahmed
- Department of Critical Care Medicine, King George’s Medical University, Lucknow, India
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Bensaoud H, Buttafuoco F, Lali S, Chevalier C. Early detection of peripheral invasive candidiasis further to cytographic interferences in Sysmex XN-9000 hematology analyzer. Clin Chem Lab Med 2024; 62:e78-e80. [PMID: 37555724 DOI: 10.1515/cclm-2023-0655] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Accepted: 08/04/2023] [Indexed: 08/10/2023]
Affiliation(s)
- Hamza Bensaoud
- Hematology Unit, Department of Clinical Biology, CHU Charleroi, Lodelinsart, Belgium
| | | | - Salah Lali
- Microbiology and Molecular Biology Unit, Department of Clinical Biology, CHU Charleroi, Lodelinsart, Belgium
| | - Charles Chevalier
- Hematology Unit, Department of Clinical Biology, CHU Charleroi, Lodelinsart, Belgium
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7
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Aldejohann AM, Menner C, Thielemann N, Martin R, Walther G, Kurzai O. In vitro activity of ibrexafungerp against clinically relevant echinocandin-resistant Candida strains. Antimicrob Agents Chemother 2024; 68:e0132423. [PMID: 38206004 PMCID: PMC10848775 DOI: 10.1128/aac.01324-23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2023] [Accepted: 11/22/2023] [Indexed: 01/12/2024] Open
Abstract
Invasive candidiasis is a major hospital-acquired infection. Usually, echinocandins are considered first-line treatment. However, resistant phenotypes have emerged. Ibrexafungerp (IBX) is a new antifungal substance with potent anti-Candida activity. We challenged IBX with a library of 192 pheno-/genotypically echinocandin-resistant Candida isolates, focusing on the substance susceptibility, its activity on certain FKS hotspot (HS) mutated strains, and applying WTULs (wild-type upper limits). Therefore, a 9-year-old strain and patient data collection provided by the German National Reference Center for Invasive Fungal Infections were analyzed. Species identification was confirmed through ITS-sequencing. Molecular susceptibility testing was performed by sequencing HS of the FKS gene. Anidulafungin (AND) and IBX EUCAST-broth-microdilution was conducted. The four most common echinocandin-resistance mediating mutations were found in Candida glabrata [112/192 isolates; F659-(43×) and S663-(48×)] and Candida albicans [63/192 isolates; F641-(15×) and S645-(39×)]. Mutations at the HS-start sequence were associated with higher IBX MIC-values (F659 and F641 (MIC 50/90 mg/L: >4/>4 and 2/4 mg/L) in comparison to AND (F659 and F641 (MIC 50/90: 1/4 and 0.25/1 mg/L). MIC-values in HS-center mutations were almost equal [MIC50/90 in S663: 2/4 (AND and IBX); in S645: 0.5/1 (AND) and 0.25/1 (IBX) mg/L]. In total, 61 vs 78 of 192 echinocandin-resistant isolates may be classified as IBX wild type by applying WTULs, whereas the most prominent effect was seen in C. albicans [48% (30/63) vs 70% (44/63)]. IBX shows in vitro activity against echinocandin-resistant Candida and thus is an addition to the antifungal armory. However, our data suggest that this effect is more pronounced in C. albicans and strains harboring mutations, affecting the HS-center.
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Affiliation(s)
| | - Carolina Menner
- Institute for Hygiene and Microbiology, University of Würzburg, Würzburg, Germany
| | - Nadja Thielemann
- Institute for Hygiene and Microbiology, University of Würzburg, Würzburg, Germany
| | - Ronny Martin
- Institute for Hygiene and Microbiology, University of Würzburg, Würzburg, Germany
| | - Grit Walther
- National Reference Center for Invasive Fungal Infections, Leibniz Institute for Natural Product Research and Infection Biology, Hans Knoell Institute, Jena, Germany
| | - Oliver Kurzai
- Institute for Hygiene and Microbiology, University of Würzburg, Würzburg, Germany
- National Reference Center for Invasive Fungal Infections, Leibniz Institute for Natural Product Research and Infection Biology, Hans Knoell Institute, Jena, Germany
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Yan JY, Lin TH, Jong YT, Hsueh JW, Wu SH, Lo HJ, Chen YC, Pan CH. Microbiota signatures associated with invasive Candida albicans infection in the gastrointestinal tract of immunodeficient mice. Front Cell Infect Microbiol 2024; 13:1278600. [PMID: 38298919 PMCID: PMC10828038 DOI: 10.3389/fcimb.2023.1278600] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Accepted: 12/22/2023] [Indexed: 02/02/2024] Open
Abstract
Candida albicans is a commensal microorganism in the human gut but occasionally causes invasive C. albicans infection (ICA), especially in immunocompromised individuals. Early initiation of antifungal therapy is associated with reduced mortality of ICA, but rapid diagnosis remains a challenge. The ICA-associated changes in the gut microbiota can be used as diagnostic and therapeutic targets but have been poorly investigated. In this study, we utilized an immunodeficient Rag2γc (Rag2-/-il2γc-/-) mouse model to investigate the gut microbiota alterations caused by C. albicans throughout its cycle, from its introduction into the gastrointestinal tract to invasion, in the absence of antibiotics. We observed a significant increase in the abundance of Firmicutes, particularly Lachnospiraceae and Ruminococcaceae, as well as a significant decrease in the abundance of Candidatus Arthromitus in mice exposed to either the wild-type SC5314 strain or the filamentation-defective mutant (cph1/cph1 efg1/efg1) HLC54 strain of C. albicans. However, only the SC5314-infected mice developed ICA. A linear discriminate analysis of the temporal changes in the gut bacterial composition revealed Bacteroides vulgatus as a discriminative biomarker associated with SC5314-infected mice with ICA. Additionally, a positive correlation between the B. vulgatus abundance and fungal load was found, and the negative correlation between the Candidatus Arthromitus abundance and fungal load after exposure to C. albicans suggested that C. albicans might affect the differentiation of intestinal Th17 cells. Our findings reveal the influence of pathogenic C. albicans on the gut microbiota and identify the abundance of B. vulgatus as a microbiota signature associated with ICA in an immunodeficient mouse model.
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Affiliation(s)
- Jia-Ying Yan
- National Institute of Infectious Disease and Vaccinology, National Health Research Institutes, Miaoli, Taiwan
| | - Tsung-Han Lin
- National Institute of Infectious Disease and Vaccinology, National Health Research Institutes, Miaoli, Taiwan
| | - Yu-Tang Jong
- National Institute of Infectious Disease and Vaccinology, National Health Research Institutes, Miaoli, Taiwan
| | - Jun-Wei Hsueh
- National Institute of Infectious Disease and Vaccinology, National Health Research Institutes, Miaoli, Taiwan
| | - Sze-Hsien Wu
- National Institute of Infectious Disease and Vaccinology, National Health Research Institutes, Miaoli, Taiwan
| | - Hsiu-Jung Lo
- National Institute of Infectious Disease and Vaccinology, National Health Research Institutes, Miaoli, Taiwan
- School of Dentistry, China Medical University, Taichung, Taiwan
| | - Yee-Chun Chen
- National Institute of Infectious Disease and Vaccinology, National Health Research Institutes, Miaoli, Taiwan
- Department of Medicine, National Taiwan University, Taipei, Taiwan
| | - Chien-Hsiung Pan
- National Institute of Infectious Disease and Vaccinology, National Health Research Institutes, Miaoli, Taiwan
- Graduate Institute of Biomedical Sciences, China Medical University, Taichung, Taiwan
- Graduate Institute of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
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9
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Lodise TP, Garey KW, Aram JA, Nathanson BH. Healthcare Resource Utilization and Discharge Readiness in Adult Hospitalized Patients With Candidemia or Invasive Candidiasis Who Received an Echinocandin: An Analysis of United States Hospitals. Open Forum Infect Dis 2024; 11:ofad703. [PMID: 38213636 PMCID: PMC10783265 DOI: 10.1093/ofid/ofad703] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Accepted: 01/01/2024] [Indexed: 01/13/2024] Open
Abstract
Background Scant real-world outcomes data are available among hospitalized patients with candidemia (C) or invasive candidiasis without candidemia (IC) who were treated with an echinocandin and few have assessed if there is an opportunity to accelerate the transition of their care to the outpatient setting. This study described the outcomes associated with echinocandin therapy for C/IC and determined the proportion of patients on an echinocandin at hospital discharge (HD) who were potentially eligible for an earlier HD. Methods A retrospective, multicenter observational study was performed using the PINC AI Healthcare Database (January 2016-April 2019) of hospitalized adult patients with C/IC who received ≥3 days of an echinocandin. Outcomes included post-index culture hospital costs and discharge location. Patients were considered potentially dischargeable earlier than actual HD day if they met the following 3 criteria prior to their actual HD day: resided on a non-intensive care unit hospital ward until HD, received any oral medications, and had no diagnostic/therapeutic interventions. Results A total of 1865 patients met study criteria. Mean (standard deviation) post-index culture hospital costs for patients with C and IC were 50 196 (64 630) US dollars and 61 551 (73 080) US dollars, respectively. Of the 1008 patients on an echinocandin near HD and discharged alive, 432 (42.9%) were potentially dischargeable prior to their actual hospital day. Most patients (35.8%) were discharged to a long-term care facility. Conclusions The findings suggest that a high proportion of hospitalized C/IC patients receiving an echinocandin near the time of HD were potentially dischargeable earlier. Like all studies of this nature, the findings need to be prospectively validated.
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Affiliation(s)
- Thomas P Lodise
- Department of Pharmacy Practice, Albany College of Pharmacy and Health Sciences, Albany, New York, USA
| | - Kevin W Garey
- Department of Pharmacy Practice, University of Houston College of Pharmacy, Houston, Texas, USA
| | - Jalal A Aram
- Melinta Therapeutics, Parsippany, New Jersey, USA
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10
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Peçanha-Pietrobom PM, Truda VSS, Fernández-Ruiz M, Gutiérrez MG, Sukiennik TCT, Santos DWDCL, Valerio M, Gioia F, Rodríguez-Goncer I, Giacobbe DR, Vena A, Machado M, Bassetti M, Muñoz P, Aguado JM, Tedesco-Silva H, Colombo AL. Natural history and prognostic factors of candidemia in kidney transplant recipients: A retrospective, multinational study. Mycoses 2024; 67:e13669. [PMID: 37946667 DOI: 10.1111/myc.13669] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Revised: 10/24/2023] [Accepted: 10/25/2023] [Indexed: 11/12/2023]
Abstract
BACKGROUND The natural history of candidemia in kidney transplant recipients (KTR) remains poorly understood. This study aimed to evaluate mortality, prognostic factors and overall graft loss after candidemia in KTRs. METHODS This is a retrospective multicentre study enrolling all KTRs ≥15 years old with candidemia diagnosed at hospitals in Brazil, Spain and Italy from 2010 to 2020. Primary endpoints were mortality rates at 14 and 30 days. Secondary endpoints were prognostic factors of 14-day mortality and overall graft loss. RESULTS We enrolled 93 KTRs of which 75 were from Brazil. The mean time interval from transplantation to the onset of candidemia was 45.2 ± 61.5 months. 42% of all patients were on haemodialysis, 31.3% had an episode of sepsis and 39% underwent surgery within 30 days before fungemia. European patients were more likely to receive echinocandin (32 vs. 72%, p < .001). 22.7% of Brazilian patients did not receive any antifungal before death. All-cause mortality at 14 days was higher in Brazil (41.3 vs. 11.1%, p = .016). Candida colonisation (OR 6.91 [95% CI: 1.08-44.3], p = .042) and hypotension (OR 4.87 [95% CI: 1.62-14.66], p = .005) were associated with 14-day mortality. Echinocandin treatment had a protective effect (OR 0.19 [95% CI: 0.05-0.73], p = .015). Graft loss at 90 days occurred in 48% of patients (70.7 in Brazil vs. 22.2% in Europe, p < .01). CONCLUSIONS Candidemia in KTR is usually documented late after engraftment in patients requiring HD, surgical procedures and dysbiosis secondary to antibiotic use. Mortality was higher in Brazil. Echinocandin therapy was associated with improved survival.
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Affiliation(s)
- Paula M Peçanha-Pietrobom
- Department of Medicine, Division of Infectious Diseases, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Vanessa S S Truda
- Department of Medicine, Division of Infectious Diseases, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Mario Fernández-Ruiz
- Unit of Infectious Diseases, Hospital Universitario '12 de Octubre', Instituto de Investigación Sanitaria Hospital '12 de Octubre' (imas12), Madrid, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III (ISCIII), Madrid, Spain
- Department of Medicine, Facultad de Medicina, Universidad Complutense, Madrid, Spain
| | - Manuel García Gutiérrez
- Unit of Infectious Diseases, Hospital Universitario Reina Sofía-IMIBIC-Universidad de Cordoba, Cordoba, Spain
| | | | - Daniel Wagner De C L Santos
- Department of Infectious Diseases and Infection Control, Universidade Federal do Maranhão, Ebserh-UFMA, São Luis, Brazil
- Instituto D'Or de Pesquisa e Ensino, IDOR, Hospital UDI, São Luis, Brazil
| | - Maricela Valerio
- Department of Medicine, Facultad de Medicina, Universidad Complutense, Madrid, Spain
- Hospital General Universitario Gregorio Marañón, Madrid, Spain
- Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain
- CIBER Enfermedades Respiratorias-CIBERES (CB06/06/0058), Madrid, Spain
| | - Francesca Gioia
- Department of Infectious Disease, University Hospital Ramon y Cajal, Madrid, Spain
- IRYCIS-Instituto Ramón y Cajal de Investigación Sanitaria, Madrid, Spain
- CIBER-Consorcio Centro de Investigación Biomédica en Red-(CB21/13/00084), Instituto de Salud Carlos III, Ministerio de Ciencia e Innovación, Madrid, Spain
| | - Isabel Rodríguez-Goncer
- Unit of Infectious Diseases, Hospital Universitario '12 de Octubre', Instituto de Investigación Sanitaria Hospital '12 de Octubre' (imas12), Madrid, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III (ISCIII), Madrid, Spain
| | - Daniele Roberto Giacobbe
- Infectious Diseases Unit, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
- Department of Health Sciences (DISSAL), University of Genoa, Genoa, Italy
| | - Antonio Vena
- Infectious Diseases Unit, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
- Department of Health Sciences (DISSAL), University of Genoa, Genoa, Italy
| | - Marina Machado
- Hospital General Universitario Gregorio Marañón, Madrid, Spain
- Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain
| | - Matteo Bassetti
- Infectious Diseases Unit, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
- Department of Health Sciences (DISSAL), University of Genoa, Genoa, Italy
| | - Patricia Muñoz
- Department of Medicine, Facultad de Medicina, Universidad Complutense, Madrid, Spain
- Hospital General Universitario Gregorio Marañón, Madrid, Spain
- Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain
- CIBER Enfermedades Respiratorias-CIBERES (CB06/06/0058), Madrid, Spain
| | - José María Aguado
- Unit of Infectious Diseases, Hospital Universitario '12 de Octubre', Instituto de Investigación Sanitaria Hospital '12 de Octubre' (imas12), Madrid, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III (ISCIII), Madrid, Spain
- Department of Medicine, Facultad de Medicina, Universidad Complutense, Madrid, Spain
| | - Helio Tedesco-Silva
- Hospital do Rim-Fundação Oswaldo Ramos, São Paulo, Brazil
- Department of Medicine, Division of Nephrology, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Arnaldo Lopes Colombo
- Department of Medicine, Division of Infectious Diseases, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, Brazil
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11
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Roepcke S, Passarell J, Walker H, Flanagan S. Population pharmacokinetic modeling and target attainment analyses of rezafungin for the treatment of candidemia and invasive candidiasis. Antimicrob Agents Chemother 2023; 67:e0091623. [PMID: 38014945 PMCID: PMC10720538 DOI: 10.1128/aac.00916-23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2023] [Accepted: 10/03/2023] [Indexed: 11/29/2023] Open
Abstract
Rezafungin is a chemically and metabolically stable echinocandin with a longer half-life than other echinocandins, allowing for a once-weekly intravenous infusion versus a daily infusion. Rezafungin is approved in the US for the treatment of candidemia and/or invasive candidiasis and is in development for the prevention of invasive fungal disease caused by Candida, Aspergillus, and Pneumocystis spp. in immunosuppressed patients. A population pharmacokinetic (PPK) model was developed using data from five Phase 1, one Phase 2, and one Phase 3 study. The model found to best describe the available data was a three-compartment PPK model with first-order elimination characterized by the parameters clearance (CL), central volume (V1), peripheral volume (V23), intercompartmental clearance 1, and intercompartmental clearance 2. The variability model included correlated interindividual variability in CL, V1, and V23 and a proportional residual variability model. The following statistically significant covariates were identified: albumin concentrations on V23; body surface area (BSA) on CL, V1, and V23; and disease state on CL and V1. Disease states were defined as patients from the Phase 2 and Phase 3 studies and hepatically impaired subjects. Covariates of BSA, disease state, or albumin, included in the final model, were not associated with clinically meaningful changes in PK, nor were any other patient factors, indicating that a common dose regimen is adequate for all adult patients. Target attainment simulations were performed to estimate the probability of achieving PK/pharmacodynamic targets across the range of minimum inhibitory concentration values for six species of Candida.
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Affiliation(s)
- Stefan Roepcke
- Cognigen Division of Simulations Plus, Inc., Buffalo, New York, USA
| | - Julie Passarell
- Cognigen Division of Simulations Plus, Inc., Buffalo, New York, USA
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12
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O’Donnell M, Shields RK, Marini RV, Groetzinger LM, Potoski BA, Falcione BA, Shah S, McCreary EK, Clarke L, Brant E, McVerry BJ, Liegey S, Pasculle AW, Clancy CJ, Nguyen MH. Stewardship-Guided T2Candida Testing Shortens Time to Antifungal Treatment and Reduces Antifungal Usage Among Medical Intensive Care Unit Patients With Septic Shock. Open Forum Infect Dis 2023; 10:ofad538. [PMID: 38023565 PMCID: PMC10651185 DOI: 10.1093/ofid/ofad538] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Indexed: 12/01/2023] Open
Abstract
Background Diagnosis of invasive candidiasis (IC) is limited by insensitivity and slow turnaround of cultures. Our objectives were to define the performance of T2Candida, a nonculture test, under guidance of a diagnostic stewardship program, and evaluate impact on time to antifungal initiation and antifungal utilization. Methods This was a retrospective study of adult medical intensive care unit (MICU) patients with septic shock for whom T2Candida testing was performed from March 2017 to March 2020. Patients with positive T2Candida results during this period were compared to MICU patients who did not undergo T2Candida testing but had septic shock and blood cultures positive for Candida from January 2016 through March 2020. Results Overall, 155 T2Candida tests from 143 patients were included. Nine percent of T2Candida tests were positive compared to 4.5% of blood cultures. Sensitivity, specificity, positive predictive value, and negative predictive value of T2Candida for proven and probable IC were 78%, 95%, 50%, and 99%, respectively. Patients who tested positive for T2Candida (n = 14) were diagnosed earlier and initiated on antifungal therapy sooner than patients with IC (n = 14) diagnosed by blood culture alone (median, 5.6 vs 60 hours; P < .0001). Median antifungal days of therapy/1000 patient-days were 23.3/month preimplementation and 15/month postimplementation (P = .007). Following a negative T2Candida result, empiric antifungals were either not administered in 58% or discontinued within 72 hours in 96% of patients. Conclusions Diagnostic stewardship guided T2Candida testing resulted in reduced time to IC diagnosis, faster initiation of antifungal therapy, and lower antifungal usage among MICU patients with septic shock.
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Affiliation(s)
- Matthew O’Donnell
- Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
- Division of Infectious Diseases, UPMC, Pittsburgh, Pennsylvania, USA
- Antibiotic Management Program, UPMC, Pittsburgh, Pennsylvania, USA
- Department of Critical Care Medicine, UPMC, Pittsburgh, Pennsylvania, USA
| | - Ryan K Shields
- Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
- Division of Infectious Diseases, UPMC, Pittsburgh, Pennsylvania, USA
- Antibiotic Management Program, UPMC, Pittsburgh, Pennsylvania, USA
- Department of Pharmacy, UPMC, Pittsburgh, Pennsylvania, USA
| | - Rachel V Marini
- Division of Infectious Diseases, UPMC, Pittsburgh, Pennsylvania, USA
- Antibiotic Management Program, UPMC, Pittsburgh, Pennsylvania, USA
- Department of Pharmacy, UPMC, Pittsburgh, Pennsylvania, USA
| | | | - Brian A Potoski
- Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
- Division of Infectious Diseases, UPMC, Pittsburgh, Pennsylvania, USA
- Antibiotic Management Program, UPMC, Pittsburgh, Pennsylvania, USA
- Department of Pharmacy, UPMC, Pittsburgh, Pennsylvania, USA
- Department of Pharmacy and Therapeutics, School of Pharmacy, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Bonnie A Falcione
- Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
- Division of Infectious Diseases, UPMC, Pittsburgh, Pennsylvania, USA
- Antibiotic Management Program, UPMC, Pittsburgh, Pennsylvania, USA
- Department of Pharmacy, UPMC, Pittsburgh, Pennsylvania, USA
- Department of Pharmacy and Therapeutics, School of Pharmacy, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Sunish Shah
- Division of Infectious Diseases, UPMC, Pittsburgh, Pennsylvania, USA
- Antibiotic Management Program, UPMC, Pittsburgh, Pennsylvania, USA
- Department of Pharmacy, UPMC, Pittsburgh, Pennsylvania, USA
| | - Erin K McCreary
- Division of Infectious Diseases, UPMC, Pittsburgh, Pennsylvania, USA
| | - Lloyd Clarke
- Antibiotic Management Program, UPMC, Pittsburgh, Pennsylvania, USA
| | - Emily Brant
- Department of Critical Care Medicine, UPMC, Pittsburgh, Pennsylvania, USA
| | - Bryan J McVerry
- Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
- Division of Pulmonary, Allergy, Critical Care, and Sleep Medicine, UPMC, Pittsburgh, Pennsylvania, USA
| | - Susan Liegey
- Division of Clinical Microbiology, UPMC, Pittsburgh, Pennsylvania, USA
| | - A William Pasculle
- Division of Clinical Microbiology, UPMC, Pittsburgh, Pennsylvania, USA
- Department of Pathology, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Cornelius J Clancy
- Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
- Veterans Affairs Pittsburgh Healthcare System, Department of Medicine, Division of Infectious Diseases, Pittsburgh, Pennsylvania, USA
| | - M Hong Nguyen
- Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
- Division of Infectious Diseases, UPMC, Pittsburgh, Pennsylvania, USA
- Antibiotic Management Program, UPMC, Pittsburgh, Pennsylvania, USA
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13
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Cabanilla MG, Briski MJ, Bruss Z, Saa L, Vasquez PC, Rodriguez CN, Mitchell JA, Bernauer ML, Argyropoulos CP, Crandall CS, Teixeira JP. The influence of continuous renal replacement therapy on 1,3-β-d-glucan levels in critically ill patients: a single-center retrospective propensity score study. Ren Fail 2023; 45:2255680. [PMID: 37781748 PMCID: PMC10547441 DOI: 10.1080/0886022x.2023.2255680] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Accepted: 08/31/2023] [Indexed: 10/03/2023] Open
Abstract
1,3-β-d-Glucan (BDG) is commonly used for diagnosing invasive fungal infections (IFIs). While exposure to cellulose-based hemodialyzers is known to cause false-positive BDG results, the impact of modern hemofilters used in continuous renal replacement therapy (CRRT) remains unclear. This retrospective, single-center cohort study aimed to evaluate the effect of CRRT on BDG levels in critically ill patients. We included adult intensive care unit (ICU) patients with ≥1 BDG measurement between December 2019 and December 2020. The primary outcome was the rate of false-positive BDG results in patients exposed to CRRT compared to unexposed patients. Propensity score analysis was performed to control for confounding factors. A total of 103 ICU patients with ≥1 BDG level were identified. Most (72.8%) were medical ICU patients. Forty patients underwent CRRT using hemofilter membranes composed of sodium methallyl sulfonate copolymer (AN 69 HF) (82.5%) and of polyarylethersulfone (PAES) (17.5%). Among the 91 patients without proven IFI, 31 (34.1%) had false-positive BDG results. Univariable analysis showed an association between CRRT exposure and false-positive BDG results. However, the association between CRRT exposure and false-positive BDG results was no longer significant across three propensity score models employed: 1:1 match (n = 32) (odds ratio (OR) 1.65, p = .48), model-adjusted (n = 91) (OR 1.75, p = .38), quintile-adjusted (n = 91) (OR 1.78, p = .36). In this single-center retrospective analysis, exposure to synthetic CRRT membranes did not independently increase the risk of false-positive BDG results. Larger prospective studies are needed to further evaluate the association between CRRT exposure and false-positive BDG results in critically ill patients with suspected IFI.
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Affiliation(s)
- M. Gabriela Cabanilla
- Department of Internal Medicine and Department of Pharmacy, Division of Infectious Diseases, University of New Mexico Health Sciences Center, Albuquerque, NM, USA
| | - Matthew J. Briski
- Department of Pharmacy, University of New Mexico Health Sciences Center, Albuquerque, NM, USA
| | - Zachary Bruss
- Department of Internal Medicine, University of New Mexico Health Sciences Center, Albuquerque, NM, USA
| | - Lisa Saa
- Department of Internal Medicine, University of New Mexico Health Sciences Center, Albuquerque, NM, USA
| | - Pamela C. Vasquez
- Department of Internal Medicine, Division of Nephrology, University of New Mexico Health Sciences Center, Albuquerque, NM, USA
| | - Chelsea N. Rodriguez
- Department of Pharmacy, University of New Mexico Health Sciences Center, Albuquerque, NM, USA
| | - Jessica A. Mitchell
- Department of Emergency Medicine, University of New Mexico Health Sciences Center, Albuquerque, NM, USA
| | | | - Christos P. Argyropoulos
- Department of Internal Medicine, Division of Nephrology, University of New Mexico Health Sciences Center, Albuquerque, NM, USA
| | - Cameron S. Crandall
- Department of Emergency Medicine, University of New Mexico Health Sciences Center, Albuquerque, NM, USA
| | - J. Pedro Teixeira
- Department of Internal Medicine, Division of Nephrology, Division of Pulmonary, Critical Care and Sleep Medicine, University of New Mexico Health Sciences Center, Albuquerque, NM, USA
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14
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Berg DM, Slish JC, Wright M, Gandhi AD, Gandhi MA. Current Utilization of Antifungal Agents for Intra-abdominal Infections Categorized by Patient Risk Factors During Surgical Procedures: A Literature Review. J Pharm Pract 2023; 36:1232-1243. [PMID: 35705106 DOI: 10.1177/08971900221108716] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The high morbidity and mortality rates associated with invasive fungal infections have led to the overutilization of empiric antifungal therapies. With increasing antibiotic resistance, the careful consideration of prophylactic or empiric antifungal use is critical. The purpose of this review is to evaluate the available literature regarding the current practice of utilizing antifungal agents for intra-abdominal infections based on specific surgical procedures and patient risk factors. Relevant articles were identified through a comprehensive literature search of several databases using the keywords antifungal agents, postoperative period, preoperative care, surgical procedures, and intra-abdominal infections. Only articles that evaluated the use of empiric antifungals for suspected or confirmed intra-abdominal infections and surgical procedures were included in this review. Based on the available literature, antifungal prophylaxis is appropriate in patients who meet the criteria for high-risk invasive candidiasis, kidney or liver transplant recipients, severely-immunocompromised patients with perforated peptic ulcer, peritonitis, and patients on peritoneal dialysis who are failing on a therapeutic antibiotic regimen. We acknowledge that the evidence for using antifungal therapy empirically for all surgical procedures is lacking, and the following review is based on available literature and current guidelines.
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Affiliation(s)
- Deanna M Berg
- Department of Pharmacy Practice, Wegmans School of Pharmacy at St John Fisher College, Rochester, NY, USA
| | - Judianne C Slish
- Department of Pharmacy Practice and Administration, Wegmans School of Pharmacy at St John Fisher College, Rochester, NY, USA
- Department of Pharmacy Practice, UR Medicine Highland Hospital, Rochester, NY, USA
| | - Murray Wright
- Department of Pharmacy Practice, Wegmans School of Pharmacy at St John Fisher College, Rochester, NY, USA
| | - Alok D Gandhi
- Department of Bariatrics and General Surgery, Rochester Regional Health, Rochester, NY, USA
| | - Mona A Gandhi
- Department of Pharmacy Practice and Administration, Wegmans School of Pharmacy at St John Fisher College, Rochester, NY, USA
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15
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Wattier RL, Bucayu RFT, Boge CLK, Ross RK, Yildirim I, Zaoutis TE, Palazzi DL, Vora SB, Castagnola E, Avilés-Robles M, Danziger-Isakov L, Tribble AC, Sharma TS, Arrieta AC, Maron G, Berman DM, Yin DE, Sung L, Green M, Roilides E, Belani K, Romero J, Soler-Palacin P, López-Medina E, Nolt D, Bin Hussain IZ, Muller WJ, Hauger SB, Halasa N, Dulek D, Pong A, Gonzalez BE, Abzug MJ, Carlesse F, Huppler AR, Rajan S, Aftandilian C, Ardura MI, Chakrabarti A, Hanisch B, Salvatore CM, Klingspor L, Knackstedt ED, Lutsar I, Santolaya ME, Shuster S, Johnson SK, Steinbach WJ, Fisher BT. Adjunctive Diagnostic Studies Completed Following Detection of Candidemia in Children: Secondary Analysis of Observed Practice From a Multicenter Cohort Study Conducted by the Pediatric Fungal Network. J Pediatric Infect Dis Soc 2023; 12:487-495. [PMID: 37589394 PMCID: PMC10533205 DOI: 10.1093/jpids/piad057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Accepted: 08/11/2023] [Indexed: 08/18/2023]
Abstract
BACKGROUND Adjunctive diagnostic studies (aDS) are recommended to identify occult dissemination in patients with candidemia. Patterns of evaluation with aDS across pediatric settings are unknown. METHODS Candidemia episodes were included in a secondary analysis of a multicenter comparative effectiveness study that prospectively enrolled participants age 120 days to 17 years with invasive candidiasis (predominantly candidemia) from 2014 to 2017. Ophthalmologic examination (OE), abdominal imaging (AbdImg), echocardiogram, neuroimaging, and lumbar puncture (LP) were performed per clinician discretion. Adjunctive diagnostic studies performance and positive results were determined per episode, within 30 days from candidemia onset. Associations of aDS performance with episode characteristics were evaluated via mixed-effects logistic regression. RESULTS In 662 pediatric candidemia episodes, 490 (74%) underwent AbdImg, 450 (68%) OE, 426 (64%) echocardiogram, 160 (24%) neuroimaging, and 76 (11%) LP; performance of each aDS per episode varied across sites up to 16-fold. Longer durations of candidemia were associated with undergoing OE, AbdImg, and echocardiogram. Immunocompromised status (58% of episodes) was associated with undergoing AbdImg (adjusted odds ratio [aOR] 2.38; 95% confidence intervals [95% CI] 1.51-3.74). Intensive care at candidemia onset (30% of episodes) was associated with undergoing echocardiogram (aOR 2.42; 95% CI 1.51-3.88). Among evaluated episodes, positive OE was reported in 15 (3%), AbdImg in 30 (6%), echocardiogram in 14 (3%), neuroimaging in 9 (6%), and LP in 3 (4%). CONCLUSIONS Our findings show heterogeneity in practice, with some clinicians performing aDS selectively, potentially influenced by clinical factors. The low frequency of positive results suggests that targeted application of aDS is warranted.
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Affiliation(s)
- Rachel L Wattier
- Department of Pediatrics, University of California San Francisco, San Francisco, California, USA
| | - Robert F T Bucayu
- Department of Pediatrics, University of California San Francisco, San Francisco, California, USA
| | - Craig L K Boge
- Department of Pediatrics, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Rachael K Ross
- Department of Epidemiology, University of North Carolina Chapel Hill, Chapel Hill, North Carolina, USA
| | - Inci Yildirim
- Department of Pediatrics, Yale University School of Medicine, Connecticut, USA
- Yale Institute for Global Health, Yale University, New Haven, Connecticut, USA
- Yale Center for Infection and Immunity, New Haven, Connecticut, USA
- Department of Epidemiology, Yale School of Public Health, New Haven, Connecticut, USA
| | - Theoklis E Zaoutis
- Department of Pediatrics, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Debra L Palazzi
- Department of Pediatrics, Baylor College of Medicine and Texas Children’s Hospital, Houston, Texas, USA
| | - Surabhi B Vora
- Department of Pediatrics, University of Washington, Division of Infectious Diseases, Seattle Children’s Hospital, Seattle, Washington, USA
| | - Elio Castagnola
- Department of Pediatrics, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - Martha Avilés-Robles
- Department of Infectious Diseases, Hospital Infantil de México Federico Gómez, Mexico City, Mexico
| | - Lara Danziger-Isakov
- Department of Pediatrics, Cincinnati Children’s Hospital Medical Center, University of Cincinnati, Cincinnati, Ohio, USA
| | - Alison C Tribble
- Division of Infectious Diseases, Department of Pediatrics, University of Michigan and C.S. Mott Children’s Hospital, Ann Arbor, Michigan, USA
| | - Tanvi S Sharma
- Division of Infectious Diseases, Boston Children’s Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Antonio C Arrieta
- Department of Infectious Diseases, Children’s Hospital of Orange County, Orange, California, USA
- Department of Pediatrics, University of California Irvine, Irvine, California, USA
| | - Gabriela Maron
- Department of Infectious Diseases, St. Jude Children’s Research Hospital, Memphis, Tennessee, USA
| | - David M Berman
- Division of Pediatric Infectious Diseases, Johns Hopkins All Children’s Hospital, St. Petersburg, Florida, USA
| | - Dwight E Yin
- Department of Pediatrics, Children’s Mercy and University of Missouri-Kansas City School of Medicine, Kansas City, Missouri, USA
| | - Lillian Sung
- Division of Haematology/Oncology, The Hospital for Sick Children, Toronto, Canada
| | - Michael Green
- Department of Pediatrics, Children’s Hospital of Pittsburgh of UPMC, Pittsburgh, Pennsylvania, USA
| | - Emmanuel Roilides
- Infectious Diseases Unit, 3rd Department of Pediatrics, Aristotle University and Hippokration Hospital, Thessaloniki, Greece
| | - Kiran Belani
- Pediatric Infectious Diseases, Children’s Minnesota, Minneapolis, Minnesota, USA
| | - José Romero
- National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Pere Soler-Palacin
- Pediatric Infectious Diseases and Immunodeficiencies Unit, Hospital Universitari Vall d’Hebron, Barcelona, Catalonia, Spain
| | - Eduardo López-Medina
- Centro de Estudios en Infectología Pediátrica, Clínica Imbanaco Grupo Quirónsalud and Universidad del Valle, Cali, Colombia
| | - Dawn Nolt
- Department of Pediatrics, Oregon Health and Science University and Doernbecher Children’s Hospital, Portland, Oregon, USA
| | - Ibrahim Zaid Bin Hussain
- Pediatric Infectious Diseases, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - William J Muller
- Department of Pediatrics, Ann & Robert H. Lurie Children’s Hospital of Chicago and Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Sarmistha B Hauger
- Department of Pediatrics, University of Texas at Austin and Dell Children’s Medical Center, Austin, Texas, USA
| | - Natasha Halasa
- Department of Pediatrics, Vanderbilt University Medical Center and Monroe Carell Jr. Children’s Hospital at Vanderbilt, Nashville, Tennessee, USA
| | - Daniel Dulek
- Department of Pediatrics, Vanderbilt University Medical Center and Monroe Carell Jr. Children’s Hospital at Vanderbilt, Nashville, Tennessee, USA
| | - Alice Pong
- Department of Pediatrics, University of California San Diego and Rady Children’s Hospital San Diego, San Diego, California, USA
| | - Blanca E Gonzalez
- Center for Pediatric Infectious Diseases, Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | - Mark J Abzug
- Department of Pediatrics, University of Colorado School of Medicine and Children’s Hospital Colorado, Aurora, Colorado, USA
| | - Fabianne Carlesse
- Instituto de Oncologia Pediatrica–IOP/GRAACC-UNIFESP, São Paulo, Brazil
| | - Anna R Huppler
- Department of Pediatrics, Medical College of Wisconsin and Children’s Wisconsin, Milwaukee, Wisconsin, USA
| | - Sujatha Rajan
- Division of Pediatric Infectious Diseases, Cohen Children’s Medical Center, New Hyde Park, New York, USA
| | - Catherine Aftandilian
- Department of Pediatrics, Stanford University School of Medicine, Palo Alto, California, USA
| | - Monica I Ardura
- Division of Infectious Diseases and Host Defense Program, Department of Pediatrics, Nationwide Children’s Hospital and The Ohio State University, Columbus, Ohio, USA
| | | | - Benjamin Hanisch
- Pediatric Infectious Diseases, Children’s National Health System, Washington, District of Columbia, USA
| | - Christine M Salvatore
- Division of Pediatric Infectious Diseases, Weill Cornell Medicine and Komansky Children’s Hospital, New York, New York, USA
| | - Lena Klingspor
- Department of Laboratory Medicine, Karolinska Institute, Stockholm, Sweden
| | | | - Irja Lutsar
- Department of Microbiology, University of Tartu, Tartu, Estonia
| | - Maria E Santolaya
- Hospital Dr. Luis Calvo Mackenna, Facultad de Medicina, Universidad de Chile, Santiago, Chile
| | - Sydney Shuster
- Department of Pediatrics, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Sarah K Johnson
- Department of Pediatrics, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | - William J Steinbach
- Department of Pediatrics, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | - Brian T Fisher
- Department of Pediatrics, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
- Department of Biostatistics, Epidemiology and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
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16
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Peixoto PH, Silva ML, Portela FV, da Silva B, Milanez E, de Oliveira D, Ribeiro A, de Almeida H, Lima-Neto R, Guedes GM, Castelo-Branco D, Cordeiro R. Clinical, Epidemiological and Laboratory Features of Invasive Candida parapsilosis Complex Infections in a Brazilian Pediatric Reference Hospital during the COVID-19 Pandemic. J Fungi (Basel) 2023; 9:844. [PMID: 37623615 PMCID: PMC10456047 DOI: 10.3390/jof9080844] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Revised: 07/31/2023] [Accepted: 08/09/2023] [Indexed: 08/26/2023] Open
Abstract
The present study aimed to describe the clinical, epidemiological and laboratory characteristics of invasive candidiasis by C. parapsilosis complex (CPC) in a Brazilian tertiary pediatric hospital during the COVID-19 pandemic. Clinical samples were processed in the BACT/ALERT® 3D system or on agar plates. Definitive identification was achieved by MALDI-TOF MS. Antifungal susceptibility was initially analyzed by the VITEK 2 system (AST-YS08 card) and confirmed by the CLSI protocol. Patient data were collected from the medical records using a structured questionnaire. CPC was recovered from 124 patients over an 18-month period, as follows: C. parapsilosis (83.87%), C. orthopsilosis (13.71%) and C. metapsilosis (2.42%). Antifungal resistance was not detected. The age of the patients with invasive CPC infections ranged from <1 to 18 years, and most of them came from oncology-related sectors, as these patients were more affected by C. parapsilosis. C. orthopsilosis infections were significantly more prevalent in patients from critical care units. Invasive infections caused by different pathogens occurred in 75 patients up to 30 days after the recovery of CPC isolates. Overall, 23 (18.55%) patients died within 30 days of CPC diagnosis. Catheter removal and antifungal therapy were important measures to prevent mortality. COVID-19 coinfection was only detected in one patient.
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Affiliation(s)
- Paulo Henrique Peixoto
- Department of Pathology and Legal Medicine, Federal University of Ceará, Fortaleza 60430-160, Brazil; (P.H.P.); (M.L.S.); (F.V.P.); (B.d.S.); (E.M.); (D.d.O.); (G.M.G.); (D.C.-B.)
| | - Maria Laína Silva
- Department of Pathology and Legal Medicine, Federal University of Ceará, Fortaleza 60430-160, Brazil; (P.H.P.); (M.L.S.); (F.V.P.); (B.d.S.); (E.M.); (D.d.O.); (G.M.G.); (D.C.-B.)
| | - Fernando Victor Portela
- Department of Pathology and Legal Medicine, Federal University of Ceará, Fortaleza 60430-160, Brazil; (P.H.P.); (M.L.S.); (F.V.P.); (B.d.S.); (E.M.); (D.d.O.); (G.M.G.); (D.C.-B.)
| | - Bruno da Silva
- Department of Pathology and Legal Medicine, Federal University of Ceará, Fortaleza 60430-160, Brazil; (P.H.P.); (M.L.S.); (F.V.P.); (B.d.S.); (E.M.); (D.d.O.); (G.M.G.); (D.C.-B.)
| | - Edlâny Milanez
- Department of Pathology and Legal Medicine, Federal University of Ceará, Fortaleza 60430-160, Brazil; (P.H.P.); (M.L.S.); (F.V.P.); (B.d.S.); (E.M.); (D.d.O.); (G.M.G.); (D.C.-B.)
| | - Denis de Oliveira
- Department of Pathology and Legal Medicine, Federal University of Ceará, Fortaleza 60430-160, Brazil; (P.H.P.); (M.L.S.); (F.V.P.); (B.d.S.); (E.M.); (D.d.O.); (G.M.G.); (D.C.-B.)
| | - Aldaíza Ribeiro
- Albert Sabin Children Hospital, Fortaleza 60410-794, Brazil;
| | - Henrique de Almeida
- Department of Tropical Medicine, Federal University of Pernambuco, Recife 50670-901, Brazil; (H.d.A.); (R.L.-N.)
| | - Reginaldo Lima-Neto
- Department of Tropical Medicine, Federal University of Pernambuco, Recife 50670-901, Brazil; (H.d.A.); (R.L.-N.)
| | - Glaucia Morgana Guedes
- Department of Pathology and Legal Medicine, Federal University of Ceará, Fortaleza 60430-160, Brazil; (P.H.P.); (M.L.S.); (F.V.P.); (B.d.S.); (E.M.); (D.d.O.); (G.M.G.); (D.C.-B.)
| | - Débora Castelo-Branco
- Department of Pathology and Legal Medicine, Federal University of Ceará, Fortaleza 60430-160, Brazil; (P.H.P.); (M.L.S.); (F.V.P.); (B.d.S.); (E.M.); (D.d.O.); (G.M.G.); (D.C.-B.)
| | - Rossana Cordeiro
- Department of Pathology and Legal Medicine, Federal University of Ceará, Fortaleza 60430-160, Brazil; (P.H.P.); (M.L.S.); (F.V.P.); (B.d.S.); (E.M.); (D.d.O.); (G.M.G.); (D.C.-B.)
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Nakamura H, Makiguchi T, Tsunoda A, Shirabe K, Yokoo S. Candida Costochondritis Induced by Traumatic Small Bowel Perforation: A Case Report. Cureus 2023; 15:e43923. [PMID: 37746406 PMCID: PMC10513002 DOI: 10.7759/cureus.43923] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/22/2023] [Indexed: 09/26/2023] Open
Abstract
Candida osteomyelitis is a manifestation of invasive candidiasis. The common sites of infection are the vertebra, sternum, and femur, whereas infection of the rib cartilage is very rare. In the present case, candida costochondritis developed after traumatic small-bowel perforation. An 82-year-old man was involved in a traffic accident while walking. His past medical history was insignificant. He was diagnosed with a pelvic fracture and perforation of the small intestine and underwent open reduction and internal fixation of the pelvic fracture and an enterectomy. Three months after the injury, swelling was observed in the right anterior thoracic region. Swelling was treated by incision and drainage but persisted in the form of infected granulation tissue. Debridement, including rib cartilage removal, was done. Biopsy and culture of the removed granulation tissue and cartilage tissue confirmed candida costochondritis. Fluconazole was administered for six months. No recurrence has been observed in the seven months postoperatively. Candida costochondritis is rare but is often refractory and requires extensive debridement in addition to the administration of antifungal agents. This disease should be included in the differential diagnosis when pain, erythema, swelling, skin ulceration, or infected granulation is found on affected costal cartilages.
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Affiliation(s)
- Hideharu Nakamura
- Department of Plastic and Reconstructive Surgery, National Hospital Organization Takasaki General Medical Center, Takasaki, JPN
| | - Takaya Makiguchi
- Department of Oral and Maxillofacial Surgery, Plastic Surgery, Gunma University Graduate School of Medicine, Maebashi, JPN
| | - Aya Tsunoda
- Department of Plastic and Reconstructive Surgery, National Hospital Organization Takasaki General Medical Center, Takasaki, JPN
| | - Ken Shirabe
- Department of General Surgical Science, Gunma University Graduate School of Medicine, Maebashi, JPN
| | - Satoshi Yokoo
- Department of Oral and Maxillofacial Surgery, Plastic Surgery, Gunma University Graduate School of Medicine, Maebashi, JPN
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18
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Eades CP, Bakri ARBA, Lau JCY, Moore CB, Novak-Frazer L, Richardson MD, Rautemaa-Richardson R. Comparison of β-1-3-D-Glucan and Candida Mannan Biomarker Assays with Serological Tests for the Diagnosis of Candidemia. J Fungi (Basel) 2023; 9:813. [PMID: 37623584 PMCID: PMC10455369 DOI: 10.3390/jof9080813] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Revised: 07/26/2023] [Accepted: 07/28/2023] [Indexed: 08/26/2023] Open
Abstract
Invasive candidiasis, including bloodstream infection (candidemia), encompasses the most severe forms of Candida infection. Several species-specific and non-specific serological assays are commercially available to aid in diagnosis. This study compared the performance of five such biomarker assays. Serum samples from 14 patients with proven or probable invasive candidiasis, and from 10 control patients, were included in the analysis. A total of 50 serum samples were tested using C. albicans germ tube antibody (CAGTA) assay (Vircell), C. albicans IgM, C. albicans IgG and Candida mannan assays (Dynamiker Biotechnology). Among these samples, the β-1-3-D-glucan (BDG) assay (Fungitell), a laboratory standard for the diagnosis of invasive candidiasis, was positive in 20 (40%), intermediate in five (10%) and negative in 25 (50%). In cases of proven or probable candidemia, the sensitivity and specificity of the BDG assay was 86% and 80%, respectively; the Candida mannan assay, 14% and 86%; the CAGTA test, 57% and 60%; the C. albicans IgM assay, 71% and 60%; and C. albicans IgG assay 29% and 90%. In 4/8 (50%) cases with multiple serum samples, C. albicans IgM was positive sooner than BDG. Thus, when used as a rule-out test for invasive candidiasis, our data suggest that the C. albicans IgM assay may assist antifungal stewardship (over serum BDG).
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Affiliation(s)
- Christopher P. Eades
- Department of Infectious Diseases, Manchester University NHS Foundation Trust, Wythenshawe Hospital, Manchester M23 9LT, UK;
- Division of Infection, Immunity and Respiratory Medicine, School of Biological Sciences, NIHR Manchester Biomedical Research Centre (BRC) at the Manchester Academic Health Science Centre, The University of Manchester and Manchester University NHS Foundation Trust, Wythenshawe Hospital, Manchester M23 9LT, UK (J.C.Y.L.); (L.N.-F.); (M.D.R.)
| | - Ahmed Rafezzan Bin Ahmed Bakri
- Division of Infection, Immunity and Respiratory Medicine, School of Biological Sciences, NIHR Manchester Biomedical Research Centre (BRC) at the Manchester Academic Health Science Centre, The University of Manchester and Manchester University NHS Foundation Trust, Wythenshawe Hospital, Manchester M23 9LT, UK (J.C.Y.L.); (L.N.-F.); (M.D.R.)
| | - Jeffrey C. Y. Lau
- Division of Infection, Immunity and Respiratory Medicine, School of Biological Sciences, NIHR Manchester Biomedical Research Centre (BRC) at the Manchester Academic Health Science Centre, The University of Manchester and Manchester University NHS Foundation Trust, Wythenshawe Hospital, Manchester M23 9LT, UK (J.C.Y.L.); (L.N.-F.); (M.D.R.)
| | - Caroline B. Moore
- Division of Infection, Immunity and Respiratory Medicine, School of Biological Sciences, NIHR Manchester Biomedical Research Centre (BRC) at the Manchester Academic Health Science Centre, The University of Manchester and Manchester University NHS Foundation Trust, Wythenshawe Hospital, Manchester M23 9LT, UK (J.C.Y.L.); (L.N.-F.); (M.D.R.)
| | - Lilyann Novak-Frazer
- Division of Infection, Immunity and Respiratory Medicine, School of Biological Sciences, NIHR Manchester Biomedical Research Centre (BRC) at the Manchester Academic Health Science Centre, The University of Manchester and Manchester University NHS Foundation Trust, Wythenshawe Hospital, Manchester M23 9LT, UK (J.C.Y.L.); (L.N.-F.); (M.D.R.)
- Mycology Reference Centre Manchester (MRCM), ECMM Excellence Centre of Medical Mycology, Manchester University NHS Foundation Trust, Wythenshawe Hospital, Manchester M23 9LT, UK
| | - Malcolm D. Richardson
- Division of Infection, Immunity and Respiratory Medicine, School of Biological Sciences, NIHR Manchester Biomedical Research Centre (BRC) at the Manchester Academic Health Science Centre, The University of Manchester and Manchester University NHS Foundation Trust, Wythenshawe Hospital, Manchester M23 9LT, UK (J.C.Y.L.); (L.N.-F.); (M.D.R.)
- Mycology Reference Centre Manchester (MRCM), ECMM Excellence Centre of Medical Mycology, Manchester University NHS Foundation Trust, Wythenshawe Hospital, Manchester M23 9LT, UK
- Manchester Fungal Infection Group (MFIG), Faculty of Biology, Medicine & Health, The University of Manchester, Manchester M13 9NT, UK
| | - Riina Rautemaa-Richardson
- Department of Infectious Diseases, Manchester University NHS Foundation Trust, Wythenshawe Hospital, Manchester M23 9LT, UK;
- Division of Infection, Immunity and Respiratory Medicine, School of Biological Sciences, NIHR Manchester Biomedical Research Centre (BRC) at the Manchester Academic Health Science Centre, The University of Manchester and Manchester University NHS Foundation Trust, Wythenshawe Hospital, Manchester M23 9LT, UK (J.C.Y.L.); (L.N.-F.); (M.D.R.)
- Mycology Reference Centre Manchester (MRCM), ECMM Excellence Centre of Medical Mycology, Manchester University NHS Foundation Trust, Wythenshawe Hospital, Manchester M23 9LT, UK
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19
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El Zakhem A, Mahmoud O, Zakhour J, Nahhal SB, El Ghawi N, Omran N, El Sheikh WG, Tamim H, Kanj SS. The Impact of COVID-19 on the Epidemiology and Outcomes of Candidemia: A Retrospective Study from a Tertiary Care Center in Lebanon. J Fungi (Basel) 2023; 9:769. [PMID: 37504757 PMCID: PMC10381108 DOI: 10.3390/jof9070769] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Revised: 07/05/2023] [Accepted: 07/18/2023] [Indexed: 07/29/2023] Open
Abstract
Invasive fungal infections, notably candidemia, have been associated with COVID-19. The epidemiology of candidemia has significantly changed during the COVID-19 pandemic. We aim to identify the microbiological profile, resistance rates, and outcomes of COVID-19-associated candidemia (CAC) compared to patients with candidemia not associated with COVID-19. We retrospectively collected data on patients with candidemia admitted to the American University of Beirut Medical Center between 2004 and 2022. We compared the epidemiology of candidemia during and prior to the COVID-19 pandemic. Additionally, we compared the outcomes of critically ill patients with CAC to those with candidemia without COVID-19 from March 2020 till March 2022. Among 245 candidemia episodes, 156 occurred prior to the pandemic and 89 during the pandemic. Of the latter, 39 (43.8%) were CAC, most of which (82%) were reported from intensive care units (ICU). Non-albicans Candida (NAC) spp. were predominant throughout the study period (67.7%). Candida auris infection was the most common cause of NAC spp. in CAC. C. glabrata had decreased susceptibility rates to fluconazole and caspofungin during the pandemic period (46.1% and 38.4%, respectively). The mortality rate in the overall ICU population during the pandemic was 76.6%, much higher than the previously reported candidemia mortality rate observed in studies involving ICU patients. There was no significant difference in 30-day mortality between CAC and non-CAC (75.0% vs. 78.1%; p = 0.76). Performing ophthalmic examination (p = 0.002), CVC removal during the 48 h following the candidemia (p = 0.008) and speciation (p = 0.028) were significantly associated with a lower case-fatality rate. The epidemiology of candidemia has been significantly affected by the COVID-19 pandemic at our center. Rigorous infection control measures and proper antifungal stewardship are essential to combat highly resistant species such as C. auris.
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Affiliation(s)
- Aline El Zakhem
- Division of Infectious Diseases, American University of Beirut Medical Center, Beirut 110236, Lebanon
| | - Omar Mahmoud
- Division of Infectious Diseases, American University of Beirut Medical Center, Beirut 110236, Lebanon
| | - Johnny Zakhour
- Division of Infectious Diseases, American University of Beirut Medical Center, Beirut 110236, Lebanon
| | - Sarah B Nahhal
- Division of Infectious Diseases, American University of Beirut Medical Center, Beirut 110236, Lebanon
| | - Nour El Ghawi
- Division of Infectious Diseases, American University of Beirut Medical Center, Beirut 110236, Lebanon
| | - Nadine Omran
- Division of Infectious Diseases, American University of Beirut Medical Center, Beirut 110236, Lebanon
| | - Walaa G El Sheikh
- Biostatistics Unit, Clinical Research Institute, American University of Beirut, Beirut 110236, Lebanon
| | - Hani Tamim
- Biostatistics Unit, Clinical Research Institute, American University of Beirut, Beirut 110236, Lebanon
- College of Medicine, Alfaisal University, Riyadh 11533, Saudi Arabia
| | - Souha S Kanj
- Division of Infectious Diseases, American University of Beirut Medical Center, Beirut 110236, Lebanon
- Center for Infectious Diseases Research, American University of Beirut, Beirut 110236, Lebanon
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20
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Apostolidi EA, Gamaletsou MN, Arapaki M, Asimakopoulos JV, Diamantopoulos P, Zafeiratou S, Kofteridis D, Pagoni M, Kotsopoulou M, Voulgarelis M, Sipsas NV. Bone Marrow Iron Stores Are Not Associated with Increased Risk for Invasive Fungal Infections in Patients with Newly Diagnosed Acute Leukemia or Myelodysplastic Syndrome in Transformation: Is There a Relationship? J Fungi (Basel) 2023; 9:748. [PMID: 37504736 PMCID: PMC10381291 DOI: 10.3390/jof9070748] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Revised: 07/02/2023] [Accepted: 07/12/2023] [Indexed: 07/29/2023] Open
Abstract
Iron plays an important role in the pathogenesis of infections, including invasive fungal infections (IFIs). Studies suggested that iron overload might represent an additional risk factor for IFIs among patients with hematological malignancies. We conducted a prospective, multi-center study amongst adult patients with newly diagnosed acute myeloid leukemia (AML) or myelodysplastic syndrome (MDS) in transformation to determine whether baseline iron overload as measured using the bone marrow iron store (BMIS) score is an independent risk factor for the development of IFIs. We also measured baseline serum iron and ferritin levels. A total of 98 patients were enrolled (76 with AML) and were followed for 12 months. Twenty-two patients developed IFI during the follow-up period (invasive aspergillosis n = 16, candidemia n = 5, mucormycosis n = 1). A baseline BMIS score ≥ 3 indicated that iron overload was relatively common (38/98 patients, 38%), and its frequency was comparable between patients with no IFIs (31/76, 40.7%) and in those with IFIs (8/22, 36.4%). Univariate analysis showed that only the presence of AML was associated with increased risk for IFIs [OR (95% CI) 7.40 (1.05-325.42)]. Both univariate and multivariate analyses showed that an increased BMIS score (≥3) at baseline was not an independent risk factor for IFIs. Similarly, there was no difference in serum iron and ferritin between the two groups that had similar demographic characteristics. Indices of iron overload were not independent risk factors for IFIs in our cohort of Greek patients with newly diagnosed AML/MDS in transformation.
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Affiliation(s)
- Eirini A Apostolidi
- Pathophysiology Department, General Hospital of Athens Laiko, Medical School, National and Kapodistrian University of Athens, 11527 Athens, Greece
| | - Maria N Gamaletsou
- Pathophysiology Department, General Hospital of Athens Laiko, Medical School, National and Kapodistrian University of Athens, 11527 Athens, Greece
| | - Maria Arapaki
- Hematology Department, General Hospital of Athens Laiko, 11527 Athens, Greece
| | | | - Panagiotis Diamantopoulos
- First Department of Internal Medicine, General Hospital of Athens Laiko, Medical School, National and Kapodistrian University of Athens, 11527 Athens, Greece
| | - Sofia Zafeiratou
- Department of Hygiene, Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, 11527 Athens, Greece
| | - Diamantis Kofteridis
- Medicine Department, Medical School, University of Crete, 71003 Heraklion, Greece
| | - Maria Pagoni
- Hematology Department, General Hospital of Athens Evangelismos, 10676 Athens, Greece
| | | | - Michael Voulgarelis
- Pathophysiology Department, General Hospital of Athens Laiko, Medical School, National and Kapodistrian University of Athens, 11527 Athens, Greece
| | - Nikolaos V Sipsas
- Pathophysiology Department, General Hospital of Athens Laiko, Medical School, National and Kapodistrian University of Athens, 11527 Athens, Greece
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21
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Alkhalifa W, Alhawaj H, Alamri A, Alturki F, Alshahrani M, Alnimr A. Clinical and Microbiological Characteristics of Candidemia Cases in Saudi Arabia. Infect Drug Resist 2023; 16:4489-4503. [PMID: 37457797 PMCID: PMC10348370 DOI: 10.2147/idr.s411865] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Accepted: 06/21/2023] [Indexed: 07/18/2023] Open
Abstract
Purpose Candidemia and antifungal resistance are major healthcare challenges. The aim of this study is to describe the frequency of candidemia cases, distribution of Candida spp., and the associated risk factors for mortality in an academic institution in Saudi Arabia over an 18-month period. We also evaluated the susceptibility patterns of Candida blood isolates. Methods Candidemia cases were collected from King Fahad Hospital of the University over the period between July 1st, 2020 through December 31st, 2021. They were prospectively reviewed for the preceding risk factors and antifungal (AF) susceptibility, testing results to fluconazole (FL), voriconazole (VO), itraconazole (IT), posaconazole (PO), caspofungin (CASP), anidulafungin (AND), micafungin (MYC), flucytosine (FLC) and amphotericin B (AMPB) using a broth microdilution kit (Sensititre™ YeastOne). Results A total of 48 candidemia isolates were included that were isolated from 43 patients. The median age of cases was 62 ± 23.3 years (60.4% males and 83% ICU patients). Independent risk factors for mortality at 30 days in candidemia patients were age, COVID-19 co-infection, and use of tocilizumab. The most commonly isolated species were C. glabrata and C. parapsilosis (22.9% each) followed by C. albicans (18.75%). AF resistance for ≥1 antifungal was detected in 39.3% of 33 cases tested, with no cross-resistance identified. Resistance rates for each AF were as follows: FL (18%), VO (6%), IT (6%), PO (9%) and AMPB (3%). No resistance was seen for echinocandins apart from one C. krusei strain showing an intermediate result for CASP. Conclusion The study showed an overall high rate of non-albicans Candida, with the predominance of C. parapsilosis and C. glabrata, representing a therapeutic challenge. AF resistance rate was high which emphasizes the importance of continuing surveillance and providing accurate and reliable tools in the laboratories for rapid speciation and susceptibility testing.
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Affiliation(s)
- Wala Alkhalifa
- Department of Microbiology, College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Hassan Alhawaj
- Department of Microbiology, College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Aisha Alamri
- Department of Clinical Laboratory Sciences, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Fatimah Alturki
- Department of Microbiology, College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Mohammed Alshahrani
- Emergency and Critical Care Department, King Fahad Hospital of the University - Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Amani Alnimr
- Department of Microbiology, College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
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22
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Bai X, Luo J. Invasive Candidiasis in Patients with Solid Tumors: A Single-Center Retrospective Study. Int J Gen Med 2023; 16:2419-2426. [PMID: 37333879 PMCID: PMC10276605 DOI: 10.2147/ijgm.s411006] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2023] [Accepted: 05/30/2023] [Indexed: 06/20/2023] Open
Abstract
Background Invasive candidiasis (ICs) is one of the common causes of death in patients with solid tumors. However, studies on the clinical characteristics of ICs with solid tumors are limited. Methods The purpose of this study was to retrospectively analyse the clinical characteristics, laboratory results and risk factor prediction of inpatients with ICs and solid tumors. We reviewed the clinical data and candida specimen information of hospitalized patients diagnosed with solid tumors combined with ICs at the First Hospital of China Medical University from January 2016 to December 2020. Multivariate logistic regression analysis was used to assess the prognostic factors associated with mortality in these patients. Results A total of 243 ICs patients with solid tumors were included in this study. The average ± SD age was 62.8 ± 11.7 (range: 27-93 years old), of which nearly 41% were ≥ 65 years old (99/243, 40.7%), and most were male (162/243, 66.6%). Most patients had malignant tumors of the digestive system. The most common candida was Candida parapsilosis (101/243, 41.5%), followed by Candida guilliermondii (83/243, 34.1%), Candida albicans (32/243, 13.1%), Candida glabrata (17/243, 6.9%), Candida tropicalis (7/243, 2.8%) and Candida krusei (3/243, 1.2%). Multivariate logistic regression analysis showed that the length of stay in the ICU, urinary catheter, total parenteral nutrition, stay in the ICU, renal failure and neutrophil count were prognostic factors related to death. Conclusion In this study, based on the clinical data of solid tumor patients with ICs in the past 5 years, the results showed that the length of stay in the ICU, urinary catheter, total parenteral nutrition, stay in the ICU, renal failure and neutrophil count were identified as the main prognostic factors. This study can be used to help clinicians carry out early intervention for high-risk patients.
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Affiliation(s)
- Xueying Bai
- Department of Thoracic Surgery, The First Hospital of China Medical University, Shenyang, 110001, People’s Republic of China
| | - Ji Luo
- Department of Thoracic Surgery, The First Hospital of China Medical University, Shenyang, 110001, People’s Republic of China
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23
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Gregorczyk-Maga I, Kania M, Sulik-Tyszka B, Namysł M, Sepioło A, Romaniszyn D, Jachowicz-Matczak E, Wójkowska-Mach J. Oral Myco- and Bacteriobiota and Yeast Infections in Mechanically Ventilated COVID-19 Patients. Microorganisms 2023; 11:1442. [PMID: 37374944 DOI: 10.3390/microorganisms11061442] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2023] [Revised: 05/26/2023] [Accepted: 05/28/2023] [Indexed: 06/29/2023] Open
Abstract
Critically ill COVID-19 patients requiring mechanical ventilation in the intensive care unit are at risk of developing invasive candidiasis. In this study we aimed to (1) characterize oral cultivable mycobiota of mechanically ventilated adult COVID-19 patients in an ICU setting by sampling four distinct oral niches in two fixed time points with regards to oral health status, (2) investigate Candida spp. infections in this population, and (3) compare oral mycobiota with selected bacteriobiota strains during the observation in the ICU. We recruited 56 adult COVID-19 patients who qualified for mechanical ventilation. Patients received either standard or extended oral care procedures with tooth brushing. Oral samples were taken first within 36 h and after 7 days of intubation. Yeast-like fungi were identified by MALDI/TOF mass spectrometry. Yeast infection cases were retrospectively analyzed. Candida spp. in oral sampling was identified in 80.4% and 75.7%, C. albicans in 57.1% and 61.1%, and non-albicans Candida species in 48.2% and 47.2% patients at baseline and follow-up, respectively. There were no differences in the overall CFU counts of Candida spp. species and individual Candida species in oral samples, both at baseline and follow-up. At baseline, a higher prevalence of Candida spp. was associated with a higher identification rate of Lactobacillus spp. (64.4% vs. 27.3%, p = 0.041). At follow-up, there was a borderline lower prevalence of Candida spp. in patients with Lactobacillus spp. identified (57.1% vs. 87.0%, p = 0.057). The incidence rate of candidiasis was 5.4% and the incidence density was 3.1/1000 pds. In conclusion, non-albicans Candida species in oral samples were identified in nearly half of patients. Oral health was moderately impaired. A high incidence of yeast infections, including invasive cases, in patients hospitalized in the ICU due to COVID-19 and requiring mechanical ventilation was noted. Severe COVID-19 and disease-specific interventions within the ICU possibly played a major role promoting Candida spp. infections.
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Affiliation(s)
- Iwona Gregorczyk-Maga
- Institute of Dentistry, Faculty of Medicine, Jagiellonian University Medical College, ul. Montelupich 4, 31-155 Kraków, Poland
| | - Michal Kania
- Doctoral School of Medicine and Health Sciences, Jagiellonian University Medical College, ul. św. Anny 12, 31-008 Kraków, Poland
- Chair of Metabolic Diseases, Faculty of Medicine, Jagiellonian University Medical College, ul. Jakubowskiego 2, 30-688 Kraków, Poland
| | - Beata Sulik-Tyszka
- Department of Dental Microbiology, Medical University of Warsaw, Banacha 1A, 02-097 Warsaw, Poland
| | - Magdalena Namysł
- Department of Microbiology, University Hospital in Krakow, Jakubowskiego Street 2, 30-688 Kraków, Poland
| | - Anna Sepioło
- Department of Microbiology, University Hospital in Krakow, Jakubowskiego Street 2, 30-688 Kraków, Poland
| | - Dorota Romaniszyn
- Department of Microbiology, Faculty of Medicine, Jagiellonian University Medical College, ul. Czysta 18, 31-121 Kraków, Poland
| | - Estera Jachowicz-Matczak
- Department of Microbiology, Faculty of Medicine, Jagiellonian University Medical College, ul. Czysta 18, 31-121 Kraków, Poland
| | - Jadwiga Wójkowska-Mach
- Department of Microbiology, Faculty of Medicine, Jagiellonian University Medical College, ul. Czysta 18, 31-121 Kraków, Poland
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24
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Agnelli C, Guimarães T, Sukiennik T, Lima PRP, Salles MJ, Breda GL, Queiroz-Telles F, Chaves Magri MM, Mendes AV, Camargo LFA, Morales H, de Carvalho Hessel Dias VM, Rossi F, Colombo AL. Prognostic Trends and Current Challenges in Candidemia: A Comparative Analysis of Two Multicenter Cohorts within the Past Decade. J Fungi (Basel) 2023; 9:jof9040468. [PMID: 37108922 PMCID: PMC10144195 DOI: 10.3390/jof9040468] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Revised: 03/29/2023] [Accepted: 04/11/2023] [Indexed: 04/29/2023] Open
Abstract
Candidemia remains a major public health challenge due to its high mortality rates, especially in developing countries. Monitoring epidemiological trends may provide insights for better clinical outcomes. This study aimed to describe trends in the epidemiology, therapeutic practices, and mortality in candidemia through a retrospective comparative analysis between two surveillance cohorts of all candidemic adults at eleven tertiary hospitals in Brazil, from 2010-2011 (Period I) versus 2017-2018 (Period II). A total of 616 cases were diagnosed, with 247 being from Period II. These patients were more likely to have three or more coexisting comorbidities [72 (29.1%) vs. 60 (16.3%), p < 0.001], had a prior history of in-hospital admissions more often [102 (40.3%) vs. 79 (21.4%), p = 0.001], and presented with candidemia earlier after admission, within 15 days (0-328) vs. 19 (0-188), p = 0.01. Echinocandins were more frequently prescribed [102 (41.3%) vs. 50 (13.6%), p = 0.001], but time to antifungal initiation [2 days (0-14) vs. 2 (0-13), p = 0.369] and CVC removal within 48 h [90/185 (48.6%) vs. 148/319 (46.4%), p = 0.644] remained unchanged. Additionally, many patients went untreated in both periods I and II [87 (23.6%) vs. 43 (17.4%), p = 0.07], respectively. Unfortunately, no improvements in mortality rates at 14 days [123 (33.6%) vs. 93 (37.7%), p = 0.343] or at 30 days [188 (51.4%) vs. 120 (48.6%), p = 0.511] were observed. In conclusion, mortality rates remain exceedingly high despite therapeutic advances, probably associated with an increase in patients' complexity and suboptimal therapeutic interventions. Management strategies should be tailored to suit epidemiological changes, expedite diagnosis to reduce the number of untreated eligible patients and guarantee early antifungal initiation and source control.
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Affiliation(s)
- Caroline Agnelli
- Division of Infectious Diseases, Department of Medicine, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo 04024-002, Brazil
| | - Thaís Guimarães
- Hospital do Servidor Público Estadual de São Paulo, São Paulo 04039-000, Brazil
| | - Teresa Sukiennik
- Santa Casa de Misericórdia de Porto Alegre, Rio Grande do Sul 90050-170, Brazil
| | - Paulo Roberto Passos Lima
- Division of Infectious Diseases, Department of Medicine, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo 04024-002, Brazil
| | - Mauro José Salles
- Santa Casa de Misericórdia de São Paulo, São Paulo 01221-010, Brazil
| | | | | | | | | | | | - Hugo Morales
- Hospital Erasto Gaertner, São Paulo 81520-060, Brazil
| | | | - Flávia Rossi
- Pathology Department, Laboratório de Microbiologia da Divisão de Laboratório Central, Hospital das Clínicas da Faculdade de Medicina USP (FMUSP), São Paulo 05403-010, Brazil
| | - Arnaldo Lopes Colombo
- Division of Infectious Diseases, Department of Medicine, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo 04024-002, Brazil
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Caballero JC, Askari E, Carrasco N, Piris MA, Perez de Camino B, Pardo L, Cornago J, Lopez-Lorenzo JL, Llamas P, Solan L. Invasive Cutaneous Candidiasis, Autoimmune Hemolytic Anemia and Pancytopenia: A Challenging Scenario for Waldenström Macroglobulinemia in an Elderly Patient. Biomedicines 2023; 11:biomedicines11041007. [PMID: 37189625 DOI: 10.3390/biomedicines11041007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2023] [Revised: 03/10/2023] [Accepted: 03/21/2023] [Indexed: 05/17/2023] Open
Abstract
Waldenström macroglobulinemia (WM) is a slowly progressive hematologic malignancy that usually responds rapidly to treatment. Being a lymphoplasmacytoid neoplasm, it is associated with a monoclonal IgM component, which may be associated with multiple manifestations and symptoms. We report the case of a 77-year-old woman diagnosed with WM following the development of severe and sudden pancytopenia associated with a cold agglutinin syndrome. In order to treat the WM and the underlying hemolysis, treatment with rituximab, corticosteroids and cyclophosphamide was started. Despite the improvement in hemolysis parameters, pancytopenia persisted, and we started a second line with ibrutinib. During treatment the patient developed an uncommon invasive fungal infection (IFI) with bone marrow granulomatosis and myelofibrosis. This case shows an unusual clinical course with a poor hematopoietic response to treatment and a large number of intercurrent complications.
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Affiliation(s)
- Juan Carlos Caballero
- Hematology Department, Fundacion Jimenez Diaz University Hospital, 28040 Madrid, Spain
| | - Elham Askari
- Hematology Department, Fundacion Jimenez Diaz University Hospital, 28040 Madrid, Spain
| | - Nerea Carrasco
- Infectious Diseases Department, Fundacion Jimenez Diaz University Hospital, 28040 Madrid, Spain
| | - Miguel Angel Piris
- Pathology Department, Fundacion Jimenez Diaz University Hospital, 28040 Madrid, Spain
| | | | - Laura Pardo
- Hematology Department, Fundacion Jimenez Diaz University Hospital, 28040 Madrid, Spain
| | - Javier Cornago
- Hematology Department, Fundacion Jimenez Diaz University Hospital, 28040 Madrid, Spain
| | | | - Pilar Llamas
- Hematology Department, Fundacion Jimenez Diaz University Hospital, 28040 Madrid, Spain
| | - Laura Solan
- Hematology Department, Fundacion Jimenez Diaz University Hospital, 28040 Madrid, Spain
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Monzó-Gallo P, Chumbita M, Lopera C, Aiello TF, Peyrony O, Bodro M, Herrera S, Sempere A, Fernández-Pittol M, Cuesta G, Simó S, Benegas M, Fortuny C, Mensa J, Soriano A, Puerta-Alcalde P, Marco F, Garcia-Vidal C. Real-life epidemiology and current outcomes of hospitalized adults with invasive fungal infections. Med Mycol 2023; 61:7067261. [PMID: 36861308 DOI: 10.1093/mmy/myad021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Revised: 02/07/2023] [Accepted: 02/28/2023] [Indexed: 03/03/2023] Open
Abstract
We aimed to describe the current epidemiology of both hosts with invasive fungal infections (IFIs) and causative fungi. And, detail outcomes of these infections at 12 weeks in a real-life cohort of hospitalized patients. The study was retrospective and observational to describe IFI diagnosed in a tertiary hospital (February 2017-December 2021). We included all consecutive patients meeting criteria for proven or probable IFI according to EORTC-MSG and other criteria. A total of 367 IFIs were diagnosed. 11.7% were breakthrough infections, and 56.4% were diagnosed in the intensive care unit. Corticosteroid use (41.4%) and prior viral infection (31.3%) were the most common risk factors for IFI. Lymphoma and pneumocystis pneumonia were the most common baseline and fungal diseases. Only 12% of IFI occurred in patients with neutropenia. Fungal cultures were the most important diagnostic tests (85.8%). The most frequent IFIs were candidemia (42.2%) and invasive aspergillosis (26.7%). Azole-resistant Candida strains and non-fumigatus Aspergillus infections represented 36.1% and 44.5% of the cases, respectively. Pneumocystosis (16.9%), cryptococcosis (4.6%), and mucormycosis (2.7%) were also frequent, as well as mixed infections (3.4%). Rare fungi accounted for 9.5% of infections. Overall, IFI mortality at 12 weeks was 32.2%; higher rates were observed for Mucorales (55.6%), Fusarium (50%), and mixed infections (60%). We documented emerging changes in both hosts and real-life IFI epidemiology. Physicians should be aware of these changes to suspect infections and be aggressive in diagnoses and treatments. Currently, outcomes for such clinical scenarios remain extremely poor.
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Affiliation(s)
- Patricia Monzó-Gallo
- Department of Infectious Diseases, Hospital Clinic of Barcelona-IDIBAPS, University of Barcelona, Barcelona, Spain
| | - Mariana Chumbita
- Department of Infectious Diseases, Hospital Clinic of Barcelona-IDIBAPS, University of Barcelona, Barcelona, Spain
| | - Carlos Lopera
- Department of Infectious Diseases, Hospital Clinic of Barcelona-IDIBAPS, University of Barcelona, Barcelona, Spain
| | - Tommaso Francesco Aiello
- Department of Infectious Diseases, Hospital Clinic of Barcelona-IDIBAPS, University of Barcelona, Barcelona, Spain
| | - Oliver Peyrony
- Department of Infectious Diseases, Hospital Clinic of Barcelona-IDIBAPS, University of Barcelona, Barcelona, Spain
- Emergency Department, Hôpital Saint Louis, Paris, France
| | - Marta Bodro
- Department of Infectious Diseases, Hospital Clinic of Barcelona-IDIBAPS, University of Barcelona, Barcelona, Spain
| | - Sabina Herrera
- Department of Infectious Diseases, Hospital Clinic of Barcelona-IDIBAPS, University of Barcelona, Barcelona, Spain
| | - Abiu Sempere
- Department of Infectious Diseases, Hospital Clinic of Barcelona-IDIBAPS, University of Barcelona, Barcelona, Spain
| | | | - Genoveva Cuesta
- Department of Microbiology, Hospital Clinic of Barcelona, Barcelona, Spain
| | - Silvia Simó
- Department of Pediatrics, Hospital Sant Joan de Deu, Barcelona, Spain
| | - Mariana Benegas
- Department of Radiology, Hospital Clinic of Barcelona, Barcelona, Spain
| | - Claudia Fortuny
- Department of Pediatrics, Hospital Sant Joan de Deu, Barcelona, Spain
| | - Josep Mensa
- Department of Infectious Diseases, Hospital Clinic of Barcelona-IDIBAPS, University of Barcelona, Barcelona, Spain
| | - Alex Soriano
- Department of Infectious Diseases, Hospital Clinic of Barcelona-IDIBAPS, University of Barcelona, Barcelona, Spain
| | - Pedro Puerta-Alcalde
- Department of Infectious Diseases, Hospital Clinic of Barcelona-IDIBAPS, University of Barcelona, Barcelona, Spain
| | - Francesc Marco
- Department of Microbiology, Hospital Clinic of Barcelona, Barcelona, Spain
| | - Carolina Garcia-Vidal
- Department of Infectious Diseases, Hospital Clinic of Barcelona-IDIBAPS, University of Barcelona, Barcelona, Spain
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Rajni E, Jain A, Gupta S, Jangid Y, Vohra R. Risk Factors for Candidemia in Intensive Care Unit: A Matched Case Control Study from North-Western India. Acta Medica (Hradec Kralove) 2023; 65:83-88. [PMID: 36735885 DOI: 10.14712/18059694.2022.23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Candidemia is one of the significant causes of mortality amongst critically ill patients in Intensive Care Units (ICUs). This study aimed to assess the incidence, risk factors and antifungal susceptibility pattern in candidemia cases admitted in ICU in a tertiary care hospital in Jaipur, Rajasthan from June 2021 to November 2021. Candida species isolated from blood culture of clinically suspected patients of sepsis were defined as candidemia cases. Blood culture and antifungal susceptibility testing were performed as per standard laboratory protocol. Analyses of risk factors was done between candidemia cases and matched controls in a ratio of 1 : 3. Forty-six candidemic cases and 150 matched controls were included in the study. C. tropicalis was the most prevalent species (22/46; 48%) followed by C. auris (8/46; 17%) and C. albicans (7/46; 15%). Candida species showed good sensitivity to echinocandins (97%) followed by amphotericin B (87%) and voriconazole (80%). In multivariate analysis, longer stay in ICU, presence of an indwelling device, use of immunosuppressive drugs and positive SARS-CoV-2 infection were associated with increased risk of candidemia. The constant evaluation of risk factors is required as prediction of risks associated with candidemia may help to guide targeted preventive measures with reduced morbidity and mortality.
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Affiliation(s)
- Ekadashi Rajni
- Mahatma Gandhi Medical University and Science Technology, Riico Institutional Area, Sitapura, Tonk Road, Jaipur, Rajasthan, India
| | - Ashish Jain
- Mahatma Gandhi Medical University and Science Technology, Riico Institutional Area, Sitapura, Tonk Road, Jaipur, Rajasthan, India
| | - Shilpi Gupta
- Mahatma Gandhi Medical University and Science Technology, Riico Institutional Area, Sitapura, Tonk Road, Jaipur, Rajasthan, India.
| | - Yogita Jangid
- Mahatma Gandhi Medical University and Science Technology, Riico Institutional Area, Sitapura, Tonk Road, Jaipur, Rajasthan, India
| | - Rajat Vohra
- Mahatma Gandhi Medical University and Science Technology, Riico Institutional Area, Sitapura, Tonk Road, Jaipur, Rajasthan, India
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Vianna CMDM, Mosegui GBG, Rodrigues MPDS. Cost-effectiveness analysis and budgetary impact of anidulafungin treatment for patients with candidemia and other forms of invasive candidiasis in Brazil. Rev Inst Med Trop Sao Paulo 2023; 65:e9. [PMID: 36722671 PMCID: PMC9886225 DOI: 10.1590/s1678-9946202365009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2022] [Accepted: 12/13/2022] [Indexed: 02/02/2023] Open
Abstract
Candidemia and other forms of invasive candidiasis (C/IC) are serious conditions, especially for immunosuppressed individuals with prolonged hospitalization in intensive care units (ICU). This study analyzed the incremental cost-effectiveness and budgetary impact (BI) of treatment for IC with anidulafungin compared to amphotericin B lipid complex (ABLC) and amphotericin B deoxycholate (ABD) or conventional amphotericin B (CAB), in the Brazilian Unified Health System (SUS). A decision model was conducted with a time horizon of two weeks from the perspective of SUS. The primary effectiveness endpoints were survival and treatment response rate. All patients were followed up until successful therapy or death. BI analysis was performed based on the measured demand method. A five-year time horizon was adopted based on the number of hospitalizations (per 1,000 hospitalizations). For effectiveness measured in the successful response rate (SRR), anidulafungin dominated the ABLC and ABD formulations. In the results of the analysis with the effectiveness measured according to survival, anidulafungin had a better cost-effectiveness ratio (R$988.26/survival) compared to ABD (R$16,359.50/survival). The BI estimate related to the incorporation of anidulafungin suggests savings of approximately 148 million reais in 5 years when comparing it to ABD. The economic evaluation of anidulafungin and its comparators found it to be cost-effective. The consensus of international scientific societies recommends it as a first-line drug for IC, and its incorporation by SUS would be important.
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Affiliation(s)
- Cid Manso de Mello Vianna
- Universidade do Estado do Rio de Janeiro, Instituto de Medicina Social, Departamento de Política, Planejamento e Administração em Saúde, Rio de Janeiro, Rio de Janeiro, Brazil
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Hohmann FB, Chaves RCDF, Olivato GB, de Souza GM, Galindo VB, Silva Jr M, Martino MDV, de Menezes FG, Corrêa TD. Characteristics, risk factors, and outcomes of bloodstream Candida infections in the intensive care unit: a retrospective cohort study. J Int Med Res 2023; 51:3000605221131122. [PMID: 36659829 PMCID: PMC9893083 DOI: 10.1177/03000605221131122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
OBJECTIVE The main objective was to assess the clinical characteristics, associated factors, and outcomes of patients admitted to the ICU for candidemia. The secondary objective was to examine the relationship of candidemia with the length of stay and mortality. METHODS The analysis was a retrospective single-center cohort study addressing the effect of invasive candidemia on outcomes. This study was performed in a medical-surgical ICU located in a tertiary private hospital in São Paulo, Brazil. Data was collected through the review of the hospital database. RESULTS In total, 18,442 patients were included in our study, including 22 patients with candidemia. The median age was similar in patients with and without candidemia [67 (56-84) vs. 67 (51-80)]. Most patients were male, and the proportion of men was higher among patients with candidemia (77% vs. 55.3%). The rates of renal replacement therapy (40.9% vs. 3.3%), mechanical ventilation (63.6% vs. 29.6%), and parenteral nutrition (40.9% vs. 4.8%) were higher in patients with candidemia than in those without candidemia. The mortality rate (77.3% vs. 11.9%) and length of hospital stay [42 days (23.0-78.8) vs. 8 days (5.0-17.0)] were significantly higher in patients with candidemia. CONCLUSIONS Patients with candidemia are prone to longer hospital stay and mortality. In addition, we found associations of candidemia with the use of invasive mechanical ventilation, renal replacement therapy, and parenteral nutrition.
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Affiliation(s)
- Fábio Barlem Hohmann
- Department of Intensive Care Unit, Hospital Israelita Albert Einstein, São Paulo, Brazil,Fábio Barlem Hohmann, Intensive Care Unit, Hospital Israelita Albert Einstein, Av. Albert Einstein, 627/701, 5th floor, São Paulo, Brazil, ZIP CODE: 05651-901.
| | - Renato Carneiro de Freitas Chaves
- Department of Intensive Care Unit, Hospital Israelita Albert Einstein, São Paulo, Brazil,Department of Anesthesiology, Hospital Israelita Albert Einstein, São Paulo, Brazil,Takaoka Anestesia, São Paulo, Brazil
| | | | | | | | - Moacyr Silva Jr
- Department of Intensive Care Unit, Hospital Israelita Albert Einstein, São Paulo, Brazil,Department of Hospital Infection Control Service, Hospital Israelita Albert Einstein, São Paulo, Brazil
| | | | - Fernando Gatti de Menezes
- Department of Hospital Infection Control Service, Hospital Israelita Albert Einstein, São Paulo, Brazil
| | - Thiago Domingos Corrêa
- Department of Intensive Care Unit, Hospital Israelita Albert Einstein, São Paulo, Brazil
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Keck JM, Cretella DA, Stover KR, Wagner JL, Barber KE, Jhaveri TA, Vijayvargiya P, Garrigos ZE, Wingler MJB. Evaluation of an Antifungal Stewardship Initiative Targeting Micafungin at an Academic Medical Center. Antibiotics (Basel) 2023; 12:antibiotics12020193. [PMID: 36830104 PMCID: PMC9952013 DOI: 10.3390/antibiotics12020193] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2022] [Revised: 01/12/2023] [Accepted: 01/13/2023] [Indexed: 01/19/2023] Open
Abstract
Delays in the treatment of proven invasive fungal disease have been shown to be harmful. However, empiric treatment for all patients at risk of infection has not demonstrated benefit. This study evaluates the effects of a micafungin stewardship initiative on the duration of therapy and clinical outcomes at the University of Mississippi Medical Center in Jackson, Mississippi. This single-center quasi-experiment evaluated patients who received micafungin. Adult inpatients who received at least one treatment dose of micafungin in the pre-intervention (1 October 2020 to 30 September 2021) or post-intervention (1 October 2021 to 30 April 2022) groups were included. Patients were placed on micafungin for prophylaxis and those who required definitive micafungin therapy were excluded. An algorithm was used to provide real-time recommendations in order to assess change in the treatment days of micafungin therapy. A total of 282 patients were included (141 pre-group versus 141 post-group). Over 80% of the patients included in the study were in an intensive care unit, and other baseline characteristics were similar. The median number of treatment days with micafungin was 4 [IQR 3-6] in the pre-group and 3 [IQR 2-6] in the post-group (p = 0.005). Other endpoints, such as time to discontinuation or de-escalation, hospital mortality, and hospital length of stay, were not significantly different between the groups. An antifungal stewardship initiative can be an effective way to decrease unnecessary empiric antifungal therapy for patients who are at risk of invasive fugal disease.
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Affiliation(s)
- J. Myles Keck
- Department of Pharmacy, University of Arkansas for Medical Sciences, Little Rock, AR 72205, USA
| | - David A. Cretella
- Division of Infectious Diseases, University of Mississippi Medical Center, Jackson, MS 39216, USA
| | - Kayla R. Stover
- Department of Pharmacy Practice, University of Mississippi School of Pharmacy, Jackson, MS 39216, USA
- Correspondence:
| | - Jamie L. Wagner
- Department of Pharmacy Practice, University of Mississippi School of Pharmacy, Jackson, MS 39216, USA
| | - Katie E. Barber
- Department of Pharmacy Practice, University of Mississippi School of Pharmacy, Jackson, MS 39216, USA
| | - Tulip A. Jhaveri
- Division of Infectious Diseases, University of Mississippi Medical Center, Jackson, MS 39216, USA
| | - Prakhar Vijayvargiya
- Division of Infectious Diseases, University of Mississippi Medical Center, Jackson, MS 39216, USA
| | - Zerelda Esquer Garrigos
- Division of Infectious Diseases, University of Mississippi Medical Center, Jackson, MS 39216, USA
| | - Mary Joyce B. Wingler
- Division of Infectious Diseases, University of Mississippi Medical Center, Jackson, MS 39216, USA
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Piao J, Li N, Zhang L, Meng H, Sun Q, He Z. Quantitatively detecting Candida albicans enolase1 with a one-step double monoclonal antibody sandwich ELISA assay. Front Microbiol 2023; 14:1078709. [PMID: 36891387 PMCID: PMC9986313 DOI: 10.3389/fmicb.2023.1078709] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Accepted: 01/30/2023] [Indexed: 02/22/2023] Open
Abstract
Invasive candidiasis (IC) is often a cause of severe concern for the hospitalized patients, particularly those who are critically sick. However management of this disease is challenging due to a lack of effective laboratory diagnostic techniques. Hence, we have developed a one-step double antibody sandwich enzyme-linked immunosorbent assay (DAS-ELISA) using a pair of specific monoclonal antibodies (mAbs) for the quantitative detection of Candida albicans enolase1 (CaEno1), which is considered as an important diagnostic biomarker for IC. The diagnostic efficiency of the DAS-ELISA was evaluated by using a rabbit model of systemic candidiasis and compared with other assays. The method validation results demonstrated that the developed method was sensitive, reliable, and feasible. The findings of the rabbit model plasma analysis indicated that the diagnostic efficiency of the CaEno1 detection assay was better in comparison to the (1,3)-β-D-glucan detection and blood culture. CaEno1 is present in the blood of infected rabbits for a brief period and at relatively low levels and thus the combination of CaEno1 antigen and IgG antibodies detection could aid to increase diagnostic efficiency. However, to improve the clinical application of CaEno1 detection in the future, efforts should be made to increase the detection limit of the test by promoting technical developments and by optimizing the protocol for the clinical serial determinations.
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Affiliation(s)
- Jingzi Piao
- College of Plant Protection, Shenyang Agricultural University, Shenyang, Liaoning, China
| | - Ning Li
- Shenyang Institute for Food and Drug Control, Shenyang, Liaoning, China
| | - Lina Zhang
- Basic Medicine Laboratory, Bethune International Peace Hospital, Shijiazhuang, Hebei, China
| | - Hanbing Meng
- Basic Medicine Laboratory, Bethune International Peace Hospital, Shijiazhuang, Hebei, China
| | - Qingqing Sun
- Basic Medicine Laboratory, Bethune International Peace Hospital, Shijiazhuang, Hebei, China
| | - Zhengxin He
- Basic Medicine Laboratory, Bethune International Peace Hospital, Shijiazhuang, Hebei, China
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Boonstra JM, van der Elst KC, Zijlstra JG, van der Werf TS, Alffenaar JWC, Touw DJ. Population Pharmacokinetic Model and Optimal Sampling Strategies for Micafungin in Critically Ill Patients Diagnosed with Invasive Candidiasis. Antimicrob Agents Chemother 2022; 66:e0111322. [PMID: 36377940 DOI: 10.1128/aac.01113-22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Candida bloodstream infections are associated with high attributable mortality, where early initiation of adequate antifungal therapy is important to increase survival in critically ill patients. The exposure variability of micafungin, a first-line agent used for the treatment of invasive candidiasis, in critically ill patients is significant, potentially resulting in underexposure in a substantial portion of these patients. The objective of this study was to develop a population pharmacokinetic model including appropriate sampling strategies for assessing micafungin drug exposure in critically ill patients to support adequate area under the concentration-time curve (AUC) determination. A two-compartment pharmacokinetic model was developed using data from intensive care unit (ICU) patients (n = 19), with the following parameters: total body clearance (CL), volume of distribution of the central compartment (V1), inter-compartmental clearance (CL12), and volume of distribution of the peripheral compartment (V2). The final model was evaluated with bootstrap analysis and the goodness-of-fit plots for the population and individual predicted micafungin plasma concentrations. Optimal sampling strategies (with sampling every hour, 24 h per day) were developed with 1- and 2-point sampling schemes. Final model parameters (±SD) were: CL = 1.03 (0.37) (L/h/1.85 m2), V1 = 0.17 (0.07) (L/kg LBMc), CL12 = 1.80 (4.07) (L/h/1.85 m2), and V2 = 0.12 (0.06) (L/kg LBMc). Sampling strategies with acceptable accuracy and precision were developed to determine the micafungin AUC. The developed model with optimal sampling procedures provides the opportunity to achieve quick optimization of the micafungin exposure from a single blood sample using Bayesian software and may be helpful in guiding early dose decision-making.
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Singh S, Kanaujia R, Agnihotri S, Kaur H, Chakrabarti A, Rudramurthy SM. The Comparative Evaluation of the Fujifilm Wako β-Glucan Assay and Fungitell Assay for Diagnosing Invasive Fungal Disease. J Fungi (Basel) 2022; 9. [PMID: 36675827 DOI: 10.3390/jof9010006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2022] [Revised: 12/03/2022] [Accepted: 12/12/2022] [Indexed: 12/24/2022] Open
Abstract
Serum 1,3-β-d-glucan(BDG) is a broad fungal biomarker for invasive fungal disease (IFD). More data is still required to support the Fujifilm Wako assay as a valuable alternative to the widely used Fungitell assay. We included archived serum samples from 157 individuals (97 cases; 33-IA, 64-IC, and 60 controls) for the comparative performance evaluation of the Fungitell assay and the Fujifilm Wako assay for IFD diagnosis. The BDG value was significantly higher in patients with IFD vs. controls (70.79 pg/mL vs. 3.03 pg/mL, p: 0.0002). An area under the curve (AUC) for the IFD, IC, and IA diagnosis was 0.895, 0.910, and 0.866, respectively, for the Fujifilm Wako assay. Based on the highest Youden’s index (0.667), a cutoff of 5 pg/mL was selected as the optimum for the Fujifilm Wako assay with good sensitivity (79.4%), specificity (88.3%) and agreement (84.7%, Cohen’s k:0.691) with the Fungitell assay. The mean run-time of the Fujifilm Wako assay was 70.12 min, and real-time observation allowed earlier time to result in Fujifilm Wako vs. Fungitell assay (37 vs. 120 min, p: < 0.0001). Thus, our findings support the diagnostic value of the Fujifilm Wako assay for the diagnosis of IFD. However, there is still a need to validate diagnostic protocols to optimize their use in multi-centre studies with different patient groups.
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Rodrigues LS, Siqueira AC, Spalanzani RN, Vasconcelos TM, Sestren B, Bispo SP, Abreu RBV, Kraft L, Ricieri MC, Motta FA, Dalla-Costa LM. Genotypic Diversity of Candida parapsilosis Complex in Invasive Candidiasis at a Pediatric Tertiary Hospital: A 5-Year Retrospective Study. J Fungi (Basel) 2022; 8. [PMID: 36547613 DOI: 10.3390/jof8121280] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2022] [Revised: 12/01/2022] [Accepted: 12/03/2022] [Indexed: 12/12/2022] Open
Abstract
Invasive candidiasis (IC) contributes to the morbidity and mortality of hospitalized patients and represents a significant burden to the healthcare system. Previous Brazilian studies have reported the presence of endemic Candida parapsilosis sensu stricto genotypes causing candidemia and clonal transmission involving fluconazole-resistant isolates. We performed a 5-year retrospective analysis of IC cases in a Brazilian tertiary pediatric hospital and conducted a molecular investigation of C. parapsilosis sensu stricto. Non-duplicate C. parapsilosis sensu stricto genotyping was performed by microsatellite analysis. Antifungal susceptibility and biofilm formation were also evaluated. A total of 123 IC episodes were identified, with an IC incidence of 1.24 cases per 1000 hospital admissions and an overall mortality of 34%. The main species were the C. parapsilosis complex (35.8%), Candida albicans (29.2%), and Candida tropicalis (21.9%). All C. parapsilosis sensu stricto were recovered from blood cultures, and 97.5% were biofilm producers. Microsatellite typing identified high genotypic diversity among the isolates. We observed that all isolates were sensitive to amphotericin B, and although one isolate was non-sensitive to fluconazole, only a silent mutation on ERG11 gene was identified. No clear evidence of clonal outbreak or emergence of fluconazole-resistant isolates was found, suggesting that multiple sources may be involved in the epidemiology of IC in children.
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Zhang T, Shen Y, Feng S. Clinical research advances of isavuconazole in the treatment of invasive fungal diseases. Front Cell Infect Microbiol 2022; 12:1049959. [PMID: 36530445 PMCID: PMC9751058 DOI: 10.3389/fcimb.2022.1049959] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2022] [Accepted: 11/16/2022] [Indexed: 12/02/2022] Open
Abstract
Purpose Invasive fungal diseases (IFD) are a major global public health concern. The incidence of IFD has increased the demand for antifungal agents. Isavuconazole (ISA) is a new triazole antifungal agent that has shown promising efficacy in the prophylaxis and treatment of invasive fungal diseases. The aim of this review is to summarize the recent real-world experiences of using ISA for the treatment and prevention of IFD. Methods We performed a comprehensive literature search of the MEDLINE, PubMed, Embase, and Cochrane databases for clinical applications of ISA in the real world. Tables and reference lists are presented for this systematic review. Results IFD poses a major threat to public health and causes high mortality rates. ISA may provide a good treatment. For example, the efficacy of ISA in the treatment of invasive aspergillosis (IA) is comparable to that of voriconazole, and its efficacy in the treatment of invasive mucormycosis (IM) is similar to that of liposomal amphotericin B (L-AmB); therefore, ISA is recommended as the first-line treatment for IA and IM. ISA can also achieve good efficacy in the treatment of invasive candidiasis (IC) and can be used as an alternative to de-escalation therapy after first-line drug therapy. In addition, most studies have shown the efficacy and safety of ISA for the prophylaxis of IFD. Conclusion Taken together, ISA are expected to become a new choice for the treatment and prevention of IFD because of their good tolerability, high bioavailability, and few drug interactions.
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Affiliation(s)
- Tingting Zhang
- State Key Laboratory of Experimental Hematology, National Clinical Research Center for Blood Diseases, Haihe Laboratory of Cell Ecosystem, Institute of Hematology and Blood Diseases Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Tianjin, China,Hematopoietic Stem Cell Transplantation Center, Tianjin Institutes of Health Science, Tianjin, China
| | - Yuyan Shen
- State Key Laboratory of Experimental Hematology, National Clinical Research Center for Blood Diseases, Haihe Laboratory of Cell Ecosystem, Institute of Hematology and Blood Diseases Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Tianjin, China,Hematopoietic Stem Cell Transplantation Center, Tianjin Institutes of Health Science, Tianjin, China
| | - Sizhou Feng
- State Key Laboratory of Experimental Hematology, National Clinical Research Center for Blood Diseases, Haihe Laboratory of Cell Ecosystem, Institute of Hematology and Blood Diseases Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Tianjin, China,Hematopoietic Stem Cell Transplantation Center, Tianjin Institutes of Health Science, Tianjin, China,*Correspondence: Sizhou Feng,
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De Bels D, Maillart E, Van Bambeke F, Redant S, Honoré PM. Existing and emerging therapies for the treatment of invasive candidiasis and candidemia. Expert Opin Emerg Drugs 2022; 27:405-416. [PMID: 36317695 DOI: 10.1080/14728214.2022.2142207] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
INTRODUCTION Invasive candidiasis or candidemia is a severe infection affecting more than 250,000 people worldwide every year. It is present in up to 16% of ICU patients. The prognosis of these infections is unfavorable, with global death estimated around 50,000 per year, which corresponds to up to 40% depending on patient severity and comorbidities. Therapeutic failure is not rare due to the emergence of multiresistant strains and of new species poorly responsive to current therapies like Candida auris. AREAS COVERED We first review the positioning of antifungal drugs used to treat candidiasis, namely polyenes, azoles, echinocandins and pyrimidine analogues. We then discuss the progresses brought by new formulations, new derivatives within these classes, compounds acting on new targets or repurposed drugs in terms of pharmacokinetic profile, spectrum of activity, potency, safety or risk of drug-drug interactions. EXPERT OPINION While new formulations (amphotericin B cochleate) improve oral bioavailability of the corresponding drugs, new azoles or echinocandins offer higher potency including against strains resistant to former generations of drugs. Repurposed drugs show synergism with current therapies in vitro. Results from ongoing and future clinical trials will be decisive to establish the interest for these drugs in our arsenal.
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Affiliation(s)
- David De Bels
- Intensive Care Department, Brugmann University Hospital, Brussels, Belgium
| | - Evelyne Maillart
- Department of Infectious Disease, Brugmann University Hospital, Brussels, Belgium
| | - Françoise Van Bambeke
- Louvain Drug Research Institute, Department of Pharmacology, Université Catholique de Louvain, Brussels, Belgium
| | - Sebastien Redant
- Intensive Care Department, Brugmann University Hospital, Brussels, Belgium
| | - Patrick M Honoré
- Intensive Care Department, Brugmann University Hospital, Brussels, Belgium.,Faculty of Medicine, Université Libre de Bruxelles, Brussels, Belgium.,Department of ICU, CHU UCL Godinne-Namur, UCL Louvain Medical School
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Bongomin F, Ekeng BE, Kibone W, Nsenga L, Olum R, Itam-Eyo A, Kuate MPN, Pebolo FP, Davies AA, Manga M, Ocansey B, Kwizera R, Baluku JB. Invasive Fungal Diseases in Africa: A Critical Literature Review. J Fungi (Basel) 2022; 8:jof8121236. [PMID: 36547569 PMCID: PMC9853333 DOI: 10.3390/jof8121236] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Revised: 11/15/2022] [Accepted: 11/18/2022] [Indexed: 11/23/2022] Open
Abstract
Invasive fungal diseases (IFDs) are of huge concern in resource-limited settings, particularly in Africa, due to the unavailability of diagnostic armamentarium for IFDs, thus making definitive diagnosis challenging. IFDs have non-specific systemic manifestations overlapping with more frequent illnesses, such as tuberculosis, HIV, and HIV-related opportunistic infections and malignancies. Consequently, IFDs are often undiagnosed or misdiagnosed. We critically reviewed the available literature on IFDs in Africa to provide a better understanding of their epidemiology, disease burden to guide future research and interventions. Cryptococcosis is the most encountered IFD in Africa, accounting for most of the HIV-related deaths in sub-Saharan Africa. Invasive aspergillosis, though somewhat underdiagnosed and/or misdiagnosed as tuberculosis, is increasingly being reported with a similar predilection towards people living with HIV. More cases of histoplasmosis are also being reported with recent epidemiological studies, particularly from Western Africa, showing high prevalence rates amongst presumptive tuberculosis patients and patients living with HIV. The burden of pneumocystis pneumonia has reduced significantly probably due to increased uptake of anti-retroviral therapy among people living with HIV both in Africa, and globally. Mucormycosis, talaromycosis, emergomycosis, blastomycosis, and coccidiomycosis have also been reported but with very few studies from the literature. The emergence of resistance to most of the available antifungal drugs in Africa is yet of huge concern as reported in other regions. IFDs in Africa is much more common than it appears and contributes significantly to morbidity and mortality. Huge investment is needed to drive awareness and fungi related research especially in diagnostics and antifungal therapy.
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Affiliation(s)
- Felix Bongomin
- Department of Medical Microbiology and Immunology, Faculty of Medicine, Gulu University, Gulu P.O. Box 166, Uganda
- Correspondence:
| | - Bassey E. Ekeng
- Department of Medical Microbiology and Parasitology, University of Calabar Teaching Hospital, Calabar P.O. Box 540281, Nigeria
| | - Winnie Kibone
- Department of Medicine, School of Medicine, Makerere University, Kampala P.O. Box 7072, Uganda
| | - Lauryn Nsenga
- Department of Medicine, School of Medicine, Kabale University, Kabale P.O. Box 317, Uganda
| | - Ronald Olum
- Department of Medicine, St. Francis’s Hospital Nsambya, Kampala P.O. Box 7176, Uganda
| | - Asa Itam-Eyo
- Department of Internal Medicine, University of Calabar Teaching Hospital, Calabar P.O. Box 540281, Nigeria
| | | | - Francis Pebalo Pebolo
- Department of Reproductive Health, Faculty of Medicine, Gulu University, Gulu P.O. Box 166, Uganda
| | - Adeyinka A. Davies
- Department of Medical Microbiology and Parasitology, Olabisi Onabanjo University Teaching Hospital, Sagamu P.O. Box 121102, Nigeria
| | - Musa Manga
- Department of Environmental Sciences and Engineering, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, 4114 McGavran-Greenberg, 135 Dauer Drive, Chapel Hill, NC 27599, USA
| | - Bright Ocansey
- Division of Evolution, Infection and Genomics, Faculty of Biology, Medicine and Health, University of Manchester, Manchester M13 9PL, UK
| | - Richard Kwizera
- Translational Research Laboratory, Department of Research, Infectious Diseases Institute, College of Health Sciences, Makerere University, Kampala P.O. Box 22418, Uganda
| | - Joseph Baruch Baluku
- Division of Pulmonology, Kiruddu National Referral Hospital, Kampala P.O. Box 7178, Uganda
- Makerere Lung Institute, College of Health Sciences, Makerere University, Kampala P.O. Box 22418, Uganda
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Kanj SS, Omrani AS, Al-Abdely HM, Subhi A, Fakih RE, Abosoudah I, Kanj H, Dimopoulos G. Survival Outcome of Empirical Antifungal Therapy and the Value of Early Initiation: A Review of the Last Decade. J Fungi (Basel) 2022; 8:1146. [PMID: 36354913 PMCID: PMC9695378 DOI: 10.3390/jof8111146] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Revised: 10/17/2022] [Accepted: 10/19/2022] [Indexed: 10/03/2023] Open
Abstract
AIM This rapid systematic review aimed to collect the evidence published over the last decade on the effect of empirical antifungal therapy and its early initiation on survival rates. METHODS A systematic search was conducted in PubMed, Cochrane, Medline, Scopus, and Embase, in addition to a hand search and experts' suggestions. RESULTS Fourteen cohort studies and two randomized clinical trials reporting the survival outcome of empirical antifungal therapy were included in this review. Two studies reported the association between early empirical antifungal therapy (EAFT) and survival rates in a hematological cancer setting, and fourteen studies reported the outcome in patients in intensive care units (ICU). Six studies reported that appropriate EAFT decreases hospital mortality significantly; ten studies could not demonstrate a statistically significant association with mortality rates. DISCUSSION The inconsistency of the results in the literature can be attributed to the studies' small sample size and their heterogeneity. Many patients who may potentially benefit from such strategies were excluded from these studies. CONCLUSION While EAFT is practiced in many settings, current evidence is conflicting, and high-quality studies are needed to demonstrate the true value of this approach. Meanwhile, insights from experts in the field can help guide clinicians to initiate EAFT when indicated.
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Affiliation(s)
- Souha S. Kanj
- Division of Infectious Diseases, Department of Internal Medicine, American University of Beirut Medical Center, Riad El Solh, Beirut P.O. Box 11-0236, Lebanon
| | - Ali S. Omrani
- Division of Infectious Diseases, Department of Medicine, Hamad Medical Corporation, Doha P.O. Box 3050, Qatar
- College of Medicine, Qatar University, Doha P.O. Box 2713, Qatar
| | - Hail M. Al-Abdely
- Division of Infectious Diseases, Department of Medicine, King Faisal Specialist Hospital and Research Centre, Riyadh 11211, Saudi Arabia
| | - Ahmad Subhi
- Division of Infectious Disease, Al-Qassimi Hospital, Emirates Health Services, Sharjah 61313, United Arab Emirates
| | - Riad El Fakih
- Department of Hematology, Stem Cell Transplant & Cellular Therapy, King Faisal Specialist Hospital and Research Centre, Riyadh 11211, Saudi Arabia
| | - Ibraheem Abosoudah
- Department of Oncology, King Faisal Specialist Hospital and Research Center, MBC J-64, Jeddah 21499, Saudi Arabia
| | - Hazar Kanj
- Faculty of Medicine, American University of Beirut Medical Center, Beirut P.O. Box 11-0236, Lebanon
| | - George Dimopoulos
- Department of Critical Care, “EVGENIDIO” Hospital, National and Kapodistrian University of Athens (NKUA), 10679 Athens, Greece
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Price JS, Fallon M, Posso R, Backx M, White PL. An Evaluation of the OLM CandID Real-Time PCR to Aid in the Diagnosis of Invasive Candidiasis When Testing Serum Samples. J Fungi (Basel) 2022; 8. [PMID: 36135660 DOI: 10.3390/jof8090935] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Revised: 08/23/2022] [Accepted: 09/01/2022] [Indexed: 11/17/2022] Open
Abstract
Background: Treatment for invasive candidiasis (IC) is time-critical, and culture-based tests can limit clinical utility. Nonculture-based methods such as Candida PCR represent a promising approach to improving patient management but require further evaluation to understand their optimal role and incorporation into clinical algorithms. This study determined the performance of the commercially available OLM CandID real-time PCR when testing serum and developed a diagnostic algorithm for IC. Methods: The study comprised a retrospective performance evaluation of the CandID real-time PCR assay when testing surplus serum (n = 83 patients, 38 with IC), followed by a prospective consecutive cohort evaluation (n = 103 patients, 24 with IC) post incorporation into routine service. A combined diagnostic algorithm, also including (1-3)-β-D-Glucan testing, was generated. Results: Prospective CandID testing generated a sensitivity/specificity of 88%/82%, respectively. Specificity was improved (>95%) when both PCR replicates were positive and/or the patient had multiple positive samples. When combining CandID with (1-3)-β-D-Glucan testing, the probability of IC when both were positive or negative was >69% or <1%, respectively. Conclusions: The CandID provides excellent performance and a rapid time-to-result using methods widely available in generic molecular diagnostic laboratories. By combining nonculture diagnostics, it may be possible to accurately confirm or exclude IC.
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Giacobbe DR, Asperges E, Cortegiani A, Grecchi C, Rebuffi C, Zuccaro V, Scudeller L, Bassetti M. Performance of existing clinical scores and laboratory tests for the diagnosis of invasive candidiasis in critically ill, nonneutropenic, adult patients: a systematic review with qualitative evidence synthesis. Mycoses 2022; 65:1073-1111. [PMID: 35938455 DOI: 10.1111/myc.13515] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Accepted: 08/03/2022] [Indexed: 11/27/2022]
Abstract
BACKGROUND The Fungal Infections Definitions in Intensive Care Unit (ICU) patients (FUNDICU) project aims to provide standard sets of definitions for invasive fungal diseases in critically ill, adult patients. OBJECTIVES To summarize the available evidence on the diagnostic performance of clinical scores and laboratory tests for invasive candidiasis (IC) in nonneutropenic, adult critically ill patients. METHODS A systematic review was performed to evaluate studies assessing the diagnostic performance for IC of clinical scores and/or laboratory tests vs. a reference standard or a reference definition in critically ill, nonneutropenic, adult patients in ICU. RESULTS Clinical scores, despite the heterogeneity of study populations and IC prevalences, constantly showed a high negative predictive value (NPV) and a low positive predictive value (PPV) for the diagnosis of IC in the target population. Fungal antigen-based biomarkers (with most studies assessing serum beta-D-glucan) retained a high NPV similar to that of clinical scores, with a higher PPV, although the latter showed important heterogeneity across studies, possibly reflecting the targeted or untargeted use of these tests in patients with a consistent clinical picture and risk factors for IC. CONCLUSIONS Both clinical scores and laboratory tests showed high NPV for the diagnosis of IC in nonneutropenic critically ill patients. The PPV of laboratory tests varies significantly according to the baseline patients' risk of IC. This qualitative synthesis will provide the FUNDICU panel with baseline evidence to be considered during the development of definitions of IC in critically ill, nonneutropenic adult patients in ICU.
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Affiliation(s)
- Daniele Roberto Giacobbe
- Department of Health Sciences, University of Genoa, Genoa, Italy.,Clinica Malattie Infettive, Ospedale Policlinico San Martino - IRCCS, Genoa, Italy
| | - Erika Asperges
- Infectious Diseases Unit, IRCCS San Matteo, Pavia, Italy
| | - Andrea Cortegiani
- Department of Surgical, Oncological and Oral Science (Di.Chir.On.S.), University of Palermo, Palermo, Italy.,Department of Anesthesia, Intensive Care and Emergency, Policlinico Paolo Giaccone, Palermo, Italy
| | | | - Chiara Rebuffi
- Scientific Direction, IRCCS Istituto Giannina Gaslini, Scientific Direction, Italy
| | | | - Luigia Scudeller
- Research and Innovation Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Matteo Bassetti
- Department of Health Sciences, University of Genoa, Genoa, Italy.,Clinica Malattie Infettive, Ospedale Policlinico San Martino - IRCCS, Genoa, Italy
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Drummond RA, Desai JV, Ricotta EE, Swamydas M, Deming C, Conlan S, Quinones M, Matei-Rascu V, Sherif L, Lecky D, Lee CCR, Green NM, Collins N, Zelazny AM, Prevots DR, Bending D, Withers D, Belkaid Y, Segre JA, Lionakis MS. Long-term antibiotic exposure promotes mortality after systemic fungal infection by driving lymphocyte dysfunction and systemic escape of commensal bacteria. Cell Host Microbe 2022; 30:1020-1033.e6. [PMID: 35568028 PMCID: PMC9283303 DOI: 10.1016/j.chom.2022.04.013] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2021] [Revised: 03/08/2022] [Accepted: 04/20/2022] [Indexed: 12/15/2022]
Abstract
Antibiotics are a modifiable iatrogenic risk factor for the most common human nosocomial fungal infection, invasive candidiasis, yet the underlying mechanisms remain elusive. We found that antibiotics enhanced the susceptibility to murine invasive candidiasis due to impaired lymphocyte-dependent IL-17A- and GM-CSF-mediated antifungal immunity within the gut. This led to non-inflammatory bacterial escape and systemic bacterial co-infection, which could be ameliorated by IL-17A or GM-CSF immunotherapy. Vancomycin alone similarly enhanced the susceptibility to invasive fungal infection and systemic bacterial co-infection. Mechanistically, vancomycin reduced the frequency of gut Th17 cells associated with impaired proliferation and RORγt expression. Vancomycin's effects on Th17 cells were indirect, manifesting only in vivo in the presence of dysbiosis. In humans, antibiotics were associated with an increased risk of invasive candidiasis and death after invasive candidiasis. Our work highlights the importance of antibiotic stewardship in protecting vulnerable patients from life-threatening infections and provides mechanistic insights into a controllable iatrogenic risk factor for invasive candidiasis.
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Affiliation(s)
- Rebecca A Drummond
- Fungal Pathogenesis Section, Laboratory of Clinical Immunology and Microbiology (LCIM), National Institute of Allergy & Infectious Diseases (NIAID), National Institutes of Health (NIH), Bethesda, MD 20892, USA; Institute of Immunology & Immunotherapy, Institute of Microbiology & Infection, University of Birmingham, Birmingham, B15 2TT, UK.
| | - Jigar V Desai
- Fungal Pathogenesis Section, Laboratory of Clinical Immunology and Microbiology (LCIM), National Institute of Allergy & Infectious Diseases (NIAID), National Institutes of Health (NIH), Bethesda, MD 20892, USA
| | - Emily E Ricotta
- Fungal Pathogenesis Section, Laboratory of Clinical Immunology and Microbiology (LCIM), National Institute of Allergy & Infectious Diseases (NIAID), National Institutes of Health (NIH), Bethesda, MD 20892, USA
| | - Muthulekha Swamydas
- Fungal Pathogenesis Section, Laboratory of Clinical Immunology and Microbiology (LCIM), National Institute of Allergy & Infectious Diseases (NIAID), National Institutes of Health (NIH), Bethesda, MD 20892, USA
| | - Clay Deming
- Microbial Genomics Section, Translational and Functional Genomics Branch, National Human Genome Research Institute, NIH, Bethesda, MD 20892, USA
| | - Sean Conlan
- Microbial Genomics Section, Translational and Functional Genomics Branch, National Human Genome Research Institute, NIH, Bethesda, MD 20892, USA
| | - Mariam Quinones
- Bioinformatics and Computational Bioscience Branch, NIAID, NIH, Bethesda, MD 20892, USA
| | - Veronika Matei-Rascu
- Institute of Immunology & Immunotherapy, Institute of Microbiology & Infection, University of Birmingham, Birmingham, B15 2TT, UK
| | - Lozan Sherif
- Institute of Immunology & Immunotherapy, Institute of Microbiology & Infection, University of Birmingham, Birmingham, B15 2TT, UK
| | - David Lecky
- Institute of Immunology & Immunotherapy, Institute of Microbiology & Infection, University of Birmingham, Birmingham, B15 2TT, UK
| | - Chyi-Chia R Lee
- Laboratory of Pathology, Center for Cancer Research, National Cancer Institute, NIH, Bethesda, MD 20892, USA
| | - Nathaniel M Green
- Fungal Pathogenesis Section, Laboratory of Clinical Immunology and Microbiology (LCIM), National Institute of Allergy & Infectious Diseases (NIAID), National Institutes of Health (NIH), Bethesda, MD 20892, USA
| | - Nicholas Collins
- Metaorganism Immunity Section, Laboratory of Host Immunity and Microbiome, NIAID, NIH, Bethesda, MD 20892, USA
| | - Adrian M Zelazny
- Department of Laboratory Medicine, NIH Clinical Center, NIH, Bethesda, MD 20892, USA
| | - D Rebecca Prevots
- Fungal Pathogenesis Section, Laboratory of Clinical Immunology and Microbiology (LCIM), National Institute of Allergy & Infectious Diseases (NIAID), National Institutes of Health (NIH), Bethesda, MD 20892, USA
| | - David Bending
- Institute of Immunology & Immunotherapy, Institute of Microbiology & Infection, University of Birmingham, Birmingham, B15 2TT, UK
| | - David Withers
- Institute of Immunology & Immunotherapy, Institute of Microbiology & Infection, University of Birmingham, Birmingham, B15 2TT, UK
| | - Yasmine Belkaid
- Metaorganism Immunity Section, Laboratory of Host Immunity and Microbiome, NIAID, NIH, Bethesda, MD 20892, USA; NIAID Microbiome Program, NIAID, NIH, Bethesda, MD 20892, USA
| | - Julia A Segre
- Microbial Genomics Section, Translational and Functional Genomics Branch, National Human Genome Research Institute, NIH, Bethesda, MD 20892, USA
| | - Michail S Lionakis
- Fungal Pathogenesis Section, Laboratory of Clinical Immunology and Microbiology (LCIM), National Institute of Allergy & Infectious Diseases (NIAID), National Institutes of Health (NIH), Bethesda, MD 20892, USA.
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Smith B, Rajapakse N, Sauer HE, Ellsworth K, Dinnes L, Madigan T. A Quality Improvement Project Aimed at Standardizing the Prescribing of Fluconazole Prophylaxis in a Level IV Neonatal Intensive Care Unit. Pediatr Qual Saf 2022; 7:e579. [PMID: 38585424 PMCID: PMC10997225 DOI: 10.1097/pq9.0000000000000579] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2021] [Accepted: 06/27/2022] [Indexed: 11/26/2022] Open
Abstract
Introduction Invasive candidiasis has a high morbidity and mortality among premature neonates. Antifungal prophylaxis with fluconazole significantly lowers the risk of invasive fungal infection in this population. We noted the use of fluconazole prophylaxis in our level IV neonatal intensive care unit (NICU) was variable and sought to standardize prescribing of prophylactic fluconazole. Methods We formed a multidisciplinary team to develop an evidence-based protocol using literature and expert consensus to guide appropriate use of fluconazole prophylaxis in our level IV NICU. After determining baseline fluconazole prophylaxis prescribing before protocol implementation, we used plan-do-study-act (PDSA) cycles to introduce protocolized prescribing and incorporate it into daily practice. A 6-month intervention phase was followed by a 2-year control phase, in which monthly audits were performed to evaluate protocol adherence. Results were displayed in a statistical process control chart. Results Before protocol implementation, fluconazole prophylaxis prescribing adhered to the protocol in 81% of patients. During the first PDSA cycle, adherence increased significantly to 94.5% (86/91 patients), which further increased to 98.7% (74/75 patients) during the second PDSA cycle and remained at 96% (120/125 patients) during the control phase (P < 0.0001). Conclusions A multidisciplinary group-designed protocol was successful in standardizing fluconazole prophylaxis prescribing for infants in the level IV NICU. Adherence to protocol was high following implementation and was sustained for the duration of the project. There were no cases of invasive candidiasis noted.
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Affiliation(s)
- Brandi Smith
- From the Department of Pharmacy, Mayo Clinic, Rochester, Minnesota
| | - Nipunie Rajapakse
- Division of Pediatric Infectious Diseases, Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, Minnesota
| | - Hannah E. Sauer
- Pharmacy Department, Texas Children’s Hospital, Houston, Texas
| | | | - Laura Dinnes
- From the Department of Pharmacy, Mayo Clinic, Rochester, Minnesota
| | - Theresa Madigan
- Division of Pediatric Infectious Diseases, Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, Minnesota
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Ferreras-Antolin L, Aziz N, Warris A. Serial (1-3)-beta-D-Glucan (BDG) monitoring shows high variability among premature neonates. Med Mycol 2022; 60:6585657. [PMID: 35561703 DOI: 10.1093/mmy/myac032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2022] [Revised: 04/05/2022] [Accepted: 05/09/2022] [Indexed: 11/13/2022] Open
Abstract
This study aimed to characterize the baseline values and dynamics of serum (1,3)-Beta-D-Glucan (BDG) in neonates at high risk of neonatal invasive candidiasis (NIC); as well as to determine the effect of various clinical variables on these levels. Single center prospective cohort study was performed including 20 high-risk neonates (gestational age < 29 weeks and/or birth weight ≤ 1000 gr). Samples for BDG (Fungitell® assay) were obtained twice weekly during 6 weeks. Nineteen neonates were enrolled with a median gestational age of 25 weeks (IQR 24-27), median birth weight of 730 gr (IQR 650-810). None of the neonates was diagnosed with NIC. 190 serum samples were included. The median BDG value was 59 pg/ml (IQR 30-148), mean was 119 pg/ml (SD ± 154). A total of 42.1% (80/190) samples showed values ≥80 pg/ml, with all the neonates presenting at least one test above this cut-off. Neonatal age did not show an association with BDG levels. Exposure to steroids and the use of a heel prick as sampling method were associated with statistically significant higher BDG levels. The BDG levels showed high variability and in a significant proportion of samples values were above the threshold for positivity (e.g., ≥80 pg/ml) in the absence of NIC. The exposure to postnatal steroids and the heel prick as the method of blood sampling were associated with higher BDG levels. LAY SUMMARY Neonatal invasive candidiasis (NIC) presents high morbi-mortality. The diagnosis of NIC is often challenging. Blood cultures have limitations and better diagnostic tools are needed. Beta-D-glucan is a diagnostic marker which could be potentially used, although still more clinical data are required.
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Affiliation(s)
- Laura Ferreras-Antolin
- St George's University Hospital NHS Foundation Trust, Paediatric Infectious Diseases Unit, London, United Kingdom.,MRC Centre for Medical Mycology, University of Exeter, United Kingdom
| | - Nasreen Aziz
- St. George's University Hospital NHS Foundation Trust, Neonatal Unit, London, United Kingdom
| | - Adilia Warris
- MRC Centre for Medical Mycology, University of Exeter, United Kingdom.,Great Ormond Street Hospital, Paediatric Infectious Diseases Unit, London, United Kingdom
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Parslow BY, Thornton CR. Continuing Shifts in Epidemiology and Antifungal Susceptibility Highlight the Need for Improved Disease Management of Invasive Candidiasis. Microorganisms 2022; 10:microorganisms10061208. [PMID: 35744725 PMCID: PMC9228503 DOI: 10.3390/microorganisms10061208] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2022] [Revised: 06/07/2022] [Accepted: 06/09/2022] [Indexed: 12/07/2022] Open
Abstract
Invasive candidiasis (IC) is a systemic life-threatening infection of immunocompromised humans, but remains a relatively neglected disease among public health authorities. Ongoing assessments of disease epidemiology are needed to identify and map trends of importance that may necessitate improvements in disease management and patient care. Well-established incidence increases, largely due to expanding populations of patients with pre-disposing risk factors, has led to increased clinical use and pressures on antifungal drugs. This has been exacerbated by a lack of fast, accurate diagnostics that have led treatment guidelines to often recommend preventative strategies in the absence of proven infection, resulting in unnecessary antifungal use in many instances. The consequences of this are multifactorial, but a contribution to emerging drug resistance is of primary concern, with high levels of antifungal use heavily implicated in global shifts to more resistant Candida strains. Preserving and expanding the utility and number of antifungals should therefore be of the highest priority. This may be achievable through the development and use of biomarker tests, bringing about a new era in improved antifungal stewardship, as well as novel antifungals that offer favorable profiles by targeting Candida pathogenesis mechanisms over cell viability.
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Affiliation(s)
- Ben Y. Parslow
- Biosciences, College of Life and Environmental Sciences, Geoffrey Pope Building, University of Exeter, Stocker Road, Exeter EX4 4QD, UK;
| | - Christopher R. Thornton
- Medical Research Council Centre for Medical Mycology, Geoffrey Pope Building, University of Exeter, Stocker Road, Exeter EX4 4QD, UK
- Correspondence:
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Rinawati W, Kumalawati J, Bardosono S, Immanuel S, Sukartini N, Indrasari ND. Invasive candidiasis among high prevalence neurological patients. J Infect Dev Ctries 2022; 16:871-880. [PMID: 35656960 DOI: 10.3855/jidc.15231] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Accepted: 01/17/2022] [Indexed: 10/31/2022] Open
Abstract
INTRODUCTION Invasive candidiasis is a severe form of infection. The incidence of invasive fungal infections has increased, due to the increasing number of patients with impaired immunity who are being treated through prolonged stay in hospital facilities. Neurological patient treatment methods such as antimicrobials, corticosteroid, central venous catheter (CVC), total parenteral nutrition, and mechanical ventilation use are associated with common risk factors for invasive candidiasis. Our study demonstrated invasive candidiasis prevalence among neurological patients. METHODOLOGY A cross-sectional study was done with consecutive sampling of neurological patients who were hospitalized from January 2017 to February 2020 at the Mahar Mardjono National Brain Center Hospital East Jakarta Indonesia. Patients with sepsis, septic shock, or fever (> 38.5 °C), and who had not received antifungals before culture were enrolled in the study. Clinical specimens were obtained from blood, liquor cerebrospinal or other sterile sites, CVC, respiratory tract specimens, and urine or other non-sterile sites. Socio-demographic data, potential risk factors based on previous studies, clinical, and other tests data were obtained from medical records. Classification of invasive candidiasis was according to the Paphitou classification criteria. RESULTS One hundred and two subjects met the study criteria. The prevalence of invasive candidiasis in neurological patients was 13.7%. All of the isolates were C. parapsilosis. CONCLUSIONS The prevalence of invasive candidiasis was high in the samples studied. The infection was associated with septic shock, tracheostomy, and duration of use of central venous catheter, ventilator, and steroids.
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Affiliation(s)
- Weny Rinawati
- Laboratory of Clinical Pathology and Blood Bank, Mahar Mardjono National Brain Center Hospital, East Jakarta, Indonesia.
| | - July Kumalawati
- Department of Clinical Pathology, Faculty of Medicine University of Indonesia/Cipto Mangunkusumo Hospital, Jakarta, Indonesia
| | - Saptawati Bardosono
- Department of Clinical Nutrition, Faculty of Medicine, University of Indonesia/Cipto Mangunkusumo Hospital, Jakarta, Indonesia
| | - Suzanna Immanuel
- Department of Clinical Pathology, Faculty of Medicine University of Indonesia/Cipto Mangunkusumo Hospital, Jakarta, Indonesia
| | - Ninik Sukartini
- Department of Clinical Pathology, Faculty of Medicine University of Indonesia/Cipto Mangunkusumo Hospital, Jakarta, Indonesia
| | - Nuri Dyah Indrasari
- Department of Clinical Pathology, Faculty of Medicine University of Indonesia/Cipto Mangunkusumo Hospital, Jakarta, Indonesia
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Forster J, Hoenigl M, Suerbaum S, Wagener J, Dichtl K. Serologic biomarkers in Candida and Aspergillus infections of the central nervous system: a comparison of galactomannan, mannan, and β-1,3-D-gucan testing from serum and cerebrospinal fluid. Mycoses 2022; 65:709-714. [PMID: 35506957 DOI: 10.1111/myc.13451] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Revised: 04/26/2022] [Accepted: 04/28/2022] [Indexed: 11/29/2022]
Abstract
BACKGROUND The incidence of Aspergillus and Candida CNS infection, which are characterized by high mortality rates, is underestimated. This underdiagnosis presumably results from the limitations of available diagnostic tools and the need for invasive sampling. Little is known about the role of serologic biomarkers in the setting of CNS aspergillosis and candidiasis. PATIENTS, MATERIALS, METHODS Serum (19) and cerebrospinal fluid (CSF; 10) samples of 19 patients, whose CNS specimens yielded growth of Aspergillus or Candida, were analyzed for different biomarkers for fungal infection, i.e., galactomannan (GM), galactomannoprotein (GP), mannan, anti-mannan-antibodies, and β-1,3-D-glucan (BDG). Serum and CSF specimens of time-matched patients (two each for every case of fungal CNS infection) were included as controls. RESULTS GM, GP, and BDG seropositivity was found in one, two, and three of five cases of CNS aspergillosis. BDG and mannan / anti-mannan-antibody sensitivity in proven CNS candidiasis was 40 % and 20 %, respectively. Applying the serum cut off, sensitivity in CSF testing was 100 % for GM and BDG, and 50 % for mannans. While serum specificity for all assays ranged from 89 - 97 %, specificity for CSF BDG was only 70 %. No false positive GM results from CSF were obtained. CONCLUSION Sensitivity for diagnosing CNS aspergillosis and CNS candidiasis from serum is mediocre for all serological biomarkers. GM testing in CSF proved excellent performance. With a sensitivity of 100 % but a specificity of only 70 %, CSF BDG might be most useful when used in patients with a high pre-test probability.
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Affiliation(s)
- Johannes Forster
- Institut für Hygiene und Mikrobiologie, Julius-Maximilians-Universität Würzburg, Würzburg, Germany
| | - Martin Hoenigl
- Division of Infectious Diseases, Department of Internal Medicine, Medical University of Graz, Graz, Austria.,Division of Infectious Diseases and Global Public Health, University of California San Diego, San Diego, United States
| | - Sebastian Suerbaum
- Max von Pettenkofer-Institut für Hygiene und Medizinische Mikrobiologie, Medizinische Fakultät, LMU München, Munich, Germany
| | - Johannes Wagener
- Institut für Hygiene und Mikrobiologie, Julius-Maximilians-Universität Würzburg, Würzburg, Germany.,Department of Clinical Microbiology, St. James's Hospital, Dublin, Ireland.,Department of Clinical Microbiology, School of Medicine, Trinity College Dublin, The University of Dublin, St. James's Hospital Campus, Dublin, Ireland
| | - Karl Dichtl
- Max von Pettenkofer-Institut für Hygiene und Medizinische Mikrobiologie, Medizinische Fakultät, LMU München, Munich, Germany.,Diagnostic and Research Institute of Hygiene, Microbiology and Environmental Medicine, Medical University of Graz, Austria
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Chen YN, Hsu JF, Chu SM, Lai MY, Lin C, Huang HR, Yang PH, Chiang MC, Tsai MH. Clinical and Microbiological Characteristics of Neonates with Candidemia and Impacts of Therapeutic Strategies on the Outcomes. J Fungi (Basel) 2022; 8:jof8050465. [PMID: 35628721 PMCID: PMC9148079 DOI: 10.3390/jof8050465] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2022] [Revised: 04/27/2022] [Accepted: 04/27/2022] [Indexed: 11/28/2022] Open
Abstract
Neonatal candidemia is associated with significant morbidities and a high mortality rate. We aimed to investigate the clinical characteristics of Candida bloodstream infections in neonates and the impact of therapeutic strategies on the outcomes. We identified all the neonates with candidemia from a medical center in Taiwan over an 18-year period (2003−2021) and analyzed them. Clinical isolates were confirmed by DNA sequencing, and antifungal susceptibility testing was performed. The prognostic factors associated with clinical treatment failure (30-day, all-cause mortality and persistent candidemia > 72 h after antifungal agents) and in-hospital mortality were analyzed using logistic regression modeling. A total of 123 neonates with 139 episodes of candidemia were included in the study. The median (IQR) gestational age and birth weight of the neonates with candidemia were 29.0 (26.0−35.0) weeks and 1104.0 (762.0−2055) g, respectively. The most common Candida spp. was Candida albicans (n = 57, 41.0%), followed by C. parapsilosis (n = 44, 31.7%), Candida guilliermondii (n = 12, 8.6%), and C. glabrata (n = 11, 7.9%). The overall susceptibility to fluconazole was 81.3%, and the resistant rates against other antifungal agents were less than 3%. The cumulative mortality rate at 7 and 30 days after the first episode of candidemia was 11.3% and 32.3%, respectively. The overall in-hospital mortality rate was 42.3%. The treatment outcomes did not change over the study period and were not affected by delayed initiation of antifungal agents. Multivariate analysis showed that delayed catheter removal (odds ratio [OR], 5.54; 95% confidence interval [CI]: 1.93−15.86, p = 0.001), septic shock (OR, 7.88; 95% CI: 2.83−21.93, p < 0.001), and multiple chronic comorbidities (OR, 8.71; 95% CI: 1.82−41.81, p = 0.007) were independently associated with the final in-hospital mortality. We concluded that the overall mortality of neonatal candidemia has remained consistently high over the past decade. Prompt early catheter removal and an aggressive treatment strategy for neonatal candidemia with septic shock would be critical to improving patient outcomes.
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Affiliation(s)
- Yu-Ning Chen
- Division of Pediatric Neonatology, Department of Pediatrics, Chang Gung Memorial Hospital, Taoyuan 333, Taiwan; (Y.-N.C.); (J.-F.H.); (S.-M.C.); (M.-Y.L.); (H.-R.H.); (M.-C.C.)
- College of Medicine, Chang Gung University, Taoyuan 333, Taiwan; (C.L.); (P.-H.Y.)
| | - Jen-Fu Hsu
- Division of Pediatric Neonatology, Department of Pediatrics, Chang Gung Memorial Hospital, Taoyuan 333, Taiwan; (Y.-N.C.); (J.-F.H.); (S.-M.C.); (M.-Y.L.); (H.-R.H.); (M.-C.C.)
- College of Medicine, Chang Gung University, Taoyuan 333, Taiwan; (C.L.); (P.-H.Y.)
| | - Shih-Ming Chu
- Division of Pediatric Neonatology, Department of Pediatrics, Chang Gung Memorial Hospital, Taoyuan 333, Taiwan; (Y.-N.C.); (J.-F.H.); (S.-M.C.); (M.-Y.L.); (H.-R.H.); (M.-C.C.)
- College of Medicine, Chang Gung University, Taoyuan 333, Taiwan; (C.L.); (P.-H.Y.)
| | - Mei-Yin Lai
- Division of Pediatric Neonatology, Department of Pediatrics, Chang Gung Memorial Hospital, Taoyuan 333, Taiwan; (Y.-N.C.); (J.-F.H.); (S.-M.C.); (M.-Y.L.); (H.-R.H.); (M.-C.C.)
- College of Medicine, Chang Gung University, Taoyuan 333, Taiwan; (C.L.); (P.-H.Y.)
| | - Chih Lin
- College of Medicine, Chang Gung University, Taoyuan 333, Taiwan; (C.L.); (P.-H.Y.)
- Department of Laboratory Medicine, Chang Gung Memorial Hospital at Linkou, Taoyuan 333, Taiwan
- Division of Neonatology, Department of Pediatrics, Chang Gung Memorial Hospital, Keelung 204, Taiwan
| | - Hsuan-Rong Huang
- Division of Pediatric Neonatology, Department of Pediatrics, Chang Gung Memorial Hospital, Taoyuan 333, Taiwan; (Y.-N.C.); (J.-F.H.); (S.-M.C.); (M.-Y.L.); (H.-R.H.); (M.-C.C.)
- College of Medicine, Chang Gung University, Taoyuan 333, Taiwan; (C.L.); (P.-H.Y.)
| | - Peng-Hong Yang
- College of Medicine, Chang Gung University, Taoyuan 333, Taiwan; (C.L.); (P.-H.Y.)
- Department of Pediatrics, Chang Gung Memorial Hospital, Chiayi 613, Taiwan
| | - Ming-Chou Chiang
- Division of Pediatric Neonatology, Department of Pediatrics, Chang Gung Memorial Hospital, Taoyuan 333, Taiwan; (Y.-N.C.); (J.-F.H.); (S.-M.C.); (M.-Y.L.); (H.-R.H.); (M.-C.C.)
- College of Medicine, Chang Gung University, Taoyuan 333, Taiwan; (C.L.); (P.-H.Y.)
| | - Ming-Horng Tsai
- College of Medicine, Chang Gung University, Taoyuan 333, Taiwan; (C.L.); (P.-H.Y.)
- Division of Neonatology and Pediatric Hematology/Oncology, Department of Pediatrics, Chang Gung Memorial Hospital, Yunlin 638, Taiwan
- Correspondence: ; Tel.: +886-5-691-5151 (ext. 2879); Fax: +886-5-691-3222
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Fisher BT, Boge CLK, Xiao R, Shuster S, Chin-Quee D, Allen J, Shaheen S, Hayden R, Suganda S, Zaoutis TE, Chang YC, Yin DE, Huppler AR, Danziger-Isakov L, Muller WJ, Roilides E, Romero J, Sue PK, Berman D, Wattier RL, Halasa N, Pong A, Maron G, Soler-Palacin P, Hutto SC, Gonzalez BE, Salvatore CM, Rajan S, Green M, Doby Knackstedt E, Hauger SB, Steinbach WJ. Multicenter Prospective Study of Biomarkers for Diagnosis of Invasive Candidiasis in Children and Adolescents. Clin Infect Dis 2022; 75:248-259. [PMID: 35134165 PMCID: PMC9890499 DOI: 10.1093/cid/ciab928] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Diagnosis of invasive candidiasis (IC) relies on insensitive cultures; the relative utility of fungal biomarkers in children is unclear. METHODS This multinational observational cohort study enrolled patients aged >120 days and <18 years with concern for IC from 1 January 2015 to 26 September 2019 at 25 centers. Blood collected at onset of symptoms was tested using T2Candida, Fungitell (1→3)-β-D-glucan, Platelia Candida Antigen (Ag) Plus, and Platelia Candida Antibody (Ab) Plus assays. Operating characteristics were determined for each biomarker, and assays meeting a defined threshold considered in combination. Sterile site cultures were the reference standard. RESULTS Five hundred participants were enrolled at 22 centers in 3 countries, and IC was diagnosed in 13 (2.6%). Thirteen additional blood specimens were collected and successfully spiked with Candida species, to achieve a 5.0% event rate. Valid T2Candida, Fungitell, Platelia Candida Ag Plus, and Platelia Candida Ab Plus assay results were available for 438, 467, 473, and 473 specimens, respectively. Operating characteristics for T2Candida were most optimal for detecting IC due to any Candida species, with results as follows: sensitivity, 80.0% (95% confidence interval, 59.3%-93.2%), specificity 97.1% (95.0%-98.5%), positive predictive value, 62.5% (43.7%-78.9%), and negative predictive value, 98.8% (97.2%-99.6%). Only T2Candida and Platelia Candida Ag Plus assays met the threshold for combination testing. Positive result for either yielded the following results: sensitivity, 86.4% (95% confidence interval, 65.1%- 97.1%); specificity, 94.7% (92.0%-96.7%); positive predictive value, 47.5% (31.5%-63.9%); and negative predictive value, 99.2% (97.7%-99.8%). CONCLUSIONS T2Candida alone or in combination with Platelia Candida Ag Plus may be beneficial for rapid detection of Candida species in children with concern for IC. CLINICAL TRIALS REGISTRATION NCT02220790.
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Affiliation(s)
- Brian T Fisher
- Correspondence: B. T. Fisher, Division of Infectious Diseases, Children’s Hospital of Philadelphia, Roberts Pediatric Research Center, 2716 South St, Room 10-362, Philadelphia, PA 19146 ()
| | - Craig L K Boge
- Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Rui Xiao
- Department of Biostatistics, Epidemiology and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Sydney Shuster
- Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | | | - John Allen
- Duke University, Durham, North Carolina, USA
| | | | - Randall Hayden
- Department of Pathology, St Jude Children’s Research Hospital, Memphis, Tennessee, USA
| | - Sri Suganda
- Department of Pathology, St Jude Children’s Research Hospital, Memphis, Tennessee, USA
| | - Theoklis E Zaoutis
- Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania, USA,Department of Biostatistics, Epidemiology and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | | | - Dwight E Yin
- Children’s Mercy and University of Missouri–Kansas City School of Medicine, Kansas City, Missouri, USA
| | - Anna R Huppler
- Medical College of Wisconsin and Children’s Wisconsin, Milwaukee, Wisconsin, USA
| | | | - William J Muller
- Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Emmanuel Roilides
- Infectious Disease Unit, 3rd Department of Pediatrics, School of Medicine, Aristotle University and Hippokration Hospital, Thessaloniki, Greece
| | - José Romero
- Arkansas Children’s Hospital Research Institute, Little Rock, Arkansas, USA
| | - Paul K Sue
- University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - David Berman
- John Hopkins All Children’s Hospital, St Petersburg, Florida, USA
| | - Rachel L Wattier
- University of California–San Francisco, San Francisco, California, USA
| | - Natasha Halasa
- Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Alice Pong
- University of California San Diego, San Diego, California, USA
| | - Gabriela Maron
- St Jude Children’s Research Hospital, Memphis, Tennessee, USA
| | | | - Susan C Hutto
- University of Alabama, Birmingham, Birmingham, Alabama, USA
| | | | | | - Sujatha Rajan
- Cohen Children’s Medical Center of New York, New Hyde Park, New York, USA
| | - Michael Green
- UPMC Children’s Hospital of Pittsburgh, Pittsburgh, Pennsylvania, USA
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Lin YL, Chen IC, Yen JH, Lai CS, Tsai YC, Lu CT, Wu CY, Lin WS, Lin CH, Huang YC. Invasive Candidiasis in Hospitalized Patients with Major Burns. J Pers Med 2022; 12:47. [PMID: 35055361 DOI: 10.3390/jpm12010047] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Revised: 12/14/2021] [Accepted: 12/21/2021] [Indexed: 02/05/2023] Open
Abstract
Background: Invasive candidiasis (IC) is a major cause of morbidities and mortality in patients hospitalized with major burns. This study investigated the incidence of IC in this specific population and analyzed the possible risk factors. Materials and Methods: We retrospectively analyzed data from the National Health Insurance Research Database (NHIRD) of Taiwan. We identified 3582 patients hospitalized with major burns on over 20% of their total body surface area (TBSA) during 2000–2013; we further analyzed possible risk factors. Result: IC was diagnosed in 452 hospitalized patients (12.6%) with major burns. In the multivariate analysis, patients older than 50 years (adjusted odds ratio (OR) = 1.96, 95% confidence interval (CI) 1.36–2.82), those of female sex (adjusted OR = 1.33, 95% CI 1.03–1.72), those with burns on the head (adjusted OR = 1.33, 95% CI 1.02–1.73), and those with burns over a greater TBSA had higher risks of IC. Conclusion: Treating IC is crucial in healthcare for major burns. Our study suggests that several risk factors are associated with IC in patients hospitalized with major burns, providing reliable reference value for clinical decisions.
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Murphy SE, Bicanic T. Drug Resistance and Novel Therapeutic Approaches in Invasive Candidiasis. Front Cell Infect Microbiol 2022; 11:759408. [PMID: 34970504 PMCID: PMC8713075 DOI: 10.3389/fcimb.2021.759408] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2021] [Accepted: 11/08/2021] [Indexed: 12/12/2022] Open
Abstract
Candida species are the leading cause of invasive fungal infections worldwide and are associated with acute mortality rates of ~50%. Mortality rates are further augmented in the context of host immunosuppression and infection with drug-resistant Candida species. In this review, we outline antifungal drugs already in clinical use for invasive candidiasis and candidaemia, their targets and mechanisms of resistance in clinically relevant Candida species, encompassing not only classical resistance, but also heteroresistance and tolerance. We describe novel antifungal agents and targets in pre-clinical and clinical development, including their spectrum of activity, antifungal target, clinical trial data and potential in treatment of drug-resistant Candida. Lastly, we discuss the use of combination therapy between conventional and repurposed agents as a potential strategy to combat the threat of emerging resistance in Candida.
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Affiliation(s)
- Sarah E Murphy
- Institute of Infection & Immunity, St George's University of London, London, United Kingdom
| | - Tihana Bicanic
- Institute of Infection & Immunity, St George's University of London, London, United Kingdom.,Clinical Academic Group in Infection and Immunity, St. George's University Hospital National Health Service (NHS) Foundation Trust, London, United Kingdom
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