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Li Y, Gu C, Yang Y, Ding Y, Ye C, Tang M, Liu J, Zeng Z. Epidemiology, antifungal susceptibility, risk factors, and mortality of persistent candidemia in adult patients in China: a 6-year multicenter retrospective study. BMC Infect Dis 2023; 23:369. [PMID: 37264301 DOI: 10.1186/s12879-023-08241-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2023] [Accepted: 04/11/2023] [Indexed: 06/03/2023] Open
Abstract
BACKGROUND Data on persistent candidemia (PC), a recognized complication of candidemia, are lacking in China. This study aimed to investigate the clinical characteristics and risk factors for the mortality of PC among adults in China. METHODS This 6-year retrospective study analyzed the prevalence, species distribution, antifungal susceptibility, risk factors, and patient mortality of PC among adults in three regional tertiary teaching hospitals in China from 2016 to 2021. We collected electronic laboratory records data of PC and non-PC patients and used the Student test or Mann-Whitney U test for a retrospective study. Logistic regression was used to identify risk factors associated with persistent candidemia. RESULTS The definition of PC was fulfilled by 36 patients (13.7%, 36/263). The mean age of the patients was 59.9 years (60 years for patients with PC; 59.8 years for those with non-PC; P > 0.05) and 131 (60.1%) were men [16 with PC (44.4%), 115 with non-PC (63.2%), P < 0.05]. The mean annual incidence was 0.15/1000 admissions (including PC 0.03/1000 admissions vs. non-PC 0.12/1000 admissions, P < 0.05). Candida parapsilosis (14/36, 38.9%) and Candida albicans (81/182, 44.5%) were the predominant pathogens in patients with PC and non-PC, respectively. Most isolates were susceptible to flucytosine (99.0%) and amphotericin B (99.5%), and the activity of antifungal agents against Candida species was not statistically significantly different between patients with PC and non-PC (P > 0.05). The 30-day mortality rate was 20.2% (16.7% with PC vs. 20.9% with non-PC, P > 0.05). Multivariable regression analysis showed that use of broad-spectrum antibiotics (odds ratio (OR), 5.925; 95% confidence interval (CI), 1.886-18.616, P = 0.002), fluconazole (OR, 3.389; 95% CI, 1.302-8.820, P = 0.012) and C. parapsilosis infection (OR, 6.143; 95% CI, 2.093-18.031, P = 0.001) were independent predictors of PC, sex (male) (OR, 0.199; 95% CI, 0.077-0.518, P = 0.001) was the protective factor for PC. Respiratory dysfunction (OR, 5.763; 95% CI, 1.592-20.864, P = 0.008) and length of hospital stay(OR, 0.925; 95% CI, 0.880-0.973, P = 0.002) were independent predictors of 30-day mortality in patients with non-PC. C. tropicalis bloodstream infection (OR, 12.642; 95% CI, 1.059-150.951; P = 0.045) was an independent predictor of 30-day mortality in patients with PC. CONCLUSIONS The epidemiological data of patients with PC and non-PC were different in the distribution of Candida species, the mean annual incidence and independent predictors of 30-day mortality. Flucytosine and amphotericin B could be used as first-choice drugs in the presence of PC infections.
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Affiliation(s)
- Yanping Li
- Department of Laboratory Medicine, the Affiliated Hospital of Southwest Medical University, 25 Taiping street, Luzhou, 646000, P.R. China
- Department of Laboratory Medicine, Luxian People's Hospital, Luxian, 646100, Sichuan Province, P.R. China
- Sichuan Province Engineering Technology Research Center of Clinical Diseases Molecular Diagnosis, Luzhou, 646000, P.R. China
- Clinical Diseases Molecular Diagnosis Key Laboratory of LuZhou, Luzhou, 646000, P.R. China
| | - Chenghong Gu
- Department of Laboratory Medicine, the Affiliated Hospital of Southwest Medical University, 25 Taiping street, Luzhou, 646000, P.R. China
- Department of Laboratory Medicine, Zigong Fourth People's Hospital, Zigong, 643000, P.R. China
| | - Yuling Yang
- Department of Laboratory Medicine, the Affiliated Hospital of Southwest Medical University, 25 Taiping street, Luzhou, 646000, P.R. China
- Department of Laboratory Medicine, The Second People's Hospital of Neijiang, Neijiang, 641000, P.R. China
| | - Yinhuan Ding
- Department of Laboratory Medicine, the Affiliated Hospital of Southwest Medical University, 25 Taiping street, Luzhou, 646000, P.R. China
- Sichuan Province Engineering Technology Research Center of Clinical Diseases Molecular Diagnosis, Luzhou, 646000, P.R. China
- Clinical Diseases Molecular Diagnosis Key Laboratory of LuZhou, Luzhou, 646000, P.R. China
| | - Caihong Ye
- Department of Laboratory Medicine, the Affiliated Hospital of Southwest Medical University, 25 Taiping street, Luzhou, 646000, P.R. China
- Sichuan Province Engineering Technology Research Center of Clinical Diseases Molecular Diagnosis, Luzhou, 646000, P.R. China
- Clinical Diseases Molecular Diagnosis Key Laboratory of LuZhou, Luzhou, 646000, P.R. China
| | - Min Tang
- Department of Laboratory Medicine, the Affiliated Hospital of Southwest Medical University, 25 Taiping street, Luzhou, 646000, P.R. China
- Sichuan Province Engineering Technology Research Center of Clinical Diseases Molecular Diagnosis, Luzhou, 646000, P.R. China
- Clinical Diseases Molecular Diagnosis Key Laboratory of LuZhou, Luzhou, 646000, P.R. China
| | - Jinbo Liu
- Department of Laboratory Medicine, the Affiliated Hospital of Southwest Medical University, 25 Taiping street, Luzhou, 646000, P.R. China.
- Sichuan Province Engineering Technology Research Center of Clinical Diseases Molecular Diagnosis, Luzhou, 646000, P.R. China.
- Clinical Diseases Molecular Diagnosis Key Laboratory of LuZhou, Luzhou, 646000, P.R. China.
| | - Zhangrui Zeng
- Department of Laboratory Medicine, the Affiliated Hospital of Southwest Medical University, 25 Taiping street, Luzhou, 646000, P.R. China.
- Sichuan Province Engineering Technology Research Center of Clinical Diseases Molecular Diagnosis, Luzhou, 646000, P.R. China.
- Clinical Diseases Molecular Diagnosis Key Laboratory of LuZhou, Luzhou, 646000, P.R. China.
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Kitaya S, Kanamori H, Katori Y, Tokuda K. Clinical Features and Outcomes of Persistent Candidemia Caused by Candida albicans versus Non-albicans Candida Species: A Focus on Antifungal Resistance and Follow-Up Blood Cultures. Microorganisms 2023; 11:microorganisms11040928. [PMID: 37110351 PMCID: PMC10142578 DOI: 10.3390/microorganisms11040928] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2023] [Revised: 03/24/2023] [Accepted: 03/30/2023] [Indexed: 04/05/2023] Open
Abstract
The clinical distinctions among variations in Candida species, antifungal resistance (AFR), and clearance status of hospital-acquired persistent candidemia (HA-PC) remain uncertain. This secondary analysis of a retrospective cohort study aimed to assess the differences in HA-PC based on different Candida species, AFR, and persistent candidemia (PC) clearance status. A retrospective review was conducted using medical records from Tohoku University Hospital of patients for whom blood cultures were performed between January 2012 and December 2021. PC cases were categorized into groups based on Candida species, azole, or echinocandin resistance, as well as PC-clearance status, and the respective characteristics were analyzed. The HA-PC non-clearance group had a tendency toward higher 30–90-day and 90-day mortality rates compared to the HA-PC-clearance group in both the susceptible and resistant strain groups, with the former group demonstrating a statistically significant difference (odds ratio = 19, p = 0.028). The high mortality rate observed in the Candida non-albicans and resistant strain groups necessitates a more meticulous therapeutic management approach for PC. Follow-up blood cultures and confirmation of PC clearance are useful for improving the survival rates of both the HA-PC-susceptible and -resistant strain groups.
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Affiliation(s)
- Shiori Kitaya
- Department of Infectious Diseases, Internal Medicine, Graduate School of Medicine, Tohoku University, Sendai 980-8574, Japan
- Department of Otolaryngology, Head and Neck Surgery, Graduate School of Medicine, Tohoku University, Sendai 980-8574, Japan
| | - Hajime Kanamori
- Department of Infectious Diseases, Internal Medicine, Graduate School of Medicine, Tohoku University, Sendai 980-8574, Japan
| | - Yukio Katori
- Department of Otolaryngology, Head and Neck Surgery, Graduate School of Medicine, Tohoku University, Sendai 980-8574, Japan
| | - Koichi Tokuda
- Department of Infectious Diseases, Internal Medicine, Graduate School of Medicine, Tohoku University, Sendai 980-8574, Japan
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The Impact of Corticosteroids on the Outcome of Fungal Disease: a Systematic Review and Meta-analysis. CURRENT FUNGAL INFECTION REPORTS 2023; 17:54-70. [PMID: 36852004 PMCID: PMC9947451 DOI: 10.1007/s12281-023-00456-2] [Citation(s) in RCA: 13] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/13/2023] [Indexed: 02/25/2023]
Abstract
Purpose of Review Corticosteroids have a complex relationship with fungal disease - risk for many, benefit for others. This systematic review aims to address the effect of corticosteroids on mortality and visual outcome in different fungal diseases. Recent Findings Corticosteroids are a risk factor of aspergillosis for patients who have COVID-19, and they also led to a worse outcome. Similarity, corticosteroids are a risk factor for candidemia and mucormycosis. Some researchers reported that using topical corticosteroid in keratitis was associated with worse visual outcome if fungal keratitis. Some studies showed that corticosteroids are linked to a negative outcome for non-HIV patients with Pneumocystis jirovecii pneumonia (PCP), in contrast to those with HIV and PCP. Summary In 59 references, we found that corticosteroid therapy showed a worse clinical outcome in invasive aspergillosis (IA) (HR: 2.50, 95%CI: 1.89-3.31, p < 0.001) and chronic pulmonary aspergillosis (CPA) (HR: 2.74, 95%CI: 1.48-5.06, p = 0.001), PCP without HIV infection (OR: 1.29, 95%CI: 1.09-1.53, p = 0.003), invasive candidiasis and candidaemia (OR: 2.13, 95%CI: 1.85-2.46, p < 0.001), mucormycosis (OR: 4.19, 95%CI: 1.74-10.05, p = 0.001) and early in the course of fungal keratitis (OR: 2.99, 95%CI: 1.14-7.84, p = 0.026). There was equivocal outcome in cryptococcal meningoencephalitis in AIDS and primary coccidioidomycosis, while corticosteroid therapy showed a better outcome in PCP in HIV-infected patients (RR: 0.62, 95%CI: 0.46-0.83, p=0.001) and fungal keratitis patients after keratoplasty surgery (OR: 0.01, 95%CI: 0.00-0.41, p = 0.041) and probably in cryptococcal meningoencephalitis in non-immunocompromised patients. A sub-analysis in invasive aspergillosis and CPA showed that use of more than 2 mg/kg/day of prednisolone equivalents per day is a significant factor in increasing mortality (HR: 2.94, 95%CI: 2.13-4.05, p < 0.001). Corticosteroid therapy during invasive fungal disease was usually associated with a slightly or greatly increased mortality or worse visual outcome (in fungal keratitis), with two disease exceptions. Avoiding the addition of corticosteroids, or minimising dose and duration in those who require them, is likely to improve the outcome of most life- and vision-threatening fungal diseases. This review provides a cornerstone for further research in exploring the accuracy of suitable dose and duration of corticosteroids treatment in fungal diseases. Supplementary Information The online version contains supplementary material available at 10.1007/s12281-023-00456-2.
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Vena A, Bovis F, Tutino S, Santagostino Barbone A, Mezzogori L, Ponzano M, Taramasso L, Baldi F, Dettori S, Labate L, Russo C, Giacobbe DR, Mikulska M, Dentone C, Magnasco L, Marchese A, Robba C, Ball L, Battaglini D, Pelosi P, Crea F, Di Pilato V, Di Biagio A, Bouza E, Muñoz P, Bassetti M. Short Course of Antifungal Therapy in Patients With Uncomplicated Candida Bloodstream Infection: Another Case of Less Is More in the Clinical Setting? Open Forum Infect Dis 2022; 10:ofac656. [PMID: 36655192 PMCID: PMC9835756 DOI: 10.1093/ofid/ofac656] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Accepted: 12/06/2022] [Indexed: 12/13/2022] Open
Abstract
Background The objective of this study was to compare the clinical outcomes of patients receiving a short course (SC) vs a prolonged course (PC) of antifungal therapy for uncomplicated Candida bloodstream infections (BSIs). Methods All episodes of uncomplicated Candida BSI from September 1, 2018, to August 31, 2020, were reviewed. We compared the primary (all-cause 90-day mortality) and secondary study end points (1-year recurrent Candida BSI and all-cause 1-year mortality) among patients who underwent SC (5-11 days) or PC (12-24 days) therapy using propensity score analysis with the inverse probability of treatment weighting (IPTW) method. Results A total of 114 patients with uncomplicated Candida BSI were included: 35 (30.7%) were classified into the SC group (median [interquartile range {IQR}], 9 [7-11] days) and 79 (69.3%) into the PC group (median [IQR], 14 [14-16] days). Patients in the SC group compared with the PC group had a higher rate of hospitalization in the surgical ward (40.0% vs 19.0%; P = .02) or septic shock at the time of Candida BSI onset (11.4% vs 1.3%; P = .03). The risk of 90-day mortality was not different between the SC and PC groups (n = 8 [22.9%] vs 17 [21.5%], respectively; IPTW-adjusted subdistribution hazard ratio [sHR], 0.67; 95% CI, 0.31-1.47; P = .20). The risk for recurrent Candida BSI within 1 year of completing therapy (IPTW-adjusted sHR, 1.07; 95% CI, 0.20-5.80; P = .94) or for all-cause 1-year mortality (IPTW-adjusted HR, 0.72; 95% CI, 0.35-1.50; P = .38) did not differ between groups. Conclusions Receiving a short vs prolonged course of antifungal therapy did not affect mortality or BSI recurrence in patients with uncomplicated candidemia.
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Affiliation(s)
- Antonio Vena
- Infectious Diseases Unit, Policlinico San Martino Hospital—IRCCS, Genoa, Italy,Department of Health Sciences (DISSAL), University of Genoa, Genoa, Italy
| | - Francesca Bovis
- Department of Health Sciences (DISSAL), University of Genoa, Genoa, Italy,Biostatistics Unit, University of Genoa, Genoa, Italy
| | - Stefania Tutino
- Infectious Diseases Unit, Policlinico San Martino Hospital—IRCCS, Genoa, Italy
| | | | - Laura Mezzogori
- Infectious Diseases Unit, Policlinico San Martino Hospital—IRCCS, Genoa, Italy
| | - Marta Ponzano
- Department of Health Sciences (DISSAL), University of Genoa, Genoa, Italy,Biostatistics Unit, University of Genoa, Genoa, Italy
| | - Lucia Taramasso
- Correspondence: Lucia Taramasso, MD, PhD, Infectious Diseases Unit, Ospedale Policlinico San Martino—IRCCS, University of Genoa, L.go R. Benzi, 10–16132 Genoa, Italy ()
| | - Federico Baldi
- Infectious Diseases Unit, Policlinico San Martino Hospital—IRCCS, Genoa, Italy
| | - Silvia Dettori
- Infectious Diseases Unit, Policlinico San Martino Hospital—IRCCS, Genoa, Italy
| | - Laura Labate
- Infectious Diseases Unit, Policlinico San Martino Hospital—IRCCS, Genoa, Italy
| | - Chiara Russo
- Infectious Diseases Unit, Policlinico San Martino Hospital—IRCCS, Genoa, Italy
| | - Daniele Roberto Giacobbe
- Infectious Diseases Unit, Policlinico San Martino Hospital—IRCCS, Genoa, Italy,Department of Health Sciences (DISSAL), University of Genoa, Genoa, Italy
| | - Malgorzata Mikulska
- Infectious Diseases Unit, Policlinico San Martino Hospital—IRCCS, Genoa, Italy,Department of Health Sciences (DISSAL), University of Genoa, Genoa, Italy
| | - Chiara Dentone
- Infectious Diseases Unit, Policlinico San Martino Hospital—IRCCS, Genoa, Italy
| | - Laura Magnasco
- Infectious Diseases Unit, Policlinico San Martino Hospital—IRCCS, Genoa, Italy
| | - Anna Marchese
- Department of Surgical Sciences and Integrated Diagnostics (DISC), University of Genoa, Genoa, Italy,Microbiology Unit, Policlinico San Martino Hospital—IRCCS, Genoa, Italy
| | - Chiara Robba
- Department of Surgical Sciences and Integrated Diagnostics (DISC), University of Genoa, Genoa, Italy,Anesthesia and Intensive Care, Policlinico San Martino Hospital—IRCCS, Genoa, Italy
| | - Lorenzo Ball
- Department of Surgical Sciences and Integrated Diagnostics (DISC), University of Genoa, Genoa, Italy,Anesthesia and Intensive Care, Policlinico San Martino Hospital—IRCCS, Genoa, Italy
| | - Denise Battaglini
- Department of Surgical Sciences and Integrated Diagnostics (DISC), University of Genoa, Genoa, Italy,Anesthesia and Intensive Care, Policlinico San Martino Hospital—IRCCS, Genoa, Italy
| | - Paolo Pelosi
- Department of Surgical Sciences and Integrated Diagnostics (DISC), University of Genoa, Genoa, Italy,Anesthesia and Intensive Care, Policlinico San Martino Hospital—IRCCS, Genoa, Italy
| | - Francesca Crea
- Microbiology Unit, Policlinico San Martino Hospital—IRCCS, Genoa, Italy
| | - Vincenzo Di Pilato
- Department of Surgical Sciences and Integrated Diagnostics (DISC), University of Genoa, Genoa, Italy,Microbiology Unit, Policlinico San Martino Hospital—IRCCS, Genoa, Italy
| | - Antonio Di Biagio
- Infectious Diseases Unit, Policlinico San Martino Hospital—IRCCS, Genoa, Italy,Department of Health Sciences (DISSAL), University of Genoa, Genoa, Italy
| | - Emilio Bouza
- Clinical Microbiology and Infectious Diseases, Hospital General Universitario Gregorio Marañón, Madrid, Spain,Instituto de Investigación Sanitaria Hospital Gregorio Marañón, Madrid, Spain,CIBER Enfermedades Respiratorias-CIBERES (CB06/06/0058), Madrid, Spain,Medicine Department, School of Medicine, Universidad Complutense de Madrid, Madrid, Spain
| | - Patricia Muñoz
- Clinical Microbiology and Infectious Diseases, Hospital General Universitario Gregorio Marañón, Madrid, Spain,Instituto de Investigación Sanitaria Hospital Gregorio Marañón, Madrid, Spain,CIBER Enfermedades Respiratorias-CIBERES (CB06/06/0058), Madrid, Spain,Medicine Department, School of Medicine, Universidad Complutense de Madrid, Madrid, Spain
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Prediction of Prognostic Risk Factors in Patients with Invasive Candidiasis and Cancer: A Single-Centre Retrospective Study. BIOMED RESEARCH INTERNATIONAL 2022; 2022:7896218. [PMID: 35692595 PMCID: PMC9185171 DOI: 10.1155/2022/7896218] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Revised: 05/09/2022] [Accepted: 05/16/2022] [Indexed: 11/18/2022]
Abstract
Background Invasive candidiasis is a common cancer-related complication with a high fatality rate. If patients with a high risk of dying in the hospital are identified early and accurately, physicians can make better clinical judgments. However, epidemiological analyses and mortality prediction models of cancer patients with invasive candidiasis remain limited. Method A set of 40 potential risk factors was acquired in a sample of 258 patients with both invasive candidiasis and cancer. To begin, risk factors for Candida albicans vs. non-Candida albicans infections and persistent vs. nonpersistent Candida infections were analysed using classic statistical methods. Then, we applied three machine learning models (random forest, logistic regression, and support vector machine) to identify prognostic indicators related to mortality. Prediction performance of different models was assessed by precision, recall, F1 score, accuracy, and AUC. Results Of the 258 patients both with invasive candidiasis and cancer included in the analysis. The median age of patients was 62 years, and 95 (36.82%) patients were older than 65 years, of which 178 (66.28%) were male. And 186 (72.1%) patients underwent surgery 2 weeks before data collection, 100 (39.1%) patients stayed in ICU during hospitalisation, 99 (38.4%) patients had bacterial blood infection, 85 (32.9%) patients had persistent invasive candidiasis, and 41 (15.9%) patients died within 30 days. The usage of drainage catheter and prolonged length of hospitalisation are the dominant risk factors for non-Candida albicans infections and persistent Candida infections, respectively. Risk factors, such as septic shock, history of surgery within the past 2 weeks, usage of drainage tubes, length of stay in ICU, total parenteral nutrition, serum creatinine level, fungal antigen, stay in ICU during hospitalisation, and total bilirubin level, were significant predictors of death. The RF model outperformed the LR and SVM models. Precision, recall, F1 score, accuracy, and AUC for RF were 64.29%, 75.63%, 69.23%, 89.61%, and 91.28%. Conclusions In this study, the machine learning-based models accurately predicted the prognosis of cancer and invasive candidiasis patients. The algorithm could be used to help clinicians in high-risk patients' early intervention.
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Chen YN, Hsu JF, Chu SM, Lai MY, Lin C, Huang HR, Yang PH, Chiang MC, Tsai MH. Clinical and Microbiological Characteristics of Neonates with Candidemia and Impacts of Therapeutic Strategies on the Outcomes. J Fungi (Basel) 2022; 8:jof8050465. [PMID: 35628721 PMCID: PMC9148079 DOI: 10.3390/jof8050465] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2022] [Revised: 04/27/2022] [Accepted: 04/27/2022] [Indexed: 11/28/2022] Open
Abstract
Neonatal candidemia is associated with significant morbidities and a high mortality rate. We aimed to investigate the clinical characteristics of Candida bloodstream infections in neonates and the impact of therapeutic strategies on the outcomes. We identified all the neonates with candidemia from a medical center in Taiwan over an 18-year period (2003−2021) and analyzed them. Clinical isolates were confirmed by DNA sequencing, and antifungal susceptibility testing was performed. The prognostic factors associated with clinical treatment failure (30-day, all-cause mortality and persistent candidemia > 72 h after antifungal agents) and in-hospital mortality were analyzed using logistic regression modeling. A total of 123 neonates with 139 episodes of candidemia were included in the study. The median (IQR) gestational age and birth weight of the neonates with candidemia were 29.0 (26.0−35.0) weeks and 1104.0 (762.0−2055) g, respectively. The most common Candida spp. was Candida albicans (n = 57, 41.0%), followed by C. parapsilosis (n = 44, 31.7%), Candida guilliermondii (n = 12, 8.6%), and C. glabrata (n = 11, 7.9%). The overall susceptibility to fluconazole was 81.3%, and the resistant rates against other antifungal agents were less than 3%. The cumulative mortality rate at 7 and 30 days after the first episode of candidemia was 11.3% and 32.3%, respectively. The overall in-hospital mortality rate was 42.3%. The treatment outcomes did not change over the study period and were not affected by delayed initiation of antifungal agents. Multivariate analysis showed that delayed catheter removal (odds ratio [OR], 5.54; 95% confidence interval [CI]: 1.93−15.86, p = 0.001), septic shock (OR, 7.88; 95% CI: 2.83−21.93, p < 0.001), and multiple chronic comorbidities (OR, 8.71; 95% CI: 1.82−41.81, p = 0.007) were independently associated with the final in-hospital mortality. We concluded that the overall mortality of neonatal candidemia has remained consistently high over the past decade. Prompt early catheter removal and an aggressive treatment strategy for neonatal candidemia with septic shock would be critical to improving patient outcomes.
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Affiliation(s)
- Yu-Ning Chen
- Division of Pediatric Neonatology, Department of Pediatrics, Chang Gung Memorial Hospital, Taoyuan 333, Taiwan; (Y.-N.C.); (J.-F.H.); (S.-M.C.); (M.-Y.L.); (H.-R.H.); (M.-C.C.)
- College of Medicine, Chang Gung University, Taoyuan 333, Taiwan; (C.L.); (P.-H.Y.)
| | - Jen-Fu Hsu
- Division of Pediatric Neonatology, Department of Pediatrics, Chang Gung Memorial Hospital, Taoyuan 333, Taiwan; (Y.-N.C.); (J.-F.H.); (S.-M.C.); (M.-Y.L.); (H.-R.H.); (M.-C.C.)
- College of Medicine, Chang Gung University, Taoyuan 333, Taiwan; (C.L.); (P.-H.Y.)
| | - Shih-Ming Chu
- Division of Pediatric Neonatology, Department of Pediatrics, Chang Gung Memorial Hospital, Taoyuan 333, Taiwan; (Y.-N.C.); (J.-F.H.); (S.-M.C.); (M.-Y.L.); (H.-R.H.); (M.-C.C.)
- College of Medicine, Chang Gung University, Taoyuan 333, Taiwan; (C.L.); (P.-H.Y.)
| | - Mei-Yin Lai
- Division of Pediatric Neonatology, Department of Pediatrics, Chang Gung Memorial Hospital, Taoyuan 333, Taiwan; (Y.-N.C.); (J.-F.H.); (S.-M.C.); (M.-Y.L.); (H.-R.H.); (M.-C.C.)
- College of Medicine, Chang Gung University, Taoyuan 333, Taiwan; (C.L.); (P.-H.Y.)
| | - Chih Lin
- College of Medicine, Chang Gung University, Taoyuan 333, Taiwan; (C.L.); (P.-H.Y.)
- Department of Laboratory Medicine, Chang Gung Memorial Hospital at Linkou, Taoyuan 333, Taiwan
- Division of Neonatology, Department of Pediatrics, Chang Gung Memorial Hospital, Keelung 204, Taiwan
| | - Hsuan-Rong Huang
- Division of Pediatric Neonatology, Department of Pediatrics, Chang Gung Memorial Hospital, Taoyuan 333, Taiwan; (Y.-N.C.); (J.-F.H.); (S.-M.C.); (M.-Y.L.); (H.-R.H.); (M.-C.C.)
- College of Medicine, Chang Gung University, Taoyuan 333, Taiwan; (C.L.); (P.-H.Y.)
| | - Peng-Hong Yang
- College of Medicine, Chang Gung University, Taoyuan 333, Taiwan; (C.L.); (P.-H.Y.)
- Department of Pediatrics, Chang Gung Memorial Hospital, Chiayi 613, Taiwan
| | - Ming-Chou Chiang
- Division of Pediatric Neonatology, Department of Pediatrics, Chang Gung Memorial Hospital, Taoyuan 333, Taiwan; (Y.-N.C.); (J.-F.H.); (S.-M.C.); (M.-Y.L.); (H.-R.H.); (M.-C.C.)
- College of Medicine, Chang Gung University, Taoyuan 333, Taiwan; (C.L.); (P.-H.Y.)
| | - Ming-Horng Tsai
- College of Medicine, Chang Gung University, Taoyuan 333, Taiwan; (C.L.); (P.-H.Y.)
- Division of Neonatology and Pediatric Hematology/Oncology, Department of Pediatrics, Chang Gung Memorial Hospital, Yunlin 638, Taiwan
- Correspondence: ; Tel.: +886-5-691-5151 (ext. 2879); Fax: +886-5-691-3222
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Frequency and Clinical Features of Candida Bloodstream Infection Originating in the Urinary Tract. J Fungi (Basel) 2022; 8:jof8020123. [PMID: 35205877 PMCID: PMC8878273 DOI: 10.3390/jof8020123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2021] [Revised: 01/21/2022] [Accepted: 01/25/2022] [Indexed: 01/11/2023] Open
Abstract
The urinary tract is considered an uncommon source of Candida bloodstream infection (CBSI). We aimed to determine the source of CBSI in hospitalized patients, and to compare clinical and microbiological features of CBSI originating in the urinary tract (U-CBSI) and non-urinary CBSI (NU-CBSI). Of 134 patients with CBSI, 28 (20.8%) met criteria for U-CBSI, 34 (25.3%) had vascular catheter-related CBSI and 21 (15.6%) had a gastrointestinal origin. Compared to NU-CBSI patients, patients with U-CBSI were older with higher rates of dementia. Bladder catheterization for urinary retention and insertion of ureteral stents or nephrostomies were risk factors for U-CBSI. Fifty percent of U-CBSI cases occurred within 48 h of hospital admission, versus 16.9% of NU-CBSI (p < 0.0001). The mortality rate was lowest for CBSI originating in the urinary tract and highest for CBSI of undetermined origin. CBSI of undetermined origin remained associated with higher mortality in a Cox regression model that included age, Candida species, Pitt bacteremia score and neutropenia as explanatory variables. U-CBSI may be increasing in frequency, reflecting extensive use of bladder catheters and urologic procedures in elderly debilitated patients. Distinct clinical features are relevant to the diagnosis, treatment and prevention of U-CBSI.
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Phuengmaung P, Panpetch W, Singkham-In U, Chatsuwan T, Chirathaworn C, Leelahavanichkul A. Presence of Candida tropicalis on Staphylococcus epidermidis Biofilms Facilitated Biofilm Production and Candida Dissemination: An Impact of Fungi on Bacterial Biofilms. Front Cell Infect Microbiol 2021; 11:763239. [PMID: 34746032 PMCID: PMC8569676 DOI: 10.3389/fcimb.2021.763239] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2021] [Accepted: 10/04/2021] [Indexed: 12/28/2022] Open
Abstract
While Staphylococcus epidermidis (SE) is a common cause of infections in implanted prostheses and other indwelling devices, partly due to the biofilm formation, Candida tropicalis (CT) is an emerging Candida spp. with a potent biofilm-producing property. Due to the possible coexistence between SE and CT infection in the same patient, characteristics of the polymicrobial biofilms from both organisms might be different from those of the biofilms of each organism. Then, the exploration on biofilms, from SE with or without CT, and an evaluation on l-cysteine (an antibiofilm against both bacteria and fungi) were performed. As such, Candida incubation in preformed SE biofilms (SE > CT) produced higher biofilms than the single- (SE or CT) or mixed-organism (SE + CT) biofilms as determined by crystal violet staining and fluorescent confocal images with z-stack thickness analysis. In parallel, SE > CT biofilms demonstrated higher expression of icaB and icaC than other groups at 20 and 24 h of incubation, suggesting an enhanced matrix polymerization and transportation, respectively. Although organism burdens (culture method) from single-microbial biofilms (SE or CT) were higher than multi-organism biofilms (SE + CT and SE > CT), macrophage cytokine responses (TNF-α and IL-6) against SE > CT biofilms were higher than those in other groups in parallel to the profound biofilms in SE > CT. Additionally, sepsis severity in mice with subcutaneously implanted SE > CT catheters was more severe than in other groups as indicated by mortality rate, fungemia, serum cytokines (TNF-α and IL-6), and kidney and liver injury. Although CT grows upon preformed SE-biofilm production, the biofilm structures interfered during CT morphogenesis leading to the frailty of biofilm structure and resulting in the prominent candidemia. However, l-cysteine incubation together with the organisms in catheters reduced biofilms, microbial burdens, macrophage responses, and sepsis severity. In conclusion, SE > CT biofilms prominently induced biofilm matrix, fungemia, macrophage responses, and sepsis severity, whereas the microbial burdens were lower than in the single-organism biofilms. All biofilms were attenuated by l-cysteine.
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Affiliation(s)
- Pornpimol Phuengmaung
- Department of Microbiology, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Wimonrat Panpetch
- Department of Microbiology, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Uthaibhorn Singkham-In
- Department of Microbiology, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Tanittha Chatsuwan
- Department of Microbiology, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand.,Antimicrobial Resistance and Stewardship Research Unit, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Chintana Chirathaworn
- Department of Microbiology, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Asada Leelahavanichkul
- Department of Microbiology, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand.,Translational Research in Inflammation and Immunology Research Unit (TRIRU), Department of Microbiology, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
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9
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Suh JW, Kim MJ, Kim JH. Risk factors of septic shock development and thirty-day mortality with a predictive model in adult candidemia patients in intensive care units. Infect Dis (Lond) 2021; 53:908-919. [PMID: 34330205 DOI: 10.1080/23744235.2021.1959052] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Abstract
BACKGROUND This study aimed to investigate factors associated with septic shock development and 30-day mortality outcome with a prediction model among adult candidemia patients in the intensive care unit (ICU). METHODS A retrospective study was conducted among patients admitted to the ICU from 2009 to 2018 at a tertiary care medical centre. The study subjects included adult patients ≥ 19 years with candidemia treated with antifungal agent for ≥ 3 days. Clinical variables were collected and analysed. RESULTS A total of 126 patients were included in the study. Of these patients, 32 patients (25.4%) had septic shock. Multivariate logistic regression analysis revealed that chronic liver disease was associated with septic shock (odds ratio [OR] 3.372, 95% confidence interval [CI] 1.057 - 10.057). The rate of 30-day mortality was 35.7% and the associated mortality risk factors were malignancy (OR 8.251, 95% CI 2.227 - 30.573), chronic liver disease (OR 3.605, 95% CI 0.913 - 14.227), haemodialysis (OR 8.479, 95% CI 1.801 - 39.924), mycological failure (OR 29.675, 95% CI 7.012 - 125.578), and septic shock (OR 3.980, 95% CI 1.238 - 12.796). A predictive model for 30-day mortality was created based on the mortality risk factor scores, which had an area of 0.862 under the receiver operating characteristic curve. CONCLUSIONS Adult candidemia patients in the ICU who have chronic liver disease may be at higher risk of developing septic shock. Furthermore, our predictive model for 30-day mortality based on the mortality risk factors may be useful for clinical assessment.
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Affiliation(s)
- Jin Woong Suh
- Division of Infectious Diseases, Department of Internal Medicine, Korea University College of Medicine, Seoul, Republic of Korea
| | - Min Ja Kim
- Division of Infectious Diseases, Department of Internal Medicine, Korea University College of Medicine, Seoul, Republic of Korea
| | - Jong Hun Kim
- Division of Infectious Diseases, Department of Internal Medicine, Korea University College of Medicine, Seoul, Republic of Korea
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10
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Boonsilp S, Homkaew A, Phumisantiphong U, Nutalai D, Wongsuk T. Species Distribution, Antifungal Susceptibility, and Molecular Epidemiology of Candida Species Causing Candidemia in a Tertiary Care Hospital in Bangkok, Thailand. J Fungi (Basel) 2021; 7:jof7070577. [PMID: 34356956 PMCID: PMC8303137 DOI: 10.3390/jof7070577] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2021] [Revised: 07/15/2021] [Accepted: 07/15/2021] [Indexed: 12/29/2022] Open
Abstract
Candida species represent a common cause of bloodstream infection (BSI). Given the emergence of non-albicans Candida (NAC) associated with treatment failure, investigations into the species distribution, fungal susceptibility profile, and molecular epidemiology of pathogens are necessary to optimize the treatment of candidemia and explore the transmission of drug resistance for control management. This study evaluated the prevalence, antifungal susceptibility, and molecular characteristics of Candida species causing BSI in a tertiary-level hospital in Bangkok, Thailand. In total, 54 Candida isolates were recovered from 49 patients with candidemia. C. tropicalis was the most prevalent species (33.3%), followed by C. albicans (29.6%). Most Candida species were susceptible to various antifungal agents, excluding C. glabrata and C. tropicalis, which had increased rates of non-susceptibility to azoles. Most C. glabrata isolates were non-susceptible to echinocandins, especially caspofungin. The population structure of C. albicans was highly diverse, with clade 17 predominance. GoeBURST analysis of C. tropicalis revealed associations between genotype and fluconazole resistance in a particular clonal complex. The population structure of C. glabrata appeared to have a low level of genetic diversity in MLST loci. Collectively, these data might provide a fundamental database contributing to the development of novel antifungal agents and diagnostic tests.
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Affiliation(s)
- Siriphan Boonsilp
- Department of Clinical Pathology, Faculty of Medicine Vajira Hospital, Navamindradhiraj University, Bangkok 10300, Thailand;
- Correspondence: (S.B.); (T.W.)
| | - Anchalee Homkaew
- Division of Central Laboratory and Blood Bank, Faculty of Medicine Vajira Hospital, Navamindradhiraj University, Bangkok 10300, Thailand; (A.H.); (D.N.)
| | - Uraporn Phumisantiphong
- Department of Clinical Pathology, Faculty of Medicine Vajira Hospital, Navamindradhiraj University, Bangkok 10300, Thailand;
- Division of Central Laboratory and Blood Bank, Faculty of Medicine Vajira Hospital, Navamindradhiraj University, Bangkok 10300, Thailand; (A.H.); (D.N.)
| | - Daranee Nutalai
- Division of Central Laboratory and Blood Bank, Faculty of Medicine Vajira Hospital, Navamindradhiraj University, Bangkok 10300, Thailand; (A.H.); (D.N.)
| | - Thanwa Wongsuk
- Department of Clinical Pathology, Faculty of Medicine Vajira Hospital, Navamindradhiraj University, Bangkok 10300, Thailand;
- Correspondence: (S.B.); (T.W.)
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11
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Epidemiological Trends of Candidemia and the Impact of Adherence to the Candidemia Guideline: Six-Year Single-Center Experience. J Fungi (Basel) 2021; 7:jof7040275. [PMID: 33917626 PMCID: PMC8067511 DOI: 10.3390/jof7040275] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2021] [Revised: 03/27/2021] [Accepted: 04/03/2021] [Indexed: 12/25/2022] Open
Abstract
This study aimed to investigate the epidemiology of candidemia and evaluate the impact of adherence to the candidemia guideline defined by the European Confederation of Medical Mycology Quality of Clinical Candidemia Management (EQUAL) Candida score. Adult candidemia patients ≥ 19 years diagnosed at a tertiary care hospital in the Republic of Korea from 2013 to 2018 were enrolled (period 1 2013–2015, period 2 2016–2018). There was a total of 223 patients. The annual incidence of candidemia increased from 0.43 to 1.33 cases per 1000 admissions between 2013 and 2018, p < 0.001. A significant increase of fluconazole-resistant C. parapsilosis candidemia was noted in period 2 (35.3%) when compared to period 1 (0.0%), p = 0.020. The 30-day mortality rate was not different between period 1 and 2 (43.5% vs. 48.1%, p = 0.527). Multivariate analysis revealed that a Charlson comorbidity index score ≥ 4, neutropenia, duration of hospital stay ≥ 21 days before candidemia diagnosis, septic shock, mycological failure, and EQUAL Candida score < 15 were significantly associated with 30-day mortality. An increase in the incidence of candidemia and fluconazole resistance in the non-albicans Candida species over time was observed. Disease severity, comorbidities, and lower adherence to the candidemia guideline were associated with mortality.
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12
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Arita GS, Faria DR, Sakita KM, Rodrigues-Vendramini FA, Capoci IR, Kioshima ES, Bonfim-Mendonça PS, Svidzinski TI. Impact of serial systemic infection on Candida albicans virulence factors. Future Microbiol 2020; 15:1249-1263. [PMID: 33026881 DOI: 10.2217/fmb-2019-0342] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Aim: To evaluate changes in virulence and pathogenicity approaches from Candida albicans after successive passages in a murine model of systemic candidiasis. Materials & methods: Phenotypic assays were performed using colonies recovered from animals infected serially, totalizing five passages. Results: A progressive infection was observed along the passages, with increased fungal burden and the presence of greater inflammatory areas in the histopathological findings. Recovered strains exhibited increased filamentation and biofilm abilities, along with modulation of phospholipase and proteinase activities. Conclusion: Repeated contact between yeast and host increased the expression of virulence factors. Furthermore, a correspondence between phenotypic profile and proteomic data obtained previously was observed.
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Affiliation(s)
- Glaucia S Arita
- Department of Clinical Analysis & Biomedicine, Laboratory of Medical Mycology, State University of Maringá, 87020-900, Maringá, Paraná, Brazil
| | - Daniella R Faria
- Department of Clinical Analysis & Biomedicine, Laboratory of Medical Mycology, State University of Maringá, 87020-900, Maringá, Paraná, Brazil
| | - Karina M Sakita
- Department of Clinical Analysis & Biomedicine, Laboratory of Medical Mycology, State University of Maringá, 87020-900, Maringá, Paraná, Brazil
| | - Franciele Av Rodrigues-Vendramini
- Department of Clinical Analysis & Biomedicine, Laboratory of Medical Mycology, State University of Maringá, 87020-900, Maringá, Paraná, Brazil
| | - Isis Rg Capoci
- Department of Clinical Analysis & Biomedicine, Laboratory of Medical Mycology, State University of Maringá, 87020-900, Maringá, Paraná, Brazil
| | - Erika S Kioshima
- Department of Clinical Analysis & Biomedicine, Laboratory of Medical Mycology, State University of Maringá, 87020-900, Maringá, Paraná, Brazil
| | - Patrícia S Bonfim-Mendonça
- Department of Clinical Analysis & Biomedicine, Laboratory of Medical Mycology, State University of Maringá, 87020-900, Maringá, Paraná, Brazil
| | - Terezinha Ie Svidzinski
- Department of Clinical Analysis & Biomedicine, Laboratory of Medical Mycology, State University of Maringá, 87020-900, Maringá, Paraná, Brazil
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13
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Muderris T, Kaya S, Ormen B, Aksoy Gokmen A, Varer Akpinar C, Yurtsever Gul S. Mortality and risk factor analysis for Candida blood stream infection: A three-year retrospective study. J Mycol Med 2020; 30:101008. [PMID: 32651136 DOI: 10.1016/j.mycmed.2020.101008] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2019] [Revised: 04/12/2020] [Accepted: 06/19/2020] [Indexed: 02/08/2023]
Abstract
BACKGROUND The aim of this study was to evaluate the possible risk factors for mortality in adult patients with candidemia by investigating the causative agents, underlying conditions and predisposing factors. MATERIAL AND METHODS The data including causative Candida species, predisposing factors, and underlying conditions of candidemia patients between the years 2015-2017 were collected and the impact of these factors on mortality was evaluated. Patients were divided into two groups as died (died patients within 30 days of the onset of candidemia) and survived and risk factors were evaluated for each group. RESULTS We found 163 adult candidemia cases during the study period. Overall 30-day mortality was 40.5%. Candida parapsilosis was the most frequent causative agent (49.1%). C. parapsilosis candidemia was more common in the survived group compared with the died group (n: 49 (61.3%) vs. n: 31 (38.8%), P=0.888). Mortality rates were significantly higher in patients with dialysis (n: 27 (69.2%) vs. n: 12 (30.8%), P<0.00) and concurrent bacteremia (n: 20 (57.1%) vs. n: 15 (42.9%), P=0.024). Survival rates were significantly higher in patients with follow-up blood cultures (n: 75 (65.8%) vs. n: 39 (34.2%), P=0.013). The most important source of candidemia was catheter (49.7%), and C. parapsilosis was the most common causative agent (58%). The catheter was removed in 96.3% of these patients and the mortality rate was 38.5%. All of the patients received antifungal therapy and there was no significant difference between the effects of antifungals on mortality (n: 65 (39.9%) vs. 98 (60.1%), P=0.607). CONCLUSIONS Dialysis and concurrent bacteremia are strong predictors of mortality in 30 days within patients with candidemia, whereas follow-up blood cultures have a protective role with lower mortality rates. In our study, the most important source of candidemia was catheter, and C. parapsilosis was the most common causative agent. The catheter was removed in almost all patients and the mortality rate was almost one third among these patients.
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Affiliation(s)
- T Muderris
- Department of Microbiology, Izmir Katip Celebi University, Izmir, Turkey.
| | - S Kaya
- Department of Microbiology, Izmir Katip Celebi University, Izmir, Turkey
| | - B Ormen
- Department of Infectious Diseases, Ataturk Education and Research Hospital, Izmir, Turkey
| | - A Aksoy Gokmen
- Department of Microbiology, Izmir Katip Celebi University, Izmir, Turkey
| | | | - S Yurtsever Gul
- Department of Microbiology, Izmir Katip Celebi University, Izmir, Turkey
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14
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Ala‐Houhala M, Anttila V. Persistent vs non‐persistent candidaemia in adult patients in 2007‐2016: A retrospective cohort study. Mycoses 2020; 63:617-624. [DOI: 10.1111/myc.13085] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2019] [Revised: 03/29/2020] [Accepted: 03/31/2020] [Indexed: 12/15/2022]
Affiliation(s)
- Mari Ala‐Houhala
- Division of Infectious Diseases Inflammation Center Helsinki University Hospital and University of Helsinki Helsinki Finland
| | - Veli‐Jukka Anttila
- Division of Infectious Diseases Inflammation Center Helsinki University Hospital and University of Helsinki Helsinki Finland
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15
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Shin SU, Yu YH, Kim SS, Oh TH, Kim SE, Kim UJ, Kang SJ, Jang HC, Park KH, Jung SI. Clinical characteristics and risk factors for complications of candidaemia in adults: Focus on endophthalmitis, endocarditis, and osteoarticular infections. Int J Infect Dis 2020; 93:126-132. [PMID: 32007642 DOI: 10.1016/j.ijid.2020.01.049] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2019] [Revised: 01/10/2020] [Accepted: 01/27/2020] [Indexed: 12/21/2022] Open
Abstract
OBJECTIVES This study evaluated the incidence, risk factors, and clinical characteristics of complications of candidaemia in adults, with a focus on endophthalmitis, endocarditis, and osteoarticular infections. METHODS All patients ≥18 years old with candidaemia in two Korean tertiary hospitals from 2007 to 2016 were investigated. Complications of candidaemia were defined as the presence of endophthalmitis, endocarditis, or osteoarticular infections documented in patients with candidaemia. The clinical characteristics and risk factors for candidaemia with complications were analysed in the patients who underwent ophthalmological examinations. RESULTS Of 765 adult patients with candidaemia, 34 (4.4%) met the definition of complications, including endophthalmitis in 29 (3.8%), endocarditis in 4 (0.5%), and osteoarticular infections in 3 (0.4%). Of the 225 patients who underwent ophthalmological examinations, 29 (12.9%) had endophthalmitis. Candida albicans was an independent risk factor for complicated candidaemia (OR, 5.12; 95% CI, 2.17-12.09; P < 0.001). Although the mortality rate was no higher in complicated candidaemia, the duration of antifungal therapy was longer (23.1 ± 17.6 vs. 16.4 ± 10.8 days, P = 0.042), and 13 patients (39.3%) underwent additional procedures or surgery. CONCLUSIONS Complications of candidaemia occurred in 4.4% of adult patients. C. albicans was an independent risk factor for complicated candidaemia in adults. Complications of candidaemia might need prolonged treatment and additional procedures or surgery. Therefore, careful evaluation and active treatment of candidaemia with complications should be encouraged.
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Affiliation(s)
- Sung Un Shin
- Department of Internal Medicine, Chonnam National University Medical School, Gwangju, South Korea
| | - Yo Han Yu
- Department of Internal Medicine, Chonnam National University Medical School, Gwangju, South Korea
| | - Soo Sung Kim
- Department of Internal Medicine, Chonnam National University Medical School, Gwangju, South Korea
| | - Tae Hoon Oh
- Department of Internal Medicine, Chonnam National University Medical School, Gwangju, South Korea
| | - Seong Eun Kim
- Department of Internal Medicine, Chonnam National University Medical School, Gwangju, South Korea
| | - Uh Jin Kim
- Department of Internal Medicine, Chonnam National University Medical School, Gwangju, South Korea
| | - Seung-Ji Kang
- Department of Internal Medicine, Chonnam National University Medical School, Gwangju, South Korea
| | - Hee-Chang Jang
- Department of Internal Medicine, Chonnam National University Medical School, Gwangju, South Korea
| | - Kyung-Hwa Park
- Department of Internal Medicine, Chonnam National University Medical School, Gwangju, South Korea
| | - Sook In Jung
- Department of Internal Medicine, Chonnam National University Medical School, Gwangju, South Korea.
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16
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Brunetti G, Navazio AS, Giuliani A, Giordano A, Proli EM, Antonelli G, Raponi G. Candida blood stream infections observed between 2011 and 2016 in a large Italian University Hospital: A time-based retrospective analysis on epidemiology, biofilm production, antifungal agents consumption and drug-susceptibility. PLoS One 2019; 14:e0224678. [PMID: 31697722 PMCID: PMC6837454 DOI: 10.1371/journal.pone.0224678] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2019] [Accepted: 10/19/2019] [Indexed: 02/05/2023] Open
Abstract
Candida bloodstream infection (BSI) represents a growing infective problem frequently associated to biofilm production due to the utilization of intravascular devices. Candida species distribution (n = 612 strains), their biofilm production and hospital antifungal drug consumption were evaluated in different wards of a tertiary care academic hospital in Italy during the years 2011–2016. In the considered time window, an increasing number of Candida BSI (p = 0.005) and of biofilm producing strains were observed (p<0.0001). Although C. albicans was the species more frequently isolated in BSI with a major biofilm production, an increased involvement of non-albicans species was reported, particularly of C. parapsilosis that displayed a high frequency in catheter infections, and lower biofilm production compared to C. albicans. Although trends of biofilm production were substantially stable in time, a decreasing biofilm production by C. parapsilosis in the Intensive Care Unit (ICU) was observed (p = 0.0041). Principal component analysis displayed a change in antifungal drugs consumption driven by two mutually independent temporal trends, i.e. voriconazole use in the general medicine wards initially, and fluconazole use mainly in the ICU; these factors explain 68.9% and 25.7% of total variance respectively. Moreover, a significant trend (p = 0.003) in fluconazole use during the whole time period considered emerged, particularly in the ICU (p = 0.017), but also in the general medicine wards (p = 0.03). These trends paralleled with significant increase MIC90 of fluconazole (p = 0.05), particularly for C. parapsilosis in the ICU (p = 0.04), with a general and significant decreased trend of the MIC90 values of caspofungin (p = 0.04), and with significant increased MIC50 values for amphotericin B (p = 0.01) over the study period. In conclusion, drug utilization in our hospital turned out to be a putative influencing factor on the ecology of the species, on the increase in time of the biofilm producing strains and on the Candida antifungal susceptibility profile, thus influencing clinical management.
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Affiliation(s)
- Grazia Brunetti
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Rome, Italy
| | - Anna Sara Navazio
- Department of Molecular Medicine, Laboratory of Microbiology and Pasteur Institute-Cenci Bolognetti Foundation, Sapienza University of Rome, Rome, Italy
| | - Alessandro Giuliani
- Department of Environment and Health, Istituto Superiore di Sanità, Rome, Italy
| | - Alessandra Giordano
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Rome, Italy
- Microbiology and Virology Unit, Sapienza University Hospital Policlinico Umberto I, Rome, Italy
| | - Enrica Maria Proli
- Hospital Pharmacy, University Hospital Policlinico Umberto I, Rome, Italy
| | - Guido Antonelli
- Department of Molecular Medicine, Laboratory of Microbiology and Pasteur Institute-Cenci Bolognetti Foundation, Sapienza University of Rome, Rome, Italy
- Microbiology and Virology Unit, Sapienza University Hospital Policlinico Umberto I, Rome, Italy
| | - Giammarco Raponi
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Rome, Italy
- Microbiology and Virology Unit, Sapienza University Hospital Policlinico Umberto I, Rome, Italy
- * E-mail:
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17
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Ortega-Loubon C, Cano-Hernández B, Poves-Alvarez R, Muñoz-Moreno MF, Román-García P, Balbás-Alvarez S, de la Varga-Martínez O, Gómez-Sánchez E, Gómez-Pesquera E, Lorenzo-López M, Tamayo E, Heredia-Rodríguez M. The Overlooked Immune State in Candidemia: A Risk Factor for Mortality. J Clin Med 2019; 8:jcm8101512. [PMID: 31547077 PMCID: PMC6832466 DOI: 10.3390/jcm8101512] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2019] [Revised: 09/10/2019] [Accepted: 09/17/2019] [Indexed: 12/13/2022] Open
Abstract
Lymphopenia has been related to increased mortality in septic patients. Nonetheless, the impact of lymphocyte count on candidemia mortality and prognosis has not been addressed. We conducted a retrospective study, including all admitted patients with candidemia from 2007 to 2016. We examined lymphocyte counts during the first 5 days following the diagnosis of candidemia. Multivariable logistic regression analysis was performed to determine the relationship between lymphocyte count and mortality. Classification and Regression Tree analysis was used to identify the best cut-off of lymphocyte count for mortality associated with candidemia. From 296 cases of candidemia, 115 died, (39.8% 30-day mortality). Low lymphocyte count was related to mortality and poor outcome (p < 0.001). Lymphocyte counts <0.703 × 109 cells/L at diagnosis (area under the curve (AUC)-ROC, 0.783 ± 0.042; 95% confidence interval (CI), 0.700-0.867, p < 0.001), and lymphocyte count <1.272 × 109 cells/L five days later (AUC-ROC, 0.791 ± 0.038; 95%CI, 0.716-0.866, p < 0.001) increased the odds of mortality five-fold (odds ratio (OR), 5.01; 95%CI, 2.39-10.93) at time of diagnosis, and three-fold (OR, 3.27; 95%CI, 1.24-8.62) by day 5, respectively. Low lymphocyte count is an independent predictor of mortality in patients with candidemia and might serve as a biomarker for predicting candidemia-associated mortality and poor outcome.
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Affiliation(s)
- Christian Ortega-Loubon
- Department of Cardiac Surgery, Clinic University Hospital of Valladolid, Ramon y Cajal Ave. 3, 47003 Valladolid, Spain.
- BioCritic. Group for Biomedical Research in Critical Care Medicine, Ramon y Cajal Ave. 7, 47005 Valladolid, Spain.
| | - Beatriz Cano-Hernández
- Department of Anaesthesiology, Clinic University Hospital of Valladolid, Ramon y Cajal Ave. 3, 47003 Valladolid, Spain.
| | - Rodrigo Poves-Alvarez
- Department of Anaesthesiology, Clinic University Hospital of Valladolid, Ramon y Cajal Ave. 3, 47003 Valladolid, Spain.
| | - María Fe Muñoz-Moreno
- Unit of Research, Clinic University Hospital of Valladolid, Ramon y Cajal Ave. 3, 47003 Valladolid, Spain.
| | - Patricia Román-García
- Department of Anaesthesiology, Clinic University Hospital of Valladolid, Ramon y Cajal Ave. 3, 47003 Valladolid, Spain.
| | - Sara Balbás-Alvarez
- Department of Anaesthesiology, Clinic University Hospital of Valladolid, Ramon y Cajal Ave. 3, 47003 Valladolid, Spain.
| | - Olga de la Varga-Martínez
- Department of Anaesthesiology, Clinic University Hospital of Valladolid, Ramon y Cajal Ave. 3, 47003 Valladolid, Spain.
| | - Esther Gómez-Sánchez
- BioCritic. Group for Biomedical Research in Critical Care Medicine, Ramon y Cajal Ave. 7, 47005 Valladolid, Spain.
- Department of Anaesthesiology, Clinic University Hospital of Valladolid, Ramon y Cajal Ave. 3, 47003 Valladolid, Spain.
- Department of Surgery, Faculty of Medicine, University of Valladolid, Ramon y Cajal Ave 7, 47005 Valladolid, Spain.
| | - Estefanía Gómez-Pesquera
- BioCritic. Group for Biomedical Research in Critical Care Medicine, Ramon y Cajal Ave. 7, 47005 Valladolid, Spain.
- Department of Anaesthesiology, Clinic University Hospital of Valladolid, Ramon y Cajal Ave. 3, 47003 Valladolid, Spain.
- Department of Surgery, Faculty of Medicine, University of Valladolid, Ramon y Cajal Ave 7, 47005 Valladolid, Spain.
| | - Mario Lorenzo-López
- BioCritic. Group for Biomedical Research in Critical Care Medicine, Ramon y Cajal Ave. 7, 47005 Valladolid, Spain.
- Department of Anaesthesiology, Clinic University Hospital of Valladolid, Ramon y Cajal Ave. 3, 47003 Valladolid, Spain.
- Department of Surgery, Faculty of Medicine, University of Valladolid, Ramon y Cajal Ave 7, 47005 Valladolid, Spain.
| | - Eduardo Tamayo
- BioCritic. Group for Biomedical Research in Critical Care Medicine, Ramon y Cajal Ave. 7, 47005 Valladolid, Spain.
- Department of Anaesthesiology, Clinic University Hospital of Valladolid, Ramon y Cajal Ave. 3, 47003 Valladolid, Spain.
- Department of Surgery, Faculty of Medicine, University of Valladolid, Ramon y Cajal Ave 7, 47005 Valladolid, Spain.
| | - María Heredia-Rodríguez
- BioCritic. Group for Biomedical Research in Critical Care Medicine, Ramon y Cajal Ave. 7, 47005 Valladolid, Spain.
- Department of Surgery, Faculty of Medicine, University of Valladolid, Ramon y Cajal Ave 7, 47005 Valladolid, Spain.
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Rodrigues LS, Motta FA, Picharski GL, Vasconcelos TM, Riccieri MC, Dalla-Costa LM. Invasive candidiasis: Risk factor for mortality in a pediatric tertiary care hospital in south of Brazil. Medicine (Baltimore) 2019; 98:e15933. [PMID: 31169713 PMCID: PMC6571356 DOI: 10.1097/md.0000000000015933] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2019] [Revised: 04/23/2019] [Accepted: 05/10/2019] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Invasive candidiasis (IC) is a major cause of morbimortality in children. Previous studies described the clinical characteristics and risk factors for this infection; however, limited data are available on the predictors of mortality in these patients. In this context, we evaluated the risk factors associated with death due to IC in a pediatric tertiary care hospital in South of Brazil. METHODS This is a retrospective, cross-sectional, observational, and analytical study of a series of pediatric patients with clinical and laboratory diagnosis of IC from March 2014 to September 2017. Univariate and multivariate analysis were performed to estimate the association between the characteristics of the patients and death. RESULTS A total of 94 cases of IC were included. The incidence was 1.13 cases per 1000 patients/d, with a mortality rate of 14%. There was a predominance of non-albicans Candida (71.3%) in IC cases and, although there is no species difference in mortality rates, biofilm formation was associated with increased mortality. Clinical characteristics such as male sex, stay in the intensive care unit, and thrombocytopenia; comorbidities such as cardiological disease and renal insufficiency; and risks such as mechanical ventilation and dialysis were associated with increased mortality. CONCLUSION Data from this study suggest that biofilm formation by Candida sp. is associated with increased mortality, and this is the first study to correlate the male sex and cardiological disease as risk factors for death in pediatric IC patients.
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Persistent Candidemia in adults: underlying causes and clinical significance in the antifungal stewardship era. Eur J Clin Microbiol Infect Dis 2019; 38:607-614. [PMID: 30680572 DOI: 10.1007/s10096-019-03477-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2018] [Accepted: 01/02/2019] [Indexed: 12/17/2022]
Abstract
To investigate the causes and the clinical significance of persistent candidemia (PC) in adults diagnosed in a tertiary hospital with an active antifungal stewardship program. Retrospective cohort including all adults with candidemia from 2010 to 2018. PC was defined as any positive follow-up blood culture (BC) obtained ≥ 5 days from the first BCs yielding the same Candida species. PC was detected in 35/255 (13.7%) patients. There were no differences regarding antifungal adequacy in PC vs. non-PC (94.3% vs. 82.3%, p = 0.084) and primary source control (63.3% vs. 76.4%, p = 0.172) at the time of the follow-up BCs. The average time until source control (2 [0-37] vs. 2 days [0-44], p = 0.311) or adequate antifungal treatment (2 [0-26] vs. 2 days [- 2-10], p = 0.748) was similar. Patients with PC had more non-ocular complications (31.4% vs. 10.5%, p = 0.002). No impact on 30-day mortality was observed (31.4% vs. 22.3%, p = 0.238). The only independent factor associated with PC was to have a previously undetected site of infection [OR 4.28, 95%CI (1.77-10.34), p = 0.001]. Persistent candidemia was not associated with inadequate or delayed therapeutic management, nor higher 30-day mortality rates. Timely screening and control of unexpected infection sources are encouraged to shorten hospitalization and improve patient care.
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Lin KY, Chen PY, Chuang YC, Wang JT, Sun HY, Sheng WH, Chen YC, Chang SC. Effectiveness of echinocandins versus fluconazole for treatment of persistent candidemia: A time-dependent analysis. J Infect 2018; 77:242-248. [PMID: 29932963 DOI: 10.1016/j.jinf.2018.05.011] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2018] [Revised: 05/26/2018] [Accepted: 05/28/2018] [Indexed: 01/05/2023]
Abstract
OBJECTIVES Echinocandins are fungicidal and more active than fluconazole against Candida biofilms. This is known to be an important mechanism for Candida persistence. However, there is limited evidence of effectiveness of echinocandins for treating persistent candidemia. METHODS We prospectively observed adult patients with persistent candidemia from March 2011 to February 2016. This was defined as the isolation of the same Candida species for ≥ 5 days from blood cultures. We used a time-dependent analysis to evaluate the impact of definitive therapy on mycological eradication and overall survival at 30 days from the index date (the date of collecting the second positive blood culture). RESULTS We screened 1162 episodes of candidemia. Of 196 non-duplicate patients enrolled, 64 received echinocandins and 132 received fluconazole as their first definitive therapy after the index date. The rates of mycological eradication and overall survival were 67.3% and 55.6%, respectively. The factors associated with mycological eradication included receipt of an echinocandin as the definitive therapy, adequate source control, and not receiving parenteral hyperalimentation. The factors related to overall survival were APACHE II, not receiving corticosteroids, and receiving cardiovascular or abdominal surgery. CONCLUSIONS Echinocandins were more effective than fluconazole in achieving mycological eradication in patients with persistent candidemia.
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Affiliation(s)
- Kuan-Yin Lin
- Department of Medicine, National Taiwan University Hospital Jin-Shan Branch, New Taipei City, Taiwan; Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan
| | - Pao-Yu Chen
- Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Yu-Chung Chuang
- Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Jann-Tay Wang
- Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Hsin-Yun Sun
- Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Wang-Huei Sheng
- Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan; Department of Medicine, National Taiwan University College of Medicine, Taipei, Taiwan
| | - Yee-Chun Chen
- Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan; Department of Medicine, National Taiwan University College of Medicine, Taipei, Taiwan.
| | - Shan-Chwen Chang
- Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan; Department of Medicine, National Taiwan University College of Medicine, Taipei, Taiwan
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21
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Li WS, Chen YC, Kuo SF, Chen FJ, Lee CH. The Impact of Biofilm Formation on the Persistence of Candidemia. Front Microbiol 2018; 9:1196. [PMID: 29915571 PMCID: PMC5994545 DOI: 10.3389/fmicb.2018.01196] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2018] [Accepted: 05/16/2018] [Indexed: 12/15/2022] Open
Abstract
This study aimed to determine the predictors of persistent candidemia and examine the impact of biofilm formation by Candida isolates in adult patients with candidemia. Of the adult patients with candidemia in Kaohsiung Chang Gung Memorial Hospital between January 2007 and December 2012, 68 case patients with persistent candidemia (repeated candidemia after a 3-day systemic antifungal therapy) and 68 control patients with non-persistent candidemia (Candida clearance from the bloodstream after a 3-day systemic antifungal therapy) were included based on propensity score matching and matching for the Candida species isolated. Biofilm formation by the Candida species was assessed in vitro using standard biomass assays. Presence of central venous catheters (CVCs) at diagnosis (adjusted odd ratio [AOR], 3.77; 95% confidence interval [CI], 1.09–13.00, p = 0.04), infection with higher biofilm forming strains of Candida species (AOR, 8.03; 95% CI, 2.50–25.81; p < 0.01), and receipt of suboptimal fluconazole doses as initial therapy (AOR, 5.54; 95% CI, 1.53–20.10; p < 0.01) were independently associated with persistent candidemia. Biofilm formation by Candida albicans, C. tropicalis, and C. glabrata strains was significantly higher in the case patients than in the controls. There were no significant differences in the overall mortality and duration of hospitalization between the two groups. Our data suggest that, other than presence of retained CVCs and use of suboptimal doses of fluconazole, biofilm formation was highly associated with development of persistent candidemia.
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Affiliation(s)
- Wei-Sin Li
- Division of Infectious Diseases, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan
| | - Yi-Chun Chen
- Division of Infectious Diseases, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan
| | - Shu-Fang Kuo
- Department of Laboratory Medicine, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan
| | - Fang-Ju Chen
- Division of Infectious Diseases, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan
| | - Chen-Hsiang Lee
- Division of Infectious Diseases, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan.,Chang Gung University College of Medicine, Kaohsiung, Taiwan
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