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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] [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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An approach to develop clinical prediction rule for candidemia in critically ill patients: A retrospective observational study. J Crit Care 2021; 65:216-220. [PMID: 34252648 DOI: 10.1016/j.jcrc.2021.06.018] [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] [Received: 03/15/2021] [Revised: 06/26/2021] [Accepted: 06/30/2021] [Indexed: 11/21/2022]
Abstract
PURPOSE Early detection of candidemia in critically ill patients is important for preemptive antifungal treatment. Our study aimed to identify the independent risk factors for the development of a new candidemia prediction score. METHODS This single-centre retrospective observational study evaluated 2479 intensive care unit (ICU) cases from January 2016 to December 2018. A total of 76 identified candidemia cases and 76 matched control cases were analyzed. The patients' demographic characteristics and illness severity were analyzed, and possible risk factors for candidemia were investigated. RESULTS Multivariate logistic regression analysis identified renal replacement therapy (RRT) (odds ratio [OR]: 52.83; 95% confidence interval [CI]: 7.82-356.92; P < 0.0001), multifocal Candida colonization (OR: 23.55; 95% CI: 4.23-131.05; P < 0.0001), parenteral nutrition (PN) (OR: 63.67; 95% CI: 4.56-889.77; P = 0.002), and acute kidney injury (AKI) (OR: 7.67; 95% CI: 1.24-47.30; P = 0.028) as independent risk factors. A new prediction score with a cut-off value of 5.0 (80.3% sensitivity and 77.3% specificity) was formulated from the logit model equation. CONCLUSIONS Renal replacement therapy, AKI, PN, and multifocal Candida colonization were the independent risk factors for the new candidemia prediction score with high discriminatory performance and predictive accuracy.
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Sousa M, Martins J, Barreto S, Santos C, Gouveia R, Santos JP, Guerra N, Ramos A. A rare complication of a hemodialysis tunneled catheter: Case report of a superior vena cava and right atrium candida endocarditis. IDCases 2020; 20:e00768. [PMID: 32382503 PMCID: PMC7200829 DOI: 10.1016/j.idcr.2020.e00768] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2020] [Accepted: 04/07/2020] [Indexed: 01/21/2023] Open
Abstract
Infections remain an important cause of death among hemodialysis patients. This population have a higher risk of candidemia. Candida endocarditis it´s a rare but frequently fatal complication of candidemia. A 64 year-old female presented with a purulent discharge at the insertion site of a hemodialysis tunneled cuff catheter. A catheter related bloodstream infection was suspected, cultures were obtained and wide-spectrum antibiotic therapy was administered. A multi sensitive Candida albicans was isolated. Transesophageal echocardiography showed a large vegetation located in the superior vena cava, in probable relation with a previous catheter. The first approach was antifungal treatment. Due to non-response, she did a surgical removal of the vegetation. Culture of the vegetation showed the same as the blood cultures. After one year she has no signs of relapse. To improve the prognosis of this high mortality condition a high index of suspicion is necessary for early diagnosis and timely intervention.
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Affiliation(s)
- Mariana Sousa
- Nephrology Department, Hospital Garcia De Orta, Almada, Portugal
| | - Joana Martins
- Nephrology Department, Hospital Garcia De Orta, Almada, Portugal
| | - Sara Barreto
- Nephrology Department, Hospital Garcia De Orta, Almada, Portugal
| | - Cristina Santos
- Nephrology Department, Hospital Garcia De Orta, Almada, Portugal
| | - Rita Gouveia
- Nephrology Department, Hospital Garcia De Orta, Almada, Portugal
| | | | - Nuno Guerra
- Cardiothoracic Surgery Department, Hospital Santa Maria, Lisboa, Portugal
| | - Aura Ramos
- Nephrology Department, Hospital Garcia De Orta, Almada, Portugal
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Jakab Á, Mogavero S, Förster TM, Pekmezovic M, Jablonowski N, Dombrádi V, Pócsi I, Hube B. Effects of the glucocorticoid betamethasone on the interaction of Candida albicans with human epithelial cells. Microbiology (Reading) 2016; 162:2116-2125. [DOI: 10.1099/mic.0.000383] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Affiliation(s)
- Ágnes Jakab
- Department of Biotechnology and Microbiology, Faculty of Science and Technology, University of Debrecen, Debrecen, Hungary
- Department of Microbial Pathogenicity Mechanisms, Hans Knöll Institute, Jena, Germany
| | - Selene Mogavero
- Department of Microbial Pathogenicity Mechanisms, Hans Knöll Institute, Jena, Germany
| | - Toni M. Förster
- Department of Microbial Pathogenicity Mechanisms, Hans Knöll Institute, Jena, Germany
| | - Marina Pekmezovic
- Department of Microbial Pathogenicity Mechanisms, Hans Knöll Institute, Jena, Germany
| | - Nadja Jablonowski
- Department of Microbial Pathogenicity Mechanisms, Hans Knöll Institute, Jena, Germany
| | - Viktor Dombrádi
- Department of Medical Chemistry, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - István Pócsi
- Department of Biotechnology and Microbiology, Faculty of Science and Technology, University of Debrecen, Debrecen, Hungary
| | - Bernhard Hube
- Department of Microbial Pathogenicity Mechanisms, Hans Knöll Institute, Jena, Germany
- Friedrich Schiller University, Jena, Germany
- Center for Sepsis Control and Care, University Hospital, Jena, Germany
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Prattes J, Schilcher G, Krause R. Reliability of serum 1,3-beta-D-glucan assay in patients undergoing renal replacement therapy: a review of the literature. Mycoses 2014; 58:4-9. [PMID: 25339221 DOI: 10.1111/myc.12267] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2014] [Accepted: 09/29/2014] [Indexed: 11/27/2022]
Abstract
The serum 1,3-beta-D-glucan (BDG) test is a pan-fungal serum marker considered to detect the majority of pathogenic fungi, including Aspergillus spp. and Candida spp. For this review we searched for publications dealing with serum BDG levels in patients undergoing renal replacement therapy (RRT). The influence of various different membrane materials used for RRTs in these publications on serum BDG has been reviewed. We found that unmodified cellulose containing membranes increased the serum BDG levels highly, whereas conflicting results have been observed for modified cellulose containing materials. Synthetic materials (e.g. polysuflone) had no influence on serum BDG levels in the majority of the reviewed publications.
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Affiliation(s)
- Juergen Prattes
- Section of Infectious Diseases and Tropical Medicine, Department of Internal Medicine, Medical University of Graz, Graz, Austria
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Mathai AM, Menezes RG, Naik R, Kanchan T, Kumar S, Bhat G, Chauhan A, Rai M. An autopsy case of renal candidiasis. J Forensic Leg Med 2008; 16:31-4. [PMID: 19061847 DOI: 10.1016/j.jflm.2008.05.021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2008] [Accepted: 05/19/2008] [Indexed: 11/29/2022]
Abstract
Systemic candidiasis is the most frequently encountered opportunistic fungal infection, the kidneys being primarily affected in 80% of the cases. Most of the cases are fatal, diagnosed either very late for effective therapeutic intervention or are documented only at postmortem examination. We, herein, report a case of renal candidiasis in an elderly male who died in the hospital while undergoing treatment for head injury and multiple fractures sustained following a road traffic incident. Renal candidiasis with fungal balls obstructing the pelvicalyceal system was diagnosed at autopsy, which may have contributed to death.
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Affiliation(s)
- Alka Mary Mathai
- Department of Pathology, Kasturba Medical College, Mangalore, India
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Actividad proteinasa y fosfolipasa como factores de virulencia en especies de Candida aisladas de sangre. Rev Iberoam Micol 2008; 25:208-10. [DOI: 10.1016/s1130-1406(08)70050-0] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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Abstract
Since the 1990s, opportunistic fungal infections have emerged as a substantial cause of morbidity and mortality in profoundly immunocompromised patients. Hypercortisolaemic patients, both those with endogenous Cushing's syndrome and, much more frequently, those receiving exogenous glucocorticoid therapy, are especially at risk of such infections. This vulnerability is attributed to the complex dysregulation of immunity caused by glucocorticoids. We critically review the spectrum and presentation of invasive fungal infections that arise in the setting of hypercortisolism, and the ways in which glucocorticoids contribute to their pathogenesis. A better knowledge of the interplay between glucocorticoid-induced immunosuppression and invasive fungal infections should assist in earlier recognition and treatment of such infections. Efforts to decrease the intensity of glucocorticoid therapy should help to improve outcomes of opportunistic fungal infections.
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Affiliation(s)
- Michail S Lionakis
- Department of Infectious Diseases, Infection Control and Employee Health, University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
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