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Dornelles G, Araújo GRDS, Rodrigues M, Alves V, Almeida-Paes R, Frases S. Comparative Analysis of Capsular and Secreted Polysaccharides Produced by Rhodotorula mucilaginosa and Cryptococcus neoformans. J Fungi (Basel) 2023; 9:1124. [PMID: 37998929 PMCID: PMC10672113 DOI: 10.3390/jof9111124] [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: 11/04/2023] [Revised: 11/13/2023] [Accepted: 11/17/2023] [Indexed: 11/25/2023] Open
Abstract
Fungal infections are a global public health challenge, especially among immunocompromised patients. Basidiomycetous yeasts, such as Rhodotorula mucilaginosa, have emerged as opportunistic pathogens, but have received less attention than Cryptococcus neoformans. This study aimed to characterize the polysaccharides of R. mucilaginosa and compare them with those of C. neoformans, analyzing their clinical implications. Comprehensive physicochemical, mechanical, and ultrastructural analyses of polysaccharides from both species were performed, revealing correlations with virulence and pathogenicity. R. mucilaginosa cells are surrounded by a capsule smaller than that produced by C. neoformans, but with similar polysaccharides. Those polysaccharides are also secreted by R. mucilaginosa. Cross-reactivity with R. mucilaginosa was observed in a diagnostic C. neoformans antigen test, using both in vitro and in vivo samples, highlighting the need for more reliable tests. Some R. mucilaginosa strains exhibited virulence comparable to that of C. neoformans in an invertebrate experimental model (Tenebrio molitor). This study contributes to a deeper understanding of yeast pathogenicity and virulence, highlighting the need for more accurate diagnostic tests to improve the differential diagnosis of infections caused by basidiomycetous yeasts.
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Affiliation(s)
- Gustavo Dornelles
- Laboratório de Biofísica de Fungos, Instituto de Biofísica Carlos Chagas Filho, Universidade Federal do Rio de Janeiro, Rio de Janeiro 21941-902, Brazil; (G.D.); (G.R.d.S.A.); (M.R.); (V.A.)
| | - Glauber R. de S. Araújo
- Laboratório de Biofísica de Fungos, Instituto de Biofísica Carlos Chagas Filho, Universidade Federal do Rio de Janeiro, Rio de Janeiro 21941-902, Brazil; (G.D.); (G.R.d.S.A.); (M.R.); (V.A.)
| | - Marcus Rodrigues
- Laboratório de Biofísica de Fungos, Instituto de Biofísica Carlos Chagas Filho, Universidade Federal do Rio de Janeiro, Rio de Janeiro 21941-902, Brazil; (G.D.); (G.R.d.S.A.); (M.R.); (V.A.)
| | - Vinicius Alves
- Laboratório de Biofísica de Fungos, Instituto de Biofísica Carlos Chagas Filho, Universidade Federal do Rio de Janeiro, Rio de Janeiro 21941-902, Brazil; (G.D.); (G.R.d.S.A.); (M.R.); (V.A.)
| | - Rodrigo Almeida-Paes
- Laboratório de Micologia, Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz, Rio de Janeiro 21040-900, Brazil;
- Rede Micologia RJ, Fundação de Amparo à Pesquisa do Estado do Rio de Janeiro (FAPERJ), Rio de Janeiro 21040-360, Brazil
| | - Susana Frases
- Laboratório de Biofísica de Fungos, Instituto de Biofísica Carlos Chagas Filho, Universidade Federal do Rio de Janeiro, Rio de Janeiro 21941-902, Brazil; (G.D.); (G.R.d.S.A.); (M.R.); (V.A.)
- Rede Micologia RJ, Fundação de Amparo à Pesquisa do Estado do Rio de Janeiro (FAPERJ), Rio de Janeiro 21040-360, Brazil
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Bosaeed M, Alhatmi H, Almansour S, Abanamy R, Akbar A, Abalkhail M, Alharbi A, Alsaedy A, Mahmoud E, Alalwan B, AlJohani S, Aldibasi O, Alothman A. Clinical characteristics and outcome of candidemia: Experience from a tertiary referral center in Saudi Arabia. SAUDI JOURNAL OF MEDICINE AND MEDICAL SCIENCES 2022; 10:125-130. [PMID: 35602394 PMCID: PMC9121703 DOI: 10.4103/sjmms.sjmms_625_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2021] [Revised: 02/23/2022] [Accepted: 03/07/2022] [Indexed: 11/13/2022] Open
Abstract
Background: Candida bloodstream infections cause significant excess morbidity and mortality in the health-care setting. There is limited evidence regarding Candida species causing invasive infections in Saudi Arabia. Objective: To identify Candida species causing bloodstream infection and determine the clinical outcome and factors associated with mortality in a tertiary center in Saudi Arabia. Materials and Methods: This retrospective study included all cases of positive blood culture for Candida in patients admitted to King Abdulaziz Medical City, a tertiary care center in Riyadh, Saudi Arabia, between January 1, 2013 and June 30, 2019. Results: A total of 532 patients with candidemia were identified (male: 55.4%; mean age: 54 ± 26.2 years). The most common Candida species isolated was Candida albicans (26.7%), followed by Candida glabrata (22.7%), Candida parapsilosis (22.2%), and Candida tropicalis (18.4%). Non-albicans candidemia was more common in patients with diabetes (76.7%; P = 0.0560), neutropenia (89.8%; P = 0.0062), recent exposure to fluconazole (85.7%; P = 0.0394), and active chemotherapy (83.1%; P = 0.0128). In non-albicans, susceptibility to fluconazole varied from 95.9% with C. tropicalis to 41.5% with C. parapsilosis; nonetheless, all species were highly susceptible to echinocandins. The overall 30- and 90-day mortality rates were 39.9% and 56.4%, respectively. The mortality rate was nonsignificantly higher with non-albicans species at 30 days (41.2% vs. 35.9%; P = 0.2634) and 90 days (58.2% vs. 51.4%; P = 0.1620). Conclusion: This study found a changing pattern in the Candida species causing bloodstream infections and an epidemiological shift toward more non-albicans Candida species in Saudi Arabia.
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Xu L, Zhao H, Zhou M, Lang G, Lou H. Single and Repeated Episodes of Candida Species Isolated From Cerebrospinal Fluid for Diagnosing Probable Candida meningitis. Front Microbiol 2021; 12:742931. [PMID: 34721340 PMCID: PMC8554295 DOI: 10.3389/fmicb.2021.742931] [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: 07/17/2021] [Accepted: 09/13/2021] [Indexed: 11/13/2022] Open
Abstract
Background: The clinical relevance of single or repeated episodes of Candida spp. in cerebrospinal fluid (CSF) in adult patients is debatable. Methods: Forty-two patients with positive Candida episodes in CSF were enrolled in this retrospective study. Results: A total of 42.9% (18/42) were determined to have probable Candida meningitis (PCM). Neurosurgery [odds ratio (OR) (95% confidence interval), OR: 14.4 (1.6–126.1), P = 0.004], lumbar drainage [OR: 5.8 (1.5–23.3), P = 0.009], VP shunt [(OR: 5.6 (1.2–25.8), P = 0.020)], external ventricular drainage [OR: 4.7 (1.3–17.7), P = 0.018], CRP ≥ 10.0 mg/L [OR: 4.9 (1.3–18.1), P = 0.034], and postsurgical broad-spectrum antibiotics [OR: 9.5 (1.8–50.5), P = 0.004] were risk factors associated with PCM. A single CSF Candida episode for the diagnosis of PCM had 7.7% (0.4–37.9%) sensitivity and 20.7% (8.7–40.3%) specificity, whereas repeated episodes of Candida had 66.7% (41.2–85.6%) sensitivity and 95.8% (76.9–99.8%) specificity. No significant difference was found in radiological imaging or CSF profiles between PCM and non-PCM patients. A total of 37.5% (9/24) of patients without PCM received empirical antifungal treatment, and 88.9% (16/18) of patients with PCM received preemptive antifungal treatment. PCM patients had hospitalized mortality rates of 50.0% (9/18). The odds ratio of mortality was 23.0 (2.5–208.6) for PCM patients compared with non-PCM patients (P = 0.001). Conclusion: Both single and repeated positive CSF samples have low validity for the diagnosis of PCM, suggesting that novel strategies for diagnosis algorithms of PCM are urgently needed. Empirical antifungal treatment should be started immediately for suspicious patients with risk factors.
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Affiliation(s)
- Lijun Xu
- National Clinical Research Center for Infectious Diseases, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China.,The State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China
| | - Handan Zhao
- College of Medicine, Zhejiang University, Hangzhou, China
| | - Minghan Zhou
- College of Medicine, Zhejiang University, Hangzhou, China
| | - Guanjing Lang
- National Clinical Research Center for Infectious Diseases, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China.,The State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China
| | - Haiyan Lou
- Department of Radiology, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China
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Thomas-Rüddel D, Schlattmann P, Pletz M, Kurzai O, Bloos F. Risk factors for invasive candida infection in critically ill patients - a systematic review and meta-analysis. Chest 2021; 161:345-355. [PMID: 34673022 PMCID: PMC8941622 DOI: 10.1016/j.chest.2021.08.081] [Citation(s) in RCA: 45] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Revised: 08/03/2021] [Accepted: 08/07/2021] [Indexed: 11/28/2022] Open
Abstract
Background Current guidelines recommend empirical antifungal therapy in patients with sepsis with high risk of invasive Candida infection. However, many different risk factors have been derived from multiple studies. These risk factors lack specificity, and broad application would render most ICU patients eligible for empirical antifungal therapy. Research Question What risk factors for invasive Candida infection can be identified by a systematic review and meta-analysis? Study Design and Methods We searched PubMed, Web of Science, ScienceDirect, Biomed Central, and Cochrane and extracted the raw and adjusted OR for each risk factor associated with invasive Candida infection. We calculated pooled ORs for risk factors present in more than one study. Results We included 34 studies in our meta-analysis resulting in the assessment of 29 possible risk factors. Risk factors for invasive Candida infection included demographic factors, comorbid conditions, and medical interventions. Although demographic factors do not play a role for the development of invasive Candida infection, comorbid conditions (eg, HIV, Candida colonization) and medical interventions have a significant impact. The risk factors associated with the highest risk for invasive Candida infection were broad-spectrum antibiotics (OR, 5.6; 95% CI, 3.6-8.8), blood transfusion (OR, 4.9; 95% CI, 1.5-16.3), Candida colonization (OR, 4.7; 95% CI, 1.6-14.3), central venous catheter (OR, 4.7; 95% CI, 2.7-8.1), and total parenteral nutrition (OR, 4.6; 95% CI, 3.3-6.3). However, dependence between the various risk factors is probably high. Interpretation Our systematic review and meta-analysis identified patient- and treatment-related factors that were associated with the risk for the development of invasive Candida infection in the ICU. Most of the factors identified were either related to medical interventions during intensive care or to comorbid conditions.
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Affiliation(s)
- Daniel Thomas-Rüddel
- Center for Sepsis Control & Care, Jena University Hospital, Jena, Germany;; Dept. of Anesthesiology and Intensive Care Medicine, Jena University Hospital, Jena, Germany;.
| | - Peter Schlattmann
- Institut für Medizinische Statistik, Informatik und Datenwissenschaften (IMSID), Jena University Hospital Jena
| | - Mathias Pletz
- Center for Sepsis Control & Care, Jena University Hospital, Jena, Germany;; Institute for Infectious Diseases and Infection Control, Jena University Hospital Jena
| | - Oliver Kurzai
- Center for Sepsis Control & Care, Jena University Hospital, Jena, Germany;; National Reference Center for Invasive Fungal Infections NRZMyk, Leibniz Institute for Natural Product Research and Infection Biology - Hans-Knoell-Institute, Jena; University of Wuerzburg, Institute for Hygiene and Microbiology, Germany
| | - Frank Bloos
- Center for Sepsis Control & Care, Jena University Hospital, Jena, Germany;; Dept. of Anesthesiology and Intensive Care Medicine, Jena University Hospital, Jena, Germany
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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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Risandy DA, Rusmawatiningtyas D, Makrufardi F, Herini ES, Nurnaningsih. Predicting Candida Infection in Pediatric Intensive Care Unit using Candida Score in a Low-Resource Setting. Glob Pediatr Health 2021; 8:2333794X21999152. [PMID: 33796635 PMCID: PMC7983425 DOI: 10.1177/2333794x21999152] [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: 10/27/2020] [Accepted: 02/08/2021] [Indexed: 11/17/2022] Open
Abstract
Candida infection was previously thought to be rare in intensive care. With the increased use of broad-spectrum antibiotics, the incidence of candida infection increased significantly. Case-control study was done in patients ≤18 years of age treated for 3 days or more in Pediatric Intensive Care Unit (PICU) Dr. Sardjito General Hospital, Yogyakarta from January 2014 to December 2016. Overall, 43 children were included in this study as a case group with positive candida culture and 43 children as a control group with no candida culture. Cut off point of candida score is ≥3 from our subjects. The area under curve (AUC) value for cut off ≥3 was moderate (0,72). Candida score ≥3 has an odd ratio (OR) 6.8 (95% CI 2.4-18.6) with P < .05. All of confounding factors in candida infection have no association with P > .05. Candida score can be used as predictor of candida infection in PICU.
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Affiliation(s)
- Dicky Ari Risandy
- Department of Child Health, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada/Dr. Sardjito General Hospital, Yogyakarta, Indonesia
| | - Desy Rusmawatiningtyas
- Department of Child Health, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada/Dr. Sardjito General Hospital, Yogyakarta, Indonesia
| | - Firdian Makrufardi
- Department of Child Health, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada/Dr. Sardjito General Hospital, Yogyakarta, Indonesia
| | - Elisabeth Siti Herini
- Department of Child Health, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada/Dr. Sardjito General Hospital, Yogyakarta, Indonesia
| | - Nurnaningsih
- Department of Child Health, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada/Dr. Sardjito General Hospital, Yogyakarta, Indonesia
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Ripoli A, Sozio E, Sbrana F, Bertolino G, Pallotto C, Cardinali G, Meini S, Pieralli F, Azzini AM, Concia E, Viaggi B, Tascini C. Personalized machine learning approach to predict candidemia in medical wards. Infection 2020; 48:749-759. [PMID: 32740866 DOI: 10.1007/s15010-020-01488-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2019] [Accepted: 07/21/2020] [Indexed: 12/21/2022]
Abstract
PURPOSE Candidemia is a highly lethal infection; several scores have been developed to assist the diagnosis process and recently different models have been proposed. Aim of this work was to assess predictive performance of a Random Forest (RF) algorithm for early detection of candidemia in the internal medical wards (IMWs). METHODS A set of 42 potential predictors was acquired in a sample of 295 patients (male: 142, age: 72 ± 15 years; candidemia: 157/295; bacteremia: 138/295). Using tenfold cross-validation, a RF algorithm was compared with a classic stepwise multivariable logistic regression model; discriminative performance was assessed by C-statistics, sensitivity and specificity, while calibration was evaluated by Hosmer-Lemeshow test. RESULTS The best tuned RF algorithm demonstrated excellent discrimination (C-statistics = 0.874 ± 0.003, sensitivity = 84.24% ± 0.67%, specificity = 91% ± 2.63%) and calibration (Hosmer-Lemeshow statistics = 12.779 ± 1.369, p = 0.120), markedly greater than the ones guaranteed by the classic stepwise logistic regression (C-statistics = 0.829 ± 0.011, sensitivity = 80.21% ± 1.67%, specificity = 84.81% ± 2.68%; Hosmer-Lemeshow statistics = 38.182 ± 15.983, p < 0.001). In addition, RF suggests a major role of in-hospital antibiotic treatment with microbioma highly impacting antimicrobials (MHIA) that are found as a fundamental risk of candidemia, further enhanced by TPN. When in-hospital MHIA therapy is not performed, PICC is the dominant risk factor for candidemia, again enhanced by TPN. When PICC is not used and MHIA therapy is not performed, the risk of candidemia is minimum, slightly increased by in-hospital antibiotic therapy. CONCLUSION RF accurately estimates the risk of candidemia in patients admitted to IMWs. Machine learning technique might help to identify patients at high risk of candidemia, reduce the delay in empirical treatment and improve appropriateness in antifungal prescription.
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Affiliation(s)
- Andrea Ripoli
- Bioengineering Department, Fondazione Toscana Gabriele Monasterio, Pisa, Italy
| | - Emanuela Sozio
- Emergency Department, North-West District, Tuscany Health Care, Spedali Riuniti Livorno, Livorno, Italy
| | - Francesco Sbrana
- U.O. Lipoapheresis and Center for Inherited Dyslipidemias, Fondazione Toscana Gabriele Monasterio, Via Moruzzi,1, 56124, Pisa, Italy.
| | - Giacomo Bertolino
- Pharmaceutical Department, ASSL Cagliari, Cagliari, Italy.,Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy
| | - Carlo Pallotto
- UOC Malattie Infettive, Ospedale San Donato Arezzo, Sud-Est District, Tuscany Health Care, Arezzo, Italy.,Sezione Di Malattie Infettive, Dipartimento Di Medicina, Università Di Perugia, Perugia, Italy
| | - Gianluigi Cardinali
- Department of Pharmaceutical Sciences-Microbiology, University of Perugia, Perugia, Italy.,CEMIN, Centre of Excellence On Nanostructured Innovative Materials, Department of Chemistry, Biology and Biotechnology, University of Perugia, Perugia, Italy
| | - Simone Meini
- Internal Medicine Unit, Santa Maria Annunziata Hospital, Florence, Italy
| | - Filippo Pieralli
- Intermediate Care Unit, Azienda Ospedaliera Universitaria Careggi, Florence, Italy
| | - Anna Maria Azzini
- Dipartimento Di Diagnostica E Sanità Pubblica, Sezione Di Malattie Infettive, Università Di Verona, Verona, Italy
| | - Ercole Concia
- Dipartimento Di Diagnostica E Sanità Pubblica, Sezione Di Malattie Infettive, Università Di Verona, Verona, Italy
| | - Bruno Viaggi
- Department of Anesthesia, Neuro Intensive Care Unit, Careggi Universital Hospital, Florence, Italy
| | - Carlo Tascini
- First Division of Infectious Diseases, Cotugno Hospital, Azienda Ospedaliera Dei Colli, Napoli, Italy
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Alves F, Carmello JC, Mima EGDO, Costa CADS, Bagnato VS, Pavarina AC. Photodithazine-mediated antimicrobial photodynamic therapy against fluconazole-resistant Candida albicans in vivo. Med Mycol 2019; 57:609-617. [PMID: 30339223 DOI: 10.1093/mmy/myy083] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2017] [Revised: 03/30/2018] [Accepted: 08/31/2018] [Indexed: 12/20/2022] Open
Abstract
This study evaluated the efficacy of antimicrobial Photodynamic Therapy (aPDT) against fluconazole-resistant Candida albicans in a murine model of oral candidosis. Mice were inoculated with two clinical isolates (R10, R15) and one reference strain (ATCC) of resistant C. albicans to produce oral candidosis. After inoculation, aPDT mediated by Photodithazine® (PDZ) and LED light was performed. The use of PDZ or light only was also investigated. Additional animals were treated with Nystatin (NYS). Untreated or healthy mice were also evaluated. Microbiological evaluation was performed by recovering C. albicans from the tongue via colony-forming units. Animals were killed 24 hours after treatments, and the tongues were removed for histological analysis. Data were analyzed by one-way ANOVA and Tukey test (P < .05). The results demonstrated that all strains showed the same behavior after aPDT and NYS treatment. A significant reduction in C. albicans viability was achieved after both treatments for R15 and ATCC. No significant reduction was verified for C. albicans R10 submitted to aPDT or NYS. The histological analysis revealed that aPDT did not cause side effects on tissues. aPDT was effective for inactivation of two fluconazole-resistant C. albicans of the three strains evaluated.
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Affiliation(s)
- Fernanda Alves
- Department of Dental Materials and Prosthodontics, São Paulo State University (Unesp), School of Dentistry, Araraquara, São Paulo, Brazil
| | - Juliana Cabrini Carmello
- Department of Dental Materials and Prosthodontics, São Paulo State University (Unesp), School of Dentistry, Araraquara, São Paulo, Brazil
| | - Ewerton Garcia de Oliveira Mima
- Department of Dental Materials and Prosthodontics, São Paulo State University (Unesp), School of Dentistry, Araraquara, São Paulo, Brazil
| | - Carlos Alberto de Souza Costa
- Department of Physiology and Pathology, São Paulo State University (Unesp), School of Dentistry, Araraquara, São Paulo, Brazil
| | - Vanderlei Salvador Bagnato
- Biophotonics Lab, Group of Optics, Physics Institute of São Carlos, University of São Paulo - USP, Av. Trabalhador São-carlense, 400, 13566-590, São Carlos, SP, Brazil
| | - Ana Cláudia Pavarina
- Department of Dental Materials and Prosthodontics, São Paulo State University (Unesp), School of Dentistry, Araraquara, São Paulo, Brazil
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Sozio E, Pieralli F, Azzini AM, Tintori G, Demma F, Furneri G, Sbrana F, Bertolino G, Fortunato S, Meini S, Bragantini D, Morettini A, Nozzoli C, Menichetti F, Concia E, Tascini C. A prediction rule for early recognition of patients with candidemia in Internal Medicine: results from an Italian, multicentric, case-control study. Infection 2018; 46:625-633. [PMID: 29949088 DOI: 10.1007/s15010-018-1162-0] [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: 03/17/2018] [Accepted: 06/05/2018] [Indexed: 12/27/2022]
Abstract
PURPOSE Increasing prevalence of candidemia in Internal Medicine wards (IMWs) has been reported in recent years, but risk factors for candida bloodstream infection in patients admitted to IMW may differ from those known in other settings. The aim of this study was to identify risk factors and define a prediction rule for the early recognition of the risk of candidemia in IMW inpatients. METHODS This was a multicentric, retrospective, observational case-control study on non-neutropenic patients with candidemia admitted to IMWs of four large Italian Hospitals. Each eligible patient with candidemia (case) was matched to a control with bacteremia. Stepwise logistic regression analyses were performed. RESULTS Overall, 300 patients (150 cases and 150 controls) were enrolled. The following factors were associated with an increased risk of candidemia and weighted to build a score: total parenteral nutrition (OR 2.45, p = 0.008; 1 point); central venous catheter (OR 2.19, p = 0.031; 1 point); peripherally inserted central catheter (OR 5.63, p < 0.0001; 3 points), antibiotic treatment prior (OR 2.06; p = 0.059; 1 point) and during hospitalization (OR2.38, p = 0.033; 1 point); neurological disability (OR 2.25, p = 0.01; 1 point); and previous hospitalization within 3 months (OR 1.56, p = 0.163; 1 point). At ROC curve analysis, a final score ≥ 4 showed 84% sensitivity, 76% specificity, and 80% accuracy in predicting the risk of candidemia. CONCLUSIONS The proposed scoring system showed to be a simple and highly performing tool in distinguishing bloodstream infections due to Candida and bacteria in patients admitted to IMW. The proposed rule might help to reduce delay in empirical treatment and improve appropriateness in antifungal prescription in septic patients.
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Affiliation(s)
- Emanuela Sozio
- Emergency Department, North-West District, Tuscany HealthCare, Spedali Riuniti Livorno, Viale Alfieri 36, 57100, Leghorn, Italy.
| | - Filippo Pieralli
- Intermediate Care Unit, Azienda Ospedaliera Universitaria Careggi, Florence, Italy
| | - Anna Maria Azzini
- Infectious Disease Unit, Azienda Ospedaliera Universitaria Integrata di Verona, p.Le LA Scuro, Verona, Italy
| | - Giancarlo Tintori
- Emergency Medicine Unit, Nuovo Santa Chiara University Hospital, Azienda Ospedaliera Universitaria Pisana, Pisa, Italy
| | - Federica Demma
- Health Economics and Outcome Research Department-EBMA Consulting, Milan, Italy
| | - Gianluca Furneri
- Health Economics and Outcome Research Department-EBMA Consulting, Milan, Italy
| | | | | | - Simona Fortunato
- Infectious Diseases Clinic, Nuovo Santa Chiara University Hospital, Azienda Ospedaliera Universitaria Pisana, Pisa, Italy
| | - Simone Meini
- Department of Internal Medicine, S.M. Annunziata Hospital, Florence, Italy
| | - Damiano Bragantini
- Infectious Disease Unit, Azienda Ospedaliera Universitaria Integrata di Verona, p.Le LA Scuro, Verona, Italy
| | - Alessandro Morettini
- Internal Medicine Unit, Azienda Ospedaliera Universitaria Careggi, Florence, Italy
| | - Carlo Nozzoli
- Internal Medicine Unit, Azienda Ospedaliera Universitaria Careggi, Florence, Italy
| | - Francesco Menichetti
- Infectious Diseases Clinic, Nuovo Santa Chiara University Hospital, Azienda Ospedaliera Universitaria Pisana, Pisa, Italy
| | - Ercole Concia
- Infectious Disease Unit, Azienda Ospedaliera Universitaria Integrata di Verona, p.Le LA Scuro, Verona, Italy
| | - Carlo Tascini
- First Division of Infectious Diseases, Cotugno Hospital, Azienda Ospedaliera dei Colli, Naples, Italy
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Alves F, Pavarina AC, Mima EGDO, McHale AP, Callan JF. Antimicrobial sonodynamic and photodynamic therapies against Candida albicans. BIOFOULING 2018; 34:357-367. [PMID: 29671631 DOI: 10.1080/08927014.2018.1439935] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/23/2017] [Accepted: 02/06/2018] [Indexed: 06/08/2023]
Abstract
Candida albicans biofilms exhibit unique characteristics and are highly resistant to antifungal agents. Antimicrobial photodynamic therapy (aPDT) is an alternative treatment limited to treating superficial infections due to the poor light penetration. In this manuscript, the antifungal properties of sonodynamic therapy (SDT) were assessed. SDT uses ultrasound instead of light, enabling the treatment of deeper infections. Planktonic cells and biofilms of C. albicans were treated with aPDT or SDT, in addition to combined aPDT/SDT, with cell survival determined using colony forming units. The total biomass and structural integrity of the biofilms were also investigated. The results demonstrated that while individual aPDT or SDT eradicated suspensions, they had little impact on biofilms. However, combined aPDT/SDT significantly reduced the viability and total biomass of biofilms. Microscopic images revealed that biofilms treated with aPDT/SDT were thinner and comprised mainly of dead cells. These results highlight the potential of combined aPDT/SDT for the inactivation of C. albicans biofilms.
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Affiliation(s)
- Fernanda Alves
- a Department of Dental Materials and Prosthodontics, School of Dentistry , São Paulo State University (UNESP) , Araraquara , Brazil
| | - Ana Cláudia Pavarina
- a Department of Dental Materials and Prosthodontics, School of Dentistry , São Paulo State University (UNESP) , Araraquara , Brazil
| | - Ewerton Garcia de Oliveira Mima
- a Department of Dental Materials and Prosthodontics, School of Dentistry , São Paulo State University (UNESP) , Araraquara , Brazil
| | - Anthony P McHale
- b School of Pharmacy and Pharmaceutical Sciences, Faculty of Life & Health Sciences , Ulster University , Coleraine , UK
| | - John Francis Callan
- b School of Pharmacy and Pharmaceutical Sciences, Faculty of Life & Health Sciences , Ulster University , Coleraine , UK
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de S Araújo GR, Souza WD, Frases S. The hidden pathogenic potential of environmental fungi. Future Microbiol 2017; 12:1533-1540. [PMID: 29168657 DOI: 10.2217/fmb-2017-0124] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Invasive fungal infections are a growing threat to immunocompromised patients, highlighting the importance of monitoring fungal pathogens. Global warming (including climatic oscillations) may select for environmental species that have acquired thermotolerance, a key step toward pathogenesis to humans. Also, important virulence factors have developed in environmental fungi, because they are essential for yeast survival in the environment. Thus, fungi traditionally regarded as nonpathogenic to humans have virulence factors similar to those of their pathogenic relatives. Here, we highlight the emergence of saprophytic environmental fungi - including species of Cryptococcus, Aspergillus, Penicillium, Candida and Scedosporium - as new human pathogens. Emerging pathogens are, in some cases, resistant to the available antifungals, potentiating the threat of novel fungal diseases.
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Affiliation(s)
- Glauber R de S Araújo
- Laboratório de Ultraestrutura Celular Hertha Meyer, Instituto de Biofísica Carlos Chagas Filho, Federal University of Rio de Janeiro, Rio de Janeiro, RJ, Brazil
| | - Wanderley de Souza
- Laboratório de Ultraestrutura Celular Hertha Meyer, Instituto de Biofísica Carlos Chagas Filho, Federal University of Rio de Janeiro, Rio de Janeiro, RJ, Brazil
| | - Susana Frases
- Laboratório de Ultraestrutura Celular Hertha Meyer, Instituto de Biofísica Carlos Chagas Filho, Federal University of Rio de Janeiro, Rio de Janeiro, RJ, Brazil
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12
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Deterrence in metabolic and biofilms forming activity of Candida species by mycogenic silver nanoparticles. J Appl Biomed 2017. [DOI: 10.1016/j.jab.2017.02.003] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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The environmental yeast Cryptococcus liquefaciens produces capsular and secreted polysaccharides with similar pathogenic properties to those of C. neoformans. Sci Rep 2017; 7:46768. [PMID: 28440301 PMCID: PMC5404263 DOI: 10.1038/srep46768] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2017] [Accepted: 03/27/2017] [Indexed: 02/07/2023] Open
Abstract
Invasive fungal infections, including cryptococcosis, are a growing threat to immunocompromised patients. Although Cryptococcus neoformans and Cryptococcus gattii are the main agents of human cryptococcosis, opportunistic infections by environmental species, such as C. liquefaciens, have been observed recently. The main Cryptococcus virulence factor is the production and secretion of polysaccharides (PS). Previously, we showed that both species produce PS of similar composition. Here, we examined the ultrastructure and biological activity of capsular and secreted PS from C. liquefaciens, and yeast pathogenicity to an invertebrate host, in comparison with C. neoformans. Ultrastructural analysis by high-resolution microscopy showed that both species produce large and complex capsules. PS from both species had indistinguishable effects on phagocytosis levels, NO production and the secretion of a variety of immune mediators. Challenge with C. liquefaciens or C. neoformans led to complete lethality of G. mellonella larvae. Treatment with C. liquefaciens PS could not protect mice against infection with C. neoformans. We conclude that polysaccharides of the environmental yeast C. liquefaciens have strikingly similar ultrastructural and biological properties to those of C. neoformans, highlighting the importance of monitoring the emergence of new fungal pathogens for which thermotolerance may be an important transitional step towards pathogenesis in humans.
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Kaaniche FM, Allela R, Cherif S, Algia NB. Invasive candidiasis in critically ill patients. TRENDS IN ANAESTHESIA AND CRITICAL CARE 2016. [DOI: 10.1016/j.tacc.2016.11.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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15
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Tascini C, Sozio E, Salini N, Sbrana F, Ripoli A, Viaggi B, Malacarne P. Risk factors for candidaemia in critically ill patients in intensive care units as compared to internal medicine wards. Infect Dis (Lond) 2016; 49:153-154. [PMID: 27550576 DOI: 10.1080/23744235.2016.1218046] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
Affiliation(s)
- Carlo Tascini
- a Infectious Diseases Clinic , Nuovo Santa Chiara University Hospital, Azienda Ospedaliera Universitaria Pisana , Pisa , Italy
| | - Emanuela Sozio
- b Emergency Medicine Unit , Nuovo Santa Chiara University Hospital, Azienda Ospedaliera Universitaria Pisana , Pisa , Italy
| | - Nicola Salini
- c U.O. Anestesia e Rianimazione VI° - Pronto Soccorso, Azienda Ospedaliera Universitaria Pisana , Pisa , Italy
| | | | - Andrea Ripoli
- d Fondazione Toscana "Gabriele Monasterio" , Pisa , Italy
| | - Bruno Viaggi
- e SOD Neuroanestesia e Rianimazione CTO , Azienda Ospedaliero-Universitaria Careggi , Firenze , Italy
| | - Paolo Malacarne
- c U.O. Anestesia e Rianimazione VI° - Pronto Soccorso, Azienda Ospedaliera Universitaria Pisana , Pisa , Italy
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Peron IH, Reichert-Lima F, Busso-Lopes AF, Nagasako CK, Lyra L, Moretti ML, Schreiber AZ. Resistance Surveillance in Candida albicans: A Five-Year Antifungal Susceptibility Evaluation in a Brazilian University Hospital. PLoS One 2016; 11:e0158126. [PMID: 27414653 PMCID: PMC4945058 DOI: 10.1371/journal.pone.0158126] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2016] [Accepted: 06/11/2016] [Indexed: 11/25/2022] Open
Abstract
Candida albicans caused 44% of the overall candidemia episodes from 2006 to 2010 in our university tertiary care hospital. As different antifungal agents are used in therapy and also immunocompromised patients receive fluconazole prophylaxis in our institution, this study aimed to perform an antifungal susceptibility surveillance with the C.albicans bloodstream isolates and to characterize the fluconazole resistance in 2 non-blood C.albicans isolates by sequencing ERG11 gene. The study included 147 C. albicans bloodstream samples and 2 fluconazole resistant isolates: one from oral cavity (LIF 12560 fluconazole MIC: 8μg/mL) and one from esophageal cavity (LIF-E10 fluconazole MIC: 64μg/mL) of two different patients previously treated with oral fluconazole. The in vitro antifungal susceptibility to amphotericin B (AMB), 5-flucytosine (5FC), fluconazole (FLC), itraconazole (ITC), voriconazole (VRC), caspofungin (CASP) was performed by broth microdilution methodology recommended by the Clinical and Laboratory Standards Institute documents (M27-A3 and M27-S4, CLSI). All blood isolates were classified as susceptible according to CLSI guidelines for all evaluated antifungal agents (MIC range: 0,125–1.00 μg/mL for AMB, ≤0.125–1.00 μg/mL for 5FC, ≤0.125–0.5 μg/mL for FLC, ≤0.015–0.125 μg/mL for ITC, ≤0.015–0.06 μg/mL for VRC and ≤0.015–0.125 μg/mL for CASP). In this study, we also amplified and sequenced the ERG11 gene of LIF 12560 and LIF-E10 C.albicans isolates. Six mutations encoding distinct amino acid substitutions were found (E116D, T128K, E266D, A298V, G448V and G464S) and these mutations were previously described as associated with fluconazole resistance. Despite the large consumption of antifungals in our institution, resistant blood isolates were not found over the trial period. Further studies should be conducted, but it may be that the very prolonged direct contact with the oral antifungal agent administered to the patient from which was isolated LIF E-10, may have contributed to the development of resistance.
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Affiliation(s)
- Isabela Haddad Peron
- Clinical Pathology Department Faculty of Medical Sciences, University of Campinas, Campinas, Sao Paulo, Brazil
- * E-mail:
| | - Franqueline Reichert-Lima
- Clinical Pathology Department Faculty of Medical Sciences, University of Campinas, Campinas, Sao Paulo, Brazil
| | - Ariane Fidelis Busso-Lopes
- Internal Medicine Department, Faculty of Medical Sciences, University of Campinas, Campinas, Sao Paulo, Brazil
| | - Cristiane Kibune Nagasako
- Internal Medicine Department, Faculty of Medical Sciences, University of Campinas, Campinas, Sao Paulo, Brazil
| | - Luzia Lyra
- Clinical Pathology Department Faculty of Medical Sciences, University of Campinas, Campinas, Sao Paulo, Brazil
| | - Maria Luiza Moretti
- Internal Medicine Department, Faculty of Medical Sciences, University of Campinas, Campinas, Sao Paulo, Brazil
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Occurrence of oral Candida colonization and its risk factors among patients with malignancies in China. Clin Oral Investig 2015. [PMID: 26220512 DOI: 10.1007/s00784-015-1524-2] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
OBJECTIVES Oral colonization of Candida could lead to later development of oropharyngeal candidiasis or candidemia among the immunocompromised patients. This study aims to describe the occurrence and risk factors of oral Candida colonization in patients with malignancies. MATERIALS AND METHODS From October 2012 to March 2013, 78 patients with pulmonary cancer (group I), 101 patients with gastrointestinal tract tumor (group II), 79 patients with hematopoietic system malignant tumor (group III), and 101 healthy controls were consecutively recruited in a hospital in Beijing, China. The oral rinse samples were taken and Candida species were identified; the enzymes activities were tested. RESULTS In total, 110 and 27 Candida strains were isolated from 91 patients and 26 controls, respectively. The oral colonization rate with Candida albicans in group III (12.7 %) was significant lower than that in group I (30.8 %), group II (33.7 %), and control group (25.7 %). The oral colonization rates with non-albicans Candida species in group I, group II, and group III were 15.4, 10.9, and 12.7 %, respectively, while only one non-albicans Candida strain was identified in control group. The non-albicans Candida species exhibited a lower virulence than C. albicans. Age was an independent risk factor for Candida colonization in patients with pulmonary cancer and digestive tract malignant tumor, "Teeth brush <1 time/day" was an independent risk factor for Candida colonization in patients with hematopoietic system tumor. CONCLUSIONS The differences of risk factors for oral Candida colonization in patients with different cancers require different strategies for the prevention and control of Candida infection. CLINICAL RELEVANCE Old aged patients with pulmonary cancer and digestive tract malignant tumor are high-risk population for Candida colonization. Increasing frequency of teeth brush might be helpful for preventing Candida colonization.
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Farrag HA, A-Karam El-Din A, Mohamed El-Sayed ZG, Abdel-Latifissa S, Kamal MM. Microbial colonization of irradiated pathogenic yeast to catheter surfaces: Relationship between adherence, cell surface hydrophobicity, biofilm formation and antifungal susceptibility. A scanning electron microscope analysis. Int J Radiat Biol 2015; 91:519-27. [DOI: 10.3109/09553002.2015.1021959] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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19
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Cervical Bone Graft Candida albicans Osteomyelitis: Management Strategies for an Uncommon Infection. Case Rep Orthop 2014; 2014:986393. [PMID: 25295206 PMCID: PMC4176649 DOI: 10.1155/2014/986393] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2014] [Accepted: 09/01/2014] [Indexed: 11/17/2022] Open
Abstract
Candida osteomyelitis in the current literature is an emerging infection. The factors contributing to its emergence include a growing population of immunosuppressed patients, invasive surgeries, broad-spectrum antibiotics, injection drug users, and alcohol abuse. The diagnosis requires a high degree of suspicion. The insidious progression of infection and the nonspecificity of laboratory and radiologic findings may contribute to a delay in diagnosis. The current case concerns a 27-year-old man with a spinal cord injury who, after undergoing anterior cervical fixation and fusion surgery, developed postoperative systemic bacterial infection and required long-term antibiotic therapy. After six months, a CT scan demonstrated an almost complete anterior dislocation of the implants caused by massive bone destruction and reabsorption in Candida albicans infection. The patient underwent a second intervention consisting firstly of a posterior approach with C4-C7 fixation and fusion, followed by a second anterior approach with a corpectomy of C5 and C6, a tricortical bone grafting from the iliac crest, and C4-C7 plating. The antifungal therapy with fluconazole was effective without surgical debridement of the bone graft, despite the fact that signs of the bone graft being infected were seen from the first cervical CT scans carried out after one month.
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Abstract
Invasive fungal infections are an increasingly frequent etiology of sepsis in critically ill patients causing substantial morbidity and mortality. Candida species are by far the predominant agent of fungal sepsis accounting for 10% to 15% of health-care associated infections, about 5% of all cases of severe sepsis and septic shock and are the fourth most common bloodstream isolates in the United States. One-third of all episodes of candidemia occur in the intensive care setting. Early diagnosis of invasive candidiasis is critical in order to initiate antifungal agents promptly. Delay in the administration of appropriate therapy increases mortality. Unfortunately, risk factors, clinical and radiological manifestations are quite unspecific and conventional culture methods are suboptimal. Non-culture based methods (such as mannan, anti-mannan, β-d-glucan, and polymerase chain reaction) have emerged but remain investigational or require additional testing in the ICU setting. Few prophylactic or pre-emptive studies have been performed in critically ill patients. They tended to be underpowered and their clinical usefulness remains to be established under most circumstances. The antifungal armamentarium has expanded considerably with the advent of lipid formulations of amphotericin B, the newest triazoles and the echinocandins. Clinical trials have shown that the triazoles and echinocandins are efficacious and well tolerated antifungal therapies. Clinical practice guidelines for the management of invasive candidiasis have been published by the European Society for Clinical Microbiology and Infectious Diseases and the Infectious Diseases Society of North America.
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Affiliation(s)
- Julie Delaloye
- Infectious Diseases Service; Department of Medicine; Centre Hospitalier Universitaire Vaudois and University of Lausanne; Lausanne, Switzerland
| | - Thierry Calandra
- Infectious Diseases Service; Department of Medicine; Centre Hospitalier Universitaire Vaudois and University of Lausanne; Lausanne, Switzerland
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21
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Simon J, Sun HY, Leong HN, Barez MYC, Huang PY, Talwar D, Wang JH, Mansor M, Wahjuprajitno B, Patel A, Wittayachanyapong S, Sany BSM, Lin SF, Dimopoulos G. Echinocandins in invasive candidiasis. Mycoses 2013; 56:601-9. [PMID: 23647521 DOI: 10.1111/myc.12085] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2012] [Revised: 04/04/2013] [Accepted: 04/06/2013] [Indexed: 12/29/2022]
Affiliation(s)
- John Simon
- University of Hong Kong; Pokfulam Hong Kong China
| | - Hsin-Yun Sun
- National Taiwan University Hospital; Taipei Taiwan
| | | | | | | | - Deepak Talwar
- Metro Group of Hospitals and Heart Institute; Delhi India
| | | | | | | | - Atul Patel
- Vedanta Institute of Medical Sciences; Ahmedabad India
| | | | | | | | - George Dimopoulos
- National and Kapodistrian University of Athens and Department of Critical Care; University Hospital “Attikon”; Athens Greece
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22
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Mallus F, Martis S, Serra C, Loi G, Camboni T, Manzin A. Usefulness of capillary electrophoresis-based multiplex PCR assay for species-specific identification of Candida spp. J Microbiol Methods 2012; 92:150-2. [PMID: 23220101 DOI: 10.1016/j.mimet.2012.11.022] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2012] [Revised: 11/30/2012] [Accepted: 11/30/2012] [Indexed: 10/27/2022]
Abstract
The study evaluated the performances of a commercial multiplex PCR assay, the Seegene Seeplex STI Master Panel 3, for Candida spp. identification. Eighty clinical strains of Candida spp. were identified with this system and a homemade multiplex PCR assay. The results were also compared with those obtained with two phenotypic methods. The study provided a preliminary evaluation of a multiplex assay from Seegene that uses capillary electrophoresis as the detection of amplified products. The Seeplex assay was found to be a rapid and useful method for identifying large numbers of yeast isolates in the clinical laboratory context.
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Affiliation(s)
- F Mallus
- Department of Biomedical Sciences, Microbiology and Virology Unit, University of Cagliari, Italy
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23
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Bicyclic peptidomimetics targeting secreted aspartic protease 2 (SAP2) from Candida albicans reveal a constrained inhibitory chemotype. Bioorg Med Chem 2012; 20:7206-13. [DOI: 10.1016/j.bmc.2012.09.031] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2012] [Revised: 09/06/2012] [Accepted: 09/11/2012] [Indexed: 11/22/2022]
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24
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Bandara HMHN, K Cheung BP, Watt RM, Jin LJ, Samaranayake LP. Pseudomonas aeruginosa lipopolysaccharide inhibits Candida albicans hyphae formation and alters gene expression during biofilm development. Mol Oral Microbiol 2012. [PMID: 23194472 DOI: 10.1111/omi.12006] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
Elucidation of bacterial and fungal interactions in multispecies biofilms will have major impacts on understanding the pathophysiology of infections. The objectives of this study were to (i) evaluate the effect of Pseudomonas aeruginosa lipopolysaccharide (LPS) on Candida albicans hyphal development and transcriptional regulation, (ii) investigate protein expression during biofilm formation, and (iii) propose likely molecular mechanisms for these interactions. The effect of LPS on C. albicans biofilms was assessed by XTT-reduction and growth curve assays, light microscopy, scanning electron microscopy (SEM), and confocal laser scanning microscopy (CLSM). Changes in candidal hypha-specific genes (HSGs) and transcription factor EFG1 expression were assessed by real-time polymerase chain reaction and two-dimensional gel electrophoresis, respectively. Proteome changes were examined by mass spectrometry. Both metabolic activities and growth rates of LPS-treated C. albicans biofilms were significantly lower (P < 0.05). There were higher proportions of budding yeasts in test biofilms compared with the controls. SEM and CLSM further confirmed these data. Significantly upregulated HSGs (at 48 h) and EFG1 (up to 48 h) were noted in the test biofilms (P < 0.05) but cAMP levels remained unaffected. Proteomic analysis showed suppression of candidal septicolysin-like protein, potential reductase-flavodoxin fragment, serine hydroxymethyltransferase, hypothetical proteins Cao19.10301(ATP7), CaO19.4716(GDH1), CaO19.11135(PGK1), CaO19.9877(HNT1) by P. aeruginosa LPS. Our data imply that bacterial LPS inhibit C. albicans biofilm formation and hyphal development. The P. aeruginosa LPS likely target glycolysis-associated mechanisms during candidal filamentation.
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Affiliation(s)
- H M H N Bandara
- Oral Biosciences, Faculty of Dentistry, The University of Hong Kong, Hong Kong City, Hong Kong
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25
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Dovigo LN, Carmello JC, de Souza Costa CA, Vergani CE, Brunetti IL, Bagnato VS, Pavarina AC. Curcumin-mediated photodynamic inactivation of Candida albicans in a murine model of oral candidiasis. Med Mycol 2012; 51:243-51. [PMID: 22934533 DOI: 10.3109/13693786.2012.714081] [Citation(s) in RCA: 93] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
In vitro investigations of curcumin-mediated photodynamic therapy (PDT) are encouraging, but there is a lack of reliable in vivo evidence of its efficacy. This study describes the photoinactivation of Candida albicans in a murine model of oral candidiasis, using curcumin as a photosensitizer. Forty immunosuppressed mice were orally inoculated with C. albicans and after five days, they received topical curcumin (20, 40 and 80 μM) and illumination with LED light. The use of curcumin or light alone were also investigated. Positive control animals did not receive any treatment and negative control animals were not inoculated with C. albicans. The number of surviving yeast cells was determined and analyzed by ANOVA and Tukey's post-hoc test (α = 0.05). Histological evaluation of the presence of yeast and inflammatory reaction was also conducted. All exposures to curcumin with LED light caused a significant reduction in C. albicans viability after PDT, but the use of 80 μM curcumin associated with light was able to induce the highest log10 reduction in colony counts (4 logs). It was concluded that curcumin-mediated PDT proved to be effective for in vivo inactivation of C. albicans without harming the host tissue of mice.
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Affiliation(s)
- Lívia Nordi Dovigo
- Department of Social Dentistry, Araraquara Dental School, UNESP-Univ Estadual Paulista, Araraquara, São Paulo, Brazil
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Ahmad S, Khan Z. Invasive candidiasis: A review of nonculture-based laboratory diagnostic methods. Indian J Med Microbiol 2012; 30:264-9. [DOI: 10.4103/0255-0857.99482] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
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Emerging trends in candidemia: A higher incidence but a similar outcome. J Infect 2012; 65:64-70. [DOI: 10.1016/j.jinf.2012.02.011] [Citation(s) in RCA: 55] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2011] [Revised: 02/19/2012] [Accepted: 02/20/2012] [Indexed: 11/19/2022]
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28
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Slenker AK, Keith SW, Horn DL. Two hundred and eleven cases of Candida osteomyelitis: 17 case reports and a review of the literature. Diagn Microbiol Infect Dis 2012; 73:89-93. [DOI: 10.1016/j.diagmicrobio.2012.02.004] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2012] [Revised: 02/10/2012] [Accepted: 02/13/2012] [Indexed: 11/24/2022]
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Dovigo LN, Pavarina AC, Ribeiro APD, Brunetti IL, Costa CADS, Jacomassi DP, Bagnato VS, Kurachi C. Investigation of the photodynamic effects of curcumin against Candida albicans. Photochem Photobiol 2011; 87:895-903. [PMID: 21517888 DOI: 10.1111/j.1751-1097.2011.00937.x] [Citation(s) in RCA: 159] [Impact Index Per Article: 12.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
This study describes the association of curcumin with light emitting diode (LED) for the inactivation of Candida albicans. Suspensions of Candida were treated with nine curcumin concentrations and exposed to LED at different fluences. The protocol that showed the best outcomes for Candida inactivation was selected to evaluate the effect of the preirradiation time (PIT) on photodynamic therapy (PDT) effectiveness, the uptake of curcumin by C. albicans cells and the possible involvement of singlet oxygen in the photodynamic action. Curcumin-mediated PDT was also assessed against biofilms. In addition to the microbiological experiments, similar protocols were tested on a macrophage cell line and the effect was evaluated by Methyltetrazolium assay (MTT) and SEM analysis. The optical properties of curcumin were investigated as a function of illumination fluence. When compared with the control group, a statistically significant reduction in C. albicans viability was observed after PDT (P < 0.05), for both planktonic and biofilm cultures. Photodynamic effect was greatly increased with the presence of curcumin in the surrounding media and the PIT of 20 min improved PDT effectiveness against biofilms. Although PDT was phototoxic to macrophages, the therapy was more effective in inactivating the yeast cell than the defense cell. The spectral changes showed a high photobleaching rate of curcumin.
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Affiliation(s)
- Lívia N Dovigo
- Araraquara Dental School, UNESP-University Estadual Paulista, Araraquara, SP, Brazil
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31
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Mayr A, Lass-Flörl C. Epidemiology and antifungal resistance in invasive Aspergillosis according to primary disease: review of the literature. Eur J Med Res 2011; 16:153-7. [PMID: 21486729 PMCID: PMC3352071 DOI: 10.1186/2047-783x-16-4-153] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2011] [Accepted: 02/22/2011] [Indexed: 11/10/2022] Open
Abstract
Aspergilli, less susceptible to antifungals emerge and resistance to azoles have been found mainly in Aspergillus fumigatus; this has launched a new phase in handling aspergillosis. Resistant strains have currently been reported from Belgium, Canada, China, Denmark, France, Norway, Spain, Sweden, The Netherlands, UK and the USA. Centres in the UK (Manchester) and The Netherlands (Nijmegen) have described particularly high frequencies (15 and 10% respectively), and a significant increase in azole resistance in recent years. The reason of this high incidence may be due to long term azole therapy in patients with chronic aspergillosis in Manchester, and due to high use of agricultural azoles in Nijmegen. The primary underlying mechanism of resistance is as a result of alterations in the cyp51A target gene, with a variety of mutations found in clinical isolates and one genotype identified in the environmental (LH98). Reports on well documented in vitro and in vivo resistance to echinocandins are rare for Aspergillus species and resistance may be under-diagnosed as susceptibility testing is less frequently performed due to technical reasons.
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Affiliation(s)
| | - C Lass-Flörl
- Division of Hygiene and Medical Microbiology, Department of Hygiene, Microbiology and Social Medicine, Innsbruck Medical University, Innsbruck, Austria
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Binder U, Lass-Flörl C. Epidemiology of invasive fungal infections in the mediterranean area. Mediterr J Hematol Infect Dis 2011; 3:e20110016. [PMID: 21625305 PMCID: PMC3103242 DOI: 10.4084/mjhid.2011.0016] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2011] [Accepted: 03/29/2011] [Indexed: 01/01/2023] Open
Abstract
Although Candida species remain the relevant cause of IFI, other fungi (especially moulds) have become increasingly prevalent. In particular, Aspergillus species are the leading cause of mould infections but also Glomeromycota (formerly Zygomycetes) and Fusarium species are increasing in frequency, and are associated with high mortality rates. Many of these emerging infections occur as breakthrough infections in patients treated with new antifungal drugs. The causative pathogens, incidence rate and severity are dependent on the underlying condition, as well as on the geographic location of the patient population. France and Italy show the highest incident rates of Fusarium infections in Europe, following the US, where numbers are still increasing. Scedosporium prolificans, which primarily is found in soil in Spain and Australia, is most frequently isolated from blood cultures in a Spanish hospital. Geotrichum capitatum represents another species predominantly found in Europe with especially high rates in Mediterranean countries. The increasing resistance to antifungal drugs especially of these new emerging pathogens is a severe problem for managing these IFIs.
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Affiliation(s)
- Ulrike Binder
- Division of Hygiene and Medical Microbiology, Medical University Innsbruck, Austria
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Naik S, Lundberg J, Kumar R, Sjolin J, Jansen JP. Economic evaluation of caspofungin versus liposomal amphotericin B for empirical antifungal therapy in patients with persistent fever and neutropenia in Sweden. ACTA ACUST UNITED AC 2011; 43:504-14. [PMID: 21332286 DOI: 10.3109/00365548.2011.556145] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE To evaluate the cost-effectiveness of caspofungin versus liposomal amphotericin B (L-AmB) for empirical antifungal therapy in patients with persistent fever and neutropenia in Sweden. METHODS With a decision-analytic model, the expected direct costs, life-years lost and quality adjusted life-years lost were estimated for an average patient in Sweden. Efficacy/tolerability data were obtained from analysis of a randomized, double-blind multinational trial. Life expectancy, medical resource use and unit costs data were gathered from the literature and expert opinion. Probabilistic sensitivity analysis was used to evaluate the impact of uncertainty in data on outcomes. RESULTS The direct cost with caspofungin amounted to 233,851 SEK (95% uncertainty interval 225,091-242,210) and with L-AmB to 271,921 SEK (262,935-281,363), a difference of 38,070 SEK (31,745-44,811) favouring caspofungin. Treatment with caspofungin resulted in 0.25 (0.01-0.55) quality-adjusted life-years (QALYs) saved in comparison to L-AmB. Given the uncertainty in the estimates there is a >95% probability that caspofungin is economically dominant over L-AmB, i.e. cost-saving and QALY-saving. CONCLUSION Given the underlying assumptions and data used, caspofungin is expected to be cost-effective with at least comparable outcomes compared to L-AmB for the empirical treatment of patients with suspected fungal infections in Sweden.
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Pratikaki M, Platsouka E, Sotiropoulou C, Douka E, Paramythiotou E, Kaltsas P, Kotanidou A, Paniara O, Roussos C, Routsi C. Epidemiology, risk factors for and outcome of candidaemia among non-neutropenic patients in a Greek intensive care unit. Mycoses 2011; 54:154-61. [DOI: 10.1111/j.1439-0507.2009.01787.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
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Ortega M, Marco F, Soriano A, Almela M, Martínez J, López J, Pitart C, Mensa J. Candida species bloodstream infection: epidemiology and outcome in a single institution from 1991 to 2008. J Hosp Infect 2011; 77:157-61. [DOI: 10.1016/j.jhin.2010.09.026] [Citation(s) in RCA: 102] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2010] [Accepted: 09/10/2010] [Indexed: 11/30/2022]
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De Luca A, Zelante T, D'Angelo C, Zagarella S, Fallarino F, Spreca A, Iannitti RG, Bonifazi P, Renauld JC, Bistoni F, Puccetti P, Romani L. IL-22 defines a novel immune pathway of antifungal resistance. Mucosal Immunol 2010; 3:361-73. [PMID: 20445503 DOI: 10.1038/mi.2010.22] [Citation(s) in RCA: 206] [Impact Index Per Article: 14.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
The role of IL-17 and Th17 cells in immunity vs. pathology associated with the human commensal Candida albicans remains controversial. Both positive and negative effects on immune resistance have been attributed to IL-17/Th17 in experimental candidiasis. In this study, we provide evidence that IL-22, which is also produced by Th17 cells, has a critical, first-line defense in candidiasis by controlling the growth of infecting yeasts as well as by contributing to the host's epithelial integrity in the absence of acquired Th1-type immunity. The two pathways are reciprocally regulated, and IL-22 is upregulated under Th1 deficiency conditions and vice versa. Whereas both IL-17A and F are dispensable for antifungal resistance, IL-22 mediates protection in IL-17RA-deficient mice, in which IL-17A contributes to disease susceptibility. Thus, our findings suggest that protective immunity to candidiasis is made up of a staged response involving an early, IL-22-dominated response followed by Th1/Treg reactivity that will prevent fungal dissemination and supply memory.
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Affiliation(s)
- A De Luca
- Department of Experimental Medicine and Biochemical Sciences, University of Perugia, Perugia, Italy
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Bandara HMHN, Lam OLT, Watt RM, Jin LJ, Samaranayake LP. Bacterial lipopolysaccharides variably modulate in vitro biofilm formation of Candida species. J Med Microbiol 2010; 59:1225-1234. [PMID: 20576747 DOI: 10.1099/jmm.0.021832-0] [Citation(s) in RCA: 53] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
The objective of this study was to evaluate the effect of the bacterial endotoxin LPS on Candida biofilm formation in vitro. The effect of the LPS of Pseudomonas aeruginosa, Klebsiella pneumoniae, Serratia marcescens and Salmonella typhimurium on six different species of Candida, comprising Candida albicans ATCC 90028, Candida glabrata ATCC 90030, Candida krusei ATCC 6258, Candida tropicalis ATCC 13803, Candida parapsilosis ATCC 22019 and Candida dubliniensis MYA 646, was studied using a standard biofilm assay. The metabolic activity of in vitro Candida biofilms treated with LPS at 90 min, 24 h and 48 h was quantified by XTT reduction assay. Viable biofilm-forming cells were qualitatively analysed using confocal laser scanning microscopy (CLSM), while scanning electron microscopy (SEM) was employed to visualize the biofilm structure. Initially, adhesion of C. albicans was significantly stimulated by Pseudomonas and Klebsiella LPS. A significant inhibition of Candida adhesion was noted for the following combinations: C. glabrata with Pseudomonas LPS, C. tropicalis with Serratia LPS, and C. glabrata, C. parapsilosis or C. dubliniensis with Salmonella LPS (P<0.05). After 24 h of incubation, a significant stimulation of initial colonization was noted for the following combinations: C. albicans/C. glabrata with Klebsiella LPS, C. glabrata/C. tropicalis/C. krusei with Salmonella LPS. In contrast, a significant inhibition of biofilm formation was observed in C. glabrata/C. dubliniensis/C. krusei with Pseudomonas LPS, C. krusei with Serratia LPS, C. dubliniensis with Klebsiella LPS and C. parapsilosis/C. dubliniensis /C. krusei with Salmonella LPS (P<0.05). On further incubation for 48 h, a significant enhancement of biofilm maturation was noted for the following combinations: C. glabrata/C. tropicalis with Serratia LPS, C. dubliniensis with Klebsiella LPS and C. glabrata with Salmonella LPS, and a significant retardation was noted for C. parapsilosis/C. dubliniensis/C. krusei with Pseudomonas LPS, C. tropicalis with Serratia LPS, C. glabrata/C. parapsilosis/C. dubliniensis with Klebsiella LPS and C. dubliniensis with Salmonella LPS (P<0.05). These findings were confirmed by SEM and CLSM analyses. In general, the inhibition of the biofilm development of LPS-treated Candida spp. was accompanied by a scanty architecture with a reduced numbers of cells compared with the profuse and densely colonized control biofilms. These data are indicative that bacterial LPSs modulate in vitro Candida biofilm formation in a species-specific and time-dependent manner. The clinical and the biological relevance of these findings have yet to be explored.
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Affiliation(s)
- H M H N Bandara
- Oral Biosciences, Faculty of Dentistry, University of Hong Kong, 5/F Prince Philip Dental Hospital, 34 Hospital Road, Sai Ying Pun, Hong Kong SAR
| | - O L T Lam
- Oral Rehabilitation, Faculty of Dentistry, University of Hong Kong, Sai Ying Pun, Hong Kong SAR
| | - R M Watt
- Oral Biosciences, Faculty of Dentistry, University of Hong Kong, 5/F Prince Philip Dental Hospital, 34 Hospital Road, Sai Ying Pun, Hong Kong SAR
| | - L J Jin
- Periodontology, Faculty of Dentistry, University of Hong Kong, Sai Ying Pun, Hong Kong SAR
| | - L P Samaranayake
- Oral Biosciences, Faculty of Dentistry, University of Hong Kong, 5/F Prince Philip Dental Hospital, 34 Hospital Road, Sai Ying Pun, Hong Kong SAR
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Trabocchi A, Mannino C, Machetti F, De Bernardis F, Arancia S, Cauda R, Cassone A, Guarna A. Identification of Inhibitors of Drug-Resistant Candida albicans Strains from a Library of Bicyclic Peptidomimetic Compounds. J Med Chem 2010; 53:2502-9. [DOI: 10.1021/jm901734u] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Andrea Trabocchi
- Department of Chemistry “Ugo Schiff”, University of Florence, Polo Scientifico e Tecnologico, Via della Lastruccia 13, 50019 Sesto Fiorentino, Florence, Italy
| | - Claudia Mannino
- Department of Chemistry “Ugo Schiff”, University of Florence, Polo Scientifico e Tecnologico, Via della Lastruccia 13, 50019 Sesto Fiorentino, Florence, Italy
| | - Fabrizio Machetti
- ICCOM- CNR, c/o Department of Chemistry “Ugo Schiff”, University of Florence, Polo Scientifico e Tecnologico, Via della Lastruccia 13, 50019 Sesto Fiorentino, Florence, Italy
| | - Flavia De Bernardis
- Department of Infectious, Parasitic, and Immune-Mediated Diseases, Istituto Superiore di Sanità, Viale Regina Elena 299, 00161 Rome, Italy
| | - Silvia Arancia
- Department of Infectious, Parasitic, and Immune-Mediated Diseases, Istituto Superiore di Sanità, Viale Regina Elena 299, 00161 Rome, Italy
| | - Roberto Cauda
- Department of Infectious Diseases, Catholic University of the Sacred Heart, Largo A. Gemelli 8, 00168 Rome, Italy
| | - Antonio Cassone
- Department of Infectious, Parasitic, and Immune-Mediated Diseases, Istituto Superiore di Sanità, Viale Regina Elena 299, 00161 Rome, Italy
| | - Antonio Guarna
- Department of Chemistry “Ugo Schiff”, University of Florence, Polo Scientifico e Tecnologico, Via della Lastruccia 13, 50019 Sesto Fiorentino, Florence, Italy
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Abstract
Fever is a normal adaptive brain response to infectious and noninfectious causes involving a cytokine-mediated response, the generation of acute phase reactants, and the activation of numerous physiologic, endocrinologic and immunologic systems. Ninety percent of patients with severe sepsis in the intensive care unit (ICU) will experience fever during their hospitalization, while the half of the new detected febrile episodes are of noninfectious origin. In the ICU, fever should be treated in cardiorespiratory and neurosurgical patients and in those in whom temperature exceeds 40 degrees C (104 degrees F). Antipyretic therapy must be justified regardless of the metabolic cost (if fever exceeds its physiologic benefit), the result (if the symptomatic relief adversely affects the course of the febrile illness) and the side effects.
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Affiliation(s)
- George Dimopoulos
- Department of Critical Care, University Hospital Attikon, Medical School, University of Athens, 7 Kirpou Street, Athens 14569, Greece.
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Emami S, Foroumadi A. 3-Imidazolyl-Substituted Flavans as Potential Antifungal Agents: Synthesis, Stereochemical Properties, and Antifungal Activity. Arch Pharm (Weinheim) 2009; 342:541-5. [DOI: 10.1002/ardp.200900024] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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Abstract
Invasive fungal diseases (IFDs) are an increasingly common complication in critically ill patients in Europe and are frequently fatal. Because of changes in treatment strategies and the increased use of antifungal prophylaxis, the epidemiology of IFDs has changed substantially in recent years and infections due to Candida species are no longer the majority in many institutions. In contrast, the emergence of non-Candida IFDs such as aspergillosis, zygomycosis and fusariosis has increased. European surveys indicate that Candida albicans is responsible for more than half the cases of invasive candidaemia; however, the occurrence of non-albicans-related IFDs appears to be increasing. Rates of IFD-related mortality in Europe depend on the pathogen, geographical location and underlying patient characteristics, with rates ranging from 28 to 59% for Candida infections and from 38 to 80% for invasive aspergillosis. Early initiation of antifungal therapy is critical for improving outcomes; however, this is complicated by the difficulty in diagnosing IFDs rapidly and accurately. The introduction of new extended-spectrum azole antifungal agents (e.g. voriconazole, posaconazole) and echinocandins (e.g. micafungin, caspofungin, anidulafungin) has increased the number of therapeutic options for early therapy. Choice between agents should be based on a variety of factors, including spectrum of activity, adverse events, drug interactions, route of administration, clinical efficacy of individual agents and local epidemiology.
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Affiliation(s)
- Cornelia Lass-Flörl
- Department of Hygiene, Microbiology and Social Medicine, Division of Hygiene and Medical Microbiology, Innsbruck Medical University, Innsbruck, Austria.
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Abstract
BACKGROUND Invasive candidiasis (IC) is associated with significant morbidity and mortality in critically ill patients. This, in conjunction with difficulties in diagnosis, underscores the need for novel treatment strategies based on the identification of significant risk factors for IC. OBJECTIVE To review the evidence surrounding the use of early antifungals in critically ill adult patients and to present concise and specific recommendations for different early treatment strategies for IC. DATA SOURCES AND DATA EXTRACTION Pubmed search from 1966 to July 2008 using the search terms "antifungals, critical care, prophylaxis, preemptive therapy, and empiric therapy." Examined all relevant peer-reviewed original articles, meta-analyses, guidelines, consensus statements, and review articles. CONCLUSION The use of early antifungal therapy should be reserved for patients with a high risk (10% to 15%) of developing IC. Despite a large number of articles published on this topic, there is no single predictive rule that can adequately forecast IC in critically ill patients. Until further prospective validation of existing data is completed, clinicians should assess patients on a case-by-case basis and determine the need for early antifungal treatment strategies based on frequent evaluations of risk factors and clinical status.
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Hernández Sierra B, Prieto Palomino M, Curiel Balsera E, Muñoz Bono J, Quesada García G, Arias Verdú M. Perfil clínico-epidemiológico y taxonómico de la candidiasis sistémica en una unidad de cuidados intensivos. Med Intensiva 2009; 33:144-7. [DOI: 10.1016/s0210-5691(09)70948-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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A 10-year survey of antifungal susceptibility of candidemia isolates from intensive care unit patients in Greece. Antimicrob Agents Chemother 2008; 53:1242-4. [PMID: 19114672 DOI: 10.1128/aac.01368-08] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
This study retrospectively reviews the susceptibility of 135 baseline ICU candidemia isolates (from 1997 to 2007) to nine antifungals as determined by the AFST-EUCAST microdilution method and identifies the most frequent causative agents of confirmed point-source candidemia outbreaks in local intensive care units. A minority of common and rare Candida species displayed decreased susceptibility to all antifungals.
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Escherichia coli and TNF-alpha modulate macrophage phagocytosis of Candida glabrata. J Surg Res 2008; 155:217-24. [PMID: 19482303 DOI: 10.1016/j.jss.2008.07.022] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2008] [Revised: 07/18/2008] [Accepted: 07/22/2008] [Indexed: 01/05/2023]
Abstract
BACKGROUND The incidence of systemic nonalbicans Candida (especially C. glabrata) infections is increasing dramatically in intensive care units, but relatively little is known about the pathogenesis or host defenses associated with these life threatening infections. MATERIALS AND METHODS The course of systemic C. glabrata infection was assessed as the fungal burden in the kidneys and livers of mice sacrificed 1, 8, and 15 d after intravenous C. glabrata. Sixteen hours before each sacrifice, half of the mice were injected intraperitoneally with intact viable or nonviable E. coli cells, or with E. coli lipopolysaccharide (LPS), or with tumor necrosis factor (TNF)-alpha. To clarify the effect of LPS and TNF-alpha on phagocytosis, resident (unstimulated) mouse peritoneal macrophages were harvested, cultivated ex vivo, and some cultures were treated with LPS or TNF-alpha prior to 30 min incubation with C. glabrata. RESULTS Compared with mice injected with vehicle, each agent (intact E. coli cells or E. coli LPS or TNF-alpha) was consistently associated with decreased numbers of tissue C. glabrata, and some of these decreases were significant (P < 0.05). Compared with untreated macrophages, phagocytosis of C. glabrata was increased with LPS-treated macrophages (P < 0.01), and phagocytosis was also increased in the presence of TNF-alpha (P < 0.01). CONCLUSION E. coli LPS and TNF-alpha may participate in host defense against C. glabrata by a mechanism involving increased macrophage phagocytosis, suggesting that stimulation of inflammatory cytokines may facilitate host clearance of C. glabrata.
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Abstract
OBJECTIVE To evaluate role of Candida colonization in development of candidemia and to identify risk factors associated with Candida colonization and candidemia in children treated for severe sepsis or septic shock in a pediatric intensive care unit (PICU) for >5 days. DESIGN Prospective observational. SETTING PICU of a tertiary care teaching hospital. SUBJECTS Of 186 children, aged 1 month to 14 yrs, consecutively admitted to PICU for severe sepsis or septic shock, 65 patients having a stay of >5 days. INTERVENTIONS Clinical and demographic data at admission and variables likely to influence Candida colonization were recorded. Oropharyngeal, rectal, and skin (groin) swabs were taken on days 0, 2, 5, and 7 of admission. Blood for fungal culture (two samples 48 hrs apart) was obtained if a patient developed signs of sepsis. The yeast growth was identified by conventional methods. Odds ratios (ORs) with 95% confidence intervals (CIs) were calculated, and multivariate logistic regression analysis was conducted. MEASUREMENTS AND MAIN RESULTS Colonization by Candida species occurred in 45 (69%) patients. Oropharyngeal (52%) and rectal (43%) colonization was more common than skin (34%) colonization. The colonizing species were C. tropicalis (34.2%), C. parapsilosis (28.8%), C. albicans (14.4%), and others. Use of central venous catheters was the only independent predictor of colonization on multivariate logistic regression (OR 4.1; 95% CI 1.01-17.1). Twenty (30.2%) patients developed candidemia; 18 (90%) of them were colonized, 15 (75%) with the same Candida species. Independent predictors of candidemia on multivariate stepwise logistic regression analysis were presence of colonization (OR 5.1; 95% CI 1.01-25.6, p = .048) and Pediatric Risk of Mortality score (OR 1.3; 95% CI 1.02-1.6, p = .034). CONCLUSIONS Monitoring for colonization with Candida species in children undergoing treatment for severe sepsis or sepsis shock in PICU for >5 days may offer opportunity for early intervention for prevention of candidemia.
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Pugliese F, Ruberto F, Cappannoli A, Perrella SM, Bruno K, Martelli S, Marcellino V, D'Alio A, Diso D, Rossi M, Corradini SG, Morabito V, Rolla M, Ferretti G, Venuta F, Berloco PB, Coloni GF, Pietropaoli P. Incidence of fungal infections in a solid organ recipients dedicated intensive care unit. Transplant Proc 2007; 39:2005-7. [PMID: 17692677 DOI: 10.1016/j.transproceed.2007.05.060] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
UNLABELLED Invasive fungal infections are a significant cause of morbidity and mortality for patients undergoing solid organ transplantation. Our aim was to evaluate the incidence of invasive fungal infections in solid organ recipients within a dedicated intensive care unit (ICU). MATERIALS AND METHODS From May 2002 to May 2005, 278 patients undergoing solid organ transplantation (105 liver, 142 kidney, 20 lung, 2 combined liver-kidney, 9 combined pancreas-kidney) were admitted to our posttransplant intensive care unit. We retrospectively analyzed data obtained from the ICU stay. Fungal infection was defined by positivity of normally sterile biological samples and by elevated positivity of normally non sterile biological samples. We did not consider superficial fungal infections and asymptomatic colonizations. RESULTS Forty-six patients (16.5%) developed a fungal infection; at least one mycotic agent was isolated from each patient. Candida albicans was the most common pathogen, isolated from 71 % of infected patients (33 of 46). Infected patients showed a mortality rate of 35%, while that for non infected recipients was 3.5%. Total length of ICU stay was the most significant risk factor among infected patients (30.26 days vs 5.04 days P < .0001). Mean time between transplantation and first positive samples was 6.17 days (SD 8.88). CONCLUSION Fungal infections in solid organ transplant patients are a major issue because of their associated morbidity and mortality. Candida albicans was the most common pathogen and total length of ICU stay was the most important risk factor.
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Affiliation(s)
- F Pugliese
- Dipartimento di Scienze Anestesiologiche, Medicina Critica e Terapia del Dolore, Universita' Degli Studi di Roma La Sapienza, Roma, Italy.
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Jordà-Marcos R, Alvarez-Lerma F, Jurado M, Palomar M, Nolla-Salas J, León MA, León C. Risk factors for candidaemia in critically ill patients: a prospective surveillance study. Mycoses 2007; 50:302-10. [PMID: 17576324 DOI: 10.1111/j.1439-0507.2007.01366.x] [Citation(s) in RCA: 70] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
Candidaemia is frequently a life-threatening complication in patients admitted to the intensive care unit (ICU). To assess the risk factors for candidaemia in critically ill patients with prolonged ICU stay, a total of 1765 adult patients admitted for at least 7 days to 73 medical-surgical ICUs of 70 tertiary care hospitals in Spain participated in a prospective cohort study. Candidaemia was defined as recovery of Candida spp. from blood culture. Sixty-eight episodes of candidaemia occurred in 63 patients, representing 35.7 episodes per 1000 ICU patients admitted, with an incidence rate of 1.5 episodes per 1000 days of ICU stay. Causative fungi were C. albicans in 57.1% of cases and non-albicans Candida spp. in 42.9%. In the multivariate analysis, independent factors significantly associated with candidaemia were Candida colonisation (OR = 4.12, 95% CI: 1.82-9.33), total parenteral nutrition (OR = 3.89, 95% CI: 1.73-8.78), elective surgery (OR = 2.75, 95% CI: 1.17-6.45) and haemofiltration procedures (OR = 1.96, 95% CI: 1.06-3.62). In the ICU setting in Spain and in patients who have stayed in units for >7 days, more than half of cases of candidaemia were caused by C. albicans. Risk factors for candidaemia identified included Candida colonisation, elective surgery, total parenteral nutrition and haemodialysis.
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Affiliation(s)
- Ricard Jordà-Marcos
- Department of Intensive Care Medicine, Hospital Son Dureta and Clínica Rotger, Palma de Mallorca, Spain.
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Dimopoulos G, Karabinis A, Samonis G, Falagas ME. Candidemia in immunocompromised and immunocompetent critically ill patients: a prospective comparative study. Eur J Clin Microbiol Infect Dis 2007; 26:377-84. [PMID: 17525857 PMCID: PMC7101586 DOI: 10.1007/s10096-007-0316-2] [Citation(s) in RCA: 55] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
The purpose of this study was to compare the risk factors, clinical manifestations, and outcome of candidemia in immunocompromised (IC) and nonimmunocompromised (NIC) critically ill patients. Data were collected prospectively over a 2-year period (02/2000–01/2002) from patients in a 25-bed, medical–surgical intensive care unit (ICU). Eligible for participation in this study were patients who developed candidemia during their ICU stay. Patients under antifungal therapy and with a confirmed systemic fungal infection prior to the diagnosis of candidemia were excluded. Cultures of blood, urine, and stool were performed for all patients in the study, and all patients underwent endoscopy/biopsy of the esophagus for detection of Candida. Smears and/or scrapings of oropharyngeal and esophageal lesions were examined for hyphae and/or pseudohyphae and were also cultured for yeasts. During the study period, 1,627 patients were hospitalized in the ICU, 57% for primary medical reasons and 43% for surgical reasons. After application of the study’s inclusion and exclusion criteria, 24 patients with candidemia (9 IC and 15 NIC) were analyzed. Total parenteral nutrition was more common in IC than in NIC patients (9/9 [100%] vs 8/15 [53%], p = 0.02). Oropharyngeal candidiasis was detected in 5 of 9 (55.5%) IC patients and in 1 of 15 (6.5%) NIC patients (p = 0.015). Esophageal candidiasis was also more common in IC than in NIC patients (4/9 [44%] vs 0/15 [0%], p = 0.012). Among the 9 IC patients, all except 2 died, resulting in a crude mortality of 78%; among the 15 NIC patients, 9 died, resulting in a crude mortality of 60% (p > 0.05). Autopsy was performed in two IC and in six NIC patients, with disseminated candidiasis found in one IC patient. Oropharyngeal and esophageal candidiasis are frequent in IC patients with candidemia. In contrast, this coexistence is rare in NIC critically ill patients with Candida bloodstream infections. A high mortality was noted in both IC and NIC critically ill patients with candidemia.
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Affiliation(s)
- G. Dimopoulos
- Department of Intensive Care Medicine, Medical School, University of Athens, Athens, Greece
| | - A. Karabinis
- Intensive Care Unit, “G. Gennimatas” General Hospital, Athens, Greece
| | - G. Samonis
- Department of Medicine, University of Crete School of Medicine, Heraklion, Crete Greece
| | - M. E. Falagas
- Alfa Institute of Biomedical Sciences (AIBS), 9 Neapoleos Street, 151 23 Marousi, Athens, Greece
- Department of Medicine, Tufts University School of Medicine, Boston, MA USA
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Shorr AF, Lazarus DR, Sherner JH, Jackson WL, Morrel M, Fraser VJ, Kollef MH. Do clinical features allow for accurate prediction of fungal pathogenesis in bloodstream infections? Potential implications of the increasing prevalence of non-albicans candidemia. Crit Care Med 2007; 35:1077-83. [PMID: 17312565 DOI: 10.1097/01.ccm.0000259379.97694.00] [Citation(s) in RCA: 84] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To describe the evolving epidemiology of fungal bloodstream infections in critically ill and noncritically ill patients and to identify predictors of infection with non-albicans yeast species. DESIGN Retrospective case series. SETTING Two academic, tertiary care centers. PARTICIPANTS All persons during a 4-yr period who developed fungemia. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS We initially compared subjects with Candida albicans vs. alternative yeast. In a sensitivity analysis, we compared persons with potentially fluconazole-resistant organisms (Candida glabrata and Candida krusei) to those with other fungi. We also repeated these analyses in the subgroup of persons in the intensive care unit when they developed fungemia. The study cohort included 245 patients (60% in the intensive care unit), and C. albicans accounted for 52% of infections, whereas C. glabrata represented 20% of cases. The distribution of isolates was similar in both intensive care unit patients and those on the wards. In the entire population, no variable, including both previous fluconazole exposure and severity of illness, correlated with the fungemia due to a non-albicans species. In our sensitivity analysis, no factor was independently associated with a potentially fluconazole-resistant yeast. For the subgroup of subjects whose fungemia was diagnosed while they were in the intensive care unit, no variable differentiated C. albicans from non-albicans isolates. CONCLUSIONS Non-albicans yeast are common both in the intensive care unit and on the wards. Simple clinical factors do not allow the clinician to effectively identify patients likely infected with non-albicans pathogens or with possible fluconazole-resistant fungi.
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Affiliation(s)
- Andrew F Shorr
- Pulmonary and Critical Care Medicine, Washington Hospital Center, Washington, DC, USA.
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