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Xu J, Sun W, Wang Y, Jiang H, Ding H, Cheng Q, Bao N, Meng J. Two-Stage Treatment Protocol of Fungal Periprosthetic Hip and Knee Joint Infections: the Clinical Experience from a Single Center Experience. ACTA CHIRURGIAE ORTHOPAEDICAE ET TRAUMATOLOGIAE CECHOSLOVACA 2024; 91:52-56. [PMID: 38447565 DOI: 10.55095/achot2024/003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/08/2024]
Abstract
PURPOSE OF THE STUDY To evaluate the clinical results and safety of fungal periprosthetic joint Infections (fPJIs) using two-stage treatment protocol. MATERIAL AND METHODS 8 patients with fPJIs (3 hips and 5 knees) using two-stage revision were reviewed retrospectively and followed up at least 2 years. The preoperative demographic data, two-stage treatment protocol, results of microbiology and histologic workup and postoperative follow-up results (reimplantation success rate and infection free time) were recorded. RESULTS 7 patients got successful reimplantation, with a 75% reimplantation success rate. Two patients got knee arthrodesis eventually. All patients were infection free with a median follow-up of 4.0 ± 2.0 years (range, 2-7 years). Of them, Candida species were found in 7 patients, while non-Candida specimen was only isolated in 1 patient with Aspergillus. Only 2 patients had coexisting bacterial infection (Methicillin-resistant coagulase-negative Staphylococci and Proteus mirabilis respectively). The average interval between the initial surgery and diagnosis of fPJIs was 21.50±34.79 months (range, 4-104 months). The mean time of spacer implantation was 7.75±2.77 months (range, 6-14 months). None serious complication or above knee amputation was found. DISCUSSION fPJIs are very rare and considerable challenge after total hip or knee arthroplasty. The goal of therapy is to eradicate local infection and maintain function. Candida species were the most common pathogen. The duration between spacer placement and staged reimplantation was highly variable, and generally dependent upon the results of joint aspirates and infl ammatory markers. The current study shows that the two-stage treatment protocol is recommended for fungal periprosthetic hip and knee joint infections. CONCLUSIONS The two-stage treatment protocol is recommended for fungal periprosthetic hip and knee joint infections. The safety and effi cacy of biantibiotical impregnated (antifungal + antibiotics) cement spacer is confi rmed. Further evidence-based work is needed to determine the optimal drug dose and reimplantation time. KEY WORDS two-stage treatment protocol, fungal periprosthetic infections, hip spacer, knee spacer.
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Affiliation(s)
- J Xu
- Department of Orthopaedics, Changzhou Traditional Chinese medical hospital, affi liated to Nanjing University of Traditional Chinese Medicine, Changzhou, Jiangsu Province, China
| | - W Sun
- Department of Orthopaedics, Jinling Hospital, School of Medicine, Nanjing University, Nanjing, Jiangsu Province, China
| | - Y Wang
- Department of Orthopaedics, Jinling Hospital, School of Medicine, Nanjing University, Nanjing, Jiangsu Province, China
| | - H Jiang
- Department of Orthopaedics, Jinling Hospital, School of Medicine, Nanjing University, Nanjing, Jiangsu Province, China
| | - H Ding
- Department of Orthopaedics, Jinling Hospital, School of Medicine, Nanjing University, Nanjing, Jiangsu Province, China
| | - Q Cheng
- Department of Orthopaedics, Jinling Hospital, School of Medicine, Nanjing University, Nanjing, Jiangsu Province, China
| | - N Bao
- Department of Orthopaedics, Jinling Hospital, School of Medicine, Nanjing University, Nanjing, Jiangsu Province, China
| | - J Meng
- Department of Orthopaedics, Jinling Hospital, School of Medicine, Nanjing University, Nanjing, Jiangsu Province, China
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Huët MAL, Wong LW, Goh CBS, Hussain MH, Muzahid NH, Dwiyanto J, Lee SWH, Ayub Q, Reidpath D, Lee SM, Rahman S, Tan JBL. Investigation of culturable human gut mycobiota from the segamat community in Johor, Malaysia. World J Microbiol Biotechnol 2021; 37:113. [PMID: 34101035 DOI: 10.1007/s11274-021-03083-6] [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: 01/28/2021] [Accepted: 05/31/2021] [Indexed: 11/28/2022]
Abstract
Although several studies have already been carried out in investigating the general profile of the gut mycobiome across several countries, there has yet to be an officially established baseline of a healthy human gut mycobiome, to the best of our knowledge. Microbial composition within the gastrointestinal tract differ across individuals worldwide, and most human gut fungi studies concentrate specifically on individuals from developed countries or diseased cohorts. The present study is the first culture-dependent community study assessing the prevalence and diversity of gut fungi among different ethnic groups from South East Asia. Samples were obtained from a multi-ethnic semi-rural community from Segamat in southern Malaysia. Faecal samples were screened for culturable fungi and questionnaire data analysis was performed. Culturable fungi were present in 45% of the participants' stool samples. Ethnicity had an impact on fungal prevalence and density in stool samples. The prevalence of resistance to fluconazole, itraconazole, voriconazole and 5-fluorocytosine, from the Segamat community, were 14%, 14%, 11% and 7% respectively. It was found that Jakun individuals had lower levels of antifungal resistance irrespective of the drug tested, and male participants had more fluconazole resistant yeast in their stool samples. Two novel point mutations were identified in the ERG11 gene from one azole resistant Candida glabrata, suggesting a possible cause of the occurrence of antifungal resistant isolates in the participant's faecal sample.
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Affiliation(s)
| | - Li Wen Wong
- School of Science, Monash University Malaysia, Subang Jaya, Malaysia
| | | | - Md Hamed Hussain
- School of Science, Monash University Malaysia, Subang Jaya, Malaysia
| | | | - Jacky Dwiyanto
- School of Science, Monash University Malaysia, Subang Jaya, Malaysia
| | | | - Qasim Ayub
- School of Science, Monash University Malaysia, Subang Jaya, Malaysia.,Genomics Facility, Monash University Malaysia, Subang Jaya, Malaysia
| | - Daniel Reidpath
- Jeffrey Cheah School of Medicine and Health Sciences, Monash University Malaysia, Subang Jaya, Malaysia.,The South East Asia Community Observatory (SEACO), Segamat, Johor, Malaysia
| | - Sui Mae Lee
- School of Science, Monash University Malaysia, Subang Jaya, Malaysia
| | - Sadequr Rahman
- School of Science, Monash University Malaysia, Subang Jaya, Malaysia.,Tropical Medicine & Biology Multidisciplinary Platform, Monash University Malaysia, Subang Jaya, Malaysia
| | - Joash Ban Lee Tan
- School of Science, Monash University Malaysia, Subang Jaya, Malaysia. .,Monash University Malaysia, Jalan Lagoon Selatan, Bandar Sunway, 47500, Subang Jaya, Selangor, Malaysia.
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Lotfali E, Fattahi A, Sayyahfar S, Ghasemi R, Rabiei MM, Fathi M, Vakili K, Deravi N, Soheili A, Toreyhi H, Shirvani F. A Review on Molecular Mechanisms of Antifungal Resistance in Candida glabrata: Update and Recent Advances. Microb Drug Resist 2021; 27:1371-1388. [PMID: 33956513 DOI: 10.1089/mdr.2020.0235] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
Candida glabrata is the second frequent etiologic agent of mucosal and invasive candidiasis. Based on the recent developments in molecular methods, C. glabrata has been introduced as a complex composed of C. glabrata, Candida nivariensis, and Candida bracarensis. The four main classes of antifungal drugs effective against C. glabrata are pyrimidine analogs (flucytosine), azoles, echinocandins, and polyenes. Although the use of antifungal drugs is related to the predictable development of drug resistance, it is not clear why C. glabrata is able to rapidly resist against multiple antifungals in clinics. The enhanced incidence and antifungal resistance of C. glabrata and the high mortality and morbidity need more investigation regarding the resistance mechanisms and virulence associated with C. glabrata; additional progress concerning the drug resistance of C. glabrata has to be further prevented. The present review highlights the mechanism of resistance to antifungal drugs in C. glabrata.
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Affiliation(s)
- Ensieh Lotfali
- Department of Medical Parasitology and Mycology, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Azam Fattahi
- Center for Research and Training in Skin Diseases and Leprosy, Tehran University of Medical Sciences, Tehran, Iran
| | - Shirin Sayyahfar
- Research Center of Pediatric Infectious Diseases, Institute of Immunology and Infectious Diseases, Iran University of Medical Sciences, Tehran, Iran
| | - Reza Ghasemi
- Student Research Committee, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mohammad Mahdi Rabiei
- Student Research Committee, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mobina Fathi
- Student Research Committee, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Kimia Vakili
- Student Research Committee, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Niloofar Deravi
- Student Research Committee, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Amirali Soheili
- Student Research Committee, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Hossein Toreyhi
- Student Research Committee, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Fariba Shirvani
- Pediatric Infections Research Center, Research Institute for Children Health, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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Morbidity and mortality of candidaemia in Europe: an epidemiologic meta-analysis. Clin Microbiol Infect 2019; 25:1200-1212. [DOI: 10.1016/j.cmi.2019.04.024] [Citation(s) in RCA: 101] [Impact Index Per Article: 20.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2019] [Revised: 04/15/2019] [Accepted: 04/18/2019] [Indexed: 01/30/2023]
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Sardari A, Zarrinfar H, Mohammadi R. Detection of ERG11 point mutations in Iranian fluconazole-resistant Candida albicans isolates. Curr Med Mycol 2019; 5:7-14. [PMID: 31049452 PMCID: PMC6488286 DOI: 10.18502/cmm.5.1.531] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Abstract
Background and Purpose Candidiasis is referred to a group of superficial and deep-tissue fungal infections often caused by Candida albicans. The superficial infections affect the oral, oropharynx, esophagus, and vaginal mucosa. The treatment of choice for these infections is the use of azoles, such as fluconazole. However, the increased use of these antifungal agents has led to the emergence of azole-resistant isolates of C. albicans. Different mechanisms have been suggested for the development of drug resistance, such as mutations in the encoding gene ERG11. Mutations in ERG11 result in changes in the ERG11p spatial construction and reduce the affinity between the protein and azole. This study aimed to determine the susceptibility profile of C. albicans clinical isolates to fluconazole using microdilution method. The present research was also targeted toward the detection of mutations that might be related to fluconazole resistance by the amplification and sequencing of ERG11 gene. Materials and Methods This study was conducted on a total of 216 clinical isolates obtained from Mashhad, Isfahan, and Tehran cities in Iran, during 2016-2018. The clinical isolates were identified using molecular techniques. Furthermore, minimum inhibitory concentration (MICs) was determined according to the clinical and laboratory standards institute M27-A3 and M27-S4 documents. The concentration range for fluconazole was obtained as 0.063-64 μg/ml. In the resistant strains, ERG11 genes were amplified by specific primers. Subsequently, cycle sequencing reactions were performed on purified polymerase chain reaction (PCR) products in forward and reverse directions. Finally, the results were analyzed by MEGA (version 7) and Gene Runner software (version 6.5.30). Results Out of 216 strains, 100 (46.3%) species were identified as C. albicans. The MIC values for fluconazole had a range of 0.125-16 μg/ml with the MIC50 and MIC90 values of 0.5 and 1 μg/ml, respectively. Totally, 41 nucleotide changes were detected among 4 resistant isolates. In this regard, 4 out of 41 mutations in codons caused changes in ERG11p; however, these mutations did not lead to fluconazole resistance. Conclusion Fluconazole resistance among clinical isolates is not merely due to the changes in ERG11p. This resistance may be also related to some other mechanisms, such as the prevention of the intracellular accumulation of the antifungal agent and alteration of the target enzyme to diminish drug binding.
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Affiliation(s)
- Ali Sardari
- Department of Medical Parasitology and Mycology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Hossein Zarrinfar
- Allergy Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Rasoul Mohammadi
- Department of Medical Parasitology and Mycology, School of Medicine, Infectious Diseases and Tropical Medicine Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
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A Fatal Case of Candida auris and Candida tropicalis Candidemia in Neutropenic Patient. Mycopathologia 2018; 183:559-564. [PMID: 29383574 PMCID: PMC5958168 DOI: 10.1007/s11046-018-0244-y] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2017] [Accepted: 01/15/2018] [Indexed: 01/18/2023]
Abstract
We report a fatal case of Candida auris that was involved in mixed candidemia with Candida tropicalis, isolated from the blood of a neutropenic patient. Identification of both isolates was confirmed by amplification and sequencing of internal transcribed spacer and D1/D2 domain of large subunit in rRNA gene. Antifungal susceptibility test by E-test method revealed that C. auris was resistant to amphotericin B, anidulafungin, caspofungin, fluconazole, itraconazole and voriconazole. On the other hand, C. tropicalis was sensitive to all antifungal tested. The use of chromogenic agar as isolation media is vital in detecting mixed candidemia.
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The identification of Meyerozyma guilliermondii from blood cultures and surveillance samples in a university hospital in Northeast Turkey: A ten-year survey. J Mycol Med 2017; 27:506-513. [PMID: 28843335 DOI: 10.1016/j.mycmed.2017.07.007] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2017] [Revised: 07/06/2017] [Accepted: 07/17/2017] [Indexed: 11/24/2022]
Abstract
Meyerozyma (Pichia) guilliermondii exists in human skin and mucosal surface microflora. It can cause severe fungal infections like candidemia, which is an opportunistic pathogen. One hundred and forty-one M. guilliermondii isolates, consisting of 122 blood culture isolates, belonging to 126 patients; 13 total parenteral nutrition solution isolates; and two rectal swab isolates were identified according to carbohydrate assimilation reactions in a university hospital in Turkey between January 2006 and December 2015. Following Candida albicans (34.0%) and C. parapsilosis (21.2%), the third yeast species most commonly isolated from blood cultures in the Farabi Hospital was M. guilliermondii (20.6%). The patients were hospitalised in 27 different departments. A total of 50% of the patients were in pediatric departments, 49.2% were in intensive care units, and 17.2% were in haematology-oncology departments. Molecular identification of the isolates was performed using DNA sequence analysis of ribosomal ITS gene regions and IGS amplification-AluI fingerprinting (IGSAF). With molecular identification, 140 isolates were identified as M. guilliermondii and one isolate was identified as Candida membranifaciens. It was observed that the ITS1 region specifically helps in identifying these species. It was demonstrated that biochemical and molecular methods were 99.3% consistent in identifying M. guilliermondii. The Wild-Type (WT) Minimum Inhibitory Concentrations (MICs) distribution of fluconazole, voriconazole, itraconazole, and flucytosine were determined using the Sensititre YeastOne YO2V system after 24h of incubation. One M. guilliermondii strain was determined to be non-WT for fluconazole, voriconazole, itraconazole and flucytosine. In total, three M. guilliermondii strains, for fluconazole, were determined to be non-WT in this study.
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Molecular Analysis of Candida species with Emphasis on Predisposing Factors in Cutaneous Candidiasis Patients. Jundishapur J Microbiol 2016. [DOI: 10.5812/jjm.41030] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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9
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Wu Y, Li YH, Yu SB, Li WG, Liu XS, Zhao L, Lu JX. A Genome-Wide Transcriptional Analysis of Yeast-Hyphal Transition in Candida tropicalis by RNA-Seq. PLoS One 2016; 11:e0166645. [PMID: 27851809 PMCID: PMC5112795 DOI: 10.1371/journal.pone.0166645] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2016] [Accepted: 11/01/2016] [Indexed: 12/28/2022] Open
Abstract
Candida tropicalis is considered as the leading pathogen in nosocomial fungemia and hepatosplenic fungal infections in patients with cancer, particularly in leukemia. The yeast-filament transition is required for virulent infection by Candida. Several studies have explored the genome-wide transcription profile of Candida, however, no report on the transcriptional profile of C. tropicalis under yeast-filament transition has been published. In this study, the transcriptomes of three C. tropicalis isolates with different adhesion and biofilm formation abilities, identified in our previous studies, were analyzed in both the yeast and filament states using RNA-Seq. Differentially expressed genes were found for each isolate during the transition. A total of 115 genes were up- or down- regulated in the two hyphal-producing isolates (ZRCT 4 and ZRCT 45). Among these differentially expressed genes, only two were down-regulated during the yeast-filament transition. Furthermore, six filament-associated genes were up-regulated in the hyphae-producing isolates. According to Candida Hypha Growth Database established in this study, 331 hyphae- related genes were discovered in C. tropicalis. ALS1 and ALS3 were down-regulated and up-regulated, respectively, during filamentous growth of C. tropicalis. These findings proved a better understanding of gene expression dynamics during the yeast-filament transition in C. tropicalis.
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Affiliation(s)
- Yuan Wu
- State Key Laboratory of Infectious Disease Prevention and Control, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, National Institute for Communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Chang bai Road 155, Chang ping District, Beijing, China
| | - Yin-hu Li
- Microbial Research Department, BGI-Shenzhen, Main building, Beishan Industry Zone, Yantian District, Shenzhen, China
| | - Shuan-bao Yu
- State Key Laboratory of Infectious Disease Prevention and Control, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, National Institute for Communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Chang bai Road 155, Chang ping District, Beijing, China
| | - Wen-ge Li
- State Key Laboratory of Infectious Disease Prevention and Control, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, National Institute for Communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Chang bai Road 155, Chang ping District, Beijing, China
| | - Xiao-shu Liu
- State Key Laboratory of Infectious Disease Prevention and Control, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, National Institute for Communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Chang bai Road 155, Chang ping District, Beijing, China
| | - Lei Zhao
- Department of Molecular Physiology and Biophysics, Holden Comprehensive Cancer Center, University of Iowa Carver College of Medicine, Iowa City, IA, 52242, United States of America
| | - Jin-xing Lu
- State Key Laboratory of Infectious Disease Prevention and Control, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, National Institute for Communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Chang bai Road 155, Chang ping District, Beijing, China
- * E-mail:
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Kim IH, Choi JK, Lee DG, Lee IS, Hong TH, You YK, Chun HJ, Lee MA. Clinical significance of isolated biliary candidiasis in patients with unresectable cholangiocarcinoma. Hepatobiliary Pancreat Dis Int 2016; 15:533-539. [PMID: 27733324 DOI: 10.1016/s1499-3872(16)60109-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
BACKGROUND The frequency of isolated biliary candidiasis is increasing in cancer patients. The clinical significance of isolated biliary candidiasis remains unclear. We analyzed the risk factors of biliary candidiasis and outcomes of the patients with unresectable cholangiocarcinoma after percutaneous transhepatic biliary drainage (PTBD). METHODS Among 430 patients who underwent PTBD between January 2012 and March 2015, 121 patients had unresectable cholangiocarcinoma. Bile and blood samples were collected for consecutive fungal culture. RESULTS The study cohort included 49 women and 72 men with a median age of 71 years. Multivariate analysis showed that cancer progression (P=0.013), concurrent presence of another microorganism (P=0.010), and previous long-term (>7 days) antibiotic use (P=0.011) were potential risk factors of biliary candidiasis. Chemotherapy was not associated with overall biliary candidiasis (P=0.196), but was significantly related to repeated biliary candidiasis (P=0.011). Patients with isolated biliary candidiasis showed remarkably reduced survival compared with those without [median overall survival (OS): 32 vs 62 days, P=0.011]. Subgroup analysis was also performed. Patients with repeated candidiasis had markedly decreased survival compared with those with transient candidiasis (median OS: 30 vs 49 days, P=0.046). Biliary candidiasis was identified as a poor prognostic factor by univariate and multivariate analyses (P=0.033). Four cases of repeated candidiasis (4/19, 21%) showed Candida species in consecutive blood culture until the end of the study, but others showed no candidemia. CONCLUSIONS Isolated biliary candidiasis may be associated with poor prognosis in patients with unresectable cholangiocarcinoma. Especially, repeated biliary candidiasis may have the possibility of progression to candidemia. We suggest that biliary dilatation treatment or antifungal agents might be helpful for patients with biliary candidiasis.
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Affiliation(s)
- In-Ho Kim
- Departments of Internal Medicine, Division of Medical Oncology, and Department of Hepato-Biliary-Pancreatic Cancer Center, Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, Korea.
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Ng KP, Kuan CS, Kaur H, Na SL, Atiya N, Velayuthan RD. Candida species epidemiology 2000-2013: a laboratory-based report. Trop Med Int Health 2015. [PMID: 26216479 DOI: 10.1111/tmi.12577] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To describe a prospective laboratory-based surveillance of Candida species that were collected from different anatomical sites of patients admitted to the University of Malaya Medical Centre, Malaysia, from the year 2000 to 2013. METHODS Conventional (culture, microscopic examination and carbohydrate assimilation test) and molecular (PCR amplification and DNA sequencing) techniques were used to identify Candida species. RESULTS A total of 16 Candida species isolated from 34 392 clinical samples were from the oral cavity (oral swabs and throat swabs), blood, respiratory tract (sputum, tracheal secretions, nasopharyngeal aspirates, bronchoalveolar lavage), high vaginal swab, pus and urine. C. albicans (66.70%, 22 941/34 392), C. glabrata (11.71%, 4029/34 392), C. parapsilopsis (10.74%, 3692/34 392), C. tropicalis (9.19%, 3162/34 392) and C. krusei (1.15%, 396/34 392) were the five predominant Candida species. C. albicans was the predominant species isolated from the oral cavity, respiratory tract and high vaginal swab; while the Candida species isolated from blood, urine and pus were predominant non-albicans Candida. Uncommon Candida species, such as C. lusitaniae, C. haemulonii, C. humicola, Pichia ohmeri and C. ciferrii, were also isolated in this study. CONCLUSION Our study expands the current knowledge of the epidemiology of non-invasive and invasive candidiasis in Malaysia. The variability of the Candida species distribution from different anatomical sites highlights the significance of local epidemiology in disease management and selection of antifungal agents.
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Affiliation(s)
- Kee Peng Ng
- Department of Medical Microbiology, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Chee Sian Kuan
- Department of Medical Microbiology, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Harvinder Kaur
- Department of Medical Microbiology, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Shiang Ling Na
- Department of Medical Microbiology, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Nadia Atiya
- Department of Medical Microbiology, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Rukumani Devi Velayuthan
- Department of Medical Microbiology, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
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Analysis of clinical and environmental Candida parapsilosis isolates by microsatellite genotyping--a tool for hospital infection surveillance. Clin Microbiol Infect 2015; 21:954.e1-8. [PMID: 26070962 DOI: 10.1016/j.cmi.2015.06.001] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2015] [Revised: 05/18/2015] [Accepted: 06/01/2015] [Indexed: 11/21/2022]
Abstract
Candida parapsilosis emerged as an important opportunistic pathogen, causing candidaemia worldwide. Nosocomial outbreaks triggered by this species have been frequently described, particularly in cancer patients. For a better understanding of its epidemiology, several typing methods are used and microsatellite analysis has been reported as highly discriminant. The main objective of this work was to study C. parapsilosis isolates by application of microsatellite genotyping to distinguish epidemiologically related strains, compare clinical and environmental isolates and determine possible routes of dispersion of the isolates in the hospital setting. A total of 129 C. parapsilosis isolates from different origins, including hospital environment and hands of healthcare workers, were genotyped using four microsatellite markers. The isolates were recovered from different health institutions. Analysis of C. parapsilosis isolates from hospital environment showed great genotypic diversity; however, the same or very similar genotypes were also found. The same multilocus genotype was shared by isolates recovered from the hand of a healthcare worker, from the hospital environment and from patients of the same healthcare institution, suggesting that these could be possible routes of transmission and that infections due to C. parapsilosis may be mainly related with exogenous transmission to the patient. Examination of sequential isolates from the same patients showed that colonizing and bloodstream isolates had the same multilocus genotype in the majority of cases. We demonstrate that this typing method is able to distinguish clonal clusters from genetically unrelated genotypes and can be a valuable tool to support epidemiologic investigations in the hospital setting.
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Gupta A, Gupta A, Varma A. Candida glabrata candidemia: An emerging threat in critically ill patients. Indian J Crit Care Med 2015; 19:151-4. [PMID: 25810610 PMCID: PMC4366913 DOI: 10.4103/0972-5229.152757] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Background: Candidemia is an important nosocomial blood stream infection in critically ill patients. Although several studies have addressed candidemia, very few have reviewed the impact of Candida glabrata candidemia in Intensive Care Unit (ICU) patients. Materials and Methods: The medical records of ICU patients between 2006 and 2010 were reviewed retrospectively. The epidemiology, clinical features and mortality related risk factors among our adult ICU patients were seen. Results: Among 144 episodes of candidemia, C. glabrata (n = 26; 18.05%) was the third most common species isolated. The incidence of C. glabrata candidemia was 0.21/1000 ICU admissions. The most common risk factors were prior exposure to broad spectrum antibiotics (100%), central venous catheter (100%), mechanical ventilation (76.9%), diabetes mellitus (50%), age >65 years (46.15%). Urine (23%) was the most common source of C. glabrata candidemia. Overall in hospital 30 days mortality rate due to C. glabrata fungemia was 53.8%. Patients who were treated with fluconazole showed better outcome than patients treated with amphotericin B. Renal failure requiring hemodialysis was the significantly associated with mortality in our study. Conclusion: Candida glabrata was the 3rd most common Candida causing candidemia in our ICUs with a incidence of 0.21/1000 ICU admissions. The outcome of ICU acquired C. glabrata candidemia was poor with 30 days mortality rate of 53.8%. Renal failure requiring hemodialysis was the only risk factor associated with mortality. Further studies are required to identify the other risk factors associated with mortality in C. glabrata candidemia.
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Affiliation(s)
- Ashish Gupta
- Department of Critical Care Medicine, Fortis Escorts Heart Institute, New Delhi, India
| | - Anu Gupta
- Department of Microbiology, Fortis Escorts Heart Institute, New Delhi, India
| | - Amit Varma
- Department of Critical Care Medicine, Fortis Escorts Heart Institute, New Delhi, India
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Influence of culture media on biofilm formation by Candida species and response of sessile cells to antifungals and oxidative stress. BIOMED RESEARCH INTERNATIONAL 2015; 2015:783639. [PMID: 25705688 PMCID: PMC4331161 DOI: 10.1155/2015/783639] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/07/2014] [Revised: 10/31/2014] [Accepted: 11/03/2014] [Indexed: 01/13/2023]
Abstract
The aims of the study were to evaluate the influence of culture media on biofilm formation by C. albicans, C. glabrata, C. krusei, and C. parapsilosis and to investigate the responses of sessile cells to antifungals and reactive oxygen species (ROS) as compared to planktonic cells. For biofilm formation, the Candida species were grown at different periods of time in YP or YNB media supplemented or not with 0.2 or 2% glucose. Sessile and planktonic cells were exposed to increasing concentrations of antifungals, H2O2, menadione or silver nanoparticles (AgNPs). Biofilms were observed by scanning electron microscopy (SEM) and quantified by the XTT assay. C. albicans formed biofilms preferentially in YPD containing 2% glucose (YPD/2%), C. glabrata in glucose-free YNB or supplemented with 0.2% glucose (YNB/0.2%), while C. krusei and C. parapsilosis preferred YP, YPD/0.2%, and YPD/2%. Interestingly, only C. albicans produced an exopolymeric matrix. This is the first report dealing with the in vitro effect of the culture medium and glucose on the formation of biofilms in four Candida species as well as the resistance of sessile cells to antifungals, AgNPs, and ROS. Our results suggest that candidiasis in vivo is a multifactorial and complex process where the nutritional conditions, the human immune system, and the adaptability of the pathogen should be considered altogether to provide an effective treatment of the patient.
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Cattel F, Ancona F, Chiumente M, Miliacca A, Motta I, De Rosa FG. Economic impact of antifungal treatment in IFD by Candidaspecies: anidulafungin administration as a cost-effective alternative for critical care patients. Eur J Hosp Pharm 2015. [DOI: 10.1136/ejhpharm-2013-000408] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
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16
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Wu Y, Zhou HJ, Che J, Li WG, Bian FN, Yu SB, Zhang LJ, Lu J. Multilocus microsatellite markers for molecular typing of Candida tropicalis isolates. BMC Microbiol 2014; 14:245. [PMID: 25410579 PMCID: PMC4247128 DOI: 10.1186/s12866-014-0245-z] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2014] [Accepted: 09/10/2014] [Indexed: 01/08/2023] Open
Abstract
Background Candida tropicalis is considered to be the leading pathogen causing nosocomial fungemia and hepatosplenic fungal infections in patients with cancer, particularly those with leukemia. Microsatellite-based typing methods using sets of genetic markers have been developed and reported for population structure analysis of C. albicans, C. glabrata, and C. parapsilosis, but no studies have been published for genetic analysis of C. tropicalis. The objective of this study was to develop new microsatellite loci that have the ability to distinguish among C. tropicalis isolates. Results DNA sequences containing over 10 bi- or tri-nucleotide repeats were selected from the C. tropicalis genome database. Thirty PCR primers sets specific for the microsatellite loci were designed and tested using eight clinically independent isolates. According to the amplification efficiency, specificity, and observed polymorphisms, eight markers were selected for further population structure analysis and molecular typing. Sixty-five independent C. tropicalis isolates were genotyped using these 8 markers. Based on these analyses, six microsatellite loci were confirmed, although two loci were found to be with unstable flanking areas. The six polymorphic loci displayed 4–22 alleles and 7–27 genotypes. The discriminatory power of the six loci ranged from 0.70 to 0.95. Genotyping results obtained by microsatellite analysis were compared to PCR-fingerprinting and multi-locus sequence typing (MLST). The comparisons showed that microsatellite analysis and MLST had the similar discriminatory power for C. tropicalis, which were more powerful than PCR-fingerprinting. Conclusions This is the first attempt to develop new microsatellite loci for C. tropicalis. These newly developed markers will be a valuable resource for the differentiation of C. tropicalis isolates. More C. tropicalis isolates will need to be sequenced and analyzed in order to fully show the potential of these newly developed microsatellite markers.
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Affiliation(s)
- Yuan Wu
- State Key Laboratory for Infectious Disease Prevention and Control, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, National Institute for Communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Chang bai Road 155, Chang ping District, Beijing, China.
| | - Hai-jian Zhou
- State Key Laboratory for Infectious Disease Prevention and Control, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, National Institute for Communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Chang bai Road 155, Chang ping District, Beijing, China.
| | - Jie Che
- State Key Laboratory for Infectious Disease Prevention and Control, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, National Institute for Communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Chang bai Road 155, Chang ping District, Beijing, China.
| | - Wen-ge Li
- State Key Laboratory for Infectious Disease Prevention and Control, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, National Institute for Communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Chang bai Road 155, Chang ping District, Beijing, China.
| | - Fu-ning Bian
- State Key Laboratory for Infectious Disease Prevention and Control, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, National Institute for Communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Chang bai Road 155, Chang ping District, Beijing, China.
| | - Shuan-bao Yu
- State Key Laboratory for Infectious Disease Prevention and Control, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, National Institute for Communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Chang bai Road 155, Chang ping District, Beijing, China.
| | - Li-juan Zhang
- Department of Gynecology and Obstetrics, Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing, China.
| | - Jinxing Lu
- State Key Laboratory for Infectious Disease Prevention and Control, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, National Institute for Communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Chang bai Road 155, Chang ping District, Beijing, China.
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Oladele RO, Bakare RA, Petrou MA, Oduyebo OO, Richardson M. Candidaemia in a tertiary hospital in Nigeria. Afr J Lab Med 2014; 3:89. [PMID: 29043172 PMCID: PMC5637757 DOI: 10.4102/ajlm.v3i1.89] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2012] [Accepted: 11/06/2013] [Indexed: 11/14/2022] Open
Abstract
Background Candidaemia is a widely-studied and reviewed topic in the developed world; however, there is a dearth of information on nosocomial candidaemia in Nigeria, despite the increasing use of more invasive therapeutic modalities, immunosuppressive agents and increasing incidence of immunosuppression as a result of malignancies and HIV. Objectives To determine the hospital-based frequency of candidaemia in a tertiary hospital in Ibadan, Nigeria. Method This was a prospective descriptive study which included 230 immunosuppressed patients. All isolates were identified to the species level using both conventional and automated methods. Thereafter, all Candida species isolated were tested for antifungal susceptibility using the broth microdilution method. Results Candidaemia occurred in 12 (5.21%) of the 230 study patients, with C. tropicalis accounting for 50% of the infections. Four patients (33.3%) presented with C. parapsilosis, one (8.3%) with C. albicans and one (8.3%) with a mixed infection of C. albicans and C. tropicalis. All 12 isolates were sensitive to fluconazole (minimal inhibitory concentration < 8 mg/mL). Univariate analysis revealed that old age, multiple surgeries and long-term hospitalisation were significant contributing factors for the occurrence of candidaemia. Eleven (91.7%) of the 12 patients with candidaemia had Candida colonisation of other sterile sites including the bladder, peritoneum and trachea. Furthermore, bivariate analysis revealed that mucositis (p = 0.019) and diarrhoea (p = 0.017) were significantly associated with an increased risk of candidaemia. The crude mortality rate of candidaemia was 91.7%. Conclusion This study highlights the significance of nosocomial candidaemia and the need for proactive laboratory investigation and clinical management of this life-threatening disease.
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Affiliation(s)
- Rita O Oladele
- Department of Medical Microbiology and Parasitology, University College Hospital, Nigeria
| | - Rashidi A Bakare
- Department of Medical Microbiology and Parasitology, University College Hospital, Nigeria
| | - Michael A Petrou
- Department of Microbiology, Hammersmith Hospital, Imperial College, London
| | - Oyinlola O Oduyebo
- Department of Medical Microbiology, College of Medicine, University of Lagos, Nigeria
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Gorton RL, Ramnarain P, Barker K, Stone N, Rattenbury S, McHugh TD, Kibbler CC. Comparative analysis of Gram's stain, PNA-FISH and Sepsityper with MALDI-TOF MS for the identification of yeast direct from positive blood cultures. Mycoses 2014; 57:592-601. [DOI: 10.1111/myc.12205] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2013] [Revised: 04/15/2014] [Accepted: 04/15/2014] [Indexed: 11/30/2022]
Affiliation(s)
- Rebecca L. Gorton
- UK Clinical Mycology Network (UKCMN) Regional Laboratory; Department of Microbiology; Royal Free Hospital; Hampstead UK
- Centre for Clinical Microbiology; Department of Infection and Immunity; Royal Free Hospital Campus; UCL; London UK
| | - P. Ramnarain
- UK Clinical Mycology Network (UKCMN) Regional Laboratory; Department of Microbiology; Royal Free Hospital; Hampstead UK
| | - K. Barker
- Department of Laboratory Medicine and Pathobiology; University of Toronto; Toronto Canada
| | - N. Stone
- Department of Infection; St. Thomas' Hospital; London UK
| | - S. Rattenbury
- UK Clinical Mycology Network (UKCMN) Regional Laboratory; Department of Microbiology; Royal Free Hospital; Hampstead UK
| | - T. D. McHugh
- Centre for Clinical Microbiology; Department of Infection and Immunity; Royal Free Hospital Campus; UCL; London UK
| | - C. C. Kibbler
- UK Clinical Mycology Network (UKCMN) Regional Laboratory; Department of Microbiology; Royal Free Hospital; Hampstead UK
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Cuenca-Estrella M, Rodriguez-Tudela JL. The current role of the reference procedures by CLSI and EUCAST in the detection of resistance to antifungal agentsin vitro. Expert Rev Anti Infect Ther 2014; 8:267-76. [DOI: 10.1586/eri.10.2] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Drgona L, Khachatryan A, Stephens J, Charbonneau C, Kantecki M, Haider S, Barnes R. Clinical and economic burden of invasive fungal diseases in Europe: focus on pre-emptive and empirical treatment of Aspergillus and Candida species. Eur J Clin Microbiol Infect Dis 2014; 33:7-21. [PMID: 24026863 PMCID: PMC3892112 DOI: 10.1007/s10096-013-1944-3] [Citation(s) in RCA: 66] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2013] [Accepted: 07/29/2013] [Indexed: 11/23/2022]
Abstract
Invasive fungal diseases (IFDs) have been widely studied in recent years, largely because of the increasing population at risk. Aspergillus and Candida species remain the most common causes of IFDs, but other fungi are emerging. The early and accurate diagnosis of IFD is critical to outcome and the optimisation of treatment. Rapid diagnostic methods and new antifungal therapies have advanced disease management in recent years. Strategies for the prevention and treatment of IFDs include prophylaxis, and empirical and pre-emptive therapy. Here, we review the available primary literature on the clinical and economic burden of IFDs in Europe from 2000 to early 2011, with a focus on the value and outcomes of different approaches.
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Affiliation(s)
- L. Drgona
- Department of Haematology/Oncology, National Cancer Institute and Comenius University, Bratislava, Slovakia
| | - A. Khachatryan
- Pharmerit International, 4350 East West Highway, Suite 430, Bethesda, MD 20814 USA
| | - J. Stephens
- Pharmerit International, 4350 East West Highway, Suite 430, Bethesda, MD 20814 USA
| | - C. Charbonneau
- Pfizer Global Outcomes Research, Pfizer Inc., New York, NY USA
| | - M. Kantecki
- Pfizer International Operations, Pfizer Inc., Paris, France
| | - S. Haider
- Pfizer Global Research and Development, Pfizer Inc., Groton, CT USA
| | - R. Barnes
- Cardiff University School of Medicine, Cardiff, UK
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Ying Y, Zhao Y, Hu X, Cai Z, Liu X, Jin G, Zhang J, Zhang J, Liu J, Huang X. In vitro fluconazole susceptibility of 1,903 clinical isolates of Candida albicans and the identification of ERG11 mutations. Microb Drug Resist 2013; 19:266-73. [PMID: 23484590 DOI: 10.1089/mdr.2012.0204] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract Fluconazole resistance of Candida albicans has been reported to be the result of one or more specific point mutations in ERG11 gene. In this study, we amplified and sequenced the entire ERG11 coding sequence of 72 isolates of C. albicans to search for possible mutations. Twenty-seven silent mutations and 14 missense mutations were identified. While the mutations K342R and V437I were found as single-amino-acid changes in Erg11p, other mutations were detected simultaneously in individual isolates. Several different clinical isolates had the same pattern of multiple amino acid alternations: (1) A114S with Y257H was identified in 11 resistant and 3 susceptible dose-dependent isolates without any other silent mutation and may be associated with resistance; (2) Y132H combined with G450E was identified in two fluconazole-resistant isolates and is known to contribute to resistance; and (3) the coexistence of D116E, K128T, Y132H, and G465S was first described in five reduced-susceptibility isolates, but the correlation of this pattern with resistance is still uncertain. These data indicate that multiple amino acid substitutions in Erg11p were found frequently in clinical isolates and may be associated with fluconazole resistance.
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Affiliation(s)
- Ying Ying
- Department of Medical Microbiology, Nanchang University, Nanchang, People's Republic of China
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22
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Cavaleiro I, Proença L, Félix S, Salema-Oom M. Prevalence of Yeast Other than Candida albicans
in Denture Wearers. J Prosthodont 2013; 22:351-7. [DOI: 10.1111/jopr.12005] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/13/2012] [Indexed: 11/26/2022] Open
Affiliation(s)
- Inês Cavaleiro
- Instituto Superior Ciências da Saúde Egas Moniz; Centro de Investigação Interdisciplinar Egas Moniz (CiiEM); Caparica Portugal
| | - Luis Proença
- Instituto Superior Ciências da Saúde Egas Moniz; Centro de Investigação Interdisciplinar Egas Moniz (CiiEM); Caparica Portugal
- Faculdade de Ciências da Universidade de Lisboa; Centro de Ciências Moleculares e Materiais (CCMM); Lisboa Portugal
| | - Sérgio Félix
- Instituto Superior Ciências da Saúde Egas Moniz; Centro de Investigação Interdisciplinar Egas Moniz (CiiEM); Caparica Portugal
| | - Madalena Salema-Oom
- Instituto Superior Ciências da Saúde Egas Moniz; Centro de Investigação Interdisciplinar Egas Moniz (CiiEM); Caparica Portugal
- Faculdade de Ciência e Tecnologia da Universidade Nova de Lisboa; Centro de Recursos Microbiológicos (CREM); Caparica Portugal
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Magri MMC, Gomes-Gouvêa MS, de Freitas VLT, Motta AL, Moretti ML, Shikanai-Yasuda MA. Multilocus sequence typing of Candida tropicalis shows the presence of different clonal clusters and fluconazole susceptibility profiles in sequential isolates from candidemia patients in Sao Paulo, Brazil. J Clin Microbiol 2013; 51:268-77. [PMID: 23152555 PMCID: PMC3536249 DOI: 10.1128/jcm.02366-12] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2012] [Accepted: 11/05/2012] [Indexed: 11/20/2022] Open
Abstract
The profiles of 61 Candida tropicalis isolates from 43 patients (28 adults and 15 children) diagnosed with candidemia at two teaching hospitals in São Paulo, Brazil, were characterized by multilocus sequence typing (MLST). For the 14 patients who had bloodstream infections, 32 isolates were serially collected from their blood and/or catheters. Thirty-nine diploid sequence types (DSTs) were differentiated. According to the C. tropicalis MLST database (http://pubmlst.org/ctropicalis/), 36 DSTs and 23 genotypes identified from the 61 isolates had not previously been described. This report represents the first study to characterize sequential isolates of C. tropicalis from candidemia cases in South America. Microvariation in a single gene was found in the sequential isolates from 7 patients. The main polymorphisms occurred in the alleles of the XYR1 gene, specifically at nucleotide positions 215, 242, and 344. Macrovariation in six gene fragments was detected in the isolates from 3 patients. eBURST analysis added two new groups to this study (groups 6 and 18). Additionally, susceptibility tests indicate that 3 isolates were resistant to fluconazole. No correlation was found between the DSTs and susceptibility to fluconazole and/or selective antifungal pressure. Two patients were sequentially infected with resistant and susceptible strains. MLST is an important tool for studying the genetic diversity of multiple/sequential isolates of patients with candidemia, allowing the comparison of our data with those from other regions of the world, as well as allowing an analysis of the genetic relationship among several clones in sequential isolates from the same or different candidemia patient sites (blood or catheter).
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Affiliation(s)
- Marcello Mihailenko Chaves Magri
- Medical Investigation Laboratory of Immunology, Clinics Hospital, Medical School, University of São Paulo (LIM-48), São Paulo, Brazil.
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Intravenous itraconazole against experimental neutropenic Candida parapsilosis infection: efficacy after suppression of bacterial translocation. J Infect Chemother 2013; 19:1080-6. [DOI: 10.1007/s10156-013-0627-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2013] [Accepted: 05/24/2013] [Indexed: 11/26/2022]
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25
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Kanji JN, Laverdière M, Rotstein C, Walsh TJ, Shah PS, Haider S. Treatment of invasive candidiasis in neutropenic patients: systematic review of randomized controlled treatment trials. Leuk Lymphoma 2012; 54:1479-87. [DOI: 10.3109/10428194.2012.745073] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- Jamil N. Kanji
- Divisions of Infectious Diseases and Medical Microbiology, Departments of Medicine and Pathology/Laboratory Medicine, University of Alberta, University of Alberta Hospital,
Edmonton, Alberta, Canada
| | - Michel Laverdière
- Department of Microbiology – Infectious Diseases, Hopital Maisonneuve-Rosemont, Université de Montréal,
Montréal, Québec, Canada
| | - Coleman Rotstein
- Division of Infectious Diseases, Department of Medicine, University Health Network, University of Toronto. Toronto General Hospital,
Toronto, Ontario, Canada
| | - Thomas J. Walsh
- Transplantation-Oncology Infectious Diseases Program, Division of Infectious Diseases, Weill Cornell Medical College of Cornell University, New York Presbyterian Hospital,
New York, NY, USA
| | - Prakesh S. Shah
- Department of Pediatrics and The Institute for Health Policy Management and Evaluation, University of Toronto, Mount Sinai Hospital,
Toronto, Ontario, Canada
| | - Shariq Haider
- Division of Infectious Diseases, Department of Medicine, McMaster University, Juravinski Hospital and Cancer Center,
Hamilton, Ontario, Canada
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26
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Wu Y, Zhou H, Wang J, Li L, Li W, Cui Z, Chen X, Cen R, Lu J, Cheng Y. Analysis of the clonality of Candida tropicalis strains from a general hospital in Beijing using multilocus sequence typing. PLoS One 2012; 7:e47767. [PMID: 23152759 PMCID: PMC3494695 DOI: 10.1371/journal.pone.0047767] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2012] [Accepted: 09/19/2012] [Indexed: 11/29/2022] Open
Abstract
Multilocus sequence typing (MLST) based on six loci was used to analyze the relationship of 58 Candida tropicalis isolates from individual patients in a general hospital in Beijing, China. A total of 52 diploid sequence types (DSTs) were generated by the MLST, all of which were new to the central database. Unweighted Pair Group Method with Arithmetic Mean (UPGMA) dendrograms were constructed, which showed that the 58 isolates were distributed robustly and 6 main groups were clustered regardless of the specimen source and medical department. The minimum spanning tree (MST) of the 58 isolates (52 DSTs) and all 401 isolates (268 DSTs) in the C. tropicalis central database (http://pubmlst.org/ctropicalis/) indicated that the isolates in this study clustered in three relative pure clonal complexes, and 2 clustered with isolates from Taiwan, Belgium, Brazil, and the US. This study presents the first MLST analysis of C. tropicalis isolates from Mainland China, which may be useful for further studies on the similarity, genetic relationship, and molecular epidemiology of C. tropicalis strains worldwide.
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Affiliation(s)
- Yuan Wu
- State Key Laboratory for Infectious Disease Prevention and Control, National Institute for Communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, People's Republic of China
| | - Haijian Zhou
- State Key Laboratory for Infectious Disease Prevention and Control, National Institute for Communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, People's Republic of China
| | - Jing Wang
- China-Japan Friendship Hospital, Beijing, People's Republic of China
| | - Lianqing Li
- Shanxi Center for Clinical Laboratories, TaiYuan, Shanxi, People's Republic of China
| | - Wenge Li
- State Key Laboratory for Infectious Disease Prevention and Control, National Institute for Communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, People's Republic of China
| | - Zhigang Cui
- State Key Laboratory for Infectious Disease Prevention and Control, National Institute for Communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, People's Republic of China
| | - Xia Chen
- Department of Critical Care Medicine, Fu Xing Hospital, Capital Medical University, Beijing, People's Republic of China
| | - Ruiqi Cen
- State Key Laboratory for Infectious Disease Prevention and Control, National Institute for Communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, People's Republic of China
| | - Jinxing Lu
- State Key Laboratory for Infectious Disease Prevention and Control, National Institute for Communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, People's Republic of China
- * E-mail: (JL); (YC)
| | - Ying Cheng
- State Key Laboratory for Infectious Disease Prevention and Control, National Institute for Communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, People's Republic of China
- * E-mail: (JL); (YC)
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Cuéllar-Cruz M, López-Romero E, Villagómez-Castro JC, Ruiz-Baca E. Candida species: new insights into biofilm formation. Future Microbiol 2012; 7:755-71. [PMID: 22702528 DOI: 10.2217/fmb.12.48] [Citation(s) in RCA: 58] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Biofilms of Candida albicans, Candida parapsilosis, Candida glabrata and Candida tropicalis are associated with high indices of hospital morbidity and mortality. Major factors involved in the formation and growth of Candida biofilms are the chemical composition of the medical implant and the cell wall adhesins responsible for mediating Candida-Candida, Candida-human host cell and Candida-medical device adhesion. Strategies for elucidating the mechanisms that regulate the formation of Candida biofilms combine tools from biology, chemistry, nanoscience, material science and physics. This review proposes the use of new technologies, such as synchrotron radiation, to study the mechanisms of biofilm formation. In the future, this information is expected to facilitate the design of new materials and antifungal compounds that can eradicate nosocomial Candida infections due to biofilm formation on medical implants. This will reduce dissemination of candidiasis and hopefully improve the quality of life of patients.
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Affiliation(s)
- Mayra Cuéllar-Cruz
- Unidad de Biotecnología Médica & Farmacéutica, Centro de Investigación & Asistencia en Tecnología & Diseño del Estado de Jalisco, AC, Guadalajara, Jalisco, México.
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Serefhanoglu K, Timurkaynak F, Can F, Cagir U, Arslan H, Ozdemir FN. Risk factors for candidemia with non-albicans Candida spp. in intensive care unit patients with end-stage renal disease on chronic hemodialysis. J Formos Med Assoc 2012; 111:325-32. [DOI: 10.1016/j.jfma.2011.03.004] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2010] [Revised: 03/16/2011] [Accepted: 03/22/2011] [Indexed: 11/24/2022] Open
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Minimal inhibitory concentration (MIC) of caspofungin and itraconazole inhibiting growth of Candida strains calculated from the linear regression equation. Adv Med Sci 2012; 57:148-51. [PMID: 22543256 DOI: 10.2478/v10039-012-0022-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
PURPOSE The aim of the study was to compare the susceptibility of Candida species to caspofungin and itraconazole. MATERIAL AND METHODS 118 strains of Candida species were used in the study: 8 pattern strains and 110 strains isolated from different ontocenoses. The susceptibility of fungi strains to drugs was determined by diffusion in agar gel. The minimal inhibitory concentration (MIC) was calculated from the linear regression equation with the use of the method by Kadłubowski. RESULTS The MIC value for caspofungin for the pattern strains ranged from 0.321 mg/L to 0.552 mg/L and for itraconazole from 0.019 mg/L to 0.11 mg/L. All the analyzed strains isolated from patients exhibited susceptibility to caspofungin; 5 strains of Candida albicans (8.06%) proved to be resistant to itraconazole. The MIC values for caspofungin ranged from 0.114 mg/L to 1.26 mg/L and for itraconazole from 0.012 mg/L to 16.1 mg/L. CONCLUSIONS 1. All the studied pattern strains are susceptible to the examined drugs; all those isolated from patients show susceptibility to caspofungin; some Candida albicans strains (8.06%) are resistant to itraconazole. 2. The mean MIC values calculated from the activity curves are 0.426 mg/L for caspofungin and 1.0245 mg/L for itraconazole. 3. The mean MIC values calculated for caspofungin are lower than for itraconazole in the case of Candida albicans, C. glabrata and C. tropicalis. Having compared the influence of the drugs on C. famata, C. lusitaniae, C. parapsilosis and C. ciferri we proved there are statistically significant differences (0.0046>p<0.044).
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Dóczi I, Pető Z, Fodor E, Bereczki L, Nagy E, Hajdú E. Evaluation of fungaemia infections in a Hungarian university hospital between 1996 and 2009. Acta Microbiol Immunol Hung 2012; 59:29-41. [PMID: 22510285 DOI: 10.1556/amicr.59.2012.1.4] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
The incidence of Candida species causing bloodstream infections in the University Hospital of Szeged, Hungary, between 1996 and 2009, and the susceptibilities of these isolates to antifungal agents were evaluated.Automated blood culture systems (Vital, bioMérieux, Marcy-l'Etoile, France; and BACTEC 9120, Becton-Dickinson Diagnostic Systems, Sparks, USA) were used. The in vitro susceptibilities of the yeast isolates to antifungal agents were determined by the Etest method (AB Biodisk, Solna, Sweden).Bloodstream infections were caused by yeast strains in 231 cases during this period, and 226 Candida strains were cultured from 216 candidaemia patients. Bloodstream infections caused by multiple Candida spp. were diagnosed almost every year. Of the 216 patients, 67 were children; and 55 infants needed intensive care. In 2005, C. glabrata caused an increase in the incidence of invasive fungal infections in the Neonatal Intensive Care Unit. The PFGE analysis of 12 isolates distinguished 4 different karyotypes. The incidence of bloodstream infections caused by fungi did not change during the 14-year study period. The most frequent species cultured from blood samples were C. albicans and C. glabrata. The incidence of resistant isolates remained constant. The local trends of fungaemia must be monitored and compared with global reports.
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Affiliation(s)
- Ilona Dóczi
- 1 University of Szeged Institute of Clinical Microbiology Szeged Hungary
| | - Zoltán Pető
- 2 University of Szeged Institute of Anaesthesiology and Intensive Care Szeged Hungary
| | - Eleonóra Fodor
- 1 University of Szeged Institute of Clinical Microbiology Szeged Hungary
| | - László Bereczki
- 1 University of Szeged Institute of Clinical Microbiology Szeged Hungary
| | - Elisabeth Nagy
- 1 University of Szeged Institute of Clinical Microbiology Szeged Hungary
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Negri M, Silva S, Henriques M, Oliveira R. Insights into Candida tropicalis nosocomial infections and virulence factors. Eur J Clin Microbiol Infect Dis 2011; 31:1399-412. [PMID: 22037823 DOI: 10.1007/s10096-011-1455-z] [Citation(s) in RCA: 80] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2011] [Accepted: 10/08/2011] [Indexed: 12/31/2022]
Abstract
Candida tropicalis is considered the first or the second non-Candida albicans Candida (NCAC) species most frequently isolated from candidosis, mainly in patients admitted in intensive care units (ICUs), especially with cancer, requiring prolonged catheterization, or receiving broad-spectrum antibiotics. The proportion of candiduria and candidemia caused by C. tropicalis varies widely with geographical area and patient group. Actually, in certain countries, C. tropicalis is more prevalent, even compared with C. albicans or other NCAC species. Although prophylactic treatments with fluconazole cause a decrease in the frequency of candidosis caused by C. tropicalis, it is increasingly showing a moderate level of fluconazole resistance. The propensity of C. tropicalis for dissemination and the high mortality associated with its infections might be strongly related to the potential of virulence factors exhibited by this species, such as adhesion to different host surfaces, biofilm formation, infection and dissemination, and enzymes secretion. Therefore, the aim of this review is to outline the present knowledge on all the above-mentioned C. tropicalis virulence traits.
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Affiliation(s)
- M Negri
- Institute for Biotechnology and Bioengineering (IBB), Centre of Biological Engineering, Universidade do Minho, Campus de Gualtar, 4710-057, Braga, Portugal
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Pannanusorn S, Elings MA, Römling U, Fernandez V. Pyrosequencing of a hypervariable region in the internal transcribed spacer 2 to identify clinical yeast isolates. Mycoses 2011; 55:172-80. [PMID: 21736632 DOI: 10.1111/j.1439-0507.2011.02064.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
The incidence of invasive fungal infection has increased significantly. A majority of the infections is caused by yeast. Clinically important yeast show species-specific differences in susceptibility to antifungal agents therefore rapid and accurate identification of the pathogen is essential. We aimed to validate pyrosequencing of 40 nucleotides in the internal transcribed spacer 2 (ITS2) for species identification of yeast. Amplification of ITS2 and pyrosequencing of targeted region were performed in 940 clinical isolates of yeast. A local database containing the 40 nucleotide ITS2 sequences of 33 species of medically important yeast was generated using published sequences of type strains. The sequencing results were searched against the local database using the BLAST algorithm to identify the species of yeast. The length of sequences obtained from pyrosequencing averaged between 40-61 nucleotides. Pyrosequencing identified 940 clinical isolates of yeast down to 14 species level, whereby 931 isolates belonged to genus Candida (11 species), four of Saccharomyces cerevisiae, three of Malassezia pachydermatis and two of Rhodotorula mucilaginosa. In addition, intraspecies specific sequence variations in Candida albicans and Candida glabrata were detected. Pyrosequencing of 40 nucleotides in ITS2 is reliable for species identification of yeast. This methodology can contribute to the high quality management of patients with fungal infections.
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Affiliation(s)
- Srisuda Pannanusorn
- Department of Parasitology, Mycology and Environmental Microbiology, Swedish Institute for Infectious Disease Control, Solna, Sweden.
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Morace G, Borghi E, Iatta R, Amato G, Andreoni S, Brigante G, Farina C, Lo Cascio G, Lombardi G, Manso E, Mussap M, Pecile P, Rigoli R, Tangorra E, Valmarin M, Montagna MT. Antifungal susceptibility of invasive yeast isolates in Italy: the GISIA3 study in critically ill patients. BMC Infect Dis 2011; 11:130. [PMID: 21586108 PMCID: PMC3111364 DOI: 10.1186/1471-2334-11-130] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2011] [Accepted: 05/17/2011] [Indexed: 01/01/2023] Open
Abstract
Background Yeasts are a common cause of invasive fungal infections in critically ill patients. Antifungal susceptibility testing results of clinically significant fungal strains are of interest to physicians, enabling them to adopt appropriate strategies for empiric and prophylactic therapies. We investigated the antifungal susceptibility of yeasts isolated over a 2-year period from hospitalised patients with invasive yeast infections. Methods 638 yeasts were isolated from the blood, central venous catheters and sterile fluids of 578 patients on general and surgical intensive care units and surgical wards. Etest strips and Sensititre panels were used to test the susceptibility of the isolates to amphotericin B, anidulafungin, caspofungin, fluconazole, itraconazole, posaconazole and voriconazole in 13 laboratories centres (LC) and two co-ordinating centres (CC). The Clinical and Laboratory Standards Institute (CLSI) reference broth microdilution method was used at the CCs for comparison. Results Etest and Sensititre (LC/CC) MIC90 values were, respectively: amphotericin B 0.5/0.38, 1/1 mg/L; anidulafungin 2/1.5 and 1/1 mg/L; caspofungin 1/0.75 and 0.5/0.5 mg/L; fluconazole 12/8 and 16/16 mg/L; itraconazole 1/1.5, 0.5/0.5 mg/L; posaconazole 0.5 mg/L and voriconazole 0.25 mg/L for all. The overall MIC90 values were influenced by the reduced susceptibility of Candida parapsilosis isolates to echinocandins and a reduced or lack of susceptibility of Candida glabrata and Candida krusei to azoles, in particular fluconazole and itraconazole. Comparison of the LC and CC results showed good Essential Agreement (90.3% for Etest and 92.9% for Sensititre), and even higher Categorical Agreement (93.9% for Etest and 96% for Sensititre); differences were observed according to the species, method, and antifungal drug. No cross-resistance between echinocandins and triazoles was detected. Conclusions Our data confirm the different antifungal susceptibility patterns among species, and highlight the need to perform antifungal susceptibility testing of clinically relevant yeasts. With the exception of a few species (e.g. C. glabrata for azoles and C. parapsilosis for echinocandins), the findings of our study suggest that two of the most widely used commercial methods (Etest and Sensititre) provide valid and reproducible results.
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Affiliation(s)
- Giulia Morace
- Department of Public Health-Microbiology-Virology, Università degli Studi di Milano, and Laboratory of Microbiology and Virology, Ospedale San Carlo Borromeo, Milan, Italy.
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Muñoz P, Giannella M, Fanciulli C, Guinea J, Valerio M, Rojas L, Rodríguez-Créixems M, Bouza E. Candida tropicalis fungaemia: incidence, risk factors and mortality in a general hospital. Clin Microbiol Infect 2010; 17:1538-45. [PMID: 20718804 DOI: 10.1111/j.1469-0691.2010.03338.x] [Citation(s) in RCA: 55] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
The risk factors and clinical features of patients with Candida tropicalis fungaemia have not been fully defined. We performed a case-control study comparing 59 cases of C. tropicalis fungaemia with 177 episodes of fungaemia caused by other species of Candida in our hospital over a 24-year period (January 1985 to December 2008). Patients with C. tropicalis fungaemia were more likely to be older (median age, 67 vs. 56 years; p 0.01), to have cancer (45.5% vs. 31.6%, p 0.04), and to have the abdomen as the portal of entry (32.2% vs. 11.9%, p 0.001), and had a higher in-hospital mortality rate (61% vs. 44%, p 0.03). Multivariate analysis showed that the independent risk factors for C. tropicalis fungaemia were cancer (OR 4.5; 95% CI 1.05-3.83; p 0.03) and the abdomen as the portal of entry (OR 13.6; 95% CI 1.9-8.2; p <0.001). When survivors were compared with non-survivors, the risk factors associated with a poor outcome were neutropenia (19.4% vs. 0; p 0.03), corticosteroid treatment (36% vs. 13%; p 0.07), and septic shock (50% vs. 17.4%; p 0.01). The independent risk factors for mortality in the multivariate analysis were corticosteroid treatment (OR 8.2; 95% CI 0.9-27.7; p 0.04) and septic shock (OR 14.6; 95% CI 2.4-90.2; p 0.004), whereas urinary tract infection (OR 0.07; 95% CI 0.01-0.8; p 0.03) and catheter removal (OR 0.06; 95% CI 0.01-0.4; p 0.002) were protective factors. C. tropicalis is the fourth most common cause of fungaemia in our hospital. It is associated with underlying malignancy, the abdomen as the portal of entry, and poor outcome.
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Affiliation(s)
- P Muñoz
- Clinical Microbiology and Infectious Diseases Department, Hospital General Universitario Gregorio Marañón, Universidad Complutense, Madrid, Spain
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Falagas ME, Roussos N, Vardakas KZ. Relative frequency of albicans and the various non-albicans Candida spp among candidemia isolates from inpatients in various parts of the world: a systematic review. Int J Infect Dis 2010; 14:e954-66. [PMID: 20797887 DOI: 10.1016/j.ijid.2010.04.006] [Citation(s) in RCA: 201] [Impact Index Per Article: 14.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2010] [Revised: 03/29/2010] [Accepted: 04/09/2010] [Indexed: 01/23/2023] Open
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Chen LM, Xu YH, Zhou CL, Zhao J, Li CY, Wang R. Overexpression of CDR1 and CDR2 genes plays an important role in fluconazole resistance in Candida albicans with G487T and T916C mutations. J Int Med Res 2010; 38:536-45. [PMID: 20515567 DOI: 10.1177/147323001003800216] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
This study was designed to investigate potential resistance mechanisms by studying the expression of resistant genes in 14 fluconazole-resistant Candida albicans isolates, with G487T and T916C mutations in the 14alpha-demethylase (ERG11) gene, collected from human immunodeficiency virus uninfected patients and a fluconazole-susceptible control strain. The in vitro susceptibilities of the C. albicans isolates to fluconazole were determined using the broth microdilution method and a disc diffusion assay. Expression of Candida drug resistance (CDR)1, CDR2, ERG11, fluconazole resistance (FLU)1 and multidrug resistance (MDR)1 genes was measured using real-time reverse transcription-polymerase chain reaction and evaluated relative to the expression of the control gene 18SrRNA. The CDR1 and CDR2 genes were upregulated in all the fluconazole-resistant C. albicans isolates, whereas only a few isolates showed high expression of MDR1, FLU1 and ERG11 genes compared with the control strain. In conclusion, overexpression of the CDR1 and CDR2 genes may play an important role in fluconazole-resistant C. albicans with G487T and T916C mutations.
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Affiliation(s)
- L M Chen
- Department of Dermatology, Qilu Hospital of Shandong University, Jinan, China
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Li Y, Theuretzbacher U, Clancy CJ, Nguyen MH, Derendorf H. Pharmacokinetic/Pharmacodynamic Profile of Posaconazole. Clin Pharmacokinet 2010; 49:379-96. [DOI: 10.2165/11319340-000000000-00000] [Citation(s) in RCA: 107] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
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Spectrum and prevalence of fungi infecting deep tissues of lower-limb wounds in patients with type 2 diabetes. J Clin Microbiol 2010; 48:2097-102. [PMID: 20410345 DOI: 10.1128/jcm.02035-09] [Citation(s) in RCA: 64] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
The prevalence rate and spectrum of fungi infecting deep tissues of diabetic lower-limb wounds (DLWs) have not been previously studied. Five hundred eighteen (382 male and 136 female) consecutive patients with type 2 diabetes hospitalized due to infected lower-limb wounds were enlisted in this study. Deep tissue (approximately 0.5- x 0.5-cm size) taken perioperatively from the wound bed was cultured for fungi. Fungi was found in 27.2% (141/518) of the study population. Candida parapsilosis (25.5%), Candida tropicalis (22.7%), Trichosporon asahii (12.8%), Candida albicans (10.6%), and Aspergillus species (5.0%) were the most predominant fungal isolates. Of the fungal isolates, 17.7% were resistant to itraconazole, 6.9% were resistant to amphotericin B, 6.9% were resistant to voriconazole, 3.9% were resistant to fluconazole, and 1.5% were resistant to flucytosine. Of the population, 79.7% (413/518) had bacterial infection in deep tissue. The predominant isolates were Enterococcus faecalis (14.1%), Staphylococcus aureus (12.2%), and Pseudomonas aeruginosa (10.8%). Mixed fungal and bacterial infections were seen in 21.4% of patients, while 5.8% had only fungal infection and 58.3% had only bacterial infections. Another 14.5% had neither bacteria nor fungi in the deep tissue. Patients with higher glycosylated hemoglobin levels had significantly more fungal infections. Our study reveals that deep-seated fungal infections are high in DLWs. In the context of delayed wound healing and amputation rates due to DLWs, it is important to study the pathogenicity of fungi in deep tissues of DLWs and their possible contribution to delayed wound healing. The role of antifungal agents in wound management needs to be evaluated further.
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Sabino R, Veríssimo C, Brandão J, Alves C, Parada H, Rosado L, Paixão E, Videira Z, Tendeiro T, Sampaio P, Pais C. Epidemiology of candidemia in oncology patients: a 6-year survey in a Portuguese central hospital. Med Mycol 2010. [DOI: 10.3109/13693780903161216] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
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40
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Dizbay M, Fidan I, Kalkanci A, Sari N, Yalcin B, Kustimur S, Arman D. High incidence of Candida parapsilosis candidaemia in non-neutropenic critically ill patients: Epidemiology and antifungal susceptibility. ACTA ACUST UNITED AC 2009; 42:114-20. [DOI: 10.3109/00365540903321572] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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41
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Nosocomial candidemia at a general hospital: The change of epidemiological and clinical characteristics. A comparative study of 2 cohorts (1993–1998 versus 2002–2005). Rev Iberoam Micol 2009; 26:184-8. [DOI: 10.1016/j.riam.2009.02.003] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2008] [Accepted: 02/10/2009] [Indexed: 11/23/2022] Open
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42
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Samonis G, Kofteridis DP, Saloustros E, Giannopoulou KP, Ntziora F, Christidou A, Maraki S, Falagas ME. Candida albicans versus non-albicans bloodstream infection in patients in a tertiary hospital: An analysis of microbiological data. ACTA ACUST UNITED AC 2009; 40:414-9. [DOI: 10.1080/00365540701765657] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
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43
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Holley A, Dulhunty J, Blot S, Lipman J, Lobo S, Dancer C, Rello J, Dimopoulos G. Temporal trends, risk factors and outcomes in albicans and non-albicans candidaemia: an international epidemiological study in four multidisciplinary intensive care units. Int J Antimicrob Agents 2009; 33:554.e1-7. [DOI: 10.1016/j.ijantimicag.2008.10.035] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2008] [Accepted: 10/30/2008] [Indexed: 12/16/2022]
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44
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Auberger J, Lass-Flörl C, Ulmer H, Nogler-Semenitz E, Clausen J, Gunsilius E, Einsele H, Gastl G, Nachbaur D. Significant alterations in the epidemiology and treatment outcome of invasive fungal infections in patients with hematological malignancies. Int J Hematol 2008; 88:508-515. [PMID: 18982251 DOI: 10.1007/s12185-008-0184-2] [Citation(s) in RCA: 74] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2008] [Accepted: 09/10/2008] [Indexed: 12/15/2022]
Abstract
Invasive fungal infections (IFI) remain a leading cause of morbidity and mortality in immunocompromised patients. This retrospective single-center study analyzed incidence, treatment and outcome of invasive fungal infections in 1,095 patients with hematological malignancies receiving either cytoreductive chemotherapy or autologous or allogeneic hematopoietic stem cell transplantation at our institution between 1995 and 2004. IFI occurred in 167/1,095 (15%) patients with a significant increase over time (12.7% between 1995 and 2000 vs. 18.1% in the later IFI cohort, P = 0.0134). Fifty-four (32%) patients had proven, 70 (42%) patients had probable, and 43 (26%) patients suffered from possible IFI according to EORTC/MSG criteria. In 108/124 (87%) cases with proven or probable IFI, moulds were the causative pathogens. Both, Aspergillus fumigatus (n = 46) and Aspergillus terreus (n = 41) were predominant. Yeast infections (Candida spp.) were documented in 16/124 (10%) cases with proven or probable IFI. Median overall survival of the entire IFI cohort was 7 (3-17) months. Overall survival was significantly better in patients with probable or possible IFI (37 and 38%, respectively) compared with patients with proven IFI (28%, P = 0.019). In 35% of patients, IFI was the principal cause of death with a significant decrease over time (44% in time cohort 1995-2000 vs. 28% in the later IFI cohort, P = 0.018) accompanied by an increased use of novel antifungals. By multivariate analysis, only proven IFI was significantly predictive for death (HR 1.7, P = 0.018). A significant decrease in fungus-related deaths was observed despite a significant increase of IFI over time, probably due to improved diagnostic and therapeutic approaches.
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Affiliation(s)
- Jutta Auberger
- Department of Internal Medicine, Division of Hematology and Oncology, Innsbruck Medical University, Anichstrasse 35, 6020, Innsbruck, Austria.
| | - Cornelia Lass-Flörl
- Section Hygiene, Institute for Hygiene and Social Medicine, Innsbruck Medical University, Innsbruck, Austria
| | - Hanno Ulmer
- Department of Medical Statistics, Informatics and Health Economics, Innsbruck Medical University, Innsbruck, Austria
| | - Elisabeth Nogler-Semenitz
- Hospital Pharmacy of Innsbruck University Hospital, Innsbruck Medical University, Innsbruck, Austria
| | - Johannes Clausen
- Department of Internal Medicine, Division of Hematology and Oncology, Innsbruck Medical University, Anichstrasse 35, 6020, Innsbruck, Austria
| | - Eberhard Gunsilius
- Department of Internal Medicine, Division of Hematology and Oncology, Innsbruck Medical University, Anichstrasse 35, 6020, Innsbruck, Austria
| | - Hermann Einsele
- Department of Internal Medicine II, University of Würzburg, Würzburg, Germany
| | - Günther Gastl
- Department of Internal Medicine, Division of Hematology and Oncology, Innsbruck Medical University, Anichstrasse 35, 6020, Innsbruck, Austria
| | - David Nachbaur
- Department of Internal Medicine, Division of Hematology and Oncology, Innsbruck Medical University, Anichstrasse 35, 6020, Innsbruck, Austria
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Auberger J, Lass-Flörl C, Clausen J, Bellmann R, Buzina W, Gastl G, Nachbaur D. First case of breakthrough pulmonary Aspergillus niveus infection in a patient after allogeneic hematopoietic stem cell transplantation. Diagn Microbiol Infect Dis 2008; 62:336-9. [DOI: 10.1016/j.diagmicrobio.2008.06.012] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2008] [Revised: 06/12/2008] [Accepted: 06/17/2008] [Indexed: 10/21/2022]
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46
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Antifungal therapy strategies in hematopoietic stem-cell transplant recipients: early treatment options for improving outcomes. Transplantation 2008; 86:183-91. [PMID: 18645475 DOI: 10.1097/tp.0b013e318177de64] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Changes in clinical practice permit more patients to undergo hematopoietic stem-cell transplantation but also have increased the risk for invasive fungal infection (IFI) in this population. Given the difficulties in the diagnosis of fungal infection and the correlation between delays in therapy and poor outcome, earlier treatment, and prophylactic strategies are attractive options for the management of IFIs in high-risk patients. The selection of the most effective antifungal treatment strategy requires a thorough knowledge of IFI risk factors, potential causative organisms, and the safety and efficacy of appropriate antifungal agents.
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47
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The emergence of non-albicans Candida species as causes of invasive candidiasis and candidemia. CURRENT FUNGAL INFECTION REPORTS 2008. [DOI: 10.1007/s12281-007-0007-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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48
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Espada R, Valdespina S, Molero G, Dea MA, Ballesteros MP, Torrado JJ. Efficacy of alternative dosing regimens of poly-aggregated amphotericin B. Int J Antimicrob Agents 2008; 32:55-61. [PMID: 18534826 DOI: 10.1016/j.ijantimicag.2008.02.025] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2007] [Revised: 02/28/2008] [Accepted: 02/28/2008] [Indexed: 11/16/2022]
Abstract
A new poly-aggregated form of amphotericin B was formulated as a non-microencapsulated form (P-AMB) or incorporated in albumin microspheres (MP-AMB) and compared with the conventional amphotericin B formulation (D-AMB). Mice were infected with Candida albicans and treated with two different intermittent dose regimens of the different amphotericin B formulations. Efficacy and toxicity were studied by the determination of survival rate, kidney colony-forming units counts, biochemical parameters and amphotericin B concentrations in plasma and organs. All the treatments significantly (P<0.05) increased the survival rate in relation to the untreated group, although non-statistically significant differences (P>0.05) were found between formulations and dosing regimens. All the treatments produced kidney toxicity, expressed by high urea levels. Kidney toxicity was especially significant for mice treated with the D-AMB formulation where unilateral kidney atrophy was observed in most of the mice, whereas most of the mice treated with P-AMB conserved both kidneys with a normal size and appearance. At 45 days post infection, variable distribution of amphotericin B in the body was obtained depending on the amphotericin B formulation. In conclusion, non-daily dosing regimens of P-AMB, which is less toxic than D-AMB, could be used as an alternative to the conventional D-AMB formulation to treat experimental candidiasis.
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Affiliation(s)
- Raquel Espada
- Department of Pharmacy and Pharmaceutical Technology, Faculty of Pharmacy, Complutense University, Plaza Ramón y Cajal s/n, Madrid, Spain
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Risk factors of oral candidosis: A twofold approach of study by fuzzy logic and traditional statistic. Arch Oral Biol 2008; 53:388-97. [DOI: 10.1016/j.archoralbio.2007.11.009] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2007] [Revised: 10/01/2007] [Accepted: 11/15/2007] [Indexed: 11/16/2022]
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50
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Hof H. Is there a serious risk of resistance development to azoles among fungi due to the widespread use and long-term application of azole antifungals in medicine? Drug Resist Updat 2008; 11:25-31. [PMID: 18325827 DOI: 10.1016/j.drup.2008.01.001] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2008] [Revised: 01/24/2008] [Accepted: 01/27/2008] [Indexed: 11/27/2022]
Abstract
It is well known that development of antibiotic resistance in bacteria is not a matter of if but of when. Recently, azoles have been recommended for long-term prophylaxis of invasive fungal infections; hence, it could be argued that fungi also will become resistant to these agents. However, fungi are different from bacteria in several critical points. Bacteria display several resistance mechanisms: alteration of the target, limited access to the target and modification/inactivation of the antibacterial compound. In fungi some mechanisms of resistance to azoles are also known; with azoles for example, alterations of the 14alpha-demethylase target, as well as efflux pumps. It has been observed that these phenotypes develop in yeast populations either due to mutations or to selection processes. However, enzymes which destroy azoles are not found. Furthermore, a horizontal transfer of genes coding resistance traits does not occur in fungi, which means that an explosive expansion of resistances is unlikely to occur, especially in moulds. Indeed, in epidemiologic studies on human and environmental isolates there is convincing evidence that azole resistance is quite uncommon.
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Affiliation(s)
- Herbert Hof
- Institute of Medical Microbiology and Hygiene, University Clinic Mannheim, University of Heidelberg, D-68167 Mannheim, Germany.
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