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Prediction of Prognostic Risk Factors in Patients with Invasive Candidiasis and Cancer: A Single-Centre Retrospective Study. BIOMED RESEARCH INTERNATIONAL 2022; 2022:7896218. [PMID: 35692595 PMCID: PMC9185171 DOI: 10.1155/2022/7896218] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Revised: 05/09/2022] [Accepted: 05/16/2022] [Indexed: 11/18/2022]
Abstract
Background Invasive candidiasis is a common cancer-related complication with a high fatality rate. If patients with a high risk of dying in the hospital are identified early and accurately, physicians can make better clinical judgments. However, epidemiological analyses and mortality prediction models of cancer patients with invasive candidiasis remain limited. Method A set of 40 potential risk factors was acquired in a sample of 258 patients with both invasive candidiasis and cancer. To begin, risk factors for Candida albicans vs. non-Candida albicans infections and persistent vs. nonpersistent Candida infections were analysed using classic statistical methods. Then, we applied three machine learning models (random forest, logistic regression, and support vector machine) to identify prognostic indicators related to mortality. Prediction performance of different models was assessed by precision, recall, F1 score, accuracy, and AUC. Results Of the 258 patients both with invasive candidiasis and cancer included in the analysis. The median age of patients was 62 years, and 95 (36.82%) patients were older than 65 years, of which 178 (66.28%) were male. And 186 (72.1%) patients underwent surgery 2 weeks before data collection, 100 (39.1%) patients stayed in ICU during hospitalisation, 99 (38.4%) patients had bacterial blood infection, 85 (32.9%) patients had persistent invasive candidiasis, and 41 (15.9%) patients died within 30 days. The usage of drainage catheter and prolonged length of hospitalisation are the dominant risk factors for non-Candida albicans infections and persistent Candida infections, respectively. Risk factors, such as septic shock, history of surgery within the past 2 weeks, usage of drainage tubes, length of stay in ICU, total parenteral nutrition, serum creatinine level, fungal antigen, stay in ICU during hospitalisation, and total bilirubin level, were significant predictors of death. The RF model outperformed the LR and SVM models. Precision, recall, F1 score, accuracy, and AUC for RF were 64.29%, 75.63%, 69.23%, 89.61%, and 91.28%. Conclusions In this study, the machine learning-based models accurately predicted the prognosis of cancer and invasive candidiasis patients. The algorithm could be used to help clinicians in high-risk patients' early intervention.
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Chen T, Wagner AS, Reynolds TB. When Is It Appropriate to Take Off the Mask? Signaling Pathways That Regulate ß(1,3)-Glucan Exposure in Candida albicans. FRONTIERS IN FUNGAL BIOLOGY 2022; 3:842501. [PMID: 36908584 PMCID: PMC10003681 DOI: 10.3389/ffunb.2022.842501] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Accepted: 01/31/2022] [Indexed: 12/21/2022]
Abstract
Candida spp. are an important source of systemic and mucosal infections in immune compromised populations. However, drug resistance or toxicity has put limits on the efficacy of current antifungals. The C. albicans cell wall is considered a good therapeutic target due to its roles in viability and fungal pathogenicity. One potential method for improving antifungal strategies could be to enhance the detection of fungal cell wall antigens by host immune cells. ß(1,3)-glucan, which is an important component of fungal cell walls, is a highly immunogenic epitope. Consequently, multiple host pattern recognition receptors, such as dectin-1, complement receptor 3 (CR3), and the ephrin type A receptor A (EphA2) are capable of recognizing exposed (unmasked) ß(1,3)-glucan moieties on the cell surface to initiate an anti-fungal immune response. However, ß(1,3)-glucan is normally covered (masked) by a layer of glycosylated proteins on the outer surface of the cell wall, hiding it from immune detection. In order to better understand possible mechanisms of unmasking ß(1,3)-glucan, we must develop a deeper comprehension of the pathways driving this phenotype. In this review, we describe the medical importance of ß(1,3)-glucan exposure in anti-fungal immunity, and highlight environmental stimuli and stressors encountered within the host that are capable of inducing changes in the levels of surface exposed ß(1,3)-glucan. Furthermore, particular focus is placed on how signal transduction cascades regulate changes in ß(1,3)-glucan exposure, as understanding the role that these pathways have in mediating this phenotype will be critical for future therapeutic development.
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Affiliation(s)
- Tian Chen
- Department of Pathogenic Biology, School of Biomedical Sciences, Shandong University, Jinan, China
| | - Andrew S. Wagner
- Department of Microbiology, University of Tennessee, Knoxville, Knoxville, TN, United States
| | - Todd B. Reynolds
- Department of Microbiology, University of Tennessee, Knoxville, Knoxville, TN, United States
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Yoo J, Kim SH, Hur S, Ha J, Huh K, Cha WC. Candidemia Risk Prediction (CanDETEC) Model for Patients With Malignancy: Model Development and Validation in a Single-Center Retrospective Study. JMIR Med Inform 2021; 9:e24651. [PMID: 34309570 PMCID: PMC8367162 DOI: 10.2196/24651] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Revised: 11/09/2020] [Accepted: 06/17/2021] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Appropriate empirical treatment for candidemia is associated with reduced mortality; however, the timely diagnosis of candidemia in patients with sepsis remains poor. OBJECTIVE We aimed to use machine learning algorithms to develop and validate a candidemia prediction model for patients with cancer. METHODS We conducted a single-center retrospective study using the cancer registry of a tertiary academic hospital. Adult patients diagnosed with malignancies between January 2010 and December 2018 were included. Our study outcome was the prediction of candidemia events. A stratified undersampling method was used to extract control data for algorithm learning. Multiple models were developed-a combination of 4 variable groups and 5 algorithms (auto-machine learning, deep neural network, gradient boosting, logistic regression, and random forest). The model with the largest area under the receiver operating characteristic curve (AUROC) was selected as the Candida detection (CanDETEC) model after comparing its performance indexes with those of the Candida Score Model. RESULTS From a total of 273,380 blood cultures from 186,404 registered patients with cancer, we extracted 501 records of candidemia events and 2000 records as control data. Performance among the different models varied (AUROC 0.771- 0.889), with all models demonstrating superior performance to that of the Candida Score (AUROC 0.677). The random forest model performed the best (AUROC 0.889, 95% CI 0.888-0.889); therefore, it was selected as the CanDETEC model. CONCLUSIONS The CanDETEC model predicted candidemia in patients with cancer with high discriminative power. This algorithm could be used for the timely diagnosis and appropriate empirical treatment of candidemia.
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Affiliation(s)
- Junsang Yoo
- Department of Nursing, College of Nursing, Sahmyook University, Seoul, Republic of Korea
| | - Si-Ho Kim
- Division of Infectious Disease, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon, Republic of Korea
| | - Sujeong Hur
- Department of Patient Experience Management, Samsung Medical Center, Seoul, Republic of Korea.,Department of Digital Health, Samsung Advanced Institute for Health Sciences & Technology, Sungkyunkwan University, Seoul, Republic of Korea
| | - Juhyung Ha
- Department of Computer Science, Indiana University Bloomington, Bloomington, IN, United States
| | - Kyungmin Huh
- Division of Infectious Disease, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Won Chul Cha
- Department of Digital Health, Samsung Advanced Institute for Health Sciences & Technology, Sungkyunkwan University, Seoul, Republic of Korea.,Department of Emergency Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.,Digital Innovation Center, Samsung Medical Center, Seoul, Republic of Korea
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Park S, Jung J, Chong YP, Kim SH, Lee SO, Choi SH, Kim YS, Kim MJ. Infectious Causes of Eosinophilic Meningitis in Korean Patients: A Single-Institution Retrospective Chart Review from 2004 to 2018. THE KOREAN JOURNAL OF PARASITOLOGY 2021; 59:227-233. [PMID: 34218594 PMCID: PMC8255497 DOI: 10.3347/kjp.2021.59.3.227] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/26/2021] [Revised: 06/03/2021] [Accepted: 06/03/2021] [Indexed: 11/23/2022]
Abstract
Eosinophilic meningitis is defined as the presence of more than 10 eosinophils per μl in the cerebrospinal fluid (CSF), or eosinophils accounting for more than 10% of CSF leukocytes in patients with acute meningitis. Parasites are the most common cause of eosinophilic meningitis worldwide, but there is limited research on patients in Korea. Patients diagnosed with eosinophilic meningitis between January 2004 and June 2018 at a tertiary hospital in Seoul, Korea were retrospectively reviewed. The etiology and clinical characteristics of each patient were identified. Of the 22 patients included in the study, 11 (50%) had parasitic causes, of whom 8 (36%) were diagnosed as neurocysticercosis and 3 (14%) as Toxocara meningitis. Four (18%) patients were diagnosed with fungal meningitis, and underlying immunodeficiency was found in 2 of these patients. The etiology of another 4 (18%) patients was suspected to be tuberculosis, which is endemic in Korea. Viral and bacterial meningitis were relatively rare causes of eosinophilic meningitis, accounting for 2 (9%) and 1 (5%) patients, respectively. One patient with neurocysticercosis and 1 patient with fungal meningitis died, and 5 (23%) had neurologic sequelae. Parasite infections, especially neurocysticercosis and toxocariasis, were the most common cause of eosinophilic meningitis in Korean patients. Fungal meningitis, while relatively rare, is often aggressive and must be considered when searching for the cause of eosinophilic meningitis.
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Affiliation(s)
- Sunghee Park
- Division of Infectious Diseases, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul 05505,
Korea
| | - Jiwon Jung
- Division of Infectious Diseases, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul 05505,
Korea
| | - Yong Pil Chong
- Division of Infectious Diseases, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul 05505,
Korea
| | - Sung-Han Kim
- Division of Infectious Diseases, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul 05505,
Korea
| | - Sang-Oh Lee
- Division of Infectious Diseases, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul 05505,
Korea
| | - Sang-Ho Choi
- Division of Infectious Diseases, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul 05505,
Korea
| | - Yang Soo Kim
- Division of Infectious Diseases, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul 05505,
Korea
| | - Min Jae Kim
- Division of Infectious Diseases, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul 05505,
Korea
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Epidemiological Trends of Candidemia and the Impact of Adherence to the Candidemia Guideline: Six-Year Single-Center Experience. J Fungi (Basel) 2021; 7:jof7040275. [PMID: 33917626 PMCID: PMC8067511 DOI: 10.3390/jof7040275] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2021] [Revised: 03/27/2021] [Accepted: 04/03/2021] [Indexed: 12/25/2022] Open
Abstract
This study aimed to investigate the epidemiology of candidemia and evaluate the impact of adherence to the candidemia guideline defined by the European Confederation of Medical Mycology Quality of Clinical Candidemia Management (EQUAL) Candida score. Adult candidemia patients ≥ 19 years diagnosed at a tertiary care hospital in the Republic of Korea from 2013 to 2018 were enrolled (period 1 2013–2015, period 2 2016–2018). There was a total of 223 patients. The annual incidence of candidemia increased from 0.43 to 1.33 cases per 1000 admissions between 2013 and 2018, p < 0.001. A significant increase of fluconazole-resistant C. parapsilosis candidemia was noted in period 2 (35.3%) when compared to period 1 (0.0%), p = 0.020. The 30-day mortality rate was not different between period 1 and 2 (43.5% vs. 48.1%, p = 0.527). Multivariate analysis revealed that a Charlson comorbidity index score ≥ 4, neutropenia, duration of hospital stay ≥ 21 days before candidemia diagnosis, septic shock, mycological failure, and EQUAL Candida score < 15 were significantly associated with 30-day mortality. An increase in the incidence of candidemia and fluconazole resistance in the non-albicans Candida species over time was observed. Disease severity, comorbidities, and lower adherence to the candidemia guideline were associated with mortality.
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Keighley CL, Pope A, Marriott DJE, Chapman B, Bak N, Daveson K, Hajkowicz K, Halliday C, Kennedy K, Kidd S, Sorrell TC, Underwood N, van Hal S, Slavin MA, Chen SCA. Risk factors for candidaemia: A prospective multi-centre case-control study. Mycoses 2020; 64:257-263. [PMID: 33185290 DOI: 10.1111/myc.13211] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Revised: 11/04/2020] [Accepted: 11/07/2020] [Indexed: 01/22/2023]
Abstract
OBJECTIVES Candidaemia carries a mortality of up to 40% and may be related to increasing complexity of medical care. Here, we determined risk factors for the development of candidaemia. METHODS We conducted a prospective, multi-centre, case-control study over 12 months. Cases were aged ≥18 years with at least one blood culture positive for Candida spp. Each case was matched with two controls, by age within 10 years, admission within 6 months, admitting unit, and admission duration at least as long as the time between admission and onset of candidaemia. RESULTS A total of 118 incident cases and 236 matched controls were compared. By multivariate analysis, risk factors for candidaemia included neutropenia, solid organ transplant, significant liver, respiratory or cardiovascular disease, recent gastrointestinal, biliary or urological surgery, central venous access device, intravenous drug use, urinary catheter and carbapenem receipt. CONCLUSIONS Risk factors for candidaemia derive from the infection source, carbapenem use, host immune function and organ-based co-morbidities. Preventive strategies should target iatrogenic disruption of mucocutaneous barriers and intravenous drug use.
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Affiliation(s)
- Caitlin Livia Keighley
- Centre for Infectious Diseases and Microbiology Laboratory Services, ICPMR, New South Wales Health Pathology, Sydney, NSW, Australia.,Marie Bashir Institute for Infectious Diseases and Biosecurity, The University of Sydney, Sydney, NSW, Australia.,The Department of Infectious Diseases, Westmead Hospital, Sydney, NSW, Australia
| | - Alun Pope
- Eastern Health Clinical School, Monash University, Melbourne, VIC, Australia
| | - Deborah J E Marriott
- Department of Microbiology and Infectious Diseases, St. Vincent's Hospital, Sydney, NSW, Australia
| | - Belinda Chapman
- Westmead Institute for Medical Research, Westmead, NSW, Australia
| | - Narin Bak
- Department of Infectious Diseases, Royal Adelaide Hospital, Adelaide, SA, Australia
| | - Kathryn Daveson
- Department of Infectious Diseases and Microbiology, Canberra Hospital, Australian National University Medical School, Canberra, ACT, Australia
| | - Krispin Hajkowicz
- Department of Infectious Diseases, School of Medicine, Royal Brisbane and Women's Hospital, University of Queensland, Brisbane, QLD, Australia
| | - Catriona Halliday
- Centre for Infectious Diseases and Microbiology Laboratory Services, ICPMR, New South Wales Health Pathology, Sydney, NSW, Australia
| | - Karina Kennedy
- Department of Infectious Diseases and Microbiology, Canberra Hospital, Australian National University Medical School, Canberra, ACT, Australia
| | - Sarah Kidd
- National Mycology Reference Centre, SA Pathology, Adelaide, SA, Australia
| | - Tania C Sorrell
- Marie Bashir Institute for Infectious Diseases and Biosecurity, The University of Sydney, Sydney, NSW, Australia.,The Department of Infectious Diseases, Westmead Hospital, Sydney, NSW, Australia.,Westmead Institute for Medical Research, Westmead, NSW, Australia
| | - Neil Underwood
- Infection Management Services, Princess Alexandra Hospital, Brisbane, QLD, Australia
| | - Sebastiaan van Hal
- Department of Infectious Diseases and Microbiology, New South Wales Health Pathology, Royal Prince Alfred Hospital, Sydney, NSW, Australia
| | - Monica A Slavin
- Department of Infectious Diseases, Peter MacCallum Cancer Centre, National Centre for Infections in Cancer, Melbourne, VIC, Australia
| | - Sharon C-A Chen
- Centre for Infectious Diseases and Microbiology Laboratory Services, ICPMR, New South Wales Health Pathology, Sydney, NSW, Australia.,Marie Bashir Institute for Infectious Diseases and Biosecurity, The University of Sydney, Sydney, NSW, Australia.,The Department of Infectious Diseases, Westmead Hospital, Sydney, NSW, Australia.,Westmead Institute for Medical Research, Westmead, NSW, Australia
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van Engen A, Casamayor M, Kim S, Watt M, Odeyemi I. "De-escalation" strategy using micafungin for the treatment of systemic Candida infections: budget impact in France and Germany. CLINICOECONOMICS AND OUTCOMES RESEARCH 2017; 9:763-774. [PMID: 29255367 PMCID: PMC5722012 DOI: 10.2147/ceor.s141548] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background The incidence of azole-resistant Candida infections is increasing. Consequently, guidelines for treating systemic Candida infection (SCI) recommend a “de-escalation” strategy: initial broad-spectrum antifungal agents (e.g., echinocandins), followed by switching to fluconazole if isolates are fluconazole sensitive, rather than “escalation” with initial fluconazole treatment and then switching to echinocandins if isolates are fluconazole resistant. However, fluconazole may continue to be used as first-line treatment in view of its low acquisition costs. The aim of this study was, therefore, to evaluate the budget impact of the de-escalation strategy using micafungin compared with the escalation strategy in France and Germany. Methods A budget impact model was used to compare de-escalation to escalation strategies. As well as survival, clinical success (resolution/reduction of symptoms and radiographic abnormalities associated with fungal infection), was considered, as was mycological success (eradication of Candida from the bloodstream). Health economic outcomes included cost per health state according to clinical success and mycological success, and budget impact. A 42-day time horizon was used. Results For all patients with SCI, the budget impact of using de-escalation rather than escalation was greater, but improved rates of survival, clinical success and mycological success were apparent with de-escalation. In patients with fluconazole-resistant isolates, clinical success rates and survival were improved by ~72% with de-escalation versus escalation, producing cost savings of €6,374 and €356 per patient in France and Germany, respectively; improvements of ~72% in mycological success rates with de-escalation versus escalation did not translate into cost savings. Conclusion Modeling provides evidence that when treating SCI in individuals at risk of azole-resistant infections, de-escalation from micafungin has potential cost savings associated with improved clinical success rates.
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Li D, Xia R, Zhang Q, Bai C, Li Z, Zhang P. Evaluation of candidemia in epidemiology and risk factors among cancer patients in a cancer center of China: an 8-year case-control study. BMC Infect Dis 2017; 17:536. [PMID: 28768479 PMCID: PMC5541644 DOI: 10.1186/s12879-017-2636-x] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2017] [Accepted: 07/25/2017] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND Candidemia is the worldwide life-threaten disease, especially in cancer patients. This study was aimed to identify and evaluate the risk factors of candidemia in cancer patients, which will prompt the improvement on current therapeutic strategies and prognosis. METHODS A retrospective, case-control study was conducted from inpatients of Tianjin Medical University Cancer Institute and Hospital, during 2006 to 2013. Analyses were performed between cancer patients with candidemia as study case, and patients with bacterial bloodstream infections as control. Each case was matched up with two controls, for gender and inpatient duration. Candida species, clinical characteristics, risk factors and outcomes were reviewed in details. RESULTS Total number of 80 cases and 160 controls were enrolled and analyzed in this study. Candida albicans was identified as the most prevalent species and account for 55.0% candidemia, followed by Candida parapsilosis complex (21.3%), Candida tropicalis (8.8%), Candida glabrata complex (7.5%), Candida lusitaniae (3.8%), and Candida famata (3.8%). The crude mortality at 30-days of candidemia was up to 30.0%, which is significantly higher than bacterial bloodstream infections (p = 0.006). Logistical analysis demonstrated that total parenteral nutrition >5 days (p = 0.036), urinary catheter >2 days (p = 0.001), distant organ metastasis of cancer (p = 0.002) and gastrointestinal cancer (p = 0.042) were the independent risk factors for candidemia. CONCLUSIONS Candidemia showed significant higher mortality than bacterial bloodstream infections, C. albicans was cited as the primary pathogen. Total parenteral nutrition, urinary catheter, distant organ metastasis of cancer and gastrointestinal cancer are independent predictors for candidemia, this findings provides potential therapeutic targets for improving the outcome.
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Affiliation(s)
- Ding Li
- Department of Clinical Laboratory, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center of Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin, Huanhu West Road, Ti-Yuan-Bei, Hexi District, Tianjin, 300060, People's Republic of China.
| | - Rui Xia
- Intensive Care Unit, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center of Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin, Huanhu West Road, Ti-Yuan-Bei, Hexi District, Tianjin, 300060, People's Republic of China
| | - Qing Zhang
- Department of Clinical Laboratory, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center of Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin, Huanhu West Road, Ti-Yuan-Bei, Hexi District, Tianjin, 300060, People's Republic of China
| | - Changsen Bai
- Department of Clinical Laboratory, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center of Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin, Huanhu West Road, Ti-Yuan-Bei, Hexi District, Tianjin, 300060, People's Republic of China
| | - Zheng Li
- Department of Clinical Laboratory, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center of Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin, Huanhu West Road, Ti-Yuan-Bei, Hexi District, Tianjin, 300060, People's Republic of China
| | - Peng Zhang
- Department of Clinical Laboratory, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center of Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin, Huanhu West Road, Ti-Yuan-Bei, Hexi District, Tianjin, 300060, People's Republic of China
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Risk Adjustment for Congenital Heart Surgery Score as a Risk Factor for Candidemia in Children Undergoing Congenital Heart Defect Surgery. Pediatr Infect Dis J 2016; 35:1194-1198. [PMID: 27753765 DOI: 10.1097/inf.0000000000001277] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
BACKGROUND Candida species are the primary cause of invasive fungal infection in hospitalized children. There are few data on risk factors for postoperative candidemia in pediatric patients with congenital heart defects. This study aimed to identify risk factors for candidemia in patients with congenital heart defects who underwent cardiac surgery. METHODS This was a case-control study conducted in patients admitted to a pediatric cardiology intensive care unit from January 2006 to December 2013. Candidemia cases were matched with control patients without candidemia. Multivariate analyses were conducted to determine predictive probabilities for the incidence of candidemia at a risk higher than 10%. RESULTS Thirty patients diagnosed with candidemia (incidence: 0.7 cases/1000 patient days) were matched with 75 controls. Risk factors independently associated with candidemia included Risk Adjustment for Congenital Heart Surgery (RACHS-1) category ≥3 [odds ratio (OR) = 3.165, 95% confidence interval: 1.377-8.467], use of acid suppression therapy (OR = 1.9, 95% confidence interval: 0.949-3.979) and thrombocytopenia (OR = 2.2, 95% confidence interval: 1.2-4.2). Predictive probabilities ranged from 11% (only in RACHS-1 category ≥3) to 58% (combined RACHS-1 ≥3, thrombocytopenia and acid suppression therapy use). The case fatality rate within 30 days after candidemia was 50%. CONCLUSION This is the first report using the RACHS-1 category as a risk factor for invasive candidiasis in patients with congenital heart defects in the pediatric intensive care unit. Further studies must be conducted to validate the risk factors for candidemia in this pediatric population.
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Moro ML, Maffei C, Manso E, Morace G, Polonelli L, Biavasco F. Nosocomial Outbreak of Systemic Candidosis Associated With Parenteral Nutrition. Infect Control Hosp Epidemiol 2016. [DOI: 10.2307/30144253] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
AbstractEight patients in two surgical units developed systemic candidosis during a 40-day period from June 5 to July 13, 1987 (in five cases Candida albicans was identified). Three of them died. All cases belonged to a group of 27 patients receiving parenteral nutrition (PN), while among the 108 patients who did not receive PN, no cases were observed (p = .000001). Candida was cultured from two PN bags administered to the cases. A specialized nutrition nurse was responsible for the PN compounding and for maintaining administration sets in the two wards involved.An epidemiological investigation in which 19 uninfected patients who had had PN were used as controls, showed no significant difference between cases and controls except that lipids were more frequently added to bags administered to cases (p = .0005). Furthermore, the bags administered to cases contained a higher average number of multidose constituents (p = .0008) when the comparison was focused on the two days before the onset of symptoms.Given the favorable medium provided by lipids, even a low level contamination of PN solutions during compounding and/or administration could have been responsible for the outbreak. The finding of a more frequent exposure of cases to multidose vials suggests, although not conclusively, that an extrinsic contamination occurred during compounding. Six isolates of C albicans were available from four cases. C albicans was cultured from the pharyngeal swabs of two physicians and three nurses, including the specialized nutrition nurse. According to DNA restriction pattern analysis, a single strain was responsible for all the cases of systemic candidosis, with only the specialized nutrition nurse harboring the same strain. DNA fingerprinting provided a reliable system for typing C albicans strains. This was the first outbreak of C albicans systemic infection associated with PN.
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Jiang TT, Chaturvedi V, Ertelt JM, Xin L, Clark DR, Kinder JM, Way SS. Commensal enteric bacteria lipopolysaccharide impairs host defense against disseminated Candida albicans fungal infection. Mucosal Immunol 2015; 8:886-95. [PMID: 25492473 PMCID: PMC4465067 DOI: 10.1038/mi.2014.119] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2014] [Accepted: 10/30/2014] [Indexed: 02/04/2023]
Abstract
Commensal enteric bacteria maintain systemic immune responsiveness that protects against disseminated or localized infection in extra-intestinal tissues caused by pathogenic microbes. However, as shifts in infection susceptibility after commensal bacteria eradication have primarily been probed using viruses, the broader applicability to other pathogen types remains undefined. In sharp contrast to diminished antiviral immunity, we show commensal bacteria eradication bolsters protection against disseminated Candida albicans fungal infection. Enhanced antifungal immunity reflects more robust systemic expansion of Ly6G(hi)Ly6C(int) neutrophils, and their mobilization into infected tissues among antibiotic-treated compared with commensal bacteria-replete control mice. Reciprocally, depletion of neutrophils from expanded levels or intestinal lipopolysaccharide reconstitution overrides the antifungal protective benefits conferred by commensal bacteria eradication. This discordance in antifungal compared with antiviral immunity highlights intrinsic differences in how commensal bacteria control responsiveness for specific immune cell subsets, because pathogen-specific CD8(+) T cells that protect against viruses were suppressed similarly after C. albicans and influenza A virus infection. Thus, positive calibration of antiviral immunity by commensal bacteria is counterbalanced by restrained activation of other immune components that confer antifungal immunity.
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Affiliation(s)
- Tony T. Jiang
- Division of Infectious Diseases, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA,Medical Scientist Training Program, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Vandana Chaturvedi
- Division of Infectious Diseases, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - James M. Ertelt
- Division of Infectious Diseases, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Lijun Xin
- Division of Infectious Diseases, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Dayna R. Clark
- Division of Infectious Diseases, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Jeremy M. Kinder
- Division of Infectious Diseases, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Sing Sing Way
- Division of Infectious Diseases, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA,for correspondence, Dr. Sing Sing Way 3333 Burnet Avenue, MLC 7017 Cincinnati, OH 45229, USA Phone, 513-636-7603 Fax, 513-636-7655
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Candida colonization as a risk marker for invasive candidiasis in mixed medical-surgical intensive care units: development and evaluation of a simple, standard protocol. J Clin Microbiol 2015; 53:1324-30. [PMID: 25673797 DOI: 10.1128/jcm.03239-14] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Colonization with Candida species is an independent risk factor for invasive candidiasis (IC), but the minimum and most practicable parameters for prediction of IC have not been optimized. We evaluated Candida colonization in a prospective cohort of 6,015 nonneutropenic, critically ill patients. Throat, perineum, and urine were sampled 72 h post-intensive care unit (ICU) admission and twice weekly until discharge or death. Specimens were cultured onto chromogenic agar, and a subset underwent molecular characterization. Sixty-three (86%) patients who developed IC were colonized prior to infection; 61 (97%) tested positive within the first two time points. The median time from colonization to IC was 7 days (range, 0 to 35). Colonization at any site was predictive of IC, with the risk of infection highest for urine colonization (relative risk [RR]=2.25) but with the sensitivity highest (98%) for throat and/or perineum colonization. Colonization of ≥2 sites and heavy colonization of ≥1 site were significant independent risk factors for IC (RR=2.25 and RR=3.7, respectively), increasing specificity to 71% to 74% but decreasing sensitivity to 48% to 58%. Molecular testing would have prompted a resistance-driven decision to switch from fluconazole treatment in only 11% of patients infected with C. glabrata, based upon species-level identification alone. Positive predictive values (PPVs) were low (2% to 4%) and negative predictive values (NPVs) high (99% to 100%) regardless of which parameters were applied. In the Australian ICU setting, culture of throat and perineum within the first two time points after ICU admission captures 84% (61/73 patients) of subsequent IC cases. These optimized parameters, in combination with clinical risk factors, should strengthen development of a setting-specific risk-predictive model for IC.
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Hoffman AE, Miles L, Greenfield TJ, Shoen C, DeStefano M, Cynamon M, Doyle RP. Clinical isolates of Candida albicans, Candida tropicalis, and Candida krusei have different susceptibilities to Co(II) and Cu(II) complexes of 1,10-phenanthroline. Biometals 2015; 28:415-23. [PMID: 25663372 DOI: 10.1007/s10534-015-9825-0] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2014] [Accepted: 01/27/2015] [Indexed: 12/31/2022]
Abstract
The minimal inhibitory concentrations (MICs) of copper and cobalt based dimeric pyrophosphate complexes with capping 1,10-phenanthroline groups on clinical isolates of C. albicans (28 isolates), C. krusei (20 isolates) and C. tropicalis (20 isolates) are reported. C. albicans was inhibited by the cobalt complex better than by the copper complex, while C. krusei demonstrated the opposite results. C. tropicalis showed similar sensitivities to both metals in terms of calculated MIC50 values but was more sensitive to cobalt when MIC90 values were noted. Knockout strains of C. albicans that had the copper efflux protein P-type ATPase (CRP1), the copper binding metallothionein CUP1 or both CRP1/CUP1 removed clearly demonstrate that the origins of copper resistant in C. albicans lies primarily in the P-type ATPase, with the MT playing an important secondary role in the absence of the efflux protein. This study suggests that certain strains of Candida have evolved to protect against particular metal ions and that in the case of C. albicans, a primary invasive fungal species, cobalt may be a good starting-point for new therapeutic development.
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Affiliation(s)
- Amanda E Hoffman
- Department of Chemistry, Syracuse University, Syracuse, NY, 13244, USA
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Abstract
AbstractEndogenous infections such as candidiasis can be minimized by oral fluconazole prophylaxis, although oral or intravenous amphotericin, or itraconazole, are suitable for certain patients. Exogenous fungal infections most commonly are transmitted by the airborne route, but the benefits of high-efficiency particulate air-filtered room air probably are diminishing as broad-spectrum prophylaxis againstAspergillusspecies and other fungi improves. However, high-risk environmental sources such as construction work always must be avoided near neutropenic patients. Reactivation of quiescent pulmonaryAspergillusinfection can be prevented by surgical resection during remission, or by systemic amphotericin prophylaxis during subsequent neutropenic episodes.
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15
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The mycobiota: interactions between commensal fungi and the host immune system. Nat Rev Immunol 2014; 14:405-16. [PMID: 24854590 DOI: 10.1038/nri3684] [Citation(s) in RCA: 439] [Impact Index Per Article: 43.9] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
The body is host to a wide variety of microbial communities from which the immune system protects us and that are important for the normal development of the immune system and for the maintenance of healthy tissues and physiological processes. Investigators have mostly focused on the bacterial members of these communities, but fungi are increasingly being recognized to have a role in defining these communities and to interact with immune cells. In this Review, we discuss what is currently known about the makeup of fungal communities in the body and the features of the immune system that are particularly important for interacting with fungi at these sites.
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Masterton RG, Casamayor M, Musingarimi P, van Engen A, Zinck R, Odufowora-Sita O, Odeyemi IAO. De-escalation from micafungin is a cost-effective alternative to traditional escalation from fluconazole in the treatment of patients with systemic Candida infections. J Med Econ 2013; 16:1344-56. [PMID: 24003830 DOI: 10.3111/13696998.2013.839948] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Systemic Candida infections (SCI) occur predominantly in intensive care unit patients and are a common cause of morbidity and mortality. Recently, changes in Candida epidemiology with an increasing prevalence of SCI caused by Candida non-albicans species have been reported. Resistance to fluconazole and azoles in general is not uncommon for non-albicans species. Despite guidelines recommending initial treatment with broad-spectrum antifungals such as echinocandins with subsequent switch to fluconazole if isolates are sensitive (de-escalation strategy), fluconazole is still the preferred first-line antifungal (escalation) in many clinical practice settings. After diagnosis of the pathogen, the initial therapy with fluconazole is switched to a broad-spectrum antifungal if a non-albicans is identified. METHODS The cost-effectiveness of initial treatment with micafungin (de-escalation) vs fluconazole (escalation) in patients with SCI was estimated using decision analysis based on clinical and microbiological data from pertinent studies. The model horizon was 42 days, and was extrapolated to cover a lifetime horizon. All costs were analyzed from the UK NHS perspective. Several assumptions were taken to address uncertainties; the limitations of these assumptions are discussed in the article. RESULTS In patients with fluconazole-resistant isolates, initial treatment with micafungin avoids 30% more deaths and successfully treats 23% more patients than initial treatment with fluconazole, with cost savings of £1621 per treated patient. In the overall SCI population, de-escalation results in 1.2% fewer deaths at a marginal cost of £740 per patient. Over a lifetime horizon, the incremental cost-effectiveness of de-escalation vs escalation was £15,522 per life-year and £25,673 per QALY. CONCLUSIONS De-escalation from micafungin may improve clinical outcomes and overall survival, particularly among patients with fluconazole-resistant Candida strains. De-escalation from initial treatment with micafungin is a cost-effective alternative to escalation from a UK NHS perspective, with a differential cost per QALY below the 'willingness-to-pay' threshold of £30,000.
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Affiliation(s)
- Robert G Masterton
- Institute of Healthcare Associated Infection, University of the West of Scotland , Ayrshire , UK
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17
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Luzzati R, Cavinato S, Giangreco M, Granà G, Centonze S, Deiana ML, Biolo G, Barbone F. Peripheral and total parenteral nutrition as the strongest risk factors for nosocomial candidemia in elderly patients: a matched case-control study. Mycoses 2013; 56:664-71. [DOI: 10.1111/myc.12090] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2013] [Revised: 03/29/2013] [Accepted: 04/22/2013] [Indexed: 01/08/2023]
Affiliation(s)
- Roberto Luzzati
- Infectious Diseases Unit; University Hospital of Trieste; Trieste Italy
| | - Silvia Cavinato
- Infectious Diseases Unit; University Hospital of Trieste; Trieste Italy
| | - Manuela Giangreco
- Hygiene and Epidemiology; Department of Medical and Biological Sciences; University of Udine; Udine Italy
| | - Gianluca Granà
- Infectious Diseases Unit; University Hospital of Trieste; Trieste Italy
| | - Sandro Centonze
- Strategic Plans and Activity Control Unit; University Hospital of Trieste; Trieste Italy
| | - Maria L. Deiana
- Laboratory for Microbiology; University Hospital of Trieste; Trieste Italy
| | - Gianni Biolo
- Department of Medical Science; University Hospital of Trieste; Trieste Italy
| | - Fabio Barbone
- Hygiene and Epidemiology; Department of Medical and Biological Sciences; University of Udine; Udine Italy
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18
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Bouza E, Alcalá L, Muñoz P, Martín-Rabadán P, Guembe M, Rodríguez-Créixems M. Can microbiologists help to assess catheter involvement in candidaemic patients before removal? Clin Microbiol Infect 2013; 19:E129-35. [DOI: 10.1111/1469-0691.12096] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2012] [Revised: 08/31/2012] [Accepted: 10/30/2012] [Indexed: 01/11/2023]
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Agarwal R, Kalita J, Marak RSK, Misra UK. Spectrum of fungal infection in a neurology tertiary care center in India. Neurol Sci 2012; 33:1305-10. [DOI: 10.1007/s10072-012-0932-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2011] [Accepted: 01/03/2012] [Indexed: 10/14/2022]
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Zaoutis TE, Prasad PA, Localio AR, Coffin SE, Bell LM, Walsh TJ, Gross R. Risk factors and predictors for candidemia in pediatric intensive care unit patients: implications for prevention. Clin Infect Dis 2010; 51:e38-45. [PMID: 20636126 DOI: 10.1086/655698] [Citation(s) in RCA: 141] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
BACKGROUND Candida species are the leading cause of invasive fungal infections in hospitalized children and are the third most common isolates recovered from patients with healthcare-associated bloodstream infection in the United States. Few data exist on risk factors for candidemia in pediatric intensive care unit (PICU) patients. METHODS We conducted a population-based case-control study of PICU patients at Children's Hospital of Philadelphia during the period from 1997 through 2004. Case patients were identified using laboratory records, and control patients were selected from PICU rosters. Control patients were matched to case patients by incidence density sampling, adjusting for time at risk. Following conditional multivariate analysis, we performed weighted multivariate analysis to determine predicted probabilities for candidemia given certain risk factor combinations. RESULTS We identified 101 case patients with candidemia (incidence, 3.5 cases per 1000 PICU admissions). Factors independently associated with candidemia included presence of a central venous catheter (odds ratio [OR], 30.4; 95% confidence interval [CI], 7.7-119.5), malignancy (OR, 4.0; 95% CI, 1.23-13.1), use of vancomycin for >3 days in the prior 2 weeks (OR, 6.2; 95% CI, 2.4-16), and receipt of agents with activity against anaerobic organisms for >3 days in the prior 2 weeks (OR, 3.5; 95% CI, 1.5-8.4). Predicted probability of having various combinations of the aforementioned factors ranged from 10.7% to 46%. The 30-day mortality rate was 44% among case patients and 14% among control patients (OR, 4.22; 95% CI, 2.35-7.60). CONCLUSIONS To our knowledge, this is the first study to evaluate independent risk factors and to determine a population of children in PICUs at high risk for developing candidemia. Future efforts should focus on validation of these risk factors identified in a different PICU population and development of interventions for prevention of candidemia in critically ill children.
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Affiliation(s)
- Theoklis E Zaoutis
- Division of Infectious Diseases, Center for Pediatric Clinical Effectiveness, The Children's Hospital of Philadelphia, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania 19104, USA.
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21
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Putignani L, Del Chierico F, Onori M, Mancinelli L, Argentieri M, Bernaschi P, Coltella L, Lucignano B, Pansani L, Ranno S, Russo C, Urbani A, Federici G, Menichella D. MALDI-TOF mass spectrometry proteomic phenotyping of clinically relevant fungi. MOLECULAR BIOSYSTEMS 2010; 7:620-9. [PMID: 20967323 DOI: 10.1039/c0mb00138d] [Citation(s) in RCA: 67] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Proteomics is particularly suitable for characterising human pathogens with high life cycle complexity, such as fungi. Protein content and expression levels may be affected by growth states and life cycle morphs and correlate to species and strain variation. Identification and typing of fungi by conventional methods are often difficult, time-consuming and frequently, for unusual species, inconclusive. Proteomic phenotypes from MALDI-TOF MS were employed as analytical and typing expression profiling of yeast, yeast-like species and strain variants in order to achieve a microbial proteomics population study. Spectra from 303 clinical isolates were generated and processed by standard pattern matching with a MALDI-TOF Biotyper (MT). Identifications (IDs) were compared to a reference biochemical-based system (Vitek-2) and, when discordant, MT IDs were verified with genotyping IDs, obtained by sequencing the 25-28S rRNA hypervariable D2 region. Spectra were converted into virtual gel-like formats, and hierarchical clustering analysis was performed for 274 Candida profiles to investigate species and strain typing correlation. MT provided 257/303 IDs consistent with Vitek-2 ones. However, amongst 26/303 discordant MT IDs, only 5 appeared "true". No MT identification was achieved for 20/303 isolates for incompleteness of database species variants. Candida spectra clustering agreed with identified species and topology of Candida albicans and Candida parapsilosis specific dendrograms. MT IDs show a high analytical performance and profiling heterogeneity which seems to complement or even outclass existing typing tools. This variability reflects the high biological complexity of yeasts and may be properly exploited to provide epidemiological tracing and infection dispersion patterns.
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Affiliation(s)
- Lorenza Putignani
- Microbiology Unit, Children's Hospital and Research Institute Bambino Gesù, Piazza Sant'Onofrio 4, 00165, Rome, Italy.
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22
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Taieb F, Méchaï F, Lefort A, Lanternier F, Bougnoux ME, Lortholary O. [Management of candidemia and invasive candidiasis]. Rev Med Interne 2010; 32:173-80. [PMID: 20951474 DOI: 10.1016/j.revmed.2010.08.019] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2010] [Accepted: 08/20/2010] [Indexed: 11/15/2022]
Abstract
Candida species is the fourth most common cause of bloodstream infection and is the leading cause of invasive fungal infection among hospitalized patients. Acute disseminated candidiasis remains a life-threatening disease that now occurs mainly in intensive care units hospitalized patients. Delay in treatment of Candida bloodstream infections could be minimized by the development of more rapid and sensitive diagnostic techniques for the identification of Candida bloodstream infections. Current guidelines for the management of invasive candidiasis recommend fluconazole or an echinocandin as the primary therapeutic option. The optimal choice of the antifungal agent should depend on local epidemiology, prior antifungal therapy and patient's characteristics.
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Affiliation(s)
- F Taieb
- Service des maladies infectieuses et tropicales, centre d’infectiologie Necker-Pasteur, université Paris Descartes, hôpital Necker Enfants-malades, 149 rue de Sèvres, Paris cedex 15, France
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23
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Pyrgos V, Ratanavanich K, Donegan N, Veis J, Walsh TJ, Shoham S. Candida bloodstream infections in hemodialysis recipients. Med Mycol 2010; 47:463-7. [PMID: 18798046 DOI: 10.1080/13693780802369332] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
Abstract
Candidemia is a major cause of morbidity and mortality in patients undergoing hemodialysis but it has not been well defined in this patient population. We performed a retrospective case-control study to characterize the epidemiology, microbiology, and outcomes of hemodialysis-associated candidemia. All cases of candidemia at our institution were evaluated from 1 January 2000 until 1 September 2004. For each case, two non-candidemic dialysis patients served as controls. Among 350 cases of candidemia, 78 (22%) occurred in adult hemodialysis patients. Cases and controls were similar with respect to age, corticosteroid, antibiotics use, prevalence of diabetes mellitus, liver cirrhosis, surgical procedures, and cancer. Multivariate analysis found total parenteral nutrition (TPN) (19.5% vs. 1.3%; P<0.0001) and dialysis through a vascular catheter (74% vs. 46.8%; P=0.0001) to be independently associated with candidemia. Non-C.albicans Candida spp. particularly C. glabrata and C. krusei were more common in hemodialysis recipients than in candidemic patients not receiving hemodialysis (31% vs. 17% p = 0.009). In-hospital mortality was significantly elevated for candidemic vs. non-candidemic hemodialysis recipients (51.9% vs. 7.8%; P<0.0001). Candidemia in hemodialysis recipients is frequently caused by non-C. albicansCandida species, is associated with TPN and dialysis via a vascular catheter (vs. shunt or fistula) and carries a high mortality rate.
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Affiliation(s)
- Vasilios Pyrgos
- Section of Infectious Diseases, Washington Hospital Center, Washington, DC 20010, USA.
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24
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Early prediction of Candida glabrata fungemia in nonneutropenic critically ill patients*. Crit Care Med 2010; 38:826-30. [DOI: 10.1097/ccm.0b013e3181cc4734] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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25
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Brillowska-Dabrowska A, Bergmann O, Jensen IM, Jarløv JO, Arendrup MC. Typing of Candida isolates from patients with invasive infection and concomitant colonization. ACTA ACUST UNITED AC 2009; 42:109-13. [DOI: 10.3109/00365540903348336] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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26
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Sayin I, Kahraman M, Sahin F, Yurdakul D, Culha M. Characterization of yeast species using surface-enhanced Raman scattering. APPLIED SPECTROSCOPY 2009; 63:1276-1282. [PMID: 19891836 DOI: 10.1366/000370209789806849] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
Surface-enhanced Raman scattering (SERS) is used for the characterization of six yeast species and six isolates. The sample for SERS analysis is prepared by mixing the yeast cells with a four times concentrated silver colloidal suspension. The scanning electron microscopy (SEM) images show that the strength of the interaction between silver nanoparticles and the yeast cells depends on the biochemical structure of the cell wall. The SERS spectra are used to identify the biochemical structures on the yeast cell wall. It is found that the density of -SH and -NH2 groups might be higher on certain yeast cell walls. Finally, the obtained SERS spectra from yeast is used for the classification of the yeast.
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Affiliation(s)
- Ismail Sayin
- Yeditepe University, Faculty of Engineering and Architecture, Genetics and Bioengineering Department, Kayisdagi, Istanbul, Turkey
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27
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Herbrecht R. The changing epidemiology of fungal infections: are the lipid-forms of amphotericin B an advance? Eur J Haematol Suppl 2009; 57:12-7. [PMID: 8706811 DOI: 10.1111/j.1600-0609.1996.tb01347.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
The incidence of invasive fungal infections is increasing and new fungal species are emerging as important pathogens. In cancer patients, the main risk factor for the development of systemic fungal disease is severe, prolonged neutropenia. Other factors, such as mucosal damage, presence of a central venous line, immunosuppressive therapy and treatment with broad spectrum antibiotics are contributory. Candida spp. are the fungi most commonly isolated in neutropenic patients. There has been a dramatic increase in non-C. albicans species, such as C. glabrata and C. krusei, largely as a result of extensive prophylactic and therapeutic use of fluconazole, to which these species are largely resistant. In neutropenic patients with candidaemia, amphotericin B is the drug of choice although the conventional formulation may be poorly tolerated. Lipid-based forms of amphotericin B, such as Abelcet, are better tolerated and can be given at a much higher dose and should therefore be considered in patients who fail on or are intolerant to the conventional agent. Aspergillosis is the second most frequent fungal infection in neutropenic patients. Primary invasive aspergillosis usually presents on chest X-ray with lung lesions and the brain is a frequent site of secondary infection. Fluconazole is inactive against Aspergillus spp. and amphotericin B is the standard treatment. Again, lipid-based forms are better tolerated than the conventional formulation in this setting, and have been shown to achieve response rates of 60% or more in a number of trials. Other potentially life-threatening fungal infections in which lipid-based amphotericin B may play an important therapeutic role in the future include cryptococcosis (increasingly problematic in AIDS patients), trichosporonosis, fusariosis and mucormycosis. Further randomized studies should be performed in a range of fungal infections to compare Abelcet with conventional amphotericin B and other lipid-based antifungal agents.
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Affiliation(s)
- R Herbrecht
- Department of Oncology and Haematology, Hôpitaux Universitaires de Strasbourg, France
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28
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Treatment-related risk factors for hospital mortality in Candida bloodstream infections*. Crit Care Med 2008; 36:2967-72. [DOI: 10.1097/ccm.0b013e31818b3477] [Citation(s) in RCA: 139] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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León C, Alvarez-Lerma F, Ruiz-Santana S, León MA, Nolla J, Jordá R, Saavedra P, Palomar M. Fungal colonization and/or infection in non-neutropenic critically ill patients: results of the EPCAN observational study. Eur J Clin Microbiol Infect Dis 2008; 28:233-42. [PMID: 18758831 DOI: 10.1007/s10096-008-0618-z] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2008] [Accepted: 08/01/2008] [Indexed: 11/29/2022]
Abstract
The purpose of this paper is to determine the incidence of fungal colonization and infection in non-neutropenic critically ill patients and to identify factors favoring infection by Candida spp. A total of 1,655 consecutive patients (>18 years of age) admitted for > or = 7 days to 73 medical-surgical Spanish intensive care units (ICUs) participated in an observational prospective cohort study. Surveillance samples were obtained once a week. One or more fungi were isolated in different samples in 59.2% of patients, 94.2% of which were Candida spp. There were 864 (52.2%) patients with Candida spp. colonization and 92 (5.5%) with proven Candida infection. In the logistic regression analysis risk factors independently associated with Candida spp. infection were sepsis (odds ratio [OR] = 8.29, 95% confidence interval [CI] 5.07-13.6), multifocal colonization (OR = 3.49, 95% CI 1.74-7.00), surgery (OR = 2.04, 95% CI 1.27-3.30), and the use of total parenteral nutrition (OR = 4.37, 95% CI 2.16-8.33). Patients with Candida spp. infection showed significantly higher in-hospital and intra-ICU mortality rates than those colonized or non-colonized non-infected (P < 0.001). Fungal colonization, mainly due to Candida spp., was documented in nearly 60% of non-neutropenic critically ill patients admitted to the ICU for more than 7 days. Proven candidal infection was diagnosed in 5.5% of cases. Risk factors independently associated with Candida spp. infection were sepsis, multifocal colonization, surgery, and the use of total parenteral nutrition.
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Affiliation(s)
- C León
- Servicio de Ciudados Críticos y Urgencias, Hospital Universitario de Valme, Universidad de Sevilla, Carretera de Cádiz s/n, 41014 Sevilla, Spain.
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Kim SH, Shin JH, Kim EC, Lee K, Kim MN, Lee WG, Uh Y, Lee HS, Lee MK, Jeong SH, Jung SI, Park KH, Lee JS, Shin MG, Suh SP, Ryang DW. The relationship between antifungal usage and antifungal susceptibility in clinical isolates of Candida: a multicenter Korean study. Med Mycol 2008; 47:296-304. [PMID: 18668423 DOI: 10.1080/13693780802291445] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
Abstract
There have been very few multicenter studies of the relationship between the use of antifungals and resistance to them. We investigated the antifungal susceptibility of 1,301 clinical isolates of Candida collected from nine Korean hospitals during a 3-month period in 2006 to explore the existence of this type of relationship. Antifungal usage in the preceding year, defined as the daily dose per 1,000 patient days (DDD/1,000 PD), was calculated for each hospital. Resistance to fluconazole, itraconazole, and amphotericin B was detected in 2, 9, and 0.2% of the isolates, respectively. The MIC(50)/MIC(90) values were 0.03/0.125 mg/L for voriconazole, 0.06/0.25 mg/l for caspofungin, and 0.03/0.125 mg/l for micafungin. The total usage of systemic antifungals varied considerably among the nine hospitals, ranging from 6.1 to 96.2 DDD/1,000 PD. No relationship was found between the use of fluconazole (MIC> or =64 mg/l) or itraconazole (MIC> or =1 mg/l) and resistance in the Candida species (P>0.05). However, significant correlations were found between the percentage of Candida isolates that were non-susceptible to fluconazole (MIC> or =16 mg/l) and fluconazole usage (r=0.733, P=0.025) or total antifungal usage (r=0.767, P=0.016).
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Affiliation(s)
- Soo Hyun Kim
- Chonnam National University Medical School, Gwangju, Korea
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Abstract
OBJECTIVE To determine risk factors for bloodstream infections (BSI) with Candida non-albicans (C-NA) species and Candida albicans (CA) among critically ill patients. DESIGN Case-control study. SETTING Adult medical and surgical intensive care units (ICUs) at two university hospitals. PATIENTS Consecutive patients with C-NA and CA BSIs from 1995-2005 formed the two case groups. Controls were patients without candidemia who were randomly selected in a ratio of 5:1 and matched by study hospital, ICU type (medical vs. surgical) and by ICU admission date within a 3-month period. INTERVENTIONS Data collected included demographics, comorbidities, exposure to antibiotics and antifungals, and ICU factors such as total parenteral nutrition (TPN), blood product transfusions, invasive procedures, central venous catheters, hemodialysis, and mechanical ventilation. We built multivariable logistic regression models, which identified risk factors for C-NA or CA BSIs compared with controls. Variables were adjusted for time-at-risk. MEASUREMENTS AND MAIN RESULTS There were 67 patients with C-NA BSIs, 79 patients with CA BSIs, and 780 controls. In multivariable models, factors associated with an increased risk of C-NA compared with controls included major pre-ICU operations [odds ratio; (95% confidence interval)] [2.12; (1.14-3.97)], gastrointestinal procedures [2.24; (1.49-3.38)], enteric bacteremia [3.43; (1.39-8.48)], number of hemodialysis days [6.20; (2.67-14.4)], TPN duration [2.87; (1.40-5.90)], and mean number of red blood cell transfusions [2.72; (1.33-5.58)]. Factors associated with an increased risk of CA BSIs compared to controls were very similar and included major ICU operations [1.26; (1.14-3.97)], enteric bacteremia [3.45; (1.38-8.63)], number of hemodialysis days [3.84; (1.75-8.40)], TPN duration [11.0; (5.52-21.7)] and mean number of red blood cell transfusions [1.97; (0.98-3.99)]. CONCLUSIONS We found multiple common risk factors for both non-C. albicans and C. albicans BSIs, however we could not differentiate between these two groups based on clinical characteristics alone.
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Abstract
The incidence of invasive fungal infections has increased dramatically over the past two decades, mostly due to an increase in the number of immunocompromised patients.1–4 Patients who undergo chemotherapy for a variety of diseases, patients with organ transplants, and patients with the acquired immune deficiency syndrome have contributed most to the increase in fungal infections.5 The actual incidence of invasive fungal infections in transplant patients ranges from 15% to 25% in bone marrow transplant recipients to 5% to 42% in solid organ transplant recipients.6,7 The most frequently encountered are Aspergillus species, followed by Cryptococcus and Candida species. Fungal infections are also associated with a higher mortality than either bacterial or viral infections in these patient populations. This is because of the limited number of available therapies, dose-limiting toxicities of the antifungal drugs, fewer symptoms due to lack of inflammatory response, and the lack of sensitive tests to aid in the diagnosis of invasive fungal infections.1 A study of patients with fungal infections admitted to a university-affiliated hospital indicated that community-acquired infections are becoming a serious problem; 67% of the 140 patients had community-acquired fungal pneumonia.8
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Ostrosky-Zeichner L, Rex JH. Antifungal and Antiviral Therapy. Crit Care Med 2008. [DOI: 10.1016/b978-032304841-5.50055-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Beger HG, Rau BM. Severe acute pancreatitis: Clinical course and management. World J Gastroenterol 2007; 32:515-8. [PMID: 17876868 DOI: 10.1016/j.ijantimicag.2008.06.020] [Citation(s) in RCA: 50] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2008] [Revised: 06/09/2008] [Accepted: 06/16/2008] [Indexed: 02/06/2023] Open
Abstract
Severe acute pancreatitis (SAP) develops in about 25% of patients with acute pancreatitis (AP). Severity of AP is linked to the presence of systemic organ dysfunctions and/or necrotizing pancreatitis pathomorphologically. Risk factors determining independently the outcome of SAP are early multi-organ failure, infection of necrosis and extended necrosis (>50%). Up to one third of patients with necrotizing pancreatitis develop in the late course infection of necroses. Morbidity of SAP is biphasic, in the first week strongly related to early and persistence of organ or multi-organ dysfunction. Clinical sepsis caused by infected necrosis leading to multi-organ failure syndrome (MOFS) occurs in the later course after the first week. To predict sepsis, MOFS or deaths in the first 48-72 h, the highest predictive accuracy has been objectified for procalcitonin and IL-8; the Sepsis-Related Organ Failure Assessment (SOFA)-score predicts the outcome in the first 48 h, and provides a daily assessment of treatment response with a high positive predictive value. Contrast-enhanced CT provides the highest diagnostic accuracy for necrotizing pancreatitis when performed after the first week of disease. Patients who suffer early organ dysfunctions or at risk of developing a severe disease require early intensive care treatment. Early vigorous intravenous fluid replacement is of foremost importance. The goal is to decrease the hematocrit or restore normal cardiocirculatory functions. Antibiotic prophylaxis has not been shown as an effective preventive treatment. Early enteral feeding is based on a high level of evidence, resulting in a reduction of local and systemic infection. Patients suffering infected necrosis causing clinical sepsis, pancreatic abscess or surgical acute abdomen are candidates for early intervention. Hospital mortality of SAP after interventional or surgical debridement has decreased in high volume centers to below 20%.
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Dimopoulos G, Karabinis A, Samonis G, Falagas ME. Candidemia in immunocompromised and immunocompetent critically ill patients: a prospective comparative study. Eur J Clin Microbiol Infect Dis 2007; 26:377-84. [PMID: 17525857 PMCID: PMC7101586 DOI: 10.1007/s10096-007-0316-2] [Citation(s) in RCA: 55] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
The purpose of this study was to compare the risk factors, clinical manifestations, and outcome of candidemia in immunocompromised (IC) and nonimmunocompromised (NIC) critically ill patients. Data were collected prospectively over a 2-year period (02/2000–01/2002) from patients in a 25-bed, medical–surgical intensive care unit (ICU). Eligible for participation in this study were patients who developed candidemia during their ICU stay. Patients under antifungal therapy and with a confirmed systemic fungal infection prior to the diagnosis of candidemia were excluded. Cultures of blood, urine, and stool were performed for all patients in the study, and all patients underwent endoscopy/biopsy of the esophagus for detection of Candida. Smears and/or scrapings of oropharyngeal and esophageal lesions were examined for hyphae and/or pseudohyphae and were also cultured for yeasts. During the study period, 1,627 patients were hospitalized in the ICU, 57% for primary medical reasons and 43% for surgical reasons. After application of the study’s inclusion and exclusion criteria, 24 patients with candidemia (9 IC and 15 NIC) were analyzed. Total parenteral nutrition was more common in IC than in NIC patients (9/9 [100%] vs 8/15 [53%], p = 0.02). Oropharyngeal candidiasis was detected in 5 of 9 (55.5%) IC patients and in 1 of 15 (6.5%) NIC patients (p = 0.015). Esophageal candidiasis was also more common in IC than in NIC patients (4/9 [44%] vs 0/15 [0%], p = 0.012). Among the 9 IC patients, all except 2 died, resulting in a crude mortality of 78%; among the 15 NIC patients, 9 died, resulting in a crude mortality of 60% (p > 0.05). Autopsy was performed in two IC and in six NIC patients, with disseminated candidiasis found in one IC patient. Oropharyngeal and esophageal candidiasis are frequent in IC patients with candidemia. In contrast, this coexistence is rare in NIC critically ill patients with Candida bloodstream infections. A high mortality was noted in both IC and NIC critically ill patients with candidemia.
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Affiliation(s)
- G. Dimopoulos
- Department of Intensive Care Medicine, Medical School, University of Athens, Athens, Greece
| | - A. Karabinis
- Intensive Care Unit, “G. Gennimatas” General Hospital, Athens, Greece
| | - G. Samonis
- Department of Medicine, University of Crete School of Medicine, Heraklion, Crete Greece
| | - M. E. Falagas
- Alfa Institute of Biomedical Sciences (AIBS), 9 Neapoleos Street, 151 23 Marousi, Athens, Greece
- Department of Medicine, Tufts University School of Medicine, Boston, MA USA
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Jensen J, Muñoz P, Guinea J, Rodríguez-Créixems M, Peláez T, Bouza E. Mixed Fungemia: Incidence, Risk Factors, and Mortality in a General Hospital. Clin Infect Dis 2007; 44:e109-14. [PMID: 17516389 DOI: 10.1086/518175] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2006] [Accepted: 02/28/2007] [Indexed: 11/03/2022] Open
Abstract
BACKGROUND Fungemia has been historically considered to be a disease caused by a single Candida species; the detection of >1 species of yeast in circulating blood was distinctly uncommon using traditional microbiological procedures. We describe episodes of mixed fungemia (MF), detected between 1985 and 2006, in a large teaching hospital. METHODS The study was divided into 2 periods that were separated by the introduction, in January 2005, of the CHROmagar Candida medium (CHROMagar) for the routine subculturing of blood cultures in which yeast has been identified. Overall, we documented 747 cases of fungemia. During the first period (1985-1994), we identified 217 episodes of fungemia and no single episode of MF; during the second period (1995-2006), 15 episodes of MF were detected among 530 episodes of fungemia (2.8%). Candida albicans was isolated in 13 patients, non-albicans species of Candida in 16 patients, and Saccharomyces cerevisiae in 1 patient. Each episode of MF was compared with 2 control episodes of monomicrobial fungemia. RESULTS Patients with MF had more frequently experienced organ transplantation (13% vs. 0%) and surgery (60% vs. 27%), had less frequently received parenteral nutrition (40% vs. 70%) or had intravenous lines (80% vs. 100%), and had a lower incidence of shock (6% vs. 37%) and a lower mortality (20% vs. 53%). CONCLUSIONS Despite the introduction of chromogenic agar, MF is still an uncommon disease and has a less severe outcome than does monomicrobial candidemia.
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Affiliation(s)
- Julia Jensen
- Clinical Microbiology and Infectious Diseases Department, Hospital General Universitario Gregorio Maranon, Universidad Complutense, Madrid, Spain
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Shorr AF, Lazarus DR, Sherner JH, Jackson WL, Morrel M, Fraser VJ, Kollef MH. Do clinical features allow for accurate prediction of fungal pathogenesis in bloodstream infections? Potential implications of the increasing prevalence of non-albicans candidemia. Crit Care Med 2007; 35:1077-83. [PMID: 17312565 DOI: 10.1097/01.ccm.0000259379.97694.00] [Citation(s) in RCA: 84] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To describe the evolving epidemiology of fungal bloodstream infections in critically ill and noncritically ill patients and to identify predictors of infection with non-albicans yeast species. DESIGN Retrospective case series. SETTING Two academic, tertiary care centers. PARTICIPANTS All persons during a 4-yr period who developed fungemia. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS We initially compared subjects with Candida albicans vs. alternative yeast. In a sensitivity analysis, we compared persons with potentially fluconazole-resistant organisms (Candida glabrata and Candida krusei) to those with other fungi. We also repeated these analyses in the subgroup of persons in the intensive care unit when they developed fungemia. The study cohort included 245 patients (60% in the intensive care unit), and C. albicans accounted for 52% of infections, whereas C. glabrata represented 20% of cases. The distribution of isolates was similar in both intensive care unit patients and those on the wards. In the entire population, no variable, including both previous fluconazole exposure and severity of illness, correlated with the fungemia due to a non-albicans species. In our sensitivity analysis, no factor was independently associated with a potentially fluconazole-resistant yeast. For the subgroup of subjects whose fungemia was diagnosed while they were in the intensive care unit, no variable differentiated C. albicans from non-albicans isolates. CONCLUSIONS Non-albicans yeast are common both in the intensive care unit and on the wards. Simple clinical factors do not allow the clinician to effectively identify patients likely infected with non-albicans pathogens or with possible fluconazole-resistant fungi.
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Affiliation(s)
- Andrew F Shorr
- Pulmonary and Critical Care Medicine, Washington Hospital Center, Washington, DC, USA.
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Gallien S, Sordet F, Enache-Angoulvant A. Traitement des candidémies chez un patient porteur d’un cathéter vasculaire. J Mycol Med 2007. [DOI: 10.1016/j.mycmed.2006.10.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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39
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Dunyach C, Eiden C, Jalabert A, Margueritte G, Bernard F, Reynes J, Hansel S. Prise en charge thérapeutique des infections fongiques invasives dans le service d’onco-hématologie pédiatrique du CHU de Montpellier. J Mycol Med 2007. [DOI: 10.1016/j.mycmed.2006.12.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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40
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Chowta MN, Adhikari* P, Rajeev** A, Shenoy AK. Study of risk factors and prevalence of invasive candidiasis in a tertiary care hospital. Indian J Crit Care Med 2007. [DOI: 10.4103/0972-5229.33388] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Perlroth J, Choi B, Spellberg B. Nosocomial fungal infections: epidemiology, diagnosis, and treatment. Med Mycol 2007; 45:321-46. [PMID: 17510856 DOI: 10.1080/13693780701218689] [Citation(s) in RCA: 487] [Impact Index Per Article: 28.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
Abstract
Invasive fungal infections are increasingly common in the nosocomial setting. Furthermore, because risk factors for these infections continue to increase in frequency, it is likely that nosocomial fungal infections will continue to increase in frequency in the coming decades. The predominant nosocomial fungal pathogens include Candida spp., Aspergillus spp., Mucorales, Fusarium spp., and other molds, including Scedosporium spp. These infections are difficult to diagnose and cause high morbidity and mortality despite antifungal therapy. Early initiation of effective antifungal therapy and reversal of underlying host defects remain the cornerstones of treatment for nosocomial fungal infections. In recent years, new antifungal agents have become available, resulting in a change in standard of care for many of these infections. Nevertheless, the mortality of nosocomial fungal infections remains high, and new therapeutic and preventative strategies are needed.
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Affiliation(s)
- Joshua Perlroth
- Division of Infectious Diseases, Harbor-University of California Los Angeles (UCLA) Medical Center, California 90502, USA
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Castón JJ, Linares MJ, Gallego C, Rivero A, Font P, Solís F, Casal M, Torre-Cisneros J. Risk Factors for Pulmonary Aspergillus terreus Infection in Patients With Positive Culture for Filamentous Fungi. Chest 2007; 131:230-6. [PMID: 17218581 DOI: 10.1378/chest.06-0767] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
BACKGROUND Invasive aspergillosis (IA) is a common fungal infection in immunocompromised patients and has a high mortality rate. Among patients with IA, Aspergillus terreus infections have become a growing concern in the past few years. OBJECTIVE To determine the clinical risk factors for isolation of and respiratory infection by A terreus in patients with culture findings positive for filamentous fungi. METHODS Cohort study of 505 consecutive isolates of filamentous fungi in 332 patients from one center. A terreus was present in 46 isolates from 40 patients (9.1%). Clinical histories were reviewed to identify the risk factors related to isolation of and infection by A terreus, which were grouped into three categories (ie, host factors, factors related to immunosuppression, and factors related to hospitalization), and were analyzed using a multiple logistic regression model. RESULTS A total of 192 of 505 isolates studied (38%) were due to invasive respiratory infection. A total of 27 of 46 cultures (58.7%) that were positive for A terreus were due to invasive infection (odds ratio [OR], 2.53; 95% confidence interval [CI], 1.37 to 4.69; p = 0.034). The factors associated with invasive A terreus infection were prophylactic use of amphotericin B aerosols (OR, 27.8; 95% CI, 6.7 to 109.7; p = 0.001) and mechanical ventilation (OR, 3.3; 95% CI, 1.02 to 10.9; p = 0.04). Transplantation was associated with a lower risk of A terreus infection (OR, 0.2; 95% CI, 0.046 to 0.789; p = 0.02). CONCLUSIONS In patients with culture findings positive for filamentous fungi, the prophylactic use of amphotericin B aerosols and mechanical ventilation are associated with a higher risk of A terreus infections. In these patients, transplantation is associated with a lower risk of isolation and respiratory infection by A terreus.
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Affiliation(s)
- Juan José Castón
- Unit of Infectious Diseases, Reina Sofía University Hospital, Córdoba, Spain
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Lin PC, Hsiao LT, Poh SB, Wang WS, Yen CC, Chao TC, Liu JH, Chiou TJ, Chen PM. Higher fungal infection rate in elderly patients (more than 80 years old) suffering from diffuse large B cell lymphoma and treated with rituximab plus CHOP. Ann Hematol 2006; 86:95-100. [PMID: 17031689 DOI: 10.1007/s00277-006-0191-4] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2006] [Accepted: 08/10/2006] [Indexed: 10/24/2022]
Abstract
Although adding rituximab to standard cyclophosphamide, doxorubicin, vincristine, and prednisone (CHOP) chemotherapy is an efficacious and well-tolerated regimen in elderly patients with diffuse large B cell lymphoma (DLBCL), it may increase susceptibility to opportunistic infections, and such cases have been reported. Our study was to identify the risk factors for fungal infection in a retrospective case-control matched study of 34 elderly DLBCL patients treated with rituximab plus CHOP (R-CHOP) and 35 control patients treated with the standard CHOP regimen at the Taipei Veterans General Hospital, Taiwan. The rate of overall infection was similar in both groups. However, subgroup analysis found that the fungal infection rate was significantly different, 41.7 and 17.1%, in the R-CHOP and CHOP groups, respectively, (P = 0.03). Univariate analysis identified the rituximab plus CHOP chemotherapy regimen (P = 0.03), age older than 80 years (P = 0.04), and bone marrow involvement (P = 0.04) as risk factors for development of fungal infection, whereas, multivariate regression analysis identified only rituximab plus CHOP and old age. Adding rituximab to the standard CHOP regimen in elderly DLBCL patients might increase the incidence of fungal infection especially in those older than 80 years old.
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MESH Headings
- Aged
- Aged, 80 and over
- Antibodies, Monoclonal/immunology
- Antibodies, Monoclonal/therapeutic use
- Antibodies, Monoclonal, Murine-Derived
- Antineoplastic Combined Chemotherapy Protocols/therapeutic use
- Cyclophosphamide/therapeutic use
- Doxorubicin/therapeutic use
- Female
- Humans
- Lymphoma, B-Cell/complications
- Lymphoma, B-Cell/drug therapy
- Lymphoma, B-Cell/immunology
- Lymphoma, B-Cell/pathology
- Lymphoma, Large B-Cell, Diffuse/complications
- Lymphoma, Large B-Cell, Diffuse/drug therapy
- Lymphoma, Large B-Cell, Diffuse/immunology
- Lymphoma, Large B-Cell, Diffuse/pathology
- Male
- Middle Aged
- Mycoses/complications
- Mycoses/epidemiology
- Mycoses/pathology
- Prednisone/therapeutic use
- Risk Factors
- Rituximab
- Vincristine/therapeutic use
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Affiliation(s)
- Peng-Chan Lin
- Division of Hematology & Oncology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
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Magill SS, Swoboda SM, Johnson EA, Merz WG, Pelz RK, Lipsett PA, Hendrix CW. The association between anatomic site of Candida colonization, invasive candidiasis, and mortality in critically ill surgical patients. Diagn Microbiol Infect Dis 2006; 55:293-301. [PMID: 16698215 DOI: 10.1016/j.diagmicrobio.2006.03.013] [Citation(s) in RCA: 54] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2005] [Revised: 03/13/2006] [Accepted: 03/22/2006] [Indexed: 01/09/2023]
Abstract
We evaluated whether the likelihood of developing invasive candidiasis (IC) differed depending upon the anatomic site of Candida colonization in 182 surgical intensive care unit (SICU) patients who participated in a randomized trial of fluconazole to prevent candidiasis. We also determined the impact of Candida colonization of different anatomic sites on all-cause SICU and hospital mortality. A total of 2851 surveillance fungal cultures collected from 5 anatomic sites were analyzed. There was a statistically significant difference in the frequency of IC comparing patients with and without urinary (13.2% versus 2.8%, P = .02), respiratory (8.0% versus 1.2%, P = .04), and rectum/ostomy (8.4% versus 0%, P = .01) colonization. Patients with negative rectum/ostomy cultures and patients with both negative urine and respiratory tract cultures did not develop IC. Candiduria detected at any time in the SICU was independently associated with SICU mortality (odds ratio, 2.86; 95% confidence interval, 1.05-7.74). Surveillance fungal cultures of particular anatomic sites may help differentiate patients at higher risk of developing IC from those at low risk.
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Affiliation(s)
- Shelley S Magill
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD 21205, USA.
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Sellami A, Sellami H, Makni F, Bahloul M, Cheikh-Rouhou F, Bouaziz M, Ayadi A. [Candiduria in intensive care unit: significance and value of yeast numeration in urine]. ACTA ACUST UNITED AC 2006; 25:584-8. [PMID: 16626924 DOI: 10.1016/j.annfar.2006.02.019] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2005] [Accepted: 02/17/2006] [Indexed: 11/25/2022]
Abstract
JUSTIFICATION Candiduria is increasingly frequent among patients admitted to intensive care units but its significance remains unclear. OBJECTIVES Search for eventual correlation between quantitative candiduria and known risk factors for invasive candidiasis. STUDY DESIGN Prospective. PATIENTS AND METHODS A four-month study was conducted in 162 patients hospitalized in the intensive care unit for more than 72 hours. All patients underwent a weekly research of candiduria added to sampling from different body sites to determine the Pittet Candida colonization index. RESULTS Candiduria has been proved in 56 cases (34%). It was superior or equal to 10(4) UFC/ml among 28 patients (50%). Candida tropicalis, Candida glabrata and Candida albicans has been isolated in 41, 22 and 20% respectively. All patients had at least one major and two minor risk factors for Candida infection. Six patients (10%) developed invasive candidiasis. The global mortality rate was at 52%. Pittet colonization index was significantly different between patients with candiduria and those with invasive candidiasis (p=0.01). There was a statistically significant correlation between candiduria superior or equal to 10(4) UFC/ml and Pittet colonization index superior or equal to 0.5 (p=0.01). CONCLUSION Candiduria superior or equal to 10(4) UFC/ml associated with risk factors may predict invasive candidiasis in critically ill patients.
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Affiliation(s)
- A Sellami
- Laboratoire de Parasitologie-Mycologie, Faculté de Médecine, Sfax, Tunisie
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Pasqualotto AC, Rosa DD, Medeiros LR, Severo LC. Candidaemia and cancer: patients are not all the same. BMC Infect Dis 2006; 6:50. [PMID: 16542444 PMCID: PMC1431538 DOI: 10.1186/1471-2334-6-50] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2005] [Accepted: 03/16/2006] [Indexed: 12/16/2022] Open
Abstract
Background Most of the studies about invasive Candida infections in cancer patients have focused on haematological patients. The aim of this study was to provide information about risk factors for candidaemia in patients with solid tumours. Methods Retrospective cohort study. During a 9-year period (1995–2003) we reviewed all cases of candidaemia that affected cancer patients in Santa Casa Complexo Hospitalar, Brazil. Results During the period of study, 210 patients had the diagnosis of candidaemia in our medical centre, and 83 of these patients had cancer (39.5%). The majority of patients with cancer had solid tumours (77.1%), mostly in the alimentary tract. Most of solid cancers were non-metastatic (71.9%). Major diagnoses in patients with haematological neoplasia were acute leukaemia (n = 13), high grade non-Hodgkin lymphoma (n = 5) and Hodgkin's disease (n = 1). Non-Candida albicans species caused 57.8% of the episodes of candidaemia in patients with cancer, mainly in patients with haematological malignancies (p = 0.034). Neutropenia and treatment with corticosteroids were more frequent in the haematological group, in comparison with patients with solid tumours. Only 22.2% of patients with solid tumours were neutropenic before candidaemia. Nonetheless, the presence of ileus and the use of anaerobicides were independent risk factors for candidaemia in patients with solid cancers. The overall mortality in cancer patients with candidaemia was 49.4%. We then compared 2 groups of adult patients with candidaemia. The first was composed of non-neutropenic patients with solid tumours, and the second group included patients without cancer. We found that central venous catheters and gastrointestinal surgery were independently associated with candidaemia in patients with solid tumour. Conclusion Cancer patients with candidaemia seem to have very different predisposing factors to acquire the infection when stratified according to baseline diseases. This study provides some useful clinical information regarding risk for candidaemia in patients with solid tumours.
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Affiliation(s)
| | | | - Lidia Rosi Medeiros
- Post-Graduation in Epidemiology, Federal University of Rio Grande do Sul, Porto Alegre, Brazil
| | - Luiz Carlos Severo
- Clinical Mycology Laboratory, Santa Casa Complexo Hospitalar, Porto Alegre, Brazil
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Morrell M, Fraser VJ, Kollef MH. Delaying the empiric treatment of candida bloodstream infection until positive blood culture results are obtained: a potential risk factor for hospital mortality. Antimicrob Agents Chemother 2005; 49:3640-5. [PMID: 16127033 PMCID: PMC1195428 DOI: 10.1128/aac.49.9.3640-3645.2005] [Citation(s) in RCA: 950] [Impact Index Per Article: 50.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
Fungal bloodstream infections are associated with significant patient mortality and health care costs. Nevertheless, the relationship between a delay of the initial empiric antifungal treatment until blood culture results are known and the clinical outcome is not well established. A retrospective cohort analysis with automated patient medical records and the pharmacy database at Barnes-Jewish Hospital was conducted. One hundred fifty-seven patients with a Candida bloodstream infection were identified over a 4-year period (January 2001 through December 2004). Fifty (31.8%) patients died during hospitalization. One hundred thirty-four patients had empiric antifungal treatment begun after the results of fungal cultures were known. From the time that the first blood sample for culture that was positive was drawn, 9 (5.7%) patients received antifungal treatment within 12 h, 10 (6.4%) patients received antifungal treatment between 12 and 24 h, 86 (54.8%) patients received antifungal treatment between 24 and 48 h, and 52 (33.1%) patients received antifungal treatment after 48 h. Multiple logistic regression analysis identified Acute Physiology and Chronic Health Evaluation II scores (one-point increments) (adjusted odds ratio [AOR], 1.24; 95% confidence interval [CI], 1.18 to 1.31; P < 0.001), prior antibiotic treatment (AOR, 4.05; 95% CI, 2.14 to 7.65; P = 0.028), and administration of antifungal treatment 12 h after having the first positive blood sample for culture (AOR, 2.09; 95% CI, 1.53 to 2.84; P = 0.018) as independent determinants of hospital mortality. Administration of empiric antifungal treatment 12 h after a positive blood sample for culture is drawn is common among patients with Candida bloodstream infections and is associated with greater hospital mortality. Delayed treatment of Candida bloodstream infections could be minimized by the development of more rapid diagnostic techniques for the identification of Candida bloodstream infections. Alternatively, increased use of empiric antifungal treatment in selected patients at high risk for fungal bloodstream infection could also reduce delays in treatment.
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Affiliation(s)
- Matthew Morrell
- Pulmonary and Critical Care Division, Washington University School of Medicine, Campus Box 8052, 660 South Euclid Avenue, St. Louis, MO 63110, USA
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48
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Weinberger M, Leibovici L, Perez S, Samra Z, Ostfeld I, Levi I, Bash E, Turner D, Goldschmied-Reouven A, Regev-Yochay G, Pitlik SD, Keller N. Characteristics of candidaemia with Candida-albicans compared with non-albicans Candida species and predictors of mortality. J Hosp Infect 2005; 61:146-54. [PMID: 16009456 DOI: 10.1016/j.jhin.2005.02.009] [Citation(s) in RCA: 70] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2004] [Accepted: 02/09/2005] [Indexed: 11/24/2022]
Abstract
Candidaemia due to non-albicans Candida species is increasing in frequency. We describe 272 episodes of candidaemia, define parameters associated with Candida albicans and other Candida species, and analyse predictors associated with mortality. Patients with C. albicans (55%) had the highest fatality rate and frequently received immunosuppressive therapy, while patients with Candida parapsilosis (16%) had the lowest fatality and complication rates. Candida tropicalis (16%) was associated with youth, severe neutropenia, acute leukaemia or bone marrow transplantation, Candida glabrata (10%) was associated with old age and chronic disease, and Candida krusei (2%) was associated with prior fluconazole therapy. The overall fatality rate was 36%, and predictors of death by multi-variate analysis were shock, impaired performance status, low serum albumin and congestive heart failure. Isolation of non-albicans Candida species, prior surgery and catheter removal were protective factors. When shock was excluded from analysis, antifungal therapy was shown to be protective. Unlike previous concerns, infection with Candida species other than C. albicans has not been shown to result in an increased fatality rate.
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Affiliation(s)
- M Weinberger
- Internal Medicine C and Infectious Diseases, Rabin Medical Centre, Beilinson Campus, Petach Tikva, Israel.
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Boo TW, O'reilly B, O'leary J, Cryan B. Candidaemia in an Irish tertiary referral hospital: epidemiology and prognostic factors. Mycoses 2005; 48:251-9. [PMID: 15982207 DOI: 10.1111/j.1439-0507.2005.01134.x] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
There were two parts to this study. Part 1 evaluated the epidemiology of Candida bloodstream isolates within the Southern Health Board (SHB) of Ireland from 1992 to 2003 by retrospective surveillance of all such isolates of patients reported from SHB hospitals to our laboratory database during that period. Part 2 reviewed candidaemia cases occurring in Cork University Hospital (CUH) from 1999 to 2003 using surveillance of all positive blood culture isolates in CUH microbiology laboratory during the 5-year period. In part 1, 250 Candida bloodstream isolates were reported in the SHB over 12 years. There was a pattern of decreasing percentage of C. albicans with time. Whereas in part 2, 63 cases of candidaemia were identified in CUH from 1999 to 2003. Candida albicans constituted 50% of all isolates, while C. parapsilosis and C. glabrata accounted for 21.2% and 18.2% respectively. Average annual incidence rate was 0.48 episodes/1000 admissions and 0.70 episodes/10 000 patient-days. Vascular catheters were the commonest source of candidaemia (61.9%) followed by the urinary tract (12.7%). Risk factors included exposure to multiple antibiotics (75%); central vascular catheterization (73%); multiple colonization sites (71%); severe gastrointestinal (GI) dysfunction (54%) and acute renal failure (43%). Crude 7-day and 30-day mortality rates were 20.6% and 39.7% respectively. Logistic regression multivariate analysis identified the following to be independent predictors for mortality: age > or =65 years [odds ratio (OR) 7.2, P = 0.013]; severe GI dysfunction (OR 10.6, P = 0.01); acute renal failure (OR 7.6, P = 0.022); recent/concurrent bacteraemia (OR 5.2, P = 0.042); endotracheal intubation (OR 7.7, P = 0.014); while major surgery was associated with a better prognosis (OR 0.05, P = 0.002). Appropriate antifungal treatment was also found to be associated with survival (Fisher's exact test, P < 0.001). The epidemiology of Candida bloodstream isolates within our health board had changed over the years. Incidence and mortality of candidaemia were relatively high in our hospital. Dysfunction of major organ systems and recent bacteraemia were found to predict mortality.
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Affiliation(s)
- T W Boo
- Department of Microbiology, Cork University Hospital, Cork, Ireland.
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50
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Pelz RK, Lipsett PA, Swoboda SM, Diener-West M, Hammond JM, Hendrix CW. The diagnostic value of fungal surveillance cultures in critically ill patients. Surg Infect (Larchmt) 2005; 1:273-81. [PMID: 12594883 DOI: 10.1089/109629600750067200] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Heavy fungal colonization is a known risk factor for fungal infection, yet the value of fungal surveillance cultures is uncertain. METHODS To evaluate the utility of fungal surveillance cultures in predicting fungal infections, we evaluated surveillance fungal cultures over a three month period in a prospective, cohort study conducted at a university medical center with a large tertiary referral population. We enrolled 172 patients in the Oncology Center and the medical and surgical intensive care units at Johns Hopkins Hospital. RESULTS Surveillance cultures from five sites were obtained twice weekly and evaluated for prediction of subsequent fungal infection. Infections were prospectively defined and evaluated by a panel of clinicians. Test characteristics were assessed. Of 159 eligible patients, 14 (9%) developed invasive fungal infections. Having two or more surveillance sites positive in a single day had an odds ratio of 8.2 (1.1-358.0) (p = 0.03), a negative predictive value of 0.98, sensitivity of 0.92, and a likelihood ratio of 1.6 for a fungal infection. In a multiple logistic regression model and Kaplan-Meier analysis, fungal burden was strongly and independently associated with infection (p < 0.05). CONCLUSIONS Surveillance cultures are helpful in determining fungal colonization but do not have a high positive predictive value for fungal infection in a broad population of intensive care unit patients. However, fungal infection is more likely in heavily colonized patients, and surveillance cultures show that fungal infection is extremely unlikely in patients without fungal colonization.
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Affiliation(s)
- R K Pelz
- Johns Hopkins University Schools of Medicine, Baltimore, MD, USA
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