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Boglione-Kerrien C, Le Bot A, Luque Paz D, Verdier MC, Guegan H, Gangneux JP, Bellissant E, Lemaitre F. Voriconazole as an alternative oral treatment in fluconazole-resistant urinary candidiasis. Infect Dis Now 2024; 54:104955. [PMID: 39043250 DOI: 10.1016/j.idnow.2024.104955] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2024] [Revised: 07/17/2024] [Accepted: 07/19/2024] [Indexed: 07/25/2024]
Abstract
OBJECTIVES This study aims to assess the urinary diffusion and clinical effectiveness of voriconazole in patients with fluconazole-resistant urinary candidiasis. PATIENTS AND METHODS In this prospective pilot study, we utilized a validated chromatography method to measure voriconazole in urine over a 12-hour period between two administrations of the drug and in plasma at trough. RESULTS Thirty-five patients, including five with fluconazole-resistant urinary candidiasis, were included. Urine and plasma voriconazole concentrations, mean 1.7 mg/L (range: 0.3-12.6) and mean 2.0 mg/L (range: 0.1-11.1) respectively, exhibited a strong correlation (R2 = 0.88). None of the five patients treated for candidiasis experienced clinical or microbiological failure following treatment, with urine concentrations ranging from 0.5 to 2.7 mg/L. CONCLUSIONS The urinary diffusion of voriconazole resulted in drug exposure above the target minimum inhibitory concentration (MIC) in the five patients treated for voriconazole-susceptible Candida strains in urine. Therapeutic drug monitoring may allow optimize in situ concentrations.
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Affiliation(s)
| | - Audrey Le Bot
- CHU Rennes, Infectious Diseases and Intensive Care Unit, F-35000 Rennes, France
| | - David Luque Paz
- CHU Rennes, Infectious Diseases and Intensive Care Unit, F-35000 Rennes, France
| | - Marie-Clémence Verdier
- CHU Rennes, Laboratory of Biological Pharmacology, F-35000 Rennes, France; Univ Rennes, CHU de Rennes, Inserm, Irset (Institut de recherche en santé, environnement et travail) - UMR_S 1085, F-35000 Rennes, France
| | - Hélène Guegan
- Univ Rennes, CHU de Rennes, Inserm, Irset (Institut de recherche en santé, environnement et travail) - UMR_S 1085, F-35000 Rennes, France; CHU Rennes, Laboratory of Parasitology and Medical Mycology, European Confederation of Medical Mycology (ECMM) Excellence Center, Centre National de Référence Aspergilloses Chroniques, F-35000 Rennes, France
| | - Jean-Pierre Gangneux
- Univ Rennes, CHU de Rennes, Inserm, Irset (Institut de recherche en santé, environnement et travail) - UMR_S 1085, F-35000 Rennes, France; CHU Rennes, Laboratory of Parasitology and Medical Mycology, European Confederation of Medical Mycology (ECMM) Excellence Center, Centre National de Référence Aspergilloses Chroniques, F-35000 Rennes, France
| | - Eric Bellissant
- CHU Rennes, Laboratory of Biological Pharmacology, F-35000 Rennes, France; Univ Rennes, CHU de Rennes, Inserm, Irset (Institut de recherche en santé, environnement et travail) - UMR_S 1085, F-35000 Rennes, France
| | - Florian Lemaitre
- CHU Rennes, Laboratory of Biological Pharmacology, F-35000 Rennes, France; Univ Rennes, CHU de Rennes, Inserm, Irset (Institut de recherche en santé, environnement et travail) - UMR_S 1085, F-35000 Rennes, France
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Konje ET, Kizenga O, Charco NJ, Kibwana UO, Shango N, Tarimo F, Mushi MF. Five-year cross-sectional study to determine the burden of Candida spp. infections of the urinary tract system among patients attending tertiary hospital in Northwestern Tanzania. BMJ Open 2023; 13:e074833. [PMID: 38154909 PMCID: PMC10759120 DOI: 10.1136/bmjopen-2023-074833] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Accepted: 11/17/2023] [Indexed: 12/30/2023] Open
Abstract
OBJECTIVE Urinary tract infections (UTIs) stand as a prominent global health concern. This study entails a 5-year retrospective analysis, using a cross-sectional study design to examine microbiology laboratory data of individuals clinically diagnosed with UTIs at Bugando Medical Centre to gain insights into the prevalence and factors linked to candiduria. METHODOLOGY Data extracted were meticulously cleaned and coded in an MS Excel sheet, subsequently transferred to STATA V.15 for analysis. Binary logistic regression analysis was used to identify factors associated with candiduria. A probability value below 0.05 at a 95% CI was considered statistically significant. RESULTS Urine samples for culture and sensitivity comprised 33.4% (20755) of the total biological samples (62335). The median age of the patients stood at 19 years. A slight majority were female, accounting for 52.8% (10051), and two-thirds sought treatment at outpatient departments (67.5%, 12843). Among patients with significant pathogenic growth, the prevalence of candiduria was 4.6% (221 out of 4772). Notably, inpatients exhibited a higher incidence of candiduria compared with outpatients, with rates of 9.4% (1882) versus 1.6% (2890), p value of 0.000. Non-albicans Candida spp. (NAC) remained the most prevalent pathogen. Factors significantly associated with candiduria included being female (OR=1.7, 95% CI 1.3 to 2.3) and hospital admission (OR=6.6, 95% CI 4.7 to 9.2). In conclusion, candiduria affect 5 out of every 100 UTI-diagnosed patients, predominantly among females and those admitted to the hospital. Clinicians at tertiary hospitals should consider urinary candidiasis as a potential diagnosis for patients at risk who present with UTI-like symptoms.
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Affiliation(s)
- Eveline T Konje
- Department of biostatistics and epidemiology, School of public health, Catholic University of Health and Allied Sciences, Mwanza, Tanzania
| | - Omary Kizenga
- School of pharmacy, Catholic University of Health and Allied Sciences, Mwanza, Tanzania
| | - Noel J Charco
- Weill Bugando School of Medicine, Catholic University of Health and Allied Sciences, Mwanza, Tanzania
| | | | - Nyanda Shango
- Microbiology section, Central pathology laboratory of Bugando Medical Center, Mwanza, Tanzania
| | - Felix Tarimo
- Department of Biochemistry and Molecular Biology, Weill Bugando School of Medicine, Catholic University of Health and Allied Sciences, Mwanza, Tanzania
| | - Martha F Mushi
- Department of biostatistics and epidemiology, School of public health, Catholic University of Health and Allied Sciences, Mwanza, Tanzania
- Microbiology and Immunology Department, Weill Bugando School of Medicine, Catholic University of Health and Allied Sciences, Mwanza, Tanzania
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Ghasemi R, Lotfali E, Rezaei K, Madinehzad SA, Tafti MF, Aliabadi N, Kouhsari E, Fattahi M. Meyerozyma guilliermondii species complex: review of current epidemiology, antifungal resistance, and mechanisms. Braz J Microbiol 2022; 53:1761-1779. [PMID: 36306113 PMCID: PMC9679122 DOI: 10.1007/s42770-022-00813-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2021] [Accepted: 06/30/2022] [Indexed: 01/13/2023] Open
Abstract
Meyerozyma guilliermondii has been accepted as a complex composed of Meyerozyma guilliermondii, Meyerozyma carpophila, and Meyerozyma caribbica. M. guilliermondii is a saprophyte detected on human mucosa and skin. It can lead to serious infections in patients with risk factors like chemotherapy, immunodeficiency, gastrointestinal or cardiovascular surgery, and oncology disorders. Most deaths related to M. guilliermondii infections occur in individuals with malignancy. In recent decades, incidence of M. guilliermondii infections is increased. Sensitivity of this microorganism to conventional antifungals (e.g., amphotericin B, fluconazole, micafungin and anidulafungin) was reduced. Prophylactic and empirical uses of these drugs are linked to elevated minimal inhibitory concentrations (MICs) of M. guilliermondii. Drug resistance has concerned many researchers across the world. They are attempting to discover appropriate solution to combat this challenge. This study reviews the most important mechanisms of resistance to antifungals developed by in M. guilliermondii species complex.
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Affiliation(s)
- Reza Ghasemi
- Student Research Committee, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Ensieh Lotfali
- Department of Medical Parasitology and Mycology, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Kamran Rezaei
- Student Research Committee, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Seyed Ataollah Madinehzad
- Student Research Committee, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mahdi Falah Tafti
- Student Research Committee, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Nikta Aliabadi
- Microbiology Department Islamic, Azad University Tehran Branch, Tehran, Iran
| | - Ebrahim Kouhsari
- Department of Laboratory Sciences, Faculty of Paramedicine, Golestan University of Medical Sciences, Gorgan, Iran
- Laboratory Sciences Research Center, Golestan University of Medical Sciences, Gorgan, Iran
| | - Mahsa Fattahi
- Center for Research and Training in Skin Diseases and Leprosy, Tehran University of Medical Sciences, Tehran, Iran.
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Gharaghani M, Rezaei-Matehkolaei A, Hardani AK, Zarei Mahmoudabadi A. Genotypic diversity and antifungal susceptibility pattern of Candida albicans species isolated from hospitalized paediatric patients with urinary tract infection in Iran. J Appl Microbiol 2021; 131:1017-1027. [PMID: 33460500 DOI: 10.1111/jam.15006] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Revised: 12/29/2020] [Accepted: 01/13/2021] [Indexed: 11/30/2022]
Abstract
AIMS The present study aimed to determine the microsatellite length polymorphism (MLP) genotypic patterns and antifungal susceptibility profiles of Candida albicans isolated from patients with candiduria. METHODS AND RESULTS DNA of 50 C. albicans isolates was used for molecular identification based on the ITS1 -5.8s-ITS2 region. MLP assays were performed to amplify three loci (EF3, CDC3 and HIS3), and PCR products were used for fragment analysis. Antifungal susceptibility tests were performed according to CLSI M27 4th ed guidelines. In all, 38 different genotypes were detected with the three polymorphic loci among C. albicans isolates, and only one genotype was homozygous. In comparison to other countries, our genotypes were divided into three clusters, two of which were linked to France and a third of which was linked to Austria. The genetic structures of the 50 C. albicans isolates revealed varied heterozygosity and significant Hardy-Weinberg equilibrium at the EF3 locus. Only one (2%) and four (8%) of isolates showed resistance to fluconazole and itraconazole, respectively. In C. albicans genotype G25, one (2%) of the isolates showed cross-resistance and non-wild-type resistance to posaconazole, itraconazole and fluconazole. CONCLUSION MLP typing is a useful tool to analyse the genetic structure of C. albicans isolates. High genetic diversity (38 genotypes) was detected in the isolates tested here. Compared to isolates in other countries, the ones from our patients had a clear relationship with French and Austrian isolates. SIGNIFICANCE AND IMPACT OF THE STUDY Iranian isolates of C. albicans have a distinct genotype and show similarities only with French and Austrian isolates.
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Affiliation(s)
- M Gharaghani
- Infectious and Tropical Diseases Research Center, Health Research Institute, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran.,Department of Medical Mycology, School of Medicine, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - A Rezaei-Matehkolaei
- Infectious and Tropical Diseases Research Center, Health Research Institute, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran.,Department of Medical Mycology, School of Medicine, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - A K Hardani
- Department of Pediatrics, School of Medicine, Abuzar Children's Hospital, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - A Zarei Mahmoudabadi
- Infectious and Tropical Diseases Research Center, Health Research Institute, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran.,Department of Medical Mycology, School of Medicine, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
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Aghili SR, Abastabar M, Soleimani A, Haghani I, Azizi S. High prevalence of asymptomatic nosocomial candiduria due to Candida glabrata among hospitalized patients with heart failure: a matter of some concern? Curr Med Mycol 2021; 6:1-8. [PMID: 34195453 PMCID: PMC8226045 DOI: 10.18502/cmm.6.4.5327] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
Background and Purpose: Heart failure is a leading cause of hospitalization, and asymptomatic candiduria is common in hospitalized patients with low morbidity.
However, in most patients, it is resolved spontaneously on the removal of the catheter. Despite the publication of guidelines,
there are still controversies over the diagnosis and management of candiduria.
However, in hospitalized patients with heart failure, the decision to treat candiduria is especially important since
the nosocomial infections are associated with an increase in morbidity, mortality, length of hospital stay, and healthcare costs.
Some species of Candida, such as Candida glabrata, are increasingly resistant to the first-line and second-line antifungal medications.
The present study aimed to investigate the incidence of asymptomatic Candida urinary tract infection due to C.
glabrata and antifungal susceptibility of Candida isolates in hospitalized patients with heart failure. Materials and Methods: In total, 305 hospitalized patients with heart failure were studied to identify asymptomatic nosocomial candiduria during 2016-17
in one private hospital in the north of Iran.
The Sabouraud’s dextrose agar culture plates with a colony count of >104 colony-forming
unit/ml of urine sample were considered as Candida urinary tract infection.
Candida species were identified based on the morphology of CHROMagar Candida (manufactured by CHROMagar, France) and
PCR-RFLP method with MspI restriction enzyme.
Antifungal susceptibility testing of the isolates was performed using five mediations, including itraconazole, voriconazole,
fluconazole, amphotericin B, and caspofungin by broth
microdilution method according to CLSI M27-S4. Results: In this study, the rate of asymptomatic Candida urinary tract infection was 18.8%, which was more common in people above 51
years old and females (70%).
In addition to the urinary and intravascular catheter, the occurrence of candiduria in hospitalized patients had significant relationships
with a history of
surgical intervention, diastolic heart failure, and use of systemic antibiotics (P>0.05). Among Candida spp., non-albicans Candida
species was the most common
infectious agent (59.7%). Moreover, C. glabrata (n=27, 40.3%) (alone or with other species) and Candida albicans (n=27, 40.3%) were the most
common agents isolated in
Candida urinary tract infection. Based on the results of the in vitro susceptibility test, the C. glabrata isolates were 15%, 59%, 70%, 74%,
and 85% susceptible to
caspofungin, amphotericin B, itraconazole, voriconazole, and fluconazole, respectively. Conclusion: According to the findings, there was a high prevalence of asymptomatic Candida urinary tract infection in hospitalized patients with heart failure.
Besides, it was suggested that there was a shift towards non-albicans Candida, especially C. glabrata, in these patients.
Therefore, asymptomatic candiduria in hospitalized patients with heart failure should be considered significant.
Furthermore, the identification of Candida species along with antifungal susceptibility is essential and helps the clinicians to
select the appropriate antifungal agent for better management of such cases.
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Affiliation(s)
- Seyed Reza Aghili
- Invasive Fungi Research Center, Communicable Diseases Institute, Mazandaran University of Medical Sciences, Sari, Iran.,Department of Medical Mycology, Faculty of Medicine, Mazandaran University of Medical Sciences, Sari, Iran
| | - Mahdi Abastabar
- Invasive Fungi Research Center, Communicable Diseases Institute, Mazandaran University of Medical Sciences, Sari, Iran.,Department of Medical Mycology, Faculty of Medicine, Mazandaran University of Medical Sciences, Sari, Iran
| | - Ameneh Soleimani
- Department of Medical Mycology, Faculty of Medicine, Mazandaran University of Medical Sciences, Sari, Iran
| | - Iman Haghani
- Invasive Fungi Research Center, Communicable Diseases Institute, Mazandaran University of Medical Sciences, Sari, Iran.,Department of Medical Mycology, Faculty of Medicine, Mazandaran University of Medical Sciences, Sari, Iran
| | - Soheil Azizi
- Department of Laboratory Medicine, Faculty of Allied Medical Sciences, Mazandaran University of Medical Science, Sari, Iran
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Arastehfar A, Khanjari S, Zareshahrabadi Z, Fang W, Pan W, Asadpour E, Daneshnia F, Ilkit M, Boekhout T, Perlin DS, Zand F, Zomorodian K. Clinical and microbiological features of candiduria in critically ill adult patients in Shiraz, Iran (2016-2018): deviations from international guidelines and fluconazole therapeutic failure. Med Mycol 2020; 59:myaa092. [PMID: 33305331 DOI: 10.1093/mmy/myaa092] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2020] [Accepted: 10/27/2020] [Indexed: 12/15/2022] Open
Abstract
Candiduria is common among patients admitted to intensive care units (ICUs); however, clinical and microbiological data are limited, which accounts for non-compliance with international guidelines, including over treatment of asymptomatic candiduria that promotes antifungal resistance. This prospective study included adult patients admitted to ICUs of five referral hospitals in Shiraz, Iran, during 2016-2018. Species were identified by MALDI-TOF MS, and antifungal susceptibility was assessed according to CLSI M27-A3/S4. Among 2086 patients, 162 and 293 developed candiduria and bacteriuria, respectively. In total, 174 yeast isolates were collected; 88.5% were Candida albicans (91/174; 52.2%), C. glabrata (38/174; 21.8%), and C. tropicalis (25/174; 14.3%). Antifungal resistance was rare; only two isolates (one C. tropicalis and one C. krusei) were fluconazole resistant. Symptomatic candiduria was noted in 31.4% of patients (51/162); only 37% (19/51) of them were treated and 36.82% (7/19) showed fluconazole therapeutic failure. Two symptomatic patients developed candidemia shortly after candiduria. Among asymptomatic patients, 31.5% (35/111) were overtreated with fluconazole. The mortality rate was 25.3% (41/162); it did not differ between symptomatic and asymptomatic patients. Our results indicate that deviation from standard-of-care treatment for candiduria is a matter of concern given the high rate of fluconazole therapeutic failure among patients with symptomatic candiduria. LAY SUMMARY Candiduria is an underestimated clinical presentation among critically ill patients and detailed data are scarce in this regard. Given the high rate of fluconazole therapeutic failure and development of candidemia in some cases, the mistreatment of candiduria should not be overlooked by clinicians.
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Affiliation(s)
- Amir Arastehfar
- Center for Discovery and Innovation, Hackensack Meridian Health, Nutley, New Jersey, USA
| | - Sara Khanjari
- Basic Sciences in Infectious Diseases Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Zahra Zareshahrabadi
- Basic Sciences in Infectious Diseases Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Wenjie Fang
- Shanghai Key Laboratory Molecular Medical Mycology, Shanghai, China
| | - Weihua Pan
- Shanghai Key Laboratory Molecular Medical Mycology, Shanghai, China
| | - Elham Asadpour
- Shiraz Anesthesiology and Critical Care Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Farnaz Daneshnia
- Westerdijk Fungal Biodiversity Institute, Utrecht, The Netherlands
| | - Macit Ilkit
- Division of Mycology, Department of Microbiology, Faculty of Medicine, University of Çukurova, Adana, Turkey
| | - Teun Boekhout
- Shanghai Key Laboratory Molecular Medical Mycology, Shanghai, China
- Westerdijk Fungal Biodiversity Institute, Utrecht, The Netherlands
- Institute of Biodiversity and Ecosystems Dynamics (IBED, University of Amsterdam, Amsterdam, The Netherlands
| | - David S Perlin
- Center for Discovery and Innovation, Hackensack Meridian Health, Nutley, New Jersey, USA
| | - Farid Zand
- Shiraz Anesthesiology and Critical Care Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
- Department of Anesthesia and Critical Care Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Kamiar Zomorodian
- Basic Sciences in Infectious Diseases Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
- Department of Medical Mycology and Parasitology, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
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Duque CM, Sanchez DM, Gaviria A, Vallejo Acosta A, Gómez B, Gómez OM, Rua Giraldo A, Hernandez O. Caracterización de Candida spp. aisladas a partir de urocultivos en la ciudad de Medellín. INFECTIO 2020. [DOI: 10.22354/in.v24i4.879] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Candida spp. es un agente etiológico importante en infecciones del tracto urinario, principalmente en población con terapia antimicótica de amplio espectro y con catéteres urinarios. Candida albicans es la especie más frecuente, pero otras especies han surgido como patógenos emergentes. En este trabajo se recolectaron aislamientos de Candida spp. de urocultivos de pacientes que consultaron en Dinamica IPS entre enero 2016 y noviembre 2017. Para estimar la frecuencia de las especies y observar los patrones de sensibilidad, se realizó la identificación fenotípica y su perfil de sensibilidad con el sistema comercial Vitek 2® (BioMérieux, Inc.), adicionalmente se evaluaron mediante análisis de las secuencia y filogenética ITS1-5.8S-ITS2. En el estudio se incluyeron 78 aislamientos de Candida spp. Las frecuencias de especies de Candida identificadas empleando las herramientas moleculares fueron: C. albicans (38,5%), C. tropicalis (23,1%), C. glabrata (21,8%), C. parapsilosis (10,3%), C. metapsilosis y C. krusei (2,5%) y C. guillermondi (1,3%). La identificación por métodos moleculares y por el sistema Vitek 2 fue: C. albicans (93,3%), C. glabrata (94,1 %), C. tropicalis (83,3%), C. parapsilosis (75%) C. guilliermondii y C. krusei (100%). La sensibilidad de todos los aislamientos al fluconazol fue 93,6%.
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Candida Urinary Tract Infection Among ICU Patients in Isfahan, Iran. ARCHIVES OF CLINICAL INFECTIOUS DISEASES 2019. [DOI: 10.5812/archcid.86472] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
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Arikan-Akdagli S, Gülmez D, Doğan Ö, Çerikçioğlu N, Doluca Dereli M, Birinci A, Yıldıran ŞT, Ener B, Öz Y, Metin DY, Hilmioğlu-Polat S, Kalkancı A, Koç N, Erturan Z, Fındık D. First multicentre report of in vitro resistance rates in candidaemia isolates in Turkey. J Glob Antimicrob Resist 2019; 18:230-234. [DOI: 10.1016/j.jgar.2019.04.003] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2019] [Revised: 03/29/2019] [Accepted: 04/03/2019] [Indexed: 10/27/2022] Open
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Abstract
Background: Adhesion, biofilm formation, yeast-hyphal transition, secretion of enzymes, and hemolytic activity are all considered important factors in Candida tropicalis infection. However, DNA sequence data for this pathogen are limited. In this study, the polymorphism and heterogeneity of genes agglutinin-like sequences (ALS)2, Lipase (LIP)1, LIP4, and secretory aspartyl proteinase tropicalis (SAPT)1-4 as well as the relationship between phenotype and genotype were analyzed. Methods: This study started in August 2013, and ended in July 2017. The complete length of ALS2, LIP1, LIP4, and SAPT1-4 of 68 clinical C. tropicalis isolates was sequenced. Single nucleotide polymorphisms (SNPs) as well as insertions and deletions (indels) were identified within these genes. In addition, phenotypic characteristics of the virulent factors, including adhesion and the secretion of aspartyl proteinases and phospholipases, were determined. Results: There were 73, 24, 17, 16, 13, and 180 SNPs in the genes LIP1, LIP4, SAPT1, SAPT2, SAPT3, and SAPT4, respectively. Furthermore, 209 SNPs were identified in total for the gene ALS2. Interestingly, large fragment deletions and insertions were also found in ALS2. Isolate FXCT 01 obtained from blood had deletions on all 4 sites and showed the lowest adhesion ability on the polymethylpentene surface. In addition, isolates with deletions in the regions 1697 to 1925 and 2073 to 2272 bp displayed relatively low abilities for adhesion and biofilm formation, and this phenotype correlated with the deletions found in ALS2. LIP1, SAPT4, and ALS2 displayed great heterogeneity among the isolates. Large deletions found in gene ALS2 appeared to be associated with the low ability of adhesion and biofilm formation of C. tropicalis. Conclusion: This study might be useful for deeper explorations of gene function and studying the virulent mechanisms of C. tropicalis.
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Antimicrobial Activity of Five Essential Oils against Bacteria and Fungi Responsible for Urinary Tract Infections. Molecules 2018; 23:molecules23071668. [PMID: 29987237 PMCID: PMC6100505 DOI: 10.3390/molecules23071668] [Citation(s) in RCA: 39] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2018] [Revised: 07/04/2018] [Accepted: 07/05/2018] [Indexed: 01/17/2023] Open
Abstract
Urinary tract infections are frequently encountered in small animal practice. Escherichia coli and Enterococcus spp. are the most common agents associated to these infections, even though other bacteria and yeasts, such as Candida albicans and Candida famata, may be involved. In view of the increasing problem of the multi-drug resistance, the aim of this study was to investigate the antimicrobial activity of essential oils obtained from star anise (Illicium verum Hook.f.), basil (Ocimum basilicum L.), origanum (Origanum vulgare L.), clary sage (Salvia sclarea L.) and thymus (Thymus vulgaris L.) against multidrug-resistant strains of Escherichia coli, Enterococcus spp., Candida albicans and Candida famata previously isolated from dogs and cats with urinary tract infections. Enterococci were resistant to Illicium verum and Salvia sclarea, such as Candida to Salvia sclarea. Thymus vulgaris and Origanum vulgare essential oils showed the best activity against all the tested pathogens, so they could be proposed for the formulation of external and/or intravesical washes in small animals.
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García-Agudo L, Rodríguez-Iglesias M, Carranza-González R. Nosocomial Candiduria in the Elderly: Microbiological Diagnosis. Mycopathologia 2017; 183:591-596. [PMID: 29196922 DOI: 10.1007/s11046-017-0232-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2017] [Accepted: 11/25/2017] [Indexed: 10/18/2022]
Abstract
Candiduria is associated with high morbidity, mortality, and long hospitalization, involving high costs for the healthcare system. The use of increasingly aggressive treatments has prolonged the lives of patients susceptible to candiduria, namely the immunosuppressed, the premature, and the elderly. Our objective was to evaluate the incidence of nosocomial candiduria and the implicated species in hospitalized patients aged over 80 years old from three Spanish centers during 2012 and 2013. Urine samples received from these patients were cultured and analyzed by flow cytometry in search of leukocyturia, hematuria, proteinuria, and microbial nitrate reductase activity. The isolated yeast species were identified microscopically, by germ tube formation in serum, colony morphology after subculture onto CHROMagar Candida (Becton-Dickinson, UK), assimilation of carbon compounds ID32C (bioMérieux, France), matrix-assisted laser desorption/ionization time-of-flight mass spectrometry (MALDITOF) (Bruker Daltonics, Germany) and, in case of inconsistency, by sequencing of the ITS regions of ribosomal DNA (ITS1-5, 8S-ITS2). Susceptibility tests were also performed. The incidence of candiduria in the elderly population was 10.3%. A total of 155 strains of yeasts were isolated. The predominant species was Candida albicans, followed by Candida glabrata and then Candida tropicalis. Several infrequent species were found; among them, the first isolate of candiduria-producing Candida pulcherrima described in the literature. Our finding should raise concerns about the elderly population, which is probably the most important risk group for candiduria in the present moment, and the emergence of unusual yeast species producing candiduria, which are resistant against the commonly used antifungal agents.
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Toka Özer T, Durmaz S, Yula E. Antifungal susceptibilities of Candida species isolated from urine culture. J Infect Chemother 2016; 22:629-32. [DOI: 10.1016/j.jiac.2016.06.012] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2015] [Revised: 06/13/2016] [Accepted: 06/29/2016] [Indexed: 11/25/2022]
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Toner L, Papa N, Aliyu SH, Dev H, Lawrentschuk N, Al-Hayek S. Candida growth in urine cultures: a contemporary analysis of species and antifungal susceptibility profiles. QJM 2016; 109:325-9. [PMID: 26537955 PMCID: PMC4888329 DOI: 10.1093/qjmed/hcv202] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2015] [Accepted: 10/05/2015] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Recent publications suggest the distribution of Candida species causing candiduria may vary geographically, which has implications for the continued efficacy of antifungal therapy and emerging resistance. AIM To investigate the incidence of Candiduria at a university hospital in the UK. Further, to assess the distribution of species and the accompanying antifungal susceptibility profile, in order to monitor the clinical utility of current antifungal treatment guidelines for candiduria so that patients receive the best possible outcomes from the most up to date care. DESIGN Retrospective audit. METHODS From 1st January 2005 to 31st October 2014, we retrospectively reviewed 37 538 positive urine cultures recorded in a computerized laboratory results database. Identification and susceptibility testing was performed using the VITEK® 2 fungal susceptibility card (bioMérieux, Marcy d'Etoile, France). RESULTS In total, 96 cultures were positive for Candida species, of which 69 (72%) were C.albicans, which translates to a prevalence of 2.6 per 1000 positive urine cultures. Candiduria was more common in younger patients, males and catheterized females. We report 94 and 73% of isolates of C.albicans and other non-C.albicans Candida species were susceptible to fluconazole. All isolates were susceptible to amphotericin B. CONCLUSIONS Our results add weight to the evidence supporting current European and North American guidelines recommending fluconazole or amphotericin B for treatment of candiduria, if antifungal treatment is clinically indicated.
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Affiliation(s)
- L Toner
- From the Department of Surgery, Urology Unit, University of Melbourne, Melbourne, Australia
| | - N Papa
- From the Department of Surgery, Urology Unit, University of Melbourne, Melbourne, Australia
| | | | - H Dev
- Department of Urology, Addenbrookes' Hospital, Cambridge University, Cambridge, UK
| | - N Lawrentschuk
- From the Department of Surgery, Urology Unit, University of Melbourne, Melbourne, Australia Olivia Newton-John Cancer Research Institute, Austin Health, Melbourne, Australia Department of Surgical Oncology, Peter MacCallum Cancer Centre, Melbourne, Australia
| | - Samih Al-Hayek
- Department of Urology, Addenbrookes' Hospital, Cambridge University, Cambridge, UK
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Micafungin in the treatment of candiduria: A case series. Med Mycol Case Rep 2016; 11:5-8. [PMID: 26937340 PMCID: PMC4752815 DOI: 10.1016/j.mmcr.2016.01.003] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2015] [Revised: 01/25/2016] [Accepted: 01/29/2016] [Indexed: 11/20/2022] Open
Abstract
Echinocandin antifungal agents are not routinely recommended for the treatment of candiduria due to low urine concentrations and a paucity of clinical data supporting this indication. This report presents five cases describing the use of micafungin for the treatment of candiduria. Each patient received parenteral micafungin for a minimum of 6 days and had resolution of baseline fungal within 30 days of treatment completion.
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Zarei Mahmoudabadi A, Rezaei-Matehkolaei A, Navid M, Torabizadeh M, Mazdarani S. Colonization and antifungals susceptibility patterns of Candida species isolated from hospitalized patients in ICUs and NICUs. J Nephropathol 2015; 4:77-84. [PMID: 26312235 PMCID: PMC4544558 DOI: 10.12860/jnp.2015.15] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2015] [Accepted: 02/25/2015] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Several studies have shown that there are an increasing in invasive candidiasis during 2-3 last decades. Although, Candida albicans is considered as the most common candidiasis agents, other non-albicans such as C. glabrata, C. krusei, C. parapsilosis, and C. tropicalis were raised as infectious agents. Resistance to fluconazole among non-albicans species is an important problem for clinicians during therapy and prophylaxis. OBJECTIVES The aim of current study was to detect the Candida species from hospitalized neonatal and children in intensive care units (ICUs) and neonatal intensive care units (NICUs). In addition, the susceptibility of isolated agents were also evaluated against three antifungals. MATERIALS AND METHODS In the present study 298 samples including 98 blood samples, 100 urines and 100 swabs from oral cavity were inoculated on CHROMagar Candida. Initial detection was done according to the coloration colonies on CHROMagar Candida . Morphology on cornmeal agar, germ tube formation and growth at 45°C were confirmed isolates. Amphotericin B, fluconazole and terbinafine (Lamisil) were used for the susceptibility tests using microdilution method. RESULTS In the present study 21% and 34% of urines and swabs from oral cavity were positive for Candida species, respectively. The most common species was C. albicans (62.5%) followed by C. tropicalis (15.6%), C. glabrata (6.3%) and Candida species (15.6%). Our study indicated that the most tested species of Candida, 70.3% were sensitive to fluconazole at the concentration of ≤8 μg/mL. Whereas 9 (14.1%) of isolates were resistant to amphotericine B at ≥8 μg/mL. CONCLUSIONS This study demonstrates the importance of species identification and antifungals susceptibility testing for hospitalized patients in ICUs and NICUs wards.
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Affiliation(s)
- Ali Zarei Mahmoudabadi
- Health Research Institute, Infectious and Tropical Diseases Research Centre, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
- Department of Medical Mycology, School of Medicine, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Ali Rezaei-Matehkolaei
- Department of Medical Mycology, School of Medicine, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Mojgan Navid
- Department of Medical Mycology, School of Medicine, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Mehdi Torabizadeh
- Department of Pediatrics, School of Medicine, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Shahnam Mazdarani
- Department of Pediatrics, School of Medicine, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
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Zarei Mahmoudabadi A, Rezaei-Matehkolaei A, Ghanavati F. The susceptibility patterns of Candida species isolated from urine samples to posaconazole and caspofungin. Jundishapur J Microbiol 2015; 8:e24298. [PMID: 25861442 PMCID: PMC4386077 DOI: 10.5812/jjm.24298] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2014] [Revised: 11/22/2014] [Accepted: 12/05/2014] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Candiduria is a rising condition among hospitalized patients and Candida albicans is the most common recovered agent. However, non-albicans Candida species (NACs) such as C. glabrata, C. krusei, C. parapsilosis, and C. tropicalis are also important. Although most Candida species especially C. albicans are sensitive to routinely used antifungals, an increasing trend in resistance has been observed among NACs. OBJECTIVES The aim of the present study was to detect the susceptibility of Candida strains recovered from candiduria in hospitalized patients against posaconazole and caspofungin. MATERIALS AND METHODS A total of 120 urine samples were taken from patients hospitalized in Intensive Care Units (ICUs) (65) and urology (55) wards. All recovered yeasts were differentiated by using CHROMagar Candida medium and routine tests for identification of Candida species. Minimal inhibitory concentrations (MICs) of all isolates towards posaconazole and caspofungin were determined using the microdilution method with serial dilutions from 8 to 0.0625 µg/mL (posaconazole) and 4 to 0.03125 µg/ mL (caspofungin). RESULTS In total, 41.7% of urine samples were positive for Candida isolation, including C. albicans (46%), C. glabrata (24%), C. tropicalis (16%) and C. krusei (14%). The MIC of caspofungin for 90% of the tested isolates was lower than 2 µg/mL. Furthermore, 94% of the tested isolates were inhibited by posaconazole at lower than 2 µg/mL after 24 hours, whereas 6% of isolates had MICs of more than 4 µg/mL. CONCLUSIONS This study demonstrates the importance of Candida species in urine samples from hospitalized patients in ICUs and urology wards. It showed that both tested antifungals had excellent effects on different species of Candida, however the strains from ICUs were found to be more sensitive to caspofungin than posaconazole.
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Affiliation(s)
- Ali Zarei Mahmoudabadi
- Department of Medical Mycology, School of Medicine, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, IR Iran
- Health Research Institute, Infectious and Tropical Diseases Research Centre, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, IR Iran
- Corresponding author: Ali Zarei Mahmoudabadi, Health Research Institute, Infectious and Tropical Diseases Research Centre, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, IR Iran. Tel: +98-6133330074, Fax: +98-6133332036, E-mail:
| | - Ali Rezaei-Matehkolaei
- Department of Medical Mycology, School of Medicine, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, IR Iran
- Health Research Institute, Infectious and Tropical Diseases Research Centre, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, IR Iran
| | - Fataemeh Ghanavati
- Department of Medical Mycology, School of Medicine, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, IR Iran
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Behzadi P, Behzadi E, Ranjbar R. Urinary tract infections and Candida albicans. Cent European J Urol 2015; 68:96-101. [PMID: 25914847 PMCID: PMC4408390 DOI: 10.5173/ceju.2015.01.474] [Citation(s) in RCA: 62] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2014] [Revised: 10/27/2014] [Accepted: 11/11/2014] [Indexed: 12/14/2022] Open
Abstract
Introduction Urinary tract candidiasis is known as the most frequent nosocomial fungal infection worldwide. Candida albicans is the most common cause of nosocomial fungal urinary tract infections; however, a rapid change in the distribution of Candida species is undergoing. Simultaneously, the increase of urinary tract candidiasis has led to the appearance of antifungal resistant Candida species. In this review, we have an in depth look into Candida albicans uropathogenesis and distribution of the three most frequent Candida species contributing to urinary tract candidiasis in different countries around the world. Material and methods For writing this review, Google Scholar –a scholarly search engine– (http://scholar.google.com/) and PubMed database (http://www.ncbi.nlm.nih.gov/pubmed/) were used. The most recently published original articles and reviews of literature relating to the first three Candida species causing urinary tract infections in different countries and the pathogenicity of Candida albicans were selected and studied. Results Although some studies show rapid changes in the uropathogenesis of Candida species causing urinary tract infections in some countries, Candida albicans is still the most important cause of candidal urinary tract infections. Conclusions Despite the ranking of Candida albicans as the dominant species for urinary tract candidiasis, specific changes have occurred in some countries. At this time, it is important to continue the surveillance related to Candida species causing urinary tract infections to prevent, control and treat urinary tract candidiasis in future.
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Affiliation(s)
- Payam Behzadi
- Islamic Azad University, Shahr-e-Qods Branch, Teheran, Iran
| | - Elham Behzadi
- Islamic Azad University, Shahr-e-Qods Branch, Teheran, Iran
| | - Reza Ranjbar
- Molecular Biology Research Center, Baqiyatallah University of Medical Sciences, Tehran, Iran
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Candida kefyr as a cause of bloodstream infection and adjunctive role of biomarkers in its diagnosis. J Mycol Med 2015; 25:71-5. [DOI: 10.1016/j.mycmed.2014.04.002] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2013] [Revised: 04/20/2014] [Accepted: 04/22/2014] [Indexed: 11/18/2022]
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Genotypic variability and antifungal susceptibility of Candida tropicalis isolated from patients with candiduria. Rev Iberoam Micol 2014; 32:153-8. [PMID: 25766792 DOI: 10.1016/j.riam.2014.06.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2013] [Revised: 03/25/2014] [Accepted: 06/02/2014] [Indexed: 10/24/2022] Open
Abstract
BACKGROUND Candida tropicalis is an emerging major human pathogen in nosocomial infections, and it is considered the second or third species of Candida most isolated from urine cultures. AIMS The study aimed at characterizing genotypically C. tropicalis strains from patients with candiduria in a university hospital, and assessed the antifungal susceptibility profile. METHODS The study was conducted with hospitalized patients who developed urinary tract infection from C. tropicalis from June 2010 to June 2011 at the Grande Dourados University Hospital of the Federal University, Dourados, MS, Brazil. Susceptibility to the antifungal agents amphotericin B and fluconazole was determined by broth microdilution. The genotypic variability of isolates of C. tropicalis was analyzed by microsatellite markers and RAPD-PCR. RESULTS Only one isolate was resistant to amphotericin B (MIC→16μg/ml); the others were susceptible to fluconazole and amphotericin B. The genotypic variability by RAPD-PCR resulted in distinct profiles for RAPD markers. A total of 10 alleles were observed for the microsatellite loci, URA3 and CT14, which were grouped differently, and four associations were observed for locus URA3 and eight for locus CT14. CONCLUSIONS C. tropicalis isolates from urine were susceptible to the antifungal agents tested. The genotyping techniques make possible proving the similarity and genetic diversity among isolates of C. tropicalis involved in nosocomial infections. This knowledge is important for the control and prevention of nosocomial infections caused by this yeast species.
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Czaika V, Nenoff P, Glöckner A, Fegeler W, Becker K, Schmalreck AF. Epidemiology and changes in patient-related factors from 1997 to 2009 in clinical yeast isolates related to dermatology, gynaecology, and paediatrics. Int J Microbiol 2013; 2013:703905. [PMID: 24391669 PMCID: PMC3874336 DOI: 10.1155/2013/703905] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2013] [Revised: 06/30/2013] [Accepted: 07/01/2013] [Indexed: 12/20/2022] Open
Abstract
From 1997 to 2009, 1,862 dermatology, gynaecology, and paediatrics (DGP) associated clinical yeast isolates were analysed for species occurrence, specimen origin and type, (multi-) resistance pattern, and testing period. The top seven of the isolated DGP-associated species remained the same as compared to total medical wards, with Candida albicans (45%) as most frequent pathogen. However, the DGP wards and DGP ICUs showed species-specific profiles; that is, the species distribution is clinic-specific similar and however differs in their percentage from ward to ward. By applying the "one fungus one name" principle, respectively, the appropriate current taxonomic species denominations, it has been shown that no trend to emerging species from 1998 to 2008 could be detected. In particular the frequently isolated non-Candida albicans species isolated in the DGP departments have already been detected in or before 1997. As yeasts are part of the cutaneous microbiota and play an important role as opportunistic pathogens for superficial infections, proper identification of the isolates according to the new nomenclature deems to be essential for specific and calculated antifungal therapy for yeast-like DGP-related infectious agents.
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Affiliation(s)
- Viktor Czaika
- Klinik für Dermatologie, Venerologie und Allergologie, Campus Benjamin Franklin, Charité-Universitätsmedizin Berlin, Hindenburgdamm 30, 12203 Berlin, Germany
| | - Pietro Nenoff
- Laboratorium für medizinische Mikrobiologie, Straße des Friedens 8, 04579 Mölbis, Germany
| | - Andreas Glöckner
- BDH-Klinik Greifswald GmbH, Karl-Liebknecht-Ring 26a, 17491 Greifswald, Germany
| | - Wolfgang Fegeler
- Institute of Medical Microbiology, Domagkstraße 10, 48149 Münster, Germany
| | - Karsten Becker
- Institute of Medical Microbiology, Domagkstraße 10, 48149 Münster, Germany
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Mohammadi R, Mirhendi H, Rezaei-Matehkolaei A, Ghahri M, Shidfar MR, Jalalizand N, Makimura K. Molecular identification and distribution profile ofCandidaspecies isolated from Iranian patients. Med Mycol 2013; 51:657-63. [DOI: 10.3109/13693786.2013.770603] [Citation(s) in RCA: 74] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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