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Durmuş M, Kalkan S, Güzel Karahan S, Biçakcioğlu M, Özdemir N, Gün ZÜ, Özer AB. Can antibiotics affect the clinical features of patients with candidemia? The retrospective evaluation of 5 years of data in an intensive care unit. Eur J Hosp Pharm 2023:ejhpharm-2022-003673. [PMID: 37098442 DOI: 10.1136/ejhpharm-2022-003673] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2022] [Accepted: 04/11/2023] [Indexed: 04/27/2023] Open
Abstract
BACKGROUND Candidemia is an opportunistic infection of intensive care units (ICUs) and causes morbidity and mortality. Multiple antibiotic exposure was found to be an independent risk factor for mortality and non-albicans candidemia (NAC) in candidemia patients. AIM The aim of this study was to determine the relationship between antibiotics and clinical features of patients with candidemia, and to determine the independent risk factors for hospital stay >50 days, 30-day mortality in hospital, candidemia types, and septic shock in candidemia patients. METHODS Patients were evaluated retrospectively for 5 years. A total of 148 candidemia cases were detected and included in the study. Characteristics of cases were defined and recorded. The relationship between qualitative data was determined by the χ2 test. Logistic regression analysis was used to determine the independent risk factors for hospital stay >50 days, 30-day mortality in hospital, candidemia types, and septic shock in candidemia patients. RESULTS The incidence of candidemia for 5 years was 4.5%. Candida parapsilosis was the most reported species with 65% (n=97). Linezolid and central venous catheters (CVC) were found to be independent risk factors for NAC. Carbapenems and cephalosporins were found in association to lower mortality. No antibiotics or characteristics were found to be independent risk factors for mortality. Some broad spectrum antibiotics and antibiotic combinations were found in relationship with hospital stay >50 days; however, none of them were found to be independent risk factors. Metisilin resistant staphylococcus aureus (MRSA) antibiotics, meropenem+linezolid piperacillin-tazobactam+fluoroquinolones and comorbidity were found in association with septic shock, although only piperacillin-tazobactam+fluoroquinolones and comorbidity were found to be independent risk factors for septic shock. CONCLUSIONS This study concluded that many antibiotics were safe for candidemia patients. However, clinicians should pay attention when prescribing linezolid or piperacillin-tazobactam and flouroquinolons concomitantly or sequentially for patients with candidemia risk factors.
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Affiliation(s)
- Mefküre Durmuş
- Clinical Pharmacy, İnönü University Faculty of Pharmacy, Malatya, Turkey
| | - Serkan Kalkan
- Anesthesiology and Reanimation, İnönü University Faculty of Medicine, Malatya, Turkey
| | - Sena Güzel Karahan
- Clinical Pharmacy, İnönü University Faculty of Pharmacy, Malatya, Turkey
| | - Murat Biçakcioğlu
- Anesthesiology and Reanimation, İnönü University Faculty of Medicine, Malatya, Turkey
| | | | - Zeynep Ülkü Gün
- Clinical Pharmacy, İnönü University Faculty of Pharmacy, Malatya, Turkey
| | - Ayşe Belin Özer
- Anesthesiology and Reanimation, İnönü University Faculty of Medicine, Malatya, Turkey
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Aydin S, Derin O, Sahin M, Dinleyici R, Yilmaz M, Ceylan B, Tosun AI, Ozturk R, Mert A. Epidemiology of nosocomial candidemia, mortality and antifungal resistance, 7-year experience, in Turkey. Jpn J Infect Dis 2022; 75:597-603. [PMID: 35908875 DOI: 10.7883/yoken.jjid.2022.181] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Candidemia is an important clinical condition that prolongs the period of hospitalization and increases morbidity, mortality, and hospital costs. In this retrospective study, we aimed to evaluate the epidemiological and microbiological characteristics of patients with candidemia, between January 2013 and December 2019. Two hundred forty-one candidemia episodes were observed in the 230 patients, of whom 45% were female. The median age was 63 and 53.9% of the episodes were in the ICU. Frequently observed predisposing factors for candidemia included the use of antibiotics (71.3%), urinary catheterization (56.3%), Central venous catheter placement (50.3%), total parenteral nutrition (47.9%), solid-organ malignancy (46%), a surgical intervention (48.6%), chemotherapy (37%), steroid treatment (25.5%). The crude mortality rate was 52.7%. A significant difference was found between survivors and non-survivors (p = 0.007) with the Charlson comorbidity index. However, no statistically significant association was found between mortality and age, sex, surgical intervention, catheter-related candidemia, or Candida spp. The most frequently isolated Candida spp. was C. albicans (51%). Overall resistance to fluconazole, voriconazole, caspofungin, micafungin and flucytosine was 3.7%, 0%, 2.5%, 1.8%,1.8%, respectively. Consequently, there is a need for tests that yield higher success rates and rapid in diagnosis candidemia and local epidemiological data for antifungal resistance.
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Affiliation(s)
- Selda Aydin
- Department of Infectious Diseases and Clinical Microbiology, Istanbul Medipol University, School of Medicine, Turkey
| | - Okan Derin
- Department of Infectious Diseases and Clinical Microbiology, University of Health Science Turkey, Sisli Hamidiye Etfal Training and Research Hospital, Turkey
| | - Meyha Sahin
- Department of Infectious Diseases and Clinical Microbiology, Istanbul Medipol University, School of Medicine, Turkey
| | - Rumeysa Dinleyici
- Department of Clinical Pharmacy, Istanbul Medipol University, School of Pharmacy, Turkey
| | - Mesut Yilmaz
- Department of Infectious Diseases and Clinical Microbiology, Istanbul Medipol University, School of Medicine, Turkey
| | - Bahadır Ceylan
- Department of Infectious Diseases and Clinical Microbiology, Istanbul Medipol University, School of Medicine, Turkey
| | - Ayse Istanbullu Tosun
- Department of Medical Microbiology; Istanbul Medipol University School of Medicine, Turkey
| | - Recep Ozturk
- Department of Infectious Diseases and Clinical Microbiology, Istanbul Medipol University, School of Medicine, Turkey
| | - Ali Mert
- Department of Internal Medicine, Istanbul Medipol University, School of Medicine, Turkey
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Taher OMEA, Othman HBEA, Gedawy SABG, Elarab HE, Elkhatib WF, El-Razzaz MK. Evaluation of Pan-fungal PCR in Early Detection of Invasive Fungal Infection in Egyptian Patients with Hematological Malignancies. Jpn J Infect Dis 2022; 75:543-548. [PMID: 35768275 DOI: 10.7883/yoken.jjid.2022.105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Incidence of invasive fungal infections (IFI) has increased due to the rising influx of patients suffering from immunodeficiency. A case-control analysis was performed at Ain Shams University Hospitals, Cairo, Egypt. The cases group (n = 80) included eighty patients diagnosed with hematological malignancies and the control group (n = 20) included twenty patients. All patients were tested for the detection of fungal species using blood culture, pan-fungal Real Time PCR. Fungal species differentiation was made by High Resolution Melting (HRM) PCR. The clinical cases suspected to have IFD were 39 cases out of the 80 patients. Pan-fungal PCR detection rate was 41/80 (51.3 %). HRM-PCR identified the fungal species to be 51.2% Candida albicans, 44% Non-Candida albicans, and 4.9% Mucor. Blood culture was positive in 2 patients with acute myeloid leukaemia (AML). There was a highly significant rate of fungal detection using pan-fungal Real Time PCR technique compared to blood culture technique (p <0.001). Real Time PCR using pan-fungal marker is a sensitive, rapid, and superior to blood culture in detection of IFI and HRM-PCR is a specific test for species identification.
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Affiliation(s)
| | | | | | - Hoda Ezz Elarab
- Clinical Pathology Department, Faculty of Medicine, Ain Shams University, Egypt
| | - Walid Faisal Elkhatib
- Microbiology and Immunology Department, Faculty of Pharmacy, Ain Shams University, Egypt.,Department of Microbiology & Immunology, Faculty of Pharmacy, Galala University, Egypt
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Thomas-Rüddel D, Schlattmann P, Pletz M, Kurzai O, Bloos F. Risk factors for invasive candida infection in critically ill patients - a systematic review and meta-analysis. Chest 2021; 161:345-355. [PMID: 34673022 PMCID: PMC8941622 DOI: 10.1016/j.chest.2021.08.081] [Citation(s) in RCA: 45] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Revised: 08/03/2021] [Accepted: 08/07/2021] [Indexed: 11/28/2022] Open
Abstract
Background Current guidelines recommend empirical antifungal therapy in patients with sepsis with high risk of invasive Candida infection. However, many different risk factors have been derived from multiple studies. These risk factors lack specificity, and broad application would render most ICU patients eligible for empirical antifungal therapy. Research Question What risk factors for invasive Candida infection can be identified by a systematic review and meta-analysis? Study Design and Methods We searched PubMed, Web of Science, ScienceDirect, Biomed Central, and Cochrane and extracted the raw and adjusted OR for each risk factor associated with invasive Candida infection. We calculated pooled ORs for risk factors present in more than one study. Results We included 34 studies in our meta-analysis resulting in the assessment of 29 possible risk factors. Risk factors for invasive Candida infection included demographic factors, comorbid conditions, and medical interventions. Although demographic factors do not play a role for the development of invasive Candida infection, comorbid conditions (eg, HIV, Candida colonization) and medical interventions have a significant impact. The risk factors associated with the highest risk for invasive Candida infection were broad-spectrum antibiotics (OR, 5.6; 95% CI, 3.6-8.8), blood transfusion (OR, 4.9; 95% CI, 1.5-16.3), Candida colonization (OR, 4.7; 95% CI, 1.6-14.3), central venous catheter (OR, 4.7; 95% CI, 2.7-8.1), and total parenteral nutrition (OR, 4.6; 95% CI, 3.3-6.3). However, dependence between the various risk factors is probably high. Interpretation Our systematic review and meta-analysis identified patient- and treatment-related factors that were associated with the risk for the development of invasive Candida infection in the ICU. Most of the factors identified were either related to medical interventions during intensive care or to comorbid conditions.
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Affiliation(s)
- Daniel Thomas-Rüddel
- Center for Sepsis Control & Care, Jena University Hospital, Jena, Germany;; Dept. of Anesthesiology and Intensive Care Medicine, Jena University Hospital, Jena, Germany;.
| | - Peter Schlattmann
- Institut für Medizinische Statistik, Informatik und Datenwissenschaften (IMSID), Jena University Hospital Jena
| | - Mathias Pletz
- Center for Sepsis Control & Care, Jena University Hospital, Jena, Germany;; Institute for Infectious Diseases and Infection Control, Jena University Hospital Jena
| | - Oliver Kurzai
- Center for Sepsis Control & Care, Jena University Hospital, Jena, Germany;; National Reference Center for Invasive Fungal Infections NRZMyk, Leibniz Institute for Natural Product Research and Infection Biology - Hans-Knoell-Institute, Jena; University of Wuerzburg, Institute for Hygiene and Microbiology, Germany
| | - Frank Bloos
- Center for Sepsis Control & Care, Jena University Hospital, Jena, Germany;; Dept. of Anesthesiology and Intensive Care Medicine, Jena University Hospital, Jena, Germany
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Alenazy H, Alghamdi A, Pinto R, Daneman N. Candida colonization as a predictor of invasive candidiasis in non-neutropenic ICU patients with sepsis: A systematic review and meta-analysis. Int J Infect Dis 2020; 102:357-362. [PMID: 33157294 DOI: 10.1016/j.ijid.2020.10.092] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2020] [Revised: 10/26/2020] [Accepted: 10/27/2020] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND Candida colonization is a risk factor for the development of invasive candidiasis. This study sought to estimate the magnitude of this association, and determine if this information can be used to guide empirical antifungal therapy initiation in critically ill septic patients. METHODS PubMed/MEDLINE and Embase were systematically reviewed for all published studies evaluating predictors of invasive candidiasis in ICU patients with sepsis. Meta-analysis was used to determine the pooled odds ratio for invasive candidiasis among colonized versus non-colonized patients. Sensitivity (SN), specificity (SP), positive and negative predictive values (PPV, NPV), and positive and negative likelihood ratios (+LR, -LR) were then calculated by considering the presence/absence of Candida colonization as the diagnostic test, and the presence/absence of invasive candidiasis as the disease of interest. RESULTS Out of 9825 patients in the 10 eligible studies, 3886 (40%) were colonized with Candida and 462 patients (4.7%) developed invasive candidiasis. Meta-analysis indicated that critically ill patients with sepsis who are colonized with candida are more likely to develop invasive candidiasis (odds ratio 3.32; 95% CI 1.68-6.58) compared with non-colonized patients. The pooled SN was 75.2% (95% CI 59.6-86.2%), while the pooled SP was 49.2% (95% CI 33.2-65.3%).The NPV of Candida colonization was high (96.9%; 95% CI 92.0-98.9%), but the PPV was low (9.1%; 95% CI 5.5-14.6%). CONCLUSION Candida colonization is strongly associated with the likelihood of invasive candidiasis among ICU patients with sepsis. Available data argue against initiating empirical antifungal treatment in non-neutropenic septic patients without prior documented Candida colonization.
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Affiliation(s)
- Hameid Alenazy
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Amenah Alghamdi
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | | | - Nick Daneman
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada; Sunnybrook Research Institute, Toronto, Ontario, Canada; Division of Infectious Diseases, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada.
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Abstract
OBJECTIVE This study aimed to evaluate the duration of intensive care unit (ICU) stay prior to onset of invasive candidiasis (IC)/candidaemia. DESIGN Systematic review and meta-analysis. DATA SOURCES PubMed, Cochrane, Embase and Web of Science databases were searched through June 2019 to identify relevant studies. ELIGIBILITY CRITERIA Adult patients who had been admitted to the ICU and developed an IC infection. DATA EXTRACTION AND SYNTHESIS The following data were extracted from each article: length of hospital stay, length of ICU stay, duration of ICU admission prior to candidaemia onset, percentage of patients who received antibiotics and duration of their antibiotic therapy prior to candidaemia onset, and overall mortality. In addition to the traditional meta-analyses, meta-regression was performed to explore possible mediators which might have contributed to the heterogeneity. RESULTS The mean age of patients ranged from 28 to 76 years across selected studies. The pooled mean duration of ICU admission before onset of candidaemia was 12.9 days (95% CI 11.7 to 14.2). The pooled mean duration of hospital stay was 36.3±5.3 days (95% CI 25.8 to 46.7), and the pooled mean mortality rate was 49.3%±2.2% (95% CI 45.0% to 53.5%). There was no significant difference in duration of hospital stay (p=0.528) or overall mortality (p=0.111), but a significant difference was observed in the mean length of ICU stay (2.8 days, p<0.001), between patients with and without Candida albicans. Meta-regression analysis found that South American patients had longer duration of ICU admission prior to candidaemia onset than patients elsewhere, while those in Asia had the shortest duration. CONCLUSIONS Patients with IC are associated with longer ICU stay, with the shortest duration of ICU admission prior to the candidaemia onset in Asia. This shows a more proactive strategy in the diagnosis of IC should be considered in caring for ICU patients.
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Affiliation(s)
- Zhidan Zhang
- Department of Critical Care Medicine, The First Hospital of China Medical University, Shenyang, China
| | - Ran Zhu
- Department of Critical Care Medicine, The First Hospital of China Medical University, Shenyang, China
| | - Zhenggang Luan
- Department of Critical Care Medicine, The First Hospital of China Medical University, Shenyang, China
| | - Xiaochun Ma
- Department of Critical Care Medicine, The First Hospital of China Medical University, Shenyang, China
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Tulasidas S, Rao P, Bhat S, Manipura R. A study on biofilm production and antifungal drug resistance among Candida species from vulvovaginal and bloodstream infections. Infect Drug Resist 2018; 11:2443-2448. [PMID: 30538510 PMCID: PMC6260174 DOI: 10.2147/idr.s179462] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Introduction Candida species, one among the opportunistic fungi, has become a common pathogen causing vaginal thrush and nosocomial bloodstream infections (BSIs). This study aims to evaluate the prevalence and antifungal susceptibility of various Candida species and slime production by Candida species in BSIs and vulvovaginal candidiasis (VVC). Materials and methods A total of 176 samples were collected for a period of 1 year. Anti-fungal susceptibility testing and biofilm production testing were performed by the Kirby-Bauer method and crystal violet assay, respectively. Results Out of 176 samples, 74 (42%) were from BSIs and 102 (58%) were from VVC. The biofilm production was comparatively high in blood isolates, 55 (74%), than cervical isolates, 45 (44%). Increase in the trends of non-albicans Candida (NAC) species was seen in our setup. Good susceptibility rates were seen among Candida species, 82.38% to voriconazole and an increasing resistance pattern of 26.13% to fluconazole. Conclusion Speciation of Candida becomes important as the prevalence of NAC is increasing. Antifungal susceptibility testing by the disk diffusion method is cost effective and should be adopted in routine testing as there is an increasing azole resistance, especially in invasive NAC infections. In this study, there was no correlation of antifungal drugs with the biofilm production.
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Affiliation(s)
- Sanyuktha Tulasidas
- Department of Microbiology, Kasturba Medical College, Manipal Academy of Higher Education, Mangalore, Manipal, India
| | - Pooja Rao
- Department of Microbiology, Kasturba Medical College, Manipal Academy of Higher Education, Manipal McGill Center for Infectious Diseases, Mangalore, Manipal, India,
| | - Sevitha Bhat
- Department of Microbiology, Kasturba Medical College, Manipal Academy of Higher Education, Manipal McGill Center for Infectious Diseases, Mangalore, Manipal, India,
| | - Radhakrishna Manipura
- Department of Microbiology, Kasturba Medical College, Manipal Academy of Higher Education, Mangalore, Manipal, India
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Vaquero-Herrero MP, Ragozzino S, Castaño-Romero F, Siller-Ruiz M, Sánchez González R, García-Sánchez JE, García-García I, Marcos M, Ternavasio-de la Vega HG. The Pitt Bacteremia Score, Charlson Comorbidity Index and Chronic Disease Score are useful tools for the prediction of mortality in patients with Candida
bloodstream infection. Mycoses 2017; 60:676-685. [DOI: 10.1111/myc.12644] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2017] [Revised: 05/02/2017] [Accepted: 05/22/2017] [Indexed: 11/29/2022]
Affiliation(s)
| | - Silvio Ragozzino
- Department of Internal Medicine; University Hospital of Salamanca; Salamanca Spain
- Institute of Biomedical Research of Salamanca (IBSAL); Salamanca Spain
| | | | - María Siller-Ruiz
- Department of Microbiology; University Hospital of Salamanca; Salamanca Spain
| | | | - José Elías García-Sánchez
- Department of Microbiology; University Hospital of Salamanca; Salamanca Spain
- Institute of Biomedical Research of Salamanca (IBSAL); Salamanca Spain
- University of Salamanca (USAL); Salamanca Spain
| | - Inmaculada García-García
- Department of Microbiology; University Hospital of Salamanca; Salamanca Spain
- Institute of Biomedical Research of Salamanca (IBSAL); Salamanca Spain
| | - Miguel Marcos
- Department of Internal Medicine; University Hospital of Salamanca; Salamanca Spain
- Institute of Biomedical Research of Salamanca (IBSAL); Salamanca Spain
- University of Salamanca (USAL); Salamanca Spain
| | - Hugo Guillermo Ternavasio-de la Vega
- Department of Internal Medicine; University Hospital of Salamanca; Salamanca Spain
- Institute of Biomedical Research of Salamanca (IBSAL); Salamanca Spain
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Enoch DA, Yang H, Aliyu SH, Micallef C. The Changing Epidemiology of Invasive Fungal Infections. Methods Mol Biol 2017; 1508:17-65. [PMID: 27837497 DOI: 10.1007/978-1-4939-6515-1_2] [Citation(s) in RCA: 226] [Impact Index Per Article: 32.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Invasive fungal infections (IFI) are an emerging problem worldwide with invasive candidiasis and candidemia responsible for the majority of cases. This is predominantly driven by the widespread adoption of aggressive immunosuppressive therapy among certain patient populations (e.g., chemotherapy, transplants) and the increasing use of invasive devices such as central venous catheters (CVCs). The use of new immune modifying drugs has also opened up an entirely new spectrum of patients at risk of IFIs. While the epidemiology of candida infections has changed in the last decade, with a gradual shift from C. albicans to non-albicans candida (NAC) strains which may be less susceptible to azoles, these changes vary between hospitals and regions depending on the type of population risk factors and antifungal use. In certain parts of the world, the incidence of IFI is strongly linked to the prevalence of other disease conditions and the ecological niche for the organism; for instance cryptococcal and pneumocystis infections are particularly common in areas with a high prevalence of HIV disease. Poorly controlled diabetes is a major risk factor for invasive mould infections. Environmental factors and trauma also play a unique role in the epidemiology of mould infections, with well-described hospital outbreaks linked to the use of contaminated instruments and devices. Blastomycosis is associated with occupational exposure (e.g., forest rangers) and recreational activities (e.g., camping and fishing).The true burden of IFI is probably an underestimate because of the absence of reliable diagnostics and lack of universal application. For example, the sensitivity of most blood culture systems for detecting candida is typically 50 %. The advent of new technology including molecular techniques such as 18S ribosomal RNA PCR and genome sequencing is leading to an improved understanding of the epidemiology of the less common mould and dimorphic fungal infections. Molecular techniques are also providing a platform for improved diagnosis and management of IFI.Many factors affect mortality in IFI, not least the underlying medical condition, choice of therapy, and the ability to achieve early source control. For instance, mortality due to pneumocystis pneumonia in HIV-seronegative individuals is now higher than in seropositive patients. Of significant concern is the progressive increase in resistance to azoles and echinocandins among candida isolates, which appears to worsen the already significant mortality associated with invasive candidiasis. Mortality with mould infections approaches 50 % in most studies and varies depending on the site, underlying disease and the use of antifungal agents such as echinocandins and voriconazole. Nevertheless, mortality for most IFIs has generally fallen with advances in medical technology, improved care of CVCs, improved diagnostics, and more effective preemptive therapy and prophylaxis.
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Affiliation(s)
- David A Enoch
- National Infection Service, Public Health England, Cambridge Microbiology and Public Health Laboratory, Addenbrooke's Hospital, Box 236, Cambridge Biomedical Campus, Hills Road, Cambridge, CB2 0QW, UK.
| | - Huina Yang
- National Infection Service, Public Health England, Cambridge Microbiology and Public Health Laboratory, Addenbrooke's Hospital, Box 236, Cambridge Biomedical Campus, Hills Road, Cambridge, CB2 0QW, UK
| | - Sani H Aliyu
- National Infection Service, Public Health England, Cambridge Microbiology and Public Health Laboratory, Addenbrooke's Hospital, Box 236, Cambridge Biomedical Campus, Hills Road, Cambridge, CB2 0QW, UK
| | - Christianne Micallef
- National Infection Service, Public Health England, Cambridge Microbiology and Public Health Laboratory, Addenbrooke's Hospital, Box 236, Cambridge Biomedical Campus, Hills Road, Cambridge, CB2 0QW, UK
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Gaspar GG, Menegueti MG, Auxiliadora-Martins M, Basile-Filho A, Martinez R. Evaluation of the predictive indices for candidemia in an adult intensive care unit. Rev Soc Bras Med Trop 2015; 48:77-82. [DOI: 10.1590/0037-8682-0292-2014] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2014] [Accepted: 02/04/2015] [Indexed: 05/28/2023] Open
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Jekarl DW, Lee SY, Lee S, Park YJ, Lee J, Baek SM, An YJ, Ock SM, Lee MK. Comparison of the Bactec Fx Plus, Mycosis IC/F, Mycosis/F Lytic blood culture media and the BacT/Alert 3D FA media for detection of Candida species in seeded blood culture specimens containing therapeutic peak levels of fluconazole. J Clin Lab Anal 2013; 26:412-9. [PMID: 23143623 DOI: 10.1002/jcla.21535] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
BACKGROUND The performance of Bactec Fx Plus Aerobic/F (PA), Mycosis IC/F (MF), Myco/F Lytic (ML) media and BacT/Alert 3D FA (FA) media in detecting 15 Candida isolates in blood cultures to which fluconazole had been added was investigated. METHODS PA with resin, MF, ML media (n = 360), and FAmedia (n = 120) were tested against Candida albicans, C. tropicalis, C. parapsilosis, and C. krusei. As the peak plasma concentration after single oral doses of fluconazole 100, 200, and 400 mg was equivalent to peak level of 1.9, 4.7, and 6.7 mg/l, respectively, corresponding fluconazole was added. Time to detection (TTD) was measured. RESULTS Overall TTD (mean hour ± standard deviation) for PA, FA, MF, and ML was as follows: 24.5 ± 7.3, 27.0 ± 7.5, 31.9 ± 21.3, and 37.7 ± 30.1, respectively. TTD of PA was shorter compared to other media. The effect of fluconazole was limited in PA and FA, but MF and ML showed delayed TTD. Larger inoculum size showed shorter TTDin PA and FA. CONCLUSION TTD of Bactec Fx Plus Aerobic/F was more than 2.5 hr faster among the tested media. As thus system and media are unaffected by added fluconazole, it could be used for the diagnosis of candidemia in the clinical settings including the patients who have been treated empirically with fluconazole at the time when blood cultures were drawn.
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Affiliation(s)
- Dong Wook Jekarl
- Department of Laboratory Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea
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Mootsikapun P, Hsueh PR, Talwar D, Co VM, Rajadhyaksha V, Ong ML. Intravenous anidulafungin followed optionally by oral voriconazole for the treatment of candidemia in Asian patients: results from an open-label Phase III trial. BMC Infect Dis 2013; 13:219. [PMID: 23676114 PMCID: PMC3659089 DOI: 10.1186/1471-2334-13-219] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2012] [Accepted: 05/07/2013] [Indexed: 11/10/2022] Open
Abstract
Background Candidemia is a significant cause of morbidity and mortality in hospitalized patients, particularly in Asia. Anidulafungin has been reported to be an effective treatment for candidemia in Western populations, but little is known about its efficacy in Asian patients, where the clinical presentation and epidemiology may be different. Methods An open-label study of anidulafungin for the treatment of candidemia was recently conducted in several Asian countries. Treatment was initiated with intravenous anidulafungin, given for at least 5 days, with the option to complete treatment with oral voriconazole. The primary endpoint was global (clinical and microbiological) response, and the primary analysis was the proportion of patients in the modified intent-to-treat population with successful global response at the end of therapy. Secondary analyses included proportion with successful global response in clinically relevant patient subgroups. The safety and tolerability profile of anidulafungin and voriconazole in this population was also investigated. Results Forty-three patients were studied, including 42 in the modified intent-to-treat population. Eighteen patients were > 65 years, the largest age subgroup, and 21 had central venous catheters. The most common Candida species causing infection were C. tropicalis (n = 18) and C. albicans (n = 10). In the primary analysis, 73.8% had a successful global response at end of therapy. Success rates in subgroups were: 72.2% for C. tropicalis and 71.4% for C. albicans infection, 58.8% for patients > 65 years, and 81.0% for patients with central venous catheters. Safety and tolerability were comparable with the known profiles for anidulafungin (and voriconazole). Conclusions Although the epidemiology of Candida infections was different in this open-label study, the efficacy of anidulafungin in Asian patients with documented candidemia was consistent with previous studies in Western populations. No new safety concerns were identified. Trial registration http://www.clinicaltrials.gov identifier NCT00537329
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Dotis J, Roilides E. Candidemia in the Pediatric Intensive Care Unit: What’s Different from Candidemia in Adults? CURRENT FUNGAL INFECTION REPORTS 2011. [DOI: 10.1007/s12281-010-0043-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Kim S, Ko KS, Moon SY, Lee MS, Lee MY, Son JS. Catheter-related candidemia caused by Candida haemulonii in a patient in long-term hospital care. J Korean Med Sci 2011; 26:297-300. [PMID: 21286025 PMCID: PMC3031018 DOI: 10.3346/jkms.2011.26.2.297] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2010] [Accepted: 10/11/2010] [Indexed: 12/05/2022] Open
Abstract
Candida haemulonii, one of the non-albicans Candida species, is an emerging yeast pathogen that is known to be resistant to amphotericin B and other antifungal agents such as azoles. These anti-fungal agents have often been associated with clinical treatment failure, so no treatment regimen has been clearly established for invasive C. haemulonii infections. We investigated a catheter-related infection of C. haemulonii candidemia in an adult patient in long-term hospital care. In the early stages, the candidemia remained persistent despite treatment with fluconazole. However, after changing the antifungal agent to caspofungin, the candidemia was resolved. Fluconazole and amphotericin B are not reliable empirical antifungal agents for invasive C. haemulonii infections, as shown in previous case reports. An echinocandin such as caspofungin may be an appropriate empirical choice of antifungal agent for an invasive C. haemulonii infection.
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Affiliation(s)
- Sunyong Kim
- Division of Infectious Disease, Department of Internal Medicine, Kyung Hee University College of Medicine, Seoul, Korea
| | - Kwan Soo Ko
- Asia Pacific Foundation for Infectious Diseases (APFID), Seoul, Korea
- Department of Molecular Cell Biology, Sungkyunkwan University School of Medicine, Suwon, Korea
| | - Su Yeon Moon
- Division of Infectious Disease, Department of Internal Medicine, Kyung Hee University College of Medicine, Seoul, Korea
| | - Mi Suk Lee
- Division of Infectious Disease, Department of Internal Medicine, Kyung Hee University College of Medicine, Seoul, Korea
| | - Mi Young Lee
- Asia Pacific Foundation for Infectious Diseases (APFID), Seoul, Korea
| | - Jun Seong Son
- Division of Infectious Disease, Department of Internal Medicine, Kyung Hee University College of Medicine, Seoul, Korea
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Ko KS, Lee JY, Song JH, Peck KR. In vitro evaluation of antibiotic lock technique for the treatment of Candida albicans, C. glabrata, and C. tropicalis biofilms. J Korean Med Sci 2010; 25:1722-6. [PMID: 21165285 PMCID: PMC2995224 DOI: 10.3346/jkms.2010.25.12.1722] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2010] [Accepted: 08/03/2010] [Indexed: 11/20/2022] Open
Abstract
Candidaemia associated with intravascular catheter-associated infections is of great concern due to the resulting high morbidity and mortality. The antibiotic lock technique (ALT) was previously introduced to treat catheter-associated bacterial infections without removal of catheter. So far, the efficacy of ALT against Candida infections has not been rigorously evaluated. We investigated in vitro activity of ALT against Candida biofilms formed by C. albicans, C. glabrata, and C. tropicalis using five antifungal agents (caspofungin, amphotericin B, itraconazole, fluconazole, and voriconazole). The effectiveness of antifungal treatment was assayed by monitoring viable cell counts after exposure to 1 mg/mL solutions of each antibiotic. Fluconazole, itraconazole, and voriconazole eliminated detectable viability in the biofilms of all Candida species within 7, 10, and 14 days, respectively, while caspofungin and amphotericin B did not completely kill fungi in C. albicans and C. glabrata biofilms within 14 days. For C. tropicalis biofilm, caspofungin lock achieved eradication more rapidly than amphotericin B and three azoles. Our study suggests that azoles may be useful ALT agents in the treatment of catheter-related candidemia.
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Affiliation(s)
- Kwan Soo Ko
- Department of Molecular Cell Biology, Sungkyunkwan University School of Medicine, Suwon, Korea
- Asia Pacific Foundation for Infectious Diseases (APFID), Seoul, Korea
| | - Ji-Young Lee
- Department of Molecular Cell Biology, Sungkyunkwan University School of Medicine, Suwon, Korea
| | - Jae-Hoon Song
- Asia Pacific Foundation for Infectious Diseases (APFID), Seoul, Korea
- Division of Infectious Diseases, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Kyong Ran Peck
- Division of Infectious Diseases, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
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Lee K, Kim H, Kim J, Lee G, Lee H, Kim H, Kim D, Sohn I, Pai H. Successful Treatment of Recurrent Methicillin-resistant Staphylococcus aureusBacteremia and Endocarditis by Linezolid, Valve Replacement, and Excisional Surgery of Limb in a Patient with Complicated Arteriovenous Malformation. Infect Chemother 2010. [DOI: 10.3947/ic.2010.42.6.415] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Affiliation(s)
- Kangwon Lee
- Department of Internal Medicine, Hanyang University College of Medicine, Seoul, Korea
| | - Hyuck Kim
- Department of Thoracic and Cardiovascular surgery, Hanyang University College of Medicine, Seoul, Korea
| | - Jieun Kim
- Department of Internal Medicine, Hanyang University College of Medicine, Seoul, Korea
| | - Gilwoo Lee
- Department of Internal Medicine, Hanyang University College of Medicine, Seoul, Korea
| | - Hyungtak Lee
- Department of Internal Medicine, Hanyang University College of Medicine, Seoul, Korea
| | - Hyungtae Kim
- Department of Internal Medicine, Hanyang University College of Medicine, Seoul, Korea
| | - Dongchan Kim
- Department of Internal Medicine, Hanyang University College of Medicine, Seoul, Korea
| | - Ilwoong Sohn
- Department of Internal Medicine, Hanyang University College of Medicine, Seoul, Korea
| | - Hyunjoo Pai
- Department of Internal Medicine, Hanyang University College of Medicine, Seoul, Korea
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