Background: Candidaemia is the most common form of invasive candidiasis. Resistant Candida blood stream infection (BSI) is rising, with limitations on the development of broader-spectrum antifungal agents worldwide. Our study aimed to identify the occurrence of antifungal-resistant candidaemia and the distribution of these species, determine the risk factors associated with antifungal resistance and evaluate the association of antifungalresistant candidaemia with the length of intensive care unit (ICU) and hospital stay and with 30-day mortality.

Background Candidemia is the most common form of invasive candidiasis. Resistant Candida blood stream infection (BSI) is rising with limitation in the development of broader spectrum antifungal agents worldwide. Our study aimed to identify rate of antifungal resistance candidemia and distribution for species, determine risk factors associated with antifungal resistance and evaluate the association of antifungal resistance candidemia with length of Intensive Care Unit (ICU) and hospital stay and with 30-day mortality. Methods A retrospective cohort study was conducted at King Faisal Specialist Hospital and Research Centre, Jeddah, Saudi Arabia. Adult patients diagnosed with candidemia from January 2006 to December 2017 were included. Results A total of 196 BSI was identified in 94 males (49.74%) and 95 females (50.26%). C.glabrata was the most common isolated Candida 59 (30%) followed by C. albicans 46 (23%). Susceptibility data were available for 122/189 patients in which 26/122 (21%) found to have one or more antifungal resistance. C. parapsilosis isolates with available sensitivity data were 31/122 in which 10/31 (32%) were resistant to fluconazole. Risk factors significantly associated with antifungal resistance candidemia include previous echinocandin exposure (Odd Ratio (OR) =1.38; 95% Confidence Interval (CI) (1.02-1.85); P= 0.006) and invasive ventilation (OR=1.3; 95% CI (1.08-1.57); P= 0.005). Median length of ICU stay was 29 days [range12-49 days] in antifungal resistance group and 18 days [range 6.7-37.5 days] in antifungal sensitive group; Median length of hospital stay was 51days [range 21-138 days] in antifungal resistance group and 35 days [range 17-77 days] in antifungal sensitive group. Thirty- day mortality was 15 (57.7%) and 54 (56.25%) among antifungal resistance and antifungal sensitive group, respectively (OR=1.01; 95% CI (0.84-1.21); P= 0.89). Conclusions Our results indicate an increase in the rate of non-albicans candidemia. Candida parapsilosis resistance to fluconazole is alarming. Further studies are required to confirm this finding.

Patients with muscle disorders are a diagnostic challenge to physicians, because of the various ways of presentation. A comprehensive approach should be followed systematically in order to reach the correct diagnosis. Weakness is a common symptom among patients including those with central or peripheral nervous systems diseases and those with muscular and/or neuromuscular diseases. Muscle weakness is not only a regular finding in rheumatologic diseases, but in inflammatory myopathies as well. This chapter focuses on skills needed to approach any patient that presents with weakness, specifically proximal myopathy.

Background: Candidaemia is the most common form of invasive candidiasis. Resistant Candida blood stream infection (BSI) is rising , with limitations on the development of broader-spectrum antifungal agents worldwide. Our study aimed to identify the occurrence of antifungal-resistant candidaemia and the distribution of these species, determine the risk factors associated with antifungal resistance and evaluate the association of antifungal-resistant candidaemia with the length of intensive care unit (ICU) and hospital stay and with 30-day mortality. Methods: A retrospective cohort study was conducted at King Faisal Specialist Hospital and Research Centre, Jeddah, Saudi Arabia. Adult patients diagnosed with candidaemia from January 2006 to December 2017 were included. Results: A total of 196 BSIs were identified in 94 males (49.74%) and 95 females (50.26%). C. glabrata was the most commonly isolated Candida species, with 59 (30%) , followed by C. albicans with 46 (23%). Susceptibility data were available for 122/189 patients , of whom 26/122 (21%) were resistant to one or more antifungals. C. parapsilosis with available sensitivity data were found in 30/122 isolates, of which 10/30 (33%) were resistant to fluconazole. Risk factors significantly associated with antifungal-resistant candidaemia included previous echinocandin exposure ( odds ratio (OR) =1.38; 95% confidence interval (CI) (1.02-1.85); P= 0.006) and invasive ventilation (OR=1.3; 95% CI (1.08-1.57); P= 0.005). The median length of ICU stay was 29 days [range 12 -49 days] in the antifungal-resistant group and 18 days [range 6.7-37.5 days] in the antifungal-sensitive group (P=0.28) . The median length of hospital stay was 51 days [range 21-138 days] in the antifungal-resistant group and 35 days [range 17-77 days] in the antifungal-sensitive group (P=0.09). Thirty-day mortality was 15 (57.7%) and 54 (56.25%) among the antifungal-resistant and antifungal-sensitive groups , respectively (OR=1.01; 95% CI (0.84-1.21); P= 0.89). Conclusions: Our results indicate a high frequancy of non- C. albicans candidaemia . The rise in C. parapsilosis resistance to fluconazole is alarming. Further studies are required to confirm this finding

Background: Candidaemia is the most common form of invasive candidiasis. Resistant Candida blood stream infection (BSI) is rising , with limitations on the development of broader-spectrum antifungal agents worldwide. Our study aimed to identify the occurrence of antifungal-resistant candidaemia and the distribution of these species, determine the risk factors associated with antifungal resistance and evaluate the association of antifungal-resistant candidaemia with the length of intensive care unit (ICU) and hospital stay and with 30-day mortality. Methods: A retrospective cohort study was conducted at King Faisal Specialist Hospital and Research Centre, Jeddah, Saudi Arabia. Adult patients diagnosed with candidaemia from January 2006 to December 2017 were included. Results: A total of 196 BSIs were identified in 94 males (49.74%) and 95 females (50.26%). C. glabrata was the most commonly isolated Candida species, with 59 (30%) , followed by C. albicans with 46 (23%). Susceptibility data were available for 122/189 patients , of whom 26/122 (21%) were resistant to one or more antifungals. C. parapsilosis with available sensitivity data were found in 30/122 isolates, of which 10/30 (33%) were resistant to fluconazole. Risk factors significantly associated with antifungal-resistant candidaemia included previous echinocandin exposure ( odds ratio (OR) =1.38; 95% confidence interval (CI) (1.02-1.85); P= 0.006) and invasive ventilation (OR=1.3; 95% CI (1.08-1.57); P= 0.005). The median length of ICU stay was 29 days [range 12 -49 days] in the antifungal-resistant group and 18 days [range 6.7-37.5 days] in the antifungal-sensitive group (P=0.28) . The median length of hospital stay was 51 days [range 21-138 days] in the antifungal-resistant group and 35 days [range 17-77 days] in the antifungal-sensitive group (P=0.09). Thirty-day mortality was 15 (57.7%) and 54 (56.25%) among the antifungal-resistant and antifungal-sensitive groups , respectively (OR=1.01; 95% CI (0.84-1.21); P= 0.89). Conclusions: Our results indicate a high frequancy of non- C. albicans candidaemia . The rise in C. parapsilosis resistance to fluconazole is alarming. Further studies are required to confirm this finding