Candida Albicans Versus Non-Albicans Intensive Care Unit-Acquired Bloodstream Infections: Differences in Risk Factors and Outcome

Dimοpoulos, George; Ntziora, Fotinie; Rachiotis, George; Armaganidis, Apostolos; Falagas, Matthew E.

doi:10.1213/ane.0b013e3181607262

Cited by 170 publications

(159 citation statements)

References 41 publications

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“…albicans was isolated from (69%) of cases and (35%) were NAC. A comparable rate were obtained by Dimopoulos et al [8], where C. albicans was recovered from (64.3%) of candidemia episodes in intensive care unit patients compared to NAC from (35.7%). On the contrary Rajendran etal.…”

Section: Discussionsupporting

confidence: 83%

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Untitled

2017

JBMOA

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Background: Invasive fungal infections are the primary cause of morbidity and mortality in patients with thalassemias. This high mortality rate stems, in part, from the prevalence of resistance to antifungal agents. Candida species remain the most common cause of invasive fungal infection in patients with thalassemia. Nevertheless, other Candida species become increasingly spreading and need to be identified to a species level.Objectives: The objectives of the study were to estimate the prevalence of Candida infection among Thalassemia major patients compared to healthy controls and to identify the resistance patterns among the recovered species.Methods: A total of 60 oral samples were collected from two groups: Group I: 40 oral swabs were collected from patients clinically diagnosed with thalassemia major from the out-patient clinics of Pediatric department in Ain Shams University Hospital. Group II: 20 oral swabs were collected from healthy subjects matched in age and sex with the patients' group. The swabs were cultured onto both CHROM and Sabaroud's agar media. The recovered colonies on Sabaroud's agar were identified using Gram stain and Germ tube test while the colonies on CHROM agar were self-identified through color produced according to manufacturer instructions. For all identified colonies API 20 C AUX was used as a confirmatory test. Antifungal Susceptibility testing using Fluconazole (25μg).Voriconazole (1μg).Nystatin (100 units) was used to identify the resistance strains.Results: C. albicans, were isolated from 69.2% of cases while 30.8% were non C. albicans. (23% C. tropicalis and 7.8% C. krusei). Susceptibility testing for all identified colonies revealed that (13.8%) of all isolates were resistant to fluoconazole, (17.3%) to voriconazole and (89.7%) to nystatin. Conclusion:The use of CHROM agar media offers multiple advantages without increasing costs in comparison to other procedures. CHROM agar media have equal or greater sensitivity of detection, superior detection of mixed cultures as a result of better visualization of different species, and enable shorter times to report results. Antifungal susceptibility tests are now required to optimize antifungal treatment to avoid emergence of new resistant strains.

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Section: Discussionsupporting

confidence: 83%

“…However different rates were reported by other studies with rates (10.7%), (9%) and (32%) respectively [8,10].…”

Section: Discussionmentioning

confidence: 53%

Untitled

2017

JBMOA

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“…(1,9,10,23) or by potentially fluconazole-resistant organisms (Candida glabrata and Candida krusei) (16,23,28) but have not taken into consideration in vitro resistance to fluconazole. In these studies, prior fluconazole exposure was an independent risk factor for candidemia caused by non-albicans Candida species (1) or by potentially fluconazole-resistant species (23), whereas other studies did not find this association (16,28).…”

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confidence: 99%

Risk Factors for Fluconazole-Resistant Candidemia

Garnacho-Montero

Díaz-Martín

García-Cabrera

et al. 2010

Antimicrob Agents Chemother

104

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Bloodstream infections (BSIs) due to Candida species are a serious complication in hospitalized patients. Candidemia is associated with a high mortality rate and has obvious effects on resource use (11). Over the past few decades, the incidence of candidemia has increased markedly (2, 3). Moreover, the increment of candidemia caused by Candida species other than Candida albicans is a common finding in recent series (3, 12). These species include C. glabrata and C. krusei, which tend to be more resistant to fluconazole and therefore present a particular challenge for clinical management.Diverse studies highlight the importance of early and appropriate empirical therapy in invasive Candida infection (14, 21). Fluconazole is currently considered the initial therapy for most adult patients with candidemia (20). As the selection of empirical therapy is driven in large part by the likely epidemiology, there is a need to identify patients at risk of candidemia caused by species resistant to fluconazole in order to begin with adequate empirical antifungal therapy.In order to provide guidance to clinicians to initiate empirical treatment for candidemia, prior studies have addressed risk factors for candidemia caused by non-albicans Candida spp.(1, 9, 10, 23) or by potentially fluconazole-resistant organisms (Candida glabrata and Candida krusei) (16, 23, 28) but have not taken into consideration in vitro resistance to fluconazole. In these studies, prior fluconazole exposure was an independent risk factor for candidemia caused by non-albicans Candida species (1) or by potentially fluconazole-resistant species (23), whereas other studies did not find this association (16,28). Therefore, to the best of our knowledge, the risk factors for microbiologically proven fluconazole-resistant Candida spp. BSIs have not been comprehensively studied. We conducted the prospective single-center study described here to identify the variables associated with the diagnosis of fluconazole-resistant candidemia. Our working hypothesis was that fluconazole administration is an independent risk factor only in the emergence of BSIs caused by fluconazole-resistant Candida. MATERIALS AND METHODSHospital. The prospective study described here was carried out in the Virgen del Rocío University Hospital, a large urban hospital with teaching accreditation, from January 2004 to June 2009. The hospital has a solid organ (liver, heart, kidney) transplantation program and an active bone marrow transplantation

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“…This would call attention to the importance of appropriate antibiotic use in hospitals and of antimicrobial stewardship programs in controlling and preventing unnecessary use of antibiotics [24,25]. Previous studies have identified other risk factors associated with non-albicans Candida, including glucocorticoids use, central venous catheter placement, candiduria, male gender, total parental nutrition and recent history of solid tumors [24][25][26][27][28][29][30].…”

Section: Discussionmentioning

confidence: 99%

Characteristics and clinical outcomes of patients with Candida bloodstream infections in a tertiary care hospital in Jordan

Ababneh

Abu-Bdair

Mhaidat

et al. 2017

J Infect Dev Ctries

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Introduction: Candida species are important causes of bloodstream infections, accounting for significant morbidity and mortality in hospitalized patients. Methodology: A retrospective observational study was conducted in an academic tertiary hospital of Jordan. The medical records of patients hospitalized over a ten-year period. were reviewed and patients with candidemia were identified. Data analysis included the infecting Candida species, resistance to antifungals, and risk factors associated with mortality. Results: A total of 158 cases of candidemia were identified, with an overall incidence rate of 0.48 episodes/1,000 admissions. The proportion of candidemia caused by Candida albicans (44.3%) was higher than that of candidemia caused by non-albicans Candida species (42.4%). Exposure to antibiotic therapy before hospitalization was the only independent factor associated with non-albicans Candida infection (OR 2.454; p = 0.033). The overall crude 30-day mortality was 38.7%. Central venous catheterization (OR 0.255; p = 0.026), mechanical ventilation (OR 0.162; p = 0.003), severe sepsis and septic shock (OR = 0.073; p = 0.008), admission to intensive care unit (OR 0.78; p = 0.001), C. albicans (OR 0.235; p = 0.018), length of stay (OR 1.057; p = 0.001), number of comorbidities (OR 0.580; p = 0.008) were independent risk factors for 30-day mortality. Conclusion: This study identified several risk factors associated with blood stream infections caused by Candida over 10-years period. Continuous surveillance programs to monitor such types of infection are of great value to antimicrobial stewardship programs.

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Candida Albicans Versus Non-Albicans Intensive Care Unit-Acquired Bloodstream Infections: Differences in Risk Factors and Outcome

Abstract: In the subset of critically ill nonimmunosuppressed patients, candidemia caused by non-albicans species occurred more frequently in those with medical devices or receiving steroids. Candidemia due to non-albicans species was also associated with higher mortality.

Cited by 170 publications

References 41 publications

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Risk Factors for Fluconazole-Resistant Candidemia

Characteristics and clinical outcomes of patients with Candida bloodstream infections in a tertiary care hospital in Jordan

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