Candida colonization as a predictor of invasive candidiasis in non-neutropenic ICU patients with sepsis: A systematic review and meta-analysis

Alenazy, Hameid; Alghamdi, Amenah; Pinto, Ruxandra; Daneman, Nick

doi:10.1016/j.ijid.2020.10.092

Cited by 32 publications

(23 citation statements)

References 20 publications

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“…In addition, our inclusion criteria aimed for a patient population with a high risk for ICI, but surprisingly, we only observed fifteen cases of proven candidemia, 48 patients with ICI and a low Candida colonization rate. A low rate of Candida colonization is associated with lower risk for developing ICI [ 44 ]. This was accompanied by a low positivity rate of the Candida-PCR.…”

Section: Discussionmentioning

confidence: 99%

(1 → 3)-β-d-Glucan-guided antifungal therapy in adults with sepsis: the CandiSep randomized clinical trial

Bloos

Kluge²,

Kogelmann³

et al. 2022

Intensive Care Med

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Purpose: To investigate whether (1 → 3)-β-d-Glucan (BDG)-guidance shortens time to antifungal therapy and thereby reduces mortality of sepsis patients with high risk of invasive Candida infection (ICI).Methods: Multicenter, randomized, controlled trial carried out between September 2016 and September 2019 in 18 intensive care units enrolling adult sepsis patients at high risk for ICI. Patients in the control group received targeted antifungal therapy driven by culture results. In addition to targeted therapy, patients in the BDG group received antifungals if at least one of two consecutive BDG samples taken during the first two study days was ≥ 80 pg/mL. Empirical antifungal therapy was discouraged in both groups. The primary endpoint was 28-day-mortality.Results: 339 patients were enrolled. ICI was diagnosed in 48 patients (14.2%) within the first 96 h after enrollment. In the BDG-group, 48.8% (84/172) patients received antifungals during the first 96 h after enrollment and 6% (10/167) patients in the control group. Death until day 28 occurred in 58 of 172 patients (33.7%) in the BDG group and 51 of 167 patients (30.5%) in the control group (relative risk 1.10; 95% confidence interval, 0.80-1.51; p = 0.53). Median time to antifungal therapy was 1.1 [interquartile range (IQR) 1.0-2.2] days in the BDG group and 4.4 (IQR 2.0-9.1, p < 0.01) days in the control group.Conclusions: Serum BDG guided antifungal treatment did not improve 28-day mortality among sepsis patients with risk factors for but unexpected low rate of IC. This study cannot comment on the potential benefit of BDG-guidance in a more selected at-risk population.

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Section: Discussionmentioning

confidence: 99%

(1 → 3)-β-d-Glucan-guided antifungal therapy in adults with sepsis: the CandiSep randomized clinical trial

Bloos

Kluge²,

Kogelmann³

et al. 2022

Intensive Care Med

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“…In ICU patients with sepsis, cutaneous Candida spp. colonization is strongly associated with risk of subsequent IC 23 . The role of prophylactic antifungals in ICU patients colonized with Candida spp .…”

Section: Discussionmentioning

confidence: 99%

Epidemiology of candidemia in lung transplant recipients and risk factors for candidemia in the early posttransplant period in the absence of universal antifungal prophylaxis

Marinelli

Pennington

Hamandi

et al. 2022

Transplant Infectious Dis

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Background: Lung transplant recipients are at increased risk of candidemia, especially in the early posttransplant period. However, the specific predisposing factors have not been established. The natural history of candidemia after lung transplantation, in the absence of universal antifungal prophylaxis, is not known. Methods:We retrospectively examined the epidemiology of candidemia at any time posttransplant in patients who underwent lung transplantation at our center between 2016 and 2019. We undertook a case-control study and used logistic regression to evaluate the risk factors for candidemia during the first 30 days posttransplantation. Results: During the study period 712 lung transplants were performed on 705 patients. Twenty-five lung transplant recipients (LTRs) (3.5%) experienced 31 episodes of candidemia. The median time to candidemia was 19.5 days (IQR 10.5-70.5), with 61.2% (n = 19) episodes of candidemia occurring within the first 30 days posttransplantation.Pretransplant hospitalization, posttransplant ECMO, and posttransplant renal replacement therapy were associated with an increased risk of candidemia in the first 30 days posttransplant. Of those with candidemia in the first 30 days, 31.2% died within 30 days of the index positive blood culture. Candidemia was associated with decreased survival within 30 days posttransplant. Conclusion:This study highlights the greatest risk period of lung transplant recipients for development of candidemia and identifies several factors associated with increased risk of candidemia. These findings will help guide future studies on antifungal prophylaxis.

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“…El primer documento sobre vacunas del Comité de expertos COVID-19 del ICOMEM [68] aboga por posiciones intermedias que favorezcan la adherencia de la población a ser vacunada tales como estrategias educativas, formativas y de promoción sobre los beneficios sanitarios de la la vacuna, aunque sea por causas justificadas, es por sí mismo discriminativo. Es difícil olvidar que los viajes internacionales fueron la vía que facilitó la dispersión de la enfermedad [58], y también las recomendaciones primeras de la OMS contra los pasaportes [59], cuyo valor puede relativizarse ahora, ya que entonces no existían las vacunas y los recursos diagnósticos eran menores.…”

Section: ¿Cuál Debe Ser La Respuesta Legal Y éTica Ante El Rechazo Injustificado a Vacunarse?unclassified

“…Additionally, colonization in differents sites by Candida spp. is strongly associated with the likelihood of invasive candidiasis among ICU patients with sepsis [68].…”

Section: Diagnostic Testsmentioning

confidence: 99%

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2021

Rev Esp Quimioter

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Candida colonization as a predictor of invasive candidiasis in non-neutropenic ICU patients with sepsis: A systematic review and meta-analysis

Cited by 32 publications

References 20 publications

(1 → 3)-β-d-Glucan-guided antifungal therapy in adults with sepsis: the CandiSep randomized clinical trial

(1 → 3)-β-d-Glucan-guided antifungal therapy in adults with sepsis: the CandiSep randomized clinical trial

Epidemiology of candidemia in lung transplant recipients and risk factors for candidemia in the early posttransplant period in the absence of universal antifungal prophylaxis

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