2015
DOI: 10.1128/jcm.03239-14
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Candida Colonization as a Risk Marker for Invasive Candidiasis in Mixed Medical-Surgical Intensive Care Units: Development and Evaluation of a Simple, Standard Protocol

Abstract: k Colonization with Candida species is an independent risk factor for invasive candidiasis (IC), but the minimum and most practicable parameters for prediction of IC have not been optimized. We evaluated Candida colonization in a prospective cohort of 6,015 nonneutropenic, critically ill patients. Throat, perineum, and urine were sampled 72 h post-intensive care unit (ICU) admission and twice weekly until discharge or death. Specimens were cultured onto chromogenic agar, and a subset underwent molecular charac… Show more

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Cited by 55 publications
(42 citation statements)
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“…Moreover, ideally, any prior exposure to antifungals unrelated to the treatment of the index candidemia case should have been recorded. However, despite these limitations, the current systematic study provides a new understanding of the level of resistance following treatment which constitutes a reservoir for future resistant Candida infections (15,16). Together with previous reports of emerging resistance, our data highlight that the risk of generating antifungal resistance should not be neglected and underscore the importance of antifungal stewardship and of susceptibility testing not only for epidemiological purposes but also for daily clinical management.…”
Section: Discussionmentioning
confidence: 56%
See 1 more Smart Citation
“…Moreover, ideally, any prior exposure to antifungals unrelated to the treatment of the index candidemia case should have been recorded. However, despite these limitations, the current systematic study provides a new understanding of the level of resistance following treatment which constitutes a reservoir for future resistant Candida infections (15,16). Together with previous reports of emerging resistance, our data highlight that the risk of generating antifungal resistance should not be neglected and underscore the importance of antifungal stewardship and of susceptibility testing not only for epidemiological purposes but also for daily clinical management.…”
Section: Discussionmentioning
confidence: 56%
“…Hence, abdominal candidiasis and Candida species at mucosal surfaces may represent a nest and reservoir for resistant isolates (10,12). Typing studies have illustrated that the concomitant and predominant colonizing Candida isolate in candidemia patients is also the invasive Candida species (90 to 95% concordance), and most patients are still colonized despite the infection being cleared (7,9,(13)(14)(15)(16)(17). Thus, the persistent colonizing microbiota is a relevant reservoir for resistant Candida strains and may impose a risk to this group of patients concerning reinfection, but also to individuals in other patient settings, where infection may follow prior antifungal drug exposure.…”
mentioning
confidence: 99%
“…Therefore, in a similar way, immunosuppression and peripheral inflammation might also be considered as risk factors for those patients. It should also be considered that most disseminated infections come from an endogenous origin, involving the translocation of the pathogen across the gut mucosa to the bloodstream (16)(17)(18)(19)(20)(21), a process that is favored by immunosuppression, gut colonization and inflammatory processes affecting gut mucosa (22)(23)(24)(25).…”
mentioning
confidence: 99%
“…The condition, though not necessarily, tends to progress in cases with severe sepsis or septic shock, those who have undergone major surgeries, receiving total parenteral nutrition (TPN) and are found to have multifocal candida colonization. A fundamental clinical issue is to identify which category of patients are at increased risk for IC Gong et al, 2016;Hawkshead, Van Dyke, Hassig, Webber, & Begue, 2016;Lau et al, 2015;Liao et al, 2015;Pu et al, 2015;Rajendran et al, 2016;Sun et al, 2016).…”
Section: Potential Risk Criteria For Invasive Fungal Infectionsmentioning
confidence: 99%