Candidaemia in a tertiary care academic hospital in Italy. The impact of C. parapsilosis complex on the species distribution and antifungal susceptibility

Abstract

Purpose. To analyse the species distribution and the susceptibility profiles to the major antifungal agents of Candida isolated from bloodstream infections (BSIs) in both intensive care units (ICUs) and non-ICU wards in a tertiary care hospital in Italy from 2010 until 2015.Methodology. Episodes of Candida BSI were recorded in a retrospective observational cohort study. Yeasts were isolated from both blood and intravascuIar devices (IVDs) and their susceptibility to antifungal drugs was tested using the microdilution method.Results. 514 Candida BSIs were evidenced and 19 % of these episodes were associated with the presence of an IVD. The trend of the general incidence increased significantly throughout the study period, ranging from 1.42 to 3.63 (mean 2.52) episodes/1000 admissions. The incidence of Candida BSIs and IVD-associated candidaemia was significantly higher in ICUs relative to the other wards. The most frequently isolated species were C. albicans and C. parapsilosis complex, with the latter presenting a significant increased trend of isolation. C. parapsilosis complex was most frequently involved in IVD-related candidaemia, coinfections and late recurrent infections. Furthermore, the MIC 50 s of C. parapsilosis complex were significantly enhanced for echinocandins compared to the MIC 50 s for the same drugs and the other yeasts, while the MIC 50 s of C. albicans for amphotericin B showed a significant increase during the study period, ranging from 0.1 to 0.5 µg ml À1 . Conclusions.A progressively enhanced incidence of Candida BSIs, a relatively high impact of C. parapsilosis complex and changes in the susceptibility profiles of the isolated yeasts were evidenced during the observation period.

Morbidity and mortality of candidaemia in Europe: an epidemiologic meta-analysis

“…In total, we included 107 studies in our analysis. [13][14][15][16][18][19][20][21][22]25,26,34,36,37, Fifty [13][14][15][16]22,37,52,[114][115][116]120,121,126,128,129,133,136 of 107 studies [13][14][15][16][18][19][20][21][22]25,26,34,36,37, were teaching hospital-based, 18 were populationbased, [20][21][22]25,26,34,…”

“…Pooled analysis indicated that studies with a study median between 2001 and 2010 had a higher IR with 1.11 (95% CI 0.83-1.39) [13][14][15][16]55,60,61,63,66,71,[73][74][75]81,136 compared to studies with a study median between 1990 and 2000 with 0.62 (95% CI 0.41-0.83), 22,77,79,[82][83][84][85] and studies with a study median between 2011 and now with 0.97 (95% CI 0.56-1.39) ( Figure 3) (p-value for interaction <0.001). 52,[56][57][58][59]62,114,115,120 Studies from southern European countries had a higher pooled IR (1.13, 95% CI 0.9-1.35) 13,14,16,52,[56][57][58][60][61][62][63]66,71,[73][74]…”

“…Reported incidence rates per 1,000 admissions varied from 0.17 in Finland (01/1995-12/1999) 22 to 2.19 in Portugal (01/2004-12/2006). 73 In studies only reporting teaching hospital data, the pooled IR of candidaemia was 0.96 per 1,000 admissions per year (95% CI 0.79-1.12) ( Figure 3) [13][14][15][16]22,52,[55][56][57][58][59][60][61][62][63]66,71,[73][74][75]77,79,81,[83][84][85]114,115,120,136 . Pooled analysis indicated that studies with a study median between 2001 and 2010 had a higher IR with 1.11 (95% CI 0.83-1.39) [13][14][15][16]55,60,61,63,66,71,[73][74][75]81,…”

Oral mucosa as a potential source of candidemia by Candida parapsilosis sensu stricto, under pathological conditions

“…A pathobiont is a microorganism which, despite expressing attributes of virulence, nevertheless continues to live in symbiosis with the host, and therefore does not cause a clinically verifiable lesion [78]. This is possible as long as the Th1-Th2-Th17-Treg balance remains intact, and fundamentally it will depend on a good Th17 response, since recent evidences show that this response is crucial for antifungal mucous defense; especially in oral mucosa [78,79]. When such balance breaks down, the clinical result could be oral candidiasis or invasive candidiasis.…”

“…The advantage of this research is that for the candidemia model by Candida parapsilosis, the skin of fingers, would not be the only route of infection as the international consensus raises [1], but for everything developed in this review, we consider that the mouth would also be a possible route of infection in candidemia by this species of Candida, and even more if the oral cavity is in inflammatory conditions determined by gingivo-periodontal disease. This is particularly important from recent retrospective cohort studies, which show a significant increase in the incidence of candidemia by Candida species not Candida albicans, with Candida parapsilosis sensu stricto being the protagonist; and even more so when it is demonstrated that the morbidity and mortality due to nosocomial candidemia in preterm infants is higher than the bloodstream infections mediated by gram-negative and grampositive bacteria [79][80][81].…”