Epidemiology ofCandidablood stream infections in patients with hematological malignancies or solid tumors

Abstract

Invasive Candida infections are associated with high morbidity and mortality. Due to an increased incidence in patients with hematological or oncological malignancies, fluconazole prophylaxis became a common practice in many centers in the late 1990s. Until recently, there was insufficient data on the effect of the use of azoles on the incidence of Candida blood stream infections and species distribution. Here we present a single center retrospective study of the epidemiology of Candida blood stream infections in hospitalized patients at a German university medical center from 2003-2009. Twenty-one Candida species were isolated in culture from blood specimens of 20 patients. The annual rate of candidemia approached 1.1 per thousand hospitalizations, during the first 5 years of the survey, but showed a significant increase after 2007. Candida albicans, although still the dominant species, was recovered as the responsible pathogen from only 28.6% of the cases. A high rate of fatal outcomes was noted at 30 days (56%) and 100 days (67%) after the first positive finding of Candida in blood culture. These results underline the clinical significance of this infectious complication, and the need for continuous monitoring for Candida blood stream infections in order to improve the clinical and therapeutic management of this specific patient population.

Novel Antifungal Drugs Against Fungal Pathogens: Do They Provide Promising Results for Treatment?

“…Patients with proven IFI was reported to need antifungal therapy switching compared to patients with probable or possible IFI (33 vs. 25 and 7 %, respectively) [27]. Candida albicans (nine cases) predominated among fungal pathogens responsible for blood stream infections in our study as reported in other studies [28]. Two patients who died of Candida parapsilosis related blood stream infection yielded this species in sputum and wound cultures that revealed colonization.…”

Identification and Antifungal Susceptibility Patterns of Candida Strains Isolated From Blood Specimens in Iran

“…Surprisingly, the current study found that most cases of candidemia were caused by C. parapsilosis (34.4%) and C. glabrata (28.1%). Historically, C. albicans and C. glabrata were reported to be the most frequently identified yeasts isolated from blood cultures worldwide; however, in the recent years, the proportion of infections caused by species other than C. albicans has markedly increased and C. parapsilosis is now one of the leading causes of invasive candidal disease (5,14,15). The current study's findings are in agreement with those of Das et al who recently reported that 58% of episodes of candidemia were caused by non-albicans Candida (16).…”

“…are the most prevalent fungal pathogens, and C. albicans is the most commonly isolated species from patients with candidemia. Nevertheless, other Candida species have emerged as clinically important opportunistic pathogens (3)(4)(5)(6). Resistance to antifungal agents is becoming increasingly prevalent in Candida species (7).…”

Real-Time Microscopic Observation of Candida Biofilm Development and Effects Due to Micafungin and Fluconazole

“…Candida albicans is known as a biofilm former. Bloodstream infections are frequently associated with the use of a catheter, and the catheter can be a scaffold for biofilms (2). Once biofilms are formed, the biofilms continuously supply detaching cells as a source of infection; thus, biofilm-related infection is associated with a poor prognosis (2,3).…”

“…Bloodstream infections are frequently associated with the use of a catheter, and the catheter can be a scaffold for biofilms (2). Once biofilms are formed, the biofilms continuously supply detaching cells as a source of infection; thus, biofilm-related infection is associated with a poor prognosis (2,3). Recently, research into molecular mechanisms related to biofilm formation has revealed transcriptional regulation (4); however, the majority of these related studies lack realtime observation of the development process, and therefore, the fate of the biofilm and the effects of antifungals against biofilms are not clearly understood.…”