Evolution of fungemia in an Italian region

Prigitano, Anna; Cavanna, C.; Passera, Marco; Gelmi, M; Sala, Eugenio; Ossi, C.; Grancini, Anna; Calabrò, Maria Grazia; Bramati, Simone; Tejada, M.; Lallitto, Fabiola; Farina, Claudio; Rognoni, Vanina; Fasano, Maria Antonietta; Pini, Beatrice; Romanò, Luisa; Cogliati, Massimo; Esposto, Maria Carmela; Tortorano, A.M.

doi:10.1016/j.mycmed.2019.100906

Cited by 23 publications

(21 citation statements)

References 18 publications

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Section: Introductionmentioning

confidence: 99%

“…Candida parapsilosis is one of the most common Candida species responsible for human infections, accounting for 15%-30% of candidemia (1)(2)(3)(4). It is generally susceptible to azole drugs, especially fluconazole and voriconazole (2,5). Isolates of azoles-resistant C. parapsilosis have occasionally been found in intensive care unit (ICU) (5) and resulted in high mortality rates in immunocompromised patients (6).…”

Section: Introductionmentioning

confidence: 99%

“…clinical origin and incidence of fluconazole resistance among 283 Candida parapsilosis isolates collected in 240 patients from a single hospital between 2012 and 2019 1 : seven patients had isolates responsible for colonization, infection and/or found in catheter culture2 : one patient had mediastinis, fungemia and other deep infection3 : three patients had superficial and respiratory tract colonization, one patient had superficial and urinary tract colonization fluconazole susceptible isolates…”

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confidence: 99%

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Hospital Outbreak of Fluconazole-Resistant Candida parapsilosis: Arguments for Clonal Transmission and Long-Term Persistence

Fekkar

Blaize

Bouglé

et al. 2021

Antimicrob Agents Chemother

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The worldwide emergence of multidrug-resistant pathogenic fungi is a threat to human health. At this very moment, an emergence of Candida parapsilosis isolates harbouring a resistance to fluconazole, one of the most popular antifungal drugs, is being described in several countries. We seek to better understanding the epidemiology, pathogenicity and transmission of resistant Candida parapsilosis. Faced with an outbreak of invasive infections due to resistant isolates of C. parapsilosis, we performed a 7-year retrospective and prospective analysis of 283 C. parapsilosis isolates collected in 240 patients, among who 111 had invasive candidiasis. Study included review of hospital records, genotyping analysis and susceptibility testing that allow determining the type and outcome of infections, as well as the spatial and temporal spread of clusters. Overall the incidence of azole resistance was 7.5%. Genotyping analysis unveiled several previously undetected outbreaks and clonal spread of susceptible and resistant isolates over a long period of time. In comparison with susceptible isolates, resistant ones have a more restricted genetic diversity and seem to be more likely to spread and more frequently associated with invasive infections. In intensive care units, patients with invasive infections due to resistant isolates had poorer outcome (overall mortality at day 30 of 40%; 4/10) than susceptible ones (overall mortality at day 30 of 26.5%; 9/34). Our results suggest that the propensity of C. parapsilosis to spread on an epidemic fashion is underestimated, which warrants reinforced control and epidemiological survey of this species.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

mentioning

confidence: 99%

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Hospital Outbreak of Fluconazole-Resistant Candida parapsilosis: Arguments for Clonal Transmission and Long-Term Persistence

Fekkar

Blaize

Bouglé

et al. 2021

Antimicrob Agents Chemother

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“…In USA, C. albicans remains the leading aetiological agent of invasive candidiasis, followed by C. glabrata [84]. In EU, the situation in adults is similar, with the prevalence of C. albicans highest (>50%), followed by C. glabrata (13-22%) then by C. parapsilosis (about 15%) depending on the hospital or region monitored [66,85]. In children and teenagers, C. albicans (>50%) is also the predominant yeast, followed by C. parapsilosis (28%).…”

Section: The Aetiological Agents: Ntm and Fungimentioning

confidence: 99%

Opportunist Coinfections by Nontuberculous Mycobacteria and Fungi in Immunocompromised Patients

2020

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Nontuberculous mycobacteria (NTM) and many fungal species (spp.) are commonly associated with opportunistic infections (OPIs) in immunocompromised individuals. Moreover, occurrence of concomitant infection by NTM (mainly spp. of Mycobacterium avium complex and Mycobacterium abscessus complex) and fungal spp. (mainly, Aspergillus fumigatus, Histoplasma capsulatum and Cryptococcus neoformans) is very challenging and is associated with poor patient prognosis. The most frequent clinical symptoms for coinfection and infection by single agents (fungi or NTM) are similar. For this reason, the accurate identification of the aetiological agent(s) is crucial to select the best treatment approach. Despite the significance of this topic it has not been sufficiently addressed in the literature. This review aims at summarizing case reports and studies on NTM and fungi coinfection during the last 20 years. In addition, it briefly characterizes OPIs and coinfection, describes key features of opportunistic pathogens (e.g., NTM and fungi) and human host predisposing conditions to OPIs onset and outcome. The review could interest a wide spectrum of audiences, including medical doctors and scientists, to improve awareness of these infections, leading to early identification in clinical settings and increasing research in the field. Improved diagnosis and availability of therapeutic options might contribute to improve the prognosis of patients’ survival.

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“…Most of the episodes are hospital-acquired with a reported incidence of 0.17-2.7 episodes per 1000 discharges, 0.30-4.9 per 10,000 patient days. 2 However, communityacquired candidemia is emerging as a consequence of an increasing use of long-term intravenous devices such as tunneled intravascular and peripherally inserted central catheter (PICC). 3 Despite treatment, mortality remains high: crude mortality rate varied from 25% to 50%, while the attributable mortality rate is estimated around 10-20%.…”

Section: Introductionmentioning

confidence: 99%

Candidemia: Evolution of Drug Resistance and Novel Therapeutic Approaches

Tortorano¹,

Prigitano²,

Morroni³

et al. 2021

IDR

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Candidemia and invasive candidiasis are the most common healthcare-associated invasive fungal infections, with a crude mortality rate of 25-50%. Candida albicans remains the most frequent etiology, followed by C. glabrata, C. parapsilosis and C. tropicalis. With the exception of a limited number of species (ie: C. krusei, C. glabrata and rare Candida species), resistance to fluconazole and other triazoles are quite uncommon. However, recently fluconazoleresistant C. parapsilosis, echinocandin-resistant C. glabrata and the multidrug resistant C. auris have emerged. Resistance to amphotericin B is even more rare due to the reduced fitness of resistant isolates. The mechanisms of antifungal resistance in Candida (altered drug-target interactions, reduced cellular drug concentrations, and physical barriers associated with biofilms) are analyzed.The choice of the antifungal therapy for candidemia must take into account several factors such as type of patient, presence of devices, severity of illness, recent exposure to antifungals, local epidemiology, organs involvement, and Candida species. The first-line therapy in nonneutropenic critical patient is an echinocandin switching to fluconazole in clinically stable patients with negative blood cultures and azole susceptible isolate. Similarly, an echinocandin is the drug of choice also in neutropenic patients. The treatment duration is 14 days after the first negative blood culture or longer in cases of organ involvement. An early removal of vascular catheter improves the outcome. The promising results of new antifungal molecules, such as the terpenoid derivative ibrexafungerp, the novel echinocandin with an enhanced half-life rezafungin, oteseconazole and fosmanogepix, representative of new classes of antifungals, are discussed.

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Evolution of fungemia in an Italian region

Cited by 23 publications

References 18 publications

Hospital Outbreak of Fluconazole-Resistant Candida parapsilosis: Arguments for Clonal Transmission and Long-Term Persistence

Hospital Outbreak of Fluconazole-Resistant Candida parapsilosis: Arguments for Clonal Transmission and Long-Term Persistence

Opportunist Coinfections by Nontuberculous Mycobacteria and Fungi in Immunocompromised Patients

Candidemia: Evolution of Drug Resistance and Novel Therapeutic Approaches

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