Impact of routine bedside infectious diseases service on clinical management and prognosis of patients with Candida fungemia – an example for Antifungal Stewardship at university level in Germany

Dudakova, Anna; Blei, Claudia; Groß, Uwe; Schulze, Marco H.

doi:10.1016/j.ijid.2022.03.054

Cited by 5 publications

(3 citation statements)

References 33 publications

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“…A German study evaluated the impact of bedside antifungal stewardship on the clinical management and prognoses of patients with candidemia [28]. The adherence to recommendations of the ESCMID and IDSA guidelines improved after the intervention of the antifungal stewardship team.…”

Section: Discussionmentioning

confidence: 99%

Guideline Adherence and Outcomes of Patients with Candidemia in Brazil

Araujo,

de Almeida Junior,

Magri

et al. 2024

JoF

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Candidemia is a significant cause of mortality among hospitalized patients, both worldwide and in Brazil. Prompt and appropriate treatment are essential to mitigate mortality, and clinical practice guidelines aim to optimize patient care based on the best scientific evidence. This study aims to examine the management of candidemia, assessing adherence to the guidelines of the Brazilian Society of Infectious Diseases in a single center located at São Paulo, Brazil. All adult patients hospitalized from 2016 to 2018 who presented one positive blood culture for Candida spp. were included. Electronic medical records were retrospectively reviewed to collect information relevant to the treatment for candidemia, in order to assess the adherence to the Brazilian guideline for the management of candidemia in relation to nine defined outcomes, and we correlated those findings with 30-day mortality by using uni- and multivariate analyses. A total of 115 patients were included; 68 patients (59.1%) were male, with a mean age of 55 years. C. albicans, C. tropicalis and C. glabrata were the most prevalent species. In total, 80 patients (69.5%) received antifungal treatment. The adherence to Brazilian guideline recommendations was determined as described in the following: initial treatment with echinocandin in 48 (60%); step-down to fluconazole in 21 (26.2%); collection of first control blood culture in 43 (58.9%); collection of second control blood culture, if the first one had been positive, in 14 (73.6%); treatment for 14 days after the first negative blood culture in 53 (65.4%); central venous catheter (CVC) removal in 66 (82.5%); CVC removal if the first control blood culture had been positive in 17 (89.4%); performance of a transthoracic echocardiogram in 51 (63.7%) and performance of a fundoscopy in 59 (73.7%). Univariate analysis showed that CVC removal and initial echinocandin therapy were more prevalent in the surviving group, but with no statistically significant difference. On the other hand, step-down to fluconazole demonstrated higher survival rate in the multivariate analysis OR 0.15 (95% CI 0.03–0.8); p = 0.02. The analysis of these nine recommendations demonstrates that it is necessary to improve adherence to specific recommendations and also disseminate strategies of the initial use of echinocandin as the drug of choice and addressing length of treatment and follow-up and complementary exams. Our study provides reassurance that the step-down to fluconazole is safe and may be recommended, if the preexisting conditions are present.

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Section: Discussionmentioning

confidence: 99%

Guideline Adherence and Outcomes of Patients with Candidemia in Brazil

Araujo,

de Almeida Junior,

Magri

et al. 2024

JoF

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“…might also cause IFIs (Kotey et al, 2021). Early detection and treatment have proven to have crucial role for prognosis, especially in guidance of antifungal stewardship committees (Butta et al, 2019;Dudakova, 2022). However, indirect diagnostic procedures (serology, etc.)…”

Section: Discussionmentioning

confidence: 99%

Can Blood Culture Contaminaton Cloud Fungal Positivity?

et al. 2023

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Objective: Blood culture (BC) is gold standard for diagnosis of fungemia. Contamination of BC is a major problem worldwide, since it may delay actual diagnosis. The aim of this study was to evaluate “contaminant” vials with a prolonged incubation (max 30 days) with antimicrobial supplemented media to observe any mycological growth. Materials and Methods: Routine BCs optained patients of XXX Hospital for a year period were included. Render BC System BC12-8 (Render Biotech Co. Ltd., Shenzhen, China) were used. Contaminated vials were reincubated and conventionally-inoculated weekly for four weeks total. In case of any growth, identifications were done by PhoenixTM 100 system (Becton Dickinson, MA, USA) with cornmeal tween 80 agar (RTA Laboratories, Kocaeli, Turkey). Antifungal susceptibility testing were applied with CLSI disk diffusion method. Results: 3.9% (235 sets and additional 138 vials) of total 6047 BC sets were contaminated. Only one vial from central venous catheter showed fungal growth within the first week of conventional inoculation (>8th day of total incubation). The isolate was identified as Candida guilliermondii complex and susceptible to caspofungin. Latter set of this patient were positive in the 3rd day of incubation. Conclusion: International guidelines recommend

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“…Most of the species of this genus are opportunistic pathogens, and infections caused by them are primarily the result of disturbances in the balance of the normal microbiological flora caused by immunosuppressants, broad-spectrum antibiotics, or the loss of the protective epithelial barrier [ 2 ]. The principal risk factors for candidiasis are neutropenia following chemotherapy or immunosuppressive treatment (oncological, hematological, and transplant patients) [ 3 ], the use of broad-spectrum antibiotic therapy, the presence of a central venous catheter or urinary catheter, parenteral nutrition, renal dialysis, and the use of endoprostheses [ 4 ]. The disseminated form of candidiasis can affect the heart, lungs, central nervous system, musculoskeletal system, peritoneum, liver, spleen, and gall bladder [ 5 ].…”

Section: Introductionmentioning

confidence: 99%

A Putative Role of Candida albicans in Promoting Cancer Development: A Current State of Evidence and Proposed Mechanisms

et al. 2023

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Candida albicans is a commensal fungal species that commonly colonizes the human body, but it is also a pervasive opportunistic pathogen in patients with malignant diseases. A growing body of evidence suggests that this fungus is not only coincidental in oncology patients, but may also play an active role in the development of cancer. More specifically, several studies have investigated the potential association between C. albicans and various types of cancer, including oral, esophageal, and colorectal cancer, with a possible role of this species in skin cancer as well. The proposed mechanisms include the production of carcinogenic metabolites, modulation of the immune response, changes in cell morphology, microbiome alterations, biofilm production, the activation of oncogenic signaling pathways, and the induction of chronic inflammation. These mechanisms may act together or independently to promote cancer development. Although more research is needed to fully grasp the potential role of C. albicans in carcinogenesis, the available evidence suggests that this species may be an active contributor and underscores the importance of considering the impact of the human microbiome on cancer pathogenesis. In this narrative review, we aimed to summarize the current state of evidence and offer some insights into proposed mechanisms.

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Impact of routine bedside infectious diseases service on clinical management and prognosis of patients with Candida fungemia – an example for Antifungal Stewardship at university level in Germany

Cited by 5 publications

References 33 publications

Guideline Adherence and Outcomes of Patients with Candidemia in Brazil

Guideline Adherence and Outcomes of Patients with Candidemia in Brazil

Can Blood Culture Contaminaton Cloud Fungal Positivity?

A Putative Role of Candida albicans in Promoting Cancer Development: A Current State of Evidence and Proposed Mechanisms

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