Invasive Candida Infections in Liver Transplant Recipients: Clinical Features and Risk Factors for Mortality

Bassetti, Matteo; Carnelutti, Alessia; Righi, Elda; Merelli, Maria; Ansaldi, Filippo; Trucchi, Cecilia; Alicino, Cristiano; Sartor, Assunta; Wauters, Joost; Lagrou, Katrien; Tascini, Carlo; Menichetti, Francesco; Mesini, Alessio; Rosa, Francesco Giuseppe De; Lagunes, Leonel; Rello, Jordi; Colombo, Arnaldo Lopes; Vena, Antonio; Tumbarello, Mario; Sganga, Gabriele; Martín‐Loeches, Ignacio; Viscoli, Claudio

doi:10.1097/txd.0000000000000673

Cited by 41 publications

(23 citation statements)

References 26 publications

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“…This is an important antecedent given that C. albicans and, on a smaller scale, other Candida species are reported to be frequently found in adults and children's oral cavities, serving as reservoir for inoculation and infection of any part of the body [60,61]. These infections are difficult to treat with antifungals, which means a high mortality rate [62,63]. Consequently, if the oral cavity in pathological conditions is a reservoir triggering Candida parapsilosis strains colonization and pathogenicity, such condition is an important risk factor for candidemia or invasive infections by this yeast.…”

Section: Discussionmentioning

confidence: 99%

The Oral Cavity: A Reservoir that Favors Colonization and Selection of Candida parapsilosis sensu stricto Strains with High Pathogen Potential Under Conditions of Gingival-periodontal Disease

Rodríguez¹

2018

J. Dent. Sci. Ther

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The Candida parapsilosis complex comprises three genetically related species: Candida parapsilosis sensu stricto, Candida orthopsilosis and Candida metapsilosis. During the last decade, Candida parapsilosis sensu stricto has become the second most commonly isolated yeast from patients with blood stream invasive fungal infections, following Candida albicans. Despite its clinical significance, little is known about its distribution and behavior in oral cavity niches. Given this background, we intended to perform a molecular characterization of 38 isolates of the Candida parapsilosis complex collected from oral cavities of immunocompetent patients with and without gingivalperiodontal disease, with the aim of determining its distribution and establishing a correlation with clinical data. Besides, we assessed the virulence of the strains by examining the in vitro biofilm-forming capacity in two different culture media: YPD and RPMI 1640. Being more frequently isolated from oral cavities with pathological conditions, 89.5% of the strains were reconfirmed to be Candida parapsilosis sensu stricto. More than 70% of the Candida parapsilosis sensu stricto strains showed biofilm-forming capacity in both culture media, reflecting a statistically significant association between biofilm-forming capacity and the clinical conditions of the subjects from whom the strains were isolated. Among the three complex species, Candida parapsilosis sensu stricto is a normal commensal in the oral cavity, being more frequently recovered in inflammatory conditions. Gingival-periodontal disease may be a factor triggering overgrowth and virulence of Candida parapsilosis sensu stricto commensal strains.

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Section: Discussionmentioning

confidence: 99%

The Oral Cavity: A Reservoir that Favors Colonization and Selection of Candida parapsilosis sensu stricto Strains with High Pathogen Potential Under Conditions of Gingival-periodontal Disease

Rodríguez¹

2018

J. Dent. Sci. Ther

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“…The most common cause of invasive fungal infections in LTR is Candida spp. Candida infections, including candidemia, abdominal infections, and biliary infections, are mostly nosocomial and occur early after LT[ 149 ]. A retrospective study in LTR identified an overall incidence of fungal infections of 12%, with non-albicans Candida accounting for 55% of the infections; of these, half were caused by fluconazole-resistant C. parapsilosis [ 150 ].…”

Section: Infections In Liver Transplant Recipientsmentioning

confidence: 99%

Management of bacterial and fungal infections in end stage liver disease and liver transplantation: Current options and future directions

Righi¹

2018

WJG

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Patients with liver cirrhosis are susceptible to infections due to various mechanisms, including abnormalities of humoral and cell-mediated immunity and occurrence of bacterial translocation from the intestine. Bacterial infections are common and represent a reason for progression to liver failure and increased mortality. Fungal infections, mainly caused by Candida spp., are often associated to delayed diagnosis and high mortality rates. High level of suspicion along with prompt diagnosis and treatment of infections are warranted. Bacterial and fungal infections negatively affect the outcomes of liver transplant candidates and recipients, causing disease progression among patients on the waiting list and increasing mortality, especially in the early post-transplant period. Abdominal, biliary tract, and bloodstream infections caused by Gram-negative bacteria [e.g., Enterobacteriaceae and Pseudomonas aeruginosa (P. aeruginosa)] and Staphylococcus spp. are commonly encountered in liver transplant recipients. Due to frequent exposure to broad-spectrum antibiotics, invasive procedures, and prolonged hospitalizations, these patients are especially at risk of developing infections caused by multidrug resistant bacteria. The increase in antimicrobial resistance hampers the choice of an adequate empiric therapy and warrants the knowledge of the local microbial epidemiology and the implementation of infection control measures. The main characteristics and the management of bacterial and fungal infections in patients with liver cirrhosis and liver transplant recipients are presented.

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“… Note: Data collated from Bassetti et al, 28 Thursz et al 10 and Vergis et al 139 Abbreviation: ICU, intensive care unit. …”

Section: Figurementioning

confidence: 99%

“…However, intraabdominal candidiasis (IAC) which includes peritonitis and abdominal abscesses is also commonly reported (40%). 19 , 28 ICU admission and mortality are found to be higher in liver transplant recipients (LTRs) with candidemia compared to those with abdominal candidiasis. 29 More than one species of Candida spp.…”

Section: Introductionmentioning

confidence: 99%

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Echinocandins for management of invasive candidiasis in patients with liver disease and liver transplantation

Yeoh¹,

Lee²,

Chew³

et al. 2018

IDR

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Candida species remains one of the most important causes of opportunistic infections worldwide. Invasive candidiasis (IC) is associated with considerable morbidity and mortality in liver disease (LD) patients if not treated promptly. Echinocandins are often recommended as a first-line empirical treatment for managing IC and can especially play a critical role in managing IC in LD patients. However, advanced LD patients are often immunocompromised and critically ill. Hence altered pharmacokinetics, drug interactions as well as tolerance issues of antifungal treatments are a concern in these patients. This comprehensive review examines the epidemiology, risk factors and diagnosis of IC in patients with LD and evaluates differences between three available echinocandins for treating this group of patients.

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Invasive Candida Infections in Liver Transplant Recipients: Clinical Features and Risk Factors for Mortality

Abstract: Supplemental digital content is available in the text.

Cited by 41 publications

References 26 publications

The Oral Cavity: A Reservoir that Favors Colonization and Selection of Candida parapsilosis sensu stricto Strains with High Pathogen Potential Under Conditions of Gingival-periodontal Disease

The Oral Cavity: A Reservoir that Favors Colonization and Selection of Candida parapsilosis sensu stricto Strains with High Pathogen Potential Under Conditions of Gingival-periodontal Disease

Management of bacterial and fungal infections in end stage liver disease and liver transplantation: Current options and future directions

Echinocandins for management of invasive candidiasis in patients with liver disease and liver transplantation

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