Is biofilm production a prognostic marker in adults with candidaemia?

Abstract

Biofilm production was not a predictor of mortality or of unfavourable prognosis in adults with candidaemia.

Candida biofilm production is associated with higher mortality in patients with candidaemia

“…Studies using biofilm mass as predictor of mortality reported similarly versatile results; Muñoz et al (2018) and Shin et al (2002) did not find biofilm development, as determined by a crystal violet or safranin‐related assay, to be associated with increased mortality . However, the latter study involved a large proportion of C parapsilosis isolates, which are generally associated with low mortality .…”

“…Based on a recent epidemiological meta‐analysis, the incidence of candidaemia in Europe is 3.88 cases per 100 000 corresponding to approximately 79 cases per day . According to a number of studies, patients infected by biofilm‐producing isolates have a worse prognosis; however, contradicting studies also exist . This controversy is probably due, at least partly, to variability in the cut‐off values used to distinguish low from intermediate and high biofilm producers The other possible reason may be the high variability of the examined patient populations …”

“…These observations are consistent with the findings published by Tumbarello et al (2012), who showed 51% mortality in the biofilm‐producer group compared with isolates not producing biofilm (32%) based on XTT assay . In contrast, Pongrácz et al (2016) and Muñoz et al (2018) did not confirm biofilm production as a risk factor for mortality . In the present study, 30‐day mortality caused by Candida isolates producing biofilms was significantly higher comparing isolates with low and intermediate/high metabolic activity; in addition, intermediate/high metabolic activity proved to be a significant predictor of mortality in multivariate analysis.…”

“…Biofilm formation is a key virulence factor for Candida species; it serves as a focus in bloodstream infections, protects the fungal cells against the immune response; furthermore, the presence of biofilms is associated with reduced susceptibility to antimicrobial agents . Until recently, data on the clinical impact of Candida biofilm on mortality were scarce and there were more contradictions than answers due to the diverse experimental settings and variable patient populations . Several studies drew attention to the problems possibly arising from the variability of biofilm detection methods and the poorly standardised cut‐off points to distinguish biofilm‐producer isolates from strains with low biofilm production capability .…”

“…9 Until recently, data on the clinical impact of Candida biofilm on mortality were scarce and there were more contradictions than answers due to the diverse experimental settings and variable patient populations. [10][11][12] Several studies drew attention to the problems possibly arising from the variability of biofilm detection methods and the poorly standardised cut-off points to distinguish biofilm-producer isolates from strains with low biofilm production capability. [10][11][12][13] Generally, two simple rapid screening platforms are used to examine biofilm production, that is quantification of biomass production using crystal violet-based staining 14 and quantification of the metabolic activity of sessile cells using XTT (2,3-bis(2-methoxy-4-nitro-5-sulfophenyl)-2H-tetrazolium-5-carboxanilide) reduction assay.…”