The Impact of Biofilm Formation on the Persistence of Candidemia

Abstract

This study aimed to determine the predictors of persistent candidemia and examine the impact of biofilm formation by Candida isolates in adult patients with candidemia. Of the adult patients with candidemia in Kaohsiung Chang Gung Memorial Hospital between January 2007 and December 2012, 68 case patients with persistent candidemia (repeated candidemia after a 3-day systemic antifungal therapy) and 68 control patients with non-persistent candidemia (Candida clearance from the bloodstream after a 3-day systemic antifungal therapy) were included based on propensity score matching and matching for the Candida species isolated. Biofilm formation by the Candida species was assessed in vitro using standard biomass assays. Presence of central venous catheters (CVCs) at diagnosis (adjusted odd ratio [AOR], 3.77; 95% confidence interval [CI], 1.09–13.00, p = 0.04), infection with higher biofilm forming strains of Candida species (AOR, 8.03; 95% CI, 2.50–25.81; p < 0.01), and receipt of suboptimal fluconazole doses as initial therapy (AOR, 5.54; 95% CI, 1.53–20.10; p < 0.01) were independently associated with persistent candidemia. Biofilm formation by Candida albicans, C. tropicalis, and C. glabrata strains was significantly higher in the case patients than in the controls. There were no significant differences in the overall mortality and duration of hospitalization between the two groups. Our data suggest that, other than presence of retained CVCs and use of suboptimal doses of fluconazole, biofilm formation was highly associated with development of persistent candidemia.

Persistent vs non‐persistent candidaemia in adult patients in 2007‐2016: A retrospective cohort study

“…The presence of CVC is a prominent risk factor for PC; however, the timing of CVC removal is complex. The association between early removal of CVC and PC was not significant in our study, supported by another recent study 24 . Nucci et al 26 showed that early CVC removal had no effect on persistent or recurrent candidaemia or time to mycological eradication, although earlier studies have reported an association of improved outcome and faster mycological eradication with prompt CVC removal 27,28 …”

“…Catheter‐related infection was the most common source of infection in persistent cases. CVC has been demonstrated as a risk factor for PC in other studies as well 11,23‐25 . However, a recent cohort study conducted in adult patients did not find a significant association between CVC andPC 12 .…”

Antifungal Resistance of Candida Species in Bacolod City, Philippines

“…Candida species can also produce biofilm, considered as the most pathogenic trait, which result in treatment failures and recurrent infection [19]. It has also the ability to generate the filamentous form that is important to tissue invasion; however, these are dependent to environmental factors and type of species [2].…”

Antifungal activity of etomidate against growing biofilms of fluconazole-resistant Candida spp. strains, binding to mannoproteins and molecular docking with the ALS3 protein

“…The adhesion and biofilm production abilities of Candida spp. are among the principal risk factors for the development of invasive candidiasis [4][5][6]. Candida spp.…”

“…From a clinical point of view, one of the most worrying characteristics of biofilms is their capacity to resist higher levels of antifungal drugs compared with planktonic cells. Hence, they are strongly associated with persistent candidaemia [6,8].…”