Epidemiology and echinocandin susceptibility of Candida parapsilosis sensu lato species isolated from bloodstream infections at a Spanish university hospital

Abstract Background Coronavirus disease 19 (COVID-19) leading to acute respiratory distress syndrome is associated with need for intensive care (IC), mechanical ventilation (MV), and prolonged recovery. These patients are thus predisposed to blood stream infections which can worsen outcomes. This risk may be aggravated by adjunctive therapies. Methods We reviewed the medical records of all adults admitted to Stony Brook University Hospital, NY, from March 1 to April 15, 2020 with severe COVID-19 pneumonia (requiring high-ﬂow O2). Patients who received MV or died within 24h were excluded. Patients were followed until death or hospital discharge. We reviewed positive blood cultures (PBC) for pathogenic microorganisms, and calculated the incidence of bacteremia, rates of infective endocarditis (IE), and impact on mortality. Microbes isolated only once and belonging to groups defined as commensal skin microbiota were labelled as contaminants. We also examined the impact of adjunctive therapies with immunosuppressive potential (steroids and tocilizumab), on bacteremia. Results A total of 469 patients with severe COVID-19 pneumonia were included (Table 1). Of these, 199 (42.4%) required IC and 172 (36.7%) MV. Median length of stay was 13 days (8–22) and 94 (20.0%) had PBC. Of these, 43 were considered true pathogens (bacteremia), with predominance of E. faecalis and S. epidermidis, and 51 were considered contaminants (Table 2). The incidence of bacteremia (43/469, 9.2%) was 5.1 per 1000 patient-days (95%CI 3.8–6.4). An echocardiogram was performed in 21 patients, 1 had an aortic valve vegetation (IE) by methicillin sensitive S. aureus. Bacteremia rates were nonsignificantly higher with steroids (5.9 vs 3.7 per 1000 patient-days; P=0.057). Use of tocilizumab was not associated with bacteremia (5.8 vs 4.8 per 1000 patient-days; P=0.28). Mortality was nonsignificantly higher in patients with (15/43, 34.9%) vs. without (108/426, 25.4%) bacteremia (P=0.20). Length of stay was the strongest predictor of bacteremia, with risk increasing by 7% (95%CI 6%-9%, P< 0.001) per additional day. Cohort Characteristics of Patients with Severe COVID-19 Pneumonia on High-Flow O2 (N= 469) All Microorganisms Isolated from Blood Cultures Conclusion The incidence of bacteremia was relatively low and IE was uncommon in this study of severe COVID-19 patients. Risk of bacteremia increased with longer hospital stay and with steroids use, but not with tocilizumab. Disclosures All Authors: No reported disclosures

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Incidence rate and risk factors of central line-associated bloodstream infections among neonates and children admitted to a tertiary care university hospital

American Journal of Infection Control ◽

10.1016/j.ajic.2021.07.016 ◽

2021 ◽

Author(s):

Kanyarat Khieosanuk ◽

Sawalak Fupinwong ◽

Anchana Tosilakul ◽

Natthanidnan Sricharoen ◽

Tavitiya Sudjaritruk

Keyword(s):

Risk Factors ◽

Incidence Rate ◽

Tertiary Care ◽

Bloodstream Infections ◽

Central Line ◽

University Hospital

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P1365HEMODIALYSIS CATHETER-RELATED BLOODSTREAM INFECTIONS : A CASE SERIES

Nephrology Dialysis Transplantation ◽

10.1093/ndt/gfaa142.p1365 ◽

2020 ◽

Vol 35 (Supplement_3) ◽

Author(s):

Ouni Amal ◽

Meriem Ben salem ◽

Malek Mojaat ◽

Hadj Brahim Mayssa ◽

Ben salah Manel ◽

...

Keyword(s):

Case Series ◽

Bloodstream Infections ◽

Descriptive Study ◽

Venous Access ◽

University Hospital ◽

Risk Of Infection ◽

Hemodialysis Catheter ◽

The Creation ◽

Bacteriological Parameters

Abstract Background and Aims the recourse to catheter among patients on hemodialysis is frequent due to many reasons. It is highly associated to a risk of infection in comparison to AVF. The aim of our study was to determine the clinical and bacteriological parameters in patients hospitalized for dialysis catheter related bloodstream infections. Method We conducted a retrospective descriptive study based on the data of patients hospitalized for hemodialysis catheter-related bloodstream infection in the department of nephrology in Fattouma Bourguiba University hospital between January 2013 and February 2018. Data concerning the bacteriological exams were obtained from our bacteriology laboratory. Results 50 patients were included with a mean-age of 56 years old. 74% were women, 30% diabetic and 18% considered immunodepressed. The indications for the placement of catheter were: 21 patients waiting for the creation of AVF, 16 patients with a dysfunction of AVF, 6 patients with AKI and 7 patients with inadequate veins for the creation of AFV. The IJV was the site of insertion in 74% of patients (with 4 % of tunneled catheters). 26 % of patients developed a septic choc, and 74 % developed a sepsis. The culture of the specimen of catheters was positive in 32 patients (64%). Staphylococcus aureus was isolated in 14 patients (28%) with MSSA among 8 patients and enterobacteria among 8 patients. Hemoculture was only positive in 13 patients. The catheter was removed in the majority of cases except in 6 patients in whom there was no other venous access. The evolution was favourable in 80 % of patients. 5 patients developed an infective endocarditis as a secondary localization. Conclusion The AVF remains the best vascular access for hemopadialysis patients. The recourse to catheters must be considered as a last choice because of the risk of infections which frequently necessitates the hospitalization with an increase in mortality.

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2143. Attempting to Add Clarity to “Indeterminates” on a Deployed Rapid Diagnostic with Antimicrobial Stewardship Program (ASP) Intervention

Open Forum Infectious Diseases ◽

10.1093/ofid/ofz360.1823 ◽

2019 ◽

Vol 6 (Supplement_2) ◽

pp. S726-S726

Author(s):

Heather L Cox ◽

April E Attai ◽

Allison M Stilwell ◽

Kasi B Vegesana ◽

Frankie Brewster ◽

...

Keyword(s):

Pasteurella Multocida ◽

Diagnostic Testing ◽

Bloodstream Infections ◽

Empiric Therapy ◽

Central Line ◽

Blood Cultures ◽

University Hospital ◽

Salmonella Spp ◽

Gram Negative ◽

Stewardship Program

Abstract Background Rapid diagnostic testing paired with ASP intervention optimizes therapy and improves outcomes but few data guide ASP response in the absence of organism identification (ID). We describe the microbiology for organisms unidentified by Accelerate Pheno™ Gram-negative platform (AXDX) in order to inform ASP-provider team communication (PTC). Methods Consecutive, non-duplicate inpatient blood cultures with Gram-negative bacilli (GNB) following AXDX implementation at a single university hospital between April 2018 and March 2019 were included. Standard of care (SOC) ID and susceptibility followed AXDX. Clinical Microbiology emailed AXDX results to the ASP in real time; results were released into the EMR paired with telephone PTC or withheld after ASP review. Bloodstream Infections (BSIs) and patient outcomes for organisms labeled no/indeterminate ID by the AXDX were characterized. Results AXDX was performed on 351 blood cultures. Among 52 (15%) labeled no/indeterminate ID, SOC methods revealed: Enterobacteriaceae (40%; 9 monomicrobial with AXDX targets), anaerobes (21%), non-lactose fermenters (NLFs) other than Pseudomonas aeruginosa (21%), and fastidious GNB (10%). Frequent organisms without AXDX targets included: Raoultella planticola (4); Bacteroides fragilis, Cupriavidus spp., Haemophilus spp., Prevotella spp., Providencia spp., non-aeruginosa Pseudomonas spp., Salmonella spp. (3 each); Pasteurella multocida, Stenotrophomonas maltophilia (2 each). BSI sources were most commonly intra-abdominal (21%), central line-associated (17%), or unknown (17%). CLABSIs were associated with immune suppression and/or substance abuse in all but 1 case. BSIs without active empiric therapy included: NDM-producing Providencia stuartii SSSI; OXA-48-producing R. planticola intraabdominal infection (IAI); Pandoraea spp. CLABSI after liver transplant; enteric fever; B. fragilis, Leptotrichia wadei, and S. maltophilia, each of unknown source. In-hospital mortality occurred in 4 of these cases. Conclusion When AXDX yields no/indeterminate ID, ASP chart review for possible anaerobic/IAI, unique environmental exposures, and travel history may assist in guiding empiric therapy. GNB with AXDX targets are not excluded. Disclosures All authors: No reported disclosures.

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Loss of C-5 Sterol Desaturase Activity Results in Increased Resistance to Azole and Echinocandin Antifungals in a Clinical Isolate of Candida parapsilosis

Antimicrobial Agents and Chemotherapy ◽

10.1128/aac.00651-17 ◽

2017 ◽

Vol 61 (9) ◽

Cited By ~ 14

Author(s):

Jeffrey M. Rybak ◽

C. Michael Dickens ◽

Josie E. Parker ◽

Kelly E. Caudle ◽

Kayihura Manigaba ◽

...

Keyword(s):

Clinical Isolate ◽

Desaturase Activity ◽

Candida Parapsilosis ◽

Prosthetic Valve Endocarditis ◽

Bloodstream Infections ◽

Resistant Isolate ◽

Ergosterol Biosynthesis ◽

Azole Resistance ◽

Content Type ◽

High Level

ABSTRACT Among emerging non-albicans Candida species, Candida parapsilosis is of particular concern as a cause of nosocomial bloodstream infections in neonatal and intensive care unit patients. While fluconazole and echinocandins are considered effective treatments for such infections, recent reports of fluconazole and echinocandin resistance in C. parapsilosis indicate a growing problem. The present study describes a novel mechanism of antifungal resistance in this organism affecting susceptibility to azole and echinocandin antifungals in a clinical isolate obtained from a patient with prosthetic valve endocarditis. Transcriptome analysis indicated differential expression of several genes in the resistant isolate, including upregulation of ergosterol biosynthesis pathway genes ERG2, ERG5, ERG6, ERG11, ERG24, ERG25, and UPC2. Whole-genome sequencing revealed that the resistant isolate possessed an ERG3 mutation resulting in a G111R amino acid substitution. Sterol profiles indicated a reduction in sterol desaturase activity as a result of this mutation. Replacement of both mutant alleles in the resistant isolate with the susceptible isolate's allele restored wild-type susceptibility to all azoles and echinocandins tested. Disruption of ERG3 in the susceptible and resistant isolates resulted in a loss of sterol desaturase activity, high-level azole resistance, and an echinocandin-intermediate to -resistant phenotype. While disruption of ERG3 in C. albicans resulted in azole resistance, echinocandin MICs, while elevated, remained within the susceptible range. This work demonstrates that the G111R substitution in Erg3 is wholly responsible for the altered azole and echinocandin susceptibilities observed in this C. parapsilosis isolate and is the first report of an ERG3 mutation influencing susceptibility to the echinocandins.

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