scholarly journals SUSCEPTIBILITY OF Candida spp. ISOLATED FROM BLOOD CULTURES AS EVALUATED USING THE M27-A3 AND NEW M27-S4 APPROVED BREAKPOINTS

2014 ◽  
Vol 56 (6) ◽  
pp. 477-482 ◽  
Author(s):  
Edileusa Rosa dos Santos ◽  
Camila F. Dal Forno ◽  
Mari Glei Hernandez ◽  
Thaís Felli Kubiça ◽  
Tarcieli P. Venturini ◽  
...  
Keyword(s):  
Antifungal Agents ◽  
Mortality Rates ◽  
Blood Cultures ◽  
Drug Resistant ◽  
Candida Spp ◽  
Fungal Isolates ◽  
Clinical Breakpoints ◽  
Susceptibility Tests ◽  
Species Specific ◽  
Emergence Of Resistance

The high mortality rates associated with candidemia episodes and the emergence of resistance to antifungal agents necessitate the monitoring of the susceptibility of fungal isolates to antifungal treatments. The new, recently approved, species-specific clinical breakpoints (SS-CBPs)(M27-S4) for evaluating susceptibility require careful interpretation and comparison with the former proposals made using the M27-A3 breakpoints, both from CLSI. This study evaluated the susceptibility of the different species of Candida that were isolated from candidemias based on these two clinical breakpoints. Four hundred and twenty-two isolates were identified and, among them, C. parapsilosis comprised 46.68%, followed by C. albicans (35.78%), C. tropicalis (9.71%), C. glabrata (3.55%), C. lusitaniae (1.65%), C. guilliermondii (1.65%) and C. krusei (0.94%). In accordance with the M27-A3 criteria, 33 (7.81%) non-susceptible isolates were identified, of which 16 (3.79%) were resistant to antifungal agents. According to SS-CBPs, 80 (18.95%) isolates were non-susceptible, and 10 (2.36%) of these were drug resistant. When the total number of non-susceptible isolates was considered, the new SS-CBPs detected 2.4 times the number of isolates that were detected using the M27-A3 interpretative criteria. In conclusion, the detection of an elevated number of non-susceptible species has highlighted the relevance of evaluating susceptibility tests using new, species-specific clinical breakpoints (SS-CBPs), which could impact the profile of non-susceptible Candida spp. to antifungal agents that require continuous susceptibility monitoring.

scholarly journals Comparison of Two Commercial Colorimetric Broth Microdilution Tests for Candida Susceptibility Testing: Sensititre YeastOne versus MICRONAUT-AM

2021 ◽  
Vol 7 (5) ◽  
pp. 356
Author(s):  
Sophie Philips ◽  
Frederik Van Van Hoecke ◽  
Emmanuel De De Laere ◽  
Steven Vervaeke ◽  
Roos De De Smedt ◽  
...  
Keyword(s):  
Amphotericin B ◽  
Antifungal Agents ◽  
Susceptibility Testing ◽  
Antifungal Susceptibility ◽  
Reference Method ◽  
Daily Practice ◽  
Broth Microdilution ◽  
Minimal Inhibitory Concentrations ◽  
Clinical Breakpoints ◽  
Susceptibility Tests

Two colorimetric broth microdilution antifungal susceptibility tests were compared, Sensititre YeastOne and MICRONAUT-AM for nine antifungal agents. One hundred clinical Candida isolates were tested, representing a realistic population for susceptibility testing in daily practice. The reproducibility characteristics were comparable. Only for fluconazole, caspofungin, 5-flucytosine and amphotericin B, an essential agreement of ≥90% could be demonstrated. Sensititre minimal inhibitory concentrations (MICs) were systematically higher than MICRONAUT MICs for all antifungals, except for itraconazole. CLSI clinical breakpoints (CBPs) and epidemiological cut-off values (ECVs) were used for Sensititre MICs while for MICRONAUT the EUCAST CBPs and ECVs were used. Only fluconazole, micafungin, and amphotericin B had a categorical agreement of ≥90%. For fluconazole, micafungin, and amphotericin B the susceptibility proportions were comparable. Susceptibility proportion of posaconazole and voriconazole was higher using the MICRONAUT system. For itraconazole and anidulafungin, the susceptibility proportion was higher using Sensititre. It was not possible to determine the true MIC values or the correctness of a S/I/R result since both commercial systems were validated against a different reference method. These findings show that there is a significant variability in susceptibility pattern and consequently on use of antifungals in daily practice, depending on the choice of commercial system.

scholarly journals Epidemiology of Candidemia at a University Hospital in Colombia, 2008-2014

2018 ◽  
Vol 60 (1) ◽  
Author(s):  
Julián Esteban Barahona Correra ◽  
Maria Gabriela Calvo Valderrama ◽  
Diana Marcela Romero Alvernia ◽  
Juliana Angulo Mora ◽  
Luisa Fernanda Alarcón Figueroa ◽  
...  
Keyword(s):  
Risk Factors ◽  
Analytical Study ◽  
Bloodstream Infections ◽  
Blood Cultures ◽  
University Hospital ◽  
Candida Spp ◽  
Cross Sectional ◽  
Microbiological Characteristics ◽  
Susceptibility Tests ◽  
Isolated Species

Introduction: Candida species are commensal yeasts of the human microbiota. However, due to several host’s conditions, bloodstream infections may arise causing high morbimortality. Methods: Retrospective cross-sectional analytical study of positive blood cultures for Candida spp. between 2008-2014 at a university hospital in Bogota, Colombia. We evaluated clinical and microbiological characteristics prior to the first positive blood sample was obtained and determined associations with non-C. albicans (NCA) species infections. Results: We included 123 candidemia cases. C. albicans was the most frequently isolated species (42%). However, NCA species as a group were observed more often. Over 70% of cases were managed at the ICU, with a median stay of 14 days. Several medical factors were frequently observed, however none appeared to be associated with NCA species candidemia. Resistance to at least one antifungal agent was observed in 29% of cases, although a reduced sample of susceptibility tests was available. Conclusions: Our results support a worldwide shift towards NCA candidemia. However, clinical features were not associated with NCA infections. The identification of risk factors and the improvement of prediction scores must be prioritized, in order to identify patients at high risk who may benefit of pre-emptive therapy.

scholarly journals Drug Resistance and Novel Therapeutic Approaches in Invasive Candidiasis

2021 ◽  
Vol 11 ◽  
Author(s):  
Sarah E. Murphy ◽  
Tihana Bicanic
Keyword(s):  
Invasive Candidiasis ◽  
Antifungal Agents ◽  
Fungal Infections ◽  
Clinical Trial Data ◽  
Mortality Rates ◽  
Antifungal Drugs ◽  
Drug Resistant ◽  
Therapeutic Approaches ◽  
Mechanisms Of Resistance ◽  
Potential Strategy

Candida species are the leading cause of invasive fungal infections worldwide and are associated with acute mortality rates of ~50%. Mortality rates are further augmented in the context of host immunosuppression and infection with drug-resistant Candida species. In this review, we outline antifungal drugs already in clinical use for invasive candidiasis and candidaemia, their targets and mechanisms of resistance in clinically relevant Candida species, encompassing not only classical resistance, but also heteroresistance and tolerance. We describe novel antifungal agents and targets in pre-clinical and clinical development, including their spectrum of activity, antifungal target, clinical trial data and potential in treatment of drug-resistant Candida. Lastly, we discuss the use of combination therapy between conventional and repurposed agents as a potential strategy to combat the threat of emerging resistance in Candida.

scholarly journals Interlaboratory Variability of Caspofungin MICs for Candida spp. Using CLSI and EUCAST Methods: Should the Clinical Laboratory Be Testing This Agent?

2013 ◽  
Vol 57 (12) ◽  
pp. 5836-5842 ◽  
Author(s):  
A. Espinel-Ingroff ◽  
M. C. Arendrup ◽  
M. A. Pfaller ◽  
L. X. Bonfietti ◽  
B. Bustamante ◽  
...  
Keyword(s):  
Storage Time ◽  
Clinical Laboratory ◽  
The United States ◽  
Candida Spp ◽  
Routine Testing ◽  
Content Type ◽  
Interlaboratory Variability ◽  
Clinical Breakpoints ◽  
Species Specific ◽  
Excessive Number

ABSTRACTAlthough Clinical and Laboratory Standards Institute (CLSI) clinical breakpoints (CBPs) are available for interpreting echinocandin MICs forCandidaspp., epidemiologic cutoff values (ECVs) based on collective MIC data from multiple laboratories have not been defined. While collating CLSI caspofungin MICs for 145 to 11,550Candidaisolates from 17 laboratories (Brazil, Canada, Europe, Mexico, Peru, and the United States), we observed an extraordinary amount of modal variability (wide ranges) among laboratories as well as truncated and bimodal MIC distributions. The species-specific modes across different laboratories ranged from 0.016 to 0.5 μg/ml forC. albicansandC. tropicalis, 0.031 to 0.5 μg/ml forC. glabrata, and 0.063 to 1 μg/ml forC. krusei. Variability was also similar among MIC distributions forC. dubliniensisandC. lusitaniae. The exceptions wereC. parapsilosisandC. guilliermondiiMIC distributions, where most modes were within one 2-fold dilution of each other. These findings were consistent with available data from the European Committee on Antimicrobial Susceptibility Testing (EUCAST) (403 to 2,556 MICs) forC. albicans,C. glabrata,C. krusei, andC. tropicalis. Although many factors (caspofungin powder source, stock solution solvent, powder storage time length and temperature, and MIC determination testing parameters) were examined as a potential cause of such unprecedented variability, a single specific cause was not identified. Therefore, it seems highly likely that the use of the CLSI species-specific caspofungin CBPs could lead to reporting an excessive number of wild-type (WT) isolates (e.g.,C. glabrataandC. krusei) as either non-WT or resistant isolates. Until this problem is resolved, routine testing or reporting of CLSI caspofungin MICs forCandidais not recommended; micafungin or anidulafungin data could be used instead.

scholarly journals Surgical treatment of infective endocarditis in intravenous drug abusers

2021 ◽  
Vol 16 (1) ◽  
Author(s):  
Alina Zubarevich ◽  
Marcin Szczechowicz ◽  
Anja Osswald ◽  
Jerry Easo ◽  
Arian Arjomandi Rad ◽  
...  
Keyword(s):  
Surgical Treatment ◽  
Drug Abuse ◽  
Infective Endocarditis ◽  
Mortality Rates ◽  
Blood Cultures ◽  
Intravenous Drug ◽  
Intravenous Drug Abuse ◽  
Enterococcus Species ◽  
Function Impairment

Abstract Background Despite current progress in antibiotic therapy and medical management, infective endocarditis remains a serious condition presenting with high mortality rates. It also is a life-threatening complication in patients with a history of chronic intravenous drug abuse. In this study, we analyzed our institutional experience on the surgical therapy of infective endocarditis in patients with active intravenous drug abuse. The aim of the study is to identify the predictive factors of mortality and morbidity in this subgroup of patients. Methods Between 2007 and 2020, a total of 24 patients (7 female, mean age 38.5 ± 8.7) presenting with active intravenous drug abuse underwent a surgical treatment for the infective endocarditis at out center. The primary endpoint was survival at 30th day after the surgery. The secondary composite endpoint included freedom from death, recurrent endocarditis, re-do surgery, and postoperative stroke during the follow-up period. Mean follow-up was 4.2 ± 4.3 years. Results Staphylococcus species was the most common pathogen detected in the preoperative blood cultures. Infection caused by Enterococcus species as well as liver function impairment were identified as mortality predictor factors. Logistic EuroSCORE and EusoSCORE-II were also predictive factors for mortality in univariate analysis. Survival at 1 and 3 years was 78 and 72% respectively. Thirty-day survival was 88%. 30-day freedom from combined endpoint was 83% and after 1 and 3 years, 69 and 58% of the patients respectively were free from combined endpoint. Five patients (20.8%) were readmitted with recurrent infective endocarditis. Conclusion In patients presenting with active intravenous drug abuse, treatment of infective endocarditis should be performed as aggressively as possible and should be followed by antibiotic therapy to avoid high mortality rates and recurrent endocarditis. Early intervention is advisable in patients with an infective endocarditis and enterococcus species in the preoperative blood cultures, liver function deterioration as well as cardiac function impairment. Attention should be also payed to addiction treatment, due to the elevated relapse rate in patients who actively inject drugs. However, larger prospective studies are necessary to support our results. As septic shock is the most frequent cause of death, new treatment options, e.g. blood purification should be evaluated.

scholarly journals Bacteremic sepsis leads to higher mortality when adjusting for confounders with propensity score matching

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Lisa Mellhammar ◽  
Fredrik Kahn ◽  
Caroline Whitlow ◽  
Thomas Kander ◽  
Bertil Christensson ◽  
...  
Keyword(s):  
Intensive Care ◽  
Clinical Review ◽  
Pathogen Detection ◽  
Mortality Rates ◽  
Blood Cultures ◽  
Population Heterogeneity ◽  
Sepsis Diagnosis ◽  
Culture Positive ◽  
Culture Negative ◽  
Microbial Samples

AbstractOne can falsely assume that it is well known that bacteremia is associated with higher mortality in sepsis. Only a handful of studies specifically focus on the comparison of culture-negative and culture-positive sepsis with different conclusions depending on study design. The aim of this study was to describe outcome for critically ill patients with either culture-positive or -negative sepsis in a clinical review. We also aimed to identify subphenotypes of sepsis with culture status included as candidate clinical variables. Out of 784 patients treated in intensive care with a sepsis diagnosis, blood cultures were missing in 140 excluded patients and 95 excluded patients did not fulfill a sepsis diagnosis. Of 549 included patients, 295 (54%) had bacteremia, 90 (16%) were non-bacteremic but with relevant pathogens detected and in 164 (30%) no relevant pathogen was detected. After adjusting for confounders, 90-day mortality was higher in bacteremic patients, 47%, than in non-bacteremic patients, 36%, p = 0.04. We identified 8 subphenotypes, with different mortality rates, where pathogen detection in microbial samples were important for subphenotype distinction and outcome. In conclusion, bacteremic patients had higher mortality than their non-bacteremic counter-parts and bacteremia is more common in sepsis when studied in a clinical review. For reducing population heterogeneity and improve the outcome of trials and treatment for sepsis, distinction of subphenotypes might be useful and pathogen detection an important factor.

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