Candida spp. isolation from critically ill patients’ respiratory tract. Does antifungal treatment affect survival?

Fungal peritonitis is a life-threatening condition which is not only difficult to diagnose, but also to treat. Following recent guidelines, echinocandins and azoles are the recommended antimycotics for the management of intra-abdominal Candida spp. infections, with a favor for echinocandins in critically ill patients. However, the new extended spectrum triazole isavuconazole also has a broad spectrum against Candida spp. Data on its target-site penetration are sparse. Therefore, we assessed isavuconazole concentrations and penetration ratios in ascites fluid of critically ill patients. Obtaining of Isavuconazole plasma and ascites fluid levels as well penetration ratios using paracentesis in critically ill patients. Isavuconazole concentrations were quantified in human plasma and ascites by a liquid chromatography/tandem mass spectrometry (LC-MS/MS) method. Isavuconazole concentrations in plasma and ascites fluid were measured in sixteen critically ill patients. Isavuconazol levels in ascites fluid (1.06 µg/mL) were lower than plasma levels (3.08 µg/mL). Penetration ratio was 36%. In two out of sixteen patients, Candida spp., in detail C. glabrata and C. tropicalis, could be isolated. Cmax/MIC Ratio in plasma of 560 for C. glabrata and 2166 for C. tropicalis could be observed. Following our results, isavuconazole penetrates into ascites. Successful treatment in Candida spp. peritonitis depends on pathogen susceptibility.

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The lower respiratory tract microbiome of critically ill patients with COVID-19

Scientific Reports ◽

10.1038/s41598-021-89516-6 ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Paolo Gaibani ◽

Elisa Viciani ◽

Michele Bartoletti ◽

Russell E. Lewis ◽

Tommaso Tonetti ◽

...

Keyword(s):

Respiratory Tract ◽

Critically Ill ◽

Critically Ill Patients ◽

Lower Respiratory Tract ◽

Multidrug Resistant ◽

Carbapenem Resistant ◽

Lung Microbiome ◽

Bacterial Microbiome ◽

Unweighted Unifrac ◽

Bacterial Superinfection

AbstractCOVID-19 infection may predispose to secondary bacterial infection which is associated with poor clinical outcome especially among critically ill patients. We aimed to characterize the lower respiratory tract bacterial microbiome of COVID-19 critically ill patients in comparison to COVID-19-negative patients. We performed a 16S rRNA profiling on bronchoalveolar lavage (BAL) samples collected between April and May 2020 from 24 COVID-19 critically ill subjects and 24 patients with non-COVID-19 pneumonia. Lung microbiome of critically ill patients with COVID-19 was characterized by a different bacterial diversity (PERMANOVA on weighted and unweighted UniFrac Pr(> F) = 0.001) compared to COVID-19-negative patients with pneumonia. Pseudomonas alcaligenes, Clostridium hiranonis, Acinetobacter schindleri, Sphingobacterium spp., Acinetobacter spp. and Enterobacteriaceae, characterized lung microbiome of COVID-19 critically ill patients (LDA score > 2), while COVID-19-negative patients showed a higher abundance of lung commensal bacteria (Haemophilus influenzae, Veillonella dispar, Granulicatella spp., Porphyromonas spp., and Streptococcus spp.). The incidence rate (IR) of infections during COVID-19 pandemic showed a significant increase of carbapenem-resistant Acinetobacter baumannii (CR-Ab) infection. In conclusion, SARS-CoV-2 infection and antibiotic pressure may predispose critically ill patients to bacterial superinfection due to opportunistic multidrug resistant pathogens.

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Clinical correlates of herpes simplex virus type 1 loads in the lower respiratory tract of critically ill patients

Journal of Clinical Virology ◽

10.1016/j.jcv.2013.05.007 ◽

2013 ◽

Vol 58 (1) ◽

pp. 79-83 ◽

Cited By ~ 14

Author(s):

Evelien Assink-de Jong ◽

A.B. Johan Groeneveld ◽

Annika M. Pettersson ◽

Alex Koek ◽

Christina M.J.E. Vandenbroucke-Grauls ◽

...

Keyword(s):

Herpes Simplex Virus ◽

Herpes Simplex ◽

Respiratory Tract ◽

Critically Ill ◽

Herpes Simplex Virus Type ◽

Critically Ill Patients ◽

Lower Respiratory Tract ◽

Clinical Correlates ◽

Simplex Virus

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Clinical Significance of Herpes Simplex Virus in the Lower Respiratory Tract of Critically Ill Patients

European Journal of Clinical Microbiology & Infectious Diseases ◽

10.1007/s10096-002-0809-y ◽

2002 ◽

Vol 21 (10) ◽

pp. 758-759 ◽

Cited By ~ 20

Author(s):

Camps K. ◽

Jorens P. ◽

Demey H. ◽

Pattyn S. ◽

Ieven M.

Keyword(s):

Herpes Simplex Virus ◽

Herpes Simplex ◽

Respiratory Tract ◽

Critically Ill ◽

Clinical Significance ◽

Critically Ill Patients ◽

Lower Respiratory Tract ◽

Simplex Virus

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Kinetic Patterns of Candida albicans Germ Tube Antibody in Critically Ill Patients: Influence on Mortality

Clinical and Vaccine Immunology ◽

10.1128/cvi.00183-09 ◽

2009 ◽

Vol 16 (10) ◽

pp. 1527-1528 ◽

Cited By ~ 20

Author(s):

Rafael Zaragoza ◽

Javier Pemán ◽

Guillermo Quindós ◽

Jose R. Iruretagoyena ◽

María S. Cuétara ◽

...

Keyword(s):

Candida Albicans ◽

Intensive Care ◽

Intensive Care Units ◽

Critically Ill ◽

Critically Ill Patients ◽

Germ Tube ◽

Antifungal Agents ◽

Mortality Rates ◽

Antifungal Treatment ◽

Lower Mortality

ABSTRACT The influence of kinetic patterns of Candida albicans germ tube antibodies (CAGTA) on mortality was analyzed in six intensive care units. Statistically significant lower mortality rates were found in patients with patterns of increasing CAGTA titers who had been treated with antifungal agents. Thus, antifungal treatment should be considered when CAGTA titers are increasing in critically ill patients.

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