scholarly journals Molecular epidemiology, risk factors, species distribution, antifungal susceptibility and outcome of candidemia in the capital of Iran: a prospective study

2020 ◽  
Author(s):  
Mohammad Kord ◽  
Mohammadreza Salehi ◽  
Seyed Jamal Hashemi ◽  
Sassan Rezaie ◽  
Ayda Maleki ◽  
...  
Keyword(s):  
Risk Factors ◽  
Molecular Epidemiology ◽  
Species Distribution ◽  
Clinical Symptoms ◽  
Antifungal Susceptibility ◽  
Underlying Disease ◽  
Antifungal Drugs ◽  
Teaching Hospitals ◽  
A Prospective Study ◽  
Underlying Diseases

Abstract Background Candidemia is a major cause of morbidity and mortality among patients receiving immunosuppressive therapy and those hospitalized with serious underlying diseases despite the commencement of antifungal therapy. We investigated the molecular epidemiology, clinical characteristics, comorbidity risk factors, species distribution, antifungal susceptibility profile, and outcome of candidemia to provide appropriate perspectives in Tehran, Iran. Methods A prospective observational study of all patients diagnosed with candidemia was performed at two referral teaching hospitals in Tehran. Demographic characteristics, underlying diseases, risk factors, clinical symptoms, and laboratory analyses were mined. Results One-hundred and fifty-two Candida isolates from 89 patients with candidemia were recovered. The overall crude mortality was 47.2%. The most common underlying disease was sepsis (48.3%) followed by malignancy (46.1%), renal failure/ dialysis (43.8%), and Hypertension (40.0%). C. albicans (43.8%) was the most frequent causative agent followed by C. glabrata (21.3%), C. parapsilosis complex (15.7%), C. tropicalis (11.2%), and C. lusitaniae (3.4%). Result of antifungal susceptibility test show that activity of all the four azole antifungal agents was low against non-albicans Candida species, especially C. tropicalis. Conclusion Increase in non-albicans Candida species with reduced susceptibility to antifungal drugs might be alarming in high-risk patients. Therefore, accurate knowledge of predisposing factors and epidemiological patterns in candidemia are effective steps for managing and decreasing the mortality rate in candidemia.

scholarly journals Risk Factors for Fluconazole-Resistant Candidemia

2010 ◽  
Vol 54 (8) ◽  
pp. 3149-3154 ◽  
Author(s):  
José Garnacho-Montero ◽  
Ana Díaz-Martín ◽  
Emilio García-Cabrera ◽  
Maite Ruiz Pérez de Pipaón ◽  
Clara Hernández-Caballero ◽  
...  
Keyword(s):  
Risk Factors ◽  
Chronic Renal Disease ◽  
Fluconazole Resistance ◽  
Factors Associated ◽  
Patient Demographics ◽  
Resistant Species ◽  
Empirical Antifungal Therapy ◽  
Fluconazole Resistant ◽  
A Prospective Study ◽  
Underlying Diseases

ABSTRACT Previous studies have sought to determine the risk factors associated with candidemia caused by non-albicans Candida spp. or with potentially fluconazole-resistant Candida spp. (C. glabrata and C. krusei). Non-albicans Candida strains are a heterogeneous group that includes species with different levels of virulence, and only a limited number of C. glabrata isolates are resistant to fluconazole. We set out to identify the risk factors associated with microbiologically proven fluconazole-resistant candidemia. A prospective study including adult patients with candidemia was performed. Data were collected on patient demographics; underlying diseases; exposure to corticosteroids, antibiotics, or fluconazole; and invasive procedures. Risk factors associated either with non-albicans Candida spp. or potentially fluconazole-resistant Candida spp. (C. glabrata or C. krusei) or with Candida spp. with microbiologically confirmed fluconazole resistance were assessed using logistic regressions. We included 226 candidemia episodes. Non-albicans Candida isolates accounted for 53.1% of the fungal isolates, but only 18.2% of the cases were caused by potentially fluconazole-resistant organisms. Thirty isolates exhibited microbiologically confirmed fluconazole resistance. The multivariate analysis revealed that independent predictors associated with fluconazole-resistant Candida spp. were neutropenia (odds ratio [OR] = 4.94; 95% confidence interval [CI] = 1.50 to 16.20; P = 0.008), chronic renal disease (OR = 4.82; 95% CI = 1.47 to 15.88; P = 0.01), and previous fluconazole exposure (OR = 5.09; 95% CI = 1.66 to 15.6; P = 0.004). Independently significant variables associated with non-albicans Candida bloodstream infection or with potentially fluconazole-resistant Candida spp. did not include previous fluconazole exposure. We concluded that prior fluconazole treatment is an independent risk factor only for candidemia caused by microbiologically confirmed fluconazole resistant species. Our findings may be of value for selecting empirical antifungal therapy.

Evaluation of infections by Candida at a university hospital of Vale do Paraíba region, São Paulo State, Brazil: species distribution, colonization, risk factors and antifungal susceptibility

2016 ◽  
Vol 2 (7) ◽  
pp. 1-2 ◽  
Author(s):  
Sonia Khouri ◽  
Luciana da Silva Ruiz ◽  
Marcos Ereno Auler ◽  
Bosco Christiano Maciel da Silva ◽  
Virgínia Bodelão Richini Pereira ◽  
...  
Keyword(s):  
Risk Factors ◽  
Species Distribution ◽  
Antifungal Susceptibility ◽  
Sao Paulo ◽  
University Hospital ◽  
São Paulo ◽  
Paulo State ◽  
São Paulo State

scholarly journals Species Distribution and Comparison between EUCAST and Gradient Concentration Strips Methods for Antifungal Susceptibility Testing of 112 Aspergillus Section Nigri Isolates

2020 ◽  
Vol 64 (7) ◽  
Author(s):  
B. Carrara ◽  
R. Richards ◽  
S. Imbert ◽  
F. Morio ◽  
M. Sasso ◽  
...  
Keyword(s):  
Cryptic Species ◽  
Amphotericin B ◽  
Species Distribution ◽  
Antifungal Susceptibility ◽  
Rank Correlation ◽  
Common Species ◽  
Teaching Hospitals ◽  
Nucleotide Sequence Analysis ◽  
Accurate Identification ◽  
Content Type

ABSTRACT Aspergillus niger, the third species responsible for invasive aspergillosis, has been considered as a homogeneous species until DNA-based identification uncovered many cryptic species. These species have been recently reclassified into the Aspergillus section Nigri. However, little is yet known among the section Nigri about the species distribution and the antifungal susceptibility pattern of each cryptic species. A total of 112 clinical isolates collected from 5 teaching hospitals in France and phenotypically identified as A. niger were analyzed. Identification to the species level was carried out by nucleotide sequence analysis. The MICs of itraconazole, voriconazole, posaconazole, isavuconazole, and amphotericin B were determined by both the EUCAST and gradient concentration strip methods. Aspergillus tubingensis (n = 51, 45.5%) and Aspergillus welwitschiae (n = 50, 44.6%) were the most common species while A. niger accounted for only 6.3% (n = 7). The MICs of azole drugs were higher for A. tubingensis than for A. welwitschiae. The MIC of amphotericin B was 2 mg/liter or less for all isolates. Importantly, MICs determined by EUCAST showed no correlation with those determined by the gradient concentration strip method, with the latter being lower than the former (Spearman’s rank correlation tests ranging from 0.01 to 0.25 depending on the antifungal agent; P > 0.4). In conclusion, A. niger should be considered as a minority species in the section Nigri. The differences in MICs between species for different azoles underline the importance of accurate identification. Significant divergences in the determination of MIC between EUCAST and the gradient concentration strip methods require further investigation.

scholarly journals Molecular Epidemiology and Microbiological Characteristics of Cryptococcus gattii VGII isolates from China

2021 ◽  
Author(s):  
xuelei zang ◽  
weixin ke ◽  
lifeng wang ◽  
hua wu ◽  
yemei huang ◽  
...  
Keyword(s):  
Molecular Epidemiology ◽  
Lung Tissue ◽  
Antifungal Susceptibility ◽  
Cryptococcus Gattii ◽  
Antifungal Drugs ◽  
Clinical Isolates ◽  
Published Data ◽  
Histopathological Analysis ◽  
Close Phylogenetic Relationship

Cryptococcus gattii (C. gattii) is a fungal pathogen that once caused an outbreak of cryptococcosis on Vancouver Island, and had spread worldwide, while few data were available in China. In this study, seven clinical isolates of C. gattii VGII were collected from 19 hospitals, Multi-locus Sequence Typing (MLST) analysis and whole-genome sequencing (WGS) was performed, and combined with published data for phylogenetic analysis. In addition, in vitro antifungal susceptibility testing, phenotypic analysis, and in vivo virulence studies were performed, subsequently, histopathological analysis of lung tissue was performed. C.gattii VGII infected patients were mainly immunocompetent male, and most of them had symptoms of central nervous system (CNS) involvement. MLST results showed that isolates from china exhibited high genetic diversity, and sequence type (ST) 7 was the major ST among the isolates. Some clinical isolates showed a close phylogenetic relationship with strains from Australia and South America. All clinical isolates did not show resistance to antifungal drugs. In addition, there was no correlation between virulence factors (temperature, melanin production, and capsule size) and virulence while in vivo experiments showed significant differences in virulence among strains. Lung fungal burden and damage to lung tissue correlated with virulence, and degree of damage to lung tissue in mice may highlight differences in virulence. Our work seeks to provide useful data for molecular epidemiology, antifungal susceptibility, and virulence differences of C. gattii VGII in China.

scholarly journals The first wave of the COVID-19 pandemic in Spain: characterisation of cases and risk factors for severe outcomes, as at 27 April 2020

2020 ◽  
Vol 25 (50) ◽  
Author(s):  
Keyword(s):  
Risk Factors ◽  
Healthcare Workers ◽  
Chronic Renal Disease ◽  
Underlying Disease ◽  
Control Measures ◽  
Multivariable Regression ◽  
Underlying Diseases ◽  
And Control ◽  
The Impact ◽  
Case Characteristics

Background The first wave of the coronavirus disease (COVID-19) pandemic spread rapidly in Spain, one of Europe’s most affected countries. A national lockdown was implemented on 15 March 2020. Aim To describe reported cases and the impact of national lockdown, and to identify disease severity risk factors. Methods National surveillance data were used to describe PCR-confirmed cases as at 27 April 2020. We compared case characteristics by severity categories (hospitalisation, admission to intensive care unit (ICU), death) and identified severity risk factors using multivariable regression. Results The epidemic peaked on 20 March. Of 218,652 COVID-19 cases, 45.4% were hospitalised, 4.6% were admitted to ICU and 11.9% died. Among those who died, 94.8% had at least one underlying disease. Healthcare workers (HCWs) represented 22.9% of cases. Males were more likely to have severe outcomes than females. Cardiovascular disease was a consistent risk factor. Patients with pneumonia had higher odds of hospitalisation (odds ratio (OR): 26.63; 95% confidence interval (CI): 25.03–28.33). The strongest predictor of death was age ≥ 80 years (OR: 28.4; 95% CI: 19.85–40.78). Among underlying diseases, chronic renal disease had highest odds of death (OR: 1.47; 95% CI: 1.29–1.68). Conclusions COVID-19 case numbers began declining 6 days after the national lockdown. The first wave of the COVID-19 pandemic in Spain had a severe impact on elderly people. Patients with cardiovascular or renal conditions were at higher risk for severe outcomes. A high proportion of cases were HCWs. Enhanced surveillance and control measures in these subgroups are crucial during future COVID-19 waves.

scholarly journals Variable effects of underlying diseases on the prognosis of patients with COVID-19

PLoS ONE ◽  
2021 ◽  
Vol 16 (7) ◽  
pp. e0254258
Author(s):  
Yong Jun Choi ◽  
Ju-Young Park ◽  
Hye Sun Lee ◽  
Jin Suh ◽  
Jeung Yoon Song ◽  
...  
Keyword(s):  
Risk Factors ◽  
Heart Failure ◽  
Congestive Heart Failure ◽  
Poor Prognosis ◽  
Total Mortality ◽  
Underlying Disease ◽  
Polymerase Chain Reaction Test ◽  
Renal Diseases ◽  
Chronic Complications ◽  
Underlying Diseases

Underlying diseases might be risk factors for poor prognosis in patients with coronavirus disease (COVID-19); however, we still do not know whether these diseases are independent factors affecting prognosis, which type of underlying diseases are risk factors, and which type of clinical outcomes are affected. We retrospectively reviewed cohort data from 7,590 de-identified patients with COVID-19 who were diagnosed using severe acute respiratory syndrome-coronavirus-2 RNA polymerase chain reaction test up to May 15, 2020. We used linked-medical claims data provided by the Health Insurance Review and Assessment Service in South Korea. Underlying diseases were identified using the diagnostic codes in the patients’ files from January 1, 2019 to December 31, 2019. The total mortality rate was 3.0% in patients with COVID-19. After adjusting for age, sex, and concomitant chronic conditions, we found that congestive heart failure, chronic pulmonary diseases, diabetes without chronic complications, renal diseases, and malignancy were factors that significantly increased the cost of treatment. Cerebrovascular disease, chronic pulmonary disease, and paralysis were found to be independent factors significant in prolonging hospital stay. Diabetes with chronic complications was independently associated with intensive care unit admission. In addition, underlying congestive heart failure (odds ratio [OR], 1.724; P = 0.003), dementia (OR, 1.598; P = 0.012), diabetes with and without chronic complications (OR, 1.821; P = 0.002 and OR, 1.518; P = 0.022, respectively), renal disease (OR, 2.299; P = 0.002), and malignancy (OR, 1.529; P = 0.039) were significant factors associated with death, even after adjustments. Underlying diseases were significant independent factors of the poor prognosis in patients with COVID-19. The effects were variable according to the type of underlying disease and clinical outcome. Therefore, patients with COVID-19 with underlying diseases should be monitored more closely because they are more at risk of a poor prognosis.

Health care-associated invasive Candida infections in children

2019 ◽  
Vol 57 (8) ◽  
pp. 929-936 ◽  
Author(s):  
Bahaettin Öncü ◽  
Nurşen Belet ◽  
Ahmet Naci Emecen ◽  
Asuman Birinci
Keyword(s):  
Risk Factors ◽  
Health Care ◽  
Parenteral Nutrition ◽  
Amphotericin B ◽  
Antifungal Susceptibility ◽  
Candida Spp ◽  
Reactive Protein ◽  
Candida Infections ◽  
Underlying Diseases ◽  
Isolated Species

Abstract The aims of the study were to examine the distribution of Candida spp. isolated from sterile body sites, the antifungal susceptibility of the isolates to amphotericin B, and fluconazole, risk factors and clinical outcomes associated with invasive health care-associated Candida infections in neonates and children. Between January 2007 and January 2012, the patients with invasive candidiasis were detected from microbiology laboratary records and medical records were examined retrospectively. Candida spp. were isolated from sterile body sites in 94 patients. The most common underlying diseases were prematurity in neonates and surgery in children. Parenteral nutrition, stay in intensive care unit (ICU), and mechanical ventilation (MV) were major risk factors in neonates. Hospitalization before infection and immunosuppressant therapy were significantly more frequent in children. Of Candida infection episodes, 29.8% was due to C. albicans and 70.2% was due to non-albicans Candida spp. The most common isolated species was C. parapsilosis. Of the Candida species, 90.8% were sensitive, and 9.2% were resistant to fluconazole. The rate of amphotericin B resistant was 1.3%; 23.4% of the patients died in the first 30 days. The main variables associated with mortality were neonates, prematurity, stay in the ICU, parenteral nutrition, MV, length of stay, amphotericin B susceptibility, and high levels of C-reactive protein.

scholarly journals Identification of risk factors for in-hospital death of COVID - 19 pneumonia -- lessions from the early outbreak

2020 ◽  
Author(s):  
Zhigang Wang ◽  
Zhiqiang Wang
Keyword(s):  
Risk Factors ◽  
Hospital Mortality ◽  
Lactate Level ◽  
Underlying Disease ◽  
Lower Percentage ◽  
Hospital Death ◽  
Laboratory Test Results ◽  
Independent Risk Factors ◽  
Novel Coronavirus ◽  
Underlying Diseases

Abstract Objective: To examine the clinical characteristics and identify independent risk factors for in-hospital mortality of 2019 novel coronavirus (COVID-19) pneumonia.Methods: A total of 156 patients diagnosed with COVID-19 pneumonia at the central Hospital of Wuhan from January 29, 2020, to March 20, 2020 and 20 healthy individuals were enrolled in this single-centered retrospective study. The epidemiological parameters, clinical presentations, underlying diseases, laboratory test results and disease outcomes were collected and analyzed. Results: The median age of all enrolled patients was 66 years. At least one underlying disease was identified in 101 COVID-19 patients, with hypertension being the most common one, followed by cardiovascular disease and diabetes. The most common symptoms identified upon admission were fever, cough, dyspnea and fatigue. Compared to survival cases, patients who dead during hospitalization had higher plasma levels of D-dimer, creatinine, creatine kinase, lactate dehydrogenase, lactate and lower percentage of lymphocytes (LYM [%]), platelet count and albumin levels. Most enrolled patients received anti-biotics and anti-viral treatment. In addition, 60 patients received corticosteroid and 51 received intravenous immunoglobulin infusion. 44 patients received noninvasive ventilation and 19 received invasive ventilation. Respiratory failure was the most frequently observed complication (106 [67.9%]), followed by sepsis (103 [66.0%]), acute respiratory distress syndrome (ARDS) (67 [42.9%]) and septic shock (50 [32.1%]). Multivariable regression suggested that advanced age (OR [odds ratio]=1.098, 95% CI [confidence interval]: 1.006-1.199, P=0.037), shorter duration from onset to admission (OR= 0.853, 95% CI: 0.750-0.969, P=0.015) and elevated lactate level upon admission (OR= 2.689, 95% CI: 1.044-6.926, P=0.040) were independent risk factors for in-hospital mortality for COVID-19 infection. Meanwhile, increased LYM (%) at admission (OR= 0.787, 95% CI: 0.686-0.903, P=0.001) indicated a better prognosis. Conclusions: In this study, we discovered that age, duration from onset to admission, LYM (%) and lactate level upon admission were independent factors that affecting in-hospital mortality rate.

scholarly journals Species Distribution, Antifungal Susceptibility, and Molecular Epidemiology of Candida Species Causing Candidemia in a Tertiary Care Hospital in Bangkok, Thailand

2021 ◽  
Vol 7 (7) ◽  
pp. 577
Author(s):  
Siriphan Boonsilp ◽  
Anchalee Homkaew ◽  
Uraporn Phumisantiphong ◽  
Daranee Nutalai ◽  
Thanwa Wongsuk
Keyword(s):  
Population Structure ◽  
Molecular Epidemiology ◽  
Species Distribution ◽  
Candida Species ◽  
Antifungal Agents ◽  
Antifungal Susceptibility ◽  
Tertiary Care ◽  
Molecular Characteristics ◽  
Care Hospital ◽  
Prevalent Species

Candida species represent a common cause of bloodstream infection (BSI). Given the emergence of non-albicans Candida (NAC) associated with treatment failure, investigations into the species distribution, fungal susceptibility profile, and molecular epidemiology of pathogens are necessary to optimize the treatment of candidemia and explore the transmission of drug resistance for control management. This study evaluated the prevalence, antifungal susceptibility, and molecular characteristics of Candida species causing BSI in a tertiary-level hospital in Bangkok, Thailand. In total, 54 Candida isolates were recovered from 49 patients with candidemia. C. tropicalis was the most prevalent species (33.3%), followed by C. albicans (29.6%). Most Candida species were susceptible to various antifungal agents, excluding C. glabrata and C. tropicalis, which had increased rates of non-susceptibility to azoles. Most C. glabrata isolates were non-susceptible to echinocandins, especially caspofungin. The population structure of C. albicans was highly diverse, with clade 17 predominance. GoeBURST analysis of C. tropicalis revealed associations between genotype and fluconazole resistance in a particular clonal complex. The population structure of C. glabrata appeared to have a low level of genetic diversity in MLST loci. Collectively, these data might provide a fundamental database contributing to the development of novel antifungal agents and diagnostic tests.

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