scholarly journals Investigation of the Emerging Nosocomial Wickerhamomyces anomalus Infections at a Chinese Tertiary Teaching Hospital and a Systemic Review: Clinical Manifestations, Risk Factors, Treatment, Outcomes, and Anti-fungal Susceptibility

2021 ◽  
Vol 12 ◽  
Author(s):  
Li Zhang ◽  
Meng Xiao ◽  
Amir Arastehfar ◽  
Macit Ilkit ◽  
Jun Zou ◽  
...  
Keyword(s):  
Risk Factors ◽  
Literature Review ◽  
Antifungal Susceptibility ◽  
Clinical Manifestations ◽  
Bloodstream Infections ◽  
Systemic Review ◽  
Extensive Literature ◽  
Wickerhamomyces Anomalus ◽  
Tertiary Teaching

Wickerhamomyces anomalus is an emerging pathogen, which has been associated with clonal outbreaks and poor clinical outcomes. Despite being an important emerging yeasts species, our understanding concerning the microbiological and clinical characteristics of infections due to this species is limited. Herein, we are reporting a retrospective analysis of fungemia patients with W. anomalus from a 2,100-bed hospital in Shanghai during 2014–2016. Moreover, we conducted an extensive literature review to gain a deeper clinical and microbiological insights. Detailed clinical data were recorded. Antifungal susceptibility testing (AFST) followed CLSI M27-A3, and isolates were identified using MALDI-TOF MS. In total, 13 patients were identified with a mortality rate of 38.5% (5/13). Central venous catheter (CVC), broad-spectrum antibiotic therapy, total parenteral nutrition (TPN), surgery, and mechanical ventilation were the most frequently observed risk factors. Eight patients (61.5%) experienced mixed bacterial/Candida bloodstream infections, and four patients developed mixed candidemia (MC). W. anomalus isolates showed high minimum inhibitory concentrations (MICs) against all azoles tested and flucytosine, while AMB showed the highest in vitro activity. Azoles were used for 84.6% (11/13) of the cases, while 36.4% (4/11) of them died. When combining with the AFST data and the literature review, our study highlights the poor efficacy of azoles and optimal efficacy of AMB and LAMB against infections caused by W. anomalus. In conclusion, our study highlights the emerging threat of W. anomalus affecting both neonates and adults. Furthermore, our results advocate the use of AMB formulations rather than azoles among patients infected with W. anomalus. Future studies are warranted to reach a definitive consensus regarding the utility of echinocandins among such patients.

scholarly journals 146. antifungal Susceptibility Patterns of candida Parapsilosis Bloodstream Isolates in the US, 2008–2018

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S203-S203
Author(s):  
Brenda L Tesini ◽  
Meghan Lyman ◽  
Brendan R Jackson ◽  
Anita Gellert ◽  
William Schaffner ◽  
...  
Keyword(s):  
Candida Species ◽  
Regional Variation ◽  
Antifungal Susceptibility ◽  
Bloodstream Infections ◽  
Emerging Infections ◽  
In Vitro Susceptibility ◽  
Fluconazole Resistance ◽  
The Us ◽  
Susceptibility Patterns

Abstract Background Multidrug resistant Candida is an increasing concern. C. parapsilosis in particular has decreased in vitro susceptibility to echinocandins. As a result, fluconazole had been favored for C. parapsilosis treatment. However, there is growing concern about increasing azole resistance among Candida species. We report on antifungal susceptibility patterns of C. parapsilosis in the US from 2008 through 2018. Methods Active, population-based surveillance for candidemia through the Centers for Disease Control and Prevention’s (CDC) Emerging Infections Program was conducted between 2008–2018, eventually encompassing 9 states (GA, MD,OR, TN, NY, CA, CO, MN, NM). Each incident isolate was sent to the CDC for species confirmation and antifungal susceptibility testing (AFST). Frequency of resistance was calculated and stratified by year and state using SAS 9.4 Results Of the 8,704 incident candidemia isolates identified, 1,471 (15%) were C. parapsilosis; the third most common species after C. albicans and C. glabrata. AFST results were available for 1,340 C. parapsilosis isolates. No resistance was detected to caspofungin (MIC50 0.25) or micafungin (MIC50 1.00) with only one (< 1%) isolate resistant to anidulafungin (MIC50 1.00). In contrast, 84 (6.3%) isolates were resistant to fluconazole and another 44 (3.3%) isolates had dose-dependent susceptibility to fluconazole (MIC50 1.00). Fluconazole resistance increased sharply from an average of 4% during 2008–2014 to a peak of 14% in 2016 with a subsequent decline to 6% in 2018 (see figure). Regional variation is also observed with fluconazole resistance ranging from 0% (CO, MN, NM) to 42% (NY) of isolates by site. Conclusion The recent marked increase in fluconazole resistance among C. parapsilosis highlights this pathogen as an emerging drug resistant pathogen of concern and the need for ongoing antifungal resistance surveillance among Candida species. Our data support the empiric use of echinocandins for C. parapsilosis bloodstream infections and underscore the need to obtain AFST prior to fluconazole treatment. Furthermore, regional variation in fluconazole resistance emphasizes the importance of understanding local Candida susceptibility patterns. Disclosures Lee Harrison, MD, GSK (Consultant)Merck (Consultant)Pfizer (Consultant)Sanofi Pasteur (Consultant)

TRANSIENT ISCHEMIC ATTACKS: ETIOPATHOGENESIS, CLINIC. (Literature review)

Vestnik ◽  
2021 ◽  
pp. 91-96
Author(s):  
Г.Ж. Жакенова ◽  
Р.Б. Нуржанова ◽  
К.Б. Сраилова ◽  
Ж.С. Шерияздан ◽  
А.Б. Ташманова ◽  
...  
Keyword(s):  
Risk Factors ◽  
Differential Diagnosis ◽  
Literature Review ◽  
Clinical Manifestations ◽  
Transient Ischemic Attacks ◽  
Review Of The Literature ◽  
Imaging Signs

В данной статье представлен обзор литературы по транзиторным ишемическим атакам: эпидемиология, этиология, патогенез, классификация, основные характеристики с учетом факторов риска, визуализационных признаков МРТ и КТ, клинических проявлений и дифференциальной диагностики данного заболевания на основе современных исследований. This article presents a review of the literature on transient ischemic attacks: epidemiology, etiology, pathogenesis, classification, main characteristics taking into account risk factors, imaging signs of MRI and CT, clinical manifestations and differential diagnosis of this disease based on modern research.

Bloodstream infections caused by Magnusiomyces capitatus and Magnusiomyces clavatus: epidemiological, clinical and microbiological features of two emerging yeast species

2021 ◽  
Author(s):  
Janina Noster ◽  
Martin Köppel ◽  
Marie Desnos-Olivier ◽  
Maria Aigner ◽  
Oliver Bader ◽  
...  
Keyword(s):  
Antifungal Susceptibility ◽  
Bloodstream Infections ◽  
Its Sequencing ◽  
Intrinsic Resistance ◽  
Columbia Blood Agar ◽  
Maldi Tof ◽  
Invasive Infections ◽  
Few Data

Background: Magnusiomyces clavatus and Magnusiomyces capitatus are emerging yeasts with intrinsic resistance to many commonly used antifungal agents. Identification is difficult, and determination of susceptibility patterns with commercial and reference methods is equally challenging. For this reason, few data on invasive infections by Magnusiomyces spp. are available. Objectives: To determine the epidemiology and susceptibility of Magnusiomyces isolates from bloodstream infections (BSI) isolated in Germany and Austria from 2001-2020. Methods: In seven institutions a total of 34 Magnusiomyces BSI were identified. Identification was done by ITS sequencing and MALDI-TOF MS. Antifungal susceptibility was determined by EUCAST broth microdilution and gradient tests. Results: Of the 34 isolates, M. clavatus was more common (N=24) compared to M. capitatus (N=10). BSI by Magnusiomyces spp. were more common in men (62%) and mostly occurred in patients with haemato-oncological malignancies (79%). The highest in vitro antifungal activity against M. clavatus / M. capitatus was observed for voriconazole (MIC 50 0.03/0.125 mg/L), followed by posaconazole (MIC 50 0.125/0.25 mg/L). M. clavatus isolates showed overall lower MICs compared to M. capitatus . With the exception of amphotericin B, low essential agreement between gradient test and microdilution was recorded for all antifungals (0-70%). Both species showed distinct morphologic traits on ChromAgar Orientation and Columbia blood agar, which can be used for differentiation if no MALDI-TOF or molecular identification is available. Conclusion: Most BSI were caused by M. clavatus. The lowest MICs were recorded for voriconazole. Gradient tests demonstrated unacceptably low agreement and should preferably not be used for susceptibility testing of Magnusiomyces spp.

scholarly journals Biofilm Formation by and Antifungal Susceptibility of Candida Isolates from Urine

2007 ◽  
Vol 73 (6) ◽  
pp. 1697-1703 ◽  
Author(s):  
N. Jain ◽  
R. Kohli ◽  
E. Cook ◽  
P. Gialanella ◽  
T. Chang ◽  
...  
Keyword(s):  
Risk Factors ◽  
Growth Medium ◽  
Biofilm Formation ◽  
Chart Review ◽  
Antifungal Susceptibility ◽  
Retrospective Chart Review ◽  
Urine Samples ◽  
Rpmi Medium

ABSTRACT Biofilm formation (BF) in the setting of candiduria has not been well studied. We determined BF and MIC to antifungals in Candida spp. isolates grown from urine samples of patients and performed a retrospective chart review to examine the correlation with risk factors. A total of 67 Candida spp. isolates were grown from urine samples from 55 patients. The species distribution was C. albicans (54%), C. glabrata (36%), and C. tropicalis (10%). BF varied greatly among individual Candida isolates but was stable in sequential isolates during chronic infection. BF also depended on the growth medium and especially in C. albicans was significantly enhanced in artificial urine (AU) compared to RPMI medium. In nine of the C. albicans strains BF was 4- to 10-fold higher in AU, whereas in three of the C. albicans strains and two of the C. glabrata strains higher BF was measured in RPMI medium than in AU. Determination of the MICs showed that planktonic cells of all strains were susceptible to amphotericin B (AMB) and caspofungin (CASPO) and that three of the C. glabrata strains and two of the C. albicans strains were resistant to fluconazole (FLU). In contrast, all biofilm-associated adherent cells were resistant to CASPO and FLU. The biofilms of 14 strains (28%) were sensitive to AMB (MIC50 of <1 μg/ml). Correlation between degree of BF and MIC of AMB was not seen in RPMI grown biofilms but was present when grown in AU. A retrospective chart review demonstrated no correlation of known risk factors of candiduria with BF in AU or RPMI. We conclude that BF is a stable characteristic of Candida strains that varies greatly among clinical strains and is dependent on the growth medium. Resistance to AMB is associated with higher BF in AU, which may represent the more physiologic medium to test BF. Future studies should address whether in vitro BF can predict treatment failure in vivo.

scholarly journals Risk Factors of Catheter-Related Infection in Patients Undergoing Hemodialysis Using Double Lumen Catheter at Dr. M. Djamil Hospital Padang

2021 ◽  
Vol 6 (1) ◽  
pp. 1292-1299
Author(s):  
Muhammad Iqbal ◽  
Raflis Rustam ◽  
Vendry Rivaldy
Keyword(s):  
Risk Factors ◽  
Pseudomonas Aeruginosa ◽  
Clinical Manifestations ◽  
Bloodstream Infections ◽  
Sampling Technique ◽  
Exit Site ◽  
Double Lumen ◽  
Exit Site Infection ◽  
Double Lumen Catheter ◽  
Lumen Catheter

Background. Chronic kidney disease (CKD) is a terminal disease requiring hemodialysis. Hemodialysis requires vascular access using a double lumen catheter (DLC). However, the use of DLC may increase complications mainly infection, either infection of exit site or bloodstream. This study is aimed to seek risk factors contributing to the incidence of central catheter-related infections in CKD patients with DLC undergoing HD at Dr. M. Djamil Hospital, Padang. Methods. This study is a prospective study on patients undergoing HD at Dr. M. Djamil Hospital, Padang. This study using consecutive sampling technique. Data were analyzed using SPSS version 25.0. Results. This study involved 40 CKD patients undergoing HD. Majority of the samples had bloodstream infections (67.5%). Clinical manifestations of purulent secretion, duration of catheter used, and hypoalbuminemia had significant differences in the incidence of DLC infection based on bloodstream infection and exit site infection (p<0.05). The most common bacterial found was Pseudomonas aeruginosa (22.5%) which was sensitive to ceftazidime, cefepime, meropenem, amikacin, gentamicin, ciprofloxacin. Conclusion. Factors contributing to the incidence of DLC-related infections at Dr. M. Djamil Hospital are duration of catheter use and hypoalbuminemia. Pseudomonas aeruginosa is the most common cause of DLC-related infections.

scholarly journals In Vitro Azole and Amphotericin B Susceptibilities of Malassezia furfur from Bloodstream Infections Using E-Test and CLSI Broth Microdilution Methods

Antibiotics ◽  
2020 ◽  
Vol 9 (6) ◽  
pp. 361 ◽  
Author(s):  
Wafa Rhimi ◽  
Chioma Inyang Aneke ◽  
Adriana Mosca ◽  
Domenico Otranto ◽  
Claudia Cafarchia
Keyword(s):  
Amphotericin B ◽  
Reading Time ◽  
Antifungal Susceptibility ◽  
Bloodstream Infections ◽  
Hospitalized Patients ◽  
Malassezia Furfur ◽  
Broth Microdilution ◽  
Test Procedures ◽  
The Media

The number of reports of Malassezia furfur bloodstream infections is constantly increasing and there is a need for more simple antifungal susceptibility methods for their management. In this study, a total of 39 M. furfur isolates collected from hospitalized patients with fungemia were screened for antifungal susceptibility to azole and amphotericin B (AmB) using Clinical and Laboratory Standards Institute broth microdilution (CLSI BMD) and E-test in Sabouraud dextrose agar + 1% Tween80 (SDAt) and mDixon agar (DIX). Essential agreement (EA) and discrepancies between the two methods were evaluated after 48 h and 72 h reading times. Itraconazole (ITZ) and posaconazole (POS) displayed the lowest MIC values whereas fluconazole (FLZ) and AmB the highest, regardless of the methods and the reading time. The EA between BMD was >95% for FLZ and voriconazole (VOR) regardless of the media in the E-tests and reading time. The EA between BMD with E-test for AmB was >97% only when E-test in SDAt was used. The EA between BMD and E-test for ITZ and POS varied according to the media in E-test procedures and the reading time and was higher than 66.6% (POS) or 72% (ITZ) only when SABt was used. Substantial discrepancies for ITZ and POS were >5.1% regardless of the media and the reading time. This study suggests that the E-test in SABt represents an alternative method to CLSI BMD to evaluate the susceptibility of M. furfur to FLZ, VOR and AmB and not for ITZ and POS.

Evaluation of Potential Risk Factors that contribute to Malignant Transformation of Oral Lichen Planus: A Literature Review

2016 ◽  
Vol 17 (8) ◽  
pp. 692-701 ◽  
Author(s):  
Farzaneh Agha-Hosseini ◽  
Nafiseh Sheykhbahaei ◽  
Maryam-Sadat SadrZadeh-Afshar
Keyword(s):  
Risk Factors ◽  
Literature Review ◽  
Malignant Transformation ◽  
Lichen Planus ◽  
Potential Risk ◽  
Oral Lichen Planus ◽  
World Health ◽  
Extensive Literature ◽  
Potential Risk Factors ◽  
Oral Lichen

ABSTRACT Aim Many studies have suggested that a lesion originally diagnosed as oral lichen planus (OLP) has different possibilities of undergoing malignant transformation in time, although these findings remain a controversial issue; for example, some studies reported different values of potential malignancy of OLP. Introduction World Health Organization (WHO) classifies OLP as a “potentially malignant disorder” with unspecified malignant transformation risk, and suggests that OLP patients should be closely monitored. Numerous studies have attempted to confirm the malignant transformation potential of OLP. Review results The Cochrane Controlled Trials Register, Medline and EMBASE databases, PubMed, Google Scholar, Ovid, Up To Date, BMJ Clinical Evidence, MD Consult, and Science Direct were searched for papers published between 1997 and 2015. The medical subject heading search terms were “lichen planus,” “oral lichen planus,” “erosive oral lichen planus,” “dysplasia,” “oral precancerous condition,” “oral premalignant condition,” oral cancer, oral squamous cell carcinoma (OSCC), and atrophic lichen planus. A total of 120 English language abstracts were reviewed, and 50 relevant articles identified. Because of the extensive literature on the association between OLP and SCC, we have divided the data into genetic and nongenetic factors for more accurate assessment. Conclusion In this evidence base, malignant transformation ranges from 0 to 37% with a mean of 4.59%. The highest rate of malignancy was noted in erythematosus and erosive lesions. In this way, follow-up of OLP patients could be carried out more efficiently and appropriately. Clinical significance Oral lichen planus is a premalignant lesion. All types of OLP in any site of oral mucosa must be monitored regularly. How to cite this article Agha-Hosseini F, Sheykhbahaei N, SadrZadeh-Afshar M-S. Evaluation of Potential Risk Factors that contribute to Malignant Transformation of Oral Lichen Planus: A Literature Review. J Contemp Dent Pract 2016;17(8):692-701.

scholarly journals Bloodstream Infections Caused by Extended-Spectrum-β-Lactamase- Producing Escherichia coli: Risk Factors for Inadequate Initial Antimicrobial Therapy

2008 ◽  
Vol 52 (9) ◽  
pp. 3244-3252 ◽  
Author(s):  
Mario Tumbarello ◽  
Michela Sali ◽  
Enrico Maria Trecarichi ◽  
Fiammetta Leone ◽  
Marianna Rossi ◽  
...  
Keyword(s):  
Risk Factors ◽  
Escherichia Coli ◽  
Antimicrobial Therapy ◽  
Bloodstream Infections ◽  
Disease Epidemiology ◽  
E Coli ◽  
Infectious Disease Epidemiology ◽  
Extended Spectrum ◽  
Initial Antimicrobial Therapy

ABSTRACT Extended-spectrum-β-lactamase (ESBL)-producing strains of Escherichia coli are a significant cause of bloodstream infections (BSI) in hospitalized and nonhospitalized patients. We previously showed that delaying effective antimicrobial therapy in BSI caused by ESBL producers significantly increases mortality. The aim of this retrospective 7-year analysis was to identify risk factors for inadequate initial antimicrobial therapy (IIAT) (i.e., empirical treatment based on a drug to which the isolate had displayed in vitro resistance) for inpatients with BSI caused by ESBL-producing E. coli. Of the 129 patients considered, 56 (43.4%) received IIAT for 48 to 120 h (mean, 72 h). Independent risk factors for IIAT include an unknown BSI source (odds ratios [OR], 4.86; 95% confidence interval [CI], 1.98 to 11.91; P = 0.001), isolate coresistance to ≥3 antimicrobials (OR, 3.73; 95% CI, 1.58 to 8.83; P = 0.003), hospitalization during the 12 months preceding BSI onset (OR, 3.33; 95% CI, 1.42 to 7.79; P = 0.005), and antimicrobial therapy during the 3 months preceding BSI onset (OR, 2.65; 95% CI, 1.11 to 6.29; P = 0.02). IIAT was the strongest risk factor for 21-day mortality and significantly increased the length of hospitalization after BSI onset. Our results underscore the need for a systematic approach to the management of patients with serious infections by ESBL-producing E. coli. Such an approach should be based on sound, updated knowledge of local infectious-disease epidemiology, detailed analysis of the patient's history with emphasis on recent contact with the health care system, and aggressive attempts to identify the infectious focus that has given rise to the BSI.

scholarly journals Risk factors and molecular entities of the etiopathogenesis of the knee osteoarthritis (literature review)

2021 ◽  
Vol 27 (1) ◽  
pp. 112-120
Author(s):  
V.B. Novakov ◽  
◽  
O.N. Novakova ◽  
M.I. Churnosov ◽  
◽  
...  
Keyword(s):  
Risk Factors ◽  
Literature Review ◽  
Knee Osteoarthritis ◽  
Subchondral Bone ◽  
Molecular Mechanisms ◽  
Wide Spectrum ◽  
Clinical Manifestations ◽  
Bibliographic Databases ◽  
Joint Involvement ◽  
Knee Oa

Introduction Osteoarthritis (OA) is a heterogenic group of disorders of different etiology with similar biological, morphological and clinical manifestations and outcomes. OA is now considered a disease of the whole joint, including alterations in the articular cartilage, subchondral bone, synovial membrane, ligaments, capsule and periarticular muscles. OA of the knee as the most commonly affected joint accounts for the great medical, medical, social and economic impact. Material and methods A literature review assessing Russian and foreign studies on molecular mechanisms of etiology and pathogenesis of knee OA identified a set of factors for which there was consistent evidence for their association with onset of knee OA. A search of studies published in Russian and in English for the last ten years was conducted using bibliographic databases, including PubMed, PubMedCentral, GoogleScholar, eLIBRARY. Search terms included 'knee osteoarthritis', 'etiology', 'pathogenesis', 'risk factors'. Results Review of the literature showed that patients with knee OA are characterized by changes in cartilage, subchondral bone, synovium, suggesting common mechanisms of joint degeneration during OA development. Osteoarthritis (OA) is multifactorial in origin and closely associated with a wide spectrum of local (previous injury, muscle weakness, knee malalignment, knee surgeries, abnormal mechanical loading, excessive high impact sports, occupational physical activities) and systemic risk factors (advanced age, female sex, height, greater body mass index and obesity, hormone status, family history, mineral bone density, vitamin D deficiency, ethnicity). The prevalence of the knee OA and patterns of joint involvement vary among different racial and ethnic groups. Conclusion The literature review allowed us to identify the molecular mechanisms of etiopathogenesis of knee OA and the major risk factors for the pathology.

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