scholarly journals Changing Epidemiology of Invasive Candidiasis in Children during a 10-Year Period

2019 ◽  
Vol 5 (1) ◽  
pp. 19 ◽  
Author(s):  
Maria Noni ◽  
Angeliki Stathi ◽  
Ilia Vaki ◽  
Aristea Velegraki ◽  
Levantia Zachariadou ◽  
...  
Keyword(s):  
Amphotericin B ◽  
Invasive Candidiasis ◽  
Candida Parapsilosis ◽  
Antifungal Susceptibility ◽  
Invasive Infection ◽  
First Line ◽  
Identification Of Species ◽  
Pediatric Populations ◽  
Therapeutic Protocols ◽  
Isolated Species

Candida species are a common cause of invasive infection in neonates and children. The aim of our study was to evaluate the epidemiology and microbiology of invasive candidiasis (IC) in the largest tertiary Greek pediatric hospital during a 10-year period. A retrospective cohort study was performed from January 2008 to December 2017. Identification of species and antifungal susceptibility testing was performed according to the Clinical and Laboratory Standards Institute (CLSI) methodology. During the study period, 178 cases of IC were recorded. The tissue distribution included blood (87.1%), cerebrospinal (7.9%), peritoneal (3.9%) and pleural fluids (1.1%). Candida albicans and Candida parapsilosis (sensu lato) were the most frequently isolated species (47.8% and 28.7% respectively). From period 2008–2012 to period 2013–2017, a significant decrease in IC rates was detected (0.21 cases/1000 hospitalization days VS 0.11 cases/1000 hospitalization days, P = 0.040), while median minimum inhibitory concentrations (MICs) of amphotericin B were significantly increased for both C. albicans and C. parapsilosis (sl) (P = 0.037 and P = 0.004 respectively). The decrease in IC rates may reflect the increased awareness as well as the effective infection control initiatives and antifungal interventions. However, the significant increase in the MICs for amphotericin B and echinocandins such as caspofungin, raises concerns about their common use as first-line treatment. Epidemiologic monitoring is, therefore, critically important in order to evaluate and optimize therapeutic protocols for IC in pediatric populations.

scholarly journals Prevalence and Antifungal Susceptibility of the Emerging Fungal Species, Candida nivariensis, Isolated in a Teaching Hospital in Poland

2019 ◽  
Vol 68 (3) ◽  
pp. 303-308 ◽  
Author(s):  
MAGDALENA SIKORA ◽  
ROBERT KUTHAN ◽  
KATARZYNA PISKORSKA-MALOLEPSZA ◽  
MARLENA GOLAS-PRADZYNSKA ◽  
DARIUSZ DOMAŃSKI ◽  
...  
Keyword(s):  
Amphotericin B ◽  
Teaching Hospital ◽  
Antifungal Susceptibility ◽  
Sensu Stricto ◽  
Fungal Species ◽  
Clinical Samples ◽  
Global Knowledge ◽  
Identification Of Species ◽  
26S Rrna

The data on susceptibility to antifungals of new specieswithin Candida glabrata complex are limited. Our study was to enrich a global knowledge of yeast epidemiology and drug resistance. The study was focused on the identification of species within clinical isolates of the C. glabrata complex and on the determination of their resistance to antifungals. Four hundred forty-five clinical C. glabrata sensu lato strains were isolated from different clinical samples at routine mycological exams at the Infant Jesus Teaching Hospital in Warsaw. The identification of the most of tested isolates to species complex level was performed using the ID 32 C system. The identification of C. nivariensisand C. bracarensis species within the C. glabrata complex was performed by DNA sequencing. The MICs of amphotericin B, fluconazole, itraconazole, posaconazole, voriconazole, caspofungin, anidulafungin, and micafungin were determined by E-test. Twenty-four isolates did not have an ITS-1 region, characteristic of C. glabrata sensu stricto and their D1/D2 regions of the 26S rRNA were 99% homologous to C. nivariensis 26S rRNA. No strains of C. bracarensis were recovered. C. nivariensis strains were very susceptible to amphotericin B, anidulafungin, micafungin, and caspofungin. Ninety-two percent of C. nivariensis were resistant to itraconazole. The halves of the strains was resistant to posaconazole. Eighty-three percent of C. nivariensis were susceptible to voriconazole. None of the tested strains were susceptible to fluconazole. In the present study, none of the C. nivariensis strains were simultaneously resistant to azoles and echinocandins. C. nivariensis should be recognized as an emerging pathogen, resistant to azoles.

scholarly journals Molecular Epidemiology, Antifungal Susceptibility, and Virulence Evaluation of Candida Isolates Causing Invasive Infection in a Tertiary Care Teaching Hospital

2021 ◽  
Vol 11 ◽  
Author(s):  
Junzhu Chen ◽  
Niya Hu ◽  
Hongzhi Xu ◽  
Qiong Liu ◽  
Xiaomin Yu ◽  
...  
Keyword(s):  
Invasive Candidiasis ◽  
Antifungal Susceptibility ◽  
Tertiary Care ◽  
Invasive Infection ◽  
Its Sequencing ◽  
Care Hospital ◽  
City Hospital ◽  
Strong Activity ◽  
Common Amino Acid ◽  
Resistant Strains

BackgroundThe incidence of invasive candidiasis is increasing worldwide. However, the epidemiology, antifungal susceptibility, and virulence of Candida spp. in most hospitals remain unclear. This study aimed to evaluate invasive candidiasis in a tertiary care hospital in Nanchang City, China.MethodsMALDI-TOF MS and 18S rDNA ITS sequencing were used to identify Candida strains. Randomly amplified polymorphic DNA analysis was used for molecular typing; biofilm production, caseinase, and hemolysin activities were used to evaluate virulence. The Sensititre™ YeastOne YO10 panel was used to examine antifungal susceptibility. Mutations in ERG11 and the hotspot regions of FKS1 of drug-resistant strains were sequenced to evaluate the possible mechanisms of antifungal resistance.ResultsWe obtained 110 Candida strains, which included 40 Candida albicans (36.36%), 37 C. parapsilosis (33.64%), 21 C. tropicalis (19.09%), 9 C. glabrata (8.18%), 2 C. rugose (1.82%), and 1 C. haemulonii (0.91%) isolates. At a limiting point of 0.80, C. albicans isolates could be grouped into five clusters, C. parapsilosis and C. tropicalis isolates into seven clusters, and C. glabrata isolates into only one cluster comprising six strains by RAPD typing. Antifungal susceptibility testing revealed that the isolates showed the greatest overall resistance against fluconazole (6.36%), followed by voriconazole (4.55%). All C. albicans and C. parapsilosis isolates exhibited 100% susceptibility to echinocandins (i.e., anidulafungin, caspofungin, and micafungin), whereas one C. glabrata strain was resistant to echinocandins. The most common amino acid substitutions noted in our study was 132aa (Y132H, Y132F) in the azole-resistant strains. No missense mutation was identified in the hotpot regions of FKS1. Comparison of the selected virulence factors detectable in a laboratory environment, such as biofilm, caseinase, and hemolysin production, revealed that most Candida isolates were caseinase and hemolysin producers with a strong activity (Pz < 0.69). Furthermore, C. parapsilosis had greater total biofilm biomass (average Abs620 = 0.712) than C. albicans (average Abs620 = 0.214, p < 0.01) or C. tropicalis (average Abs620 = 0.450, p < 0.05), although all C. glabrata strains were either low- or no-biofilm producers. The virulence level of the isolates from different specimen sources or clusters showed no obvious correlation. Interesting, 75% of the C. albicans from cluster F demonstrated azole resistance, whereas two azole-resistant C. tropicalis strains belonged to the cluster Y.ConclusionThis study provides vital information regarding the epidemiology, pathogenicity, and antifungal susceptibility of Candida spp. in patients admitted to Nanchang City Hospital.

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 Epidemiological data and antifungal susceptibility in invasive fungal infections - a Romanian infectious diseases tertiary hospital’s experience. Preliminary report

2017 ◽  
Vol 25 (4) ◽  
pp. 345-353
Author(s):  
Radu Agrosoaie ◽  
Adrian Streinu-Cercel ◽  
Doina Azoicai ◽  
Codrina Bejan ◽  
Olga Dorobat ◽  
...  
Keyword(s):  
Infectious Diseases ◽  
Amphotericin B ◽  
Antifungal Therapy ◽  
Fungal Infections ◽  
Antifungal Susceptibility ◽  
Epidemiological Data ◽  
Healthcare Services ◽  
Invasive Fungal Infections ◽  
First Line ◽  
Antifungal Stewardship

Abstract Introduction: Invasive fungal infections have stood as an important research subject for the past 20 years, being considered as a crucial effect of advancing healthcare services. Low identification rates of invasive fungal infections in blood cultures and low sensibility of biomarkers determine empiric treatments which lead to a change in epidemiological data and antifungal susceptibility. The aim: The epidemiological evaluation of invasive fungal infections and the assessment of antifungal resistance related to this condition. Methods and material: An “antifungal stewardship” retrospective study was developed between January 2010 and April 2016. An epidemiological analysis was performed on 79 cases with proven invasive fungal infections in bloodstream, catheter, and cerebrospinal fluid. We considered: age, gender, HIV status, place of residence, and first option in medical practice of antifungal treatment. The laboratory analysis was performed by the Microbiology Laboratory at “Prof. Dr. Matei Bals” National Institute for Infectious Diseases, Bucharest. Minimum inhibitory concentrations (MIC’s) of 15 isolates were identified using colorimetric micro broth dilution panel YEASTONE ®YO10 and compared with susceptibilities obtained by VITEK2®C system. Candida parapsilosis ATCC 22019 was used as reference. Results: The incidence of invasive fungal infections was 3.7 on 1000 hospitalized patients. The age of the study population ranged between 12 and 83 years, and most were male (59%). The majority of subjects were from an urban area (84%), and 27% of them were HIV positive. The results obtained in VITEK2C® were similar with those from YEASTONE® YO10 for fluconazole, voriconazole, amphotericin B (100%), without any minor, major or very major errors. The fluconazole was the first option of treatment, followed by voriconazole, caspofungin, anidulafungin. In 37% of cases the first treatment option was replaced with a secondary antifungal therapy accordingly with antifungal breakpoints obtained by Vitek ®. Conclusions: No rates of resistance to fluconazole, amphotericin B, voriconazole were obtained. Fluconazole was the major first line antifungal therapy. Conclusions: No rates of resistance to fluconazole, amphotericin B, voriconazole were obtained. Fluconazole was the major first line antifungal therapy.

scholarly journals Echinocandins for candidemia: a rational choice

2013 ◽  
Vol 4 (2S) ◽  
pp. 5-12
Author(s):  
Francesco Menichetti ◽  
Enrico Tagliaferri
Keyword(s):  
Rational Choice ◽  
Amphotericin B ◽  
Invasive Candidiasis ◽  
Fungicidal Activity ◽  
Similar Efficacy ◽  
Antifungal Drugs ◽  
First Line ◽  
Candida Spp ◽  
Level Of Evidence ◽  
First Line Therapy

Among antifungal drugs, echinocandins (micafungin, caspofungin and anidulafungin) represent a rational choice for the first-line therapy of candidemia/invasive candidiasis in critically ill patients. Among other properties characterizing echinocandins, it’s important to emphasize the broad spectrum of activity, the fungicidal activity against the majority of Candida spp., and the activity against the biofilm. Furthermore, echinocandins show greater efficacy than conventional amphotericin B and fluconazole, and similar efficacy to liposomal amphotericin B (but they are less toxic). Finally, echinocandins are recommended at the highest level of evidence (AI) for the treatment of invasive candidiasis by IDSA and ESCMID guidelines.

scholarly journals Constant Low Rate of Fungemia in Norway, 1991 to 1996

1998 ◽  
Vol 36 (12) ◽  
pp. 3455-3459 ◽  
Author(s):  
Per Sandven ◽  
Lars Bevanger ◽  
Asbjørn Digranes ◽  
Peter Gaustad ◽  
Hanne H. Haukland ◽  
...  
Keyword(s):  
Amphotericin B ◽  
Candida Glabrata ◽  
Candida Parapsilosis ◽  
Antibiotic Use ◽  
Blood Cultures ◽  
Candida Krusei ◽  
University Hospitals ◽  
Local Hospital ◽  
The University ◽  
Isolated Species

Since 1991 information on yeast isolates from blood cultures has been recorded prospectively from all microbiological laboratories (5 university and 16 county or local hospital laboratories) in Norway (population, 4.3 million). From 1991 to 1996 a total of 571 episodes of fungemia in 552 patients occurred (1991, 109 episodes; 1992, 81 episodes; 1993, 93 episodes; 1994, 89 episodes; 1995, 98 episodes; and 1996, 101 episodes). The fungemia rates per 10,000 patient days were 0.29 in 1991 and 0.27 in 1996. The average rates for the years 1991 to 1996 were 0.37 for the university laboratories and 0.20 for the other laboratories. These rates are low compared to the rate (0.76) in five Dutch university hospitals in 1995 and the rate (2.0) in Iowa in 1991. The four most frequently isolated species wereCandida albicans (66%), Candida glabrata(12.5%), Candida parapsilosis (7.6%), and Candida tropicalis (6.4%). The incidences of both C. albicans (range, 63 to 73%) and C. glabrata (range, 8.4 to 15.7%) varied somewhat throughout this period, but no significant increase or decrease was noted. MICs of amphotericin B, flucytosine, and fluconazole were determined for 89% of the isolates. All were susceptible to amphotericin B, and only 29 (5.6%) strains had decreased susceptibility to flucytosine. All C. albicansisolates were susceptible to fluconazole. The percentage of yeast isolates with decreased susceptibility to fluconazole (MICs, ≥16 μg/ml) did increase, from 9.6% in 1991 and 1992 to 12.2% in 1994, 16.1% in 1995, and 18.6% in 1996. This was largely due to increases in the percentages of resistant C. glabrata andCandida krusei strains in the last 2 years. Compared to the incidence in other countries, it is remarkable that Norway has such a low and constant incidence of fungemia. A possible reason for this difference might be a restricted antibiotic use policy in Norway.

Genetically related micafungin-resistant Candida parapsilosis blood isolates harbouring novel mutation R658G in hotspot 1 of Fks1p: a new challenge?

2020 ◽  
Author(s):  
Amir Arastehfar ◽  
Farnaz Daneshnia ◽  
Süleyha Hilmioglu-Polat ◽  
Macit Ilkit ◽  
Melike Yasar ◽  
...  
Keyword(s):  
Amphotericin B ◽  
Candida Parapsilosis ◽  
Genetic Relatedness ◽  
Novel Mutation ◽  
Antifungal Susceptibility ◽  
Underlying Mechanism ◽  
Therapeutic Failure ◽  
Paediatric Surgery ◽  
Echinocandin Resistance

Abstract Background Echinocandin resistance rarely occurs in clinical Candida parapsilosis isolates and the underlying mechanism is unknown. Objectives To determine the prevalence of echinocandin resistance and the underlying mechanism for a large collection of C. parapsilosis blood isolates and to determine whether the echinocandin-resistant isolates were clonally related. Methods C. parapsilosis blood isolates (n = 213) were subjected to antifungal susceptibility testing (CLSI M27), for micafungin, anidulafungin, amphotericin B and, if appropriate, caspofungin. Hotspot (HS) 1 and HS2 of FKS1 were sequenced for all isolates (n = 213) and microsatellite typing was performed for echinocandin-resistant isolates. Results All isolates were susceptible to amphotericin B and two isolates were intermediate to anidulafungin (MIC = 4 mg/L), while micafungin resistance was noted in four isolates (MIC >8 mg/L); three of which were also fluconazole resistant and therefore were MDR. Interestingly, micafungin-resistant isolates, but not those intermediate to anidulafungin, carried novel mutation R658G in HS1 of Fks1p; three of which also harboured Y132F+K143R in Erg11. The first isolate (MICR1) was recovered in November 2017 from a patient admitted to paediatric gastroenterology who showed therapeutic failure under caspofungin treatment. MICR2–MICR4 were collected during 2018–19 and were recovered from three echinocandin-naive paediatric-surgery patients; the isolates shared the same genotype. Conclusions Herein, for the first time (to the best of our knowledge), we identified micafungin-resistant C. parapsilosis blood isolates harbouring a novel mutation in HS1 of FKS1, which was likely attributable to in vitro micafungin resistance and in vivo caspofungin therapeutic failure. The acquisition of micafungin-resistant C. parapsilosis isolates in echinocandin-naive patients likely implicates clonal expansion, as supported by the close genetic relatedness of MICR2–MICR4.

scholarly journals Species distribution and antifungal susceptibility of Candida bloodstream isolates in Kuwait: a 10-year study

2007 ◽  
Vol 56 (2) ◽  
pp. 255-259 ◽  
Author(s):  
Eiman M. Mokaddas ◽  
Noura A. Al-Sweih ◽  
Zia U. Khan
Keyword(s):  
Amphotericin B ◽  
Species Distribution ◽  
Candida Parapsilosis ◽  
Antifungal Susceptibility ◽  
Bloodstream Infections ◽  
Identification System ◽  
Yeast Identification ◽  
The Past ◽  
Vitek 2 ◽  
Susceptibility Profiles

Bloodstream infections due to Candida species are important complications in severely ill hospitalized patients. This study presents data on species distribution and antifungal susceptibility profiles of Candida bloodstream isolates obtained from Kuwait during a 10-year period. All the bloodstream isolates were identified to species level by the germ tube test and carbohydrate assimilation profile using the VITEK 2 yeast identification system. Using E-test strips for amphotericin B, fluconazole, 5-flucytosine and voriconazole, MICs were determined on RPMI agar supplemented with 2 % glucose. The MIC breakpoints for resistance were based on Clinical and Laboratory Standards Institute criteria or those published by reference laboratories, and were as follows: amphotericin B, >1 μg ml−1; fluconazole, ⩾64 μg ml−1; 5-flucytosine, ⩾32 μg ml−1; and voriconazole, 4 μg ml−1. In all, 607 bloodstream yeast isolates were obtained over the past 10 years in Kuwait. Candida albicans was the predominant species (39.5 %), followed by Candida parapsilosis (30.6 %), Candida tropicalis (12.4 %), Candida glabrata (5.6 %) and Candida krusei (1.6 %). All C. albicans, C. tropicalis and C. glabrata isolates were susceptible to amphotericin B. Of 186 isolates of C. parapsilosis tested, only four (2 %) exhibited an MIC for amphotericin B of >1 μg ml−1. Resistance to fluconazole was observed in nine (3.8 %) C. albicans isolates, two (5.8 %) C. glabrata isolates and four (40 %) C. krusei isolates. Resistance to 5-flucytosine was observed in two (0.8 %) C. albicans isolates, seven (9.3 %) C. tropicalis isolates, three (1.6 %) C. parapsilosis isolates and all ten (100 %) C. krusei isolates. All the isolates of C. albicans, C. tropicalis, C. parapsilosis, C. glabrata and C. krusei were susceptible to voriconazole, including those resistant to fluconazole. Although amphotericin B and fluconazole are widely used in clinical practice in Kuwait, resistance to these drugs remained low.

scholarly journals General hospital outbreak of invasive candidiasis due to azole-resistant Candida parapsilosis associated with an Erg11 Y132F mutation

2020 ◽  
Author(s):  
Dora E Corzo-Leon ◽  
Mark Peacock ◽  
Patricia Rodriguez-Zulueta ◽  
Grace J Salazar-Tamayo ◽  
Donna M MacCallum
Keyword(s):  
General Hospital ◽  
Invasive Candidiasis ◽  
Candida Species ◽  
Candida Parapsilosis ◽  
Antifungal Susceptibility ◽  
Species Level ◽  
Hospital Outbreak ◽  
Time Period ◽  
Microsatellite Typing ◽  
Fluconazole Resistant

Abstract An increasing number of outbreaks due to resistant non-albicans Candida species have been reported worldwide. Between 2014 and 2016, Candida isolates causing invasive candidiasis were recovered in a Mexican hospital. Isolates were identified to species level and antifungal susceptibility was determined. In the time period studied, 74 invasive candidiasis cases were identified, with 38% (28/74) caused by Candida parapsilosis, out of which 54% (15/28) were fluconazole resistant. The ERG11 gene was sequenced for 12 recoverable fluconazole-resistant C. parapsilosis isolates and SNPs identified. The 12 isolates had one common silent point mutation in ERG11 (T591C) and seven isolates had an additional (A395T) mutation, which corresponded to Y132F. Four of the isolates carrying this mutation were closely related within the same cluster by microsatellite typing. This is the first report of an invasive candidiasis outbreak in Mexico due to azole-resistant C. parapsilosis associated with the Y132F substitution.

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