scholarly journals Candida profiles and antifungal resistance evolution over a decade in Lebanon

2015 ◽  
Vol 9 (09) ◽  
pp. 997-1003 ◽  
Author(s):  
George Farah Araj ◽  
Rima George Asmar ◽  
Aline Zakaria Avedissian
Keyword(s):  
Medical Center ◽  
Care Center ◽  
Antifungal Susceptibility ◽  
Tertiary Care ◽  
Antifungal Resistance ◽  
Candida Spp ◽  
American University ◽  
Antifungal Drug Resistance ◽  
Resistance Evolution

Introduction: Infection with and antifungal resistance of Candida species have been on the rise globally. Relevant data on these pathogens are relatively few in our region, including Lebanon, thus warranting this study. Methodology: This retrospective study of Candida spp. profiles and their in vitro antifungal susceptibility was based on analysis requests for 186 Candida non-albicans and 61 C. albicans during three periods (2005–2007, 2009–2011, and 2012–2014) over the span of the last 10 years at the American University of Beirut Medical Center (AUBMC), a major tertiary care center in Lebanon. Identification of Candida was done using the API 20C AUX system, and the E-test was used to determine the minimum inhibitory concentrations (MICs) of antifungal agents. Results: Among the 1,300–1,500 Candida isolates recovered yearly, C. albicans rates decreased from 86% in 2005 to around 60% in 2014. Simultaneously, the non-albicans rates increased from 14% in 2005 to around 40% in 2014, revealing 11 species, the most frequent of which were C. tropicalis, C. glabrata, and C. parapsilosis. All these demonstrated high resistance (35%–79%) against itraconazole, but remained uniformly susceptible (100%) to amphotericin B. Though C. albicans and the other species maintained high susceptibility against fluconazole and voriconazole, their MIC90 showed an elevated trend over time, and C. glabrata had the highest resistance rates. Conclusions: The observed rise in resistance among Candida spp. in Lebanon mandates the need for close surveillance and monitoring of antifungal drug resistance for both epidemiologic and treatment purposes.

scholarly journals Antifungal Resistance to Fluconazole and Echinocandins Is Not Emerging in Yeast Isolates Causing Fungemia in a Spanish Tertiary Care Center

2014 ◽  
Vol 58 (8) ◽  
pp. 4565-4572 ◽  
Author(s):  
Laura Judith Marcos-Zambrano ◽  
Pilar Escribano ◽  
Carlos Sánchez ◽  
Patricia Muñoz ◽  
Emilio Bouza ◽  
...  
Keyword(s):  
Susceptibility Testing ◽  
Molecular Level ◽  
Care Center ◽  
Antifungal Susceptibility ◽  
Tertiary Care ◽  
Candida Guilliermondii ◽  
Antifungal Resistance ◽  
Its2 Region ◽  
Content Type

ABSTRACTAccurate knowledge of fungemia epidemiology requires identification of strains to the molecular level. Various studies have shown that the rate of resistance to fluconazole ranges from 2.5% to 9% inCandidaspp. isolated from blood samples. However, trends in antifungal resistance have received little attention and have been studied only using CLSI M27-A3 methodology. We assessed the fungemia epidemiology in a large tertiary care institution in Madrid, Spain, by identifying isolates to the molecular level and performing antifungal susceptibility testing according to the updated breakpoints of European Committee for Antimicrobial Susceptibility Testing (EUCAST) definitive document (EDef) 7.2. We studied 613 isolates causing 598 episodes of fungemia in 544 patients admitted to our hospital (January 2007 to December 2013). Strains were identified after amplification and sequencing of the ITS1-5.8S-ITS2 region and further tested forin vitrosusceptibility to amphotericin B, fluconazole, posaconazole, voriconazole, micafungin, and anidulafungin. Resistance was defined using EUCAST species-specific breakpoints, and epidemiological cutoff values (ECOFFs) were applied as tentative breakpoints. Most episodes were caused byCandida albicans(46%),Candida parapsilosis(28.7%),Candida glabrata(9.8%), andCandida tropicalis(8%). Molecular identification enabled us to better detect cryptic species ofCandida guilliermondiiandC. parapsilosiscomplexes and episodes of polyfungal fungemia. The overall percentage of fluconazole-resistant isolates was 5%, although it was higher inC. glabrata(8.6%) and non-Candidayeast isolates (47.4%). The rate of resistance to echinocandins was 4.4% and was mainly due to the presence of intrinsically resistant non-Candidaspecies. Resistance mainly affected non-Candidayeasts. The rate of resistance to fluconazole and echinocandins did not change considerably during the study period.

scholarly journals First Candida auris Outbreak during a COVID-19 Pandemic in a Tertiary-Care Center in Lebanon

Pathogens ◽  
2021 ◽  
Vol 10 (2) ◽  
pp. 157
Author(s):  
Fatima Allaw ◽  
Nada Kara Zahreddine ◽  
Ahmad Ibrahim ◽  
Joseph Tannous ◽  
Hussein Taleb ◽  
...  
Keyword(s):  
Infection Control ◽  
Medical Center ◽  
Care Center ◽  
Tertiary Care ◽  
Arab Countries ◽  
Infection Prevention And Control ◽  
Tertiary Care Center ◽  
Candida Auris ◽  
American University ◽  
American University Of Beirut

Candida auris is an emerging fungal pathogen considered as a global health threat. Recently there has been growing concern regarding drug resistance, difficulty in identification, as well as problems with eradication. Although outbreaks have been reported throughout the globe including from several Arab countries, there were no previous reports from Lebanon. We herein report the first cases of C. auris infection from the American University of Beirut Medical Center, a tertiary care center in Lebanon describing the clinical features of the affected patients in addition to the infection control investigation and applied interventions to control the outbreak. Fourteen patients with C. auris infection/colonization identified using MALDI-TOF and VITEK 2- Compact system were reported over a period of 13 weeks. Patients were admitted to four separate critical care units. All of them came through the emergency room and had comorbid conditions. Half of the patients were infected with COVID-19 prior to isolation of the C. auris. C. auris was isolated from blood (two isolates), urine (three isolates), respiratory tract (10 isolates) and skin (one isolate). All the patients had received broad spectrum antibiotics prior to isolation of C. auris. Six patients received antifungal treatment, while the remaining eight patients were considered colonized. Environmental cultures were taken from all four units and failed to isolate the organism from any cultured surfaces. A series of interventions were initiated by the Infection Prevention and Control team to contain the outbreak. Rapid detection and reporting of cases are essential to prevent further hospital transmission. A national standardized infection control registry needs to be established to identify widespread colonization.

scholarly journals Five-Year Incidence and Progression of Diabetic Retinopathy in Patients with Type II Diabetes in a Tertiary Care Center in Lebanon

2017 ◽  
Vol 2017 ◽  
pp. 1-7 ◽  
Author(s):  
Carl-Joe Mehanna ◽  
Maamoun Abdul Fattah ◽  
Hani Tamim ◽  
Mona P. Nasrallah ◽  
Raya Zreik ◽  
...  
Keyword(s):  
Diabetic Retinopathy ◽  
Type Ii Diabetes ◽  
Medical Center ◽  
Statistical Significance ◽  
Care Center ◽  
Tertiary Care ◽  
Progression Rate ◽  
Type Ii ◽  
American University ◽  
American University Of Beirut

Objective. To estimate the 5-year incidence of progression rate and regression rate and risk factors for diabetic retinopathy (DR) in a cohort of Lebanese patients with type II diabetes. Methods. We followed a cohort of 462 Lebanese patients with type II diabetes for over 5 years at the American University of Beirut Medical Center. Patients underwent yearly complete ophthalmic evaluation and fundus photographs and were assessed for the incidence, stage, and evolution of DR using modified Airlie House classification. Results. Among the 462 patients, 281 had no DR at baseline. The 5-year cumulative incidence of any DR was 10% (95% CI: 6–13), and only baseline microalbuminuria correlated with the development of DR (OR=10.53, 95% CI: 4.39–25.23, p<0.0001). Among the 181 patients with baseline DR, the worsening and regression rates of DR were 31.5% (95% CI: 25–38) and 9% (95% CI: 5–13), respectively. Microalbuminuria also approached statistical significance as a risk factor for DR worsening (OR=1.89, 95% CI: 0.97–3.70, p=0.06). Conclusion. The 5-year incidence of DR in this hospital-based cohort is relatively low. Microalbuminuria was independently associated with the incidence and progression of the disease. We recommend to screen patients with type II diabetes for microalbuminuria as prognostic for the development and worsening of DR.

scholarly journals Emergence of Nonalbicans Candida in Neonatal Septicemia and Antifungal Susceptibility: Experience from a Tertiary Care Center

2009 ◽  
Vol 1 (02) ◽  
pp. 053-055 ◽  
Author(s):  
Nidhi Goel ◽  
Prabhat K Ranjan ◽  
Ritu Aggarwal ◽  
Uma Chaudhary ◽  
Nanda Sanjeev
Keyword(s):  
Care Center ◽  
Antifungal Susceptibility ◽  
Tertiary Care ◽  
Empirical Therapy ◽  
Candida Spp ◽  
Neonatal Septicemia ◽  
Sugar Fermentation ◽  
Crude Mortality Rate ◽  
Crude Mortality

ABSTRACT Aims: To know the distribution and antifungal susceptibility pattern of Candida species in neonatal septicemia cases. Materials and Methods: In a prospective analysis blood samples from 825 clinically suspected cases of neonatal septicemia, collected aseptically, were cultured to look for the role of Candida spp. in septicemia. Candida isolates were speciated by germ tube test, Hi-CHROME agar, sugar fermentation, and sugar assimilation tests using standard protocol. All the Candida isolates were tested for antifungal susceptibility to fluconazole by the Disk Diffusion (DD) method and broth micro dilution-minimum inhibitory concentration (BMD-MIC) method using NCCLS guidelines. Results: Isolation rate of Candida from neonatal septicemia cases was 8.1%. Most common isolate was C. tropicalis (61.19%), followed by C. albicans (19.40%), C. glabrata (11.94%), C. parapsilosis (5.97%) and C. guillermondii (1.49%). Low birth weight and previous antibiotic prophylaxis was found in 100% cases. Crude mortality rate was 50.1%. By DD method, 95.53% of the Candida isolates were sensitive to fluconazole. A discrepancy between DD method and BMD-MIC method was noted in 4.47% strains. One isolates each of C. tropicalis, C. albicans, and C. glabrata showed discrepancy. Conclusion: Nonalbicans Candida has emerged as an important cause of neonatal septicemia. Routine susceptibility testing of Candida isolates by DD method should be confirmed by BMD-MIC method. Fluconazole can be used as empirical therapy for neonatal candidemia at our center.

Clinical and Microbiological Profile of Urinary Tract Infection at a Tertiary-Care Center in Lebanon

2004 ◽  
Vol 25 (1) ◽  
pp. 82-85 ◽  
Author(s):  
Roula Fadel ◽  
Ghenwa K. Dakdouki ◽  
Zeina A. Kanafani ◽  
George F. Araj ◽  
Souha S. Kanj
Keyword(s):  
Urinary Tract Infection ◽  
Urinary Tract ◽  
Tract Infection ◽  
Medical Center ◽  
Care Center ◽  
Tertiary Care ◽  
American University ◽  
E Coli ◽  
American University Of Beirut ◽  
Hospital Acquired

AbstractWe compared community-acquired urinary tract infection (UTI) with hospital-acquired UTI at the American University of Beirut Medical Center. Escherichia coli was the most frequently isolated organism. Hospital-acquired E. coli isolates were often rnultidrug resistant. These results can be used to improve empiric treatment of UTI.

scholarly journals Promoting COVID-19 vaccination among healthcare personnel: a multifaceted intervention at a tertiary care center in Japan

2021 ◽  
pp. 1-26
Author(s):  
Akane Takamatsu ◽  
Hitoshi Honda ◽  
Tomoya Kojima ◽  
Kengo Murata ◽  
Hilary Babcock
Keyword(s):  
Medical Center ◽  
Care Center ◽  
Tertiary Care ◽  
Vaccination Rate ◽  
Multifaceted Intervention ◽  
Vaccine Hesitancy ◽  
Healthcare Personnel ◽  
Tertiary Care Center ◽  
Post Intervention ◽  
Post Vaccination

Abstract Objective The COVID-19 vaccine may hold the key to ending the pandemic, but vaccine hesitancy is hindering the vaccination of healthcare personnel (HCP). Design Before-after trial Participants and setting Healthcare personnel at a 790-bed tertiary care center in Tokyo, Japan. Interventions A pre-vaccination questionnaire was administered to HCP to examine their perceptions of the COVID-19 vaccine. Then, a multifaceted intervention involving (1) distribution of informational leaflets to all HCP, (2) hospital-wide announcements encouraging vaccination, (3) a mandatory lecture, (4) an educational session about the vaccine for pregnant or breastfeeding HCP, and (5) allergy testing for HCP at risk of allergic reactions to the vaccine was implemented. A post-vaccination survey was also performed. Results Of 1,575 HCP eligible for enrollment, 1,224 (77.7%) responded to the questionnaire, 43.5% (n =533) expressed willingness to be vaccinated, 48.4% (n = 593) were uncertain, and 8.0% (n=98) expressed unwillingness to be vaccinated. The latter two groups were concerned about the vaccine’s safety rather than its efficacy. Post-intervention, the overall vaccination rate reached 89.7% (1,413/1,575), with 88.9% (614/691) of the pre-vaccination survey respondents who answered “unwilling” or “unsure” eventually receiving a vaccination. In the post-vaccination questionnaire, factors contributing to increased COVID-19 vaccination included information and endorsement of vaccination at the medical center (26.4%; 274/1,037). Conclusions The present, multifaceted intervention increased COVID-19 vaccinations among HCP at a Japanese hospital. Frequent support and provision of information were crucial for increasing the vaccination rate and may be applicable to the general population as well.

scholarly journals Phenotypic Characterization and Molecular Identification of Intestinal Candida Spp. in Tunisia

2021 ◽  
Vol 14 (6) ◽  
Author(s):  
Khouloud Ben-Rhouma ◽  
Salma Feki Ben-Salah ◽  
Nada Boulehmi ◽  
Aida Bouratbine
Keyword(s):  
Oxidative Stress ◽  
Antifungal Susceptibility ◽  
Resistance Rate ◽  
Phenotypic Characterization ◽  
Its2 Region ◽  
Candida Spp ◽  
Health And Disease ◽  
Stool Samples ◽  
Stool Specimens

Background: Yeast naturally colonize the mammalian digestive tract and play an important role in health and disease. This community is composed of commensal yeasts, mostly Candida and Saccharomyces described as a part of the intestinal mycobiome and could be associated with resident or transient flora. Objectives: The aim of our study was to perform the phenotypic and genotypic characterization of culturable Candida isolates present in stool specimens of healthy Tunisian individuals and to evaluate their antifungal susceptibility. Methods: Yeasts were recovered from 46 stool samples cultured on Sabouraud dextrose agar at 37°C. Species were identified using conventional methods and ITS-PCR sequencing. Candida isolates were tested by exploring their tolerance to oxidative stress and extreme acidic conditions. In addition, their biofilm formation ability and in vitro resistance to antifungals was determined by the VITEK 2 system. Results: The identification by sequencing the ITS1-5.8S-ITS2 region of the 56 yeast strains isolated from 37 stool samples revealed that Candida was the dominant genus and was represented by Candida albicans (n = 21), C. parapsilosis (n = 10), C. glabrata (n = 9), and C. krusei (n = 9). In contrast, the other genera, including trichosporon, geotrichum, and rhodotorula, were sporadically occurring. We found that most Candida strains were able to form biofilms under oxidative stress and extreme pH conditions. Regarding antifungal susceptibility, a higher resistance rate to fluconazole was revealed in comparison to caspofungin and micafungin. However, nonresistance was revealed against voriconazole, amphotericin B, and 5-flucytosine. Conclusions: This is the first work-generated data on cultivable yeasts from stool specimens of healthy individuals in Tunisia. Further metagenomic studies with a larger sample size are needed to better characterize the intestinal mycobiota.

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