nosocomial candidemia
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2021 ◽  
Vol 8 (Supplement_1) ◽  
pp. S249-S250
Author(s):  
Oluwadamilola A Adeyemi ◽  
Gregg Gonzaga ◽  
Sean Cariño ◽  
Steve B Kalish

Abstract Background 1,416 patients with acute COVID-19 infection were admitted to our hospital in 2020. During that year we noticed an alarming increase in cases of nosocomial Candidemia: 26 versus an average of 2.8 cases per year over the previous 5 years. 19 of the 26 episodes (73%) of Candidemia occurred in patients who were admitted with acute COVID-19 infection. Recent reports suggest that hospitalized patients with COVID-19 are at increased risk for developing Candidemia, however their clinical characteristics, risk factors and outcomes have not been well described. We evaluated the risk factors and mortality of hospitalized COVID-19 patients with Candidemia. Methods We performed a retrospective chart review of 19 patients with Candidemia and confirmed COVID-19 infection at a 292-bed community teaching hospital in Chicago, Illinois from January through December 2020. We report a descriptive analysis of the demographic characteristics, comorbidities, complications, and outcomes of these patients. Results The average age of our study population was 65 years; 68% were male. The average hospital length of stay (LOS) was 34 days. The mean time from admission to the development of Candidemia was 16 days. Associated co-morbidities included cardiovascular diseases (CVD) in 79%, diabetes mellitus (DM), in 68%, and obesity in 50%. Underlying kidney disease was present in 10%. Treatments for COVID-19 included convalescent plasma (53%), remdesivir (53%), steroids (52%) and tocilizumab (19%). All patients were managed in the intensive care unit (ICU) and 95% required multiple central line (CL) placements. Most of the patients (58%) required hemodialysis (HD); all patients were treated with multiple antibiotics. The average LOS in the ICU was 25 days. Despite anti-fungal treatment, 68% expired. The 28-day mortality was 50%. Conclusion The occurrence of Candidemia in our hospitalized patients with acute COVID-19 infection was associated with a history of CVD, DM, obesity, prolonged hospital LOS, requirement for multiple CL, HD, treatment with multiple antibiotics and a long stay in the ICU. The mortality of COVID-19 patients with Candidemia is high. The development of strategies to mitigate the occurrence of nosocomial Candidemia in this population of patients is urgently needed. Disclosures All Authors: No reported disclosures


2021 ◽  
Vol 10 (1) ◽  
pp. 01-011
Author(s):  
Rodríguez María Lourdes ◽  
Rosa Alcira Cristina ◽  
Nastri María Lorena ◽  
Jewtuchowicz Virginia Martha

Candida parapsilosis sensu stricto is the second to third most frequent cause of candidemia. Studies place this yeast as a frequent colonizer of niches of the oral cavity, predominantly in pathological conditions. We hypothesize that a buccal environment in dysbiosis enhances the virulence of C. parapsilosis sensu stricto. Objective: To evaluate at the phenotype and molecular level the production of biofilm in oral isolates of C. parapsilosis sensu stricto and correlate the results with the clinical origin (dysbiosis versus eubiosis). Material and methods: The biofilm-forming ability was compared in 50 oral isolates of C. parapsilosis sensu stricto obtained from patients with and without oral dysbiosis; by quantification of biofilm biomass and metabolic activity. The results were corroborated by optical and confocal fluorescence microscopy, and correlated with the transcriptional activity of CPH2, by RT-qPCR. The data were analyzed by Excel 2010, and InfoStat 2018, with a 95% confidence interval. Results: The metabolic activity in biofilm was significantly higher in oral dysbiosis relative to control (p = 0.0025). Basal expression of CPH2 increased 2.8 times more in oral dysbiosis related to the control condition and showed no significant differences with pathogenic isolates of this same yeast, derived from onychomycosis lesions. Conclusion: The oral cavity in dysbiosis increases the virulence of C. parapsilosis sensu stricto due to possible changes in epigenetic marks. This finding suggests that the oral cavity in dysbiosis may be an alternative route to the skin in the epidemiology of nosocomial candidemia.


Author(s):  
Rodríguez ML ◽  
Rodríguez ML ◽  
Rosa AC ◽  
Nastri ML ◽  
Jewtuchowicz VM

Introduction: Candida parapsilosis sensu stricto is the second to third most frequent cause of candidemia. Studies place this yeast as a frequent colonizer of niches of the oral cavity, predominantly in pathological conditions. We hypothesize that a buccal environment in dysbiosis enhances the virulence of C. parapsilosis sensu stricto. Objective: To evaluate the phenotype and molecular level of the production of biofilm in oral isolates of Candida parapsilosis sensu stricto and correlate the results with the clinical origin (dysbiosis versus eubiosis). Materials and Methods: The biofilm-forming ability was compared in 50 oral isolates of Candida parapsilosis sensu stricto obtained from patients with and without oral dysbiosis; by quantification of metabolic activity. The results were corroborated by confocal fluorescence microscopy, and correlated with the transcriptional activity of CPH2, by RT-qPCR. The data were analysed by Excel 2010, and InfoStat 2018, with a 95% confidence interval. Results: The metabolic activity in biofilm was significantly higher in oral dysbiosis relative to control (p = 0.0025). Basal expression of CPH2 increased 2.8 times more in oral dysbiosis related to the control condition and showed no significant differences with pathogenic isolates of this same yeast, derived from onychomycosis lesions. Conclusion: The oral cavity in dysbiosis increases the virulence of C. parapsilosis sensu stricto due to possible changes in epigenetic marks. This finding suggests that the oral cavity in dysbiosis may be an alternative route to the skin in the epidemiology of nosocomial candidemia.


Gerontology ◽  
2020 ◽  
Vol 66 (6) ◽  
pp. 532-541
Author(s):  
Marta Zatta ◽  
Stefano Di Bella ◽  
Daniele Roberto Giacobbe ◽  
Filippo Del Puente ◽  
Maria Merelli ◽  
...  

<b><i>Introduction:</i></b> Being elderly is a well-known risk factor for candidemia, but few data are available on the prognostic impact of candidemia in the very old (VO) subjects, as defined as people aged ≥75 years. <b><i>Objective:</i></b> The aim of this study was to assess risk factors for nosocomial candidemia in two groups of candidemia patients, consisting of VO patients (≥75 years) and adult and old (AO) patients (18–74 years). In addition, risk factors for death (30-day mortality) were analysed separately in the two groups. <b><i>Methods:</i></b> We included all consecutive candidemia episodes from January 2011 to December 2013 occurring in six referral hospitals in north-eastern Italy. <b><i>Results:</i></b> A total of 683 nosocomial candidemia episodes occurred. Of those, 293 (42.9%) episodes were in VO and 390 (57.1%) in AO patients. Hospitalization in medical wards, chronic renal failure, urinary catheter, and peripheral parenteral nutrition (PPN) were more common in VO than in AO patients. In the former patient group, adequate antifungal therapy (73.2%) and central venous catheter (CVC) removal (67.6%) occurred less frequently than in AO patients (82.5 and 80%, <i>p</i> &#x3c; 0.002 and <i>p</i> &#x3c; 0.004, respectively). Thirty-day mortality was higher in VO compared to AO patients (47.8 vs. 23.6%, <i>p</i> &#x3c; 0.0001). In AO patients, independent risk factors for death were age (OR 1.04, 95% CI 1.00–1.09, <i>p</i> = 0.038), recent history of chemotherapy (OR 22.01, 95% CI 3.12–155.20, <i>p</i> = 0.002), and severity of sepsis (OR 40.68, 95% CI 7.42–223.10, <i>p</i> &#x3c; 0.001); CVC removal was associated with higher probability of survival (OR 0.10, 95% CI 0.03–0.33, <i>p</i> &#x3c; 0.001). In VO patients, independent risk factors for death were PPN (OR 3.5, 95% CI 1.17–10.47, <i>p</i> = 0.025) and hospitalization in medical wards (OR 2.58, 95% CI 1.02–6.53, <i>p</i> = 0.046), while CVC removal was associated with improved survival (OR 0.40, 95% CI 0.16–1.00, <i>p</i> = 0.050). <b><i>Conclusion:</i></b> Thirty-day mortality was high among VO patients and was associated with inadequate management of candidemia, especially in medical wards.


2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S662-S662
Author(s):  
Andrea Bedini ◽  
Marianna Meschiari ◽  
Erica Franceschini ◽  
Cristina Mussini

Abstract Background Antimicrobial stewardship programs allow a reduction in antibiotic prescription and, consequently, in the incidence of multidrug-resistance infections. However, the impact on nosocomial candidemia is still unclear. Methods The present study is an interrupted time-series (ITS) before-after study, based on an ecological time-trend analysis. Since 2014, an antimicrobial stewardship program (ASP) has been implemented at an Italian tertiary-care hospital. The first objective of the program was to reduce carbapenem consumption, through an active and computerized surveillance of all carbapenem prescriptions, each of which was checked and validated by ID specialists always after audit of the cases with treating physicians. We retrospectively evaluated the changing in the consumption of antimicrobials, carbapenems, and in the incidence of candidemia, during two study periods: before (2007–2013) and after (2014–2018) the implementation of the ASP. Results The implementation of ASP was followed by a significant decrease in antibiotic consumption, which was consistent through the following 5 years. At the end of the study, total antibiotic consumption has decreased by 38.476 DDDs per 100 patient-days (PDs) per quarter (95% CI: −21.784 to −55.168; P < 0.001) and carbapenems decreased by 4.452 DDD per 100 PDs per quarter (95% CI: −3.658 to −5.246; P = 0.001). After 5 years of ASP, incidence of candidemia decreased by 2.034 episodes per 1,000 PDs per quarter (95% CI: −0.738 to −3.330; P = 0.003), decreasing, at the end of 2018, by 53% compared with the expected value if the program had not been implemented. Conclusion At our Institution, the ASP had a positive impact on the consumption of carbapenems, and antimicrobials. The incidence of candidemia was also favorably affected by the program, reversing the trend after 2014. The ASP, even if not directly targeted to fungal infections, indirectly caused a reduction in the incidence of candidemia, probably reducing the number of patients colonized by Candida spp. Disclosures All authors: No reported disclosures.


PLoS ONE ◽  
2019 ◽  
Vol 14 (8) ◽  
pp. e0221033 ◽  
Author(s):  
Mariana Araújo Paulo de Medeiros ◽  
Ana Patrícia Vieira de Melo ◽  
Aurélio de Oliveira Bento ◽  
Luanda Bárbara Ferreira Canário de Souza ◽  
Francisco de Assis Bezerra Neto ◽  
...  

2016 ◽  
Vol 03 (04) ◽  
pp. 362-364
Author(s):  
Niraj Kumar Dipak ◽  
Samir Sultanbhai Sheikh ◽  
D S Madhusudhan ◽  
Kishore Kanajibhai Kikani ◽  
Prachi Gandhi ◽  
...  

Infection ◽  
2016 ◽  
Vol 44 (6) ◽  
pp. 747-755 ◽  
Author(s):  
Roberto Luzzati ◽  
Maria Merelli ◽  
Filippo Ansaldi ◽  
Chiara Rosin ◽  
Annamaria Azzini ◽  
...  

PLoS ONE ◽  
2016 ◽  
Vol 11 (1) ◽  
pp. e0146909 ◽  
Author(s):  
André Mario Doi ◽  
Antonio Carlos Campos Pignatari ◽  
Michael B. Edmond ◽  
Alexandre Rodrigues Marra ◽  
Luis Fernando Aranha Camargo ◽  
...  

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