Rapid identification of the Candida species from direct blood cultures by CHROMagar Candida

We evaluated the ability of CHROMagar Candida to identify Candida species isolated directly from blood cultures. A total of 50 clinical isolates of Candida were incubated at 35 degrees C, and once growth was established, an aliquot of each was plated onto CHROMagar Candida medium. A control specimen was plated directly from Sabouraud's dextrose agar. Following incubation at 30 degrees C, all yeast isolates were identified by colony morphology and colour. We were able to identify all isolates of C. albicans (n = 20), C. tropicalis (n = 14), C. glabrata (n = 6), and C. krusei (n = 5), which were isolated from blood or from control cultures. This study demonstrated that CHROMagar Candida reliably isolated and identified yeast taken directly from blood cultures. We conclude that this rapid and easy method of identifying Candida species will enable clinicians to quickly choose the appropriate antifungal agent. This should decrease patient morbidity and mortality.     

Coryneform bacteria isolated from blood cultures and their antibiotic susceptibilities

We aimed to determine the types of corynebacteria isolated from the blood of patients at Gaziantep University Hospital, Turkey, and their antibiotic susceptibilities. Between February 1999 and June 2001, 3530 blood samples were cultured, of which 915 were found to be positive, and these were further investigated in the bacteriology laboratory. Among positive blood cultures, coryneform bacteria were identified in 31 (3.4%) isolates. Of these, 16 (51.6%) were Corynebacterium jeikeium, six (19.4%) were Corynebacterium striatum, four (12.9%) were Corynebacterium amycolatum, two (6.5%) were Cellulomonas species, two (6.5%) were Corynebacterium afermentans and one isolate (3.2%) was Corynebacterium propinquum. Antibiotic susceptibility tests showed that C. jeikeium was resistant to various antibiotics, whereas all isolates were susceptible to vancomycin and teicoplanin. This study illustrates the importance of taking coryneform bacteria into consideration when culturing blood samples. The need to identify the species and determine its antibiotic sensitivity is emphasized.     

Susceptibility patterns of Candida species recovered from Canadian intensive care units

OBJECTIVE: The objective of this study was to determine the speciation and susceptibility patterns of Candida species recovered from Canadian intensive care units (ICUs) during a 1-day point-prevalence study on fungal colonization/infection in Canadian ICUs. METHODS AND SETTING: Blood, urine, respiratory tract, rectal, and wound fungal cultures were performed for 357 patients present at any time during a single-day 24-hour period in 35 Canadian ICUs. Comparative in vitro activities of amphotericin B, fluconazole, itraconazole, voriconazole, posaconazole, micafungin, anidulafungin, and aminocandin were determined. RESULTS: Four hundred fifteen yeasts (409 Candida species and 6 non-Candida yeasts) were recovered. Almost 50% of the patients were found to have positive respiratory tract or rectal cultures. Candida albicans accounted for 72% of the Candida species isolated, followed by Candida glabrata (16%), Candida tropicalis (5%), Candida parapsilosis (3%), Candida krusei (2%), and other Candida species or nonspeciated isolates (2%). Minimum inhibitory concentrations (milligrams per liter) at which 90% of the strains were inhibited were 0.06 for micafungin as well as anidulafungin, 0.12 for voriconazole, 0.25 for itraconazole, posaconazole, as well as aminocandin, 1 for amphotericin B, and 4 for fluconazole. Only 4% of the isolates were resistant to fluconazole and/or itraconazole. CONCLUSIONS: Candida albicans is the predominant species colonizing Canadian ICU patients. Overall, the triazoles, both older and new compounds, and the echinocandins have excellent in vitro antifungal activities against Candida species recovered from Canadian ICUs patients.     

Distribution of Candida species isolated from blood cultures in hospitals in Osaka,Japan

BackgroundCandida species are clinically important causes of bloodstream infections because their mortality is very high. Given that some species of Candida are azole-resistant, identifying the distributions of Candida species could facilitate the formulation of an appropriate empirical antifungal therapy. It has been shown that the distribution varies depending on the continent, country, city, and hospital. In this paper, we describe the distributions of species in hospitals in northern Osaka, Japan.MethodWe evaluated blood culture results obtained from six tertiary hospitals in the northern Osaka area between 2004 and 2011. We also obtained comorbidity information from the patients' hospital medical records. Kaplan–Meier curves were drawn to compare the risk of death related to the different species.ResultsOf the 165 cases of candidemia confirmed by blood culture, 66% were male and the mean age was 62 years (range = 0–96). Overall, Candida albicans comprised 70 cases (43%), followed by Candida parapsilosis with 36 cases (22%), Candida glabrata with 25 cases (15%), Candida tropicalis with 11 cases (7%), Candida krusei with 10 cases (6%), and other Candida species with 13 cases (8%). C. tropicalis had higher associated mortality than other species, although it was not statistically significant.ConclusionsC. albicans was the most frequently isolated species, but the proportion of non-albicans Candida species was not negligible. The relatively high frequency of non-albicans Candida species distinguished the Japanese distribution from other areas. This characteristic distribution may have important implications when formulating an empirical antifungal therapy for Japanese clinical practice.     

Distribution and drug susceptibilities of Candida species causing candidemia from a medical center in central Taiwan

Invasive fungal infections have increased significantly in the past few decades because of the increase in high-risk populations. To investigate the distribution and drug susceptibilities of such infections, we analyzed all 152 Candida isolates causing candidemia from 2004 to 2006 at the China Medical University Hospital, a medical center in central Taiwan. Candida albicans was the most common species, accounting for 52.6 % of the isolates, followed by C. tropicalis (19.7 %), C. parapsilosis (14.5 %), C. glabrata (8.6 %), C. guilliermondii (3.9 %), and C. pelliculosa (0.7 %). All isolates were susceptible to amphotericin B, anidulafungin, micafungin, and voriconazole according to minimum inhibitory concentrations (MICs) after a 24-h incubation; 0.7 %, 6.6 %, and 7.9 % of isolates were resistant to amphotericin B, fluconazole, and voriconazole, respectively, after 48-h incubation. Both C. albicans and C. parapsilosis had high degrees of agreement for azoles between 24- and 48-h incubation periods, whereas C. glabrata (38.5–46.2 %) and C. tropicalis (56.7–63.3 %) did not. The majority of the isolates with high azole MICs displayed a trailing growth phenotype. Hence, the MICs of different drugs after 24-h incubation may be considered for prognosis of candidemia.     

Impact of autologous blood transfusion on blood support in general thoracic surgery: analysis of 969 patients over a 5-year period

Autologous blood transfusion (ABT) is increasingly used in order to avoid transfusion-related risks. The effectiveness of this simple and feasible procedure depends on several factors, such as the timing of surgery, the patient's overall condition and, last but not least, the pre-disposition of the medical team towards the routine use of ABT. We report our experience in blood support with ABT for general thoracic surgical patients, indicating an overall partially satisfactory outcome due to a limited use of the procedure. In 1992, 61 patients (38%) received autologous blood only, as compared to 9 patients (6%) who had received ABT in 1989. The average pre-deposit per patient ratio in 1992 was 1.2 units, which provided insufficient autologous blood support. In the same period, only 23 patients were subjected to acute normovolemic hemodilution (ANH). However, we noted a reduction of homologous transfusions from 2.9 +/- < 2.1 in 1989 to 2.0 +/- < 1.5 in 1992 (P < 0.01). In addition, we observed that a single pre-deposit was not enough to enhance erythropoiesis and to improve post-operative red blood cell rescue when performed in patients with Hb > 11 g%. Based on our data, we emphasize a more extensive move to ANH, along with pre-deposit, in order to avoid unnecessary homologous blood transfusions.     

Early detection and identification of commonly encountered Candida species from simulated blood cultures by using a real-time PCR-based assay

In a recent study, Candida species in clinical blood samples were detected using a real-time PCR-based method (Maaroufi et al, J Clin Microbiol 2003, 41:3293-3298). For the present study, we evaluated the efficiency of this method as an adjunct to the BACTEC blood culture system to early detection of positivity and negativity of simulated low candidemias. We first established an in vitro correlation between the inoculum of the most frequently encountered Candida species and the time to positivity of these microorganisms. Then, aliquots from blood culture bottles infected with a final average candidal inoculum of 3.18 colony-forming units (CFU)/culture bottle (range, 1 to 6 CFU) were collected at increasing incubation times, and DNA was extracted and submitted to the TaqMan-based PCR assay. To optimize this assay, we evaluated the effect of adding 0.5% bovine serum albumin (BSA) to DNA extracts and found that it decreased the effects of inhibitors. Using specific probes for the tested Candida species, the PCR assay was positive on blood culture aliquots collected from the BACTEC system after a minimum culture turnaround time (TAT) of 3.11 +/- 1.24 hours. Addition of BSA to PCR reaction mixtures improves the TAT (1.84 +/- 0.41 hours). Hence, the combination of DNA "amplification" in the culture bottles by normal growth with an additional DNA amplification by PCR might be a reliable tool facilitating the early diagnosis of low candidemias.     

Occurrence and molecular characterization of Klebsiella pneumoniae ST37 clinical isolates producing plasmid-mediated AmpC recovered over a 3-year period

We investigated the clinical and microbiological epidemiology of AmpC plasmidic cephalosporinases (pAmpC) in Klebsiella pneumoniae strains resistant to ceftazidime, during a 3-year period (2007-2009). Among 1505 K. pneumoniae, 7 were pAmpC producers. Molecular characterization revealed the spread of a ST37 strain producing DHA-1 within intensive care units and the diffusion of the same plasmid among unrelated strains.     

Within-subject variation of plasma resistin levels over a 1-year period.

BACKGROUND: Resistin, a recently discovered hormone, is purportedly involved in metabolic and inflammatory processes in humans and may thus be an important marker to assess disease risk in large-scale epidemiological studies. METHODS: We assessed the reliability of human resistin levels in 63 men and 51 women aged 35-67 years with repeated measurements of resistin over a period of 1 year. Student's paired t-test was used to compare resistin concentrations at baseline and 1 year later. Intraclass correlation coefficients (ICCs) were calculated by analysis of variance. RESULTS: There was no significant difference between resistin concentrations at baseline and after 1 year for both sexes combined or when analyzed separately for men and women. The ICCs were 0.70 (95% CI 0.59-0.78) for both sexes combined, 0.75 (95% CI 0.62-0.84) for men, and 0.66 (95% CI 0.47-0.79) for women. Resistin levels were not significantly related to age, body mass index, waist-to-hip ratio, sex, or fasting status. CONCLUSIONS: Individual blood resistin concentrations did not significantly change over a period of 1 year, but showed a high degree of reliability. Our findings suggest that a single resistin measurement may be sufficient for risk assessment in epidemiological studies.     

Epidemiologic comparison of human T-lymphotropic virus type I-infected blood donors from endemic and nonendemic regions over a 3-year period

BACKGROUND: Screening for human T-lymphotropic virus type I (HTLV-I) infection became systematic in 1989 in the French West Indies for blood from all donors and in France for blood from natives of endemic areas; in 1990, it was extended to blood from donors with at-risk sex partners and in July 1991 to blood from all donors. STUDY DESIGN AND METHODS: The epidemiologic characteristics of individuals found through the screening of donated blood to be HTLV-I infected were compared for an endemic region (Guadeloupe, French West Indies) and a nonendemic region (Paris area) over a 3-year period (1989 through 1991). RESULTS: In Guadeloupe, 131 HTLV-I-infected individuals were detected in the screening of 28,801 units; in the Paris area, 38 HTLV-I-infected donors were detected in the screening of 109,824 units. All Guadeloupean HTLV- I-infected donors were natives of endemic areas. Among the 38 Parisian HTLV-I-infected donors, 21 were natives of endemic areas, 10 were natives of endemic areas and had received transfusions, 2 were whites who had received transfusions, and 5 were whites who had had heterosexual contact with natives of endemic areas. The percentage of HTLV-I-infected individuals whose blood would have been excluded because of positivity for one or more markers for other viruses did not significantly change over the study period and did not significantly differ between regions (41%). Among the eight Parisian HTLV-I-infected blood donors detected after July 1991, six would not have been detected without the biologic screening. CONCLUSION: The generalization of biologic screening of HTLV-I-infected donated blood in France was useful for the prevention of HTLV-I and HTLV type II infections through transfusion.     

Clinical evaluation of a NASBA-based assay for detection of Candida spp. in blood and blood cultures

The number of life-threatening opportunistic fungal infections has shown a dramatic increase. However, the diagnosis of candidemia remains difficult. Nucleic acid amplification assays may improve the detection rate and decrease the time needed for detection and identification of Candida spp. Whole blood samples of patients suspected of having candidemia were analyzed using Nucleic Acid Sequence-Based Amplification (NASBA). Furthermore, aliquots of blood cultures of the patients after 2 days of culturing were tested. Eleven data sets from ten patients in two hospitals were generated. None of the whole blood samples was positive in the NASBA assay. Eight samples were positive in the NASBA assay after two days of culturing, whereas only two additional positive samples were found after longer incubation periods. Thus, a two-day culture step is sufficient to greatly improve the sensitivity of the NASBA assay. The NASBA assay detected Candida RNA in three patients. In one patient, the yeast was not detected by automated blood culturing, in another patient the NASBA assay detected the infection two days earlier than the blood culture system.     

The PTFE plastic prosthesis as an arterial replacement: experiences over a 5-year period

Unilateral iliac femoral reconstructions with PTFE are yielding good results-similar to those with Dacron, with patency rates of 75, 67, and 65% at 1, 2 and 3 years, respectively (Kaplan-Meier). PTFE has additional advantages compared with other materials: a) no need of preclotting; b) smooth inner surface-easy thrombectomy in case of thrombosis and c) good handling characteristics. In view of the above-mentioned facts PTFE can be recommended without restriction for unilateral pelvic reconstructions. The functional early results of bilateral aorto-femoral Goretex-Y bifurcation grafts in 50 cases after 2 years are encouraging. Long-term results are still pending. Reports of other groups using this material as aorto-bifemoral substitute are not yet available. The functional results with PTFE for femoro-popliteal grafts are not satisfactory: 35% after 2.5 years. Extra-anatomical bypasses yielded 70% one-year functioning rate. Especially the ring-or spiral-armoured PTFE grafts seem to be suitable for these reconstruction procedures.     

Molecular characterization of Italian Candida parapsilosis isolates reveals the cryptic presence of the newly described species Candida orthopsilosis in blood cultures from newborns

The authors report the molecular characterization of Candida parapsilosis isolates recovered from the blood and venous central catheter tips of patients admitted to different care units of the Polyclinic Hospital, University of Messina, Italy. Among 97 presumed C. parapsilosis isolates examined, 94 were identified as C. parapsilosis sensu stricto and the remaining 3 isolates were found to belong to the cryptic species Candida orthopsilosis which was recovered only from blood cultures of neonates (<30 days old) born prematurely. No C. metapsilosis was found in this study. This study emphasizes the role of C. parapsilosis as an important nosocomial pathogen, and it also describes, for the first time, the occurrence of C. orthopsilosis in newborns.     

Stability of steroids in plasma over a 10-year period

In order to examine whether plasma samples may be used for steroid analysis after long periods of storage, cortisol, testosterone, oestrone and oestradiol were remeasured in samples, which had been analysed 1.3-10.8 years earlier. The method for the measurement of these steroids was unchanged over this period. The results demonstrate that at a temperature of -25 degrees C steroids remained stable. Only cortisol and testosterone concentrations showed a small, insignificant decrease (6-9%) after 3 to 4 years of storage. These differences are well within the range of the precision of the method (interassay variation), which over a period of 11 years was 9.4%, 8.0%, 10.0% and 9.5% for cortisol, testosterone, oestrone and oestradiol, respectively. It is concluded that steroid hormones in human plasma are stable in our laboratory, and that they might be analysed even after more than 10 years of storage at -25 degrees C.     

Asthma medication – persistence with adrenergics, steroids and combination products over a 5-year period

Background:  Many patients with asthma underuse steroids for inhalation. This has been identified as a main cause of therapy failure and of excess health care utilization.
Objective:  To elucidate the medication persistence of patients using asthma drugs, how patients combine the drugs over time and whether medication persistence was influenced by patients switching to combination products.
Methods:  Individual patients' drug acquisition data were obtained from a pharmacy record database for the period 2000–2004. A patient was considered to have satisfactory medication possession ratio (MPR) if the medication supplies covered ≥80% of the prescribed treatment. Drug use profiles were constructed as graphs for each patient, showing the date of each refill and the time period covered by the dispensed drugs. From the graphs the combination of drugs, the continuity of the therapy over time and the MPR for each patient could be determined.
Results:  Of 1812 patients with asthma drugs in the database, 815 fulfilled the inclusion criteria. The percentage of patients with satisfactory MPR was low (11–27%), but significantly higher among patients using combination products than among those using steroids. For patients who switched from adrenergics plus steroids in two inhalers to combination products in one inhaler, the number of patients with satisfactory MPR was significantly increased.
Conclusion:  Satisfactory MPR was low for all types of asthma drugs. More patients had satisfactory MPR with combination products in one inhaler than with adrenergics and steroids in two separate inhalers. Asthma drug-delivery is important and combination products of the two ingredients could therefore improve asthma therapy.     

Clinical significance of Bacillus species isolated from blood cultures

To determine the clinical significance of blood isolates of Bacillus, we reviewed all blood cultures obtained at North Carolina Memorial Hospital between 1981 and 1985. Over the five-year study period the number of patients (incidence per 10,000 hospital admissions) from whom Bacillus was isolated increased from 4.97 in 1981 to 12.5 in 1985. The incidence per 1,000 blood cultures also increased from 1.12 in 1981 to 2.33 in 1985. Review of the medical records of 78 of the 95 patients (82%) with positive cultures allowed retrospective classification of five isolates (6.4%) as clinically significant, 33 isolates (42.3%) as possibly significant, and 40 isolates (51.3%) as nonsignificant. Underlying diseases in patients with clinically significant Bacillus bacteremia included burn trauma in two, leukemia in one, carcinoma in one, and gastrointestinal hemorrhage in one. All isolates judged to be clinically significant and the majority of possibly significant isolates were B cereus. We conclude that the isolation of Bacillus species from blood cultures is clinically significant in 5% to 10% of cases, that the incidence of Bacillus bacteremia is increasing, and that burn trauma should be added to the list of conditions known to predispose to clinically significant Bacillus bacteremia.     

Evaluation of the risk of fatal outcome in patients with stable stenocardia over a 5-year period

The results have been analyzed of the 5-year prospective observation over patients with associated coronary heart disease (CHD) and stable angina pectoris without grave concomitant diseases and heart failure signs. A rule of prediction has been elaborated enabling one to distinguish on the basis of the clinical data a group of patients in whom the disease runs a favourable course. It is unlikely that in the future such a group of patients would require any combined instrumental examination or surgical intervention. The use of the common therapeutic measures (long-acting nitrates, beta-blockers, and calcium antagonists) can be recognized as quite sufficient and effective. The clinical observation can be limited by the patient's attendance of the health center for repeated examination and specification of the further prognosis, which is to be made once a year. The above-said confirms the importance of defining CHD prognosis, since the properly chosen tactics of such patients' management makes it possible to attain the maximal efficacy of the diagnostic and treatment measures and to save costs as well.