Epidemiology of adult candidemia at Chiang Mai University Hospital

A retrospective study was conducted between July 1, 2004 and June 30, 2009 at Chiang Mai University Hospital among 138 patients with candidemia; 85 patients (61.6%) were male and the mean age was 57.7 +/- 19.4 years. Seventy-eight patients (56.5%) had underlying medical conditions. Candida albicans and non-albicans Candida were identified in 42 (30.4%) and 96 (69.6%) patients, respectively. Not being admitted to the ICU was the only factor associated with non-albicans candidemia (p = 0.018). Sixty patients (43.5%) had favorable outcomes. Factors independently associated with unfavorable outcomes included patients who were in the ICU (p = 0.025), were intubated (p < 0.001) or were on hemodialysis (p = 0.031); prior abdominal surgery was associated with a favorable outcome (p = 0.026). Candidemia is not a rare condition at this hospital. Early recognition and prompt empirical treatment are essential to improve outcomes of patients at risk for developing candidemia. Improvement of surveillance is crucial to recognizing emergence of highly resistant strains of Candida spp.     

The emergence of non-albicans Candida species as causes of invasive candidiasis and candidemia

The last three decades have seen an expanding pool of high-risk patients susceptible to the opportunistic pathogen Candida. Accordingly, a dramatic increase in nosocomial blood stream infections (BSIs) due to Candida spp has been reported throughout the world, starting in tertiary care centers and spreading to community hospitals. This absolute increase in Candida BSIs was accompanied by both an absolute and then a proportional increase in invasive infection caused by reduced fluconazole-susceptible non-albicans Candida spp. Currently, the incidence trend of BSI has stabilized, and Candida albicans remains the most common species causing fungal BSI. Clinicians must be aware of the importance and implications of non-albicans Candida spp when selecting antifungal drugs, although most studies have not shown significant outcome differences with use of the various antifungal classes.     

Incidence and antifungal susceptibility of Candida species in neonatal septicemia

Septicemia is the leading cause of morbidity and mortality in neonates. In this study, 828 consecutive neonates suspected of having septicemia from various neonatal intensive care unit hospitals in Gulbarga, Karnataka were investigated for isolation of microorganisms. Two samples of blood were collected aseptically for isolating the etiology. The cultures were positive in 346 (41.9%) cases for aerobic bacteria and 68 (8.3%) for Candida species. Among Candida species, C. tropicalis--27(39.7%) was the predominant organism followed by C. albicans 16(23.5%) and C. guillermondi 13(19.1%). The standard macrobroth dilution method was carried out to determine the minimum inhibitory concentration (MIC); C. krusei ATCC 6258 standard strain was included for quality control purpose. 4(25.0%) stains of C. albicans were resistant to amphotericin-beta and 2(12.5%) to fluconazole. High-level resistance to fluconazole was observed in C. krusei 4(40.0%).     

Epidemiology of candidemia in Qatar,the Middle East: performance of MALDI-TOF MS for the identification of Candida species,species distribution,outcome, and susceptibility pattern

Introduction

Bloodstream infections (BSIs) due to Candida spp. constitute the predominant group of hospital-based fungal infections worldwide. A retrospective study evaluated the performance of matrix-assisted laser desorption/ionization time-of-flight mass spectrometry (MALDI-TOF MS) for the identification of BSI Candida isolates. The epidemiology, risk factors, demographic features, species distribution, and clinical outcome associated with candidemia in patients admitted to a single tertiary-care hospital in Qatar, were analyzed.

Methods

A single-center, retrospective analysis covering the period from January 1, 2004 to December 31, 2010 was performed. Molecular identification used sequence analysis of the D1/D2 domains of the large subunit ribosomal DNA (LSU rDNA) and the ITS1/2 regions of the rDNA. MALDI-TOF MS-based identification of all yeast isolates was performed with the ethanol/formic acid extraction protocol according to Bruker Daltonics (Bremen, Germany). The susceptibility profiles of 201 isolates to amphotericin B, itraconazole, fluconazole, voriconazole, anidulafungin, caspofungin, posaconazole, and isavuconazole were tested using CLSI standard broth microdilution method (M27-A3 and M27 S4) guidelines. Statistical analyses were performed with the statistical package SPSS 19.0.

Results

A total of 187 patients with 201 episodes of candidemia were identified. Candida albicans was the most common species isolated (33.8 %; n = 68), whereas non-albicans Candida species represented 66.2 % (n = 133) of the episodes. The species distribution and outcome of candidemia showed a difference in the crude mortality between patients infected with C. albicans (n = 30; 45.5 %) and non-albicans Candida species. For example, C. parapsilosis candidemia was associated with the lowest mortality rate (40.6 %), and patients with other non-albicans species had the highest mortality rate (68–71.4 %). High mortality rates were observed among pediatric (<1 year of age) and elderly patients (>60 years of age). All strains showed low minimum inhibitory concentrations (MICs) (MIC₉₀ of 0.063 μg/ml) to isavuconazole. The overall resistance to voriconazole in vitro antifungal activity was 2.5 %. C. glabrata (n = 38) had an MIC₉₀ of 8 μg/ml for fluconazole. Most yeast isolates were susceptible to anidulafungin (>99.5 %) and 81.1 % to caspofungin. Resistance to anidulafungin was detected in 1/8 (12.5 %) isolates of C. orthopsilosis. According to new Clinical and Laboratory Standards Institute (CLSI) breakpoints, C. glabrata (n = 38) showed 100 % resistance, and 37/68 (54.4 %) C. albicans isolates were susceptible dose dependent (SDD) to caspofungin. Identification by MALDI-TOF MS was in 100 % concordance with molecular identification.

Conclusion

The Middle East epidemiology of candidemia has a unique species distribution pattern distinct from other parts of the globe. High mortality rates were observed among pediatric (<1 year of age) and elderly patients (>60 years of age). All strains were susceptible to isavuconazole. All isolates of C.glabrata were resistant to caspofungin based on M27 S4. MALDI-TOF MS is a highly useful method for the routine identification of yeast isolates in clinical setting to achieve successful therapeutic treatment.     

Ten-year review of candidemia in a Canadian tertiary care centre: Predominance of non-albicans Candida species

OBJECTIVE:

To review the epidemiology and associated risk factors for candidemia at a tertiary care centre, in view of recent reports on the changing epidemiology of bloodstream infection due to Candida species.

METHODS:

Between January 2000 and December 2009, patients with blood culture samples positive for Candida species were identified using the microbiology laboratory information system. Patient data were collected by retrospective chart review of clinical characteristics including demographic data, underlying medical diagnoses and risk factors.

RESULTS:

A total of 266 candidemia episodes were included in the final analysis. Fifty-nine per cent of these episodes occurred in males and 51% were in patients >60 years of age. The most common risk factor for candidemia was previous antibiotic use (85%). The most frequent species was Candida albicans (49%), followed by Candida glabrata (30%). C albicans was the predominant species in all study years with the exception of 2002, in which C glabrata was more frequent. The likelihood of recovering a non-albicans Candida species was found to be significantly associated with previous antifungal therapy (P=0.0004), immunosuppressive therapy (P=0.002), abdominal surgery (P=0.003) and malignancy (P=0.05). Mixed candidemia was found in 10 episodes (4%); 80% grew C albicans and C glabrata. Risk factors for mixed candidemia were not significantly different from those with monomicrobial candidemia.

CONCLUSION:

C albicans remains the most commonly isolated species in this setting, consistent with findings from other Canadian centres. However, non-albicans Candida species were overall predominant. Mixed-species candidemia does not appear to be more prevalent in patients with identified risk factors.     

Prospective study of Candida endophthalmitis in hospitalized patients with candidemia

To determine the frequency of endogenous Candida endophthalmitis in patients with candidemia, we prospectively evaluated 32 inpatients with fungemia by weekly indirect ophthalmoscopic examinations. Chorioretinitis compatible with Candida infection was found in 9 (28%) patients. Patient age, sex, underlying diseases, or hospital-acquired factors, such as presence of central venous or Foley catheters, bacteremia, use of multiple antibiotics, hyperalimentation, or surgery, did not distinguish between groups. Groups were also similar in number of sites colonized with yeast and species of Candida recovered. Patients with endophthalmitis tended to have more blood cultures positive for Candida (mean, 4.3) than the patients without endophthalmitis (mean, 2.8), but this trend did not reach statistical significance. Based on these results, we recommend periodic ophthalmoscopic examinations in all patients with documented candidemia.     

新型隐球菌及念珠菌临床分离株对5种抗真菌药物的体外敏感性

目的 了解临床分离的新型隐球和念珠菌对氟康唑、两性霉素B、伊曲康唑、氟胞嘧啶和酮康唑的体外敏感性及临床治疗效果的相关性。方法 采用标准微量稀释法测定了上述5种抗真菌药物对临床分离株的35株新型隐球菌和56株念株菌量的最低抑菌浓度（MIC）。结果 56株念珠菌对5种药物的敏感性（MIC）分别为氟康唑0.125～64ug/ml,94.6%的菌株对氟康唑敏感,1.8%为剂量依赖性敏感,3.6%耐药;伊曲康唑0.03～1ug/ml,57.1%敏感,37.5%剂量依赖性敏感,5.4%耐药;氟咆嘧啶 0.125～32ug/ml,92.8%敏感,3.6%中度敏感,3.6%耐药;两性霉素B0.06～2ug/ml;酮康唑0.03～0.5ug/ml。35株新型隐球菌对5种药物的MIC范围分别为氟康唑2～64ug/ml,伊曲康唑0.25～1ug/ml,两性霉素B0.3～1ug/ml,氟胞嘧啶0.25～64ug/ml,酮康唑0.125～1ug/ml。结论 标准微量稀释法测定酵母菌对抗真菌药物的敏感性其结果具有可重复性和一致性的特点。     

A successful treatment with micafungin of candidemia due to Candida krusei

We report a case of candidemia due to Candida krusei after subarachinoid hemorrhage. A 51 year-old male patient consulted us for high fever and increase of CRP 10 days post operation against subarachinoid hemorrhage. There was a temporary decrease in the CRP after administration of ceftazidime (CAZ) but it again when treatment with CAZ was stopped. Because of detected Candida sp. by blood culture, fluconazole was administered i.v. for 5 days, but C. krusei was positive during the treatment. Therefore, fluconazole was replaced with micafungin. The patient became better after the administration with micafungin for 14 days without side effect. Micafungin is effective against candidemia due to C. krusei.     

Eikenella corrodens causing deep-seated infections. Six-year experience in a University Hospital in Madrid

IntroductionEikenella corrodens (EC) is part of the normal microbiota of the oropharynx and a recognised opportunistic pathogen. It is mainly involved in head and neck infections, but it has also been identified as a cause of pleuropulmonary and intraabdominal infections. Its identification could be difficult due to its fastidious growth requirements, especially in the context of polymicrobial infection and is probably underreported.MethodsWe carried out a retrospective 5-year review of clinical charts and laboratory database.ResultsWe describe the clinical and microbiological characteristics of 9 deep-seated infections caused by EC, diagnosed in locations different from the head and neck.ConclusionEC deep-seated infections are often found in patients with comorbid conditions and a history of interventional procedures. Due to the characteristic torpid evolution of EC abscesses, imaging to assess the necessity of debridement and avoid early cessation of antibiotics is necessary.     

Significance of isolation and drug susceptibility testing of non-Candida albicans species causing oropharyngeal candidiasis in HIV patients

Oropharyngeal candidiasis (OPC) continues to be a common opportunistic infection in patients infected with Human Immunodeficiency Virus (HIV) and is predictive of increasing immunosuppression. Though Candida albicans remains the predominant isolate, a rise in the frequency of isolation of non-albicans Candida (NAC) species is being observed. The levels of virulence and the sensitivities to available antifungal drugs vary among these species. Of 340 HIV seropositive patients in this study, 132 (38.8%) had oral lesions suggestive of candidiasis. Samples were collected from the lesion using sterile cotton swabs. Isolation and speciation were done by standard techniques. Antifungal drug susceptibility testing was done by macro broth dilution. The total number of Candida isolates was 135, of which, 45 (33.3%) were NAC species and 90 were C.albicans (66.6%). Of the NAC species, C. dubliniensis was the predominant pathogen (22,48.9%). Antifungal susceptibility testing showed that 14 (31.1%) of the NAC species and 11 (12.2%) of C. albicans were resistant to fluconazole (MIC > 8 microg/ml). A very high MIC of > 32 microg/ml was noted among the NAC species resistant to fluconazole.     

In vitro susceptibility of Candida species isolated from blood culture to some antifungal agents

Fungal infections are among the major causes of morbidity in cancer patients. In order to optimize the treatment of such patients, it is critical to determine the type of fungus causing infection as well as its susceptibility to antifungals. This study was undertaken to the study resistance of Candida spp. isolated from blood cultures of cancer patients to ketoconazole (KET), fluconazole (FLU), amphotericin B (AmpB), and flucytosine (FCU). A modified NCCLS M 27-A method was used to evaluate the activity of the species. Of the 56 Candida albicans isolates, 7 (12.5%) were resistant to FLU (MIC > or = 64 microg/ml), 6 (10.7%) were resistant to KET (MIC > or = 64 microg/ml) and 3 (5.3%) were resistant to FCU (MIC > or = 32 microg/ml). One (14.3%) of 7 C. parapsilosis isolates was resistant to FLU (MIC > or = 64 microg/ml). One (33.3%) of 3 C. tropicalis isolates was resistant to KET (MIC > or = 64 microg/ml). None of the C. guilliermondii or C. pelliculosa isolates was resistant to KET, FLU, AmpB, or FCU. Based on these results, AmpB is an effective antifungal agent that can be used against all Candida isolates.     

The comparison of susceptibility of Candida albicans and Candida glabrata to miconazole

Candida glabrata is very important pathogen which is resistant to some imidazoles (fluconazole). The aim of study was to compare a susceptibility of Candida albicans and Candida glabrata - strains isolated from patietnts treated in Centre for Treatment of Parasitic Diseases and Mycoses - to miconazole using MIC. 96.5% of strains were sensitive to miconazole; values of MIC for C. albicans were lower than for C. glabrata.     

Distribution and epidemiology of Candida species causing fungemia at a Saudi Arabian hospital, 1996-2004.

OBJECTIVES: The objective of this study was to evaluate the Candida species and the change over time in the organisms causing candidemia at Saudi Aramco Medical Services Organization in Saudi Arabia. We also describe the risk factors associated with mortality. METHODS: This was a retrospective study of candidemia over nine years (1996-2004). RESULTS: A total of 98 distinct episodes of candidemia were identified over the study period. The annual incidence of candidemia ranged between 0.2 and 0.76 cases/1000 hospital discharges with an incidence per 10 000 patient-days per year of 0.45 to 1.6. The most frequent Candida species were Candida albicans (53%), Candida tropicalis (19%), Candida parapsilosis (16%), and Candida glabrata (7%). In relation to predisposing factors, 83% of candidemia occurred in patients with central venous catheters and 96% had received broad-spectrum antibiotics. Other predisposing factors included complicated abdominal surgeries (22%), total parenteral nutrition (52%), neutropenia (9%), acute renal failure (24%), malignancy (26%) and burns (15%). However, prior fluconazole use was low (8%). The overall crude mortality rate was 43% for all candidemia. Logistic regression analysis identified two independent determinants of death, C. albicans (OR 5.91, 95% CI 1.50, 23.24, p=0.01) and acute renal failure (OR 5.15, 95% CI 1.18, 22.55, p=0.03). CONCLUSION: The study showed that the rate of candidemia was low in our hospital and that C. albicans was the major species followed by C. tropicalis and C. parapsilosis. Future studies are needed to evaluate the antifungal susceptibility pattern in our hospital.     

HIV感染者与健康人群口腔念珠菌的体外药物敏感性比较

目的探讨HIV感染者与健康人群口腔念珠菌对常用抗真菌药物敏感性的异同。方法采用美国临床和实验室标准化研究所推荐方案M27-A2,即微量液基稀释法对60株HIV感染者口腔念珠菌和61株健康人群口腔念珠菌进行体外抗真菌药物敏感性试验,分别测定两种来源的念珠菌对氟康唑(fluconazole,FCZ)、酮康唑(ketoconazole,KETO)、氟胞嘧啶(fluorocytosine,5-FC)和两性霉素B(amphotericin B,Amb)共4种常用抗真菌药物的敏感性,SPSS 13.0统计分析。结果HIV感染组对上述4种药物敏感性的几何均数分别为0.87μg/mL、0.05μg/mL、0.18μg/mL和0.33μg/mL,耐药率分别为1.7%、5%、3.3%和5%,1株光滑念株菌对FCZ、KETO和Amb同时耐药;健康人群组敏感性的几何均数分别为3.45μg/mL、0.06μg/mL、0.30μg/mL和0.42μg/mL,耐药率分别为9.8%、6.6%、9.8%和9.8%,1株光滑念株菌对FCZ、KETO和5-FC同时耐药,另1株光滑念珠菌对KETO、5-FC和Amb同时耐药。结论除FCZ外,两组念珠菌对KETO、5-FC和Amb的敏感性差异无显著性(P>0.05);两组念珠菌对上述4种药物的耐药率差异无显著性(P>0.05);两组念珠菌中非白色念珠菌的耐药率均高于白色念珠菌(P<0.05),且存在交叉耐药现象。