Résumé
Introducción: La tasa de mortalidad de la candidemia es variable, pero puede estar influenciada por la patología de base, en especial aquella que condiciona la presencia de neutropenia. En niños con patología oncohematológica, son pocos los trabajos que han abordado la mortalidad relacionada a candidemias y sus factores asociados. Las preguntas que promueven esta revisión sistemática, son: ¿Cuáles son las características epidemiológicas, clínicas y de evolución de los pacientes pediátricos oncohematológicos con candidemia? ¿Cuál es la mortalidad relacionada con esta entidad? Materiales y métodos: Revisión sistemática de la literatura. Se utilizaron los siguientes términos de búsqueda: candidemia por Candida spp. y los siguientes filtros humanos, niños y adolescentes y patología oncohematológica. Se revisaron los artículos publicados en inglés, español o francés hasta el 21 de septiembre de 2023. Las referencias bibliográficas de los artículos incluidos se revisaron manualmente para identificar estudios relevantes adicionales. Resultados: Se encontraron 66 artículos. Del análisis cualitativo realizado en sus textos completos, quedaron finalmente 4 estudios que se consideró que cumplían con los criterios de inclusión. Todos los artículos seleccionados sumaron 191 pacientes con diversas patologías oncohematológicas. La presencia de accesos vasculares fue frecuente en esta serie y la no extracción del catéter venoso central fue el factor más prevalente entre los que fallecieron. El agente infectante predominante fue Candida no albicans y la mortalidad osciló entre el 11,3 y el 31% con una mediana de 25%. No fue posible establecer si la especie de Candida influía en la letalidad
Introduction: The mortality rate of candidemia is variable, but may be influenced by underlying diseases, especially those causing neutropenia. In children with cancer and blood disorders, few studies have addressed mortality related to candidemia and its associated factors. The questions that motivated this systematic review were: What are the epidemiological, clinical and outcome characteristics of pediatric cancer patients with candidemia? What is the mortality related to this condition? Materials and methods: Systematic review of the literature. The following search terms were used: Candida spp., candidemia, with the following filters: human, children and adolescents, and cancer and blood disorders. Articles published in English, Spanish, or French up to September 21, 2023 were reviewed. References of included articles were manually reviewed to identify additional relevant studies. Results: 66 articles were identified. From the qualitative analysis carried out on their full texts, 4 studies that were considered to meet the inclusion criteria were finally selected. The selected articles included a total of 191 patients with various types of cancer and blood disorders. The presence of vascular access was common in this series and failure to remove the central venous catheter was the most prevalent factor among those who died. The predominant infectious agent was non-albicans Candida and mortality ranged from 11.3% to 31% with a median of 25%. It was not possible to establish whether Candida species influenced mortality.
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Humains , Nouveau-né , Nourrisson , Enfant d'âge préscolaire , Enfant , Adolescent , Leucémies/complications , Facteurs de risque , Mortalité hospitalière , Candidémie/microbiologie , Candidémie/mortalité , Tumeurs/complications , Sujet immunodéprimé , Antifongiques/usage thérapeutiqueRésumé
In the healthcare setting, Candida bloodstream infections significantly increase morbidity and mortality. There is little proof that invasive infections in Saudi Arabia are brought on by Candida spp. To identify Candida species that cause bloodstream infections and ascertain the clinical outcome and risk factors for mortality in a Saudi Arabian tertiary hospital. This retrospective analysis covered all instances in which patients hospitalized to Ohud hospital, a tertiary care facility in Madinah, Saudi Arabia, between January 2019 and December 2021, had positive blood cultures for Candida. Anaerobic and aerobic Bactec bottles were inoculated with blood samples and then incubated at 35°C for five days. Identification-YST card kits from VITEK II (BioMerieux, France) for yeast and yeast-like organisms. Testing for antifungal susceptibility was done using AST YS07. A total of 78 patients (71% men, 29% women) were found to have candidemia. Candida albicans (51.3%), Candida parapsilosis (16.7%), and Candida tropicalis (16.7%) were the three Candida spp. that were most frequently isolated. Those with Saudi (51%; P = 0.500), leukopenia (40%; P = 0.001), neutrophilia (92%; P = 0.638), and thrombocytopenia (42%; P = 0.374) had a higher incidence of candidemia. Fluconazole sensitivity in non-albicans Candida species was 39.5%. Nonetheless, caspofungin was effective against all species. This study discovered an epidemiological shift toward more non-albicans Candida spp. in Saudi Arabia as well as a changing pattern in the Candida spp. causing bloodstream infections.
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Introdução: A infecção da corrente sanguínea (ICS) por leveduras, tem como principal gênero a Candida. As principais espécies que causam a candidemia no Brasil são Candida albicans, Candida parapsilosis e Candida tropicalis, sendo a C. albicans a mais prevalente. Todavia, nas últimas décadas tem aumentado a prevalência de espécies de Candidanão albicans (CNA) e principalmente a emergência de Candida auris, que possuem mecanismos de resistência aos antifúngicos mais usados, caracterizando um cenário de preocupação mundial. Objetivo: Avaliar a prevalência de candidemia e das principais espécies de Candida spp. isoladas de amostras de hemocultura e sua distribuição por setores de internação de um hospital de ensino. Material e Métodos: Trata-se de um estudo observacional e retrospectivo, em que foram analisadas, através de bancos de dados, hemoculturas positivas para Candida spp. de pacientes internados em um hospital de ensino da cidade de Juiz de Fora, Minas Gerais, no período de janeiro de 2021 a dezembro de 2022. Resultados: Foram analisadas 3.262 hemoculturas, sendo 1.059 (32,46%) positivas. Destas, 1.008 (95,18%) tiveram crescimento bacteriano e 51 (4,82%) tiveram crescimento de Candida spp. divididos em, 20 (39,22%) C. albicans e 31 (60,78%) CNA. Das CNA isolados, 14 foram C. tropicalis (45,16%), 10 C. parapsilosis(32,26%), 3 C. glabrata (9,68%), 2 Candida kefyr (6,45%) e 2 Candida lusitaniae (6,45%). Dos 51 isolados de Candida spp., 25 (49,02%) foram no centro de tratamento intensivo, 11 (21,57%) no bloco cirúrgico e 15 (29,41%) foram nas enfermarias. Conclusão: Candida albicans é a principal espécie relacionada a candidemia em pacientes hospitalizados, porém espécies do grupo CNA têm apresentado elevada prevalência em isolados de hemocultura, principalmente em pacientes de centro de tratamento intensivo.
Introduction: Bloodstream infection (BSI) by yeasts has Candida as its main genus. The main species that cause candidemia in Brazil are Candida albicans, Candida parapsilosis and Candida tropicalis, and C. albicans referred as the most prevalent. However, in recent decades, the prevalence of non-albicans Candida species (NAC) has increased and especially the emergence of Candida auris, which have mechanisms of resistance to the most used antifungals, characterizing a scenario of global concern. Objective: To evaluate the prevalence of candidemia and the main species of Candida spp. isolated from blood culture samples and their distribution by hospitalization sectors of a teaching hospital. Material and Methods: This is an observational and retrospective study, of positive blood cultures for Candida spp. of patients admitted to a teaching hospital in the city of Juiz de Fora, Minas Gerais, from January 2021 to December 2022. Results: Among 3262 blood cultures analyzed, 1059 (32.46%) of which were positive. Of these, 1008 (95.18%) had bacterial growth and 51 (4.82%) had Candida spp. divided into, 20 (39.22%) C. albicans and 31 (60.78%) NAC. Of the NAC isolated, 14 were C. tropicalis (45.16%), 10 C. parapsilosis (32.26%), 3 C. glabrata (9.68%), 2 Candida kefyr (6.45%) and 2 Candida lusitaniae (6.45%). Of the 51 Candida spp. isolates, 25 (49.02%) were in the intensive care unit, 11 (21.57%) in the operating room and 15 (29.41%) were in the wards. Conclusion: Candida albicans is the main species related to candidemia in hospitalized patients, but species from the NAC group have shown high prevalence in blood culture isolates, especially in the intensive care unit patients.
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Introducción: La candidemia es considerada el tipo de fungemia más frecuente asociada a pacientes en unidades de cuidados intensivos. Es una afección rápidamente progresiva con elevada mortalidad, la cual presenta dificultad en un diagnóstico precoz y capacidad de resistencia al tratamiento. Objetivos: Caracterizar aspectos epidemiológicos, clínicos y microbiológicos de las especies de Candida aisladas en niños hospitalizados en unidades de cuidados intensivos. Métodos: Se realizó un estudio descriptivo y transversal en 143 aislamientos de especies de Candida obtenidas en hemocultivos de pacientes menores de 18 años, en el laboratorio de Microbiología del Hospital Universitario Ginecobstétrico «Mariana Grajales», en el período de enero de 2009 a diciembre de 2018. Se utilizaron tablas de contingencia (prueba de Ji Cuadrado y V de Cramer); se utilizaron las variables: edad, sexo, factores de riesgo, especies y servicios hospitalarios. Resultados: Los mayores aislamientos de candidemia correspondieron a pacientes del sexo femenino de edades comprendidas entre 29 días y 18 años. Todos fueron sometidos al uso de antimicrobianos y con ventilación mecánica. El mayor número de aislamientos en pacientes de 9 años correspondió a Candida tropicalis, que fue la más aislada en la Unidad de Neonatología y Cuidados Intensivos Pediátricos, no así en Cuidados Intermedios donde predominó Candida sin precisar especie. Por estas razones se puede señalar que existe una relación entre las especies y los servicios hospitalarios. Conclusiones: Predominaron pacientes del sexo femenino mayores de 29 días y hasta 18 años hospitalizados en la Unidad de Cuidados Intensivos Pediátricos; la especie más aislada fue Candida tropicalis.
Introduction: candidemia is considered the most frequent type of fungemia associated with patients hospitalized in intensive care units. It is a rapidly progressive condition with high mortality, difficult to diagnose early and resistant to treatment. Objective: to characterize the epidemiological, clinical and microbiological aspects of Candida species isolated from children hospitalized in intensive care units. Methods: a descriptive and cross-sectional study was carried out on 143 isolates of Candida species corresponding to blood cultures from patients under 18 years of age and obtained in the Microbiology laboratory at "Mariana Grajales" Gynecological and Obstetric University Hospital, from January 2009 to December 2018. Contingency tables were used (Chi- square and Cramer's V tests); age, gender, risk factors, species and hospital services were the used variables. Results: the largest candidemia isolates corresponded to female patients aged between 29 days and 18 years. All were subjected to the use of antimicrobials and mechanical ventilation. The highest number of isolates in 9-year-old patients corresponded to Candida tropicalis, which was the most isolated species in the Neonatology and Pediatric Intensive Care Unit, but not in the Intermediate Care Unit where Candida predominated without specifying the species. For these reasons, it can be pointed out that there is a relationship between species and hospital services. Conclusions: female patients older than 29 days and up to 18 years hospitalized in the Pediatric Intensive Care Unit predominated; the most isolated species was Candida tropicalis.
Sujets)
Candida , Soins de réanimation , Candida tropicalis , CandidémieRésumé
ABSTRACT Candidemia and other forms of invasive candidiasis (C/IC) are serious conditions, especially for immunosuppressed individuals with prolonged hospitalization in intensive care units (ICU). This study analyzed the incremental cost-effectiveness and budgetary impact (BI) of treatment for IC with anidulafungin compared to amphotericin B lipid complex (ABLC) and amphotericin B deoxycholate (ABD) or conventional amphotericin B (CAB), in the Brazilian Unified Health System (SUS). A decision model was conducted with a time horizon of two weeks from the perspective of SUS. The primary effectiveness endpoints were survival and treatment response rate. All patients were followed up until successful therapy or death. BI analysis was performed based on the measured demand method. A five-year time horizon was adopted based on the number of hospitalizations (per 1,000 hospitalizations). For effectiveness measured in the successful response rate (SRR), anidulafungin dominated the ABLC and ABD formulations. In the results of the analysis with the effectiveness measured according to survival, anidulafungin had a better cost-effectiveness ratio (R$988.26/survival) compared to ABD (R$16,359.50/survival). The BI estimate related to the incorporation of anidulafungin suggests savings of approximately 148 million reais in 5 years when comparing it to ABD. The economic evaluation of anidulafungin and its comparators found it to be cost-effective. The consensus of international scientific societies recommends it as a first-line drug for IC, and its incorporation by SUS would be important.
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Candida auris is a deadly fungal pathogen able to cause fatal symptoms in immunocompromised patients. It may be misidentified and difficult to clinically diagnose. The guidelines are to employ Echinocandin and Amphotericin B in the treatment, but the following study elucidates successful treatment of infection by a combination of three classes of antifungal drugs; never reported before. We present a patient with fulminant acute disseminated encephalomyelitis and neutropenia who developed invasive candidiasis despite appropriate antifungal therapy. We successfully treated ongoing candidemia with three antifungal drugs which lead to the resolution of fungemia after 18 days of treatment. Isolation, segregation, waste disposal, and deep cleaning technique were also followed as recommended by the Infectious Diseases Society of America guidelines. First report ofCandidemia in an immunocompromised patient was successfully treated with three classes of antifungal drugs, IV Micafungin, Amphotericin B, and Posaconazole for nearly 18 days.
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Objective: To evaluate the prevalence of Candida species in cancer patients with candidemia around the world, and to identify related risk factors and their antifungal resistance, with an emphasis on non-albicans Candida species (NACs). Methods: The published papers related to the subject were systematically searched in databases of MEDLINE (including PubMed), Web of Science, Scopus, Science Direct, and Google Scholar between the 1 st January 2000 and 21 st April 2021. Results: Among the 4 546 records, 69 studies met the inclusion criteria. The pooled prevalence of NACs in cancer patients with candidemia was 62% (95% CI 58%-67%; I 2 =94.85%, P=0.00). Based on type of cancer, the pooled prevalence of NACs in hematologic and solid cancer patients were 68% (95% CI 65%-70%) and 52% (95% CI 49%-54%), respectively. Among NACs, Candida (C.) parapsilosis was the most frequently isolated organism followed by C. tropicalis and C. glabrata. In addition, the therapeutic usage of antibiotics was found as the most common risk factor, accounting for 85% (95% CI 81%-89%) and central venous catheter accounting for 69% (95% CI 62%-77%). Conclusions: The incidence of Candida bloodstream infections among cancer patients is a growing concern, especially when the etiologic agents of candidemia tend to shift towards NACs.
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Abstract Background Patients with severe Coronavirus Disease 2019 (COVID-19) are treated with corticosteroids. Aim We aimed to evaluate the role of corticosteroid treatment in candidemia development during the COVID-19 pandemic. Methods This retrospective study was conducted in a Greek ICU, from 2010 to August 2021, encompassing a pre-pandemic and a pandemic period (pandemic period: April 2020 to August 2021). All adult patients with candidemia were included. Results During the study period, 3,572 patients were admitted to the ICU, 339 patients during the pandemic period, of whom 196 were SARS-CoV-2-positive. In total, 281 candidemia episodes were observed in 239 patients, 114 in the pandemic period. The majority of candidemias in both periods were catheter-related (161; 50.4%). The incidence of candidemia in the pre-pandemic period was 5.2 episodes per 100 admissions, while in the pandemic period was 33.6 (p < 0.001). In the pandemic period, the incidence among COVID-19 patients was 38.8 episodes per 100 admissions, while in patients without COVID-19 incidence was 26.6 (p= 0.019). Corticosteroid administration in both periods was not associated with increased candidemia incidence. Conclusions A significant increase of candidemia incidence was observed during the pandemic period in patients with and without COVID-19. This increase cannot be solely attributed to immunosuppression (corticosteroids, tocilizumab) of severe COVID-19 patients, but also to increased workload of medical and nursing staff.
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SUMMARY OBJECTIVE: Parenteral nutrition is an important risk factor for candidemia. In this risk analysis study, the effect of previous antibiotic administration apart from the length of hospital stay, duration of Parenteral nutrition treatment, and Candida score parameters on developing candidemia was evaluated in the non-neutropenic patients receiving Parenteral nutrition treatment. METHODS: In this double center, retrospective, and cross-sectional study, the data of patients who received Parenteral nutrition treatment were collected. Patients with or without candidemia after the initiation of Parenteral nutrition treatment were compared in terms of demographic features, Candida score, length of hospital stay, duration of Parenteral nutrition treatment, and previous use of antibiotics. Then, predictor factors affecting the probability of candidemia during Candida growth time were determined by the Cox regression analysis. RESULTS: A total of 148 patients (59.5% males) were included and 16 (10.81%) of these had candidemia after initiation of parenteral nutrition treatment. The median (min-max) duration of parenteral nutrition treatment was 11 (4-72) days and the Candida growth time was 13 (7-29) days. Statistically significant differences were found between patients with or without candidemia groups in terms of length of hospital stay (p<0.001), duration of parenteral nutrition treatment (p<0.001), and Candida score (p<0.001). To determine the effect of these variables and antibiotics on candidemia, length of hospital stay [Hazard Ratio 1.030; p=0.021] and piperacillin-tazobactam (Hazard Ratio 5.626; p=0.030) were found significant and independent risk factors on the development of candidemia. CONCLUSION: There are some well-known risk factors including length of hospital stay, duration of Parenteral nutrition treatment, and Candida score; the potential impact of piperacillin-tazobactam administration should also be considered since they may be effective on the development of candidemia.
Sujets)
Humains , Mâle , Femelle , Candidémie/traitement médicamenteux , Études transversales , Études rétrospectives , Facteurs de risque , Nutrition parentérale/effets indésirables , Antibactériens , AntifongiquesRésumé
En diciembre de 2019 se identificó en Wuhan, China, un nuevo coronavirus denominado SARS-CoV-2, agente causal de la epidemia de neumonía atípica COVID-2019, que el 11 de marzo de 2020 fue declarada pandemia por la OMS.Hasta el 30 de septiembre de 2020, en Argentina fueron confirmados 751.001 casos y más de 16.937 muertes.La frecuencia y el impacto de las coinfecciones que afectan a los pacientes infectados por SARS-Cov-2 se ha estudiado junto con el avance de la pandemia. Entre las debidas a hongos se encuentran las fungemias por Candida sp, la aspergilosis invasora, las micosis sistémicas endémicas y la neumocistosis. Presentamos las distintas coinfecciones micosis-COVID-19 que fueron asistidas en nuestra institución entre abril y septiembre de 2020, y se realiza un análisis de las características de estas infecciones en pacientes con y sin sida. En este período se internaron 2837 pacientes, 2287 tuvieron diagnóstico confirmado de COVID-19. La coinfección de COVID-19 con micosis pulmonares o sistémicas fue menor al 1%.Dieciocho pacientes presentaron infecciones fúngicas pulmonares o sistémicas. Ocho padecieron candidemias, cinco criptococosis meningeas, dos histoplasmosis, dos aspergilosis invasoras agudas probables y una aspergilosis pulmonar crónica. La estadía prolongada en terapia intensiva facilitó las fungemias por Candida sp, los casos de histoplasmosis y criptococosis parecen relacionarse con la enfermedad avanzada por VIH y no con COVID-19. Los enfermos con un componente inflamatorio basal alto con neumonía grave por coronavirus se relacionan más con micosis invasoras que los enfermos VIH positivos con niveles bajos de LTCD4+
On December 2019 a new coronavirus (SARS-CoV2) result in atypical pneumonía epidemic, it was identified in Wuhan China and it was called COVID-19. Then on March 11 was declared pandemic by the WHO.Until September 30, 2020 in Argentina 751,001 cases and more than 16,937 deaths have been confirmed. The frequency and impact of co-infections affecting SARS-Cov2 infected patients has been studied with the advance of the pandemic. Among those due to fungi are Candida sp fungemias, invasive aspergillosis, endemic systemic mycoses, and pneumocystosis.We present the different mycosis-COVID-19 co-infections that were assisted in F. J. Muñiz Hospital between April and September of this year and review the characteristics of these infections in patients with and without AIDS is carried out.In this period, 2,837 patients were admitted in the Muñiz hospital, 2,287 had a confirmed diagnosis of COVID-19.Co-infection of COVID-19 with pulmonary or systemic mycoses was less than 1%.Eighteen patients had pulmonary or systemic fungal infections. Eight suffered from candidemia, five meningeal cryptococcosis, two histoplasmosis, two probable acute invasive aspergillosis, and one chronic pulmonary aspergillosis.Prolonged stay in intensive care facilitated fungemia due to Candida sp. Histoplasmosis and cryptococcosis cases seem to be related to advanced HIV disease and not to COVID-19.Patients with a high baseline inflammatory component with severe coronavirus pneumonia are more associated with invasive mycoses than HIV-positive patients with low levels of LTCD4 +
Sujets)
Humains , Épidémiologie Descriptive , Études rétrospectives , Aspergillose pulmonaire invasive/microbiologie , Candidémie/microbiologie , Co-infection , Mycoses pulmonaires/microbiologieRésumé
Candida auris es un hongo emergente, con gran relevancia en corto tiempo, como problema de salud pública mundial. Se reporta por primera vez en el Perú la presencia de Candida auris en 3 pacientes adultos internados en un hospital nacional de alta complejidad en el último trimestre del año 2020, durante la pandemia COVID-19. Los pacientes fueron hospitalizados en UCI; sin embargo, solo en 2 pacientes se aisló dicho germen durante su internamiento en UCI. Los pacientes tuvieron varias comorbilidades y tiempos prolongados de hospitalización desde su admisión hasta tener el primer cultivo positivo a C. auris. Todos los pacientes adquirieron una infección nosocomial bacteriana en algún momento de su hospitalización y recibieron antibióticos de amplio espectro. Todas las cepas aisladas fueron resistentes a fluconazol. El equipo de control de infecciones del hospital reforzó las medidas de contención y el Ministerio de Salud del Perú emitió una alerta epidemiológica.
Candida auris is an emerging fungus that has gained great relevance as a global public health problem in a short time. The presence of Candida auris in 3 adult patients admitted to a national hospital of high complexity in the last quarter of 2020 in the midst of the COVID-19 pandemic is reported for the first time in Peru. The patients were hospitalized in the ICU, however, this germ was isolated in only 2 patients while they were hospitalized in the ICU. The patients had various comorbidities and long hospitalization times from admission to having their first culture positive for C. auris. All patients acquired a bacterial nosocomial infection at some point during their hospitalization and received broad-spectrum antibiotics. All isolates were resistant to fluconazole. The hospital's infection control team reinforced containment measures and the Ministry of Health of Peru issued an epidemiological alert.
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ABSTRACT Objectives: Candida spp. has been reported as one of the common agents of nosocomial bloodstream infections and is associated with a high mortality. Therefore, this study evaluated the clinical findings, local epidemiology, and microbiological aspects of candidemia in eight tertiary medical centers in the state of Parana, South of Brazil. Methods: In this study, we reported 100 episodes of candidemia in patients admitted to eight different hospitals in five cities of the state of Parana, Brazil, using data collected locally (2016 and 2017) and tabulated online. Results: The incidence was found to be 2.7 / 1000 patients / day and 1.2 / 1000 admissions. C. albicans was responsible for 49% of all candidemia episodes. Cancer and surgery were the two most common underlying conditions associated with candidemia. The mortality rate within 30 days was 48%, and removal of the central venous catheter (p = 0.029) as well as empirical or prophylactic exposure to antifungals were both related to improved survival (p = 0.033). Conclusions: This study highlights the high burden and mortality rates of candidemia in hospitals from Parana as well as the need to enhance antifungal stewardship program in the enrolled medical centers.
Sujets)
Humains , Infection croisée/traitement médicamenteux , Infection croisée/épidémiologie , Incidence , Candidémie/traitement médicamenteux , Candidémie/épidémiologie , Brésil/épidémiologie , Candida , Antifongiques/usage thérapeutiqueRésumé
This study aimed to evaluate the frequency of cryptic Candida species from candidemia cases in 22 public hospitals in São Paulo State, Brazil, and their antifungal susceptibility profiles. During 2017 and 2018, 144 isolates were molecularly identified as 14 species; C. parapsilosis (32.6%), C. albicans (27.7%), C. tropicalis (14.6%), C. glabrata (9.7%), C. krusei (2.8%), C. orthopsilosis (2.8%), C. haemulonii var. vulnera (2.1%), C. haemulonii (1.4%), C. metapsilosis (1.4%), C. dubliniensis (1.4%), C. guilliermondii (1.4%), C. duobushaemulonii (0.7%), C. kefyr (0.7%), and C. pelliculosa (0.7%). Poor susceptibility to fluconazole was identified in 6.4% of C. parapsilosis isolates (0.12 to >64 µg/mL), 50% of C. guilliermondii (64 µg/mL), 66.6% of C. haemulonii var. vulnera (16-32 µg/mL), and C. duobushaemulonii strain (MIC 64 µg/mL). Our results corroborated the emergence of C. glabrata in Brazilian cases of candidemia as previously reported. Importantly, we observed a large proportion of non-wild type C. glabrata isolates to voriconazole (28.6%; <0.015 to 4 µg/mL) all of which were also resistant to fluconazole (28.6%). Of note, C. haemulonii, a multidrug resistant species, has emerged in the Southeast region of Brazil. Our findings suggested a possible epidemiologic change in the region with an increase in fluconazole-resistant species causing candidemia. We stress the relevance of routine accurate identification to properly manage therapy and monitor epidemiologic trends.
Sujets)
Candida , Antifongiques/pharmacologie , Brésil , Tests de sensibilité microbienne , Résistance des champignons aux médicaments , HôpitauxRésumé
Introducción: las infecciones por cándida en el ámbito intrahospitalario han ido en ascenso en las últimas décadas en especial en las unidades de cuidado intensivo (UCI), dado el uso cada vez más frecuente de antibióticos de amplio espectro y de procedimientos invasivos tanto diagnósticos como terapéuticos. Hoy se consideran las especies de cándida como la cuarta causa de infección del torrente sanguíneo en los Estados Unidos de Norteamérica, con alto riesgo de complicaciones que incluyen endocarditis, trombosis y embolismo séptico al sistema nervioso central (SNC) entre otros. En relación con la endocarditis por especies de cándida, se ha considerado de mal pronóstico por el alto riesgo de afectación al SNC, por lo que se ha recomendado el manejo quirúrgico como piedra angular de su tratamiento. Presentación del caso: se describe el caso clínico de un paciente con endocarditis y con candidemia por Candida parapsilosis a quien se le realizó manejo médico.
Nosocomial Candida infections have increased in the last decades particularly in the intensive care units (ICU) due to the rise in broad-spectrum antibiotics usage and invasive diagnostic and therapeutic procedures usage. Today, Candida species are recognized as the fourth causative organisms of endovascular infection in the United States of America posing a high risk of endocarditis, thrombosis and septic embolization to the central nervous system (CNS). Endocarditis due to Candida species is associated with a poor prognosis because of the increased risk of CNS involvement for which surgical approach has been recommended as the cornerstone of therapy. We hereby report a patient with endocarditis and candidemia due to Candida parapsilosis, who received medical management.
Sujets)
Humains , Mâle , Sujet âgé , Endocardite/microbiologie , Candidémie/complications , Candida parapsilosis/isolement et purification , Valvulopathies/microbiologie , Endocardite/thérapie , Candidémie/thérapie , Valvulopathies/thérapieRésumé
Introducción: Candida spp. Es la principal causa de fungemia, cuya incidencia ha aumentado en los últimos años. Existen datos locales insuficientes sobre este tipo de infecciones. Materiales y métodos: Este fue un estudio observacional retrospectivo de 44 pacientes diagnosticados con candidiasis invasiva hospitalizados en la Fundación Valle del Lili, el cual es un centro de cuarto nivel afiliado a la Universidad Icesi en el Suroccidente Colombiano, entre los años 2012 a 2017. Resultados: Se identificaron 44 pacientes con candidiasis invasiva, 27 de ellos mujeres (61%). La mediana de edad fue de 56 años (36 - 70). Más del 50% tenían una enfermedad crónica subyacente, uso de antibióticos (84%), catéter venoso central (80%), ventilación mecánica (68%) y nutrición enteral (66%) El 80% requirió manejo en unidad de cuidados intensivos (UCI) donde debutaron con sepsis (68%) y falla respiratoria (61%). En el 90% de los casos se aisló alguna especie de Candida spp. A partir de hemocultivo y sólo al 22% se le realizó prueba de sensibilidad. El tratamiento de elección fue con fluconazol (80%), asociado a caspofungina (70%). La tasa de mortalidad fue del 49%, con una mediana de 33 (22-49,5) días desde el ingreso hasta el fallecimiento. C. albicans fue el principal microorganismo aislado. La resistencia a azoles en especies no albicans existe en nuestro medio. Conclusión: La candidiasis se presenta como candidemia asociada a infección bacteriana concomitante, que cobra mayor importancia en el contexto del paciente inmunosuprimido asociado a elevadas tasas de mortalidad.
Introduction: Candida spp. is the main cause of fungemia, whose incidence has increased in recent years. There are insufficient local data about this pathology. Materials and methods: This was an observational, retrospective chart review of 44 patients diagnosed with invasive candida who were hospitalized at Fundación Valle del Lili, which is a fourth level center affiliated to Icesi university between 2012 and 2017. Results: We identified 44 patients with invasive candidiasis, 27 of them women (61%). The median age was 56 years (36 - 70). More than 50% had an underlying chronic disease, use of antibiotics (84%), central venous catheter (80%), mechanical ventilation (68%) and enteral nutrition (66%). 80% required management in an intensive care unit. Sepsis (68%) and respiratory failure (61%) were the most common clinical presentation. Almost 90% of the cases, had positive blood cultures, but only 22% presented susceptibility tests. The treatment was mainly fluconazole (80%), associated with caspofungin (70%). The mortality rate was 49%, median of 33 (22-49.5) days from admission to death. Candida albicans was the main isolated organism. Azole resistance in non-albicans species was observed. Conclusion: Candidiasis presents as bacterial infection associated candidemia, which becomes more important in the context of the immunosuppressed patient with high mortality rates.
Sujets)
Humains , Mâle , Femelle , Adulte , Adulte d'âge moyen , Sujet âgé , Infections bactériennes , Sujet immunodéprimé , Fongémie , Candidose invasive , Candida , Candida albicans , Fluconazole , Colombie , Sepsie , Caspofungine , Infections , Unités de soins intensifs , AntibactériensRésumé
Una de las principales consecuencias del desarrollo de biopelículas es la resistencia a los antifúngicos. Se determinó la formación de biopelículas por Candida parapsilosis sensu stricto aisladas de sangre y su perfil de susceptibilidad. Se evaluaron 30 cepas de C. parapsilosis sensu stricto de la Red de Candidemias del Dpto. de Micología del Instituto Nacional de Higiene Rafael Rangel-Venezuela, por el método cuantitativo en microplaca con tinción de cristal violeta y el método cualitativo en agar Sabouraud dextrosa suplementado con rojo Congo. Se utilizó el método de microdilución según el documento M-27 del Clinical and Laboratory Standards Institute. La formación de biopelículas de C. parapsilosis sensu stricto por el método cuantitativo fue de 63% y por el método cualitativo de 50%. El método cualitativo presentó valores de sensibilidad, especificidad, valores predictivos positivo y negativo de 61,1%, 23%, 78,6%, 43,8% respectivamente frente al método cuantitativo. Los aislados en forma planctónica fueron 100% sensibles a anfotericina B y caspofungina, con susceptibilidad variable a los azoles. El método cuantitativo es una técnica confiable para determinar la formación de biopelículas. El método cualitativo puede usarse como método pantalla inicial. No se encontró relación entre la susceptibilidad de las formas planctónicas y la capacidad de producción de biopelículas
One of the main consequences of biofilm development is resistance to antifungals. Biofilmforming by Candida parapsilosis sensu stricto isolated from blood and its susceptibility profile was determined. Thirty strains of C. parapsilosis sensu stricto belonging to the Candidemia Network of the Mycology Department of the Instituto Nacional de Higiene Rafael Rangel-Venezuela, were evaluated by microplate quantitative method with violet crystal staining, and Sabouraud dextrose agar supplemented with Congo red qualitative method. The microdilution method was used to determine the susceptibility, according to the Clinical and Laboratory Standards Institute M-27 document. Biofilm formation of C. parapsilosis sensu stricto by both quantitative and qualitative method was 63% and 50%, respectively. Sensitivity, specificity, and positive and negative predictive values of the qualitative method were 61.1%, 23%, 78.6%, and 43.8% respectively, when compared with quantitative method. Planktonic isolates were 100% sensitive to amphotericin B and caspofungin, with variable susceptibility to azoles. Quantitative method is a reliable assay to determine biofilm formation, while qualitative method can be used as an initial screening assay. No relationship was found between susceptibility of planktonic isolates and the ability to biofilm-forming
Résumé
RESUMEN Con el objetivo de conocer las características de las fungemias en 285 pacientes oncológicos hospitalizados del 2012 al 2016 en el Instituto Nacional de Enfermedades Neoplásicas se realizó un estudio descriptivo retrospectivo. Se evaluó información demográfica, clínica y microbiológica. Las fungemias por C. albicans predominaron en pacientes con tumores sólidos y sin neutropenia, mientras las causadas por C. tropicalis predominaron en pacientes con neoplasias hematológicas y neutropenia. C. tropicalis fue el agente más aislado (47,0%). Las fungemias aumentaron con el tiempo en los pacientes sin neutropenia. Las fungemias causadas por C. albicans aumentan con la edad en pacientes con tumores sólidos sin neutropenia. Se concluye que las fungemias son mayormente causadas por C. tropicalis en pacientes con neoplasias hematológicas con neutropenia y por C. albicans en pacientes con tumores sólidos sin neutropenia. Además, las fungemias en pacientes sin neutropenia aumentan en el tiempo y las causadas por C. albicans, en tumores sólidos sin neutropenia, aumentan con la edad.
ABSTRACT Retrospective descriptive study carried out to determine the characteristics of fungemia in 285 cancer patients hospitalized from 2012 to 2016 at the Instituto Nacional de Enfermedades Neoplásicas (INEN). Demographic, clinical and microbiological information was evaluated. Fungemia by C. albicans predominated in patients with solid tumors and without neutropenia, while those caused by C. tropicalis predominated in patients with hematological neoplasia and neutropenia. C. tropicalis was the agent isolated in most cases (47.0%). Fungemia increased over time in patients without neutropenia. Fungemia caused by C. albicans increases with age in patients with solid tumors without neutropenia. It is concluded that fungemia are mainly caused by C. tropicalis in patients with hematological neoplasia with neutropenia and by C. albicans in patients with solid tumors without neutropenia. In addition, fungemia in patients without neutropenia increases over time; and those caused by C. albicans increase with age in patients with solid tumors without neutropenia.
Sujets)
Humains , Établissements de cancérologie , Candidose , Fongémie , Patients , Pérou/épidémiologie , Orientation vers un spécialiste , Candida albicans/isolement et purification , Candidose/complications , Candidose/microbiologie , Candidose/épidémiologie , Études rétrospectives , Fongémie/complications , Fongémie/microbiologie , Fongémie/épidémiologie , Candida tropicalis/isolement et purification , Tumeurs , Tumeurs/complications , Tumeurs/thérapieRésumé
Resumen Introducción: La candidemia es una micosis sistémica asociada a los cuidados de la salud de elevada morbimortalidad. Los adultos mayores presentan las tasas más altas y la información en esta población es escasa. Objetivos: Describir las características de las candidemias en los adultos mayores, identificar factores asociados a mortalidad y evaluar la utilidad de un score predictor. Métodos: Estudio retrospectivo de las candidemias en adultos mayores en un hospital de la ciudad de Buenos Aires. Se analizaron todos los episodios en pacientes mayores de 60 años en un período de ocho años. Resultados: Se incluyeron 59 episodios. La co-morbilidad más frecuente fue diabetes mellitus. El principal sitio de origen fue infección asociada a catéter (45%). Sólo 17% presentó un Candida score mayor a 2,5. La mortalidad global a las 48 h fue 20% y a 15 días 49%. Las variables asociadas a mortalidad fueron: shock, asistencia respiratoria mecánica (ARM), plaquetopenia, insuficiencia renal y leucocitosis (rango p < 0,0001-0,006). En el análisis multivariado el shock fue la única variable independiente asociada a mortalidad (HR 4,02 [IC 95% 1,18-13,72], p = 0,026). Conclusiones: La mitad de los adultos mayores con candidemia falleció en los primeros 15 días. Shock, ARM, plaquetopenia, insuficiencia renal y leucocitosis fueron factores asociados a mortalidad. El score predictor de uso habitual no fue útil en esta población.
Abstract Background: Candidemia is a nosocomial bloodstream infection and an important cause of comorbidity and mortality. Elderly patients present the highest rates of candidemia but data about this population is scarce. Aims: To describe characteristics of candidemia in elderly patients, to identify risk factors associated with mortality and to evaluate the usefulness of a predictive score. Methods: A retrospective observational study of candidemia in elderly patients from a tertiary care hospital was carried out. We analyzed all Candida bloodstream infections during an eight-year period in patients older than 60 years. Results: Fifty-nine episodes were included. Diabetes was the most frequent comorbidity. Most candidemia were catheter related infections (45%). Only 17% of patients had a Candida score > 2.5. Overall mortality at 48 hours was 20%, and at 15 days was 49%. Mortality-related factors were shock, assisted mechanical ventilation, thrombocytopenia, renal failure and leukocytosis (p range < 0.0001-0.006). On multivariate analysis septic shock was independently associated with mortality (HR 4.02 [CI 95% 1.18-13.72] p = 0.026). Conclusions: Nearly half of patients with candidemia died during the first fifteen days. Shock, assisted mechanical ventilation, thrombocytopenia, renal failure, and leukocytosis were factors associated with mortality. The predictive score was not useful in this population.
Sujets)
Humains , Adulte d'âge moyen , Sujet âgé , Infection croisée , Candidémie , Candida , Études rétrospectives , Facteurs de risque , AntifongiquesRésumé
En Colombia, especialmente en las unidades de cuidados intensivos, la candidemia es una causa frecuente de infección del torrente sanguíneo y representa el 88 % de las infecciones fúngicas en pacientes hospitalizados, con una mortalidad entre 36 y 78 %. Su incidencia en Colombia es mayor a la reportada en los países desarrollados e, incluso, en otros países de Latinoamérica. Para su manejo deben considerarse los factores de riesgo del paciente, luego valorar las características clínicas y, finalmente, hacer los estudios microbiológicos y, si es necesario, pruebas moleculares. En general, las guías estadounidenses, latinoamericanas y europeas recomiendan las equinocandinas como el tratamiento de primera línea de la candidemia y difieren en el uso de fluconazol dependiendo de la 'evidencia', la gravedad de la enfermedad, la exposición previa a los azoles y la prevalencia de Candida no albicans. Dada su gran incidencia en nuestro país, asociada con una elevada mortalidad, esta infección debe buscarse sistemáticamente en pacientes con factores de riesgo, con el fin de iniciar oportunamente el tratamiento antifúngico.
In Colombia, especially in intensive care units, candidemia is a frequent cause of infection, accounting for 88% of fungal infections in hospitalized patients, with mortality ranging from 36% to 78%. Its incidence in Colombia is higher than that reported in developed countries and even higher than in other Latin American countries. First, the patient's risk factors should be considered, and then clinical characteristics should be assessed. Finally, microbiological studies are recommended and if the evidence supports its use, molecular testing. In general, American, Latin American, and European guides place the echinocandins as the first-line treatment for candidemia and differ in the use of fluconazole based on evidence, disease severity, previous exposure to azoles, and prevalence of Candida non-albicans. Taking into account the high incidence of this disease in our setting, it should be looked for in patients with risk factors to start a prompt empirical anti-fungal treatment.
Sujets)
Candidémie , Candidose , Colombie , Candidose invasive , Infections fongiques invasives , Unités de soins intensifs , MycosesRésumé
Introduction: Central venous catheter related bloodstreaminfections is a fatal complication of central venous catheteruse and is associated with patient morbidity, mortality, andexcess hospital costs. Study aimed to determine frequency ofcatheter related blood stream infections in patients admitted inCardiac Surgery Intensive Care Unit.Material and methods: This study was conducted atMicrobiology laboratory of Punjab Institute of Cardiology,Lahore. A total number of 134 central venous catheter tipcultures along with percutaneously drawn blood culturesfrom patients suspected of having catheter related bloodstream infection were collected. Blood cultures as well ascentral venous catheter tip cultures were processed to isolatemicroorganisms. Organisms were identified on the basis ofcolonial morphology, Gram staining and biochemical tests.Results: Out of 134 central venous catheter tip cultures,59.7% showed significant microbial growth. Most frequentcolonizers were Coagulase negative Staphylococci (31.1%),S. aureus (26.7%), Candida species (22.2%), Klebsiellaspecies (13.3%) and Acinetobactor species (4.4%). Out of 134blood cultures, microbial growth was obtained from 11.9%.Microbes responsible for causing central line associated bloodstream infection were Candida species (37.5%), S.aureus(25%), Klebsiella (25%) and Acinetobactor species (12.5%).Frequency of catheter related blood stream infection orfrequency of catheter related candidemia was found to be4.5%.Conclusion: Candida species emerged as important cause ofcatheter related blood stream infection in patients admitted incardiology intensive care units. Therefore in high risk patientscatheter related candidemia and administration of antifungaldrugs must also be considered.