Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 549
Filtrar
1.
J Assoc Physicians India ; 69(8): 11-12, 2021 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-34472809

RESUMO

INTRODUCTION: Candidemia is the fourth common cause of blood stream infection worldwide leading to increased mortality and morbidity. A paradigm shift of Candida albicans to Non-albicans candida (NAC) had led to the increase in resistance to empirically used antifungals. So, an epidemiological study and antifungal susceptibility is essential for meticulous use of antifungals. AIMS AND OBJECTIVES: To find out the prevalence and antifungal susceptibility of Candida species causing candidemia. METHODS: automated blood culture done in BACTEC system followed by its identification and susceptibility testing in VITEK-2 system. RESULTS: Non-albicans candida was isolated from 73% cases of candidemia. The commonest isolate among neonates and adults were C.krusei and C.tropicalis respectively. C.haemulonii was significantly high among adult population while C.krusei was significantly high among the neonates. 10.4% NAC isolates were resistant to amphotericin B, flucytosine resistance among 37% NAC isolates and among 44% C.albicans isolates, fluconazole resistance was found among 13% and 15% of NAC and C. albicans respectively. Echinocandins were comparatively sensitive to the candida spp.


Assuntos
Candida , Candidemia , Adulto , Antifúngicos/farmacologia , Antifúngicos/uso terapêutico , Candidemia/tratamento farmacológico , Candidemia/epidemiologia , Fluconazol/farmacologia , Humanos , Índia/epidemiologia , Recém-Nascido , Testes de Sensibilidade Microbiana
2.
Front Public Health ; 9: 631865, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34458217

RESUMO

Catheter-related bloodstream infection (CRBSI) is an important healthcare-associated infection caused by various nosocomial pathogens. Candida parapsilosis has emerged as a crucial causative agent for the CRBSI in the last two decades. Many factors have been associated with the development of CRBSI including, demography, pre-maturity, comorbidities (diabetes mellitus, hypertension, heart diseases, neuropathy, respiratory diseases, renal dysfunction, hematological and solid organ malignancies, and intestinal dysfunction), intensive care unit (ICU) admission, mechanical ventilation (MV), total parenteral nutrition (TPN), prior antibiotic and/or antifungal therapy, neutropenia, prior surgery, immunosuppressant, and type, site, number, and duration of catheters. This study aims to determine C. parapsilosis CRBSI risk factors. A retrospective study has been performed in an 853-bedded tertiary-care hospital in north-eastern Malaysia. All inpatients with C. parapsilosis positive blood cultures from January 2006 to December 2018 were included, and their medical records were reviewed using a standardized checklist. Out of 208 candidemia episodes, 177 had at least one catheter during admission, and 31 cases had not been catheterized and were excluded. Among the 177 cases, 30 CRBSI cases were compared to 147 non-CRBSI cases [81 bloodstream infections (BSIs), 66 catheter colonizers]. The significance of different risk factors was calculated using multivariate analysis. Multivariate analysis of potential risk factors shows that ICU admission was significantly associated with non-CRBSI as compared to CRBSI [OR, 0.242; 95% CI (0.080-0.734); p = 0.012], and TPN was significantly positively associated with CRBSI than non-CRBSI [OR, 3.079; 95%CI (1.125-8.429); p = 0.029], while other risk factors were not associated significantly. Patients admitted in ICU were less likely to develop C. parapsilosis CRBSI while patients receiving TPN were more likely to have C. parapsilosis CRBSI when compared to the non-CRBSI group.


Assuntos
Candida parapsilosis , Candidemia , Candidemia/epidemiologia , Cateteres , Humanos , Estudos Retrospectivos , Fatores de Risco
3.
Front Cell Infect Microbiol ; 11: 676177, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33968809

RESUMO

As the second leading etiological agent of candidemia in Turkey and the cause of severe fluconazole-non-susceptible (FNS) clonal outbreaks, Candida parapsilosis emerged as a major health threat at Ege University Hospital (EUH). Evaluation of microbiological and pertinent clinical profiles of candidemia patients due to C. parapsilosis in EUH in 2019-2020. Candida parapsilosis isolates were collected from blood samples and identified by sequencing internal transcribed spacer ribosomal DNA. Antifungal susceptibility testing was performed in accordance with CLSI M60 protocol and ERG11 and HS1/HS2-FKS1 were sequenced to explore the fluconazole and echinocandin resistance, respectively. Isolates were typed using a multilocus microsatellite typing assay. Relevant clinical data were obtained for patients recruited in the current study. FNS C. parapsilosis isolates were recovered from 53% of the patients admitted to EUH in 2019-2020. Y132F was the most frequent mutation in Erg11. All patients infected with C. parapsilosis isolates carrying Y132F, who received fluconazole showed therapeutic failure and significantly had a higher mortality than those infected with other FNS and susceptible isolates (50% vs. 16.1%). All isolates carrying Y132F grouped into one major cluster and mainly recovered from patients admitted to chest diseases and pediatric surgery wards. The unprecedented increase in the number of Y132F C. parapsilosis, which corresponded with increased rates of fluconazole therapeutic failure and mortality, is worrisome and highlights the urgency for strict infection control strategies, antifungal stewardship, and environmental screening in EUH.


Assuntos
Candida parapsilosis , Candidemia , Antifúngicos/farmacologia , Antifúngicos/uso terapêutico , Candida parapsilosis/genética , Candidemia/tratamento farmacológico , Candidemia/epidemiologia , Criança , Surtos de Doenças , Farmacorresistência Fúngica , Fluconazol/farmacologia , Humanos , Testes de Sensibilidade Microbiana , Turquia/epidemiologia
4.
Mycoses ; 64(7): 753-762, 2021 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-33786895

RESUMO

BACKGROUND: Candida bloodstream infections (BSI) became an important invasive disease in the late 20th century, in particular among immunocompromised patients. Although considerable progress has been made in the management of patients with invasive mycoses, Candida BSI are still widespread among hospitalised patients and are associated with relatively high mortality. OBJECTIVES: We conducted a retrospective study to evaluate patient characteristics, incidence, species distribution and antifungal susceptibility of BSI isolates of Candida spp. as well as outcomes of Candida BSI from 2001 to 2012, before the widespread use of echinocandins. This is the first epidemiological study of Candida BSI in Slovenia so far. METHODS: All documented candidaemia cases from 2001 to 2012 in two major hospitals-University Medical Centre and Institute of Oncology in Ljubljana, Slovenia-were taken into consideration. Candida BSI were identified in 422 patients (250 male, 172 female). Laboratory and clinical data of these patients were retrospectively analysed. Mann-Whitney U test was used to compare continuous variables and Fisher's exact test or chi-squared test for categorical variables. RESULTS AND CONCLUSIONS: The average incidence of Candida BSI was 0.524/10.000 patient-days (0,317/1000 admissions); 16/422 were younger than 1 year and 251/422 patients were over 60 years old. The most commonly isolated species were Candida albicans and Candida glabrata, followed by Candida parapsilosis. Majority of the patients had a single episode of Candida BSI, multiple episodes of Candida BSI occurred in 18/434 patients (4.1%); in 25/434 patients (5.8%) mixed Candida BSI were observed. Crude 30-day case-fatality rate was 55.4%.


Assuntos
Candidíase/epidemiologia , Adolescente , Adulto , Antifúngicos/uso terapêutico , Candida/isolamento & purificação , Candida albicans/isolamento & purificação , Candida glabrata/isolamento & purificação , Candidemia/tratamento farmacológico , Candidemia/epidemiologia , Candidemia/microbiologia , Candidíase/sangue , Candidíase/tratamento farmacológico , Candidíase/microbiologia , Criança , Pré-Escolar , Farmacorresistência Fúngica , Feminino , Humanos , Incidência , Lactente , Infecções Fúngicas Invasivas/tratamento farmacológico , Infecções Fúngicas Invasivas/epidemiologia , Infecções Fúngicas Invasivas/microbiologia , Masculino , Testes de Sensibilidade Microbiana , Pessoa de Meia-Idade , Mortalidade , Estudos Retrospectivos , Fatores de Risco , Eslovênia/epidemiologia , Adulto Jovem
5.
Artigo em Inglês | MEDLINE | ID: mdl-33787740

RESUMO

We analyzed the clinical features and risk factors of candidemia due to C. parapsilosis (n=104) in the intensive care unit of a tertiary hospital over six years. This was a monocentric, retrospective study of candidemia, conducted from January 2013 to March 2019. Epidemiological characteristics, clinical features, invasive procedures, laboratory data and outcomes of 267 patients with candidemia were analyzed to determine risk factors of candidemia due to C. parapsilosis. Sixty-three cases of C. albicans and 204 cases of non-C. albicans Candida (NCAC) species were included, the latter was composed of 104 cases of C. parapsilosis and 100 cases of non-C. albicans species (46 cases of C. tropicalis, 22 cases of C. glabrata, 23 cases of C. guilliermondii, 5 cases of C. krusei and 4 cases of C. lusitaniae), suggesting that C. parapsilosis was the predominant Candida species isolated from cases of candidemia. A binary multivariate logistic regression analysis showed that APACHE II scores, central venous catheterization and the use of broad-spectrum antibiotics were closely related to C. parapsilosis candidemia, with OR values of 1.159, 3.913 and 2.217, respectively. In conclusion, we found that C. parapsilosis was the main pathogen among the NCAC candidemia in the ICU patients. APACHE II scores, central venous catheterization and the use of broad-spectrum antibiotics were independent risk factors for the occurrence of C. parapsilosis candidemia, which may provide data to support the early introduction of anti-fungal therapy.


Assuntos
Candida parapsilosis/isolamento & purificação , Candidemia/epidemiologia , Unidades de Terapia Intensiva/estatística & dados numéricos , Adulto , Idoso , Idoso de 80 Anos ou mais , Antifúngicos/uso terapêutico , Candidemia/diagnóstico , Candidemia/tratamento farmacológico , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Fatores de Risco , Resultado do Tratamento
6.
Clin Infect Dis ; 73(4): 689-696, 2021 08 16.
Artigo em Inglês | MEDLINE | ID: mdl-33564858

RESUMO

BACKGROUND: Candidemia is one of the most common causes of nosocomial bloodstream infections, but the impacts of factors affecting its incidence have not been evaluated. METHODS: We analyzed a retrospective cohort of all candidemia patients at 130 acute care hospitals in the Veterans Health Administration (VHA) system from January 2000 through December 2017. Cases were classified as hospital-onset (HO) and non-hospital-onset (NHO). We used Joinpoint regression analysis to assess temporal associations between significant changes in candidemia incidence rates and guidelines or horizontal infection control (IC) interventions. RESULTS: Over 18 years, 17 661 candidemia episodes were identified. Incidence rates of HO cases were increasing until the mid-2000s, followed by a sustained decline, while NHO cases showed a steady decline. The first change in HO candidemia incidence rates (August 2004 [95% confidence interval {CI}, February 2003-April 2005]) was preceded by the publication of catheter-related bloodstream infection (CRBSI) prevention guidelines and the CRBSI surveillance initiation. The second (September 2007 [95% CI, September 2006-June 2009]) had close temporal proximity to the expansion of IC resources within the VHA system. Collectively, these trend changes resulted in a 77.1% reduction in HO candidemia incidence rates since its peak in 2004. CONCLUSIONS: A substantial and sustained systemwide reduction in candidemia incidence rates was observed after the publication of guidelines, VHA initiatives about CRBSI reporting and education on CRBSI prevention, and the systemwide expansion of IC resources.


Assuntos
Candidemia , Infecção Hospitalar , Candidemia/epidemiologia , Infecção Hospitalar/epidemiologia , Infecção Hospitalar/prevenção & controle , Humanos , Incidência , Controle de Infecções , Estudos Retrospectivos , Saúde dos Veteranos
8.
Mycoses ; 64(6): 634-640, 2021 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-33608923

RESUMO

The epidemiology and mycology of invasive candidiasis in the ICU is well-described in certain types of critically ill patients but not in others. One population that has been scarcely studied is non-neutropenic patients admitted specifically to medical ICUs. Even less is known about the broader category of medical ICU patients without active oncological disease. This group constitutes a very large share of the patients requiring critical care across the globe, especially in the era of the SARS-CoV-2 pandemic. We analysed medical ICU candidaemia episodes that occurred in non-oncological patients in our tertiary academic centre in the United States from May 2014 to October 2020 to determine the incidence and species distribution of the associated isolates. We then separately considered non-COVID-19 and COVID-19 cases and compared their characteristics. In the non-COVID-19 group, there were 38 cases for an incidence of 1.1% and rate of 11/1000 admissions. In the COVID-19 group, there were 12 cases for an incidence of 5.1% and rate of 51/1000 admissions. In the entire sample, as well as separately in the non-COVID-19 and COVID-19 groups,Candida albicans accounted for a minority of isolates. Compared to non-COVID-19 patients with candidaemia, COVID-19 patients had lower ICU admission SOFA score but longer ICU length of stay and central venous catheter dwell time at candidaemia detection. This study provides valuable insight into the incidence and species distribution of candidaemia cases occurring in non-oncological critically ill patients and identifies informative differences between non-COVID-19 and COVID-19 patients.


Assuntos
COVID-19/epidemiologia , COVID-19/microbiologia , Candidemia/epidemiologia , Candidemia/microbiologia , Candidemia/virologia , Adulto , Idoso , Candida/isolamento & purificação , Cuidados Críticos , Estado Terminal , Feminino , Humanos , Incidência , Unidades de Terapia Intensiva , Masculino , Pessoa de Meia-Idade , SARS-CoV-2/isolamento & purificação , Centros de Atenção Terciária , Estados Unidos/epidemiologia
9.
Eur J Clin Microbiol Infect Dis ; 40(7): 1539-1545, 2021 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-33495941

RESUMO

Fungemia caused by uncommon Candida species (UCS) (other than C.albicans, C.glabrata, C.parapsilosis, C.tropicalis, C.krusei) is a rare but emerging threat with their potential to exhibit reduced susceptibility or resistance to antifungal agents. We identified 25 patients with UCS fungemia (9 C.kefyr, 8 C.lusitaniae, 4 C.dubliniensis, 2 C.guilliermondii, 1 C.pelliculosa, 1 C.rugosa) through January 2011 and August 2018. Echinocandins were the most common administered agents, followed by fluconazole. Overall mortality was 44%. Echinocandins and voriconazole showed sufficient activity against all tested isolates. High fluconazole MICs among C.guilliermondii, C.pelliculosa, and C.rugosa were determined. MIC value of C.pelliculosa was above the epidemiological cut-off proposed for fluconazole.


Assuntos
Candida/classificação , Candidemia/epidemiologia , Candidemia/microbiologia , Infecção Hospitalar/epidemiologia , Infecção Hospitalar/microbiologia , Adulto , Idoso , Feminino , Hospitais Universitários , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Fatores de Risco , Turquia/epidemiologia
10.
BMC Infect Dis ; 21(1): 77, 2021 Jan 15.
Artigo em Inglês | MEDLINE | ID: mdl-33451284

RESUMO

BACKGROUND: Candidemia has emerged as an important nosocomial infection, with a mortality rate of 30-50%. It is the fourth most common nosocomial bloodstream infection (BSI) in the United States and the seventh most common nosocomial BSI in Europe and Japan. The aim of this study was to assess the performance of the Sequential Organ Failure Assessment (SOFA) score for determining the severity and prognosis of candidemia. METHODS: We performed a retrospective study of patients admitted to hospital with candidemia between September 2014 and May 2018. The severity of candidemia was evaluated using the SOFA score and the Acute Physiology, Age, Chronic Health Evaluation II (APACHE II) score. Patients' underlying diseases were assessed by the Charlson Comorbidity Index (CCI). RESULTS: Of 70 patients enrolled, 41 (59%) were males, and 29 (41%) were females. Their median age was 73 years (range: 36-93 years). The most common infection site was catheter-related bloodstream infection (n=36, 51%).The 30-day, and in-hospital mortality rates were 36 and 43%, respectively. Univariate analysis showed that SOFA score ≥5, APACHE II score ≥13, initial antifungal treatment with echinocandin, albumin < 2.3, C-reactive protein > 6, disturbance of consciousness, and CCI ≥3 were related with 30-day mortality. Of these 7, multivariate analysis showed that the combination of SOFA score ≥5 and CCI ≥3 was the best independent prognostic indicator for 30-day and in-hospital mortality. CONCLUSIONS: The combined SOFA score and CCI was a better predictor of the 30-day mortality and in-hospital mortality than the APACHE II score alone.


Assuntos
APACHE , Candidemia/diagnóstico , Candidemia/mortalidade , Infecção Hospitalar/diagnóstico , Infecção Hospitalar/mortalidade , Confiabilidade dos Dados , Escores de Disfunção Orgânica , Adulto , Idoso , Idoso de 80 Anos ou mais , Proteína C-Reativa/análise , Candidemia/epidemiologia , Candidemia/patologia , Comorbidade , Infecção Hospitalar/epidemiologia , Infecção Hospitalar/patologia , Feminino , Mortalidade Hospitalar , Humanos , Japão/epidemiologia , Masculino , Pessoa de Meia-Idade , Prognóstico , Curva ROC , Estudos Retrospectivos
11.
Int J Clin Pract ; 75(1): e13655, 2021 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-32869497

RESUMO

INTRODUCTION: Bloodstream infections caused by Candida species, known as candidemia are on the rise because of increasing complexity of surgical procedures, patient's underlying co-morbidities and shift in patient's demographics. This study was conducted to evaluate the epidemiology, risk factors, co-morbidities, antifungal treatment and outcomes of candidemia in Candida albicans (C. albicans) and Candida non-albicans (C. non-albicans) in East Sussex Healthcare Trust (ESHT), England. MATERIAL AND METHODS: This retrospective and prospective study was performed during January 2006 to June 2017. RESULT: A total of 102 episodes of candidemia on 100 patients (55 males) were identified. C. non-albicans were predominant (55%). All isolates were sensitive to amphotericin B, caspofungin and voriconazole while one C. albicans and five C. non-albicans isolates were resistant to fluconazole. The risk factors in C. albicans and C. non-albicans groups were comparable which included intensive care unit (ICU) stay (15% vs 10%), the presence of intravascular line (35% vs 42%), previous antibiotic exposure (39% vs 49%), surgical intervention (19% vs 19%), mechanical ventilation (5% vs 8%), total parenteral nutrition (30% vs 27%) and urinary catheters (33 vs 38). The comorbidities in both groups (C. albicans and C. non-albicans) were solid organ cancer (15&14), haematology malignancy (1&3), steroid use (14&13), diabetes (9&7) and chemotherapy (2&4). Main sources of candidemia in C. albicans were line (12), respiratory (10) and urinary tracts (6) while line (26) and urinary tract (9) were predominant in C. non-albicans group. Only a small number of patients underwent echocardiography (30%) and ophthalmology reviews (20%). A total of 45 fatal cases were recorded (C. albicans 23). The highest mortality was seen in patients with C. albicans and among them the risk factors were elderly age group > 65 years (17/23), surgical intervention (9/23) and the history of ICU stay (7/23). CONCLUSION: C. albicans candidemia, >65 years of age and surgical procedure is associated with significant mortality, however, the use of fluconazole has shown the increased survival rate. This study suggests the surveillance of candidemia, and antifungal susceptibility pattern in current practice and the treatment.


Assuntos
Candida albicans , Candidemia , Idoso , Antifúngicos/uso terapêutico , Candida , Candidemia/tratamento farmacológico , Candidemia/epidemiologia , Inglaterra , Fluconazol/uso terapêutico , Hospitais Gerais , Humanos , Masculino , Testes de Sensibilidade Microbiana , Estudos Prospectivos , Estudos Retrospectivos , Fatores de Risco , Resultado do Tratamento , Reino Unido/epidemiologia
13.
J Matern Fetal Neonatal Med ; 34(16): 2655-2659, 2021 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31581861

RESUMO

AIMS AND OBJECTIVE: To study the profile of Candida infection and antifungal susceptibility (AFS) pattern in neonatal sepsis. MATERIALS AND METHODS: In this prospective observational study, 850 blood samples were collected and processed from neonates who were suspected clinically to have sepsis. The blood culture that showed growth of Candida was further processed for species identification. Antifungal susceptibility was done as per the National Committee for Clinical Laboratory Standards (NCCLS)/Clinical Laboratory Standards Institute (CLSI) M44-A-2 guidelines by disc diffusion method and automated vitek-2 compact system. Candidemia was diagnosed by isolation of Candida species from at least one positive blood culture containing pure growth of Candida species with supportive clinical features. RESULTS: Candida species were isolated in 32 specimens of the total 322 culture-positive cases. The most common isolate was Candida tropicalis (14/32; 43.75%) followed by Candida albicans (7/32; 21.87%) and Candida glabrata (6/32; 18.75%). The three most common neonatal risk factors for candidemia were low birth weight, prolonged use of intravenous antibiotics and presence of central venous line. Non-albicans Candida (NAC) showed good sensitivity to fluconazole as compared to Candida albicans. The fluconazole sensitivity of Candida tropicalis, Candida glabrata, and Candida parapsilosis was 93, 67, and 100%, respectively, whereas it was 57% in Candida albicans. The sensitivity to amphotericin B was 95% among all Candida isolates. All NAC were sensitive to amphotericin B, while only 72% Candida albicans were sensitive to amphotericin B. CONCLUSIONS: The incidence of neonatal sepsis secondary to NAC is increasing and has replaced Candida albicans as a major cause of neonatal fungal sepsis. Low birth weight is the most important risk factor for Candida sepsis. The resistance of Candida albicans is increasing for both fluconazole and amphotericin B when compared to NAC. Increasing antifungal resistance warrants its judicious use both for prophylaxis and treatment.


Assuntos
Candidemia , Sepse Neonatal , Antifúngicos/farmacologia , Antifúngicos/uso terapêutico , Candida , Candidemia/tratamento farmacológico , Candidemia/epidemiologia , Fluconazol/farmacologia , Humanos , Índia/epidemiologia , Recém-Nascido , Testes de Sensibilidade Microbiana , Sepse Neonatal/tratamento farmacológico , Sepse Neonatal/epidemiologia , Centros de Atenção Terciária
14.
Mycoses ; 64(2): 152-156, 2021 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-33275821

RESUMO

BACKGROUND: The incidence of candidemia in our hospital has been stable over an 18-year period (1.3 episodes per 1000 admissions). Since March 2020, we have observed an increase in cases of candidemia. METHODS: In March 2020, the hospital was prepared to receive patients with COVID-19, with cancellation of elective procedures, discharge of less sick patients and the activation of beds for COVID-19. We compared the incidence of candidemia in 2 periods: from January 2019 to February 2020 (period 1) and from March to September 2020 (period 2). RESULTS: We diagnosed 41 episodes of candidemia, 16 in period 1 and 25 in period 2 (9 COVID-19 patients). Compared with non-COVID-19 patients, COVID-19 patients with candidemia were more likely to be under mechanical ventilation (100% vs. 34.4%, P < .001). The median number of monthly admissions in period 1 and 2 was 723 (interquartile range 655-836) and 523 (interquartile range 389-574), respectively. The incidence of candidemia (per 1000 admissions) was 1.54 in period 1 and 7.44 in period 2 (P < .001). In period 2, the incidence of candidemia (per 1000 admissions) was 4.76 if we consider only cases of candidemia in non-COVID-19 patients, 2.68 if we consider only cases of candidemia in COVID-19 patients and 14.80 considering only admissions of patients with COVID-19. CONCLUSIONS: The increase in the incidence of candidemia in our hospital may be attributed to 2 factors: a reduction in the number of admissions (denominator) and the occurrence of candidemia in COVID-19 patients.


Assuntos
COVID-19/complicações , Candidemia/etiologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Brasil/epidemiologia , COVID-19/epidemiologia , COVID-19/virologia , Candida/genética , Candida/isolamento & purificação , Candida/fisiologia , Candidemia/epidemiologia , Candidemia/microbiologia , Feminino , Hospitalização , Humanos , Masculino , Pessoa de Meia-Idade , Pandemias , SARS-CoV-2/fisiologia , Centros de Atenção Terciária/estatística & dados numéricos , Adulto Jovem
15.
Mycoses ; 64(5): 503-510, 2021 May.
Artigo em Inglês | MEDLINE | ID: mdl-33377571

RESUMO

BACKGROUND AND OBJECTIVES: Candida species are one of the most common causes of health care-associated bloodstream infections. However, recurrent candidemia is rare, and the characteristics of late recurrent (LR) candidemia are partly unclear. Our aim was to evaluate the characteristics of LR candidemia in adult patients. PATIENTS AND METHODS: A retrospective cohort study was performed in the hospital district of Helsinki and Uusimaa in Finland (2007-2016). All candidemia cases were searched in an electronic database during the study period. Patients with LR candidemia were compared with patients with a single candidemia episode to evaluate the characteristics of LR candidemia. LR candidemia was defined as having at least two episodes of candidemia more than 30 days apart. RESULTS: We identified 24 episodes of LR candidemia in 20 patients. Patients with LR candidemia represented 6% of all patients with candidemia during the study period, and most of these cases were nosocomial. The median time between the first and the recurrent episode was 5.1 months. One-year mortality in LR candidemia was 45%. Underlying gastrointestinal disease (OR 7.21, 95% CI 2.52-20.61) and history of intra-venous drug use (IVDU) (OR 3.62, 95% CI 1.03-12.69) were independent risk factors for LR candidemia in the multivariable analysis. CONCLUSION: Our study indicates that the gastrointestinal tract may be a continuous source of infection in patients with chronic gastrointestinal diseases. Gastrointestinal diseases and IVDU should be regarded as risk factors for LR candidemia.


Assuntos
Candida , Candidemia/epidemiologia , Infecção Hospitalar/epidemiologia , Adulto , Idoso , Candida/classificação , Candida/isolamento & purificação , Candida albicans/isolamento & purificação , Candida glabrata/isolamento & purificação , Candida parapsilosis/isolamento & purificação , Candidemia/etiologia , Infecções Relacionadas a Cateter/complicações , Doença Crônica , Feminino , Finlândia/epidemiologia , Gastroenteropatias/complicações , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Reinfecção/epidemiologia , Estudos Retrospectivos , Fatores de Risco , Abuso de Substâncias por Via Intravenosa
16.
J Mycol Med ; 31(1): 101102, 2021 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-33338776

RESUMO

BACKGROUND: Endogenous fungal endophthalmitis (EFE) is a critical complication of candidemia. We conducted a study to investigate the prevalence and risk factors for EFE. METHODS: Adult candidemia patients≥19years who underwent an ophthalmological examination at a tertiary care hospital in the Republic of Korea from 2006 to 2018 were enrolled. RESULTS: There was a total of 152 adult candidemia patients analyzed. EFE was found in 29 patients (19.1%). Patients were categorized into two groups (Non-endophthalmitis [NE] and endophthalmitis [E]). Between the two groups, there was no significant difference in terms of age, sex, and underlying comorbidities. However, there were more Candida albicans candidemia, abnormal alanine aminotransferase (ALT) at the time of candidemia diagnosis, receipt of antifungal treatment≥48hours after onset of candidemia symptoms and blood culture sample (AOCS), and candidemia clearance≥5days after initiation of antifungal treatment (AIAT) in the E group. A predictive model for the E was created, which had an area of 0.811 under the receiver operating characteristics curve. In a multivariate logistic regression analysis, C. albicans candidemia, ALT at the time of candidemia diagnosis, receipt of antifungal treatment≥48hours AOCS, and candidemia clearance≥5days AIAT were significantly associated with EFE. CONCLUSION: EFE occurred in 19% of adult patients with candidemia. Adult candidemia patients with C. albicans candidemia, abnormal ALT, receipt of antifungal treatment≥48hours AOCS, and candidemia clearance≥5days AIAT need to be closely monitored for the possibility of EFE.


Assuntos
Candidemia/epidemiologia , Infecções Oculares Fúngicas/epidemiologia , Centros de Atenção Terciária/estatística & dados numéricos , Idoso , Antifúngicos/uso terapêutico , Candidemia/complicações , Infecções Oculares Fúngicas/tratamento farmacológico , Infecções Oculares Fúngicas/microbiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Prevalência , República da Coreia , Estudos Retrospectivos , Fatores de Risco
17.
Braz J Infect Dis ; 25(1): 101041, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33370563

RESUMO

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.


Assuntos
Candidemia , Infecção Hospitalar , Antifúngicos/uso terapêutico , Brasil/epidemiologia , Candida , Candidemia/tratamento farmacológico , Candidemia/epidemiologia , Infecção Hospitalar/tratamento farmacológico , Infecção Hospitalar/epidemiologia , Humanos , Incidência
18.
Clin Infect Dis ; 71(Suppl 4): S394-S399, 2020 12 23.
Artigo em Inglês | MEDLINE | ID: mdl-33367573

RESUMO

BACKGROUND: Antifungal prophylaxis may result in breakthrough infections in hematology patients with severe agranulocytosis, with few studies assessing risk factors and clinical outcomes of breakthrough candidemia. We described the distribution of Candida species, assessed risk factors for mortality in such patients, and determined differences in the incidence and mortality of breakthrough candidemia between patients who did or did not receive an allogeneic hematopoietic stem cell transplant. METHODS: We collected clinical and microbiological data of patients with hematologic malignancies and breakthrough candidemia from a single center. Seven-day and 30-day follow-up outcomes were recorded; the incidence and mortality of breakthrough candidemia between patients who did or did not undergo an allogeneic transplant were compared. Kaplan-Meier survival estimates were used to generate survival curves, and predictors were identified using Cox regression analyses. RESULTS: Of 71 enrolled patients, 17 received allogeneic transplants. Incidences of breakthrough candidemia were 17 of 2924 (0.58%) and 54 of 12 015 (0.45%) in the transplant and nontransplant groups, respectively (P = .35). The most common isolate was Candida tropicalis, and antifungal agent combinations were the most common first-line treatment. Cumulative mortality rates of patients were 21.1% and 31.0% at days 7 and 30, respectively, and they significantly differed between both groups. Septic shock, central venous catheter removal, and granulocyte recovery were significantly associated with 7-day mortality; the latter 2 remained independent predictors of 30-day mortality. CONCLUSIONS: Breakthrough candidemia-related mortality was higher in the allogeneic transplant group, although the incidence was not significantly different between the groups. Prompt and adequate antifungal treatment with catheter removal may reduce mortality.


Assuntos
Candidemia , Neoplasias Hematológicas , Transplante de Células-Tronco Hematopoéticas , Antifúngicos/uso terapêutico , Candidemia/tratamento farmacológico , Candidemia/epidemiologia , China/epidemiologia , Neoplasias Hematológicas/tratamento farmacológico , Neoplasias Hematológicas/terapia , Humanos , Estudos Retrospectivos , Fatores de Risco
19.
J Pak Med Assoc ; 70(9): 1568-1571, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-33040110

RESUMO

OBJECTIVE: To determine the risk factors for candidaemia in babies admitted to a tertiary care hospital with neonatal sepsis. METHODS: This nested case control study was conducted in the Neonatal Unit of the department of Paediatrics, King Edward Medical University/Mayo Hospital, Lahore, from January 2017 to June 2018. A total of 350 neonates having sepsis according to the clinical case definition were enrolled in this study by non-probability convenient sampling. Blood culture for bacteria on first day and for candida on fifth day was sent. Patients were started antimicrobial therapy as per institutional policy on admission. All patients were followed for risk factors for development of candidaemia. Data was analyzed by SPSS 22.0, Odds ratio and logistic regression was used to determine the magnitude of risk factors. RESULTS: Among 350 septic neonates, 36 isolates were positive for Candida spp, constituting 10.2% of candidaemia among septic neonates. Necrotizing enterocolitis was found to be the significantly associated risk factor for development of candidaemia. CONCLUSIONS: Necrotizing enterocolitis was found to be an important risk factor for development of candidaemia among hospitalized septic neonates.


Assuntos
Antifúngicos , Candidemia , Antifúngicos/uso terapêutico , Candidemia/tratamento farmacológico , Candidemia/epidemiologia , Estudos de Casos e Controles , Criança , Humanos , Recém-Nascido , Paquistão/epidemiologia , Fatores de Risco , Centros de Atenção Terciária
20.
Rev. iberoam. micol ; 37(3/4): 87-93, jul.-oct. 2020. tab, graf
Artigo em Inglês | IBECS | ID: ibc-200358

RESUMO

BACKGROUND: The epidemiology of candidemia has changed over the last decades and varies widely among geographic areas. AIMS: We examined in children (aged 0-14) with candidemia the trends in the incidence rate of this infection, as well as the clinical characteristics of the patients, in order to optimize the prognosis and the control measures of this serious disease. METHODS: A retrospective cohort study of candidemia in the period 2011-2018 in the neonatal intensive care unit (NICU), pediatric ICU (PICU) and pediatric wards of a tertiary hospital, was conducted. The clinical course, Candida species isolated, antifungal susceptibility, outcome and incidence rates were analyzed and compared. RESULTS: We diagnosed 68 episodes of candidemia in 62 children, 48% occurred in the NICU, 31% in the PICU and 21% in pediatric wards. Candida albicans was the most frequent species isolated in NICU infants (53%), and Candida parapsilosis predominated among PICU patients (59%) and pediatric wards (50%). One third of NICU infants had invasive candidiasis (IC), most of them having extremely low birth weight (ELBW) (35%). All isolates were susceptible to the antifungal administered. Over time, the incidence of candidemia decreased in the PICU (from 2.2 to 0.3 episodes/1000 patient-days, OR=0.6; 95%CI 0.5-0.8), whereas in the NICU and in the wards remained stable. Mortality occurred mostly in NICU patients (26%), predominated in ELBW infants and did not change over time. CONCLUSIONS: The higher incidence and mortality of candidemia and IC observed in preterm infants requires a continuous evaluation of practices and diagnostic methods which will allow improving the prognosis of this most vulnerable population


ANTECEDENTES: La epidemiología de la candidemia varía con el tiempo y entre las áreas geográficas. OBJETIVOS: Se ha estudiado en niños (0-14 años) con candidemia la evolución de la tasa de incidencia y las características clínicas de los pacientes para optimizar el pronóstico y las medidas de control de esta grave enfermedad. MÉTODOS: Se llevó a cabo un estudio de cohorte retrospectivo de los casos de candidemia en la unidad de cuidados intensivos neonatales (UCIN), UCI pediátrica (UCIP) y salas pediátricas de un hospital terciario, entre los años 2011 y 2018. Se compara el curso clínico, las especies de Candida, la sensibilidad antifúngica y las tasas de incidencia. RESULTADOS: Se diagnosticaron 68 episodios de candidemia en 62 niños; el 48% de ellos tuvieron lugar en UCIN, el 31% en UCIP y el 21% en salas pediátricas. Candida albicans fue la especie más frecuente en UCIN (53%), y Candida parapsilosis predominó en UCIN (59%) y salas pediátricas (50%). Un tercio de los bebés de la UCIN tenía candidiasis invasora (CI) y la mayoría presentaba extremado bajo peso al nacimiento (EBPN) (35%). Con el tiempo, la incidencia de candidemia disminuyó en la UCIP (de 2,2 a 0,3 episodios/1.000 días/paciente, OR: 0,6; IC 95%: 0,5-0,8), mientras que en la UCIN y en las salas permaneció estable. La mortalidad se produjo principalmente en pacientes de UCIN (26%), predominó en lactantes EBPN y no cambió con el tiempo. CONCLUSIONES: La mayor incidencia y mortalidad de la candidemia y CI observadas en lactantes prematuros requiere una evaluación continua de prácticas y métodos de diagnóstico que permitan mejorar el pronóstico de esta población más vulnerable


Assuntos
Humanos , Masculino , Feminino , Recém-Nascido , Lactente , Pré-Escolar , Criança , Adolescente , Candidemia/epidemiologia , Candidemia/microbiologia , Centros de Atenção Terciária , Antifúngicos/uso terapêutico , Estudos Retrospectivos , Candidemia/tratamento farmacológico , Estudos de Coortes , Fatores de Risco , Espanha/epidemiologia , Incidência
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA
...