Biofilm formation is a risk factor for mortality in patients with Candida albicans bloodstream infection – Scotland, 2012-2013 (original) (raw)

Rajendran, Ranjith, Sherry, Leighann ORCID: https://orcid.org/0000-0002-0493-6135, Nile, Christopher ORCID: https://orcid.org/0000-0001-8218-2167, Sherriff, Andrea ORCID: https://orcid.org/0000-0002-1016-037X, Johnson, Elizabeth, Hanson, Mary, Williams, Craig, Munro, Carol, Jones, Brian and Ramage, Gordon ORCID: https://orcid.org/0000-0002-0932-3514(2016) Biofilm formation is a risk factor for mortality in patients with Candida albicans bloodstream infection – Scotland, 2012-2013.Clinical Microbiology and Infection, 22(1), pp. 87-93. (doi: 10.1016/j.cmi.2015.09.018) (PMID:26432192)

Abstract

Bloodstream infections caused by Candida species remain a significant cause of morbidity and mortality in hospitalised patients. Biofilm formation by Candida species is an important virulence factor for disease pathogenesis. A prospective analysis of patients with Candida bloodstream infection (n=217) in Scotland (2012/13) was performed to assess the risk factors associated with patient mortality; in particular the impact of biofilm formation. Candida bloodstream isolates (n=280) and clinical records for 157 patients were collected through 11 different health boards across Scotland. Biofilm formation by clinical isolates was assessed in vitro by standard biomass assays. The role of biofilm phenotype on treatment efficacy was also evaluated in vitro by treating preformed biofilms by fixed concentrations of different classes of antifungals. Out of 134 available patient mortality data, the 30-day candidaemia case mortality was 41%, with predisposing factors including patient age and catheter removal. Multivariate Cox’s regression survival analysis with 42 patients showed significantly higher mortality with C. albicans infection compared to C. glabrata. Biofilm-forming ability was significantly associated with C. albicans mortality (n=34 patients). Finally, in-vitro antifungal sensitivity testing showed that LBF and HBF were differentially affected by azoles and echinocandins, but not polyenes. This study provides further evidence of the biofilm phenotype represents a significant clinical entity, and that isolates with this phenotype differentially respond to antifungal therapy based on in vitro evidence. Collectively, these findings highlight that a greater clinical understanding is required with respect to Candida biofilm infections, and the implications of isolate heterogeneity.

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