Candida guilliermondii Fungemia in Patients with Hematologic Malignancies (original) (raw)
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Candida Glabrata: An emerging threat for the Immunocompromised
2010
Background: Fungal infections cause a significant amount of morbidity and mortality among immuno compromised population. Various fungal agents are responsible but candida are one the most frequently isolated ones. Recently, a redistribution of candida species has been observed that has highlighted a non Candida albicans species i.e. Candida glabrata. High frequency of Candida glabrata exhibits high resistance rates and it has emerged as a difficult to treat pathogen. The objective of this study was to identify the various strains of fungi and their sensitivity in immuno compromised patients. Material & Methods: This was a cross-sectional study in which immunocompromised patients were screened for fungal infections on the basis of conventional and API 20-C methods. In this study 165 cases were inducted that included cases on dialysis, chemotherapy for malignancies, those with transplant and receiving immunosuppressive therapy and were positive for fungal infections. Results: Candida glabrata was isolated from 39(23.6%) cases and of these isolates, 13% were resistant to fluconazole. Conclusion: Apart from Candida albicans, Candida glabrata is another difficult to treat fungal agent in immunocompromised patients.
The Epidemiology of Hematogenous Candidiasis Caused by Different Candida Species
Clinical Infectious Diseases, 1997
The medical records of patients with hematogenous candidiasis at M. D. Anderson Cancer Center (Houston) between 1988 and 1992 were retrospectively reviewed. There were 491 episodes of infection (6 per 1,000 admissions), 79% of which occurred outside the intensive care unit setting. A significant decrease in incidence was observed among patients with leukemia over the study period, together with a relative decrease in Candida albicans and Candida tropicalis infections and an increase in Candida krusei and possibly Candida glabrata infections. In the multivariate analysis, fluconazole prophylaxis provided strong protection against the development of C. tropicalis infection (odds ratio [OR] Å 0.08) and C. albicans infection (OR Å 0.15), in comparison with protection against infections due to other species, but it was the single most important determinant for the relative increase in C. krusei (OR Å 27.07) and C. glabrata (OR Å 5.08) infections. In conclusion, there has been a substantial shift in the epidemiology of hematogenous candidiasis caused by different Candida species in recent years. Fluconazole appears to be playing a major role in this observed shift.
Antimicrobial agents and chemotherapy, 2017
Objectives: The objectives of our study were to describe the characteristics of patients infected with C. guilliermondii candidemia and to perform an in-depth microbiological characterization of isolates and compare them with those of patients with C. albicans candidemia.Methods: We described the risk factors and outcome of 22 patients with candidemia caused by C. guilliermondii complex. Incident isolates were identified using molecular techniques, and susceptibility to fluconazole, anidulafungin and micafungin was studied. Biofilm formation was measured using the crystal violet assay (biomass production) and the XTT reduction assay (metabolic activity), and virulence was studied using the Galleria mellonella model. Biofilm formation was compared with that observed for C. albicansResults: The main conditions predisposing to infection were malignancy (68%), immunosuppressive therapy (59%), and neutropenia (18%). Clinical presentation of candidemia was less severe in patients infected...
Archives of Internal Medicine, 2000
Background: Candida krusei is inherently resistant to fluconazole and is emerging as a frequent cause of fungemia in patients with hematologic malignant neoplasms. Objective: To determine the risk and prognostic factors associated with C krusei fungemia in comparison with Candida albicans fungemia in patients with cancer. Methods: Retrospective study of 57 cases of C krusei fungemia occurring at the M. D. Anderson Cancer Center, Houston, Tex, from 1989 to 1996. The C krusei cases were compared with 57 cases of C albicans fungemia with respect to demographics, underlying cancer, Acute Physiology and Chronic Health Evaluation II score, immunosuppression status, chemotherapy, and the use of central venous catheters, as well as fluconazole prophylaxis.
Epidemiology of candidemia in oncology patients: a 6-year survey in a Portuguese central hospital
Medical Mycology, 2010
This study presents data on the incidence of candidemia in a Portuguese oncology hospital during a 6-year period. The species distribution and their antifungal susceptibility, as well as the clinical outcomes associated with candidemia were evaluated. A total of 119 episodes were reported, with the majority occurring among patients older than 56 years. The most common underlying medical conditions were solid tumors (64.5%) and hematological disease (28.2%). The most frequent species found was Candida albicans (48.7%), followed by C. parapsilosis (20.2%), C. tropicalis (8.4%), C. krusei (6.7%) and C. glabrata (5.0%), but Saccharomyces cerevisiae and Rhodotorula mucilaginosa were also isolated. Candida albicans was more frequently associated with solid tumors of the gastrointestinal and genitourinary tracts and breast (P = 0.005), while non-C. albicans Candida species were most frequently recovered from hematological patients (P = 0.007). The mortality rate associated with candidemia was 31.9% (P = 0.016). All C. albicans and C. parapsilosis isolates were susceptible to fl uconazole, voriconazole and itraconazole. Resistance to caspofungin was only observed in C. albicans and in the R. mucilaginosa isolates. Posaconazole was active against all C. parapsilosis isolates tested but resistant strains were found among C. albicans (4.9%), C. tropicalis (12.5%), C. krusei (25%) and C. glabrata (50%). This study provides useful information regarding the local epidemiology of candidemia in cancer patients. Keywords Candidemia, blood cultures, cancer patients treatment of invasive fungal infections, candidemia has been associated with the highest crude mortality rate of all bloodstream infections and even in non-neutropenic patients, the crude mortality of candidemia may exceed 50% [ 4 ]. Cancer chemotherapy, neutropenia, organ transplantation, indwelling catheters and devices, autoimmune diseases, burns, antimicrobial therapy, abdominal surgery, radiotherapy, and intensive care are among the main risk factors predisposing for Candida infections [ 5-7 ]. Candida albicans is the most frequently isolated species from deeper tissue, blood and organs. According to recent literature, although C. albicans remains the most common fungal isolate from blood, several studies have detected a trend toward an increased prevalence of other Candida species [ 8-10 ]. Compared to 20 years ago, a larger proportion of Candida bloodstream infections is presently caused by
Frontiers in Cellular and Infection Microbiology, 2023
Objective: Opportunistic fungal infections by Candida species arise among cancer patients due to the weakened immune system following extensive chemotherapy. Prophylaxis with antifungal agents have developed the resistance of Candida spp. to antifungals. Accurate identification of yeasts and susceptibility patterns are main concerns that can directly effect on the treatment of patients. Methods: Over a period of three years, 325 cancer patients suspected to Candida infections were included in the current investigation. The clinical isolates were molecularly identified by polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP). All strains, were examined for in vitro susceptibility to the amphotericin B, itraconazole, fluconazole, and anidulafungin according to the CLSI M27 document. Results: Seventy-four cancer patients had Candida infections (22.7%). Candida albicans was the most common species (83.8%). Antifungal susceptibility results indicated that 100% of the Candida isolates were sensitive to amphotericin B; however, 17.6%, 9.4%, and 5.4% of clinical isolates were resistant to anidulafungin, fluconazole, and itraconazole, respectively. The findings of the present work shows a warning increase in resistance to echinocandins. Since all fluconazole resistance isolates were obtained from candidemia, we recommend amphotericin B as the first line therapy for this potentially fatal infection.
Mycoses, 2020
Background: Candidaemia is an important infectious complication for haematological malignancy patients. Antifungal prophylaxis reduces the incidence of candidaemia but may be associated with breakthrough candidaemia. Objective: To analyse the Candida species' distribution and relative antifungal susceptibility profiles of candidaemia episodes in relation to the use of antifungal prophylaxis among Italian SEIFEM haematology centres. Methodology: This multi-centre retrospective observational SEIFEM study included 133 singlespecies candidaemia episodes of haematological malignancy patients for whom antifungal susceptibility testing results of blood Candida isolates were available between 2011 and 2015. Each participating centre provided both clinical and microbiological data. Results: Non-Candida albicans Candida (NCAC) species were the mostly isolated species (89, 66.9%), which accounted for C. parapsilosis (35, 26.3%), C. glabrata (16, 12.0%), C. krusei (14, 10.5%), C. tropicalis (13, 9.8%) and uncommon species (11, 8.3%). C. albicans caused the remaining 44 (33.1%) episodes. Excluding 2 C. albicans isolates, 23 of 25 fluconazole-resistant isolates were NCAC species (14 C. krusei, 6 C. glabrata, 2 C. parapsilosis and 1 C. tropicalis). Fifty-six (42.1%) of 133 patients developed breakthrough candidaemia. Systemic antifungal prophylaxis consisted of azoles, especially fluconazole and posaconazole, in 50 (89.3%) of 56 patients in whom a breakthrough candidaemia occurred. Interestingly, all these patients tended to develop a C. krusei infection (10/56, P = 0.02) or a fluconazole-resistant isolate's infection (14/50, P = 0.04) compared to patients (4/77 and 10/77, respectively) who did not have a breakthrough candidaemia. Conclusions: Optimization of prophylactic strategies is necessary to limit the occurrence of breakthrough candidaemia and, importantly, the emergence of fluconazole-resistant NCAC isolates' infections in haematological malignancy patients.
Clinical Infectious Diseases, 1996
Over the years 1983-1994, Candida parapsilosis caused 3S of 138 fungemic episodes (24 of 69 candidemias in the last quadriennium) in patients with hematologic malignancies who were being treated at a large university hospital in Italy. The central venous catheter was usually the source of bloodstream invasion; in most cases, the resolution of fungemia in patients receiving antifungal therapy required catheter removal. In seven cases, C. parapsilosis fungemia evolved to five proven (two cases with endocarditis) and two probable deep-seated infections; three of these seven patients died of deep-seated infections. Deep-seated infection was associated with the detection of a circulating mannoprotein antigen of C.parapsilosis but not with in vitro resistance to antifungal agents. Almost all fungal isolates produced slime in vitro, but only 34%were pathogenic in a model of bloodstream infection in neutropenic mice. The four isolates associated with endocarditis or persistent fungemia with multiorgan failure were among the most virulent in the model of infection. Overall, our findings highlight the role of C.
Evidence for a Pseudo-Outbreak of Candida guilliermondii Fungemia in a University Hospital in Brazil
Journal of Clinical Microbiology, 2007
Fungal infections due to Candida species represent an important cause of nosocomial bloodstream infections. We report a large pseudo-outbreak of Candida guilliermondii fungemia that occurred in a university hospital in Brazil. C. guilliermondii was identified in 64 (43%) of the 149 blood samples drawn between June 2003 and July 2004. The samples were from patients in different wards of the hospital but concentrated in pediatric units. None of the patients had clinical signs of fungemia, and observational analysis revealed errors in the collection of blood samples. During the investigation of the pseudo-outbreak, C. guilliermondii was isolated from environmental surfaces and from the skin and nails of members of the nursing team. Through a subtyping analysis it was found that some of the nonpatient isolates were highly related to the patient isolates, and all the patient isolates were highly related. This is consistent with the hypothesis that the pseudo-outbreak was from a limited number of common sources. The adoption of intervention measures was effective in resolving the outbreak, supporting the hypothesis that the outbreak was due to poor techniques of drawing blood samples for culture.