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Candidemia and disseminated candidiasis are major causes of morbidity and mortality in hospitalized patients especially in the intensive care units (ICU). The incidence of invasive candidasis is on a steady rise because of increasing use of multiple antibiotics and invasive procedures carried out in the ICUs. Worldwide there is a shifting trend fro...
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Invasive candidiasis occurs frequently in hospitalized patients, and is associated with high mortality rates due to delays in recognition and initiation of appropriate antifungals. Management of invasive candidiasis must take into account multiple host, pathogen, and drug-related factors, including the site of infection, host immune status, severit...
Background:
Invasive candidiasis differs greatly between children and neonates. We aimed to investigate the different therapeutic approaches and their effects on treatment outcomes of these two groups.
Methods:
Episodes of neonatal invasive candidiasis were compared with non-neonatal pediatric episodes during a 12-year cohort study. Clinical iso...
PurposeTo describe temporal trends in the epidemiology, clinical management and outcome of candidemia in intensive care unit (ICU) patients.MethodsThis study was a retrospective analysis of 1,392 episodes of candidemia in 647 adult ICU patients from 22 Brazilian hospitals. The characteristics of candidemia in these ICU patients were compared in two...
Invasive candidiasis is a life-threatening complication of critically ill immunocompromised patients with high attributable mortality. Due to non-specific clinical presentation, early detection of candidemia and accurate identification of Candida species are essential pre-requisites for improved therapeutic outcome. Since blood culture-based method...
Background:
Invasive candidiasis is not uncommon in critically ill patients but has variable epidemiology and outcomes between intensive care units (ICUs). This study evaluated the epidemiology, characteristics, management, and outcomes of patients with invasive candidiasis at 6 ICUs of 2 tertiary care centers.
Methods:
This was a prospective ob...
Citations
... according to the Centres for Disease Control, emphasizing Candidemia's gravity in the context of nosocomial infections [3]. In recent decades, there has been a discernible surge in nosocomial candidiasis, extending beyond tertiary care centers to impact community hospitals globally [4]. Recently, the epidemiology of Candidemia has been moving away from the prevalence of Candida albicans towards the dominance of non-albicans Candida species [5]. ...
... In these patients, infections with Candida and Aspergillus species are the most common, even if mucormycosis have emerged as increasingly relevant and highly lethal causes of IFIs in many centers worldwide [16][17][18]. The diagnosis of IFIs is difficult for several reasons: various but non-specific clinical symptoms, delicate isolation of fungal organisms, non-specific imaging and biological markers [19][20][21][22][23][24]. This often leads to a delay in therapeutic support and therefore poses a challenge to children's survival. ...
Background:
Allogenic hematopoietic stem cell transplantation (a-HCT) remains a therapeutic treatment for many pediatric hematological diseases. The occurrence of invasive fungal infections (IFIs) is a complication for which ECIL-8 recommends primary antifungal prophylaxis. In this study, we evaluated the impact of our local strategy of not systematically administering primary antifungal prophylaxis in children undergoing a-HCT on the occurrence and mortality of IFIs.
Methods:
We performed a retrospective monocentric study from 2010 to 2020. We retained all proven and probable IFIs diagnosed during the first year post a-HCT.
Results:
308 patients were included. Eighteen patients developed twenty IFIs (thirteen proven, seven probable) (6.5%) among which aspergillosis (n = 10, 50%) and candidosis (n = 7, 35%) were the most frequently diagnosed infections. Only 2% of children died because of an IFI, which represents 14% of all deaths. Multivariate analysis found that age > 10 years (OR: 0.29), the use of a therapeutic antiviral treatment (OR: 2.71) and a low neutrophil count reconstitution (OR: 0.93) were significantly associated with the risk of IFI occurrence. There was also a trend of malignant underlying disease and status ≥ CR2 but it was not retained in multivariate analysis.
Conclusions:
IFI occurrence was not higher in our cohort than what is reported in the literature with the use of systematic antifungal prophylaxis, with a good survival rate nonetheless. Thus, a prophylaxis could be considered for children with a high risk of IFI such as those aged over 10 years.
... IFIs result from the defects in immune mechanisms among the immunosuppressed individuals and invasive procedures [1]. The pathogen enters through the puncture sites of the skin, gastrointestinal tract lesion, indwelling catheters and is spread by the hematogenous route in different parts of the body [4]. Immunodeficient children Pneumocystis jirovecii, Aspergillus species, Cryptococcus species, Histoplasma Capsulatum, and their associated factors, outcome among under-5-year-old diarrheal children. ...
Invasive fungal infections (IFIs) are opportunistic, especially in immunocompromised and hospitalized patients. Children with IFIs are more vulnerable to a fatal outcome. For early diagnosis and treatment, knowledge of the spectrum and frequency of IFIs among children is prerequisite. In this prospective observational study, we enrolled 168 children of 2–59 months old of either sex from March 2018 to December 2019 admitted to the Dhaka hospital, icddr,b. Study participants with suspected IFIs were with or without severe acute malnutrition (SAM) along with sepsis/pneumonia and fulfilled any of the following criteria: (i) failure to respond to injectable antibiotics, (ii) development of a late-onset hospital-acquired infection, (iii) needed ICU care for >7 days, (iv) took steroids/antibiotics for >2 weeks before hospitalization, and (v) developed thrush after taking injectable antibiotics. The comparison group included non-SAM (weight-for-length Z score ≥ −2) children with diarrhea and fever <3 days in the absence of co-morbidity. We performed real-time PCR, ELISA, and blood culture for the detection of fungal pathogen. Study group children with SAM, positive ELISA and PCR considered to have a IFIs. In the study group, 15/138 (10.87%) children had IFIs. Among IFIs, invasive candidiasis, aspergillosis, histoplasmosis detected in 6 (4.53%), 11 (7.97%), and 1 (0.72%) children, respectively, and (3/15 [2.17%]) children had both candidiasis and aspergillosis. Children with IFIs more often encountered septic shock (26.7% vs. 4.9%; p = 0.013) and had a higher death rate (46.7% vs. 8.9%; p < 0.001) than those without IFIs. IFIs were independently associated with female sex (OR = 3.48; 95% CI = 1.05, 11.55; p = 0.042) after adjusting for potential confounders. Our findings thus implicate that, malnourished children with septic shock require targeted screening for the early diagnosis and prompt management of IFIs that may help to reduce IFIs related deaths.
... With rising resistance of pathogens to antibiotics, there is a human health main concern for finding and developing cheaper and efficient natural antimicrobial agents with better efficacy, less side effects than any synthetic antibiotics, good bioavailability and lower toxicity (Thanigaivel et al., 2015). Diseases cause by fungi are ranging from different type of disease to invasive illnesses, such as peritonitis, hepatosplenic candidiasis and systemic candidiasis (Singhi and Deep 2009). Treating infection caused by different Candida spp. ...
The phytochemical screening, antimicrobial, antioxidant and anticancer activity was evaluated for the marine seaweeds Cystoseira indica and Sargassum vulgare from Porbandar coast, Gujarat. Methanol extract was used for seaweed extraction by using cold percolation extraction method to investigate the antibacterial activity against gram positive viz. Bacilus spizizenii, Eenterococcus faecalis, Staphylococcus aureus and Gram negative bacteria viz., Salmonella abony, Proteas mirabilis and Euterobacter aerogenes. S. vulgare(13.66 ± 0.21 mm) showed maximum zone of inhibition against E. aerogenes. Both are seaweed shown zone of inhibition for antifungal activity against Candida albicans. The radical scavenging property of 1,1-diphenyl-2-picrylhydrazyl (DPPH) antioxidant capacity were determined in methanol extracted seaweeds were used in this study to assess the antioxidant capacity of Cystoseira indica and Sargassum vulgare. The good DPPH activity was shown by the methanol extract of S. vulgare (67.71 ± 1.38 % inhibition) compared to the standard at 1000 µg/ml concentration of ascorbic acid percent of inhibition of 96.02%. This result indicate that seaweed have great potential for antioxidant power. Both are seaweeds extracts were tested for cytotoxicity against HeLa cell lines at various concentrations to determine cell viability or survival rate by using the MTT assay. The cytotoxicity of S. vulgare thallus extract against HeLa cells shown higher anticancer activity comparatively C. indica at different concentration. Hence, from the present study it is evaluated that the seaweeds collected from porbandar coast has excellent inhibitory activity against various human pathogens and has significant antioxidant potential as well as gave anticancer activity against Human cervical cancer cell lines.
... Antifungal susceptibility surveillance programs have been successfully developed in several countries but not yet in India; 25 Although species-specific epidemiology, disease and risk factors have been reported, the cumulative burden of disease with antifungals resistance have not yet been reported. 7,[26][27][28][29] Possible causes of this research gap include inadequate clinical knowledge, lack of public awareness, and a lack of research into disease manifestations and treatment. The present review illustrates Candida species prevalence, distribution and antifungal resistance patterns in different regions of India. ...
The emergence of antifungal drug resistance in Candida species has led to increased morbidity and mortality in immunocompromised patients. Understanding species distribution and antifungal drug resistance patterns is an essential step for novel drug development. A systematic review was performed addressing this challenge in India with keywords inclusive of ‘Candida’, ‘Antifungal Drug Resistance’, ‘Candidemia’, ‘Candidiasis’ and ‘India’. A total of 106 studies (January 1978–March 2020) from 20 Indian states were included. Of over 11,429 isolates, Candida albicans was the major species accounting for 37.95% of total isolates followed by C. tropicalis (29.40%), C. glabrata (11.68%) and C. parapsilosis (8.36%). Rates of antifungal resistance were highest in non-albicans Candida (NAC) species - C. haemuloni (47.16%), C. krusei (28.99%), C. lipolytica (28.89%) and C. glabrata (20.69%). Approximately 10.34% isolates of C. albicans were observed to be drug resistant. Candida species were frequently resistant to certain azoles (ketoconazole-22.2%, miconazole–22.1% and fluconazole–21.8%). In conclusion, the present systematic review illustrates the overall distribution and antifungal resistance pattern of Candida species among the Indian population that could be helpful in the future for the formation of treatment recommendations for the region but also elsewhere.
Lay Summary
A total of 106 studies were reviewed to define the prevalence, distribution and antifungal resistance pattern of Candida species in India. The presented data could become the point of reference for all reported findings on Candida species in India.
... [7][8][9][10][11][12][13][14][15] Other risk factors for candidemia/ICI have also been reported in children and neonates: corticosteroids, blood transfusions, recent surgery, preterm birth, congenital anomalies, H2 receptor antagonists, tunneled CVC, previous bloodstream infections and gastrointestinal pathology. 6,[16][17][18] None of the published studies of candidemia in children come from Croatia, so the purpose of this retrospective study was to identify the incidence, risk factors, the outcome and antifungal susceptibility of Candida species in PICU patients in our institution. The study also aimed to propose a predictive probability model or a scoring system for candidemia in this setting. ...
Background:
Candidemia is one of the leading causes of bloodstream infections in the pediatric intensive care unit (PICU). The aim of this study was to define characteristics and risk factors for candidemia in the PICU setting and propose a predictive model to identify the patients at risk.
Methods:
This was a retrospective matched case-control study in the PICU during a 9-year period. Patients with candidemia were studied and matched with control patients without candidemia. Univariate analysis was performed for potential risk factors and multivariate analysis was conducted to determine the prediction score for candidemia.
Results:
Forty-two cases of candidemia were matched with 84 control patients. Candida parapsilosis was the most common (71.4%) species. Risk factors independently associated with candidemia were: the use of >2 antibiotics in a maximum period of 4 weeks before the candidemia (odds ratio [OR]: 10.59; 95% confidence interval [CI]: 2.05-54.83), a previous bacterial infection in a maximum period of 4 weeks before the candidemia (OR: 5.56; 95% CI: 1.44-21.5) and the duration of PICU stay of >10 days (OR: 4.22; 95% CI: 1.02-17.41). The proposed predictive scoring system has a sensitivity of 95.24%, specificity of 76.12%, OR 64.0, 95% CI 14.2-288.6, the positive predictive value of 66.67% and the negative predictive value of 96.97%.
Conclusions:
Previously reported risk factors for candidemia have been confirmed and some new have been detected. The presented scoring system can help identify patients who would benefit from prophylactic antifungal therapy.
... Candida species were the most frequently isolated organism from any sites and comprise 85% of total number of cultures 3 A.nigra figure (2). in univariate analysis the most important factors related to acquiring fungal infection among patients were age and smoking where age group ≥ 18 years was 4.18 times more risky to acquire fungal infection than age group < 18 years (p value 0.0002) and Smokers were 1.89 time more risky to acquire fungal infection than nonsmokers (p value 0.03) table (1). ...
... Candida species were the most frequently isolated organism from any sites and comprise 85% of total number of cultures 3 A.nigra figure (2). in univariate analysis the most important factors related to acquiring fungal infection among patients were age and smoking where age group ≥ 18 years was 4.18 times more risky to acquire fungal infection than age group < 18 years (p value 0.0002) and Smokers were 1.89 time more risky to acquire fungal infection than nonsmokers (p value 0.03) table (1). Long-term users of antibiotic were 4.5 time more risky to acquire fungal infection than non-users or short term users (p value 0.00004), patients who receive steroids were 3.49 time more risky to acquire fungal infections than patient not receiving steroids (p value 0.016), while patients who receive Immunosuppressive drugs were 7.69 time more risky to acquire fungal infections than patients not receiving it (p value 0.04) table (2). patients with positive HBV or HCV were 3.21 times more risky to acquire fungal infection than negative (p value 0.002), Diabetic patients were 3.08 times more risky to acquire fungal infection than non-diabetics (p value 0.001), patients with History of cancer were 5.88 times risky to acquire fungal infection than patients with no history of cancer (p value 0.000008), anemic patients were 1.84 times more risky to acquire fungal infections than who not anemic (p value 0.049), patients with Organ transplantation were 7.4 times more risky to acquire fungal infections than who not had organ transplantation (p value 0.003) while patients with past operations were 5.18 times more risky to acquire fungal infections than patient with no history of past operations (p value 0.0002) table (3). ...
... Candidemia and disseminated candidiasis are major causes of morbidity and mortality in hospitalized patients especially in the Intensive Care Units (ICU), the incidence of invasive candidiasis is on a steady rise because of increasing use of multiple antibiotics and invasive procedures carried out in the ICUs. Worldwide there is a shifting trend from C.albicans towards non albicans species, with an associated increase in mortality and antifungal resistance [2] . ...
... (8) Candidemia commonly results in high rate of morbidity and mortality, as well as high medical expense, among patients who are hospitalized. (9) I Candida colonization in the gastrointestinal tract has also been suggested to be correlated with elevated risk of invasive candidiasis. (2,10,11) Keeping Candida colonization in check using systemic anti-fungal drugs has been successful in controlling the prevalence of invasive fungal infections. ...
Resistance to anti-fungal drugs has become the main cause for increasing incidence rate of Candida infections in pediatric intensive care units (PICU). Zinc supplementation has been shown to exhibit beneficial effects on many pediatric illnesses. This study aimed to investigate the efficacy of zinc supplementation on prevalence of candidemia and candiduria infections in PICU. 724 eligible children between 1 to 5 years old admitted in PICU were randomly assigned into either zinc supplementation group or placebo group. Primary endpoints were the number of Candida infections, length of PICU stay and cases of patient death 14 days after enrollment. Secondary endpoints were the incidence rates of candidemia and candiduria. The incidences of candiduria and candidemia were significantly lower in the zinc group than the placebo group. The length of PICU stay and cases of patient death were obviously lowered in the zinc group compared to the placebo group. In conclusion, zinc supplementation shows beneficial clinical efficacy in reducing Candida infections among PICU patients on broad-spectrum antibiotics with critical illnesses.
... One previous study identified C.glabrata as a risk factor for the development of persistent candidemia [20]. Additionally, non-albicans species themselves may also play a critical role in the pathogenesis of persistent candidemia due to their notorious capabilities of adherence to foreign surfaces, high virulence, and inherent or potential resistance to fluconazole [2,3,9,19,[21][22][23]. ...
Background:
The prevalence and risk factors for persistent candidemia among very low birth weight infants are poorly understood. This study aimed to investigate the epidemiology of persistent candidemia over a 4-year period in a neonatal intensive care unit (NICU) in Liuzhou, China.
Methods:
We retrospectively extracted demographic data, risk factors, microbiological results and outcomes of very low birth weight infants with candidemia in our hospital between January 2012 and November 2015. Persistent candidemia was defined as a positive blood culture for > 5 days. Logistic regression was used to identify risk factors associated with persistent candidemia.
Results:
Of 48 neonates with candidemia, 28 had persistent candidemia. Both mechanical ventilation and intubation were significantly associated with increased rates of persistent candidemia (P = 0.044 and 0.004, respectively). The case fatality rate for the persistent candidemia group was 14.3%.
Conclusion:
The rate of persistent candidemia was high among very low birth weight neonates. Mechanical ventilation and intubation were the major factors associated with the development of persistent candidemia. This study highlights the importance of intensive prevention and effective treatment among neonates with persistent candidemia.
