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Order rank of the different species of Candida causing invasive candidiasis (A) and candidemia (B) in all medical and surgical patients.
Source publication
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...
Contexts in source publication
Context 1
... our cohort, Candida non-albicans accounted for the majority of species causing invasive candidiasis (56.2% of all cases) as described in Figure 1A. The most frequent species were albi- cans (n ¼ 62, 38.3%), tropicalis (n ¼ 27, 16.7%), glabrata (n ¼ 26, 16%), and parapsilosis (n ¼ 22, 13.6%). In patients with candidemia, non-albicans species were more prevalent (74.1%; Figure 1B)
...
Context 2
... our cohort, Candida non-albicans accounted for the majority of species causing invasive candidiasis (56.2% of all cases) as described in Figure 1A. The most frequent species were albi- cans (n ¼ 62, 38.3%), tropicalis (n ¼ 27, 16.7%), glabrata (n ¼ 26, 16%), and parapsilosis (n ¼ 22, 13.6%). In patients with candidemia, non-albicans species were more prevalent (74.1%; Figure 1B)
...
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Background
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Objectives
We reported the pharmacokinetic/pharmacodynamic (PK/PD) targets of the biosimilar product of ABCD (G-ABCD) against Candida albicans (MIC 1-2 μg/mL) in a rat model of invasive candidiasis in order to facilitate its precision administration.
Methods
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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...
Citations
... Although the disease burden is lower in the paediatric population than in adults, there have been 256 reported cases in children, mostly from South Africa and South Asia [42]. Mortality rates for paediatric patients with C. auris bloodstream infections were up to 40%, which is lower than that of adult patients [42][43][44]. Healthcare-acquired transmission of C. auris mainly affects individuals with chronic illnesses, a history of other resistant pathogens, and invasive medical devices such as mechanical ventilation, tracheostomies, feeding tubes, and urinary catheters [30,45]. The halotolerance of C. auris enables it to survive on the skin, particularly in areas that are frequently exposed to high salinity and temperatures during periods of strenuous physical activity, such as the axilla and groin [46]. ...
Candida auris has been identified by the World Health Organization (WHO) as a critical priority pathogen on its latest list of fungi. C. auris infections are reported in the bloodstream and less commonly in the cerebrospinal fluid and abdomen, with mortality rates that range between 30% and 72%. However, no large-scale epidemiology studies have been reported until now. The diagnosis of C. auris infections can be challenging, particularly when employing conventional techniques. This can impede the early detection of outbreaks and the implementation of appropriate control measures. The yeast can easily spread between patients and in healthcare settings through contaminated environments or equipment, where it can survive for extended periods. Therefore, it would be desirable to screen patients for C. auris colonisation. This would allow facilities to identify patients with the disease and take appropriate prevention and control measures. It is frequently unsusceptible to drugs, with varying patterns of resistance observed among clades and geographical regions. This review provides updates on C. auris, including epidemiology, clinical characteristics, genomic analysis, evolution, colonisation, infection, identification, resistance profiles, therapeutic options, prevention, and control.
... Candidemia is the fourth most common healthcare-associated bloodstream infection (BSI) [1,2]. Multiple studies over the last two decades have highlighted an overall increase in prevalence and incidence rates in candidemia in all clinical wards [3][4][5]. Patients affected by candidemia are frequently immunocompromised, critically ill, low-weight newborns and subjects who underwent surgical procedures [3][4][5]. Clinical implications and consequences of such an invasive fungal infection include prolonged hospital stay and even death, as candidemia-attributable mortality rates range from 30% to 50% [4,6]. ...
... Multiple studies over the last two decades have highlighted an overall increase in prevalence and incidence rates in candidemia in all clinical wards [3][4][5]. Patients affected by candidemia are frequently immunocompromised, critically ill, low-weight newborns and subjects who underwent surgical procedures [3][4][5]. Clinical implications and consequences of such an invasive fungal infection include prolonged hospital stay and even death, as candidemia-attributable mortality rates range from 30% to 50% [4,6]. In a recent study fluconazole-resistant isolates in Africa and 13.3% across Europe. ...
Candidemia is the fourth most common healthcare-related bloodstream infection. In recent years, incidence rates of Candida parapsilosis have been on the rise, with differences in prevalence and antifungal susceptibility between countries. The aim of the present study was to evaluate temporal changes in prevalence and antifungal susceptibility of C. parapsilosis among other species causing candidemia. All candidemia episodes from January 2015 to August 2022 were evaluated in order to depict time trends in prevalence of C. parapsilosis sensu stricto among all Candida species recovered from blood cultures as well as fluconazole- and voriconazole-non-susceptibility rates. Secondary analyses evaluated time trends in prevalence and antifungal non-susceptibility according to clinical settings. The overall prevalence of C. parapsilosis was observed to increase compared to the prevalence of other Candida species over time (p-trend = 0.0124). From 2019, the number of C. parapsilosis sensu stricto isolates surpassed C. albicans, without an increase in incidence rates. Overall rates of fluconazole- and voriconazole-non-susceptible C. parapsilosis sensu stricto were both 3/44 (6.8%) in 2015 and were 32/51 (62.7%) and 27/51 (52.9%), respectively, in 2022 (85% cross-non-susceptibility). The risk of detecting fluconazole- or voriconazole-non-susceptibility was found to be higher in C. parapsilosis compared to other Candida species (odds ratio (OR) = 1.60, 95% CI [1.170, 2.188], p-value < 0.0001 and OR = 12.867, 95% CI [6.934, 23.878], p-value < 0.0001, respectively). This is the first study to report C. parapsilosis sensu stricto as the most prevalent among Candida spp. isolated from blood cultures, with worrisome fluconazole- and voriconazole-non-susceptibility rates, unparalleled among European and North American geographical regions.
... This is similar in distribution to other regions of the world. However, the epidemiology of candidemia and IC in different patient populations (e.g., intensive care unit (ICU), neutropenic) has not been studied extensively in the Middle East [19,21]. There is also a lack of published regional studies specifically on invasive aspergillosis (IA), other invasive mold infections, and infection with dimorphic fungi such as histoplasmosis in this region [5]. ...
Invasive fungal infection (IFI) is a significant global healthcare concern among critically ill and immunocompromised patients. In Middle Eastern countries, IFI has been steadily increasing among hospitalized patients in the past two decades. Diagnosis of IFI at an early stage is crucial for efficient management. Invasive fungal infection management is complex and requires the involvement of physicians from different specialties.
There are several challenges associated with IFI management in the countries in the Middle East. This review aims to understand the key challenges associated with IFI management in the Middle East, encompassing epidemiology, diagnosis, therapeutic options, and optimizing a multidisciplinary approach. In addition, this review aims to incorporate expert opinions from multidisciplinary fields for optimizing IFI management in different Middle Eastern countries by addressing key decision points throughout the patient’s journey. Lack of epidemiological data on fungal infections, slow and poorly sensitive conventional culture-based diagnostic tests, limited availability of biomarker testing, lack of awareness of clinical symptoms of the disease, limited knowledge on fungal infections, lack of local practice guidelines, and complicated disease management are the major challenges associated with IFI diagnosis and management in the Middle Eastern countries. Implementation of a multidisciplinary approach, antifungal stewardship, improved knowledge of fungal infections, the use of rapid diagnostic tests, and enhanced epidemiological research are warranted to lower the IFI burden in the Middle East.
... China (36.1%), Kuwait (31%), and Egypt (27.8% in adults,and 48.3% in pediatrics) (Lin et al., 2018;Mencarini, 2018;Al-Dorzi et al., 2020;Alobaid et al., 2021;Reda et al., 2023). Results of our study highlighted that the most commonly isolated NACs were C. parapsilosis (18.6%), followed by C. krusei (11.2%), C. tropicalis (10.6%), and C. glabrata (10.6%). ...
... In addition, different species of Candida also have different prognoses in patients with bloodstream infection. Al-Dorzi et al, 8 in monitoring 174 patients with fungal bloodstream infections at a Saudi hospital ICU, found higher mortality for C. albicans compared with C. non-albicans. However, in a study in a Thai hospital, Candida tropicalis caused a higher mortality. ...
... 14 Koehler 15 et al conducted a meta-analysis of candidemia in European countries and found that there were considerable differences among different central strains, with Candida nonalbicans strains generally dominating. The results of this study show that Candidia non-albicans accounted for more than half of the Candida bloodstream infections in our hospital, which were similar to domestic reports, but showed different results reported for a university teaching hospital in Saudi Arabia by Tariq et al. 8,16 This may be related to the highest, accounting for 47.5%. Our data show that the infection rate of Candida bloodstream infection in patients ≥60 years old was 55.83%, and the infection rate gradually increased with increasing age, which was similar to that report. ...
Background
Candida is one of the most important pathogens of hospital-acquired bloodstream infections. Its morbidity and mortality are still high, which is a serious global public problem.
Purpose
To investigate the strain distribution, drug susceptibility, clinical characteristics of patients, and risk factors affecting the prognosis of Candida bloodstream infection (BSI).
Materials and Methods
We retrospectively collected the clinical data, infection-related indicators, prognosis, strain prevalence and drug susceptibility of 163 patients with Candida BSI in a teaching hospital from January 2012 to December 2022. Univariate and multivariate logistic regression were used to analyze the risk factors affecting the prognosis.
Results
In 163 cases of Candida BSI, Candida albicans accounted for 48.47%, and Candida non-albicans accounted for 51.53%. A total of 163 patients with Candida BSI were mainly distributed in intensive care unit (ICU) and emergency department, accounting for 40.49% and 14.72%, respectively. The resistance rate of Candida albicans to fluconazole, itraconazole and voriconazole was less than 10%, and the sensitivity rate of Candida tropicalis to fluconazole, itraconazole and voriconazole was less than 80%. The mortality rate of 163 patients with Candida BSI was 33.13%, with Candida non-albicans higher than that of Candida albicans (p = 0.04). Multivariate analysis showed that hemodialysis (OR = 0.199, 95% CI: 0.059–0.673, P = 0.009), arteriovenous catheters (OR = 0.344, 95% CI: 0.130–0.913, P = 0.032), elevated neutrophil count (OR = 0.409, 95% CI: 0.194–0.862, P = 0.019) and APACHE II score (OR = 0.848, 95% CI: 0.789~0.911, P < 0.001) were independent risk factors for death in patients with candidemia.
Conclusion
The blood flow infection rate of Candida non-albicans is increasing, and the mortality rate and resistance to antifungal drugs are higher than that of Candida albicans. Hemodialysis, arteriovenous catheters, elevated neutrophil count and APACHE II score were associated with death in patients with Candida BSI.
... Invasive candidiasis (IC) occurs in almost 9% of those patients, primarily by translocation to the bloodstream (Al-Dorzi et al., 2020). Invasive candidiasis results in prolonged hospital stay, increased costs of medical care and high mortality rates (Fernando et al., 2022). ...
... The epidemiology of Candida spp. and their antifungal susceptibilities vary greatly in different regions (Al-Dorzi et al., 2020). Four classes of antifungal drug were used for the treatment of systemic fungal infections. ...
... and C. krusei (0-7.8%). Also, Al-Dorzi et al., (2020) where CNA accounted for the majority of spp. causing IC 56.2%. ...
... It can be further observed that Candida albicans is the most dominant Candida species reported by HCPs in our study (70%) and others were not dominantly reported including Candida tropicalis (8%) and Candida parapsilosis (4.8%). Literature from Saudi Arabia reported that Candida albicans is the most commonly detected Candida species [28][29][30]. However, in the study by Aldardeer et al. [4], Candida glabrata was the most commonly specified blood culture of Candida species followed by C. albicans, which is not consistent with our results. ...
Management of invasive fungal infections (IFI) and subsequent treatment choices remain challenging for physicians in the ICU. Documented evidence shows increased practice of the inappropriate use of antifungal agents in the ICU. Continuous education of healthcare providers (HCPs) represents the cornerstone requirement for starting an antifungal stewardship program (AFS). This study aimed at evaluating knowledge gaps in systemic antifungal prescribing among physicians and clinical pharmacists in a critical care setting. A cross-sectional, multi-center, survey-based study was conducted in five tertiary hospitals located in Al-Ahsaa, Saudi Arabia between January and May 2021. A self-administered questionnaire was distributed among the targeted clinicians. A total of 63 clinicians were involved (65.5% ICU physicians and 34.5% clinical pharmacists). It was noted that a minority of the participating HCPs (3.2%) had overall good knowledge about antifungal prescribing, but the majority had either moderate (46%) or poor (50.8%) knowledge. The difference in overall knowledge scores between the ICU physicians and the clinical pharmacists (p = 0.925) was not significant. However, pharmacists showed better scores for the pharmacokinetics of antifungal therapy (p = 0.05). This study has revealed a significant gap in the knowledge and practice of clinicians as regards prescribing antifungal therapy in our area. Although the results cannot be generalized, the outcome of this study has exposed the need for a tailored training program essential for carrying out an AFS program.
... Invasive candidiasis is an important problem for critically ill patients admitted to intensive care unit (ICU) because it increases length of stay and mortality. [1] Majority of invasive candidiasis was developed in ICU; only approximately one tenth was discovered before admission to ICU. [2] The most common cause of invasive fungal disease is Candida, followed by Aspergillus and other fungi such as Mucor. [3,4] Candida is a commensal organism in human body, and if accompanied by host or environmental factor, it can turn into pathogenic form. ...
... Critically ill patients are particularly vulnerable, with 62.5% of invasive candidiasis was developed during ICU admission. [1] For surgical patients, 89.2% of those cases were diagnosed in ICU setting. [9] Prompt identification of invasive fungal infection is essential so that antifungal treatment can be administered rapidly. ...
... [11] Al-Dorzi conducted a prospective cohort study in two tertiary centers and reported that invasive candidiasis was developed on a median of five days after ICU admission (25th and 75th percentiles = 1 and 8 days, respectively). [1] On the basis of those findings, we conducted serial testing of laboratory, microscopic, and culture on day-1, day-5, and day-9, which was around time considered as development and pathogenesis of Candida in host tissue. immunosuppresion, malignancies, diabetes mellitus, urinary catheter, and liver or pulmonary diseases had been known as risk factors for invasive fungal disease. ...
Background: Majority of invasive candidiasis in critically ill patients was developed after admission to intensive care unit. The aim of this study was to identify risk factors for development of invasive candidiasis among patients admitted to intensive care unit, especially considering the timing of laboratory, microscopic, and culture examinations. Materials and Methods: This was a prospective observational study in which critically ill patients were assessed on the first, fifth, and ninth day since admission to intensive care unit. Potential risk factors were demographic and clinical characteristic, clinical managements profile proportions, laboratory profile (leukocyte, platelet, erythrocyte sedimentation rate, C-reactive protein and procalcitonin), morphological change (from yeast to hypae or pseudohyphae in microscopic examination) and colonization increase (from serial culture examination). Results: A total of 115 subjects enrolled in this study. Multivariate analysis identified older age (HR 2.8, 95% CI 0.8–8.9), parenteral nutrition (HR 3.1, 95% CI 0.77–12.3), central venous catheter (HR 1.7, 95% CI 0.43–6.67), corticosteroid (HR 2.8, 95% CI 0.53–14.8), procalcitonin day-5 (HR 3.1, 95% CI 0.89–10.8), morphology change in the axilla and rectal swab (HR 5.1, 95% CI 1.6–18.51), and morphology change and colonization increase in rectal swab day-9 (HR 4.3, 95% CI 1.0–18.02) as independent risk factors of invasive candidiasis. Conclusion: In addition to several typical risk factors, procalcitonin test on day-5 as well as serial microscopic and culture examinations were associated with the development of invasive candidiasis, therefore potentially help in the diagnosis and treatment of critically ill patients in intensive care unit.
... It is 16.5/1000 admissions in Italy (Montagna et al., 2013) and 6.7/1000 admissions in France (Sasso et al., 2017). It is 26/1000 admissions in Saudi Arabia (Aldorzi et al., 2018), 2.49/1000 admissions in Brazil (Yapar, 2014), and 0.026/ 1000 admissions in Norway (Berdal et al., 2014). Our series studied candidemia in adults; the mean age of patients was 55 ± 15.9 years, with age extremes ranging from 23 to 88 years. ...
Background: patients, is of poor prognosis. Our study aimed to study the epidemiology of a series of candidemia and the factors favoring their aggravation in the intensive care unit (USI) of the Military Hospital of Tunis. and the UCI of the Military Hospital of Tunis over six years. Blood cultures were performed in the MYCOSIS chlamydospor software. of 1.7%, or 17.5 episodes of candidemia per 1000 admissions. The average cases/year. The mean age of the patients was 55 ± 15.9 years. We noted a male predominance in 59% of cases with a sex ratio of 1.4. The study of the pathological antecedents showed that these patients were followed mainly for pancr The predominantly isolated species was isolation of high mortality. candidemia in a Tunisian series. It can help resuscitators by allowing an optimization of the recommendations for the treatment of candidemia Copyright©2022, Tasnime Labiedh et al. This is an open use, distribution, and reproduction in any medium, provided
... Prior studies show that 33-55% of all candidemia infections occur in the ICU and 5-71% of these cases are reported to result in mortality. 15,16 In a multicentre study evaluating candida infections in 23 ICUs in Europe, crude 30-day mortality was reported to be 42%. 17 Other studies estimating attributable mortality rates show values between 40-50%. ...
... The APACHE II score, which is widely used in the ICU and is one of the important tools in showing prognosis, has been shown to accurately measure the severity of the disease and is also strongly associated with mortality in critically-ill patients. 26 In addition, it has been frequently emphasized that a high APACHE II score may be a predictor of mortality in patients with candida infection, 16,27,28 similar to our findings. In a recent study, it was reported that an APACHE II score above 20 was an independent risk factor for mortality in patients with candidiasis. ...
Background
Candidemia is the most common invasive fungal disease in intensive care units (ICUs).
Objective
We aimed to investigate cases of candidemia infection developing in the ICU and factors associated with mortality due to this infection.
Materials and Methods
This is a retrospective study including patients admitted to a tertiary university hospital ICU between January 2012 and December 2020. Patients over 18 years of age who had candida growth in at least one blood culture taken from central or peripheral samples (>48 h after admission to the ICU) without concurrent growth were evaluated.
Results
The study group consisted of 136 patients with candida. Eighty-seven (63.97%) patients were male, with a median age of 69.5 (59–76.5) years. The 7-day mortality rate was 35.29%, while the 30-day mortality rate was 69.11%. As a result of multiple logistic regression analysis, after adjusting for age and malignancy, high APACHE II score and low platelet-lymphocyte ratio (PLR) - were found to be significant factors in predicting both 7-day and 30-day mortality.
Conclusion
In this study, PLR and APACHE II scores were shown to be independent predictors of mortality in patients with candidemia in the ICU.
