Cases Of Fungemia Research Articles

A fatal neonatal case of fungemia due to Exophiala dermatitidis—case report and literature review

BackgroundSystemic infections caused by the black yeast-like fungus Exophiala dermatitidis are rare, but are associated with high mortality especially in immunocompromised patients. We report the first case of E. dermatitidis fungemia in a premature extremely low birth weight (ELBW) neonate who succumbed despite antifungal therapy with liposomal amphotericin (AMB) and fluconazole. A systematic review of all fungemia cases due to E. dermatitidis was also conducted aiming for a better understanding of the risk factors, treatment strategies and outcomes.Case presentationA male, ELBW premature neonate, soon after his birth, developed bradycardia, apnoea and ultimately necrotizing enterocolitis with intestinal perforation requiring surgical intervention. Meanwhile, he had also multiple risk factors for developing bloodstream infection, such as intubation, mechanical ventilation, central venous catheter (CVC), parenteral nutrition, empirical and prolonged antibiotic use. His blood cultures were positive, firstly for Acinetobacter junii and then for Klebsiella pneumoniae together with E. dermatitidis while on fluconazole prophylaxis and antibiotic empiric therapy. Despite the treatment with broad spectrum antibiotics, liposomal AMB and fluconazole, the newborn succumbed. A literature review identified another 12 E. dermatitidis bloodstream infections, mainly in patients with hematologic malignancies and solid organ transplant recipients (61%), with overall mortality 38% despite CVC removal and antifungal therapy.ConclusionsDue to the rarity of E. dermatitidis infections, little is known about the characteristics of this yeast, the identification methods and the optimal therapy. Identification by common biochemical tests was problematic requiring molecular identification. Resolution of neonatal fungemia is difficult despite proper antifungal therapy especially in cases with multiple and severe risk factors like the present one. Therapeutic intervention may include CVC removal and treatment for at least 3 weeks with an azole (itraconazole or fluconazole after susceptibility testing) or AMB monotherapy but not echinocandins or AMB plus azole combination therapy.

Impact of the COVID-19 Pandemic on the Clinical Profile of Candidemia and the Incidence of Fungemia Due to Fluconazole-Resistant Candida parapsilosis.

Severely ill COVID-19 patients are at high risk of nosocomial infections. The aim of the study was to describe the characteristics of candidemia during the pre-pandemic period (January 2019–February 2020) compared to the pandemic period (March 2020–September 2021). Antifungal susceptibilities were assessed using the EUCAST E.Def 7.3.2 broth dilution method. Fluconazole-resistant C. parapsilosis isolates (FRCP) were studied for sequencing of the ERG11 gene. The incidence of candidemia and C. parapsilosis bloodstream infection increased significantly in the pandemic period (p = 0.021). ICU admission, mechanical ventilation, parenteral nutrition and corticosteroids administration were more frequent in patients with candidemia who had been admitted due to COVID-19. Fifteen cases of FRCP fungemia were detected. The first case was recorded 10 months before the pandemic in a patient transferred from another hospital. The incidence of FRCP in patients admitted for COVID-19 was 1.34 and 0.16 in all other patients (p < 0.001). ICU admission, previous Candida spp. colonization, arterial catheter use, parenteral nutrition and renal function replacement therapy were more frequent in patients with candidemia due to FRCP. All FRCP isolates showed the Y132F mutation. In conclusion, the incidence of candidemia experienced an increase during the COVID-19 pandemic and FRCP fungemia was more frequent in patients admitted due to COVID-19.

The prevalence of pulmonary aspergillosis in coronavirus disease 19 (COVID-19) patients in Shebin El-Kom teaching hospital in Egypt

BackgroundA high rate of invasive fungal infection has been demonstrated among critically COVID-19 ill patients admitted to the ICU, with high odds of mortality. Simple and rapid risk stratification methods are mandatory to recognize severe patients.ObjectivesThe aims was to study the prevalence of invasive fungal infection in Corona virus disease 19 (COVID-19) patients, the effect of some inflammatory markers that lead to the development and progression of invasive fungal infection and to assess the value of PCR in early and rapid detection of invasive fungal infection in immune compromised patients with COVID-19.MethodsThis study was conducted at the period from October 2020 to October 2021 on two groups classified as following: Group I: included 120 immuno-compromised inpatients (2-80 years), (68 males and 52 females) from ICUs. Group II: included 40 outpatient's COVID-19 (4 – 56 years). All basic laboratory biomarkers at time of admission were recorded.ResultsOf this study showeda highly significant increase in neutrophil/ lymph, IL6,CRP, D-dimer and malondialdhyde (MDA) in COVID-19 patients in ICU compared with outpatient one with P value < 0.001). No significant difference between them in LDH, ferritin and procalcitonine. The most common isolated organisms (167 isolates) from group I (230 samples from 120 patients) were bacterial spp. (111/167, 66.5%)followed by Candida spp. (30, 17.9%), Aspergillus spp. (11, 6.6%) while mucormycosis was 5 isolates (3%) and associated bacterial infection represented 5.9%of all. Out of 120 patients suspected of complaining of BSI 17 (14.1%) of them proved to be fungemia. The most common isolated yeast was Candida spp. (11/120, 9.1%) followed by Aspergillus spp. (6/120, 5%). While out of 20 patients (group I) suspected of complaining of eye infections, mucormycosis was represented by 5/20 (25%). Fungaemia was detected by PCR and blood culture in 50 high risk ICU patients was 22/50 (44%) and 17/50 (34%) respectively. PCR is more sensitive than blood culture, as blood culture failed to detect 5 cases of fungemia with a significant difference (P-value <0.05).ConclusionIncrease in neutrophil/lymph, IL6,CRP, D-dimer and MDA in COVID-19 ICU patients compared with outpatients may be significant biomarkers used to detect severity of disease in ICU patients and monitor treatment. Also decrease in immunity as results of corticostorides admission, lead to presence of fungaemia in some patients in ICU.

348. Characteristics and Outcomes in Hospitalized Patients with Covid-19 Complicated by Fungemia: A Single Center Retrospective Study

BackgroundCovid19 caused by SARS-CoV2 can lead to significant morbidity and mortality. Fungemia is a rare hospital-associated infection and there are limited data regarding its association with Covid19. We reviewed all cases of fungemia in our Covid19 cohort at Stony Brook University Hospital (SBUH). MethodsWe conducted a retrospective medical record review of patients admitted with Covid19 in a 3-month interval. We reviewed positive blood cultures for fungi and recorded co-morbidities, co-infections, length of stay, treatments, and outcomes (survival vs death). There were 60 positive blood cultures for fungi in 25 unique patients (Table 1); in prior years < 30 per year reported at SBUH.Table 1. Fungal Blood Cultures Collation of each unique identified fungal species from fungal blood cultures in patients hospitalized with Covid-19ResultsDuring a 3 month interval at the local peak of the pandemic 1398 patients hospitalized with Covid19 at SBUH, 25 cases of fungemia were detected; C. albicans (CA) n=8,32%, non C albicans species (nCA) n=16,64%, and C. neoformans n=1,4%, 17/25 (68%) also with bacteremia during same hospitalization. In same 3 months there were 264 cases of bacteremia and Covid19 co-infection. Demographics and medical co-morbidities of fungemic patients are in Table 2. Majority were men (76%). No difference between fungaemic (FC) and total cohort (TC) in median age (62 vs 62), DM p=0.31, HTN p=1.0, COPD p=0.12. Within FC, DM was higher in nCA group (58.8%) vs CA group (37%). Mortality was 40% in FC vs 15% in TC, p< 0.001. Within FC mortality was 56% in nCA and 25% in CA group. C. parapsilosis was the most common nCA species isolated with 43% mortality. FC more likely to require ICU and mechanical ventilation (88% vs 15%, p< 0.0001) and had longer median length of stay 42 days vs 22 days. The median time from admission to fungaemia was 21d, from central line placement 19d, Table 3. Of FC 21 (84%) were treated with steroids/Tocilizumab concurrently. Of note, no mortality was recorded in the 4 patients that did not receive steroids/Tocilizumab. PCT and WBC were significantly higher at time of fungemia as compared to admission, Table 3. Table 2, Patient co-morbidities and hospitalization stay characteristics Co-morbidities and requirement for ICU stay, mechanical ventilation for total cohort Covid-19 and fungemic cohortTable 3, Patient Characteristics and Laboratory Parameters Relevant patient characteristics and laboratory parameters in patients hospitalized with Covid19 and fungemiaConclusionFungemia in hospitalized patients with COVID-19 is associated with higher mortality. We observed higher fatality in non C. albicans infections. Prolonged use of central line catheters and concurrent treatment with steroids/tociluzimab are likely high-risk factors for development of fungemia. Disclosures All Authors: No reported disclosures

β-1,3-d-Glucan and Galactomannan as Biomarkers for the Detection of Invasive Geotrichum and Magnusiomyces Infections: a Retrospective Evaluation.

Magnusiomyces and Geotrichum species are ascomycetous yeasts that can cause potentially life-threatening invasive fungal infections commonly referred to as geotrichosis. In this study, we aimed to estimate the incidence and mortality of these infections in a German tertiary care center. Furthermore, we evaluated the suitability of the fungal biomarkers galactomannan (GM) and β-1,3-d-glucan (BDG), which are both recommended as surrogate markers for Magnusiomyces capitatus infection by the European Society of Clinical Microbiology and Infectious Diseases (ESCMID) and the European Confederation of Medical Mycology (ECMM) joint clinical guidelines for the diagnosis and management of rare invasive yeast infections for detection of invasive geotrichosis. Cases meeting the inclusion criteria for invasive Magnusiomyces/Geotrichum infection were retrospectively identified. Serum samples and culture supernatants were analyzed with two commercially available fungal antigen tests (Platelia Aspergillus Ag EIA and Wako β-glucan test). For a control cohort, outpatient samples sent for lues testing were included. Thirty-eight cases of Magnusiomyces/Geotrichum infection were identified over an 11-year observation period. In the majority of cases, the fungus was isolated from intra-abdominal specimens of patients with a history of abdominal surgery/procedures (n = 32). All cases of fungemia occurred exclusively in haemato-oncologic patients (n = 14). Thirty-day survival was 42% in the fungemia and 43% in the intra-abdominal geotrichosis group. Serum samples were available for 23 patients (14 bloodstream and nine intra-abdominal infections). While BDG sensitivity was 65%, none of the sera was GM positive. This finding was supported by in vitro experiments analyzing fungal culture supernatants: M. capitatus secretes significant amounts of BDG but not GM. Specificity was 96% for BDG and 100% for GM. Magnusiomyces and Geotrichum infections are not limited to haemato-oncologic patients. Contrasting the current ESCMID/ECMM recommendation, our results indicate that GM is no suitable biomarker for the diagnosis of Magnusiomyces infection. Contrarily, BDG sensitivity is comparable to that of candidemia.

Fungemia and Other Fungal Infections Associated with Use of Saccharomyces boulardii Probiotic Supplements.

Abstract Because of widespread use of probiotics, their safety must be guaranteed. We assessed use of Saccharomyces boulardii probiotic yeast from medical records for patients who had Saccharomyces fungemia or other clinical Saccharomyces culture findings. We evaluated all Saccharomyces sp. findings at 5 university hospitals in Finland during 2009–2018. We found 46 patients who had Saccharomyces fungemia; at least 20 (43%) were using S. boulardii probiotic. Compared with a control group that had bacteremia or candidemia, the odds ratio for use of an S. boulardii probiotic was 14 (95% CI 4–44). Of 1,153 nonblood culture findings, the history for 125 patients was checked; at least 24 (19%) were using the probiotic (odds ratio 10, 95% CI 3–32). This study adds to published fungemia cases linked to use of S. boulardii probiotic and sheds light on the scale of nonblood Saccharomyces culture findings that are also linked to use of this probiotic.

COVID-19 with Sporotrichosis (aka Sporothrix schenckii) and Fusobacterium Bloodstream Infections (BSI)

We present a case of COVID-19 complicated by sporotrichosis and fusobacterium blood stream infections - no known prior cases of sporotrichosis fungemia nor polymicrobial fusobacterium bloodstream infections in COVID-19 patients. Severe COVID-19, uncontrolled diabetes mellitus (DM), and prolonged corticosteroid use contributed to immune dysregulation, increasing the patient's vulnerability to blood stream infection. This highlights the importance of vigilance regarding risks and complications of steroid use in COVID-19 patients.

Low sensitivity of conventional fungal agars in fungemia by Rhodotorula mucilaginosa: description of two cases

BackgroundAlthough most bloodstream yeast infections are caused by Candida spp., infections by rare or less common species have increased in recent years. Diagnosis of infections caused by these species is difficult due to the lack of specific symptoms and adequate diagnostic tools.Cases presentationWe describe two cases of fungemia by Rhodotorula mucilaginosa within a few months of each other, in a secondary Spanish hospital. In both cases, diagnosis was challenging. Blood subcultures in conventional fungal media were persistently negatives and the use of non-conventional fungal media was essential for isolating the yeasts and achieving a correct diagnosis. 1–3 beta-d-glucan detection and a panfungal PCR assay were helpful techniques to confirm the diagnosisConclusionIt is highly important to establish an early diagnosis for fungemia. The process is challenging because often non-specific symptoms are presents. When yeasts grow in blood cultures other genera than Candida spp. could be the cause of infection. Patient risk factors should be assessed to incorporate alternative culture media and the available rapid diagnostic test, in order to provide an early recognition of the pathogen.

Two Cases of Fungemia after Endoscopic Variceal Obturation for Gastric Variceal Bleeding

Fever is a common complication of endoscopic variceal obturation (EVO) therapy for gastric variceal bleeding. However, fungemia related to EVO therapy has not yet been reported. Herein, we report two cases of post-EVO fungemia in cirrhotic patients who underwent therapeutic EVO for gastric variceal bleeding. Both patients developed sustained high fever after repeated EVO procedures while on prophylactic antibiotic use. In both patients, blood cultures revealed yeast, and they were finally diagnosed with Candida infection. Candida is a common member of the intestinal flora; however, it can cause invasive infection with consequent poor prognosis in cirrhotic patients. The route of Candida invasion is unclear; however, repeated EVO may predispose patients to Candida infection, particularly those who are in the end stage of liver disease and receiving prophylactic antibiotics. Our cases highlight that repeated invasive procedures can increase the risk of fungal infections, and fungemia should be considered in the differential diagnosis of post-EVO fever.

1167. Got Micafungin? The Incidence of Fungemia in Patients with Septic Shock

BackgroundTimely administration of antibiotics in patients presenting with sepsis decreases mortality, however evidence evaluating empiric antifungal coverage has been inconclusive. Recent data have shown no mortality benefit of empiric antifungal therapy in patients with ICU-acquired sepsis. Despite the lack of data, the Surviving Sepsis Campaign recommends empiric coverage for all suspected pathogens, including fungi. The purpose of this study is to determine the frequency of concomitant septic shock and fungemia at UMass Memorial Medical Center, a large tertiary care center.MethodsThis was a retrospective cohort study that included adult patients with a discharge diagnosis of severe sepsis or septic shock and/or fungemia admitted to UMMMC between October 2017 and October 2019. Patients with positive fungal blood cultures were further reviewed to identify if septic shock was present within 24 hours of blood culture collection. Additionally, risk factors for fungemia and 30-day mortality were assessed. Exclusion criteria included pregnancy, cultures from outside hospitals, incarceration, and hospice care.ResultsIn the analysis period, 4,253 patients had a discharge diagnosis of severe sepsis or septic shock. There were 68 cases of fungemia. In total, 54 patients with fungemia were included after applying exclusion criteria. Of the 54 patients with fungemia, 8 patients (15.1%) met criteria for septic shock at the time of positive blood culture, while 81% met SIRS criteria. Of the 4,253 total patients, 0.19% had coexisting fungemia and septic shock. At 30 days, four patients (7.4%) with both septic shock and fungemia had expired out of 12 total deaths. Three of the four deaths had multiple risk factors for fungemia including central line in place for greater than 48 hours, parenteral nutrition, and prolonged antibiotic therapy.ConclusionSeptic shock is a rare presentation of fungemia. Most patients with septic shock and fungemia have known risk factors. Despite recommendations by the Surviving Sepsis Campaign to initiate therapy for all likely pathogens, including fungal species, the incidence of fungemia presenting as septic shock at our academic medical center was very low and does not appear to warrant empiric coverage.Disclosures All Authors: No reported disclosures

A Cluster of Candida auris Blood Stream Infections in a Tertiary Care Hospital in Oman from 2016 to 2019.

(1) Background: Candida auris has been reported as emerging yeast pathogen that can cause invasive bloodstream infections in healthcare settings. It is associated with high mortality rates and resistance to multiple classes of antifungal drugs and is difficult to identify with standard laboratory methods. (2) Methods: We conducted a retrospective review of epidemiological, clinical, and microbiological records for 23 C. auris fungemia cases at the Royal Hospital, a tertiary care facility in Oman, between 2016 and 2018. Demographic data, risk factors associated with mortality, microbiology investigation and treatment regimens are described. Yeasts were identified by MALDI-TOF. (3) Results: We identified 23 patients with C. auris fungemia. All positive samples from patients were confirmed as C. auris using MALDI-TOF, and ITS-rDNA sequencing. Microsatellite genotyping showed that the Omani isolates belong to the South Asian clade I. The majority of patients had multiple underlying illnesses and other risk factors that have been associated with fungemia. All isolates were non-susceptible to fluconazole. Isolates from all patients were sensitive to echinocandins and these were used as first line therapy. (4) Conclusions: Candida auris affects adults and children with a variety of risk factors including central venous catheters and overuse of antibiotics. Infections occur in both immunocompromised and immunocompetent individuals. Mortality was high in this series, and the organism can be transmitted in healthcare settings. Programs for raising awareness in Oman hospitals are warranted. Caspofungin remains 1st line therapy as MICs are still low despite its wide use.

The Development and Validation of a Machine Learning Model to Predict Bacteremia and Fungemia in Hospitalized Patients Using Electronic Health Record Data.

Bacteremia and fungemia can cause life-threatening illness with high mortality rates, which increase with delays in antimicrobial therapy. The objective of this study is to develop machine learning models to predict blood culture results at the time of the blood culture order using routine data in the electronic health record. Retrospective analysis of a large, multicenter inpatient data. Two academic tertiary medical centers between the years 2007 and 2018. All hospitalized patients who received a blood culture during hospitalization. The dataset was partitioned temporally into development and validation cohorts: the logistic regression and gradient boosting machine models were trained on the earliest 80% of hospital admissions and validated on the most recent 20%. There were 252,569 blood culture days-defined as nonoverlapping 24-hour periods in which one or more blood cultures were ordered. In the validation cohort, there were 50,514 blood culture days, with 3,762 cases of bacteremia (7.5%) and 370 cases of fungemia (0.7%). The gradient boosting machine model for bacteremia had significantly higher area under the receiver operating characteristic curve (0.78 [95% CI 0.77-0.78]) than the logistic regression model (0.73 [0.72-0.74]) (p < 0.001). The model identified a high-risk group with over 30 times the occurrence rate of bacteremia in the low-risk group (27.4% vs 0.9%; p < 0.001). Using the low-risk cut-off, the model identifies bacteremia with 98.7% sensitivity. The gradient boosting machine model for fungemia had high discrimination (area under the receiver operating characteristic curve 0.88 [95% CI 0.86-0.90]). The high-risk fungemia group had 252 fungemic cultures compared with one fungemic culture in the low-risk group (5.0% vs 0.02%; p < 0.001). Further, the high-risk group had a mortality rate 60 times higher than the low-risk group (28.2% vs 0.4%; p < 0.001). Our novel models identified patients at low and high-risk for bacteremia and fungemia using routinely collected electronic health record data. Further research is needed to evaluate the cost-effectiveness and impact of model implementation in clinical practice.

Case report: nosocomial fungemia caused by Candida diddensiae

BackgroundCandida diddensiae, a yeast found in olive oil, is considered non-pathogenic to humans. Here, we describe the first case of fungemia caused by C. diddensiae in a hospitalized patient with underlying diseases.Case presentationA 62-year-old woman was admitted because of multiple contusions due to repeated falls and generalized weakness. She presented with chronic leukopenia due to systemic lupus erythematosus, and multiple cranial nerve neuropathies due to a recurring chordoma. She was given a lipid emulsion containing total parenteral nutrition (TPN) starting on the day of admission. Broad-spectrum antibiotics had been administered during her last hospital stay and from day 8 of this hospitalization. However, no central venous catheter was used during this hospital stay. Blood cultures obtained on hospital days 17, 23, and 24 yielded the same yeast, which was identified as C. diddensiae via sequence analyses of the internal transcribed spacer region and D1/D2 regions of the 26S ribosomal DNA of the rRNA gene. In vitro susceptibility testing showed that the minimum inhibitory concentration of fluconazole for all isolates was 8 μg/mL. On day 23, TPN was discontinued and fluconazole therapy was started. Blood cultures obtained on day 26 were negative. The fluconazole therapy was replaced with micafungin on day 26 and the patient exhibited improvements.ConclusionThe use of lipid TPN may potentially contribute to the occurrence of nosocomial fungemia by C. diddensiae, an unusual Candida species.

Yarrowia lipolytica causes sporadic cases and local outbreaks of infections and colonisation.

Yarrowia lipolytica belongs to the normal human microbiota but is also found in substrates with high contents in lipids and used in biotechnological processes. It is sometimes reported as human pathogen and especially in catheter-related candidaemia. Two apparently grouped cases of infections and/or contamination were reported involving 3 and 9 patients, respectively, in two hospitals. The goal of this study was to design a molecular tool to study the genetic diversity of Ylipolytica and confirm or not the common source of contamination during these grouped cases. Given that there is no genotyping method, we used genomic markers assessed on environmental isolates to determine intra-species relationship. We selected five highly polymorphic intergenic regions, totalling more than 3200bp and sequenced them for clinical (n=20) and environmental (n=14) isolates. Antifungal susceptibility was determined by EUCAST broth microdilution method. Multiple alignment of the five sequences revealed divergence of 0%-5.8% between isolates as compared to approximately 0.2%-0.25% after alignment of whole genomes, suggesting their potential usefulness to establish genetic relatedness. The analysis showed the multiple origins of the isolates. It uncovered two grouped case of fungaemia involving 3 and 2 patients, respectively. It also revealed several unrelated sporadic cases despite their temporal relationship and one probable laboratory contamination by a common yet uncovered source, explaining several consecutive positive cultures without infection. All isolates had high minimal inhibitory concentration (MIC) for flucytosine, the majority (14/34) was susceptible to fluconazole, and all to the other antifungal agents tested. This method could help elucidate cases related to the opportunistic pathogen Y lipolytica.

Outbreak of Dirkmeia churashimaensis Fungemia in a Neonatal Intensive Care Unit, India.

Bloodstream infections caused by uncommon or novel fungal species are challenging to identify and treat. We report a series of cases of fungemia due to a rare basidiomycete yeast, Dirkmeia churashimaensis, in neonatal patients in India. Whole-genome sequence typing demonstrated that the patient isolates were genetically indistinguishable, indicating a single-source infection.

A Fatal Case of Bloodstream Infection by Fusarium Solani in a Patient with Adrenocortical Carcinoma From Isfahan, Iran

Introduction: Fusarium species are hyaline saprophytic fungi that are frequently found in the soil, air, and water. They can cause severe systemic infections in immunocompromised patients. Clinical manifestations depend on the way of entry of the mold and host immune system status. The main ways of entrance are the airways, skin, and mucosal membranes. Disseminated fusariosis often occurs in patients with hematological disorders, patients with cancer, and solid organ transplant recipients. Case Presentation: Herein we report a case of Fusarium fungemia in a patient with adrenocortical carcinoma from Isfahan, Iran. The patient was a 41-year-old female with stage III adrenal cortical carcinoma. Despite antifungal therapy with liposomal amphotericin B, the patient passed away 6 days after admission. Internal transcribed spacer region sequencing applied for species identification and its sequence deposited in the GenBank (accession number: MK880379). Conclusions: Since the ideal strategies against invasive fungal infections remain uncertain and the mortality rate is high, we recommend primary prophylaxis with a broad-spectrum antifungal agent for vulnerable patients particularly those admitted to high-risk units such as oncology, hematology, and transplant units.

Semi-nested polymerase chain reaction over blood culture in detection of bloodstream fungal infection in leukemic children with febrile neutropenia

BACKGROUND: Children with hematologic malignancies are currently at a severe threat of developing bloodstream fungal infection (BSFI). The early detection of BSFI followed by appropriate management of these patients remains a challenge to the oncologist of today. The conventional method of detection like blood culture followed by identification is time-consuming and of low accuracy. The molecular approaches like polymerase chain reaction (PCR) and its variants like semi-nested PCR (SnPCR) can be an attractive alternative to diagnose early and accurately BSFI but need to be explored.OBJECTIVE: The aim of our study was to determine the utility of SnPCR over conventional blood culture in detecting BSFI in leukemic children with febrile neutropenia.MATERIALS AND METHODS: A total of 53 pediatric patients with febrile neutropenia due to hematological malignancy were included in this study. From each patient, blood sample was collected for conventional blood culture, while SnPCR was performed from the overnight incubated blood broth. The blood culture-positive isolates were further identified to species level using conventional techniques. The PCR products obtained were sequenced and results interpreted after nucleotide BLAST and refinement.RESULTS: Fungal DNA was detected in 13 (24.5%) febrile neutropenic patients by SnPCR, while the conventional blood culture could detect only 6 (11.3%) fungemia cases. The SnPCR had a sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of 93%, 100%, 100%, 98%, and 98%, respectively, versus 43%, 100%, 100%, 83%, and 85%, respectively, for blood culture. The results by SnPCR alone showed almost perfect agreement with the results of the combined method (κ = 0.95) in the detection of BSFI.CONCLUSION: The SnPCR method proved to be better compared to blood culture for the early and accurate detection of BSFI in febrile neutropenic pediatric patients.

Saccharomyces Cerevisiae Var. Boulardii Probiotic Yeasts As Etiological Agents Of Oportunistic Infections In Humans

Abstract S. cerevisiae var. boulardii yeasts, historically recognized as a separate species, are now considered a subspecies of S. cerevisiae. Strains of S. cerevisiae var. boulardii are widely used for prevention and treatment of disorders of human digestive system. The use of preparations based on S. cerevisiae var. boulardii impacts the functioning of the intestinal barrier, which leads to a change in the composition of the digestive tract microbiota and alleviates intestinal epithelial defects. Despite the clinically confirmed probiotic properties of these unicellular microorganisms, the number of reports of infections in humans has been increasing. Population studies suggest that S. cerevisiae yeasts are responsible for 0.1–3.6% of all cases of mycoses in patients receiving therapy with probiotics containing S. cerevisiae var. boulardii. The presence of a central venous catheter, parenteral nutrition, immunosuppression and co-morbidities in patients are considered as factors predisposing for infection. This work summarizes the most important information on biology of S. cerevisiae var. boulardii and presents the latest epidemiological data on fungemia caused by these fungi. 1. Introduction. 2. Applications of S. cerevisiae yeasts. 3. Isolation and taxonomy of probiotic yeasts S. cerevisiae var. boulardii. 4. Probiotic features of S. cerevisiae var. boulardii. 5. S. cerevisiae var. boulardii infections. 5.1. Review of S. cerevisiae var. boulardii fungemia cases. 6. Conclusions

Fungemia following Saccharomyces cerevisiae var. boulardii probiotic treatment in an elderly patient

The yeast Saccharomyces cerevisiae var. boulardii is a biotherapeutic agent used for the prevention and treatment of several gastrointestinal diseases. We report a case of fungemia in a patient suffering from Clostridiumdifficile-associated diarrhea and treated with metronidazole and a probiotic containing S. cerevisiae var. boulardii. The yeasts isolated from the blood culture and capsules were identified by MALDI-TOF MS and API ID 32 C as S. cerevisiae, and showed the same appearance and color on CHROMAgar Candida. Treatment with fluconazole 400mg/day was initiated and the probiotic was stopped. The patient was discharged from hospital in good condition and was referred to a rehabilitation center. We suggest that the potential benefit of S. cerevisiae var. boulardii should be accurately evaluated, especially in elderly patients. Moreover, all physicians should be trained in the use of probiotic agents and enquire whether the use probiotics was included in the patients’medical histories.

Outcomes of Endourologic Interventions in Patients with Preoperative Funguria

Introduction: Funguria is encountered in 1% to 5% of cultured urine specimens and may be a result of specimen contamination, colonization, or invasive infection. The characteristics and outcomes of patients with funguria undergoing endourologic intervention have not been evaluated. Materials and Methods: Patients with preoperative funguria undergoing endourologic intervention were retrospectively identified. Preoperative funguria was defined as a urine culture containing >10,000 colony forming units of fungus within 30 days of the operative intervention. Univariable and multivariable regression was performed to identify predictors of postoperative systemic inflammatory response syndrome (SIRS). Results: A total of 65 patients with preoperative funguria were identified, of whom 49 (75.4%) underwent ureteroscopy and 16 (24.6%) underwent percutaneous nephrolithotomy. Average patient age was 55.1 ± 18.3 years, body mass index was 31.8 ± 11.0, and Charlson comorbidity index was 2.52 ± 2.0. Twenty-three patients (35.4%) carried a diagnosis of neurogenic bladder, of whom 18 (27.7%) required indwelling or intermittent catheterization. In total 57 patients (87.7%) had been exposed to antibiotics in the 3 months before intervention. Eighteen (27.7%) patients met SIRS criteria postoperatively, of whom 11 (16.9%) required intensive care unit (ICU) admission. Three (4.6%) and two (3.1%) patients developed postoperative fungemia and bacteremia, respectively. All cases of fungemia were caused by Candida glabrata. On univariable analysis, presence of an indwelling catheter (p = 0.009), presence of a known neurological diagnosis (p = 0.02), presence of C. glabrata on preoperative culture (p = 0.04), and longer operative time (p = 0.04) were predictive of development of postoperative SIRS. No significant predictors were identified on multivariable analysis. Conclusions: Patients with preoperative funguria have high rates of comorbid illness, urinary catheterization, and recent exposure to antibiotics. This patient population is at high risk of perioperative infectious complications after endourologic intervention.