Distribution Of Candida Species Research Articles

Detection and Antimicrobial Susceptibility of Candida Species Isolated from the Urine of Patients in a Tertiary Health Facility, Southwest Nigeria

Aims: This study aimed to identify and determine the antimicrobial susceptibility profiles of Candida species causing UTI among patients attending a tertiary Teaching Hospital, in southwest Nigeria. Study Design: Comparative cross-sectional study. Place and Duration of Study: Lagos State University Teaching Hospital, Ikeja, Nigeria between June 2017 and February, 2018. Methodology: A total of 250 participants whose provisional diagnosis was candiduria were recruited for this study. Urine samples were collected from consenting participants early in the morning into sterile wide mouth universal containers. These samples were cultured aerobically on Blood agar, Cystine-Lactose-Electrolyte Deficient (CLED) agar and Sabouraud dextrose agar (SAB) at 370C within 1 to 2 days. The isolates were profiled into species level using microscopic, biochemical test, chromogenic media (Chrom agar Candida) and Analytical Profile Index (API) 32C examination analysis. Results: An overall rate for Candidiasis in this study was 12.8% (32/250). The rate was higher in female 17.5% compared to 6.5% in their male counterparts (p=0.014). Highest rate of infections peaked at 28.6% among age group 83-92 years and lowest (6.7%) in age group 23-32 years. A total of 11 (4.4%) urine culture from participants produced C. albicans pure fungi isolates. However, by gender, this was statistically significant (p=0.003). A total of 81 bacterial (32.4%) and fungal isolates 32 (12.8%) were isolated and profiled. Distribution of Candida species indicated highest incidence in age range 31-40 years, followed by 21-30years and age 61-70 years age brackets. The isolated species were Candida albicans 11(34.4%), C. tropicalis 8(25%), C. parapsilopsis 6(19%), C. krusei 2(6.3%) and C. hellenica 1(3.1%). Sixty to seventy percent of fungal isolates were susceptible to ketoconazole and fluconazole while the susceptibility pattern of Candida species to itraconazole, terbinafine and nystatin varied between moderately susceptible to resistance. All the Candida isolates were resistant to griseofulvin. However, C. albicans was found to be the major Candida species causing Candidal urinary tract infection. The only C. hellenica isolated was resistant to all the antifungal drugs were approved except nystatin. Conclusion: High profile of Candida isolates and related UTI microbes were found in this study. There is need for advocacy for the use of API and Chrom agar Candida for routine diagnosis for Candida identification. Nevertheless, the Candida isolates were mostly susceptible to ketoconazole and Fluconazole but only the isolates were griseofulvin resistant.

A Systematic Review of Denture Stomatitis: Predisposing Factors, Clinical Features, Etiology, and Global Candida spp. Distribution.

Denture stomatitis (DS) is a very common disease in wearers of removable complete and partial dentures with a worldwide prevalence in the range of 20-67%. Both industrially developed and impoverished nations are affected by the illness. DS is often associated with ill-fitting dentures or a fungal infection with Candida spp. Candida is normally found in the oral cavity microbiota, but it can be harmful to the health of elderly people with underlying diseases. Therefore, the purpose of the present study is to offer the most recent information about the epidemiology, etiology, and global distribution of Candida species associated with DS through a systematic review. Several databases, including Medline, Web of Science, and Scopus, were used to conduct an extensive search of the literature published in the previous 20 years. The selection of studies was performed by two authors. The extracted data were as follows: author, year of publication, country, sample, frequency of DS, method of diagnosing stomatitis, species of Candida, risk factors, and etiology of the disease. The JBI Critical appraisal tools were used to assess the quality of the studies. Eventually, twenty-eight studies were included in the systematic review. Twenty-one studies investigated DS, while seven studies examined Candida colonization in patients using removable dentures. The results show that the main causes of DS include the type of dentures, continuous wearing of dentures, and the formation of a Candida biofilm, which is facilitated by poor dental hygiene. Additionally, previous studies have pinpointed the significance of the salivary flow, saliva composition, and salivary pH. The findings of the current review indicate that it is crucial to monitor denture wearers for the appearance of DS, especially the patients whose immunity has been impaired due to a systemic condition. Finally, frequent follow-ups should include a clinical examination and microbial swabs of the palatal mucosa and the mucosal surface of the denture.

Outcomes by Candida spp. in the ReSTORE Phase 3 trial of rezafungin versus caspofungin for candidemia and/or invasive candidiasis.

Rezafungin is a long-acting, intravenously administered echinocandin for the treatment of candidemia and invasive candidiasis (IC). Non-inferiority of rezafungin vs caspofungin for the treatment of adults with candidemia and/or IC was demonstrated in the Phase 3 ReSTORE study based on the primary endpoints of day 14 global cure and 30-day all-cause mortality. Here, an analysis of ReSTORE data evaluating efficacy outcomes by baseline Candida species is described. Susceptibility testing was performed for Candida species using the Clinical and Laboratory Standards Institute reference broth microdilution method. There were 93 patients in the modified intent-to-treat population who received rezafungin; 94 received caspofungin. Baseline Candida species distribution was similar in the two treatment groups; C. albicans (occurring in 41.9% and 42.6% of patients in the rezafungin and caspofungin groups, respectively), C. glabrata (25.8% and 26.6%), and C. tropicalis (21.5% and 18.1%) were the most common pathogens. Rates of global cure and mycological eradication at day 14 and day 30 all-cause mortality by Candida species were comparable in the rezafungin and caspofungin treatment groups and did not appear to be impacted by minimal inhibitory concentration (MIC) values for either rezafungin or caspofungin. Two patients had baseline isolates with non-susceptible MIC values (both in the rezafungin group: one non-susceptible to rezafungin and one to caspofungin, classified as intermediate); both were candidemia-only patients in whom rezafungin treatment was successful based on the day 30 all-cause mortality endpoint. This analysis of ReSTORE demonstrated the efficacy of rezafungin for candidemia and IC in patients infected with a variety of Candida species.

Changing Epidemiology of Clinical Isolates of Candida Species during the Coronavirus Disease 2019 Pandemic: Data Analysis from a Korean Tertiary Care Hospital for 6 Years (2017-2022).

This study assessed the changes in Candida species distribution and antifungal susceptibility patterns during the coronavirus disease 2019 (COVID-19) pandemic compared with a pre-pandemic period in Korea. We retrospectively investigated the specimen, species type, and antifungal susceptibility of Candida isolates obtained between 2016 and 2022. Data between two periods were compared: 2016-2019 (pre-pandemic) and 2020-2022 (pandemic). We included 11,396 clinical isolates of Candida species (5137 isolates in the pre-pandemic and 6259 isolates in the pandemic). The most prevalent species was Candida albicans (50.4%), followed by Candida glabrata (22.7%), Candida tropicalis (12.5%), and Candida parapsilosis complex (12.5%). Their ranks were unchanged; however, their relative isolation ratios varied during the pandemic, exhibiting differences ranging from 0.4 to 2.5 across species. The incidence of candidemia increased during the pandemic (average 1.79 episodes per 10,000 patient days) compared with pre-pandemic levels (average 1.45 episodes per 10,000 patient days) in both intensive-care-unit (ICU) and non-ICU patients. Additionally, C. parapsilosis complex candidemia increased by 1.6-fold during the pandemic. During the pandemic, C. albicans and C. tropicalis candidemia significantly increased by 1.5- and 1.4-fold in ICU patients. In contrast, C. parapsilosis complex candidemia surged 2.1-fold in non-ICU patients. These species exhibited reduced resistance to fluconazole, voriconazole, caspofungin, and micafungin in the pandemic compared with the pre-pandemic. This study underscores the heightened incidence of Candida-related infections during the COVID-19 pandemic and emphasizes the importance of ongoing surveillance of Candida species epidemiology beyond the pandemic's scope.

The Prevalence of Candida Species among HIV-Positive Women in Aluu, Nigeria: A Call for Awareness

Background: The acquired immune deficiency syndrome (AIDS), which HIV brings on, is a major public health concern. The human immunodeficiency virus (HIV) is still a pandemic. Only 2.1% of HIV cases worldwide are recorded in Nigeria. Usually, under the control of the immune system, Candida infections may be dangerous for immunocompromised people, particularly those living with HIV/AIDS.
 Aim: At the Mbodo Health Centre in Aluu, Rivers State, Nigeria, this study aimed to assess the prevalence of Candida infections and their relationship to HIV-positive patients.
 Methods: Fifty HIV-positive women were chosen at random. Self-collected oral and vaginal swabs were used to gather data. To identify Candida species, biochemical testing, culture, and microscopy were used.
 Results: Eighty percent of the 50 individuals had positive candidiasis tests. Oral and vaginal mono/co-candidiasis were found to be common, with Candida albicans being the most common specie. Based on demographic parameters, statistical analysis did not show a significant difference in the prevalence of oral candidiasis. The frequency of vaginal candidiasis was much greater in those with secondary education and aged 31-40 years. The age group of 31 to 40 years old had a considerably greater co-occurrence rate of oral and vaginal candidiasis. Adult female HIV-positive patients at Mbodo Health Centre have a significant prevalence of candidiasis.
 Conclusion: The study sheds light on the distribution of Candida species and how demographic variables relate to them. These results highlight the significance of treating candidiasis as a serious health issue in people living with HIV. To improve overall health outcomes for HIV-positive people and reduce related risk factors, further research and treatments may be required.

Epidemiology of Invasive Candidiasis in Patients with Hematologic Malignancy on Antifungal Prophylaxis.

The landscape of invasive Candida infections in patients with hematologic malignancy has evolved due to the adoption of anti-fungal prophylaxis, advances in oncological therapies, and developments in antifungal therapies and diagnostics. Despite these scientific gains, the morbidity and mortality caused by these infections remain unchanged, highlighting the importance of an updated understanding of its epidemiology. Non-albicans Candida species are now the predominant cause of invasive candidiasis in patients with hematological malignancy. This epidemiological shift from Candida albicans to non-albicans Candida species is partially a consequence of selective pressure from extensive azole use. Further analysis of this trend suggests other contributing factors including immunocompromise caused by the underlying hematologic malignancy and the intensity of its associated treatments, oncological practices, and regional or institution specific variables. This review characterizes the changing distribution of Candida species in patients with hematologic malignancy, describes the causes driving this change, and discusses clinical considerations to optimize management in this high-risk patient population.

Epidemiology, antifungal susceptibility, risk factors, and mortality of persistent candidemia in adult patients in China: a 6-year multicenter retrospective study

BackgroundData on persistent candidemia (PC), a recognized complication of candidemia, are lacking in China. This study aimed to investigate the clinical characteristics and risk factors for the mortality of PC among adults in China.MethodsThis 6-year retrospective study analyzed the prevalence, species distribution, antifungal susceptibility, risk factors, and patient mortality of PC among adults in three regional tertiary teaching hospitals in China from 2016 to 2021. We collected electronic laboratory records data of PC and non-PC patients and used the Student test or Mann–Whitney U test for a retrospective study. Logistic regression was used to identify risk factors associated with persistent candidemia.ResultsThe definition of PC was fulfilled by 36 patients (13.7%, 36/263). The mean age of the patients was 59.9 years (60 years for patients with PC; 59.8 years for those with non-PC; P > 0.05) and 131 (60.1%) were men [16 with PC (44.4%), 115 with non-PC (63.2%), P < 0.05]. The mean annual incidence was 0.15/1000 admissions (including PC 0.03/1000 admissions vs. non-PC 0.12/1000 admissions, P < 0.05). Candida parapsilosis (14/36, 38.9%) and Candida albicans (81/182, 44.5%) were the predominant pathogens in patients with PC and non-PC, respectively. Most isolates were susceptible to flucytosine (99.0%) and amphotericin B (99.5%), and the activity of antifungal agents against Candida species was not statistically significantly different between patients with PC and non-PC (P > 0.05). The 30-day mortality rate was 20.2% (16.7% with PC vs. 20.9% with non-PC, P > 0.05). Multivariable regression analysis showed that use of broad-spectrum antibiotics (odds ratio (OR), 5.925; 95% confidence interval (CI), 1.886–18.616, P = 0.002), fluconazole (OR, 3.389; 95% CI, 1.302–8.820, P = 0.012) and C. parapsilosis infection (OR, 6.143; 95% CI, 2.093–18.031, P = 0.001) were independent predictors of PC, sex (male) (OR, 0.199; 95% CI, 0.077–0.518, P = 0.001) was the protective factor for PC. Respiratory dysfunction (OR, 5.763; 95% CI, 1.592–20.864, P = 0.008) and length of hospital stay(OR, 0.925; 95% CI, 0.880–0.973, P = 0.002) were independent predictors of 30-day mortality in patients with non-PC. C. tropicalis bloodstream infection (OR, 12.642; 95% CI, 1.059–150.951; P = 0.045) was an independent predictor of 30-day mortality in patients with PC.ConclusionsThe epidemiological data of patients with PC and non-PC were different in the distribution of Candida species, the mean annual incidence and independent predictors of 30-day mortality. Flucytosine and amphotericin B could be used as first-choice drugs in the presence of PC infections.

Species Distribution and Antifungal Susceptibilities of Candida Species Isolated From Blood Culture.

Introduction Candidaspecies (spp.) are among the leading agents of bloodstream infections. Candidemias are a major cause of morbidity and mortality. Having an understanding of Candida epidemiology and antifungal susceptibility patterns in each center is crucial in guiding the management of candidemia.In this study, the species distribution and antifungal susceptibility of Candida spp. isolated from blood culture at the University of Health Sciences, Bursa Yuksek Ihtisas Training & Research Hospital were examined and the first data on the epidemiology of candidemia in our center were presented. Methods A total of 236 Candida strains isolated from blood cultures in our hospital over a four-year period were analyzed and their antifungal susceptibilities were studied retrospectively. Strains were identified at the species complex (SC) level by the germ tube test, morphology in cornmeal-tween 80 medium, and the automated VITEK 2 Compact (bioMérieux, Marcy-l'Étoile, France) system. Antifungal susceptibility tests were performed on VITEK 2 Compact (bioMérieux, Marcy-l'Étoile, France) system. The susceptibilities of the strains to fluconazole, voriconazole, micafungin, and amphotericin B were determined according to Clinical and Laboratory Standards Institute (CLSI) guidelines and epidemiologic cut-off values. Results Of theCandida (C.)strains, 131 wereC. albicans(55.5%), 40 wereC. parapsilosisSC (16.9%), 21 wereC. tropicalis(8.9%), 19 wereC. glabrataSC (8.1%), eight wereC. lusitaniae(3.4%), seven wereC. kefyr(3.0%), six wereC. krusei(2.6%), two wereC. guilliermondii(0.8%) and two wereC. dubliniensis(0.8%). Amphotericin B resistance was not detected inCandidastrains. Micafungin susceptibility was 98.3%, and fourC. parapsilosisSCstrains (10%) were intermediate (I) to micafungin. Fluconazole susceptibility was 87.2%. Apart fromC. kruseistrains which intrinsically resistant to fluconazole, threeC. parapsilosis(7.5%), oneC. glabrataSC (5.3%) strain were resistant (R) to fluconazole, and oneC. lusitaniae(12.5%) strain was wild-type (WT). Voriconazole susceptibility ofCandidastrains was 98.6%. TwoC. parapsilosisSC strains were I to voriconazole, while one strain was R. Conclusion In this study, the first epidemiological data of candidemia agents in our hospital were presented. It was determined that rare and naturally resistant species did not cause any problem in our center yet.C. parapsilosisSC strains showed decreased susceptibility to fluconazole, whereasCandidastrains were highly susceptible to the four antifungals tested. Close monitoring of these data will help guide the treatment of candidemia.

Candidemia diagnosed within the Hassan II University Hospital in Fez

Introduction: Candidemia are yeast infections of the candida type that are relatively common in intensive care and are burdened with a high mortality rate that has not decreased for decades. The aim of this work is to determine the frequency of candidaemia and to identify the epidemiological profile of the Candida species most implicated in these infections. Materials and methods: This is a descriptive retrospective study over a period of 5 years and 7 months, spanning from January 2017 to July 2022, and involving all blood cultures of patients hospitalized at the CHU Hassan II in Fez. The samples were inoculated into Mycosis IC/F bottles and incubated for 7 days in the BD Bactec® automaton. 37°C. The identification of yeasts was based on morphological, phenotypic, biochemical and sometimes immunological criteria. This identification is followed by the realization of an antifungigram. Results: During the study period, 145 blood cultures were performed, 42 of which were positive for candida. 69% of patients were hospitalized in intensive care. The female sex (52.3%) was more affected than the male sex (47.6%) with an average age of 31 years. The frequency of candidaemia is estimated at 28.9%. They were mainly caused by Candida non albicans (64.2%) including Candida glabrata 33.3%, Candida tropicalis 29.6%, Candida parapsilosis 20%, Candida krusei 18.5% and Candida lusitaniae 3.7%. While Candida albicans was positive in 15 patients. Sensitivity to amphotericin B and fluconazole was 89% and 70% respectively. Conclusion: Candidemia is a frequently fatal opportunistic infection. The proper use of antifungals is essential to better understand changes in the distribution of Candida species and limit the emergence of resistance

Candidemia in Pediatric Patients: Changing Pattern of Isolated Candida Species and Risk Factors in Eastern India.

Background: Candidemia is a life-threatening bloodstream infection caused by Candida species and is a major concern in pediatric patients, particularly in developing countries like India. Therefore, the goals of the current study are to isolate and identify several Candida species from blood samples, link various risk factors with candidemia, and ascertain the antifungal sensitivity pattern of each species.&#x0D; Methodology: This study is an observational, cross-sectional study conducted to determine the prevalence, distribution, and antifungal susceptibility of Candida species among pediatric patients with candidemia. The current study collected blood samples in BACT/ALERT 3D Pediatric bottles for fungal blood culture. After positive growth was obtained from Blood agar and Sabouraud's dextrose agar (SDA), a range of biochemical reactions, including Gram staining, Germ tube test, CHROM agar Candida Medium, and Sugar fermentation, were carried out. The Kirby-Bauer disc diffusion method was used for conducting the antifungal susceptibility test.&#x0D; Results: Among the total of 156 different species of Candida, the maximum isolates were Candida albicans (CA) (42.9%), followed by Candida tropicalis (23.1%) and Candida parapsilosis (14.7%). The Pediatric Intensive Care Unit (PICU) had the most Candida isolates, and catheterization was a leading risk factor. Susceptibility to Amphotericin B, Caspofungin, and Voriconazole was 84.6%, 81.4%, and 76.9%, respectively. Our study observed that the azole group of antifungals revealed pretty high resistance to Non-Candida albicans (NCA).&#x0D; Conclusion: The prevalence of candidemia was higher in the pediatric ICU and neonatal ICU, and the incidence rate was highest among neonates and infants. The study concludes that NCA species are gradually replacing C. albicans as an important pathogen, and clinicians need to be aware of the antifungal resistance patterns of the different Candida species.

A study on candiduria in neonates and infants from a tertiary care center, North India.

Candida albicans is the major cause of fungal UTI in neonates and infants but nowadays non albicans Candida is also increasing and these are mostly multidrug resistant. So it's important to know the species of candidal UTI for the proper management. This study was undertaken to determine the Candida species distribution in UTI along with their susceptibility pattern and outcome in infants and neonates admitted in different wards and ICU of our hospital. We also assess the incidence rate of candiduria in ICUs. Urine samples were collected from infants and neonates presented in pediatrics and neonatal ICU (intensive care units) and clinical wards with a clinical suspicion of candiduria and infants at risk of invasive candidiasis were also included in the study. Identification of Candida sp. was done by Gram's staining, germ tube test, chlamydospore formation on corn meal agar, color appearance on CHROM agar and also confirmed by MALDI-TOF Assay. Antifungal susceptibility was performed by using broth microdilution method as per the CLSI M27-A3/M27-S4. Urine samples were received from 219 infants, and Candida was isolated from samples from 52 infants (isolation rate 23.75%), of which 30 were admitted in pediatric or neonatal ICU and 22 in the wards. The incidence rate of candiduria in ICU was 3.25%. Candida albicans was the most frequently isolated species from the samples of infants in the wards (13/22 i.e. 59%), while Candida tropicalis was most frequently isolated from samples of infants in the ICUs (13/30 i.e. 43.34%). Candida glabrata was the least commonly isolated species and was only encopuntered in the ICU. There was no discrepancy between the results of conventional methods of identification and MALDI-TOF. Antifungal susceptibility was performed for 18 randomly selected isolates. All were found to be susceptible to caspofungin, micafungin, itraconazole, voriconazole, fluconazole, amphotericin B. High suspicion of candiduria is needed especially in ICU admitted infants and identification of candida at species level along with the susceptibility pattern is important for the better management of patients.

Candida bloodstream infection among children hospitalised in three public-sector hospitals in the Metro West region of Cape Town, South Africa

BackgroundCandida bloodstream infection (BSI) causes appreciable mortality in neonates and children. There are few studies describing the epidemiology of Candida BSI in children living in sub-Saharan Africa.MethodsA retrospective descriptive study was conducted at three public sector hospitals in Cape Town, South Africa. Demographic and clinical details, antifungal management and patient outcome data were obtained by medical record review. Candida species distribution and antifungal susceptibility testing results were obtained from the National Health Laboratory Service database.ResultsOf the 97 Candida BSI episodes identified during a five-year period, 48/97 (49%) were Candida albicans (C. albicans), and 49/97 (51%) were non-C. albicans species. The overall incidence risk was 0.8 Candida BSI episodes per 1000 admissions at Red Cross War Memorial Children’s Hospital. Of the 77/97 (79%) Candida BSI episodes with available clinical information, the median age (interquartile range) at the time of BSI was 7 (1–25) months, 36/77 (47%) were associated with moderate or severe underweight-for-age and vasopressor therapy was administered to 22/77 (29%) study participants. Most of the Candida BSI episodes were healthcare-associated infections, 63/77 (82%). Fluconazole resistance was documented among 17%, 0% and 0% of C. parapsilosis, C. tropicalis and C. albicans isolates, respectively. All Candida isolates tested were susceptible to amphotericin B and the echinocandins. The mortality rate within 30 days of Candida BSI diagnosis was 13/75 (17%). On multivariable analysis, factors associated with mortality within 30 days of Candida BSI diagnosis included vasopressor therapy requirement during Candida BSI, adjusted Odds ratio (aOR) 53 (95% confidence interval 2–1029); hepatic dysfunction, aOR 13 (95% CI 1–146); and concomitant bacterial BSI, aOR 10 (95% CI 2–60).ConclusionThe study adds to the limited number of studies describing paediatric Candida BSI in sub-Saharan Africa. Non-C. Albicans BSI episodes occurred more frequently than C. albicans episodes, and vasopressor therapy requirement, hepatic dysfunction and concomitant bacterial BSI were associated with an increase in 30-day mortality.

476. Epidemiology and Outcomes of Candidemia in a Large Academic Medical Center

Abstract Background Candidemia is an important cause of morbidity and mortality. Fluconazole resistance is associated with increased mortality in candidemia and thus echinocandins are recommended as first line empiric therapy. To understand the current landscape of candidemia treatment, we evaluated the epidemiology and outcomes of candidemia at our medical center, with a focus on differences in traditional azole-susceptible and non-susceptible candida species. Methods This is a retrospective cohort study including unique episodes of candidemia from 7/2017 – 12/2021 in hospitalized adult patients. We characterized candidemia episodes by species, age, hospital-onset, hospital location and critical illness. We compared traditionally azole susceptible organisms (e.g. C.albicans, C. parapsilosis, C.tropicalis) to non-susceptible (e.g. C.krusei, C.glabrata) based on antibiogram (cut off &amp;gt;94% susceptible) with the primary outcome of 30-day mortality. Secondary outcomes were recurrent/persistent candidemia, 90-day mortality and length of stay. Comparisons were done with χ2 or Wilcoxon rank sum tests. Logistic regression was performed to determine if azole-nonsusceptible candidemia was associated with 30-day mortality. Results 404 candidemic episodes for 389 patients were identified, of which 72% were due to azole-susceptible Candida spp. and C.glabrata and C.krusei were 23% and 5%, respectively. Critically ill patients were more likely to have azole-non-susceptible Candida spp (59 vs. 48%, p=0.04). Overall 30-day mortality was 35%, and was similar between azole-susceptible and non-susceptible groups, with no difference in other outcomes (Table 1). After adjusting for age and hospital-onset, critically ill patients with azole-non-susceptible candidemia had odds ratio of 1.5 (95% CI 0.87 – 2.7 p=0.13) for 30-day mortality. Distribution of candida species and associated 30-day mortality are found in Table 2. Demographics and Outcome Distribution of most common Candida spp. in candidemia in critically ill (n=205) Conclusion We found similar 30-day mortality rates in azole-susceptible and non-susceptible candida species since echinocandin first-line empiric therapy was implemented in guidelines. The impact on critically ill and invasive infections, including ocular involvement, needs further evaluation. Disclosures All Authors: No reported disclosures.

Distribution of candida species and risk factors for invasive candidiasis

Aim: The aim of this study was to investigate the Candida species isolated from the clinical samples of patients in the pediatric intensive care unit and to determine the risk factors for invasive candidiasis. Materials and Methods: Patients with Candida species detected in clinical samples between January 2013 and December 2018 were included in this study. The demographic characteristics of the patients, the use of broad-spectrum antibiotics and immunosuppressive drugs, underlying diseases, blood transfusions, history of surgical operations, whether there is bacterial growth with Candida species in the same clinical sample, parenteral nutrition and invasive interventions were retrospectively analyzed and their relationship with invasive candidiasis was investigated. Results: A total of 91 patients were included in the study. The mean age was 72.3 ± 70.1 months. Among the patients 48.4% had Candida albicans while 51.6% had non-albicans Candida. Candida parapsilosis (n = 18, 19.8%) and Candida tropicalis (n = 14, 15.4%) were the most common non-albicans Candida species. The most common antifungal treatment was fluconazole (n = 34, 59.6%). There was no statistically significant relationship between invasive candidiasis and the underlying disease, central venous and / or urinary catheter, broad-spectrum antibiotic, corticosteroid, gender and surgical operation (p&amp;gt; 0.05). On the other hand, there was a statistically significant relationship between invasive candidiasis and parenteral nutrition, blood transfusion and bacterial growth with Candida species in the same clinical sample (p &amp;lt;0.05). Conclusions: Non-albicans Candida species are more common than Candida albicans in the pediatric intensive care units. Candida parapsilosis is the most common among non-albicans Candida species. Parenteral nutrition, blood transfusion and bacterial growth with Candida species in the same clinical sample increased the risk of invasive candidiasis.

Evaluation of Candida colonization index, molecular identification, and antifungal susceptibility pattern of Candida species isolated from critically ill pediatric patients: A single-center study in Iran.

Given the high mortality rate of invasive candidiasis in hospitalized pediatric patients, it is crucial to establish a predictive system to achieve early diagnosis and treatment of patients who are likely to benefit from early antifungal treatment. This study aimed to assess the Candida colonization index, species distribution, and antifungal susceptibility pattern of Candida strains isolated from pediatric patients with high Candida colonization index (CI). This study was carried out at the Children's Medical Center in Tehran-Iran. In total, 661 samples were collected from 83 patients. The Candida CI was calculated according to the descriptions of previous studies. The isolates were identified using polymerase chain reaction-based techniques. The Clinical and Laboratory Standard Institute protocol M60 was used to conduct the antifungal susceptibility test. A colonization index greater than 0.5 was confirmed in 29 cases (58% of positive samples) with two children developing candidemia. Candida albicans (n=53, 49.5%) was the most common Candida species in patients with CI > 0.5. Except for acute lymphoblastic leukemia, no risk factors were linked to a high index in colonized children (P > 0.05). Twelve isolates (7.01%) were multi-azole resistant with high MICs against both isavuconazole and ravuconazole and seven strains (4.09%) were echinocandins resistant. In pediatric intensive care units, patients are at risk of fungal infection, particularly candidemia. In this study, more than half of the children with positive yeast cultures had CI > 0.5, and 6.8% developed candidemia.

Effects of biofilm formation and plethora of Candida species causing ailments: a mini review

Biofilm formation is an independent predictor of higher mortality rate and significant virulence factor that increase the dissemination ability and persistence of Candida species. However, Candida species distribution differs in population based studies evaluated in different geographical locations. This study aimed to evaluate the biofilm associated mortality rate, spectrum and resistance profile of Candida species. A systemic literature review was carried out to evaluate all current epidemiology that reports the incidence of the biofilm associated mortality rate, spectrum and resistance profile of Candida species. Several studies used optical density of the biomass from culture to measure biofilm formation. Data regarding the prevalence of Candida species, in vitro biofilm assay and rate of biofilm-related Candida species in clinical isolates were also extracted from the case-control, cohort, and retrospective studies. The result of this study shows that the mortality rate due to biofilm associated infections ranged from 6.9% to 70.0% and biofilm formation varied greatly from 27.2% to 100% evaluated from different published studies. Candida albicans was the predominant pathogen and the percentage frequency of the isolates ranged from 36.3% to 78.5%. The distribution of Candida species from 2016 to 2020 revealed that Candida albicans (39.42%) had the highest percentage frequency. High prevalence of Candida species was reported in 2018 (28.2%). The current data revealed that United Kingdom, Spain, Austria and Norway shows resistance profile for Candida tropicalis, Candida albicans, Candida parapsilosis and Candida glabrata. Biofilm formation is considered as potential risk factor of higher mortality rate and effective antifungal agents to eliminate or reduce this menace is urgently needed. The reports of the biofilm-forming potentials and properties among Candida species could provide a remarkable step toward the improvement of Candida infection therapies.

Oral Candida colonization and anti-fungal susceptibility pattern in patients with hematological malignancy.

Candidiasis is regarded as one of the most important fungal infections and a cause of disease and mortality in patients with hematological malignancy. Accordingly, antifungal prophylaxis is of significant importance in this regard. This study aimed to identify the epidemiology of Candida colonization and evaluate its antifungal susceptibility pattern in patients with hematological malignancy. In this study, the samples were collected from the oral cavity of 100 patients, and Candida colonization was confirmed by fungal culture. Candida strains were also identified by ITS-PCR. In vitro antifungal susceptibility tests against fluconazole, amphotericin B, and caspofungin were performed according to CLSI M60. Demographic characteristics, comorbidities, distribution of Candida species (spp.), and antifungal susceptibility were analyzed in this study. The study participants included 100 patients with a mean age of 15.48%±48.74 years (age range: 17-84 years). Regarding gender distribution, the majority (64%) of the patients were male. In terms of the distribution of underlying hematologic malignancy, 27% of the cases had lymphoma. The most commonly isolated species among patients were C. albicans complex (49%; n=49), C. glabrata (39%; n=39), and co-colonization of C. albicans complex and C. with C. glabrata (10%; n=10). The overall resistance of C. albicans complex was 5% to fluconazole (n=5) and 2% to amphotericin B (n=2). Furthermore, C. glabrata showed 11% (n=11) resistance to fluconazole and was susceptible to amphotericin B. All Candida spp. isolated from patients who were susceptible to caspofungin. The high rate of colonization of Candida spp., especially the significant increase in the frequency of C. glabrata in patients with blood malignancies and the gradual increase in resistance to fluconazole, necessitate a change in the use of antifungal drugs for the prevention and experimental treatment of hematological malignancy.

Candida species isolated from clinical samples in a tertiary hospital in Honduras: Where is Candida auris?

Infections by emerging and multiresistant Candida species are becoming more frequent throughout the world. This study aimed to describe Candida species in different wards of a tertiary hospital in Honduras. The prevalence of species within the C. albicans complex was estimated using a molecular approach, and C. auris was investigated using a yeast pool-based DNA extraction method. In total, 328 yeast isolates were identified using phenotypic approaches. For the identification of species within the C. albicans complex, a molecular approach based on the size polymorphisms of the hpw1 gene was used. In addition, a technique was optimized based on DNA extraction in pools for the rapid identification of C. auris. A total of 11 species of Candida were identified in the hospital wards. C. albicans showed the highest number of isolates (52.4%). Within the C. albicans complex, C. albicans sensu stricto was the most common, followed by C. dubliniensis. However, C. auris was not found. Reports on the distribution of Candida species in Honduras are limited; accordingly, the data from this study are of importance for a better understanding of their epidemiology. Moreover, a simple method was offered for the detection of C. auris that could help in its detection in low-resource settings.

Species distribution and susceptibility profiles of oral candidiasis in hematological malignancy and solid tumor patients.

Oral colonization and infection by Candida species are common in cancer patients receiving chemoradiotherapy, which has significantly increased in recent years. This study aimed to evaluate the frequency, distribution, and antifungal susceptibility profiles of Candida species isolates in patients with hematological malignancy and solid tumors. This study was conducted on a total of 45 cancer patients undergoing treatment with concurrent chemoradiotherapy within 2019-2020. The identification of Candida species was accomplished based on conventional examination and molecular assays. The minimum inhibitory concentrations were determined based on the guidelines of Clinical and Laboratory Standards Institute. The highest prevalence rates of oral candidiasis were observed in patients with chronic lymphoid leukemia (24.4%) and lymphoma (20%). The majority of the patients had oral candidiasis caused by non-albicans Candida species (64.4%). The results of the multiplex PCR for the identification of Candida glabrata, Candida nivariensis, Candida bracarensis, and species-specific Candida parapsilosis complex showed that all isolate amplification products at 397 bp and 171 bp were related to C. glabrata and C. parapsilosis, respectively. There was a significant difference in the Candida species distribution between the hematological malignancies and solid tumors patients. The results of MIC showed that clotrimazole, voriconazole, and caspofungin were the most effective antifungal drugs against oral non-Candida albicans isolates. An understanding of the epidemiology of oral candidiasis among hematological malignancies and solid tumors patients is currently imperative to guide optimal empirical treatment strategies for affected patients.

Epidemiologic features, clinical characteristics, and predictors of mortality in patients with candidemia in Alameda County, California; a 2017–2020 retrospective analysis

BackgroundBloodstream infections caused by Candida species are responsible for significant morbidity and mortality worldwide, with an ever-changing epidemiology. We conducted this study to assess trends in the epidemiologic features, risk factors and Candida species distribution in candidemia patients in Alameda County, California.MethodsWe analyzed data collected from patients in Alameda County, California between 2017 and 2020 as part of the California Emerging Infections Program (CEIP). This is a laboratory-based, active surveillance program for candidemia. In our study, we included incident cases only.ResultsDuring the 4-year period from January 1st, 2017, to December 31st, 2020, 392 incident cases of candidemia were identified. The mean crude annual cumulative incidence was 5.9 cases per 100,000 inhabitants (range 5.0–6.5 cases per 100,000 population). Candida glabrata was the most common Candida species and was present as the only Candida species in 149 cases (38.0%), followed by Candida albicans, 130 (33.2%). Mixed Candida species were present in 13 patients (3.3%). Most of the cases of candidemia occurred in individuals with one or more underlying conditions. Multivariate regression models showed that age ≥ 65 years (RR 1.66, CI 1.28–2.14), prior administration of systemic antibiotic therapy, (RR 1.84, CI 1.06–3.17), cirrhosis of the liver, (RR 2.01, CI 1.51–2.68), and prior admission to the ICU (RR1.82, CI 1.36–2.43) were significant predictors of mortality.ConclusionsNon-albicans Candida species currently account for the majority of candidemia cases in Alameda County.