Epidemiology Of Candida Species Research Articles

Antifungal resistance, combinations and pipeline: oh my!

Invasive fungal infections are a strong contributor to healthcare costs, morbidity and mortality, especially amongst hospitalized patients. Historically, Candida was responsible for approximately 15% of all nosocomial bloodstream infections. In the past 10 years, the epidemiology of Candida species has altered, with increasing prevalence of resistant species. With rising fungal resistance, especially in Candida spp., the demand for novel antifungal therapies has exponentially increased over the last decade. Newer antifungal agents have become an attractive option for patients needing long-term therapy for infections or those requiring antifungal prophylaxis. Despite advances in coverage of non-Candida pathogens with newer agents, clinical scenarios involving multidrug-resistant fungal pathogens continue to arise in practice. Combination antifungal therapy can lead to a host of side-effects, some of which can be drug limiting. Additional antifungal therapies with enhanced fungal spectrum of activity and decreased rates of adverse effects are warranted. Fosmanogepix, ibrexafungerp, olorofim and rezafungin may help fill some of these gaps in the antifungal armamentarium. This article is part of the Challenges and strategies in the management of invasive fungal infections Special Issue: https://www.drugsincontext.com/special_issues/challenges-and-strategies-in-the-management-of-invasive-fungal-infections.

Epidemiology of Candidemia in Children over 7 Years in a Medical Center in Turkey.

ABSTRACTThe aims of the study were to describe Candida species in children with candidemia, to determine the changing epidemiology of candidemia over time in our tertiary care hospital, and to examine the demographic and clinical characteristics of patients with candidemia caused by parapsilosis and nonparapsilosis Candida spp. From 2012 to 2018, we identified a total of 126 cases of candidemia. The most commonly isolated Candida sp. was C. parapsilosis (n = 71, 56.3%), followed by C. albicans (n = 34, 26.9%). A total of 21 candidemia episodes (16.6%) were caused by other Candida species. Patients were divided into two groups (parapsilosis and nonparapsilosis) to identify any potential differences between the groups in terms of risk factors, mortality, and antifungal resistance. The median age of the patients, the median durations of the hospital and pediatric intensive care unit stay, receipt of immunosuppressive therapy within 2 weeks of developing candidemia, the rate of using total parenteral nutrition, need for mechanical ventilation, and receipt of carbapenems were statistically significantly higher in the parapsilosis group than in the nonparapsilosis group (P = 0.020, P = 0.001, P = 0.011, P = 0.036, P = 0.002, P = 0.038, and P = 0.004, respectively). The overall 30-day mortality rates (4.2% versus 3.6%) and resistance to fluconazole (33.8% versus 32.7%) were similar between the groups (P = 0.790 and P = 0.860, respectively). The distribution of Candida strains isolated in this study was consistent with the global trend, with C. parapsilosis being the most commonly identified species. Determining local epidemiologic data at regular intervals in candidemia cases is important in terms of determining both the changing epidemiology and empirical antifungal agents.IMPORTANCE In our study, the changing epidemiology of Candida species in candidemia in children was evaluated. The dominance of Candida parapsilosis species in the changing epidemiology was remarkable. We found that fluconazole resistance was high in both parapsilosis and nonparapsilosis groups. Updating local epidemiologic data at certain intervals in candidemia cases is important in determining both the changing epidemiology and empirical antifungal agents.

Automated Identification and Antifungal Susceptibility Testing of Candida Species Using Vitek 2 Compact System in ICUs and Pediatric Oncology Unit, Alexandria, Egypt

Background: The epidemiology of candida species has changed over the last two decades. Early species identification and rapid antifungal susceptibility testing (AFST) is mandatory in such critical patients. Objectives: To determine the prevalence of different types of Candida species in ICU and pediatric oncology patients as well as their antifungal susceptibility profile using the Vitek 2 compact system. Methodology: 1023 candida isolates were collected from different clinical samples between May 2014 and February 2017. Identification and antifungal susceptibility testing were performed using Vitek 2 compact system. Results: In the present study fifteen candida species were identified. Non albicans Candida species (NAC) were predominant (65.6%). Candida albicans was the most prevalent species (34.5%). Candida tropicalis (c.tropicalis) was the most common isolated NAC species and the second common isolated species (32.8%), followed by Candida glabrata (C.glabrata) (17.3%), Candida Parapsilosis (C.parapsilosis)(7.5%), accounting for 92.1% of the total number of isolates. Uncommon Candida species were also isolated in this study.C. tropicalis was the most frequent species isolated from urine (50.9%), while C. albicans was the most frequent species isolated (43.3%) & (30.8%) from respiratory and blood samplesrespectively.C. parapsilosis was the most common species isolated from indwelling devices (44.4%). Regarding antifungal susceptibility profile (5.1%) and (2 %) of C.albicans were resistant to fluconazole, and voriconazole repectively. C. tropicalis (24.6%) and (17.5%) were resistant to Fluconazole and voriconazole respectively. (13.9%), (7.2%), (2.4%) of C.glabrata isolates were resistant to fluconazole, voriconazole and amphotericin respectively. All C. parapsilosis isolates were sensitive to fluconazole, voriconazole. Although resistant to fluconazole, all C. krusei isolates were susceptible to voriconazole, while, (84.6%) of isolates were resistant to flucytosine. Conclusions: The increased isolation rates of NAC species and gradual shift in the antifungal susceptibility profile underlines the need of early and accurate diagnosis of infecting Candidaspecies along antifungal susceptibility testing.

Antifungal susceptibility pattern of Candida species isolated from suspected cases of tuberculosis

Background: Candida species are emerging as a potentially pathogenic fungus in patients with broncho-pulmonary diseases. The synergistic growth promoting association of Candida and Mycobacterium tuberculosis has raised increased concern for studying the various Candida spp. and its significance in tuberculosis patients during current years. Aim: Aim of our study was isolation and identification of Candida spp from tuberculosis patients; as well as testing sensitivity of these clinical isolates to commonly prescribed antifungal drugs. Method: Totally 178 sputum specimens were screened by RNTCP Unit were included in the study. In vitro susceptibility testing of C. albicans isolated from pulmonary tuberculosis patients to five antifungal drugs was carried by direct susceptibility method using CHROM agar. Results: We could able to obtain 20.2% of Candida strains from 178 RNTCP clinic attendees and Candida albicans, Candida parapsilosis, Candida dubliniensis and Candida krusei was identified. Overall based on our study report we could able to report 33.3%,19.4% and 8.3% antifungal resistance by Candida strains towards the antifungal drugs Itraconazole, Nystatin, and Amphotericin B, respectively. Conclusion: In this study we found a shifting pattern of epidemiology of Candida species from commensal to emerging pathogen. Therefore, screening of tuberculosis patients for Candida infection should be routinely practiced along with anti-fungal sensitivity testing for non-albicans Candida isolates. Keywords: Antifungal susceptibility, azoles, Candida, disk diffusion, tuberculosis, Non-albicans Candida(NAC)

Candida species: current epidemiology, pathogenicity, biofilm formation, natural antifungal products and new therapeutic options

The incidence of fungal infections has increased significantly, so contributing to morbidity and mortality. This is caused by an increase in antimicrobial resistance and the restricted number of antifungal drugs, which retain many side effects. Candida species are major human fungal pathogens that cause both mucosal and deep tissue infections. Recent evidence suggests that the majority of infections produced by this pathogen are associated with biofilm growth. Biofilms are biological communities with a high degree of organization, in which micro-organisms form structured, coordinated and functional communities. These biological communities are embedded in a self-created extracellular matrix. Biofilm production is also associated with a high level of antimicrobial resistance of the associated organisms. The ability of Candida species to form drug-resistant biofilms is an important factor in their contribution to human disease. The study of plants as an alternative to other forms of drug discovery has attracted great attention because, according to the World Health Organization, these would be the best sources for obtaining a wide variety of drugs and could benefit a large population. Furthermore, silver nanoparticles, antibodies and photodynamic inactivation have also been used with good results. This article presents a brief review of the literature regarding the epidemiology of Candida species, as well as their pathogenicity and ability to form biofilms, the antifungal activity of natural products and other therapeutic options.

Increasing incidence of Candida parapsilosis candidemia with caspofungin usage

To determine the impact on the change in epidemiology of Candida species at our institution since the introduction of caspofungin. A 5-year retrospective review of all candidemia at a major tertiary care center. Only one episode of candidemia per patient per admission was counted. All antifungal defined daily doses were also collected in this same time period. Regression analysis was performed on the data and correlation statistics among antifungal use and Candida species were assessed using a Pearson correlation analysis. There were 469 individual episodes of candidemia between fiscal year 2002 and 2006 with the rate increasing every year. On regression analysis there was a significant increase in Candida parapsilosis candidemia (R(2)=0.90, p=0.02) and significant increase in caspofungin usage (R(2)=0.80, p<0.01), with a correspondingly significant decline in conventional (R(2)=-0.77, p<0.01) and lipid amphotericin B (R(2)=-0.95, p<0.05) usage. We found correlations between increased caspofungin usage (R(2)=0.94, p=0.017) and increased C. parapsilosis candidemia and decreased Candida tropicalis candidemia (R(2)=0.92, p<0.05) and a trend towards decreased Candida glabrata (R(2)=0.64, p=0.1). We showed significant correlations between increased caspofungin usage and an increased incidence of C. parapsilosis candidemia and reduction in C. tropicalis candidemia, with a trend towards less C. glabrata candidemia.

Y a-t-il un changement perceptible dans l'écologie des Candida species responsables de fungémie? Observation de 2000 à 2006 à l'hôpital Foch

Some Candidemia studies have documented changes in epidemiology of Candida species and some species were reported as emerging species. We conducted a study over a 6 years period and until 2005 we do not noticed any change in epidemiology of Candida even if Candida albicans still the most common species followed by Candida glabrata. No increase of candidemia was observed from 2000 to 2005 and we observed a decrease during the year 2006, this fact have to be confirm and may be related to other data: reinforcement of hygienic measures in our hospital, changes in treatment or preemptive treatment of yeasts and fungi with new azoles or candines molecules. On another side, patients from intensive care units and patients suffering of cancer were, as expected, the most represented population in our study.

Distribution and epidemiology of Candida species causing fungemia at a Saudi Arabian hospital, 1996–2004

The objective of this study was to evaluate the Candida species and the change over time in the organisms causing candidemia at Saudi Aramco Medical Services Organization in Saudi Arabia. We also describe the risk factors associated with mortality. This was a retrospective study of candidemia over nine years (1996-2004). A total of 98 distinct episodes of candidemia were identified over the study period. The annual incidence of candidemia ranged between 0.2 and 0.76 cases/1000 hospital discharges with an incidence per 10 000 patient-days per year of 0.45 to 1.6. The most frequent Candida species were Candida albicans (53%), Candida tropicalis (19%), Candida parapsilosis (16%), and Candida glabrata (7%). In relation to predisposing factors, 83% of candidemia occurred in patients with central venous catheters and 96% had received broad-spectrum antibiotics. Other predisposing factors included complicated abdominal surgeries (22%), total parenteral nutrition (52%), neutropenia (9%), acute renal failure (24%), malignancy (26%) and burns (15%). However, prior fluconazole use was low (8%). The overall crude mortality rate was 43% for all candidemia. Logistic regression analysis identified two independent determinants of death, C. albicans (OR 5.91, 95% CI 1.50, 23.24, p=0.01) and acute renal failure (OR 5.15, 95% CI 1.18, 22.55, p=0.03). The study showed that the rate of candidemia was low in our hospital and that C. albicans was the major species followed by C. tropicalis and C. parapsilosis. Future studies are needed to evaluate the antifungal susceptibility pattern in our hospital.