Invasive Candidiasis Infection Research Articles

The association between Geriatric Nutritional Risk Index and the risk of Invasive Candidiasis in critically ill older adults

BackgroundInvasive candidiasis is the most common hospital-acquired fungal infection in intensive care units (ICU). The Geriatric Nutritional Risk Index (GNRI) score was developed to evaluate the nutritional status of elderly adults. We aimed to assess the association between the GNRI score and the risk of invasive candidiasis in elderly patients admitted to ICU.MethodsHospitalization information of elderly patients with invasive candidiasis was collected retrospectively from Medical Information Mart for Intensive Care (MIMIC) IV and MIMIC-III Clinical Database CareVue subset from 2001 to 2019. The main outcome of this study was the diagnosis of invasive candidiasis in patients. We employed a multivariable Cox regression and propensity score matching to balance the influence of confounding factors on the outcome. Furthermore, we conducted sensitivity analyses by categorizing the GNRI into classes based on thresholds of 98, 92, and 81.ResultsA total of 6739 patients were included in the study, among whom 134 individuals (2%) were diagnosed with invasive candidiasis. The GNRI scores of patients with invasive candidiasis upon admission to the ICU were significantly lower, measuring 88.67 [79.26–98.27], compared to the control group with a score of 99.36 [87.98-110.45] (P < 0.001). The results of the multivariable Cox regression analysis demonstrated a strong association between higher GNRI scores and a decreased risk of invasive candidiasis infection (HR: 0.98, 95% CI: 0.97–0.99, P = 0.002). Consistently, similar results were obtained when analyzing the propensity score-matched cohort (HR: 0.99, 95% CI: 0.98-1, P = 0.028). Sensitivity analyses further confirmed a significantly increased risk of invasive candidiasis infection with lower GNRI scores. Specifically, the following associations were observed: GNRI ≤ 98 (HR: 1.83, 95% CI: 1.23–2.72, P = 0.003), GNRI ≤ 92 (HR: 1.68, 95% CI: 1.17–2.4, P = 0.005), 82 ≤ GNRI ≤ 92 (HR: 1.63, 95% CI: 1.01–2.64, P = 0.046), GNRI ≤ 81 (HR: 2.31, 95% CI: 1.44–3.69, P < 0.001).ConclusionsLower GNRI score was significantly associated with an increased risk of invasive candidiasis in elderly patients in ICU. Further research is needed to validate whether improving nutrition can prevent invasive candidiasis.

Establishment and application of loop-mediated isothermal amplification coupled with nanoparticle-based lateral flow biosensor (LAMP-LFB) for visual and rapid diagnosis of Candida albicans in clinical samples.

Candida albicans is an opportunistic pathogenic yeast that predominantly causes invasive candidiasis. Conventional methods for detecting Candida species are costly, take 3-5 days, and require skilled technicians. Rapid pathogen identification is important in managing invasive candidiasis infection. Here, a novel molecular diagnostic assay termed loop-mediated isothermal amplification combined with nanoparticles-based lateral flow biosensor (LAMP-LFB) was developed for C. albicans rapid detection. A set of six primers was designed based on the C. albicans species-specific internal transcribed spacer 2 (ITS2) gene. The C. albicans-LAMP results were visually reported by LFB within 2min. Various fungal strains representing Candida species, as well as several Gram-negative and Gram-positive bacterial species, were used to determine the analytical sensitivity and specificity of the assay. The optimal LAMP conditions were 64 °C for 40 min, with a sensitivity of 1fg of genomic DNA template from C. albicans pure cultures. No cross-reactions were obtained with non-albicans strains. Thus, the analytical specificity of the LAMP-LFB assay was 100%. The entire procedure could be completed within 85 min, including specimen processing (40min), isothermal reaction (40min), and result reporting (within 2min). In 330 clinical samples (including 30 whole blood, 100 middle segment urine, and 200 sputum samples), all C. albicans-positive (62/330) samples were identified by LAMP-LFB assay, and the diagnostic accuracy was 100% when compared to the traditional clinical cultural-based methods. Thus, this assay can be used as a diagnostic tool for the rapid, accurate, sensitive, low-cost and specific detection of C. albicans strains, especially in resource-limited settings.

Machine-learning based prediction of prognostic risk factors in patients with invasive candidiasis infection and bacterial bloodstream infection: a singled centered retrospective study

BackgroundInvasive candidal infection combined with bacterial bloodstream infection is one of the common nosocomial infections that is also the main cause of morbidity and mortality. The incidence of invasive Candidal infection with bacterial bloodstream infection is increasing year by year worldwide, but data on China is still limited.MethodsWe included 246 hospitalised patients who had invasive candidal infection combined with a bacterial bloodstream infection from January 2013 to January 2018; we collected and analysed the relevant epidemiological information and used machine learning methods to find prognostic factors related to death (training set and test set were randomly allocated at a ratio of 7:3).ResultsOf the 246 patients with invasive candidal infection complicated with a bacterial bloodstream infection, the median age was 63 years (53.25–74), of which 159 (64.6%) were male, 109 (44.3%) were elderly patients (> 65 years), 238 (96.7%) were hospitalised for more than 10 days, 168 (68.3%) were admitted to ICU during hospitalisation, and most patients had records of multiple admissions within 2 years (167/246, 67.9%). The most common blood index was hypoproteinemia (169/246, 68.7%), and the most common inducement was urinary catheter use (210/246, 85.4%). Moreover, the most frequently infected fungi and bacteria were Candida parapsilosis and Acinetobacter baumannii, respectively. The main predictors of death prognosis by machine learning method are serum creatinine level, age, length of stay, stay in ICU during hospitalisation, serum albumin level, C-Reactive protein (CRP), leukocyte count, neutrophil count, Procalcitonin (PCT), and total bilirubin level.ConclusionOur results showed that the most common candida and bacteria infections were caused by Candida parapsilosis and Acinetobacter baumannii, respectively. The main predictors of death prognosis are serum creatinine level, age, length of stay, stay in ICU during hospitalisation, serum albumin level, CRP, leukocyte count, neutrophil count, PCT and total bilirubin level.

NLR、PLR对侵袭性念珠菌感染致重症脓毒症患者的诊断意义及预后价值

NLR、PLR对侵袭性念珠菌感染致重症脓毒症患者的诊断意义及预后价值

Diagnostic and prognostic value of peripheral lymphocyte subtyping for invasive candidiasis infection in critically ill patients with non-neutropenic sepsis

Objective: To assess the diagnostic and prognostic value of lymphocyte subtyping for invasive candidiasis infection (ICI) in critically ill patients with non-neutropenic sepsis. Methods: A prospective observational cohort study was performed at Peking Union Medical College Hospital (PUMCH), 377 patients with non-neutropenic sepsis admitted to Department of Critical Care Medicine from January 2017 to November 2019 were enrolled. There were 9.0% (34/377) patients diagnosed as ICI. Vital signs, supportive care therapy and microbiological specimens were collected. Peripheral blood lymphocyte subtypes, serum globulin, complements, inflammatory factors such as interleukin(IL)-6, IL-8, IL-10 and tumor necrosis factor were detected within 24 hours after sepsis was diagnosed. The receiver operating characteristic (ROC) curve was used to evaluate the diagnostic value and prognostic significance of immunological indicators for ICI. Multiple logistic regression was used to analyze the independent risk factors for ICI. Kaplan-Meier analysis was used to analyze survival. Results: The acute physiology and chronic health evaluation Ⅱ (APACHE Ⅱ) score was 17.0 (13.0, 21.0) in all 377 patients. The sequential organ failure score (SOFA) was 11.0 (8.0, 13.0), and the 28-day mortality rate was 27.6% (104/377). Peripheral blood CD8+absolute T lymphocyte count≤177 cells/μl, CD28+CD8+T-cell count≤81 cells/μl and 1, 3-β-D-glucan (BDG) ≥88.20 ng/L were closely correlated with the diagnosis of ICI (AUC=0.793,95%CI 0.749-0.833,P<0.000 1;AUC=0.892,95%CI 0.856-0.921, P<0.000 1;AUC=0.761, 95%CI 0.715-0.803,P<0.000 1, respectively), with sensitivity of diagnosis 94.12%, 100.00%, and 88.24%; the specificity of diagnosis 81.34%, 62.39%, 63.56% respectively. Multivariate logistic regression analysis identified CD8+T-cell count≤139 cells/μl (OR=7.463, 95%CI 1.300-42.831, P=0.024) and CD28+CD8+T-cell counts≤52 cells/μl (OR=57.494, 95%CI 3.986-829.359, P=0.003) as independent risk factors for higher mortality. Kaplan-Meier survival analysis suggested that CD8+T-cell count ≤139 cells/μl (P=0.0159) and CD28+CD8+T-cell count≤52 cells/μl (P=0.000 1) were associated with higher mortality within 28 days (68.8%, 91.7%). Conclusions: Low CD28+CD8+T cell count in peripheral blood is closely related to the development and clinical outcome of ICI in sepsis patients, which could be used as an effective indicator for the diagnosis and prognosis prediction of ICI.

Efficacy of Fluconazole Prophylaxis on Invasive Candidiasis Infection in Extremely Low Birth Weight Neonates

Background: Invasive candidiasis infection is one of the main life-threatening problems for extremely low birth weight (ELBW) neonates who are in the neonatal intensive care unit (NICU). Candidiasis can cause mortality, short-term morbidity, and long-term neurodevelopmental outcome in infected infants who survive. Therefore, since several years ago fluconazole prophylaxis has begun for premature newborns who were admitted to NICUs in some parts of the world.Methods: In this retrospective cohort, the population study was all the infants of less than 1,000 gram admitted to Valiasr Hospital during the years 2011-2016. The subjects were divided into two groups of control and intervention. The control group did not receive any fluconazole prophylaxis, while for the test group, intravenous fluconazole was administered. Finally, we compared the incidence of candidiasis between the two groups.Results: Fluconazole was administered to 70 out of 167 neonates. Our findings showed that two infants of the prophylaxis group (2.9%) and two (1.2%) of the non-prophylaxis group were infected with Candida species. The difference between the two groups was not statistically significant (P=0.501). Among the risk factors, bacterial sepsis, the duration of central catheter installation, total parenteral nutrition, meropenem or vancomycin administration, and hospitalization costs were significantly related to the incidence of invasive candidiasis infection.Conclusion: The incidence of candidiasis in our study was 2.39% and fluconazole prophylaxis has not been effective in reducing fungal infections. Consequently, further investigations in larger sample sizes with different study settings and a variety of methodologies are needed to evaluate the efficacy of fluconazole prophylaxis on invasive candidiasis infection in ELBW neonates.

Results of the use of micafungin in newborns

Invasive candidiasis is a common and serious infection in premature newborns. Preventing and treating fungal infections is very important to improve the prognosis of premature infants. Fluconazole and amphotericin B are used as the first choice in the treatment of invasive fungal infections of the newborns. In some cases, fluconazole and amphotericin B cannot be used due to nephrotoxicity, hepatotoxicity or resistant strains. Micafungin, which is among recently developed echinocandins, is the drug of choice in these cases. The use of micafungin in newborns is new and there is a limited experience about the effect of high dose usage in the central nervous system. The aim of this study was to evaluate the electronic files of patients who used micafungin for the treatment of culture-proven or possible invasive fungal infection during their hospital stay in the neonatal intensive care unit during a 24-month period (2016-2017) in the third-level intensive care unit. A total of 15 patients (10 premature and 5 term babies) were included in the study. The mean birth weight of the patients was 1732 ± 999 g and the mean gestational age was 32.2 ± 5.8 weeks. All patients had long-term intensive care and increased risk of invasive candidiasis infection. Central venous catheterization and multiple antibiotics usage were the most common risk factors in these patients. The other risk factors included intubation, total parenteral nutritional use and surgical procedure application. Candida species were isolated from the cultures of four patients. Candida species isolated from patients were Candida albicans, Candida glabrata, Candida catenulata, Candida parapsilosis. The mean time for onset of micafungin was 29.9 ± 16.6 days. Mean duration of micafungin therapy was 22.4 ± 11.2 days. Eight patients received amphotericin B, three patients received fluconazole therapy and four patients did not receive any antifungal therapy before the onset of micafungin. None of these patients had an abnormal kidney or liver function tests due to micafungin use. As a conclusion, high dose (10 mg/kg/day) micafungin is a safe and effective treatment choice both in the treatment of neonatal culture proven or probable invasive candida infections that were caused by refractory Candida strains, and in the case of nephrotoxicity and hepatotoxicity.

Not all probiotics are the same: Gut microbiota modulation with a multistrain probiotics

The highest incidence of invasive candidiasis infection (ICI) occurs in low birth weight infant with an estimated incidence of 4% and of 15% in extremely low birth weight infant. Low birth weight is an important risk factor. The other main risk factors associated with invasive candidiasis are the use of multiple antibiotics and central venous catheters, immunosuppression, parenteral nutrition, fungal colonization, and necrotizing enterocolitis. In this population, ICI cause high mortality, lead to significant neurodevelopmental impairment, and result in increate length of hospitalization and cost.[1] Originality of the study is the use of probiotics combination Alkem Batch PWS3002C comprising Bifidobacterium infantis, Lactobacillus acidophilus, Bifidobacterium longum, and Bifidum lactis. These preparations are considered more effective than single probiotic strain, characterized instead by a single bacterial strain. In fact, a recent study showed that the use of a multistrain probiotics have an action of greater efficacy.[2] Important focal point is gastrointestinal symptoms. Another interesting result of this study is that the control group presented a higher percentage of gastrointestinal symptoms than did the probiotic group, which showed an increased food tolerance, shortening the period of parenteral nutrition probably due to its changes in intestinal flora, improvement in mucosal barrier and anti-infiammatory properties. Reduction of stool fungal colonization is an important principal outcome parameter in the probiotics group by reduced invasive fungal sepsis is an important outcome parameter in the probiotics group because reduced invasive fungal sepsis 55.4% in probiotics group versus 75% in the control group.[3] Also the number of days to full enteral feeds and duration of hospitalization was less in probiotic group. Candida albicans is the most commonly isolated species, although C. parapsilosis. These species are commonly isolated in invasive candidiasis, while C. glabrata and C. krusei are isolated only in 3% of ICI. The published data show that fluconazolo use since birth is highly effective in preventing both colonization and infection in preterm neonates. This can lead to a high prevalence of azole-resistant Candida species.[4] In this study 35 (7%) newborns of control group presented C. glabrata infection, while the probiotics group presented only C. albicans. Loss of gut commensals, such as Bifidobacteria and Lactobacilli, due to the difficulties in oral feeding, translates into an increased susceptibility to pathogenic gut colonization. Probiotics are increasingly being used for their beneficial properties, considered to be particularly useful in reducing some symptoms related to gastrointestinal disorders.[5] In particular, preparations of a multistrain, consisting of different bacterial strains but belonging to the same species or anyway similar species are considered more effective than single probiotic strain. Evidence regarding the potential beneficial effects of probiotics supplementation in preterm infants is encouraging. Further studies to assess clinically relevant outcomes are needed.