Risk Factors For Candida Infection Research Articles

Candida Glabrata Pneumonia in Post COVID-19 Patient: A Rare Case Report

Background: One of the issues in post COVID-19 is secondary infection and fungal infection is one of the complications that must be detected at early stage to prevent. Early detection to prevent underdiagnosed and undertreatment. Candida glabrata, one of the pathogens in fungal infection is rare and can acts as infectious agent with immunocompromised patients.Case: A 69-year-old man came to hospital with major complaints of cough and shortness of breath for five days. He was diagnosed COVID-19, After completed treatment the nasopharyngeal PCR swab show negative result for COVID-19. After being discharged, he did several chest X-ray examinations with progressively worsening cough. Chest CT-Scan revealed consolidations and cavity. Sputum culture was positive for Candida glabrata and negative for BTA. He received echinocandins as anti-fungal treatment, which inhibits enzymes that is necessary for fungi’s cell wall synthesis, shows clinical and radiological improvement.Discussion: COVID-19 affect immune system which resulting higher risk for secondary infection. The use of broad-spectrum antibiotics, immune-suppression of the host, and use of medical devices are major risk factors for Candida infections. Meanwhile C. Albicans is still the most common cause of fungal pneumonia by Candida, we should consider C. glabrata as one of its pathogens. Conclusion: COVID-19 affects many aspects in our life, even after we treat the main problem, some patients manifest symptoms later. Diagnosing fungal infection especially invasive candidiasis is quite challenging with higher mortality rate. Not only C. glabrata more uncommon than C. albicans, but also it was one of difficult to treat pathogens.

Risk Factors for Candidiasis as an Intra-Abdominal Infection after Gastrectomy in Patients with Gastric Cancer.

Intra-abdominal infections (IAIs) develop in 2.4%-26.6% of patients who underwent gastrectomy for gastric cancer and are occasionally serious. However, there are few reports on the causative organisms of IAI following upper gastrointestinal tract surgery and subsequent risk factors for Candida infections. This study aimed to identify the microorganisms that cause IAIs after gastrectomy and risk factors for Candida-related IAI. The records of patients who underwent gastrectomy for gastric cancer between January 2009 and December 2019 at Shizuoka General Hospital were retrospectively collected. Patients with IAIs of grade II or higher, as measured by the Clavien-Dindo classification, were included in the analysis. The selected patients were divided into the Candida and non-Candida groups according to the presence or absence of Candida as the causative organism. Of 1,379 patients, 56 (4.1%) were diagnosed with IAIs after gastrectomy. Fifty-two patients were included in the study based on culture analyses. A total of 111 strains and 28 bacterial species were isolated during the initial culture test. Candida constituted 7.2% of all identified pathogens. Regarding the risk factors for Candida-related IAI, a history of antimicrobial use and ≥ 4 postoperative days of IAI development were independent risk factors for Candida-related IAI.

Rectal screening for azole non-susceptible Candida species in patients undergoing liver transplantation.

Candidiasis is the most common invasive fungal infection in solid organ transplant recipients, and liver transplant (LT) recipients are at heightened risk. We hypothesized that pre-transplant screening for azole non-susceptible Candida (ANSC) allows for tailored antifungal prophylaxis to reduce the incidence of post-LT ANSC infection. We performed a retrospective chart review of adult (age ≥18 years) patients who underwent LT at Yale New Haven Hospital from April 2019 to March 2021. Screening for ANSC, defined as Candida glabrata or Candida krusei, was performed using a rectal swab prior to or at the time of LT. During the study period, ANSC screening was performed in 47 patients who underwent a total of 48 LTs, with 46/48 (96%) primary LTs and two re-transplantations. Ten of 48 screened cases (21%) had ANSC-positive rectal swabs. Only seven of 10 ANSC-colonized patients received appropriate antifungal prophylaxis (i.e., anidulafungin), and one of these seven patients developed candidemia within 30 days of LT. The median number of candidiasis risk factors was one, and 29% of the cohort had two or more risk factors. Routine ANSC screening of LT candidates may assist in selecting appropriate antifungal prophylaxis but may be insufficient to prevent infection in those with multiple risk factors for Candida infection.

Protocol for the pBDG2 Study: Prospective Evaluation of 1.3-β-D-Glucan in the Peritoneal Fluid for the Diagnosis of Intra-Abdominal Candidiasis in Critically Ill Patients

Background: The delayed diagnosis of the presence of Candida in severe intra-abdominal infections exposes patients to an increased risk of mortality. The prevalence of intra-abdominal candidiasis (IAC) varies with the type of intra-abdominal infection, the underlying conditions and the presence of risk factors for Candida infection. This study aims to evaluate the interest of the measure of 1.3-β-D-glucan (BDG) in the peritoneal fluid for the early diagnosis of IAC. Methods and analysis: This is a prospective multicenter (n = 5) non-interventional study, focusing on all critically ill patients with an intra-abdominal infection requiring intra-abdominal surgery. The primary objective is to assess the diagnostic performance of the BDG measured in the peritoneal fluid for the early detection of IAC using the Candida culture as the gold standard. The secondary objective is to report the prevalence of IAC in the selected population. This study aims to enroll 200 patients within 48 months. By estimating the prevalence of IAC in the selected population at 30%, 50 patients with IAC (cases) are expected. These 50 IAC cases will be matched with 50 non-IAC patients (as a control group). The peritoneal BDG will be measured a posteriori in all of these 100 selected patients. This article presents the protocol and the current status of the study. Only the prevalence of IAC is reported as preliminary result.

61. Evaluation of the Impact of a Micafungin Time-Out Protocol for Hospitalized Patients

BackgroundEchinocandin overuse is associated with increased prevalence of non-albicans Candida spp, resistance, and high costs. Prospective review of micafungin prescribing by an Antimicrobial Stewardship Pharmacist (ASP) has shown reduced rates of inappropriate therapy. The aim of this study was to describe ASP’s interventions following introduction of a micafungin time out (MTO) protocol.MethodsThe approved MTO protocol was implemented in November 2019. Active micafungin orders for hospitalized patients were reviewed Monday through Friday at initiation and on day five. The MTO algorithm assessed micafungin use based on patient risk factors for Candida infection and de-escalation was guided by clinical status, culture data, and susceptibility testing. Micafungin use and ASP’s interventions were reviewed post-implementation between 12/01/2019 and 02/29/2020. Micafungin use was also characterized between 12/01/2018 and 02/28/2019 to serve as a control.ResultsA random sample of 50 patients who received micafungin for ≥ 48 hours during the pre- and post- protocol periods were included. 39 (78%) and 38 (76%) patients in the pre- and post-MTO cohort had indications for micafungin initiation according to algorithm. In the post-MTO group, 9 (75%) of the 12 micafungin initiations outside of algorithm approval were intervened on successfully by the ASP, increasing appropriate antifungal therapy to 47 (94%) patients. On day five, 18 (50%) and 25 (65.8%) (p=0.17) micafungin orders were according to algorithm in the pre- and post-MTO groups, respectively. Culture data on day five revealed 18 (50%) in the pre-MTO and 13 (34.2%) in the post-MTO group were eligible for de-escalation. An ASP-initiated MTO on day five identified 23 opportunities for antifungal therapy optimization in the post-MTO group. Interventions included de-escalation (13; 61.9%), discontinuation (6; 28.6%), and dose optimization (4; 19%). Of the 23 ASP interventions on day 5, 10 (43.4%) led to micafungin discontinuation or de-escalation, increasing the overall antifungal appropriateness to 35 (92.1%) patients.ConclusionAn ASP-initiated MTO can facilitate appropriate and timely optimization of antifungal therapy. The most frequent interventions were de-escalation from micafungin or therapy discontinuation.Disclosures All Authors: No reported disclosures

Nötropenik Olmayan Yoğun Bakım Hastalarında Kandida Kolonizasyonu ve Enfeksiyonu İçin Risk Faktörlerinin Değerlendirilmesi

Objective: In patients who are followed in intensive care unit (ICU), colonization and/or invasive infections with Candida species occur in the presence of various risk factors. Difficulties in diagnosis cause delays in antifungal therapy and this is related with increased mortality. Material and Methods: In this retrospective case control study, patients were classified as colonized, infected and control group and independent risk factors for Candida colonization and invasive Candida infections were evaluated. Patients followed in Anesthesiology-Reanimation and Medical ICUs of Ankara University Ibn-i Sina Hospital between June 2013 and June 2015 were retrospectively screened. A total of 225 patients, who stayed more than 48 hours in ICU, who were non-neutropenic and above 18 years were included. All demographics and risk factors were recorded. Results: Central venous catheter and sepsis/septic shock were found to be the independent risk factors for Candida colonization; presence of central venous catheter, total parenteral nutrition (TPN) use and sepsis/septic shock were found to be the independent risk factors for Candida infection. Conclusion: In high risk patients, early and appropriate antifungal therapy decreases mortality. Therefore, for doctors, who works with intensive care, identifying high risk patients for invasive Candida infections is important. Presence of central venous catheter, sepsis/septic shock and TPN use should be considered in intensive care patients.

Candida arthritis: 18 cases report and literature review

Objective To analyze the clinical features of candida arthritis and to conduct literature review to improve diagnosis and treatment. Methods From January 2008 to June 2018, eighteen patients (5 females and 13 males) with candida arthritis were admitted to two hospitals. The mean age at diagnosis was 59±8 (range 48-71 years). The diagnosis was determined based on joint fluid aspirate in all cases and on intra-operative samples in 1 patients. Seventeen patients received MR examination, and on epatient who underwent total knee arthroplasty underwent knee X-ray examination. The clinical features, risk factors, clinical manifestations, etiology, treatment and prognosis are recorded. Results Knee joints were involved in all patients as infection sites. Seventeen patients had risk factors for candida infection, including diabetes mellitus in 2 patients, artificial joint replacement in 1, and glucocorticoid injection in the joint cavity in 16. Swelling and pain were presented in all cases. Peripheral blood leukocytes were increased or normal, while C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR) were increased. Magnetic resonance showed joint effusion and slip membrane hyperplasia. Joint turbidity and synovial hyperplasia were presented by arthroscopy. X-ray demonstrated swelling of soft tissue around the prosthesis and bone absorption around the prosthesis. The most frequent species was non-candida albicans. Susceptibility to antifungals was tested in all cases. Thirteen patients underwent surgery combined with antifungal therapy, while 4 patients only received antifungal therapy and 1 patient refused to treat. The duration of antifungal therapy was from 6 weeks to 52 weeks (median, 12 weeks). Twelve cases were treated with fluconazole and 1 with voriconazole, 1 with voriconazole and fluconazole, 1 with fluconazole combined with lipid formulation amphotericin B, 1 with terbinatine and fluconazole, 1 with flucytosine combined with fluconazole. Seventeen cases were followed up for 3 to 72 months. At final follow-up, twelve patients were healed, while 1 case was amputated and 4 patients relapsed and refused further treatment. Conclusion As a rare disease, candida arthritis is usually happened after artificial joint replacement and in high-risk patients with diabetes and immunosuppressant applications. In immunocompetent patients without surgery, infection may be related to multiple injections into the joint cavity with glucocorticoids. The infection may be difficult to be diagnosed and with poor prognosis. Surgery with long-term antifungal therapy is required. Key words: Knee joint; Arthritis; Prosthesis-related infections; Candidiasis

2054. Physician Responses to Positive Rapid Diagnostic Tests for Candida Fungemia in the Absence of Concomitant Positive Blood Cultures

Background Candida species are the fourth leading cause of nosocomial bloodstream infections in the United States. Unfortunately, detection, identification and susceptibility testing using standard instrumented blood culture systems and routine microbiological techniques may take 4–10 days. Moreover, sensitivity of routine blood cultures for candidemia is only ~50 to 75%. The T2 Candida Panel (T2CP) is an FDA-approved assay that rapidly detects the presence of five Candida species directly from whole blood in 3–5 hours. We examined mortality and antifungal therapy (AFT) decisions based on positive (pos) results of a T2CP in patients with negative (neg) blood cultures.MethodsWe performed a case series of all patients who had a pos T2CP with concomitant neg blood cultures at our institution from March 1, 2016 to March 1, 2018. If a patient had multiple valid T2CP, only the first pos result was used for analysis. Medical records were reviewed for demographics, comorbidities, risk factors for candida infection, length of stay, use and duration of AFT, and 14-day and in-hospital mortality from the time of the T2CP.ResultsFifteen patients were identified who met inclusion criteria. Eight patients were immunocompromised: four (26.7%) solid cancer malignancy, three (20%) hematologic malignancy, and one kidney transplant recipient. Pos T2CP results by species were as follows: 53.3% C. albicans/C. tropicalis, 40% C. parapsilosis, and 6.7% C. glabrata/C. krusei. Median SOFA, Charlson comorbidity index, and Candida scores were 6, 6, and 9, respectively. Fourteen-day mortality was 40% and in-hospital mortality was 53.3%. Only two patients were on prophylactic AFT due to an underlying hematologic malignancy at the time of T2CP; in both cases, azole AFT was replaced with an echinocandin in response to the pos T2CP. Of the remaining 13 patients who were not on prophylactic AFT, all were started on AFT after pos T2CP result.ConclusionPhysicians escalated or initiated AFT therapy based on pos T2CP in severely ill patients who had negative blood cultures. Unfortunately, the population had high severity index scores and high mortality despite initiation or escalation of AFT. We hypothesize that earlier testing and detection of Candida fungemia may lead to faster initiation of AFT and better outcomes.Disclosures All authors: No reported disclosures.

Candida periprosthetic joint infection: A rare and difficult-to-treat infection

Candida periprosthetic joint infection (CPJI) is a rare, difficult-to-treat disease. The purpose of this study was to evaluate the clinical characteristics and outcomes of CPJI treated with various surgical and antifungal strategies. We conducted a multicenter retrospective study of all CPJI diagnosed between 2003 and 2015 in 16 Spanish hospitals. Forty-three patients included: median age, 75 years, and median Charlson Comorbidity Index score, 4. Thirty-four (79.1%) patients had ≥1 risk factor for Candida infection. Most common causative species were C. albicans and C. parapsilosis. Thirty-five patients were evaluable for outcome: overall, treatment succeeded in 17 (48.6%) and failed in 18 (51.4%). Success was 13/20 (67%) in patients with prosthesis removal and 4/15 (27%) with debridement and prosthesis retention (p = 0.041). All 3 patients who received an amphotericin B-impregnated cement spacer cured. In the prosthesis removal group, success was 5/6 (83%) with an antibiofilm regimen and 8/13 (62%) with azoles (p = 0.605). In the debridement and prosthesis retention group, success was 3/10 (30%) with azoles and 1/5 (20%) with antibiofilm agents. Therapeutic failure was due to relapse in 9 patients, need for suppressive treatment in 5, persistent infection in 2, and CPJI-related death in 2; overall attributable mortality was 6%. CPJI is usually a chronic disease in patients with comorbidities and risk factors for Candida infection. Treatment success is low, and prosthesis removal improves outcome. Although there is insufficient evidence that use of antifungals with antibiofilm activity has additional benefits, our experience indicates it may be recommendable.

Incidence, Risk Factors, and Long-term Outcome of Acute Leukemia Patients With Early Candidemia After Allogeneic Stem Cell Transplantation: A Study by the Acute Leukemia and Infectious Diseases Working Parties of European Society for Blood and Marrow Transplantation.

This study was performed to assess the incidence of and risk factors for Candida infection in the first 100 days after allogeneic hematopoietic stem cell transplantation (HSCT) and the impact on long-term survival. We performed an outcome analysis of 28542 acute leukemia patients who underwent HSCT from 2000 to 2012. There were 347 patients with candidemia by day 100 and 28195 without candidemia or any other type of Candida infection. The incidence of candidemia by day 100 was 1.2% and occurred at a median of 22 days after HSCT. Higher 100-day nonrelapse mortality (NRM; hazards ratio [HR], 3.0, P < .0001) and lower 100-day overall survival (OS; HR, 2.5, P < .0001) were observed in patients with candidemia. The case fatality rate by day 100 in patients with candidemia was 22% (76/347). Factors associated with candidemia occurrence were female gender, bone marrow or cord blood stem cell source, T-cell depletion, use of total body irradiation, and acute graft vs host disease. Among the patients alive at day 100, the 5-year NRM and OS after a median follow-up of 5.6 years (95% confidence interval, 5.5 - 5.7) for patients with and without candidemia were 22.5% vs 13.5%, P < .0001 and 45.6% vs. 53.4%, P = .0003, respectively. In multivariate analysis, the occurrence of a candidemia episode by day 100 was an independent risk factor for higher NRM (HR, 1.7, P = .001) and lower OS (HR, 1.4, P = .001). The early occurrence of candidemia after HSCT is still associated with higher NRM and lower short- and-long-term OS.

Does a Negative Rapid Diagnostic Test for Detection of Candida Bloodstream Infection Lead to Less Antifungal Use?

Background Candida species are the fourth leading cause of nosocomial bloodstream infections in the United States, however incidence is low and most patients who receive empiric treatment do not actually have candidemia. Unfortunately, detection, identification and susceptibility testing using standard instrumented blood culture systems and routine microbiological techniques takes 4–10 days. Astute clinicians may empirically treat patients with antifungal therapy (AFT) prior to having any results, often leading to unnecessary coverage for candida infection for up to 10 days. The T2 Candida Panel is an FDA-approved assay that rapidly detects the presence of 5 Candida species directly from whole blood in 3–5 hours. We determined whether AFT decisions were altered based on negative (neg) results of a T2 assay.MethodsWe performed a retrospective chart review of the first 50 patients at our institution from March 1, 2016 to March 1, 2017 with a neg T2 Candida assay result (data collection is ongoing). If a patient had multiple valid T2 assays, only the first result was used for analysis. The patients’ medical records were reviewed for use and duration of empiric AFT, results of blood cultures, treatment modification, underlying illness, risk factors for candida infection, length of stay, and 14-day mortality from the time of the T2 assay.ResultsTwenty-four patients were never started on AFT. Of the 26 who received AFT, it was stopped in 15 (57%) following T2 results (median time to stop empiric AFT = 2 days (1–16)). The reasons for continuing AFT in the cases of neg T2 assays included hematologic malignancy patients who were on long-term prophylaxis with antifungals (6 patients), empiric use in a case of severe sepsis (1 patient), and positive culture results despite neg T2 assay in 4 patients: 1 patient with C. lusitaniae in blood culture, 1 patient with C. parapsilosis from positive culture of medical device, 1 patient with neg T2 but positive blood cultures from 2 days prior for C. albicans (was on antifungal therapy at time of test), 1 patient with C. guilliermondii in blood culture.ConclusionWe conclude that a neg T2 Candida assay affects empirical use of AFT in certain patient populations and may be useful in controlling the overuse of antifungal agents.Disclosures All authors: No reported disclosures.

Risk factors for candida infection of the genital tract in the tropics.

To investigate the risk factors associated with candida infection of the genital tract in the tropics. We performed questionnaire survey and experiments at the Hainan branch of General Hospital of People's Liberation Army, Hainan General Hospital and Sanya Maternity and Child Health Care Hospital in 2013. Controls were without Candida infection of genital tract, and cases had from Candida infection. We recruited 689 cases and 652 controls. The average age of cases with Candida infection of the genital tract was higher than that of controls. In the multivariate modeling, marriage (adjusted odds ratio: 2.49, 95% confidential interval: 1.09-5.67) and vaginal lavage (adjusted odds ratio: 4.41, 95% confidential interval: 1.13-5.14) were significantly associated with Candida infection of genital tract in tropics. Candida infection was related with age. Marriage and Vaginal lavage were significant risk factors. Attention should be paid to health education for the prevention of these infections.

What’s new in the clinical and diagnostic management of invasive candidiasis in critically ill patients

Invasive candidiasis (IC) is a severe complication in the ICU setting. A high proportion of ICU patients become colonized with Candida species, but only 5-30 % develop IC. Progressive colonization and major abdominal surgery are well-known risk factors for Candida infection. IC is difficult to predict and early diagnosis remains a major challenge. In addition, microbiological documentation often occurs late in the course of infection. Delays in initiating appropriate treatment have been associated with increased mortality. In an attempt to decrease Candida-related mortality, an increasing number of critically ill patients without documented IC receive empirical systemic antifungal therapy, leading to concern for antifungal overuse. Scores/predictive rules permit the stratification and selection of IC high-risk patients who may benefit from early antifungal therapy. However, they have a far better negative predictive value than positive predictive value. New IC biomarkers [mannan, anti-mannan, (1,3)-β-D-glucan, and polymerase chain reaction] are being increasingly used to enable earlier diagnosis and, ideally, to provide prognostic information and/or therapeutic monitoring. Although reasonably sensitive and specific, these techniques remain largely investigational, and their clinical usefulness has yet to be established.

A research agenda on the management of intra-abdominal candidiasis: results from a consensus of multinational experts

intra-abdominal candidiasis (IAC) may include Candida involvement of peritoneum or intra-abdominal abscess and is burdened by high morbidity and mortality rates in surgical patients. Unfortunately, international guidelines do not specifically address this particular clinical setting due to heterogeneity of definitions and scant direct evidence. In order to cover this unmet clinical need, the Italian Society of Intensive Care and the International Society of Chemotherapy endorsed a project aimed at producing practice recommendations for the management of immune-competent adult patients with IAC. A multidisciplinary expert panel of 22 members (surgeons, infectious disease and intensive care physicians) was convened and assisted by a methodologist between April 2012 and May 2013. Evidence supporting each statement was graded according to the European Society of Clinical Microbiology and Infection Diseases (ESCMID) grading system. Only a few of the numerous recommendations can be summarized in the Abstract. Direct microscopy examination for yeast detection from purulent and necrotic intra-abdominal specimens during surgery or by percutaneous aspiration is recommended in all patients with nonappendicular abdominal infections including secondary and tertiary peritonitis. Samples obtained from drainage tubes are not valuable except for evaluation of colonization. Prophylactic usage of fluconazole should be adopted in patients with recent abdominal surgery and recurrent gastrointestinal perforation or anastomotic leakage. Empirical antifungal treatment with echinocandins or lipid formulations of amphotericin B should be strongly considered in critically ill patients or those with previous exposure to azoles and suspected intra-abdominal infection with at least one specific risk factor for Candida infection. In patients with nonspecific risk factors, a positive mannan/antimannan or (1→3)-β-D-glucan (BDG) or polymerase chain reaction (PCR) test result should be present to start empirical therapy. Fluconazole can be adopted for the empirical and targeted therapy of non-critically ill patients without previous exposure to azoles unless they are known to be colonized with a Candida strain with reduced susceptibility to azoles. Treatment can be simplified by stepping down to an azole (fluconazole or voriconazole) after at least 5-7 days of treatment with echinocandins or lipid formulations of amphotericin B, if the species is susceptible and the patient has clinically improved. Specific recommendations were elaborated on IAC management based on the best direct and indirect evidence and on the expertise of a multinational panel.

Posterior Pharyngeal Candidiasis in the Absence of Clinically Overt Oral Involvement: A Cross-Sectional Study

Although oropharyngeal candidiasis is associated with inhaled corticosteroid (ICS) usage, there is sparse data on the prevalence of posterior pharyngeal candidiasis in those without any detectable oral candidiasis on clinical examination. We systematically investigated the relationship between oral candidiasis on clinical examination and the presence of posterior pharyngeal candidiasis at bronchoscopy. We conducted a cross-sectional study on a convenience sample of 100 patients undergoing bronchoscopy at our institution. Patients were assessed for symptoms of and risk factors for candida infection and had an examination of their oropharynx for evidence of candidiasis before bronchoscopy. They subsequently had a detailed assessment for posterior candidiasis at bronchoscopy. We performed a posteriori subgroup analysis, which focused solely on those patients on ICS maintenance therapy. Median age was 54.7 (27-84) years, and 55 patients were male; 47% of patients were on ICS, and 20% of this cohort received recent oral corticosteroids. Twenty-eight percent of this convenience sample had posterior pharyngeal candidiasis; however, only 10.7% (3/28) of these patients had clinically detectable oral candidiasis on clinical examination before bronchoscopy. Factors that were independently associated with the presence of pharyngeal candidiasis at bronchoscopy were OR (95% CI) ICS usage 6.9 (2.5-19.2), particularly fluticasone usage 6.8 (2.62-17.9) and the presence of dysphonia 3.2 (1.3-8.0). In the subgroup analysis of ICS usage, posterior pharyngeal candidiasis was correlated with the presence of dysphonia but was not independently associated with fluticasone or budesonide dosage. This study demonstrates that posterior pharyngeal candidiasis in the absence of clinically overt oral candidiasis is frequent amongst ICS users. A history of ICS use, particularly fluticasone usage, as well as the presence of dysphonia are associated with posterior pharyngeal candidiasis at bronchoscopy, even in the absence of clinically overt oral involvement.

1335 Efficacy of Prophylactic Fluconazole in Reducing Candidemia in High Risk NICU And PICU Patients

BackgroundCandidal infection is a common cause of morbidity and mortality in neonatal intensive care unit (NICU) and pediatric intensive care unit(PICU) pateints, especially those with risk factors.ObjectivesTo determine the prevalence...

Risk Factors for Systemic Candida Infections in Pediatric Small Bowel Transplant Recipients

Fungal infections are an important cause of morbidity and mortality after small bowel transplantation (SBT). Little information about risk factors for Candida infections in pediatric SBT is available. We performed a 1:1 matched retrospective case-control study including 23 Candida culture-positive patients (cases) and 23 culture-negative patients (controls), matched based on age and time of transplantation. Patients' characteristics were compared using Wilcoxon rank-sum, χ, or Fisher exact tests. McNemar test was used to assess discordance between pretransplant and posttransplant fungemia. Univariate and multivariable conditional logistic regression analyses were performed to identify risk factors. The median age of the group was 1.87 years (range, 0.87-17.60); 59% patients were male. Within 1 month before transplant, 8.7% cases had fungemia and within 1-6 months before transplant, 30.4% cases had fungemia, compared with 69.6% within the 12 months after transplantation (P = 0.0001 and P = 0.02). By univariate analysis, total parenteral nutrition (TPN) (odds ratio [OR], 17.0 [95% confidence interval: 2.12, 2198]; P = 0.003) and antibiotic administration (OR, 18.99 [2.42, 2449]; P = 0.002) were risk factors for fungal infections. By multivariable analysis, both remained independent risk factors (TPN: OR, 10.86 [1.23, 1425], P = 0.03; antibiotic administration: OR, 12.83 [1.52, 1672], P = 0.01). Fungemia was significantly more frequent after SBT than before transplantation. Patients receiving TPN and antibiotic treatment had, respectively, 11 and 13 times higher risk of developing Candida infections after SBT.

Candida infection and colonization among trauma patients

Background: Data on Candida infection among critically ill trauma patients are limited and not recently updated. Here we study the epidemiology and economic impact of Candida and examine potential risk factors for Candida infection in this population. Methods: In this 5-year retrospective study, all severely injured patients with ³4 days of intensive care unit stay were included, with the primary outcome being Candida infection. We identified 3 distinct patient groups: 1) The Candida infection, 2) The Candida colonization and 3) the Candida-free group. All comparisons between groups with p-values ≤0.2 from the univariate analysis were entered into stepwise logistic regression to identify independent risk factors for candidiasis. Results: 374 patients were included. Upon comparisons between groups, candidiasis patients received significantly more blood transfusions (p=0.013), antibiotics (p=0.005), and total parenteral nutrition (TPN) (p=0.004), had a longer duration of mechanical ventilation (MV) (p=0.008) and underwent more laparotomy procedures than Candida free patients (56.5% versus 16.4%; p

Immunizations and infectious diseases in pediatric liver transplantation

Liver transplantation (LTx) is an established and effective treatment for children with end-stage and metabolic liver disease. Improved surgical techniques and immunosuppressive regimens have led to enhanced short-term and long-term survival rates, which now approach or exceed 90%. Consequently, more children are being referred for LTx, and an increasing numbers of pediatric centers routinely perform this procedure. Infectious complications are an important cause of morbidity and mortality in children undergoing LTx. However, improvements in immune suppression management along with the availability of new antimicrobial agents and diagnostic tools have resulted in improved treatment and preventative regimens, thus reducing the impact of infectious complications on these children. This review provides an overview of the infectious complications and prevention strategies for children undergoing LTx.

La candidurie en milieu de réanimation : signification et intérêt de la numération des levures dans les urines

Justification Candiduria is increasingly frequent among patients admitted to intensive care units but its significance remains unclear. Objectives Search for eventual correlation between quantitative candiduria and known risk factors for invasive candidiasis. Study design Prospective. Patients and methods A four-month study was conducted in 162 patients hospitalized in the intensive care unit for more than 72 hours. All patients underwent a weekly research of candiduria added to sampling from different body sites to determine the Pittet Candida colonization index. Results Candiduria has been proved in 56 cases (34%). It was superior or equal to 10 4 UFC/ml among 28 patients (50%). Candida tropicalis, Candida glabrata and Candida albicans has been isolated in 41, 22 and 20% respectively. All patients had at least one major and two minor risk factors for Candida infection. Six patients (10%) developed invasive candidiasis. The global mortality rate was at 52%. Pittet colonization index was significantly different between patients with candiduria and those with invasive candidiasis ( p = 0.01). There was a statistically significant correlation between candiduria superior or equal to 10 4 UFC/ml and Pittet colonization index superior or equal to 0.5 ( p = 0.01). Conclusion Candiduria superior or equal to 10 4 UFC/ml associated with risk factors may predict invasive candidiasis in critically ill patients.