BACKGROUND: Our multicentre study aims to identify baseline factors and provide guidance for therapeutic decisions regarding Magnusiomyces-associated infections, an emerging threat in patients with haematological malignancies. METHODS: HM patients with proven (Magnusiomyces capitatus) M. capitatus or (Magnusiomyces clavatus) M. clavatus (formerly Saprochaete capitata and Saprochaete clavata) infection diagnosed between January 2010 and December 2020 were recorded from the SEIFEM (Sorveglianza Epidemiologica Infezioni nelle Emopatie) group and FungiScope (Global Emerging Fungal Infection Registry). Cases of Magnusiomyces fungemia were compared with candidemia. RESULTS: Among 90 Magnusiomyces cases (60 [66%] M. capitatus and 30 (34%) M. clavatus), median age was 50 years (range 2-78), 46 patients (51%) were female and 67 (74%) had acute leukaemia. Thirty-six (40%) of Magnusiomyces-associated infections occurred during antifungal prophylaxis, mainly with posaconazole (n = 13, 36%) and echinocandins (n = 12, 34%). Instead, the candidemia rarely occurred during prophylaxis (p < .0001). First-line antifungal therapy with azoles, alone or in combination, was associated with improved response compared to other antifungals (p = .001). Overall day-30 mortality rate was 43%. Factors associated with higher mortality rates were septic shock (HR 2.696, 95% CI 1.396-5.204, p = .003), corticosteroid treatment longer than 14 days (HR 2.245, 95% CI 1.151-4.376, p = .018) and lack of neutrophil recovery (HR 3.997, 95% CI 2.102-7.601, p < .001). The latter was independently associated with poor outcome (HR 2.495, 95% CI 1.192-5.222, p = .015). CONCLUSIONS: Magnusiomyces-associated infections are often breakthrough infections. Effective treatment regimens of these infections remain to be determined, but neutrophil recovery appears to play an important role in the favourable outcome.
- MeSH
- antifungální látky terapeutické užití MeSH
- dítě MeSH
- dospělí MeSH
- echinokandiny terapeutické užití MeSH
- hematologie * MeSH
- kandidemie * farmakoterapie MeSH
- lidé středního věku MeSH
- lidé MeSH
- mladiství MeSH
- mladý dospělý MeSH
- předškolní dítě MeSH
- prognóza MeSH
- senioři MeSH
- Check Tag
- dítě MeSH
- dospělí MeSH
- lidé středního věku MeSH
- lidé MeSH
- mladiství MeSH
- mladý dospělý MeSH
- mužské pohlaví MeSH
- předškolní dítě MeSH
- senioři MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- multicentrická studie MeSH
BACKGROUND: The European Confederation of Medical Mycology (ECMM) collected data on epidemiology, risk factors, treatment, and outcomes of patients with culture-proven candidaemia across Europe to assess how adherence to guideline recommendations is associated with outcomes. METHODS: In this observational cohort study, 64 participating hospitals located in 20 European countries, with the number of eligible hospitals per country determined by population size, included the first ten consecutive adults with culture-proven candidaemia after July 1, 2018, and entered data into the ECMM Candida Registry (FungiScope CandiReg). We assessed ECMM Quality of Clinical Candidaemia Management (EQUAL Candida) scores reflecting adherence to recommendations of the European Society of Clinical Microbiology and Infectious Diseases and the Infectious Diseases Society of America guidelines. FINDINGS: 632 patients with candidaemia were included from 64 institutions. Overall 90-day mortality was 43% (265/617), and increasing age, intensive care unit admission, point increases in the Charlson comorbidity index score, and Candida tropicalis as causative pathogen were independent baseline predictors of mortality in Cox regression analysis. EQUAL Candida score remained an independent predictor of mortality in the multivariable Cox regression analyses after adjusting for the baseline predictors, even after restricting the analysis to patients who survived for more than 7 days after diagnosis (adjusted hazard ratio 1·08 [95% CI 1·04-1·11; p<0·0001] in patients with a central venous catheter and 1·09 [1·05-1·13; p<0·0001] in those without one, per one score point decrease). Median duration of hospital stay was 15 days (IQR 4-30) after diagnosis of candidaemia and was extended specifically for completion of parenteral therapy in 100 (16%) of 621 patients. Initial echinocandin treatment was associated with lower overall mortality and longer duration of hospital stay among survivors than treatment with other antifungals. INTERPRETATION: Although overall mortality in patients with candidaemia was high, our study indicates that adherence to clinical guideline recommendations, reflected by higher EQUAL Candida scores, might increase survival. New antifungals, with similar activity as current echinocandins but with longer half-lives or oral bioavailability, are needed to reduce duration of hospital stay. FUNDING: Scynexis.
- MeSH
- antifungální látky terapeutické užití MeSH
- Candida * MeSH
- dodržování směrnic MeSH
- dospělí MeSH
- kandidemie * farmakoterapie epidemiologie mikrobiologie MeSH
- kohortové studie MeSH
- lidé MeSH
- Check Tag
- dospělí MeSH
- lidé MeSH
- Publikační typ
- časopisecké články MeSH
- pozorovací studie MeSH
- práce podpořená grantem MeSH
- Geografické názvy
- Evropa MeSH
- MeSH
- antifungální látky terapeutické užití MeSH
- Candida * MeSH
- kandidemie * farmakoterapie MeSH
- lidé MeSH
- rizikové faktory MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- dopisy MeSH
- práce podpořená grantem MeSH
Candidemia is one of the significant causes of mortality amongst critically ill patients in Intensive Care Units (ICUs). This study aimed to assess the incidence, risk factors and antifungal susceptibility pattern in candidemia cases admitted in ICU in a tertiary care hospital in Jaipur, Rajasthan from June 2021 to November 2021. Candida species isolated from blood culture of clinically suspected patients of sepsis were defined as candidemia cases. Blood culture and antifungal susceptibility testing were performed as per standard laboratory protocol. Analyses of risk factors was done between candidemia cases and matched controls in a ratio of 1 : 3. Forty-six candidemic cases and 150 matched controls were included in the study. C. tropicalis was the most prevalent species (22/46; 48%) followed by C. auris (8/46; 17%) and C. albicans (7/46; 15%). Candida species showed good sensitivity to echinocandins (97%) followed by amphotericin B (87%) and voriconazole (80%). In multivariate analysis, longer stay in ICU, presence of an indwelling device, use of immunosuppressive drugs and positive SARS-CoV-2 infection were associated with increased risk of candidemia. The constant evaluation of risk factors is required as prediction of risks associated with candidemia may help to guide targeted preventive measures with reduced morbidity and mortality.
- MeSH
- antifungální látky farmakologie terapeutické užití MeSH
- Candida MeSH
- COVID-19 * MeSH
- jednotky intenzivní péče MeSH
- kandidemie * epidemiologie mikrobiologie MeSH
- lidé MeSH
- rizikové faktory MeSH
- SARS-CoV-2 MeSH
- studie případů a kontrol MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- časopisecké články MeSH
- Geografické názvy
- Indie MeSH
Akutní lymfoblastická leukemie (ALL) je nejčastějším maligním nádorovým onemocněním v dětském věku. Léčba ALL je založena na kombinované chemoterapii. Trvalého vyléčení lze v dnešní době dosáhnout až u 90 % pacientů. Onemocnění často doprovází řada komplikací. Mezi nejčastější komplikace patří bakteriální a mykotické infekce způsobené běžnými i oportunními patogeny. Mykotické infekce tvoří až 40 % všech infekčních komplikací. Prezentujeme případ dvouletého děvčátka asijského původu s projevy invazivní kandidózy diagnostikované během indukční fáze léčby ALL komplikovaného život ohrožujícím multiorgánovým selháním.
Acute lymphoblastic leukemia (ALL) represents 25 % of childhood tumors and it ́s the most frequent cancer in children. ALL treatment is based on combined chemotherapy. Long-lasted treatment is now achieved in up to 90 % of patients. The disease is accompanied by a number of complications. The most prevalent complications include bacterial and fungal infections caused by common and opportunistic pathogens. Fungal infections make up 40 % of all infectious complications. We present the case of a 2year-old girl of Asian origin with manifestations of invasive candidiasis diagnosed during the induction phase of treatment of ALL complicated by life-threatening multiorgan failure.
- MeSH
- akutní lymfatická leukemie * diagnóza farmakoterapie komplikace MeSH
- antibakteriální látky terapeutické užití MeSH
- antifungální látky terapeutické užití MeSH
- bakteriemie farmakoterapie MeSH
- fungemie farmakoterapie MeSH
- kandidóza invazivní * diagnóza farmakoterapie MeSH
- kombinovaná farmakoterapie metody MeSH
- lidé MeSH
- multiorgánové selhání terapie MeSH
- předškolní dítě MeSH
- progrese nemoci MeSH
- Check Tag
- lidé MeSH
- předškolní dítě MeSH
- ženské pohlaví MeSH
- Publikační typ
- kazuistiky MeSH
- MeSH
- antifungální látky terapeutické užití MeSH
- invazivní plicní aspergilóza terapie MeSH
- kandidemie terapie MeSH
- lidé MeSH
- mykózy * terapie MeSH
- převzatá imunita * MeSH
- T-lymfocyty transplantace MeSH
- transplantace hematopoetických kmenových buněk * MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- přehledy MeSH
The aim of the study was to identify the most important systemic and local risk factors for the development of infectious complications in patients with toxic epidermal necrolysis (TEN). MATERIAL AND METHODOLOGY: This is a multicentric study that included all patients with TEN who were hospitalized between 2000-2015 in specialized centres in the Czech Republic and Slovakia. The total catchment area included a population of over 12.5 million inhabitants. The actual implementation of the project was carried out using data obtained from the CELESTE (Central European LyEll Syndrome: Therapeutic Evaluation) registry, wherein specific parameters related to epidemiological indicators and infectious complications in patients with TEN were evaluated as a retrospective analysis. RESULTS: A total of 38 patients (97%) of the group were treated with corticosteroids. The comparison of patients with different doses of corticosteroids did not exhibit a statistically significant effect of corticosteroid administration on the development of infectious complications (p=0.421). There was no effect of the extent of the exfoliated area on the development of infectious complications in this area. The average extent of the exfoliated area was 66% TBSA (total body surface area) in patients with reported infectious complications and 71% TBSA (p=0.675) in patients without infectious complications. In the case of the development of an infectious complication in the bloodstream (BSI), the increasing effect of the SCORTEN (SCORe of Toxic Epidermal Necrosis) value was monitored during hospitalization. Within 5days from the beginning of the hospitalization, the average SCORTEN value was 2.7 in 6 patients with BSI and 3.0 in 32 patients without BSI (p=0.588). In the period after the 15th day of hospitalization, 7 patients with BSI had an average SCORTEN value of 3.4, and 16 patients without BSI had an average SCORTEN value of 2.5 (p=0.079). In the case of low respiratory tract infection (LRTI), the effects of the necessity for artificial pulmonary ventilation and the presence of tracheostomy were monitored. The statistically significant effect of mechanical ventilation on the development of LRTI occurred only during the period of 11-15days from the beginning of the hospitalization (p=0.016). The effect of the tracheostomy on the development of LRTI was proven to be more significant. CONCLUSION: We did not find any statistically significant correlation between the nature of immunosuppressive therapy and the risk of developing infectious complications. We failed to identify statistically significant risk factors for the development of BSI. Mechanical ventilation and tracheostomy increase the likelihood of developing LRTIs in patients with TEN.
- MeSH
- bakteriální infekce epidemiologie MeSH
- bakteriemie epidemiologie MeSH
- cyklosporin terapeutické užití MeSH
- dospělí MeSH
- fungemie epidemiologie MeSH
- hormony kůry nadledvin terapeutické užití MeSH
- imunologické faktory terapeutické užití MeSH
- imunosupresiva terapeutické užití MeSH
- infekce močového ústrojí epidemiologie MeSH
- intravenózní imunoglobuliny terapeutické užití MeSH
- lidé středního věku MeSH
- lidé MeSH
- mykózy epidemiologie MeSH
- pneumonie epidemiologie terapie MeSH
- registrace * MeSH
- retrospektivní studie MeSH
- rizikové faktory MeSH
- senioři MeSH
- Stevensův-Johnsonův syndrom epidemiologie terapie MeSH
- stupeň závažnosti nemoci MeSH
- tracheostomie MeSH
- umělé dýchání MeSH
- Check Tag
- dospělí MeSH
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- senioři MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- Geografické názvy
- Česká republika MeSH
- Slovenská republika MeSH
Cíl práce: Kandidémie patří mezi poměrně časté infekční komplikace u kriticky nemocných pacientů. V posledním desetiletí se díky novým terapeutickým přístupům (zejména u některých skupin pacientů) mění spektrum kvasinek, které infekci způsobují. Předkládaná multicentrická studie si dala za úkol získat aktuální informace o epidemiologické situaci týkající se invazivních kandidóz (IC) v České republice. Materiál a metody: Do souboru byla zařazena data pacientů s kultivačně pozitivním nálezem kvasinky v krvi z 11 mikrobiologických pracovišť v České republice v rozmezí let 2012–2015. Byla hodnocena incidence, zastoupení jednotlivých kvasinkových druhů podle sledovaných let, podle věku a podle odborností. Dále byl posouzen vliv kolonizace a nakonec zda IC předcházela přítomnost toxigenního kmene Clostridium difficile ve stolici. U části izolovaných kmenů byly standardní metodikou stanoveny minimální inhibiční koncentrace (MIC) systémových antimykotik. Výsledky: V průběhu sledovaného období bylo v zúčastněných laboratořích zachyceno 921 kvasinkových kmenů od 886 pacientů. Celková incidence IC na 1 000 přijatých pacientů byla 0,40 (rozmezí 0,21–1,22 podle pracovišť). Takřka polovina izolátů spadala do druhu Candida albicans (49,7 %), následovaná Candida glabrata (15,3 %) a Candida parapsilosis (11,2 %). Na onkologických odděleních výrazně převažovaly non-albicans druhy (71,6 %), na rozdíl od chirurgických (40,4 %) nebo interních (52,0 %) oborů. Více než 70,0 % pacientů bylo v době pozitivní kultivace hospitalizováno na jednotkách intenzivní péče (JIP) a 65,0 % nemocných bylo kolonizováno stejným druhem kvasinky, který byl později nalezen v hemokultuře. Pouze u 5,1 % pacientů z celkového počtu byla potvrzena předchozí přítomnost toxigenního kmene C. difficile ve stolici. Celkem bylo otestováno 56 kmenů kvasinek (z 921) a byla zaznamenána zvýšená MIC u azolů pro C. glabrata. Závěr: Incidence kandidémií v České republice se ve sledovaném období výrazně neměnila a po C. albicans je druhou nejčastěji izolovanou kvasinkou v krvi C. glabrata.
Background: Candidemia is a severe and often life-threatening infection frequently occurring in critically ill patients. During the last decade, new therapeutic and prophylactic strategies influenced (at least in some patient subgroups) the epidemiological situation and the spectrum of causative Candida strains. The present multicentre study aimed to assess the current epidemiological situation of Candida strains causing invasive candidiasis (IC) in patients of tertiary care hospitals in the Czech Republic. Material and methods: Clinical and microbiological data on patients with bloodstream yeast isolates collected in 11 tertiary care hospitals in the Czech Republic between 2012 and 2015 were analysed. The incidence of cases and species distribution were assessed by study year, age, and specialty. Moreover, an association with the Candida colonization and presence of toxigenic strains of Clostridium difficile in stool prior to blood culture positivity was analysed. For some of the strains, minimum inhibitory concentrations (MICs) of systemic antifungals were determined using standard methods. Results: A total of 886 episodes of candidemia (921 yeast strains) were identified during the study period. The overall incidence per 1000 admissions was 0.40 (range 0.21–1.22 depending on the hospital). Almost half of the isolates belonged to the species Candida albicans (49.7 %), followed by Candida glabrata (15.3 %) and Candida parapsilosis (11.2 %). Non-albicans species of Candida significantly predominated in oncology wards (71.6 %) as compared to surgery (40.4 %) or internal medicine (52.0 %) departments. More than 70.0 % of patients stayed in intensive care units at the time of positive culture; in 65.0 % of patients, colonization with the same yeast species preceded blood culture positivity. In only 5.1 % of all patients, the previous presence of toxigenic strains of Clostridium difficile in stool was found. Fifty-six of the 921 yeast strains were tested for antifungal susceptibility, with an increase in MICs to azoles being observed for C. glabrata. Conclusion: The incidence of candidemia in the Czech Republic did not vary significantly between 2012 and 2015, and C. glabrata was the second most common yeast species after C. albicans isolated from blood.
- MeSH
- antifungální látky MeSH
- Candida klasifikace patogenita MeSH
- incidence MeSH
- infekce spojené se zdravotní péčí * MeSH
- kandidemie * diagnóza epidemiologie krev MeSH
- lidé MeSH
- mikrobiální testy citlivosti metody MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- multicentrická studie MeSH
- Geografické názvy
- Česká republika MeSH
Hemolytic factor production by pathogenic Candida species is considered an important attribute in promoting survival within the mammal host through the ability to assimilate iron from the hemoglobin-heme group. Hemolytic capability has been evaluated for Candida species based on hemolysis zones on plate assay, analysis of hemolytic activity in liquid culture medium, and hemolysis from cell-free culture broth. The production of hemolytic factor is variable among Candida species, where C. parapsilosis is the less hemolytic species. In general, no intraspecies differences in beta-hemolytic activities are found among isolates belonging to C. albicans, C. glabrata, C. krusei, C. tropicalis, and C. parapsilosis. The production of hemolytic factor by Candida species is affected by several factors such as glucose supplementation in the culture medium, blood source, presence of erythrocytes and hemoglobin, and presence of electrolytes. On the basis of existing achievements, more researches are still needed in order to extend our knowledge about the biochemical nature of hemolytic molecules produced by distinct Candida species, the mechanism of hemolysis, and the molecular basis of the hemolytic factor expression.
- MeSH
- Candida klasifikace metabolismus fyziologie MeSH
- druhová specificita MeSH
- faktory virulence biosyntéza chemie MeSH
- hemolýza * MeSH
- kandidemie mikrobiologie patologie MeSH
- kultivační média chemie metabolismus MeSH
- lidé MeSH
- membránové glykoproteiny metabolismus MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- časopisecké články MeSH
- přehledy MeSH
- MeSH
- antifungální látky aplikace a dávkování farmakologie škodlivé účinky MeSH
- gastrointestinální nemoci mikrobiologie MeSH
- hostitel s imunodeficiencí MeSH
- kandidemie MeSH
- kandidóza invazivní diagnóza farmakoterapie ošetřování MeSH
- lidé MeSH
- nemoci jater farmakoterapie mikrobiologie MeSH
- nemoci sleziny farmakoterapie mikrobiologie MeSH
- oportunní infekce farmakoterapie mikrobiologie MeSH
- orofarynx mikrobiologie MeSH
- Check Tag
- lidé MeSH
