• MeSH
• dítě MeSH
• dospělí MeSH
• infekce spojené se zdravotní péčí MeSH
• kandidóza etiologie   mikrobiologie   MeSH
• lidé MeSH
• nádory komplikace   MeSH
• péče o pacienty v kritickém stavu MeSH
• rizikové faktory MeSH
• Check Tag
• dítě MeSH
• dospělí MeSH
• lidé 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

Prehľad sa zaoberá epidemiológiou, rizikovými faktormi, diagnostikou a liečbou invazívnych mykotických infekcií. Článok poukazuje na nárast incidencie invazívnych kandidémií, najmä v populácii pacientov na jednotkách intenzívnej starostlivosti, a na dominujúce postavenie invazívnej aspergilózy hematoonkologických pacientov. Na základe interdisciplinárneho pohľadu prináša odporúčané diagnostické a liečebné postupy. Včasná diagnostika, včasná a správna liečba invazívnych mykotických infekcií sú kľúčovými faktormi na zníženie mortality rizikových pacientov.

The overview on epidemiology, risk factors, diagnosis and treatment of invasive fungal infections/diseases. There is a increase of incidence of invasive candidaemia among patients on intensive care units; invasive aspergillosis is dominating fungal disease in patients with heamatological malignancies. Diagnostic and therapeutic recommendations are made according to the interdisciplinary point of view. Rapid, in-time diagnosis and appropriate therapy are the key factors for decreasing mortality in patients at risk.

We have estimated the number of serious fungal infections in the Czech Republic. All published epidemiology papers reporting Czech fungal infection rates were identified. Where no data existed, we used specific populations at risk and fungal infection frequencies in those populations. Population statistics were obtained from the 2011 Census data, prevalence and incidence data for at-risk conditions were obtained from publicly accessible healthcare statistics and relevant surveys. We estimate that 152,840 Czech women suffer with recurrent vaginal thrush. Allergic bronchopulmonary aspergillosis is likely in 4739 adults and 6581 more have severe asthma with fungal sensitisation. Hypersensitivity pneumonitits secondary to fungi is estimated in 1050 cases and 365 people may have chronic pulmonary aspergillosis. Oesophageal candidiasis is estimated in 210 HIV-positive people. There are 12 cases of Pneumocystis pneumonia in HIV population and 60 more cases in non-HIV population. There are an estimated 526 cases of candidaemia, 79 cases of Candida peritonitis and 297 cases of invasive aspergillosis a year. About 176,000 (1.67%) Czech people suffer from severe fungal infections each year, predominantly from recurrent vaginitis and allergic respiratory conditions. Substantial uncertainty surrounds these estimates except for invasive aspergillosis in haematology and candidaemia in critical care.

• MeSH
• aspergilóza alergická bronchopulmonální epidemiologie   mikrobiologie   MeSH
• bronchiální astma komplikace   epidemiologie   mikrobiologie   MeSH
• dospělí MeSH
• hypersenzitivní pneumonitida epidemiologie   mikrobiologie   MeSH
• incidence MeSH
• kandidemie epidemiologie   mikrobiologie   MeSH
• kandidóza epidemiologie   mikrobiologie   MeSH
• lidé středního věku MeSH
• lidé MeSH
• mladiství MeSH
• mladý dospělý MeSH
• mykózy ekonomika   epidemiologie   mikrobiologie   MeSH
• oportunní infekce doprovázející AIDS epidemiologie   MeSH
• osobní újma zaviněná nemocí MeSH
• plicní aspergilóza epidemiologie   mikrobiologie   MeSH
• pneumocystová pneumonie epidemiologie   MeSH
• pneumonie epidemiologie   mikrobiologie   MeSH
• prevalence MeSH
• vaginitida epidemiologie   mikrobiologie   MeSH
• Check Tag
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• mladiství MeSH
• mladý dospělý MeSH
• mužské pohlaví MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• práce podpořená grantem MeSH
• přehledy MeSH
• Research Support, N.I.H., Extramural MeSH
• Geografické názvy
• Česká republika MeSH

• MeSH
• analýza rozptylu MeSH
• antifungální látky terapeutické užití   MeSH
• Candida klasifikace   účinky léků   MeSH
• flukonazol aplikace a dávkování   MeSH
• lidé MeSH
• Check Tag
• lidé MeSH

INTRODUCTION: Despite antifungal advancements, candidaemia still has a high mortality rate of up to 40%. The ECMM Candida III study in Europe investigated the changing epidemiology and outcomes of candidaemia for better understanding and management of these infections. METHODS: In this observational cohort study, participating hospitals enrolled the first ten consecutive adults with blood culture-proven candidemia. Collected data included patient demographics, risk factors, hospital stay duration (follow-up of 90 days), diagnostic procedures, causative Candida spp., management details, and outcome. Controls were included in a 1:1 fashion from the same hospitals. The matching process ensured similarity in age (10-year range), primary underlying disease, hospitalization in intensive care versus non-ICU ward, and major surgery within 2 weeks before candidemia between cases and controls. Overall and attributable mortality were described, and a survival probability for cases and controls was performed. RESULTS: One hundred seventy-one pairs consisting of patients with candidemia and matched controls from 28 institutions were included. In those with candidemia, overall mortality was 40.4%. Attributable mortality was 18.1% overall but differed between causative Candida species (7.7% for Candida albicans, 23.7% for Candida glabrata/Nakaseomyces glabratus, 7.7% for Candida parapsilosis and 63.6% for Candida tropicalis). Regarding risk factors, the presence of a central venous catheter, total parenteral nutrition and acute or chronic renal disease were significantly more common in cases versus controls. Duration of hospitalization, and especially that of ICU stay, was significantly longer in candidemia cases (20 (IQR 10-33) vs 15 days (IQR 7-28); p = 0.004). CONCLUSIONS: Although overall and attributable mortality in this subgroup analysis of matched case/control pairs remains high, the attributable mortality appears to have decreased in comparison to historical cohorts. This decrease may be driven by improved prognosis of Candida albicans and Candida parapsilosis candidemia; whereas candidemia due to other Candida spp. exhibits a much higher attributable mortality.

• MeSH
• antifungální látky terapeutické užití   MeSH
• Candida * izolace a purifikace   klasifikace   MeSH
• dospělí MeSH
• kandidemie * mortalita   mikrobiologie   MeSH
• kohortové studie MeSH
• lidé středního věku MeSH
• lidé MeSH
• rizikové faktory MeSH
• senioři nad 80 let MeSH
• senioři MeSH
• studie případů a kontrol MeSH
• Check Tag
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• senioři nad 80 let MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• multicentrická studie MeSH
• pozorovací studie MeSH
• Geografické názvy
• Evropa MeSH

Kvasinky jsou oportunní patogeny člověka, jejich patogenita závisí na celkovém stavu makroorganismu a na funkčnosti jeho imunitního systému, ale i na virulenci jednotlivých kvasinek. Kvasinky mohou vyvolat jak kožní, tak systémové infekce. V typických případech postihují sliznice, kůži, nehty a gastrointestinální trakt. Za určitých podmínek mohou postihnout kterýkoliv orgán v těle. Invazivní kandidóza a kandidémie jsou nejčastějšími klinickými projevy systémové fungální infekce, která je také spojena s nejvyšší mortalitou. Práce předkládá přehled současných poznatků o taxonomii, klinickém obrazu, diagnóze a léčbě těchto onemocnění. Klíčová slova: kandidóza – C. albicans – taxonomie – klinický obraz – diagnóza – terapie

Yeasts are opportunistic human pathogens which pathogenicity depends on the general condition of the macroorganism and its immune system, but also on the virulence of individual yeasts. Yeasts can cause both cutaneous and systemic infections. In typical cases they affect mucosa, skin, nails and gastrointestinal tract. However, under certain circumstances, they can infect any organ. Invasive candidiasis and candidaemia are the most frequent clinical manifestations of systemic fungal infections, which are also associated with the highest mortality. The article provides the review of the current knowledge of the candida taxonomy, of the clinical picture, of the diagnosis and of the therapy of these diseases. Key words: candidose – C. albicans – taxonomy – clinical picture – diagnosis – therapy

• MeSH
• antifungální látky MeSH
• buněčná membrána účinky léků   MeSH
• buněčná stěna účinky léků   MeSH
• Candida albicans patogenita   MeSH
• Candida izolace a purifikace   klasifikace   patogenita   účinky léků   MeSH
• kandidóza kožní * diagnóza   klasifikace   patofyziologie   terapie   MeSH
• kandidóza vulvovaginální MeSH
• kandidóza klasifikace   MeSH
• klinické laboratorní techniky MeSH
• kůže mikrobiologie   MeSH
• lidé MeSH
• onychomykóza MeSH
• orální kandidóza farmakoterapie   patologie   MeSH
• příznaky a symptomy MeSH
• recidiva MeSH
• rizikové faktory MeSH
• sliznice mikrobiologie   MeSH
• Check Tag
• lidé MeSH
• mužské pohlaví MeSH
• ženské pohlaví MeSH
• Publikační typ
• přehledy MeSH

Mycotic infections are lastly a significant morbidity and mortality cause of critically ill patients in surgical intensive care units. The most frequent causative agents of mycotic infections in surgical patients are Candida species. In order to assess the significance of mycotic infections for the critically ill in surgical intensive care and resuscitation units a retrospective evaluation of mycotic infection incidence and of their sensitivity to antimycotics has been performed, and some risk factors occurring in patients with fungal colonization have been determined. It was shown that colonization with yeasts, and candidaemia are most frequently caused by the fungus Candida albicans (88.2 - 93 %). Colonization with yeasts occurs most frequently in the air passages and the efferent urinary tract. The lowest resistance rate of Candida spp. was noted to Amphotericin B. Among the most frequent risk factors occurring in surgical patients with yeast colonization are risks from antibiotic treatment, and from certain interventional therapeutic procedures. In case of simultaneous occurrence of risk factors and proven yeast colonization, the route of choice is prophylactic, or pre-emptive therapy with an antimycotic (fluconazole, or Amphotericin B if resistance to the former has been proven).

• MeSH
• amfotericin B farmakokinetika   terapeutické užití   MeSH
• antibakteriální látky terapeutické užití   MeSH
• antifungální látky terapeutické užití   MeSH
• Candida izolace a purifikace   patogenita   účinky léků   MeSH
• chirurgie operační škodlivé účinky   využití   MeSH
• infekce dýchací soustavy farmakoterapie   klasifikace   komplikace   MeSH
• infekce močového ústrojí farmakoterapie   klasifikace   komplikace   MeSH
• infekce spojené se zdravotní péčí farmakoterapie   komplikace   MeSH
• infekce etiologie   farmakoterapie   komplikace   MeSH
• jednotky intenzivní péče využití   MeSH
• lidé MeSH
• mikrobiologické techniky metody   využití   MeSH
• péče o pacienty v kritickém stavu metody   využití   MeSH
• Check Tag
• lidé MeSH

Candida spp. is able to form a biofilm, which is considered resistant to the majority of antifungals used in medicine. The aim of this study was to evaluate the in vitro activity of micafungin against Candida spp. biofilms at different stages of their maturation (2, 6, and 24 h). We assessed the inhibitory effect of micafungin against 78 clinical isolates of Candida spp., growing as planktonic or sessile cells, by widely recommended broth microdilution method. The in vitro effect on sessile cells viability was evaluated by colorimetric reduction assay. All examined strains were susceptible or intermediate to micafungin when growing as planktonic cells. At the early stages of biofilm maturation, from 11 (39.3%) to 20 (100%), tested strains, depending on the species, exhibited sessile minimal inhibitory concentrations (SMICs) of micafungin at ≤ 2 mg/L. For 24-h-old Candida spp. biofilms, from 3 (10.7%) to 20 (100%) of the tested strains displayed SMICs of micafungin at ≤ 2 mg/L. Our findings confirm that micafungin exhibits high potential anti-Candida-biofilm activity. However, this effect does not comprise all Candida species and strains. All strains were susceptible or intermediate to micafungin when growing as planktonic cells, but for biofilms, micafungin displays species- and strain-specific activity. Paradoxical growth of C. albicans and C. parapsilosis was observed. Antifungal susceptibility testing of Candida spp. biofilms would be the best solution, but to date, no reference method is available. The strongest antibiofilm activity of micafungin is observed at early stages of biofilm formation. Possibly, micafungin could be considered as an effective agent for prevention of biofilm-associated candidiasis, especially catheter-related candidaemia.

• MeSH
• antifungální látky farmakologie   MeSH
• biofilmy účinky léků   MeSH
• Candida albicans účinky léků   růst a vývoj   fyziologie   MeSH
• Candida glabrata účinky léků   růst a vývoj   fyziologie   MeSH
• Candida parapsilosis účinky léků   růst a vývoj   fyziologie   MeSH
• echinokandiny farmakologie   MeSH
• kandidóza mikrobiologie   MeSH
• lidé MeSH
• lipopeptidy farmakologie   MeSH
• mikrobiální testy citlivosti MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH

A prospective, observational, multicentre study of invasive candidosis (IC) in surgical patients in intensive care units (ICUs) was conducted from 2006 to 2008 in 72 ICUs in 14 European countries. A total of 779 patients (62.5% males, median age 63 years) with IC were included. The median rate of candidaemia was 9 per 1000 admissions. In 10.8% the infection was already present at the time of admission to ICU. Candida albicans accounted for 54% of the isolates, followed by Candida parapsilosis 18.5%, Candida glabrata 13.8%, Candida tropicalis 6%, Candida krusei 2.5%, and other species 5.3%. Infections due to C. krusei (57.9%) and C. glabrata (43.6%) had the highest crude mortality rate. The most common preceding surgery was abdominal (51.5%), followed by thoracic (20%) and neurosurgery (8.2%). Candida glabrata was more often isolated after abdominal surgery in patients ≥60 years, and C. parapsilosis was more often isolated in neurosurgery and multiple trauma patients as well as children ≤1 year of age. The most common first-line treatment was fluconazole (60%), followed by caspofungin (18.7%), liposomal amphotericin B (13%), voriconazole (4.8%) and other drugs (3.5%). Mortality in surgical patients with IC in ICU was 38.8%. Multivariate analysis showed that factors independently associated with mortality were: patient age ≥60 years (hazard ratio (HR) 1.9, p 0.001), central venous catheter (HR 1.8, p 0.05), corticosteroids (HR 1.5, p 0.03), not receiving systemic antifungal treatment for IC (HR 2.8, p <0.0001), and not removing intravascular lines (HR 1.6, p 0.02).

• MeSH
• antibiotická profylaxe MeSH
• antifungální látky terapeutické užití   MeSH
• Candida * MeSH
• chirurgie operační statistika a číselné údaje   MeSH
• dítě MeSH
• dospělí MeSH
• jednotky intenzivní péče statistika a číselné údaje   MeSH
• kandidóza invazivní farmakoterapie   epidemiologie   prevence a kontrola   MeSH
• kojenec MeSH
• lidé středního věku MeSH
• lidé MeSH
• mladiství MeSH
• mladý dospělý MeSH
• novorozenec MeSH
• předškolní dítě MeSH
• prospektivní studie MeSH
• senioři nad 80 let MeSH
• senioři MeSH
• Check Tag
• dítě MeSH
• dospělí MeSH
• kojenec MeSH
• lidé středního věku MeSH
• lidé MeSH
• mladiství MeSH
• mladý dospělý MeSH
• mužské pohlaví MeSH
• novorozenec MeSH
• předškolní dítě MeSH
• senioři nad 80 let MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• multicentrická studie MeSH
• pozorovací studie MeSH
• práce podpořená grantem MeSH