Diagnostic Issues, Clinical Characteristics, and Outcomes for Patients with Fungemia

Unit of Mycology, 43/117, Department of Microbiological Surveillance and Research, Statens Serum Institut, Artillerivej 5, 2300 Copenhagen, Denmark.
Journal of clinical microbiology (Impact Factor: 3.99). 06/2011; 49(9):3300-8. DOI: 10.1128/JCM.00179-11
Source: PubMed


This study investigated microbiological, clinical, and management issues and outcomes for Danish fungemia patients. Isolates
and clinical information were collected at six centers. A total of 334 isolates, 316 episodes, and 305 patients were included,
corresponding to 2/3 of the national episodes. Blood culture positivity varied by system, species, and procedure. Thus, cases
with concomitant bacteremia were reported less commonly by BacT/Alert than by the Bactec system (9% [11/124 cases] versus
28% [53/192 cases]; P < 0.0001), and cultures with Candida glabrata or those drawn via arterial lines needed longer incubation. Species distribution varied by age, prior antifungal treatment
(57% occurrence of C. glabrata, Saccharomyces cerevisiae, or C. krusei in patients with prior antifungal treatment versus 28% occurrence in those without it; P = 0.007), and clinical specialty (61% occurrence of C. glabrata or C. krusei in hematology wards versus 27% occurrence in other wards; P = 0.002). Colonization samples were not predictive for the invasive species in 11/100 cases. Fifty-six percent of the patients
had undergone surgery, 51% were intensive care unit (ICU) patients, and 33% had malignant disease. Mortality increased by
age (P = 0.009) and varied by species (36% for C. krusei, 25% for C. parapsilosis, and 14% for other Candida species), severity of underlying disease (47% for ICU patients versus 24% for others; P = 0.0001), and choice but not timing of initial therapy (12% versus 48% for patients with C. glabrata infection receiving caspofungin versus fluconazole; P = 0.023). The initial antifungal agent was deemed suboptimal upon species identification in 15% of the cases, which would
have been 6.5% if current guidelines had been followed. A large proportion of Danish fungemia patients were severely ill and
received suboptimal initial antifungal treatment. Optimization of diagnosis and therapy is possible.

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    • "The standard of care for treating fungal biofilm infections on medical devices varies depending on the age and health status of the patient, the infection site, and the causative fungal species, but generally, the consensus on care involves administration of antifungal drugs and ultimately removal of the presumed infected medical device (Andes et al., 2012; Cornely et al., 2012; Lepak and Andes, 2011). The majority of fungal infections (deviceand non-device-associated) involve Candida species, and as such, current general guidelines for care tend to recommend treatments most effective against candidaemia and candidiasis (Arendrup et al., 2011; Mikolajewska et al., 2012). Four major classes of antifungal drugs are used for treatment of fungal infections: azoles, polyenes, nucleoside analogues, and echinocandins (Chen et al., 2011; Cowen, 2008; Jabra-Rizk et al., 2004; Mikolajewska et al., 2012; Ramage et al., 2012; White et al., 1998). "
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    ABSTRACT: Infections caused by pathogenic fungi are a significant medical problem, as they are able to disseminate to nearly every organ of the human body and there are few classes of antifungal drugs available as therapeutic options. Fungal infections are even more difficult to manage when they are biofilm-associated due to the natural properties of the biofilm mode of growth. Like bacterial biofilms, fungal biofilms consist of adherent communities of cells that are attached to a substrate and to one another, and are enclosed in a protective extracellular matrix material. Biofilms in general are able to withstand much higher concentrations of antimicrobial agents compared to single free-floating (or planktonic) cells, making biofilm infections extremely challenging to treat. In this chapter, we review the current knowledge of biofilm formation in representative, pathogenic species from several phyla of fungi. We also discuss the molecular mechanisms of drug resistance in fungal biofilms, the current standards of care for treating these biofilm-associated infections, and strategies for overcoming challenges in developing new antifungal drugs with efficacies against biofilms.
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    • "In a previous European Confederation of Medical Mycology (ECMM) prospective multinational study performed in seven European countries, the rates of candidaemia ranged from 0.20 to 0.38 per 1000 hospital admissions [6]. Intensive care treatments accounted for about 40% of all episodes of candidaemia in various surveys conducted in Europe [2] [6] [7]. Moreover, two recent European studies documented the significance of fungal diseases in the intensive care setting [8] [9]. "
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    ABSTRACT: 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). Copyright © 2014 European Society of Clinical Microbiology and Infectious Diseases. Published by Elsevier Ltd. All rights reserved.
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    • "In recent point prevalence studies, a candidaemia incidence of 6.9 per 1000 ICU patients was reported, and 7.5% of ICU patients received antifungal therapy (Kett et al., 2011; Azoulay et al., 2012). Candidaemia increases mortality rates in the range of 20–49% (Gudlaugsson et al., 2003; Arendrup et al., 2011), but still there are many open management questions. Pulmonary candida infections may present as the manifestations of disseminated candidiasis spread by hematogenous route or as a primary bronchial or pulmonary process from the airways (Odds, 1988). "
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