Aim. To study the risk factors, symptoms and outcomes of candidemia caused by C. albicans and C. non - albicans in patients with hematological malignancies. Materials and methods. The study included patients with hematological malignancies and candidemia. The diagnosis of candidemia was established according to the single isolation of Candida spp. from blood culture and the presence of symptoms of infection. Results and discussion. Over 12 years (2006-2017), candidemia was diagnosed in 75 patients aged 17 to 77 years (median 48 years). The causative agents of candidemia were C. albicans in 34.7% of patients, C. non - albicans - in 65.3%. Candidemia caused by C. albicans prevailed in patients of the older age group (median 56.5 years, p=0.04) and in patients with lymphoma (61.5%, p=0.01) with colonization of the gut by the same species of Candida (88.5%, p=0.002). Isolation of C. non - albicans from blood culture was more common in patients with acute leukemia (51%, p=0.01) and in recipients of allogeneic hematopoietic stem cells (22.5%, p=0.01). The ability to form biofilms was observed more frequently among C. non - albicans (59.2%) than C. albicans (19.2%, p=0.001). The clinical symptoms of candidemia were non - specific (fever was in 97%). Septic shock developed in 25 (33%) patients with comparable frequency in both groups. Concomitant infections was also comparable (73% vs. 73.5%). Overall 30-day survival in patients with candidemia caused by C. albicans and C. non - albicans was 61.2% and 61.5%. Treatment with echinocandin was associated with increase of survival compared to other antifungal agents among patients with C. albicans candidaemia (88.9% versus 40%, p=0.02) and among C. non - albicans (77.3% versus 47.8%). Conclusion. C. non - albicans constituted a high proportion among causative agents of candidemia. High mortality rate was observed in both groups. Initial therapy with echinocandin was associated with increase of survival.
Introduction. Biofi lm-forming ability among Candida spp. on indwelling medical devices may have a negative infl uence on the outcome of invasive candidiasis in various groups of patients. Aim. The objective of this study was to evaluate the biofi lm-forming ability among Candida spp. isolated from clinical specimens in patients with hematological malignancies and patients without hematological malignancies. Materials and methods. Biofi lm production among Candida spp. was studied using XTT (Sigma-Aldrich, USA) reduction assay. Candida spp. were classifi ed as biofi lm-forming, having optical density equal to and more than 0.1, and non-biofi lmforming with optical density less than 0.1. Results. A total of 428 Candida spp. (C. albicans n = 192, C. parapsilosis n = 121, C. krusei n = 40, C. tropicalis n = 38, C. glabrata n = 37) were evaluated (172 from hematological patients, 256 from non-hematological patients, 361 from blood culture, 67 from other sterile specimens). Biofi lm-forming ability was detected among 179 (41.8%) Candida spp. with the same rate in hematological patients and non-hematological patients (41.9 % and 41.8 %, respectively). Biofi lm production predominated among non-C. albicans (52.5 %) compared to C. albicans (28.6 %, p = 0.001). Biofi lm production prevailed among C. tropicalis (89.5 %) and C. krusei (75 %) compared to C. parapsilosis (41.3 %), C. albicans (28.6 %), and C. glabrata (27 %, respectively, p < 0.05). Biofi lm-forming ability among C. tropicalis and C. krusei dominated in both groups of patients. Biofi lm production among C. albicans prevailed in non-hematological patients compared to hematological patients (34.1% vs 18.2%, p = 0.03). There were no differences in biofi lm production among Candida spp. isolated from blood culture (42.9%) and other sterile specimens (35.8%, p = 0.3). Conclusion. Biofi lm-forming ability varied among the Candida spp. and prevailed among C. tropicalis and C. krusei. Biofi lm production among Candida spp. was detected with the same rate in hematological and non-hematological patients.
Objective.
To present the results of using in-house method for rapid identification of fungi from funguspositive bottles with routine conventional culture-based identification by matrix-assisted laser desorption ionization time-of-flight mass spectrometry (MALDI-TOF MS) in patients with bloodstream infection.
Materials and Methods.
Prospective study was performed from 2016 to 2019 at the National Research Center for Hematology, Moscow. During the study period, all blood cultures (BC) bottles obtained from hematological patients were incubated in the BACTEC FX system (Becton Dickinson, USA). Positive BC bottles were examined by Gram stain. In house method was used after Gram stain was positive for yeast cells or hyphae. For that, BC media was transfer from fungus-positive bottles into tube. In house method included series section steps consisted from centrifugation and extraction of fungal proteins by adding of sodium dodecyl sulfate. Routine conventional culture-based identification on Sabouraud with chloramphenicol agar (bioMerieux, France) for yeasts and on Sabouraud dextrose agar (Oxoid, UK) for molds was used simultaneously with the in house method.
Results.
During the study period, 16 fungus-positive bottles were obtained from which were isolated in monoculture 14 (87.5%) Candida spp.: C. parapsilosis (n = 5), C. tropicalis (n = 4), C. albicans (n = 3), C. krusei (n = 1), C. guilliermondii (n = 1), one (6.3%) Rhodotorula mucilaginosa and one (6.3%) Fusarium dimerum. The in house method resulted in 75% (12⁄16) and 68.8% (11⁄16) identification rate at the genus and species level of fungi, respectively. The identification of fungi to species level was confirmed by conventional culture-based method in all cases. The median time from the start of vial incubation in BACTEC FX system to identification of fungi by in house method was less than conventional culture-based identification: 36 hrs 20 min vs 55 hrs 31 min (p = 0.028).
Conclusions.
A high rate of correct direct species identification and significant reduction in time to verification of fungi from fungus-positive bottles by in house method were obtained. The proposed in house method should be recommended for use in real microbiology practice to reduce the time for submitting results of identification to clinical units.
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