Biofilm production by<i>Candida</i>isolates from a survey of invasive fungal infections in Italian intensive care units

Prigitano, Anna; Dho, Giovanna; Lazzarini, C.; Ossi, C.; Cavanna, C.; Tortorano, Anna Maria

doi:10.1179/1120009x12z.00000000014

Cited by 8 publications

(6 citation statements)

References 14 publications

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“…For example, if we consider only the articles from Italy, we can notice that the sample size in 5 of 6 studies do not considerably differ but the effect size is quite different (this will impact directly in the funnel plot geometry as presented in Fig 3 ). In three studies, we found a low prevalence of biofilm formation [ 33 , 39 , 40 ] while in other two articles we found a high prevalence of biofilm formation [ 41 , 42 ]. This distribution suggests that factors quite beyond the geography are possible causes of heterogeneity within groups.…”

Section: Discussionmentioning

confidence: 96%

Prevalence of biofilms in Candida spp. bloodstream infections: A meta-analysis

et al. 2022

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Context Candida-related infections are nowadays a serious Public Health Problem emerging multidrug-resistant strains. Candida biofilm also leads bloodstream infections to invasive systemic infections. Objective The present meta-analysis aimed to analyze Candida biofilm rate, type, and antifungal resistance among hospitalized patients between 1995 and 2020. Data sources Web of Science, Scopus, PubMed, and Google Scholar databases were searched for English papers using the following medical subject heading terms (MESH): “invasive candidiasis”; “bloodstream infections”; “biofilm formation”; “biofilm-related infections”; “mortality”; and “prevalence”. Study selection The major inclusion criteria included reporting the rate of biofilm formation and the prevalence of biofilm-related to Candida species, including observational studies (more exactly, cohort, retrospective, and case-control studies). Furthermore, data regarding the mortality rate, the geographical location of the study set, and the use of anti-fungal agents in clinical isolates were also extracted from the studies. Data extraction Independent extraction of articles by 2 authors using predefined data fields, including study quality indicators. Data synthesis A total of 31 studies from publicly available databases met our inclusion criteria. The biofilm formation in the data set varied greatly from 16 to 100% in blood samples. Most of the studies belonged to Europe (17/31) and Asia (9/31). Forest plot showed a pooled rate of biofilm formation of 80.0% (CI: 67–90), with high heterogeneity (Q = 2567.45, I2 = 98.83, τ2 = 0.150) in random effects model (p < 0.001). The funnel plot and Egger’s linear regression test failed to find publication bias (p = 0.896). The mortality rate in Candida-related bloodstream infections was 37.9% of which 70.0% were from biofilm-associated infections. Furthermore, Candida isolates were also characterized in low, intermediate, or high biofilm formers through their level of biofilm mass (crystal violet staining or XTT assays) after a 24h growth. When comparing between countries, statistical differences were obtained (p = 0.0074), showing the lower and higher biofilm prevalence values in Italy and Spain, respectively. The prevalence of low, intermediate, and high biofilms were 36.2, 18.9, and 35.0% (p < 0.0001), respectively. C. tropicalis was the prevalent species in high biofilm formation (67.5%) showing statistically significant differences when compared to other Candida species, except for C. krusei and C. glabrata. Finally, the rates of antifungal resistance to fluconazole, voriconazole, and caspofungin related to biofilm were 70.5, 67.9 and 72.8% (p < 0.001), respectively. Conclusions Early detection of biofilms and a better characterization of Candida spp. bloodstream infections should be considered, which eventually will help preserve public health resources and ultimately diminish mortality among patients.

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Section: Discussionmentioning

confidence: 96%

Prevalence of biofilms in Candida spp. bloodstream infections: A meta-analysis

et al. 2022

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“…Biofi lm production was also investigated among 297 invasive isolates (276 from blood, 160 C. albicans ) among ICU patients in Italy, finding 32.3 % of all isolates to be high biofi lm producers (33.8 % for C. albicans versus 30.7 % for non-C. albicans ). Clinical outcomes were compared between 77 and 53 patients infected by high and low biofi lmproducing Candida , respectively, fi nding no differences in crude mortality according to biofi lm formation (40 % versus 37.5 %) or species (59.3 % for C. albicans versus 59.4 % for non-C. albicans ) (Prigitano et al 2012 ). The biofi lm formation of 107 sequential isolates from 32 candidemic patients was compared to single oropharyngeal isolates from 19 AIDS patients with oral lesions.…”

Section: Biofi Lms In Clinical Isolates Of Candida Sppmentioning

confidence: 99%

Biofilm Formation by Clinical Isolates and Its Relevance to Clinical Infections

Akers

Cardile

Wenke

et al. 2014

Advances in Experimental Medicine and Biology

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Reports of biofilms have increased exponentially in the scientific literature over the past two decades, yet the vast majority of these are basic science investigations with limited clinical relevance. Biofilm studies involving clinical isolates are most often surveys of isolate collections, but suffer from lack of standardization in methodologies for producing and assessing biofilms. In contrast, more informative clinical studies correlating biofilm formation to patient data have infrequently been reported. In this chapter, biofilm surveys of clinical isolates of aerobic and anaerobic bacteria, mycobacteria, and Candida are reviewed, as well as those pertaining to the unique situation of cystic fibrosis. In addition, the influence of host components on in vitro biofilm formation, as well as published studies documenting the clinical impact of biofilms in human infections, are presented.

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“…Second, Albert et al [15] did not provide details on biofilm production of isolated Candida spp. A recent survey of ICU patients with IC reported in 297 Candida isolates, percentages of biofilm formation ability ranging between of 20 and 50 % and higher mortality rates in patients with candidemia may be observed in the presence of high producers strains [17]. In the CANTREAT trial, patients in the intervention group received anidulafungin for a mean of 5.9 ± 3 days but only 22.6 % were not sequentially switched to fluconazole.…”

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confidence: 99%