Breakthrough Candidaemias During Empirical Therapy with Fluconazole in Non-cancer and Non-HIV Adults Caused by In Vitro-susceptible Candida Spp.: Report of 33 Cases

Kovacicova, G.; Mateicka, F.; Hanzen, Juraj; Líšková, Anna; Sabo, Alex N.; Szovényová, Zuzana; B, Chmelik; Huttova, M; Krčméry, V.

doi:10.1080/003655401317074554

Cited by 9 publications

(6 citation statements)

References 9 publications

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“…However, our group published three studies on breakthrough fungaemia in a cancer or non-HIV adult patient population. 5,11,12 In contrast to our previously published studies, all the fungaemias in children were due to species susceptible to fluconazole in vitro (C. albicans and C. parapsilosis). All Candida isolates were inhibited by fluconazole at MICs of 0.25-4 mg/L.…”

Section: Discussioncontrasting

confidence: 63%

“…1 In our previous three papers we summarized our 10 year experience with breakthrough fungaemia in cancer and mixed non-cancer adult populations. 5,11,12 However, none of our studies pub-lished findings for neonates and infants separately from those for adults.…”

Section: Introductionmentioning

confidence: 68%

“…There have been several reports of fungaemia appearing during antifungal prophylaxis [1][2][3][4][5][6] but none of them analysed the paediatric patient population separately. The fungaemias were usually caused by fungi other than Candida albicans (Candida krusei, Candida glabrata, Candida tropicalis, Trichosporon spp., Candida lusitaniae) [7][8][9][10][11] and appeared mainly in cancer patients (particularly acute leukaemia and bone marrow transplant recipients). C. albicans was observed less frequently, as antifungals currently used for prophylaxis have shown sufficient in vitro activity against C. albicans.…”

Section: Introductionmentioning

confidence: 99%

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Breakthrough fungaemia in neonates and infants caused by Candida albicans and Candida parapsilosis susceptible to fluconazole in vitro

Krčméry

Huttova²,

Mateicka³

et al. 2001

Journal of Antimicrobial Chemotherapy

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Breakthrough fungaemias due to Candida albicans and Candida parapsilosis appearing during fluconazole therapy in neonates and infants were assessed for risk factors and outcome. Forty fungaemias occurred during therapy with fluconazole within a 12 year national survey and were compared with 161 cases of non-breakthrough paediatric fungaemias. The agar disc diffusion test method was used for antifungal susceptibility testing and the Vitek system for species identification. Univariate and multivariate analysis for risk factors for breakthrough fungaemia were carried out. All the fungaemias were a result of strains susceptible to fluconazole at 0.25-4 mg/L in vitro [C. albicans (85%) and C. parapsilosis (15%)]. The mean number of positive blood cultures per episode was 2.2. Sixteen children had 'early' breakthrough fungaemias (within 4-5 days) and 24 fungaemias appeared on day 6 and later. Mean fluconazole MICs in the 'early' group were 1.2, and 2.8 mg/L in the 'late' group (P < 0.03, t-test). However, no difference was observed in the average dose of fluconazole used in the two groups. Neonatal age, total parenteral nutrition, very low birth weight, before surgery, central or umbilical venous catheterization and artificial ventilation were all significantly related to breakthrough fungaemia in univariate analysis but only central or umbilical venous catheterization were significant in multivariate analysis. The outcome of breakthrough fungaemia was better overall and attributable mortalities in non-breakthrough fungaemia was significantly higher in comparison with breakthrough fungaemia.

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Section: Discussioncontrasting

confidence: 63%

Section: Introductionmentioning

confidence: 68%

Section: Introductionmentioning

confidence: 99%

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Breakthrough fungaemia in neonates and infants caused by Candida albicans and Candida parapsilosis susceptible to fluconazole in vitro

Krčméry

Huttova²,

Mateicka³

et al. 2001

Journal of Antimicrobial Chemotherapy

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“…(39,40), Trichomonascus ciferrii (39), K. ohmeri (39), Rhodotorula spp. (43,44,56), Saccharomyces cerevisiae (46), Blastoschizomyces capitatus (49), and Meyerozyma guilliermondii (57,58). A word of caution, however, is necessary in this respect, since it is likely that case reports and small case series will overemphasize cases of poor outcome (8).…”

Section: Discussionmentioning

confidence: 99%

Fluconazole Resistance in Isolates of Uncommon Pathogenic Yeast Species from the United Kingdom

Borman

Müller

Walsh-Quantick

et al. 2019

Antimicrob Agents Chemother

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The triazole drug fluconazole remains one of the most commonly prescribed antifungal drugs, both for prophylaxis in high-risk patients and also as a second-line treatment option for invasive Candida infections. Established susceptibility profiles and clinical interpretive breakpoints are available for fluconazole with Candida albicans, Candida glabrata, Candida tropicalis, and Candida parapsilosis, which account for the majority of infections due to pathogenic yeast species. However, less common species for which only limited susceptibility data are available are increasingly reported in high-risk patients and from breakthrough infections. The UK National Mycology Reference Laboratory performs routine antifungal susceptibility testing of clinical isolates of pathogenic yeast submitted from across the United Kingdom. Between 2002 and 2016, ϳ32,000 isolates were referred, encompassing 94 different yeast species. Here, we present fluconazole antifungal susceptibility data generated using a CLSI methodology over this 15-year period for 82 species (2,004 isolates) of less common yeast and yeast-like fungi, and amphotericin B, fluconazole, itraconazole, voriconazole, posaconazole, and anidulafungin, with members of the Nakaseomyces clade (C. glabrata, Candida nivariensis, and Candida bracarensis). At least 22 different teleomorph genera, comprising 45 species, exhibited high MICs when tested with fluconazole (Ͼ20% of isolates with MICs higher than the clinical breakpoint [Ն8 mg/liter] proposed for C. albicans). Since several of these species have been reported anecdotally from breakthrough infections and therapeutic failures in patients receiving fluconazole, the current study underscores the importance of rapid and accurate yeast identification and may aid clinicians dealing with infections with rarer yeasts to decide whether fluconazole would be appropriate.

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“…Literature reports breakthrough Candida bloodstream infection with in vitro-susceptible Candida strains during empiric therapy with fluconazole [16]. We believe that this case study represents the first documented European case of successful treatment of breakthrough C. glabrata infection with micafungin following unsuccessful treatment with caspofungin.…”

Section: Discussionmentioning

confidence: 81%

Treatment of Candida Glabrata With Micafungin: A Case Report and Brief Review of the Literature

Guleri

2013

J Med Cases

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We report the case of a patient with multiple Candida bloodstream infections post emergency laparotomy, Hartmann's procedure, abdominal closure and drainage. The patient also experienced recurrent central venous catheter Candida infections. The treatment of Candida tropicalis bloodstream infection with fluconazole and caspofungin was initially successful; however the patient consequently developed Candida glabrata bloodstream infection which did not respond to therapy with fluconazole or caspofungin. Although at the time of treatment of this patient, the C. glabrata strain was considered to be susceptible to caspofungin, the new clinical breakpoints recently published by the Clinical and Laboratory Standards Institute show that this strain was in fact resistant to caspofungin. The patient was successfully treated with micafungin and a line lock was used for the Hickman line. This case study is the first documented European case report of successful treatment of breakthrough C. glabrata blood stream infection with micafungin.

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Breakthrough Candidaemias During Empirical Therapy with Fluconazole in Non-cancer and Non-HIV Adults Caused by In Vitro-susceptible Candida Spp.: Report of 33 Cases

Cited by 9 publications

References 9 publications

Breakthrough fungaemia in neonates and infants caused by Candida albicans and Candida parapsilosis susceptible to fluconazole in vitro

Breakthrough fungaemia in neonates and infants caused by Candida albicans and Candida parapsilosis susceptible to fluconazole in vitro

Fluconazole Resistance in Isolates of Uncommon Pathogenic Yeast Species from the United Kingdom

Treatment of Candida Glabrata With Micafungin: A Case Report and Brief Review of the Literature

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