CAND-LO 2014–15 study: changing epidemiology of candidemia in Lombardy (Italy)

Prigitano, Anna; Cavanna, C.; Passera, Marco; Ossi, C.; Sala, Eugenio; Lombardi, Giuseppe; Grancini, Anna; Luca, Concetta De; Bramati, Simone; Gelmi, M; Tejada, M.; Grande, Romualdo; Farina, Claudio; Lallitto, Fabiola; Tortorano, A.M.

doi:10.1007/s15010-016-0951-6

Cited by 20 publications

(23 citation statements)

References 12 publications

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“…The main finding of this study is a steady increase in the incidence of candidaemia, both due to C albicans , and even more pronounced due to C parapsilosis . Candidaemia incidence in hospitalised population can vary greatly depending on geographical reasons, but similar increase overtime was recently described in a single centre in Belgium (1.48/10 000 patient‐days) and in regional collection in Lombardy ‐ Italy (1.59/10 000 patient‐days) . Such an increase in C parapsilosis has been also reported in several other centres worldwide, both in Southern Europe, namely in Italy and Spain, and in other regions such as in Serbia or South Africa …”

Section: Discussionsupporting

confidence: 75%

“…Candidaemia incidence in hospitalised population can vary greatly depending on geographical reasons, but similar increase overtime was recently described in a single centre in Belgium (1.48/10 000 patient-days) 20 and in regional collection in Lombardy -Italy (1.59/10 000 patient-days). 21 Such an increase in C parapsilosis has been also reported in several other centres worldwide, both in Southern Europe, namely in Italy 21,22 and Spain, 7,23 and in other regions such as in Serbia 24 or South Africa. 25 The increase in C parapsilosis was concomitant to the activation of a PICC team in our hospital and due to the particular tropism of this species for CVC thanks to biofilms production, 26,27 our first clinical suspicion was that the two events were associated.…”

Section: Discussionsupporting

confidence: 55%

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Changing epidemiology of candidaemia: Increase in fluconazole‐resistant Candida parapsilosis

Mesini

Mikulska

Giacobbe

et al. 2020

Mycoses

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Summary Aim During the last decade a continuous increase in non‐albicans species isolation has been observed with Candida parapsilosis being one of the leading species. Aim of this study was to describe the epidemiology of candidemia, particularly of C parapsilosis, its predictors and clinical outcome. Materials and Methods Incidences of candidemia was evaluated analyzing data from both a prospective collection (2012‐2016) and a retrospective one (2008‐2011). Predictors and outcome were based only on the prospective phase. C parapsilosis potential clusters were analysed by randomly amplified polymorphic DNA (RAPD) technique. Results 1240 episodes were identified. Incidences of candidemia increased from 1.97 episodes/10 000 patient‐days in 2008 to 4.59/10 000 patient‐days in 2016 (P < .001), mainly due to an increase of C parapsilosis (incidence rate ratio, IRR: 1.04, P < .001). 33.0% of C parapsilosis strains were resistant to fluconazole; no resistance to echinocandins was found. Independent predictors of C parapsilosis candidemia were time of infection (P = .007), previous use of echinocandins (P < .0001) and year in which the episode was registered (P < .0001). 30 days mortality was 32.4% for C parapsilosis, with a significant difference compared to C non‐parapsilosis. Potential clonal C parapsilosis strains were detected by genetic analyses, showing RAPD profile A as the most represented (72.6% of isolates). Discussion C parapsilosis candidemia is an emerging issue in our center, possibly attributed to some extent to horizontal transmission of the pathogen, as confirmed by the analysis of isolates similarities. Further microbiological and epidemiological investigations are needed in order to identify the most effective measures to reduce the rate of this infection.

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Section: Discussionsupporting

confidence: 75%

Section: Discussionsupporting

confidence: 55%

Changing epidemiology of candidaemia: Increase in fluconazole‐resistant Candida parapsilosis

Mesini

Mikulska

Giacobbe

et al. 2020

Mycoses

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“…According to current guidelines, it is the drug of choice for Candida meningoencephalitis, Candida endocarditis and urinary tract infections caused by fluconazole-resistant Candida [ 12 , 13 ]. Recent epidemiological data from 11 Italian centres revealed amphotericin B susceptibility of all clinical Candida isolates [ 14 ].…”

Section: Amphotericin Bmentioning

confidence: 99%

Pharmacokinetics of antifungal drugs: practical implications for optimized treatment of patients

2017

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IntroductionBecause of the high mortality of invasive fungal infections (IFIs), appropriate exposure to antifungals appears to be crucial for therapeutic efficacy and safety.Materials and methodsThis review summarises published pharmacokinetic data on systemically administered antifungals focusing on co-morbidities, target-site penetration, and combination antifungal therapy.Conclusions and discussionAmphotericin B is eliminated unchanged via urine and faeces. Flucytosine and fluconazole display low protein binding and are eliminated by the kidney. Itraconazole, voriconazole, posaconazole and isavuconazole are metabolised in the liver. Azoles are substrates and inhibitors of cytochrome P450 (CYP) isoenzymes and are therefore involved in numerous drug–drug interactions. Anidulafungin is spontaneously degraded in the plasma. Caspofungin and micafungin undergo enzymatic metabolism in the liver, which is independent of CYP. Although several drug–drug interactions occur during caspofungin and micafungin treatment, echinocandins display a lower potential for drug–drug interactions. Flucytosine and azoles penetrate into most of relevant tissues. Amphotericin B accumulates in the liver and in the spleen. Its concentrations in lung and kidney are intermediate and relatively low myocardium and brain. Tissue distribution of echinocandins is similar to that of amphotericin. Combination antifungal therapy is established for cryptococcosis but controversial in other IFIs such as invasive aspergillosis and mucormycosis.

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“…Echinocandins are recommended as the first-line treatment for invasive candidiasis (5,6). Although the rates of resistance to echinocandins remain low (1,(7)(8)(9)(10), recent publications are alerting physicians to an increased rate of resistance in some geographic areas (11,12). Resistance is associated with a poor prognosis in patients with candidemia treated with echinocandins; consequently, detection may help to optimize antifungal treatment (11,13).…”

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confidence: 99%

Resistance to Echinocandins in Candida Can Be Detected by Performing the Etest Directly on Blood Culture Samples

Bordallo-Cardona

Marcos-Zambrano

Sánchez‐Carrillo

et al. 2018

Antimicrob Agents Chemother

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We examined the rapid evaluation of susceptibility to echinocandins in spp. using the Etest performed directly on positive blood cultures and anidulafungin-containing agar plates. We prospectively collected 80 positive blood cultures (Bactec-FX system, Becton-Dickinson, Cockeysville, MD, USA) with echinocandin-susceptible spp. ( = 60) and echinocandin-intermediate ( = 20) from patients with candidemia. Additionally, blood culture bottles of nonfungemic/bacteremic patients were spiked with 35 echinocandin-resistant species isolates. A total of 2 to 4 drops of medium from each bottle were stroked directly onto both RPMI 1640 agar plates with micafungin and anidulafungin Etest strips (ET) and Sabouraud agar plates containing 2 mg/liter of anidulafungin. The isolates were tested according to the EUCAST method and Etest standard (ET). Essential and categorical agreement between the methods was calculated. The essential agreement and categorical agreement between the EUCAST method and ET and ET were both >97.4%. The essential agreement between ET and the EUCAST method for both echinocandins was >97%. The categorical agreement between the sequence and ET was 97.4%. The ET MICs of anidulafungin and micafungin (≥0.19 mg/liter and ≥0.064 mg/liter, respectively) effectively separated all susceptible wild-type isolates from the resistant mutant isolates. The categorical agreement (62.6%) between the EUCAST method and growth on anidulafungin-containing plates was poor, with the best agreement observed for (94.2%). When performed directly on positive blood cultures from patients with candidemia, the Etest with micafungin and anidulafungin is a reliable procedure for the rapid testing of susceptibility to echinocandins in species isolates.

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CAND-LO 2014–15 study: changing epidemiology of candidemia in Lombardy (Italy)

Abstract: Data from regional surveys may highlight the influence of therapeutic practices on the epidemiology of Candida BSIs and may optimize empirical therapies.

Cited by 20 publications

References 12 publications

Changing epidemiology of candidaemia: Increase in fluconazole‐resistant Candida parapsilosis

Changing epidemiology of candidaemia: Increase in fluconazole‐resistant Candida parapsilosis

Pharmacokinetics of antifungal drugs: practical implications for optimized treatment of patients

Resistance to Echinocandins in Candida Can Be Detected by Performing the Etest Directly on Blood Culture Samples

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