Candida guilliermondii fungemia in cancer patients: Report of three cases

Krčméry, V.; Grausova, S.; Mraz, Marian; Pichnova, E.; Jurga, L

doi:10.1007/s101560050010

Cited by 11 publications

(14 citation statements)

References 2 publications

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“…The isolate was shown by in vitro testing to be resistant to amphotericin B. Subsequently, others have documented the failure of amphotericin B therapy in invasive or ocular infections with potential in vitro resistance (MICs, 1 to 4 g/ml) or neutropenia (3,14,39). Among the 174 isolates tested against amphotericin B by Etest, 9 isolates (5.2%) appeared to be resistant to amphotericin B, with MICs for these isolates ranging from 2 g/ml (2 isolates) to 64 g/ml (5 isolates) ( Table 2).…”

Section: Resultsmentioning

confidence: 99%

In Vitro Activity of Seven Systemically Active Antifungal Agents against a Large Global Collection of RareCandidaSpecies as Determined by CLSI Broth Microdilution Methods

et al. 2009

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2%). Among the isolates not susceptible to one or more of the echinocandins, most (68%) were C. guilliermondii. All isolates of the less common species within the C. parapsilosis complex (C. orthopsilosis and C. metapsilosis) were susceptible to voriconazole, posaconazole, anidulafungin, caspofungin, and micafungin. Over 95% of clinical isolates of the rare Candida species were susceptible to the available antifungals. However, activity did vary by drug-species combination, with some species (e.g., C. rugosa and C. guilliermondii) demonstrating reduced susceptibilities to commonly used agents such as fluconazole and echinocandins.

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Section: Resultsmentioning

confidence: 99%

In Vitro Activity of Seven Systemically Active Antifungal Agents against a Large Global Collection of RareCandidaSpecies as Determined by CLSI Broth Microdilution Methods

et al. 2009

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“…This species has caused a variety of deep-seated infections in immunocompromised hosts and, less frequently, intravenous drug users. Like Candida lusitaniae, it is one of the fungal pathogens most likely to display in vitro resistance to amphotericin B and fluconazole (8,19,20,28,33,49,60,63,68). The present study was an attempt to learn more about the clinical characteristics of infections caused by C. guilliermondii and its antifungal susceptibility pattern.…”

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Candida guilliermondii Fungemia in Patients with Hematologic Malignancies

et al. 2006

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The microbiological, clinical, and epidemiological features of most non-Candida albicans Candida species are well known, but much less is known about species such as Candida guilliermondii, an uncommon pathogen causing a variety of deep-seated infections in immunocompromised hosts. To characterize C. guilliermondii fungemia in patients with hematological malignancies and its susceptibility to antifungal drugs, all cases of C. guilliermondii fungemia diagnosed in our department between 1983 and 2005 were retrospectively analyzed and the literature was reviewed. C. guilliermondii caused 29/243 (11.7%) candidemia episodes diagnosed during the study period. Central venous catheters were the documented sources of candidemia in 19/29 episodes (65.5%), and invasive tissue infections were documented in 2 (6.9%). In the remaining eight, the catheter was not removed and the source of the fungemia remained obscure. Seven episodes ended in death, but only one could be attributed to invasive C. guilliermondii infection. Molecular typing data reveal no evidence of common infection sources. Isolates displayed high rates of in vitro susceptibility to amphotericin B (100%), voriconazole (95%), and fluconazole (90%) and lower rates of in vitro susceptibility to flucytosine (86%), itraconazole (76%), and caspofungin (33%). Our literature review confirms that C. guilliermondii is a significantly more frequent cause of candidemia among cancer patients compared with the general hospital population. It accounted for <1% of the total number of Candida bloodstream isolates reported in the articles we reviewed, with higher rates in Europe (1.4%) and Asia (1.8%) compared with North America (0.3%).Non-Candida albicans Candida species have been recognized as emerging pathogens in cancer patients, particularly those with hematological malignancies. Not only are serious infections caused by these yeast species increasing in frequency, but in a number of cases the strains responsible for the infection display tolerance or resistance to antimycotics (13,41,67). The microbiological, clinical, and epidemiological features of Candida parapsilosis, Candida tropicalis, Candida krusei, and Candida glabrata are well known, but much less is known about other non-C. albicans Candida species. The few reports in the literature on Candida guilliermondii infections suggest that they are associated with poor clinical outcomes. This species has caused a variety of deep-seated infections in immunocompromised hosts and, less frequently, intravenous drug users. Like Candida lusitaniae, it is one of the fungal pathogens most likely to display in vitro resistance to amphotericin B and fluconazole (8,19,20,28,33,49,60,63,68). The present study was an attempt to learn more about the clinical characteristics of infections caused by C. guilliermondii and its antifungal susceptibility pattern. All cases of candidemia diagnosed in our department over the past 22 years were retrospectively analyzed to identify the prevalence and clinical features of C. guilliermondii fun...

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“…Candida guilliermondii is infrequently isolated from blood cultures (1 to 5%) (14), and infections caused by this species have been reported in cancer, surgical, and intensive care unit patients (13)(14), including a pseudo-outbreak of candidemia in a neonatal intensive care unit (23). Malignancy, neutropenia, and bone marrow transplantation have been reported as risk factors for acquiring C. guilliermondii infections (22).…”

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Killing Kinetics of Caspofungin, Micafungin, and Amphotericin B against Candida guilliermondii

Cantón¹,

Pemán

Sastre³

et al. 2006

Antimicrob Agents Chemother

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Amphotericin B (AMB), micafungin, and caspofungin MICs, minimal fungicidal concentrations, and timekilling curves were determined in the presence and absence of 10% inactivated serum. AMB was the only agent with consistent killing activity (time required to achieve 99.9% of growth reduction was 2.1 to 3.2 h). The presence of serum enhanced caspofungin activity but lowered those of micafungin and AMB.Candida guilliermondii is infrequently isolated from blood cultures (1 to 5%) (14), and infections caused by this species have been reported in cancer, surgical, and intensive care unit patients (13)(14), including a pseudo-outbreak of candidemia in a neonatal intensive care unit (23). Malignancy, neutropenia, and bone marrow transplantation have been reported as risk factors for acquiring C. guilliermondii infections (22). Treatment of these infections may present problems, especially for immunocompromised patients; a high percentage of strains have diminished susceptibility to fluconazole (MIC at which 90% of organisms are inhibited, 16 mg/liter) and itraconazole (MIC at which 90% of organisms are inhibited, 1 mg/liter) (17-18). Amphotericin B (AMB), caspofungin, and micafungin have fungicidal activity against some Candida spp. (3)(4)(8)(9), but most studies have focused on Candida albicans and little is known about the killing activity of these agents against C. guilliermondii. A previous evaluation demonstrated that the same AMB MIC may correspond to different killing activities, depending on the Candida species or strain tested, and that each species has a different AMB killing pattern (5). Because the killing kinetics of AMB, caspofungin, and micafungin against C. guilliermondii are unknown, this study aimed to characterize the in vitro pharmacodynamics and fungicidal activities of these drugs against this species. Since these agents are highly protein bound (Ͼ90%) (9, 10, 11), the influence of serum on their in vitro activity has also been evaluated. For the first time, we provide the dynamics of the fungicidal activity of these three agents against C. guilliermondii.Drugs. AMB deoxycholate (Bristol-Myers Squibb, Madrid, Spain) was dissolved in dimethyl sulfoxide, and caspofungin (Merck Sharpe & Dome, Madrid, Spain) and micafugin (Fujisawa Pharmaceutical Company, Japan) were dissolved in water. Further drug dilutions were prepared in standard RPMI 1640 medium (Sigma-Aldrich, Madrid, Spain) as recommended in the M27-A2 document (16).MIC and MFC determination. MICs were determined for 19 C. guilliermondii clinical isolates at least twice (on different days) in RPMI and RPMI plus 10% inactivated fetal bovine serum (FBS) (Sigma-Aldrich) by the M27-A2 method but using a higher inoculum (2.5 ϫ 10 4 CFU/ml). Complement was inactivated by heating the undiluted serum (30 min, 60°C). Both MIC 2 and MIC 0 (Ն50% and 100% growth reduction, respectively) were determined for caspofungin and micafungin and MIC 0 s for AMB. Minimal fungicidal concentrations (MFCs) were obtained by transferring 0.1 ml from all clear MIC wells (...

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Candida guilliermondii fungemia in cancer patients: Report of three cases

Cited by 11 publications

References 2 publications

In Vitro Activity of Seven Systemically Active Antifungal Agents against a Large Global Collection of RareCandidaSpecies as Determined by CLSI Broth Microdilution Methods

In Vitro Activity of Seven Systemically Active Antifungal Agents against a Large Global Collection of RareCandidaSpecies as Determined by CLSI Broth Microdilution Methods

Candida guilliermondii Fungemia in Patients with Hematologic Malignancies

Killing Kinetics of Caspofungin, Micafungin, and Amphotericin B against Candida guilliermondii

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