Consensus statement on the management of invasive candidiasis in Intensive Care Units in the Asia-Pacific Region

Hsueh, Po-Ren; Graybill, John R.; Playford, E. Geoffrey; Watcharananan, Siriorn P.; Oh, Myoung Don; Jaalam, Kamarudin; Huang, Sheng; Nangia, Vivek; Kurup, Asok; Padiglione, Alexander A

doi:10.1016/j.ijantimicag.2009.03.014

Cited by 46 publications

(35 citation statements)

References 37 publications

(55 reference statements)

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“…Early antifungal therapy reduces IC-related mortality and approximately halves the incidence of IC (3)(4)(5)(6)(7)(8). Untargeted prophylactic antifungal use, however, is expensive, has the potential to cause adverse drug reactions, and may select for resistant fungal species (9).…”

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Candida Colonization as a Risk Marker for Invasive Candidiasis in Mixed Medical-Surgical Intensive Care Units: Development and Evaluation of a Simple, Standard Protocol

et al. 2015

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k Colonization with Candida species is an independent risk factor for invasive candidiasis (IC), but the minimum and most practicable parameters for prediction of IC have not been optimized. We evaluated Candida colonization in a prospective cohort of 6,015 nonneutropenic, critically ill patients. Throat, perineum, and urine were sampled 72 h post-intensive care unit (ICU) admission and twice weekly until discharge or death. Specimens were cultured onto chromogenic agar, and a subset underwent molecular characterization. Sixty-three (86%) patients who developed IC were colonized prior to infection; 61 (97%) tested positive within the first two time points. The median time from colonization to IC was 7 days (range, 0 to 35). Colonization at any site was predictive of IC, with the risk of infection highest for urine colonization (relative risk [RR] ‫؍‬ 2.25) but with the sensitivity highest (98%) for throat and/or perineum colonization. Colonization of >2 sites and heavy colonization of >1 site were significant independent risk factors for IC (RR ‫؍‬ 2.25 and RR ‫؍‬ 3.7, respectively), increasing specificity to 71% to 74% but decreasing sensitivity to 48% to 58%. Molecular testing would have prompted a resistance-driven decision to switch from fluconazole treatment in only 11% of patients infected with C. glabrata, based upon species-level identification alone. Positive predictive values (PPVs) were low (2% to 4%) and negative predictive values (NPVs) high (99% to 100%) regardless of which parameters were applied. In the Australian ICU setting, culture of throat and perineum within the first two time points after ICU admission captures 84% (61/73 patients) of subsequent IC cases. These optimized parameters, in combination with clinical risk factors, should strengthen development of a setting-specific risk-predictive model for IC. Invasive candidiasis (IC), particularly, candidemia, is a significant cause of mortality in critically ill patients, accounting for almost a third of nosocomial infections in intensive care units (ICUs) (1, 2). Early antifungal therapy reduces IC-related mortality and approximately halves the incidence of IC (3-8). Untargeted prophylactic antifungal use, however, is expensive, has the potential to cause adverse drug reactions, and may select for resistant fungal species (9).Clinical risk prediction rules that identify the high-risk patients most likely to benefit from prophylaxis have been developed (10-16), but those studies have used different sets of predictors, including (a) clinical risk factors only and (b) clinical risk factors in combination with colonization indices (CIs). Those rules have been applied in various settings and have included assessment at different times postadmission to the ICU and different types of ICU (surgical ICUs only or mixed medical/surgical ICUs-defined as units that house both medical and surgical populations). These differences may explain why predictive models and algorithms have performed poorly outside their derivative populations (17).Since IC is pr...

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Candida Colonization as a Risk Marker for Invasive Candidiasis in Mixed Medical-Surgical Intensive Care Units: Development and Evaluation of a Simple, Standard Protocol

et al. 2015

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“…A ntifungal susceptibility testing is crucial for the management of invasive infections due to Candida species, particularly among critically ill patients and patients with cancer (1)(2)(3)(4)(5)(6). C. albicans is frequently the most common species isolated from patients with hematological cancer and prolonged neutropenia (1,3,7).…”

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“…In Asia, a previous report indicated that invasive isolates of Candida spp. remain highly susceptible to fluconazole (Ͼ90% susceptible) although among Asian countries the resistance rate of C. glabrata to fluconazole varies widely from 2% to 16% (2). However, voriconazole and echinocandins exhibited excellent in vitro activity against invasive Candida isolates (2, 5).…”

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Antifungal Susceptibilities of Candida Isolates Causing Bloodstream Infections at a Medical Center in Taiwan, 2009-2010

Huang

Liu

Liao

et al. 2014

Antimicrob Agents Chemother

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Nearly all isolates of C. albicans, C. parapsilosis, and C. krusei were susceptible to voriconazole; however, rates of voriconazole susceptibility were 78.6% in C. tropicalis. Few isolates of C. albicans (n ‫؍‬ 5; 2.1%) and C. glabrata (n ‫؍‬ 3; 3.9%), no isolates of C. parapsilosis, C. krusei, and C. guilliermondii, but 62.2% (n ‫؍‬ 51) of C. tropicalis isolates were non-wild type for posaconazole susceptibility. For itraconazole susceptibility, 98.3% of C. albicans isolates were wild type, and 3.9% (n ‫؍‬ 3) of C. glabrata isolates were non-wild type. Almost all of the isolates tested (>97% for all species) were susceptible to both micafungin and anidulafungin. All isolates tested were found to be wild type for amphotericin B susceptibility, with MICs of <1g/ml. Further evaluation is needed to establish CBPs of antifungal agents by the 24-h SYO method for the management of patients with candidemia or other invasive candida infections.

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“…Candidiasis is the most common fungal infection diagnosed in humans [41][42][43] . Due to the emergence of pathogens resistant to conventional antifungals and the toxicity of some antimycotics, intense efforts have been made to develop more effective antifungal agents for clinical use [44][45][46][47][48] . The pathogenesis of C. albicans is multifactorial and different virulence attributes are important during the various stages of infection [20,21,[49][50][51][52][53][54][55] .…”

Section: Tripeptidyl Peptidases Dipeptidyl Peptidasesmentioning

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Protease expression by microorganisms and its relevance to crucial physiological/pathological events

Santos¹

2011

WJBC

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The treatment of infections caused by fungi and trypanosomatids is difficult due to the eukaryotic nature of these microbial cells, which are similar in several biochemical and genetic aspects to host cells. Aggravating this scenario, very few antifungal and anti-trypanosomatidal agents are in clinical use and, therefore, therapy is limited by drug safety considerations and their narrow spectrum of activity, efficacy and resistance. The search for new bioactive agents against fungi and trypanosomatids has been expanded because progress in biochemistry and molecular biology has led to a better understanding of important and essential pathways in these microorganisms including nutrition, growth, proliferation, signaling, differentiation and death. In this context, proteolytic enzymes produced by these eukaryotic microorganisms are appointed and, in some cases, proven to be excellent targets for searching novel natural and/or synthetic pharmacological compounds, in order to cure or prevent invasive fungal/trypanosomatid diseases. With this task in mind, our research group and others have focused on aspartic-type proteases, since the activity of this class of hydrolytic enzymes is directly implicated in several facets of basic biological processes of both fungal and trypanosomatid cells as well as due to the participation in numerous events of interaction between these microorganisms and host structures. In the present paper, a concise revision of the beneficial effects of aspartic protease inhibitors, with emphasis on the aspartic protease inhibitors used in the anti-human immunodeficiency virus therapy, will be presented and discussed using our experience with the following microbial models: the yeast Candida albicans , the filamentous fungus Fonsecaea pedrosoi and the protozoan trypanosomatid Leishmania amazonensis .

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Consensus statement on the management of invasive candidiasis in Intensive Care Units in the Asia-Pacific Region

Cited by 46 publications

References 37 publications

Candida Colonization as a Risk Marker for Invasive Candidiasis in Mixed Medical-Surgical Intensive Care Units: Development and Evaluation of a Simple, Standard Protocol

Candida Colonization as a Risk Marker for Invasive Candidiasis in Mixed Medical-Surgical Intensive Care Units: Development and Evaluation of a Simple, Standard Protocol

Antifungal Susceptibilities of Candida Isolates Causing Bloodstream Infections at a Medical Center in Taiwan, 2009-2010

Protease expression by microorganisms and its relevance to crucial physiological/pathological events

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