Invasive Candida Infections in the ICU: Diagnosis and Therapy

Hankovszky, Péter; Társy, Domokos; Öveges, Nándor; Molnár, Zsolt

doi:10.1515/jccm-2015-0025

Cited by 17 publications

(25 citation statements)

References 58 publications

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“…This finding is consistent with observations by Ravi and colleagues [84]. C. albicans is recognised as a serious concern in critically ill patients and colonization with Candida predisposes for invasive Candida infections in intensive care patients [85].…”

Section: Impact Of Antimicrobials On the Microbiomesupporting

confidence: 93%

Antimicrobial-associated harm in critical care: a narrative review

et al. 2020

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The belief that, for the individual patient, the benefit of prompt and continued use of antimicrobials outweighs any potential harm is a significant barrier to improved stewardship of these vital agents. Antimicrobial stewardship may be perceived as utilitarian rationing, seeking to preserve the availability of effective antimicrobials by limiting the development of resistance in a manner which could conflict with the immediate treatment of the patient in need. This view does not account for the growing evidence of antimicrobial-associated harm to individual patients. This review sets out the evidence for antimicrobial-associated harm and how this should be balanced with the need for prompt and appropriate therapy in infection. It describes the mechanisms by which antimicrobials may harm patients including: mitochondrial toxicity; immune cell toxicity; adverse drug reactions; selection of resistant organisms within a given patient; and disruption of the microbiome. Finally, the article indicates how the harms of antimicrobials may be mitigated and identifies areas for research and development in this field.

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Section: Impact Of Antimicrobials On the Microbiomesupporting

confidence: 93%

Antimicrobial-associated harm in critical care: a narrative review

et al. 2020

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“…In our laboratory, the frequency of these diseases is high, with histoplasmosis being the most frequent IFD, followed by aspergillosis, cryptococcosis, pneumocystosis, PCM, invasive candidiasis, and less frequently, IFD caused by other emerging agents including some basidiomycetes and mucorales. Several publications related to IFD based on different methodological designs (prospective, retrospective, multicentric) and different patient populations (onco-hematological, transplant, intensive care unit) have reported for countries in Europe and the Americas a greater frequency of patients with invasive candidiasis and aspergillosis, which is different from the findings observed in our study [2,5,[18][19][20][21].…”

Section: Discussioncontrasting

confidence: 99%

Frequency of Invasive Fungal Disease in Adults: Experience of a Specialized Laboratory in Medellín, Colombia (2009–2015)

Valencia

Cáceres

Bedout

et al. 2020

JoF

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Invasive fungal diseases (IFD) contribute significantly to worldwide morbidity and mortality, but their frequency is not well-described in some countries. The present work describes the frequency of IFD in a specialized laboratory in Colombia. A retrospective, descriptive study was implemented between March 2009 and December 2015. Results: 13,071 patients with clinical suspicion of IFD were referred during the study period, from which 33,516 biological samples were processed and analyzed using 14 laboratory methods. Diagnosis was confirmed in 1425 patients (11%), distributed according to the mycoses of interest analyzed here: histoplasmosis in 641/11,756 patients (6%), aspergillosis in 331/10,985 patients (3%), cryptococcosis in 239/8172 patients (3%), pneumocystosis in 111/1651 patients (7%), paracoccidioidomycosis in 60/10,178 patients (0.6%), and invasive candidiasis in 48/7525 patients (0.6%). From the first year of the study period to the last year, there was a 53% increase in the number of cases of IFD diagnosed. Our laboratory experienced a high frequency of IFD diagnosis, possibly attributable to the availability of a greater range of diagnostic tools. Frequency of IFD in this study was atypical compared with other studies, probably as a result of the single laboratory-site analysis. This demonstrates that implementing educational strategies helps to create a high index of clinical suspicion, while the availability and utilization of appropriate diagnostic assays assure greater reliability in identification of these cases.

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“…Identifying the species of Candida isolates is important when selecting an appropriate antifungal agent due to their varying drug susceptibilities [16] . Local epidemiology and resistance profiles should be considered when selecting antifungals [9] .…”

Section: Discussionmentioning

confidence: 99%

“…The inappropriate but widespread use of azoles for the treatment of bloodstream infections caused by non-albicans Candida species may result in the increment of resistant Candida strains or the development of resistance during treatment [8] . Hence, identifying the causative Candida species and performing antifungal susceptibility tests are imperative when managing Candida bloodstream infections [9] .…”

Section: Introductionmentioning

confidence: 99%

“…Since waiting for the results of yeast identification and antifungal susceptibility testing may lead to unacceptable outcomes, empirical antifungal therapy must be initiated immediately in clinical practice. To this end, it is necessary to identify the causative yeast very quickly and to perform antifungal susceptibility tests [9] . However, this cannot be performed in every laboratory.…”

Section: Introductionmentioning

confidence: 99%

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Rapid Differentiation of Candida albicans from Non-albicans Species by Germ Tube Test Directly From Blood Culture Bottles

Yılmaz¹,

Demiray²,

Köroğlu³

et al. 2020

mjima

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Introduction: It is important to identify infection-causing yeasts rapidly and perform antifungal susceptibility tests in order to determine the treatment to be applied. The aim of this study was to use direct germ tube test (GTT) from blood culture bottle for rapid differentiation of albicans/ non-albicans Candida species to evaluate the possble contribution of this test to the implementation of earlier and narrower-spectrum antifungal therapy compared to conventional methods. Materials and Methods: This 4-years retrospective study included 129 positive automated blood culture samples with yeast detected in Gram staining among 11,080 blood cultures obtained from inpatients in various wards. GTT was performed directly from these bottles. All isolates were identified by VITEK (bioMérieux, Marcy-l'Étoile, France) and antifungal susceptibility tests were performed with the VITEK 2® automated system (bioMérieux, Marcy-l'Étoile, France). Results: Candida albicans was identified as the causative agent in 57 (44.2%) of the 129 blood cultures with direct Gram staining from the bottle. Conventional GTT was positive for all C. albicans isolates (100%), while direct GTT from blood culture bottle was positive in 54 (94.73%). Direct GTT from blood culture yielded false-negative results in the remaining three samples (5.27%). There was 97.6% (126/129) agreement between conventional GTT method and direct GTT from blood culture bottle. Non-albicans Candida species were isolated from the 72 samples with negative direct GTT from blood culture bottle (43 C. parapsilosis, 17 C. tropicalis, 7 C. famata, 4 C. glabrata, and 1 C. lipolytica). Conventional GTT results were also negative for all of these isolates. Conclusion: Direct GTT from positive blood cultures that are shown to contain yeast by Gram staining enabled differentiation of albicans/nonalbicans Candida species one day earlier than conventional culture. This method shows a high agreement rate with conventional diagnostic tests. It should be kept in mind that false negative results may be obtained at very low rates. This test may be helpful for initiation of a more appropriate empirical antifungal treatment. Furthermore, it is easy and can be applied in all clinical microbiology laboratories.

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Invasive Candida Infections in the ICU: Diagnosis and Therapy

Cited by 17 publications

References 58 publications

Antimicrobial-associated harm in critical care: a narrative review

Antimicrobial-associated harm in critical care: a narrative review

Frequency of Invasive Fungal Disease in Adults: Experience of a Specialized Laboratory in Medellín, Colombia (2009–2015)

Rapid Differentiation of Candida albicans from Non-albicans Species by Germ Tube Test Directly From Blood Culture Bottles

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