Liposomal and Deoxycholate Amphotericin B Formulations: Effectiveness against Biofilm Infections of Candida spp.

Abstract

Background: candidiasis is the primary fungal infection encountered in patients undergoing prolonged hospitalization, and the fourth leading cause of nosocomial bloodstream infections. One of the most important Candida spp. virulence factors is the ability to form biofilms, which are extremely refractory to antimicrobial therapy and very difficult to treat with the traditional antifungal therapies. It is known that the prophylaxis or treatment of a systemic candidiasis are recurrently taken without considering the possibility of a Candida spp. biofilm-related infections. Therefore, it is important to assess the effectiveness of the available drugs and which formulations have the best performance in these specific infections. Methods: 24-h-biofilms of four Candida spp. and their response to two amphotericin B (AmB) pharmaceutical formulations (liposomal and deoxycholate) were evaluated. Results: generally, Candida glabrata was the less susceptible yeast species to both AmBs. MBECs revealed that it is therapeutically more appealing to use AmB-L than AmB-Deox for all Candida spp. biofilms, since none of the determined concentrations of AmB-L reached 10% of the maximum daily dose, but both formulations showed a very good capacity in the biomass reduction. Conclusions: the liposomal formulation presents better performance in the eradication of the biofilm cells for all the species in comparison with the deoxycholate formulation.

Lack of efficacy of echinocandins against high metabolic activity biofilms of Candida parapsilosis clinical isolates

“…An earlier study showed that C. parapsilosis biofilms were resistant to d-AMB and susceptible to lipid formulations of AMB (both lipid complex and liposomal) [28]. Conversely, our results are in agreement with recently published data demonstrating good activity of d-AMB on the biomass reduction of C. parapsilosis biofilms [38,39]. Moreover, a previous study showed higher activity of d-AMB than ANF against C. parapsilosis biofilms [39], in agreement with our results, which extend this observation to CAF and MIF.…”

“…Biofilm formation by C. parapsilosis has shown a high degree of variability among isolates [5,36] and the antibiofilm activity of d-AMB has been reported to be species and strain dependent [37,38]. An earlier study showed that C. parapsilosis biofilms were resistant to d-AMB and susceptible to lipid formulations of AMB (both lipid complex and liposomal) [28].…”

Opportunistic invasive fungal disease in patients with type 2 diabetes mellitus from Southern China: Clinical features and associated factors

“…Of note, the liposomal formulation of amphotericin B is found to be more effective in the eradication of the biofilm cells for all the Candida spp. than deoxycholate formulation. Echinocandin tolerance was not detected in the present study.…”

Combination of Posaconazole and Amphotericin B in the Treatment of Candida glabrata Biofilms

“…The formation of Candida species biofilms raises significant clinical issues because of an additional increase in antifungal drug resistance, as well as increased evasion of host immune defenses. Furthermore, biofilm development on medical devices can cause the failure of the device and may turn into a source of future infection [9].…”