The association between treatment appropriateness according to EUCAST and CLSI breakpoints and mortality among patients with candidemia: a retrospective observational study

Ghanem-Zoubi, Nesrin; Zorbavel, Danny; Khoury, Johad; Geffen, Yuval; Qasum, Majd; Predescu, Svetlana

doi:10.1007/s10096-018-3389-1

Cited by 6 publications

(6 citation statements)

References 26 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Similarly, a 30-day-mortality of 45% has been reported after candidemia in internal medicine wards [19]. The French Mycoses study group observed 50% survival in a mixed ICU population 30 days after candidemia [11], which is similar to the findings of a retrospective observation by Ghanem-Zoubi and colleagues [3]. An analysis from prospectively collected data in the French REA-RAISIN network showed a mortality rate of 52% among patients with ICU-acquired candidemia in 213 ICUs [20].…”

Section: Discussionsupporting

confidence: 69%

“…The influence of different definitions of appropriate antifungal treatment on the strength of association with mortality after candidemia has been reported by another retrospective trial. Three definitions of appropriate empiric treatment and their association with 30-day mortality were compared in a cohort of 302 critically ill patients [ 3 ]. Interestingly, statistical associations varied by definition, which underlines the impact of treatment criteria on outcome prediction.…”

Section: Discussionmentioning

confidence: 99%

“…have become a major concern in critical care medicine due to the increasing number of immunocompromised patients [ 1 , 2 ]. Yeast-related BSI are usually healthcare-associated infections with a high mortality of up to 60% in critically ill patients [ 1 , 3 – 5 ]. Importantly, BSI caused by Candida spp., central-line-associated BSI in particular, have been increasing over the past decades [ 6 ].…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Epidemiology, clinical characteristics, and outcome of candidemia in critically ill patients in Germany: a single-center retrospective 10-year analysis

Schroeder

Weber

Denker

et al. 2020

Ann. Intensive Care

View full text Add to dashboard Cite

Background Despite advances in the management of bloodstream infections (BSI) caused by Candida spp., the mortality still remains high in critically ill patients. The worldwide epidemiology of yeast-related BSI is subject to changing species distribution and resistance patterns, challenging antifungal treatment strategies. The aim of this single-center study was to identify predictors of mortality after 28 and 180 days in a cohort of mixed surgical and medical critically ill patients with candidemia. Methods Patients, who had been treated for laboratory-confirmed BSI caused by Candida spp. in one of 12 intensive care units (ICU) at a University hospital between 2008 and 2017, were retrospectively identified. We retrieved data including clinical characteristics, Candida species distribution, and antifungal management from electronic health records to identify risk factors for mortality at 28 and 180 days using a Cox regression model. Results A total of 391 patients had blood cultures positive for Candida spp. (incidence 4.8/1000 ICU admissions). The mortality rate after 28 days was 47% (n = 185) and increased to 60% (n = 234) after 180 days. Age (HR 1.02 [95% CI 1.01–1.03]), a history of liver cirrhosis (HR 1.54 [95% CI 1.07–2.20]), septic shock (HR 2.41 [95% CI 1.73–3.37]), the Sepsis-related Organ Failure Assessment score (HR 1.12 [95% CI 1.07–1.17]), Candida score (HR 1.25 [95% CI 1.11–1.40]), and the length of ICU stay at culture positivity (HR 1.01 [95% CI 1.00–1.01]) were significant risk factors for death at 180 days. Patients, who had abdominal surgery (HR 0.66 [95% CI 0.48–0.91]) and patients, who received adequate (HR 0.36 [95% CI 0.24–0.52]) or non-adequate (HR 0.31 [95% CI 0.16–0.62]) antifungal treatment, had a reduced mortality risk compared to medical admission and no antifungal treatment, respectively. Conclusions The mortality of critically ill patients with Candida BSI is high and is mainly determined by disease severity, multiorgan dysfunction, and antifungal management rather than species distribution and susceptibility. Our results underline the importance of timely treatment of candidemia. However, controversies remain on the optimal definition of adequate antifungal management.

show abstract

Section: Discussionsupporting

confidence: 69%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Epidemiology, clinical characteristics, and outcome of candidemia in critically ill patients in Germany: a single-center retrospective 10-year analysis

Schroeder

Weber

Denker

et al. 2020

Ann. Intensive Care

View full text Add to dashboard Cite

show abstract

“…In recent years, the incidences of Candida fungal infections have substantially increased. According to various studies, the attributable mortality among all patients with candidaemia has been recorded to be between 10% and 47%; however, a more accurate estimate is approximately 10-20%, with the risk of death being strictly connected with the increasing age, the species of Candida strain causing the infection, the use of immunosuppressive agents, and the presence of the venous catheter, as well as pre-existing renal dysfunction and other comorbidities [1][2][3][4][5].…”

Section: Introductionmentioning

confidence: 99%

Ceragenin-Coated Non-Spherical Gold Nanoparticles as Novel Candidacidal Agents

et al. 2021

View full text Add to dashboard Cite

Background: Infections caused by Candida spp. have become one of the major causes of morbidity and mortality in immunocompromised patients. Therefore, new effective fungicides are urgently needed, especially due to an escalating resistance crisis. Methods: A set of nanosystems with rod- (AuR), peanut- (AuP), and star-shaped (AuS) metal cores were synthesized. These gold nanoparticles were conjugated with ceragenins CSA-13, CSA-44, and CSA-131, and their activity was evaluated against Candida strains (n = 21) through the assessment of MICs (minimum inhibitory concentrations)/MFCs (minimum fungicidal concentrations). Moreover, in order to determine the potential for resistance development, serial passages of Candida cells with tested nanosystems were performed. The principal mechanism of action of Au NPs was evaluated via ROS (reactive oxygen species) generation assessment, plasma membrane permeabilization, and release of the protein content. Finally, to evaluate the potential toxicity of Au NPs, the measurement of hemoglobin release from red blood cells (RBCs) was carried out. Results: All of the tested nanosystems exerted a potent candidacidal activity, regardless of the species or susceptibility to other antifungal agents. Significantly, no resistance development after 25 passages of Candida cells with AuR@CSA-13, AuR@CSA-44, and AuR@CSA-131 nanosystems was observed. Moreover, the fungicidal mechanism of action of the investigated nanosystems involved the generation of ROS, damage of the fungal cell membrane, and leakage of intracellular contents. Notably, no significant RBCs hemolysis at candidacidal doses of tested nanosystems was detected. Conclusions: The results provide rationale for the development of gold nanoparticles of rod-, peanut-, and star-shaped conjugated with CSA-13, CSA-44, and CSA-131 as effective candidacidal agents.

show abstract

“…Other studies have found that the 30day survival rate of candidemia patients who receive appropriate pharmacotherapy was better than that of patients who received delayed or no treatment. ese studies show that late initiation of adequate pharmacotherapy in infected patients correlates with an increased mortality rate [5][6][7].…”

Section: Introductionmentioning

confidence: 99%

Evaluation of Identification and Susceptibility for Candida Spp. Isolated Directly from Positive Blood Culture Bottles

Souza

Goldani

Roesch

et al. 2021

International Journal of Microbiology

View full text Add to dashboard Cite

Determination of the susceptibility profile of isolates of Candida from blood culture bottles is extremely important for correctly guiding patient pharmacotherapy. The aim of this study was to compare the results of analysis of Candida isolated directly from blood culture bottles by the VITEK MS MALDI-TOF identification system and the fluconazole disk diffusion assay with those of standard identification methods. Testing directly from the bottle allowed results 24 to 48 hours quicker than the standard method. There was a categorical agreement of 51.64% (47 of 91 samples) between the results of analysis directly from the bottle and analysis by the standard method. Regarding species identification, there was 96.15% agreement for Candida parapsilosis (25 of 26 samples). Categorical agreement between the rapid and standard disk diffusion methods was 95%, and the agreement between the rapid disk diffusion method and the broth microdilution method was 97%. Only minor errors in the rapid method were observed: 3 (5%) in the standard disk diffusion method and 2 (3%) in the broth microdilution method. Our study concluded that the rapid disk diffusion method for fluconazole is a fast, easy, reproducible, and consistent method. Its timely implementation for testing antifungal agents in the clinical microbiology laboratory can help reduce profile release times, thus helping to determine the most appropriate antifungal treatment.

show abstract

The association between treatment appropriateness according to EUCAST and CLSI breakpoints and mortality among patients with candidemia: a retrospective observational study

Cited by 6 publications

References 26 publications

Epidemiology, clinical characteristics, and outcome of candidemia in critically ill patients in Germany: a single-center retrospective 10-year analysis

Epidemiology, clinical characteristics, and outcome of candidemia in critically ill patients in Germany: a single-center retrospective 10-year analysis

Ceragenin-Coated Non-Spherical Gold Nanoparticles as Novel Candidacidal Agents

Evaluation of Identification and Susceptibility for Candida Spp. Isolated Directly from Positive Blood Culture Bottles

Contact Info

Product

Resources

About