Search Results (123)

Candidemia is a highly prevalent invasive fungal infection caused primarily by C. albicans, C. parapsilosis, C. glabrata (currently Nakaseomyces glabratus), C. tropicalis, and C. krusei (currently Pichia kudriavzevii). Risk factors for the development of candidemia include steroid-induced immunosuppression used in solid organ or hematopoietic transplantation, and neutropenia secondary to infectious or tumorous processes. Alterations in the gut microbiota in people living with HIV, caused by antiretroviral therapy, increase the possibility of colonization by C. albicans. Likewise, the presence of a central venous catheter, parenteral nutrition, and abdominal surgery stand out as the main risk factors for the development of candidemia. New diagnostic tools have been developed for the diagnosis of this mycosis that allow the identification of the main species, from improvements in conventional stains such as calcofluor white, which increases sensitivity, as well as technologies such as T2 Candida, MoiM assay, biomarker panel (1,3 β-D-glucan, C-reactive protein, presepsin, and procalcitonin), and, more recently, the development of biosensors for the identification of Candida spp. Regarding treatment, the use of micafungin and anidulafungin in patients with obesity defined by a BMI > 30 kg/m² has shown higher survival rates and therapeutic success. Meanwhile, newer antifungals such as rezafungin and fosmanogepix have demonstrated excellent results in the treatment of these patients. Therefore, this review aims to update the epidemiology and risk factors of candidemia, as well as analyze the diagnostic tools and treatments currently available. Full article

Invasive yeast infections (IYIs) remain a significant cause of morbidity and mortality in patients with hematologic diseases. We retrospectively analyzed 193 IYI episodes among 179 patients admitted to a tertiary hematology hospital (2012–2023). Candida species accounted for 91.7% (n = 177), while non-Candida yeasts comprised 8.3% (n = 16). Among invasive candidiasis, non-albicans Candida spp. were predominant, representing 76.8% (136/177), with C. tropicalis (36.2%, 64/177) being the most frequently isolated species. Among non-Candida yeasts, Cryptococcus neoformans (n = 10) was the most commonly identified pathogen. The incidence and 42-day mortality rate of IYIs were 0.199 and 0.095 per 1000 patient-days, respectively. The 42-day case-fatality rate remained high at 47.7%. In categorical analysis, age >65 years, corticosteroid use, elevated lactate (>2 mmol/L), neutropenia (<500/mm³), vasopressor use, and mechanical ventilation were more common in non-survivors. Primary bloodstream infections were more frequent in non-survivors, whereas catheter-related and abdominal-origin infections were predominant among survivors. Concomitant bacteremia was observed in 32.6% of IYI cases (n = 63), with Enterococcus faecium being the most frequently isolated co-pathogen. Our findings illustrate the evolving epidemiology of IYIs in hematologic patients, marked by the emergence of C. tropicalis as the predominant species, sustained mortality, and frequent bacterial co-infections, collectively reflecting the substantial clinical burden of IYIs. Full article

Introduction: Candida auris (now Candidozyma auris) and multidrug-resistant (MDR) bacterial infections pose significant therapeutic challenges due to high antimicrobial resistance, increased mortality, and persistence in healthcare settings. In Greece, their rising prevalence is raising concerns regarding co-infection, yet comprehensive data remain limited. This study aims to investigate the epidemiology, risk factors, and clinical outcomes of MDR bacterial co-infection in patients with C. auris candidemia. Methods: This single-center, retrospective observational cohort study was conducted at a Greek tertiary university hospital and included adult patients with C. auris bloodstream infections from January 2019 to June 2024. The data were analyzed using appropriate statistical methodologies. Results: Among 96 patients, those with C. auris candidemia and MDR bacterial co-infection exhibited a significantly higher mortality rate (87.23% vs. 61.22%, p = 0.007). The presence of a central venous catheter was the only factor significantly associated with MDR co-infection (p = 0.030). In univariate analysis, MDR co-infection, a higher Charlson Comorbidity Index, and mechanical ventilation correlated with increased mortality. Multivariate analysis identified MDR co-infection (OR = 3.19, p = 0.045) and mechanical ventilation (OR = 7.07, p = 0.002) as independent mortality predictors. Conclusions: These findings underscore the need for enhanced surveillance, precise identification, and stringent infection control measures to prevent C. auris and MDR bacterial outbreaks in healthcare settings. Full article

Invasive candidiasis represents a major global health concern, with incidence and mortality rates expected to rise due to medical advancements and unavoidable risk factors. This retrospective, multicentric study was conducted in eight hospitals in a northeastern Italian region, enrolling adult patients diagnosed with candidemia from 1 January 2018 to 31 December 2022. Epidemiological trends and clinical characteristics were analyzed and compared to those from a prior regional study (2009–2011), allowing a fourteen-year comparative evaluation. A shift in species distribution was observed, with a decline in Candida albicans (from 65.7% to 57.8%) and a rise in non-albicans species, particularly the Candida parapsilosis complex (from 16.1% to 18.2%). Guideline adherence was assessed applying the EQUAL Candida score; scores ≥ than 11.5 were independently associated with improved in-hospital survival (HR 3.51, p < 0.001). Among individual score components, empiric echinocandin therapy and central venous catheter removal correlated with better outcomes. Centers with routine infectious disease (ID) consultations showed higher survival and adherence, reinforcing the value of specialist involvement. These findings support local epidemiological and management practice surveillance program adoption to address context-specific gaps, promote the adoption of best practices in Candida BSI management—as expanded ID specialist consultations and education programs—and, ultimately, reduce candidemia-related mortality rates. Full article

Catheter-associated bloodstream infections (CABSIs) and catheter-related bloodstream infections (CRBSIs) are significant causes of morbidity and mortality worldwide. The current practice favors the removal of vascular access devices (VADs); however, the evidence on this topic remains inconclusive. This study evaluates the clinical outcomes in terms of in-hospital mortality and catheter retention vs. removal in CABSI and CRBSI cases. A retrospective, observational, single-center study was conducted at Luigi Sacco Hospital, Milan, Italy (May 2021–December 2023), and it analyzed non-ICU adult patients with VADs diagnosed with CRBSIs or CABSIs. Clinical and microbiological data were collected to assess the outcomes based on catheter management. Among 1874 patients with VADs, 147 were included, with 164 VAD infection events (92 CABSIs and 72 CRBSIs). Overall, 35 (23.8%) patients with CABSIs and CRBSIs died. Out of those who retained the catheter 19 (35.8%) patients died, while among removal patients 16 (17%) died (p = 0.018). A Candida spp. isolation was found to be significantly associated with a higher likelihood of catheter removal (p = 0.04). Our findings suggest that, in non-ICU CRBSI and CABSI cases, VAD removal may be associated with improved outcomes when feasible. Full article

Background/Objectives: Various factors associated with seasonality, including temperature, humidity, geographical composition, and seasonal fluctuations, can influence the trends of microbes responsible for hospital infections, such as Candida spp. This study evaluates the seasonal variability of Candida spp. bloodstream infections and antifungal resistance in hospitalized patients in Sicily. Methods: We retrospectively analyzed the demographic and epidemiological characteristics of 175 patients with blood cultures positive for Candida spp. Who were hospitalized at University Hospital Paolo Giaccone (A.U.O.P.), University of Palermo, Italy, from 1 January 2022 to 31 December 2024. Data on Candida species and antifungal resistance were also collected from the hospital’s database system to prevent and control hospital infections in A.U.O.P. Results: A total of 175 patients, 57.7% males, with a mean age of 68.3 years, were included in this study. Candida parapsilosis, Candida albicans, and Candida glabrata were more frequent in ICU (54.5%, p = 0.0001), medical (72.5%, p = 0.0003), and surgical settings (24%, p = 0.0161), respectively. C. parapsilosis was more frequent in dead patients (53.2%, p = 0.005). Among the seasons, we observed a significantly higher presence of C. glabrata in Autumn (20%, p = 0.0436). From the analysis of the seasons, C. parapsilosis and C. albicans were more frequent for each season, except in Spring, where the most frequent isolates were C. glabrata (5.1%, p = 0.0237) and C. parapsilosis (9.7%, p < 0.0001). The antifungal with the most resistance to Candida spp. was fluconazole in all seasons. Conclusions: Our study highlights the seasonal trends in Candida spp. and antifungal resistance, emphasizing climate change’s challenges on fungal diseases. These findings may contribute to improving prevention and treatment strategies for candidemia. Full article

Background: Candida infections have become a significant cause of morbidity and mortality in pediatric cardiac intensive care units following congenital heart surgery, ranking among the most common causes of complications in this patient population. There is a paucity of information available regarding the epidemiology, clinical features, and risk factors associated with candidemia in this patient population. The present study evaluates the incidence of Candida bloodstream infections in pediatric cardiac intensive care units. Methods: The study was conducted retrospectively on cases of patients under the age of 18 who were admitted to the pediatric cardiac intensive care unit between 1 January 2021 and 1 January 2024. The isolated pathogens were recorded. A reanalysis was conducted on 36 patients with Candida bloodstream infections, with data pertaining to age, weight, cardiac pathologies, duration of mechanical ventilation, length of hospital stay, and antibiotic use being subjected to further examination. Each case was matched with two control patients based on age and date of surgery. The results were analyzed statistically. Results: A total of 36 cases of candidemia were identified and matched with 72 control cases. The incidence of candidemia was found to be 21.8 episodes per 1000 hospital admissions. The median age of patients with candidemia was four months. Candida species were identified in the blood cultures of 36 out of 1650 patients (0.21%). Candida albicans (n = 12, 33.3%), Candida parapsilosis (n = 16, 44.4%), Candida glabrata (n = 2, 5.5%), and other non-albicans Candida species (n = 6, 16.6%) were isolated. The mortality rate associated with Candida bloodstream infections was 61.1% (22/36). The following independent risk factors were identified as being associated with candidemia: a birth weight of less than 2500 g (OR: 3.2; 95% confidence interval (CI): 2.5–5; p = 0.009), a RACHS-1 score of 4 or above (OR: 2.1; 95% CI: 1.3–6; p = 0.01), cumulative antibiotic exposure of seven days or more (OR: 2.5; 95% CI: 2–10; p < 0.001), duration of central venous catheterization (CVC) of ≥14 days (OR: 6.1; 95% CI: 4–18; p < 0.001), mechanical ventilation dependency of ≥10 days (OR: 4.2; 95% CI: 3–11; p = 0.01), a requirement for total parenteral nutrition (OR: 9; 95% CI: 6–24; p < 0.001), and delayed sternal closure of ≥2 days (OR: 1.8; 95% CI: 1–4; p = 0.04). Conclusions: Postoperative candidemia represents a significant complication in pediatric patients with congenital heart disease (CHD), with different Candida species identified as a potential cause. The primary risk factors that contribute to the likelihood of a Candida bloodstream infection in these cases are a low birth weight, a high RACHS-1 score, dependence on mechanical ventilation, prolonged exposure to antibiotics, prolonged central venous catheter duration, delayed sternal closure, and total parenteral nutrition. Full article

Candidemia and invasive candidiasis represent critical healthcare-associated fungal infections that pose substantial challenges to medical systems worldwide. These conditions arise when fungi from the Candida genus infiltrate the bloodstream or deeper tissues, leading to a range of clinical manifestations. Among the various species, Candida albicans continues to hold its position as the most frequently encountered causative agent, largely due to its prevalence and adaptability within human hosts. However, it is far from the only significant player; other Candida species, such as Candida glabrata, Candida parapsilosis, and the particularly concerning Candida auris, contribute significantly to the disease burden and exhibit varying dominance depending on geographic regions. The clinical presentation of these infections can differ widely, spanning from subtle, almost imperceptible symptoms in some patients to severe, life-threatening fulminant sepsis in others, often accompanied by alarmingly high mortality rates that underscore the urgency of effective management strategies. Several well-established risk factors predispose individuals to developing invasive candidiasis and candidemia. Breaches in the body’s natural barriers—such as the skin (cutaneous) or the gastrointestinal (GI) tract—provide entry points for these opportunistic pathogens. Additionally, deficiencies in the host’s immune responses, whether due to medical treatments, underlying diseases, or genetic predispositions, heighten vulnerability to infection. Among the diverse Candida species, Candida auris has emerged as an especially troubling entity in recent years. This multidrug-resistant species is notorious for its resistance to standard antifungal therapies, which complicates treatment efforts and contributes to elevated morbidity and mortality rates. Its rapid global spread has positioned it as a formidable public health threat, prompting heightened surveillance and research into its behavior and control. Full article

Candida species are major pathogens of bloodstream infections (BSIs) in hospitalized patients, with high mortality. This study examined Candida species distribution, clinical characteristics, and the mortality of patients with Candida BSIs. Adult patients (≥16 years) with Candida BSIs at a teaching hospital (2014–2023) were retrospectively reviewed. Over 10 years, 487 Candida isolates were obtained from 462 patients. C. albicans was the most frequent (38.2%), followed by C. glabrata (21.1%), C. parapsilosis (20.5%), and C. tropicalis (13.3%). The annual incidence of Candida BSIs remained stable (p = 0.525). However, non-albicans species BSIs increased 1.61-fold compared to C. albicans (95% CI: 1.19–2.19, p = 0.002). Fluconazole-non-susceptible Candida isolates increased after 2021 (p = 0.040). The overall 30-day mortality was 40.6%. In the multivariate analysis, a high Charlson comorbidity index (aHR: 1.20, 95% CI: 1.07–1.35, p = 0.001) and high SOFA score (aHR: 1.12, 95% CI: 1.02–1.23, p = 0.022) were the strongest predictors of 30-day mortality. Meanwhile, C. parapsilosis BSIs (aHR: 0.46, 95% CI: 0.22–0.99, p = 0.047) and central venous catheter removal at any time (aHR: 0.22, 95% CI: 0.13–0.37, p < 0.001) were associated with reduced 30-day mortality. The mortality of patients with Candida BSIs was mainly determined by disease severity, while catheter removal was associated with improved survival. Full article

Background: Despite significant prevention efforts, the incidence of central line-associated bloodstream infection (CLABSI) in intensive care units (ICUs) is rising at an alarming rate. CLABSI contributes to increased morbidity, mortality, prolonged hospital stays and elevated healthcare costs. This study aimed to determine the incidence rate of CLABSI, compliance with the central venous catheter (CVC) care bundle and risk factors associated with CLABSI among ICU patients. Method: This prospective observational study was conducted in one university hospital and two public hospitals in Malaysia between October 2022 to January 2023. Adult ICU patients (aged > 18 years) with CVC and admitted to the ICU for more than 48 h were included in this study. Data collected included patient demographics, clinical diagnosis, CVC details, compliance with CVC care bundle and microbiological results. All data analyses were performed using SPSS version 23. Results: A total of 862 patients with 997 CVCs met the inclusion criteria, contributing to 4330 central line (CL) days and 18 CLABSI cases. The overall incidence rate of CLABSI was 4.16 per 1000 CL days. The average of overall compliance with CVC care bundle components was 65%. The predominant causative microorganisms isolated from CLABSI episodes were Gram-negative bacteria (78.3%), followed by Gram-positive bacteria (17.4%) and Candida spp. (2.0%). Multivariate analysis identified prolonged ICU stay (adjusted odds ratio (AOR): 1.994; 95% confidence interval (CI): 1.092–3.009), undergoing surgery (AOR: 2.02, 95% CI: 1.468–5.830) and having had multiple catheters (AOR: 3.167, 95% CI: 1.519–9.313) as significant risk factors for CLABSI. Conclusions: The findings underscore the importance of robust surveillance, embedded infection-control and -prevention initiatives, and strict adherence to the CVC care bundle to prevent CLABSI in ICUs. Targeted interventions addressing identified risk factors are crucial to improve patient outcomes and reduce healthcare costs. Full article

Background/Objectives: Mixed bloodstream infections associated with central venous catheter (CVC) use are a growing problem. The aim of this study was to evaluate the activity of a cationic arginine-based gemini surfactant, C₉(LA)₂, against mixed biofilms of fluconazole-resistant Candida albicans and extended-spectrum beta-lactamase (ESBL)-producing E. coli, and the preventive effect of this surfactant impregnated in CVCs on the formation of inter-kingdom biofilms. Methods: Broth microdilution assays were performed along with evaluation of the effect against mixed biofilms in formation. The impregnation of CVCs with the surfactant and with a hydrogel containing the cationic surfactant was investigated to assess their potential to prevent the formation of mixed biofilms. Scanning electron microscopy (SEM) was also utilized. Results: Minimum inhibitory concentrations (MICs) for resistant C. albicans ranged from 4–5.3 µg/mL, while for E. coli, the MICs varied from 85.3 to 298.7 µg/mL. Fungicidal and bactericidal action patterns were obtained. In mixed biofilm formation in 96-well plates, there was a significant reduction in the colony-forming unit (CFU) count. The impregnation of the CVC with C₉(LA)₂ alone resulted in a biofilm reduction of 62% versus C. albicans and 48.7% against E. coli in terms of CFUs. When the CVC was impregnated with the surfactant hydrogel, the effect was improved with an inhibition of 71.7% for C. albicans and 86.7% for E. coli. The images obtained by SEM corroborated the results. Conclusions: C₉(LA)₂ has potential for use in CVC impregnation to prevent the formation of mixed biofilms of fluconazole-resistant C. albicans and ESBL-producing E. coli. Full article

Introduction: The epidemiology of candidemia has shifted in the past few decades; drug-resistant non-albicans Candida species have become more prevalent worldwide. The aim of this retrospective study was to determine the epidemiology of Candida species isolated from hospitalized neonates, children and adults, and to investigate a potential changing susceptibility pattern in a large general tertiary hospital. Methods: All unique Candida strains isolated from candidemia cases between 1 January 2020 and 15 October 2024 were identified, and their susceptibility profile was characterized. The distribution pattern in different ward types (medical, surgical, pediatric and ICU) was recorded. Cumulative annual susceptibility profiles were compared. Results: Candidemia incidence increased during the COVID-19 pandemic, from 0.63/1000 patient-days in 2020 to 0.96/1000 patient-days in 2022, and has since slightly decreased (0.83 and 0.89 in 2023 and 2024, respectively). Candidemia-associated mortality was high (>50%) in 2020 and peaked during the pandemic. During the study period, Candida parapsilosis remained the most frequent Candida spp. However, since the first isolation of Candida auris from the bloodstream in late 2022, and despite intense infection control measures taken, its frequency sharply climbed to the second position after only C. parapsilosis in the first 10 months of 2024 (33.6% vs. 25.2% for C. parapsilosis and 21.0% for C. albicans). While C. albicans has remained highly susceptible to fluconazole (1% resistance rate), C. parapsilosis manifested significant resistance to fluconazole during 2022–2024 (52%). C. auris was universally resistant to azoles and one isolate also resistant to echinocandins. Conclusions: A high prevalence of azole resistance of C. parapsilosis, the most frequently isolated Candida species, persists, and a significant rise of C. auris was recorded in nosocomial bloodstream infections with severe implications on public health. Full article

Background: Patients in critical care units (CCUs) are at an increased risk of bloodstream infections (BSIs), which can be associated with central vascular catheters (CVCs). This study describes BSIs, CVC-BSIs, organism distribution, percentage of antimicrobial resistant (AMR) organisms, and case fatality rates (CFRs) over the first six years of a voluntary national CCU surveillance programme in England. Methods: Surveillance data on BSIs, CVCs, and bed-days between 04/2017 and 03/2023 for adult CCUs were linked to mortality and AMR data, and crude rates were calculated. Results: The rates of CCU-BSIs and CCU-CVC-BSIs were stable for the first three years (3.6 and 1.7 per 1000 bed-days in 2019/20), before increasing by 75% and 94% in 2020/21, respectively, and returning to near pre-pandemic levels by 2022/23. Gram-negative bacteria accounted for 50.3% of all CCU-BSIs, followed by Gram-positive bacteria (39.6%) and Candida spp. (8.6%). Klebsiella spp. saw increases in percentage AMR, whereas other organisms saw declines or similar levels. The overall CFR was 30.2%. Conclusions: BSI incidence in CCUs remained stable across the study period, except for an increase in 2020/21 which reverted by 2022/23. These data provide a benchmark for CCUs and give insight into long-term AMR patterns where comparable national data are limited. Full article

Candida albicans is an emerging multidrug-resistant opportunistic pathogen that causes candidiasis, superficial infections on the mucosa, nails or skin, and life-threatening candidemia in deep tissue when disseminated through the bloodstream. Recently, there has been a sharp rise in resistant strains, posing a considerable clinical challenge for the treatment of candidiasis. There has been a resurged interest in the pharmacological properties of essential oils and their active components, for example, monoterpenes with alcohol (-OH) and aldehyde (-CHO) groups. Eugenol and citral have shown promising in vitro and in vivo activity against Candida species. Although there is substantial research on the efficacy of these essential oil components against C. albicans, a detailed knowledge of their mycological mechanisms is lacking. To explore the broad-spectrum effects of EOs, it is more meaningful and rational to study the whole essential oil, along with some of its major components. This review provides a comprehensive overview of eugenol and citral anticandidal and antivirulence activity, alone and together, along with the associated mechanisms and limitations of our current knowledge. Full article

An elderly male, with a recent COVID-19 infection and cardiovascular comorbidities, experienced a prolonged hospitalization due to a periprosthetic joint infection (PJI) and bacteremia, post hip hemiarthroplasty. Despite the initial clinical improvement while on targeted antimicrobial therapy, the patient later developed a low-grade fever and signs of myelosuppression. In the May–Grünwald–Giemsa stain of peripheral blood smear (PBS), pseudohyphae among red blood cells (RBCs) and phagocytosed blastospores in neutrophils and monocytes were detected, indicating candidemia rather than contamination of the stain. Echinocandin treatment was immediately initiated, and Candida albicans was identified from the blood culture, using multiplex polymerase chain reaction (PCR). Despite the early initiation of antifungal therapy and the removal of the central venous line (CVL), the patient passed away within 24 h. Candidemia is a leading cause of nosocomial bloodstream infections with high morbidity and mortality and is associated with multiple risk factors including surgery, CVLs, prolonged hospitalization, concomitant bacterial infection, broad-spectrum antibiotics, and immunosuppression. Isolation from blood cultures remains the gold standard for diagnosing candidemia. Detection of candidemia by PBS is extremely rare, requires an experienced microscopist, and is considered to be an emergency. Clinical suspicion, early laboratory identification, and immediate clinician notification are crucial for prompt antifungal treatment. Full article