Search Results (95)

Background: Candidemia remains a life-threatening infection with high mortality despite advances in antifungal therapy. Malnutrition has been suggested as an important contributor to poor outcomes; however, the prognostic value of different nutritional assessment tools in candidemia has not been fully clarified. This study aimed to evaluate the impact of nutritional status on prognosis in patients with candidemia and to identify the most reliable nutritional assessment tool. Method: We conducted a retrospective cohort study of adult patients diagnosed with candidemia at a tertiary teaching hospital in Japan between 2014 and 2024. A total of 170 patients were included, with a mean age of 73 years. Nutritional status was assessed using the Global Leadership Initiative on Malnutrition (GLIM) criteria and Controlling Nutritional Status (CONUT) score. The primary outcome was 30-day mortality. Results: According to the GLIM criteria, 72% of patients were classified as malnourished. The 30-day and in-hospital mortality rates were 35% and 44%, respectively. The CONUT score demonstrated good prognostic performance for 30-day mortality (Area under the Receiver operating characteristic 0.723, p < 0.001), with an optimal cut-off value of 12. Patients with higher CONUT scores had significantly shorter overall survival (Log-rank test p < 0.001). In multivariate analysis, a CONUT score ≥ 12, SOFA score ≥ 5, and the European Confederation of Medical Mycology Quality of Clinical Candidemia Management (EQUAL) Candida score ≥ 10 were independent predictors of 30-day mortality, whereas malnutrition defined by the GLIM criteria was not. Conclusions: The CONUT score is a useful prognostic indicator for short-term mortality in patients with candidemia, outperforming the GLIM criteria. Full article

Background: Bacterial vaginosis and vaginal dysbiosis represent major causes of morbidity among women in sub-Saharan Africa, yet data from Madagascar remain scarce. This study aimed to assess the prevalence and determinants of vaginal bacterial infections among women in northern Madagascar and to explore how vaginal microflora composition reflects broader aspects of reproductive health. Methods: A cross-sectional study was conducted in April 2024 among 159 women (15–80 years) attending a rural second-referral clinic in Manerinerina, Ambatoboeny District. Sociodemographic and hygiene data were obtained through structured questionnaires. Vaginal pH was measured in situ, and Gram-stained smears were evaluated using the Nugent scoring system. The presence of Trichomonas vaginalis, Neisseria gonorrhoeae, and Candida spp. was assessed microscopically. Associations were analyzed using Chi-square or Fisher’s exact tests, with p < 0.05 considered significant. Results: Abnormal vaginal flora was observed in 68.6% of women, including 43.4% with BV (Nugent 7–10) and 25.2% with intermediate flora. Elevated vaginal pH correlated strongly with higher Nugent scores (p < 0.01). T. vaginalis and N. gonorrhoeae were detected in 10.7% and 9.4% of women, respectively, and both were significantly associated with dysbiosis (p = 0.02 and p = 0.04). Poor hygiene practices, vaginal douching (79.1% vs. 64.5%; p = 0.04), and unsafe water sources (p = 0.04) were major behavioral and environmental determinants. Conclusions: Vaginal dysbiosis is highly prevalent among women in northern Madagascar and closely linked to modifiable hygiene behaviors and environmental conditions. In resource-limited settings, Gram-stained microscopy and Nugent scoring remain cost-effective tools for surveillance and patient care. Culturally adapted education, improved water access, and integration of low-cost diagnostics are essential for reducing the burden of vaginal infections in rural Madagascar. Full article

Background: While Candida auris is well known to cause hospital outbreaks, other species in the C. haemulonii complex are less well documented but gained attention as opportunistic pathogens. Only one documented outbreak has been published. We describe the second, silent, fungemia outbreak due to antifungal-susceptible C. duobushaemulonii. Methods: We retrospectively genotyped six C. duobushaemulonii bloodstream isolates, collected in a 4-month-period in 2022 (n = 4) and during a week in 2024 (n = 2) in pediatric patients in Brazil. Whole genome sequencing (WGS) was done and compared to n = 33 publicly available genomes, including four cases from an outbreak in Panama. Antifungal susceptibility was performed with the reference CLSI method. Results: MALDI-TOF-MS identified isolates as either C. pseudohaemulonii or C. duobushaemulonii albeit with low scores. ITS sequence analyses confirmed all isolates as C. duobushaemulonii. WGS proved the presence of an outbreak among four pediatric patients in 2022 and a genetically distinct cluster of two cases in 2024. All six isolates were susceptible to azoles and echinocandins and were interpreted as being resistant to amphotericin B with a MIC at breakpoint of 2 µg/mL. Conclusions: This study describes the second documented outbreak due to the rare yeast C. duobushaemulonii, belonging to the C. haemulonii species complex, during 2022–2024 in patients admitted to a pediatric oncology ward in a Brazilian hospital. Full article

Background and Objectives: Healthcare-associated infections (HAIs) significantly increase morbidity and mortality in critically ill patients, and their burden became more pronounced during the COVID-19 pandemic. However, data describing the temporal evolution of HAIs, pathogen distribution, and associated risk factors across consecutive pandemic waves remain limited. This study aimed to characterize the epidemiology, microbiology, and outcomes of HAIs in COVID-19 intensive care units (ICU) patients and to identify clinical and laboratory predictors of mortality. Materials and Methods: This retrospective observational study included adult patients with RT-PCR–confirmed COVID-19 who developed at least one HAI ≥ 48 h after ICU admission between March 2020 and December 2020, encompassing the first three pandemic waves in Türkiye, in a tertiary-care ICU. Demographic, clinical, laboratory, and microbiological data were collected. Inflammatory markers and severity scores (SAPS-II, MCCI, and NLR) were analyzed. Receiver operating characteristic (ROC) curve analysis was used to determine optimal cut-off values for mortality prediction. Results: Among the 1656 ICU admissions, 145 patients (8.7%) developed HAIs; after exclusions, 136 patients were included in the final analysis. Bloodstream infections were the most frequent HAI (57%), followed by urinary tract infections (31%), ventilator-associated pneumonia (9%), and surgical site infections (1%). Klebsiella pneumoniae was the predominant pathogen, followed by Candida albicans and Acinetobacter baumannii. Multidrug-resistant organisms, including MRSA and VRE, showed variable distribution across pandemic periods. Overall in-hospital mortality was 74.3%. Non-survivors had significantly higher SAPS-II, MCCI, and NLR values. ROC analysis identified NLR > 38.8 and SAPS-II > 35.5 as mortality-predictive thresholds. Dynamic inflammatory marker patterns correlated with infection timing, and early peaks of CRP, WBC, and IL-6 were associated with worse outcomes. Conclusions: HAIs imposed a substantial clinical burden on critically ill COVID-19 patients, with high mortality driven predominantly by multidrug-resistant bloodstream infections. Severity indices and inflammation-based biomarkers demonstrated strong prognostic value. Temporal shifts in pathogen ecology across pandemic waves underscore the need for adaptive infection-prevention strategies, continuous microbiological surveillance, and strengthened antimicrobial stewardship in critical care settings. Full article

Background:  Clostridioides difficile infection (CDI) remains a challenging condition, particularly in severe or recurrent cases. This study aimed to identify factors associated with recurrent CDI (rCDI), severe disease (defined by ZAR score or ESCMID criteria), death during CDI, and bloodstream infections (BSI) or candidemia within 8 weeks of CDI onset. Methods: We conducted a prospective study at an Italian university hospital that included all adult CDI cases diagnosed between November 2022 and December 2024. Statistical analyses were performed with IBM SPSS Statistics. A p-value < 0.05 was considered statistically significant in univariate analyses. For the multivariable analysis, we selected the variables that were statistically significant in the univariate analysis and considered the most clinically relevant. Results: A total of 161 CDI cases were identified. Recurrence occurred in 13%, higher than the 4% reported in a previous retrospective cohort at the same center (2013–2022). In univariate analysis, independent predictors of recurrent CDI (rCDI) were therapeutic regimens including oral vancomycin (p = 0.008; OR 6.17; 95% CI 1.36–27.97), peripheral vascular disease (PVD) (p < 0.001; OR 5.92; 95% CI 2.07–16.94), and dysphagia (p = 0.034; OR 4.61; 95% CI 1.25–17.07), whereas fidaxomicin use was associated with a protective effect (p = 0.016; OR 0.17; 95% CI 0.04–0.78). In multivariable analysis, oral vancomycin use (p = 0.008; OR 15.03) and peripheral vascular disease (p = 0.002; OR 7.27) remained independently associated with rCDI. Overall, 15 of 161 patients (9.3%) died during the CDI episode (either presenting CDI or rCDI), with all deaths directly attributable to CDI. Mortality during CDI was associated with age > 77 years (median value of the study population), transfer from a nursing home or long-term care facility within the previous 3 months, lymphoma, hematological malignancy, peripheral vascular disease, connective tissue disease, immobilization syndrome, dysphagia, elevated lactate levels (>1 mmol/L), septic shock, severe or severe-complicated CDI according to ESCMID criteria, severe-complicated CDI according to ESCMID criteria, leukocytosis (WBC > 15,000/mm³) during CDI, ZAR score ≥ 2, concomitant BSI, and concomitant pneumonia. During follow-up, 11 of 127 (8.7%) patients developed a BSI. BSI was associated with corticosteroid use and osteomyelitis. Only four patients developed candidemia due to Candida albicans during follow-up. Conclusions: Our study confirms that Clostridioides difficile infection remains a major clinical challenge, particularly due to its high recurrence rate and the burden of severe forms. The evidence strongly supports the preferential use of fidaxomicin, which should now be regarded as the standard of reference in clinical practice. Full article

Background: Infection prevention and control (IPC) in hospitals relies heavily on infection control nurses (ICNs) who manage complex consultations to prevent and control infections. This study evaluated large language models (LLMs) as artificial intelligence (AI) tools to support ICNs in IPC decision-making processes. Our goal is to enhance the efficiency of IPC practices while maintaining the highest standards of safety and accuracy. Methods: A cross-sectional benchmarking study at Queen Mary Hospital, Hong Kong assessed three LLMs—GPT-4.1, DeepSeek V3, and Gemini 2.5 Pro Exp—using 30 clinical infection control scenarios. Each model generated clarifying questions to understand the scenarios before providing IPC recommendations through two prompting methods: an open-ended inquiry and a structured template. Sixteen experts, including senior and junior ICNs and physicians, rated these responses on coherence, conciseness, usefulness and relevance, evidence quality, and actionability (1–10 scale). Quantitative and qualitative analyses assessed AI performance, reliability, and clinical applicability. Results: GPT-4.1 and DeepSeek V3 scored significantly higher on the composite quality scale, with adjusted means (95% CI) of 36.77 (33.98–39.57) and 36.25 (33.45–39.04), respectively, compared with Gemini 2.5 Pro Exp at 33.19 (30.39–35.99) (p < 0.001). GPT-4.1 led in evidence quality, usefulness, and relevance. Gemini 2.5 Pro Exp failed to generate responses in 50% of scenarios under structured prompt conditions. Structured prompting yielded significant improvements, primarily by enhancing evidence quality (p < 0.001). Evaluator background influenced scoring, with doctors rating outputs higher than nurses (38.83 vs. 32.06, p < 0.001). However, a qualitative review revealed critical deficiencies across all models, for example, tuberculosis treatment solely based on a positive acid-fast bacilli (AFB) smear without considering nontuberculous mycobacteria in DeepSeek V3 and providing an impractical and noncommittal response regarding the de-escalation of precautions for Candida auris in Gemini 2.5 Pro Exp. These errors highlight potential safety risks and limited real-world applicability, despite generally positive scores. Conclusions: While GPT-4.1 and DeepSeek V3 deliver useful IPC advice, they are not yet reliable for autonomous use. Critical errors in clinical judgment and practical applicability highlight that LLMs cannot replace the expertise of ICNs. These technologies should serve as adjunct tools to support, rather than automate, clinical decision-making. Full article

Coconut oil is highly regarded for its nutritional and functional attributes, making it an attractive candidate for diverse food and health applications. This study evaluates the fatty acid profile, antioxidant and antimicrobial activities, oxidative stability, and sensory properties of selected coconut oils (Coco24, Health, Kospa, Smetol, and Vita) from the Slovak republic market. Acid values (0.09 ± 0.060–0.42 ± 0.060 mg KOH/g) and peroxide values (0.51 ± 0.058–1.20 ± 0.010 mmol O₂/kg) were within recommended safety limits. Oxidative stability varied significantly (p ˂ 0.05), with Smetol showing the highest induction time (124.5 ± 0.98 h) and Coco24 the lowest (25.8 ± 0.22 h). DPPH antioxidant activity was highest in health (469.2 ± 2.01 mg TEAC/kg) and Coco24 (369.3 ± 1.99 mg TEAC/kg) (TEAC—Trolox equivalent antioxidant capacity). Coco24, Health, and Kospa exhibited the most potent antimicrobial activity against Staphylococcus aureus (2.01 ± 0.001 mm, 1.37 ± 0.021 mm, 1.15 ± 0.010 mm, respectively), Candida glabrata (1.17 ± 0.015 mm, 1.17 ± 0.015 mm, 0.45 ± 0.025 mm, respectively), Candida tropicalis (2.12 ± 0.017 mm, 2.13 ± 0.017 mm, 1.52 ± 0.006 mm, respectively), and Bacillus subtilis (1.29 ± 0.055 mm, 1.35 ± 0.006 mm, 0.31 ± 0.020 mm, respectively). FAME analysis revealed that saturated fatty acids dominated, especially in Smetol (97.6 ± 0.067%), while Coco24 had the highest levels of unsaturated fatty acids. Vita and Kospa received the highest panel ratings for smell, taste, and overall acceptability, indicating superior sensory appeal, whereas Smetol scored the lowest. Correlation analysis showed strong positive relationships between MUFA and PUFA (r = 0.986) and taste and acceptability (r = 0.993), as well as between antioxidant activity and Candida albicans inhibition (r = 0.859). Oxidative stability was negatively correlated with PUFA (r = –0.924). PCA grouped oils high in MUFA/PUFA (Kospa, Vita) with superior sensory scores, while PC2 reflected microbial safety. These differences suggest that Coco24, Health, Vita, and Kospa offer enhanced functional and sensory benefits, whereas Smetol is better suited for applications that prioritize oxidative stability. Full article

Background/Objectives: Acute-on-chronic liver failure (ACLF) is a life-threatening complication of cirrhosis, characterized by organ failures and high short-term mortality. Alcohol-related cirrhosis is one of the most frequent underlying etiologies of ACLF in Europe. Infections, particularly those leading to sepsis are recognized triggers; however, their relative contribution, clinical features, and prognostic impact in critically ill patients with alcohol-related cirrhosis remain incompletely defined. This study aimed to systematically identify and characterize precipitating events of ACLF in this population and to compare outcomes between sepsis- and non-sepsis-related cases. Methods: We conducted a retrospective cohort study including 188 ICU patients with alcohol-related cirrhosis who were treated for ACLF at a tertiary university medical center. ACLF was defined and graded according to the European Association for the Study of the Liver—Chronic Liver Failure Consortium (EASL-CLIF) criteria, and sepsis was diagnosed according to Sepsis-3 definitions. Clinical data, precipitating events, microbiological evidence, organ support requirements, and in-hospital outcomes were systematically analyzed. Results: Sepsis was the most frequent precipitating event, identified in 118 patients (62.8%), while 70 patients (37.2%) developed ACLF due to non-septic triggers such as gastrointestinal bleeding. Patients with sepsis-associated ACLF presented with more advanced disease (ACLF grade 2–3 in 80.5% vs. 57.1%, p = 0.004), higher Chronic Liver Failure Consortium—Acute-on-Chronic Liver Failure Score (CLIF-C ACLF) scores (median 55 vs. 50, p = 0.04), longer ICU stays (median 11 vs. 4.5 days, p < 0.001), and markedly higher in-hospital mortality (60.2% vs. 20.0%, p < 0.001) compared to patients without sepsis. Pneumonia (48.3%), urinary infections (17.8%) and spontaneous bacterial peritonitis (16.1%) were the leading infectious foci triggering sepsis. Microbiological evidence was obtained in 82.2% of sepsis cases, with frequent polymicrobial infections and opportunistic pathogens including Enterococcus faecium and Candida albicans. Conclusions: In critically ill patients with alcohol-related cirrhosis, infections leading to sepsis are the predominant precipitating event of ACLF and the strongest determinant of short-term prognosis. Compared with non-sepsis triggers, sepsis-associated ACLF is characterized by more severe disease, greater need for organ support, longer ICU stays, and substantially higher mortality. These findings highlight the urgent need for early recognition, rapid diagnostic strategies, and optimized infection management to improve outcomes in this high-risk population. Full article

Objective: Maxillofacial silicone elastomers represent a standard material in maxillofacial prosthetic applications due to their excellent biocompatibility and aesthetic properties. However, their long-term performance is limited by color degradation and susceptibility to fungal colonization. Incorporating nanoparticles into silicone matrices has emerged as a potential solution to enhance durability and hygiene. This study aimed to evaluate the effect of zinc oxide (ZnO) and titanium dioxide (TiO₂) nanoparticles used individually and in combination to evaluate the color stability and antifungal activity of pigmented maxillofacial silicone elastomers. Material and Methods: Fifty specimens were fabricated for each test and divided into five groups: Group (A) control (pigmented silicone only, no nanoparticles), Group (B) ZnO (1.5 wt%), Group (C) TiO₂ (2.5 wt%), and two combinations: Group(D1) (0.75 wt% ZnO + 1.25 wt% TiO₂) and Group (D2)(0.5 wt% ZnO + 0.83 wt% TiO₂) ratios. Color stability was assessed before and after 500 h of artificial aging using CIELAB-ΔE values and visual scoring. Antifungal activity was evaluated against Candida albicans using the disk diffusion method. Attenuated Total Reflectance with Fourier Transform Infrared Spectroscopy (ATR-FTIR), Scanning electron microscopy (SEM) along side with Energy-dispersive X-ray spectroscopy (EDS) were applied for Specimen characterization. Data were analyzed with one-way ANOVA and Tukey’s post hoc test (α = 0.05). Results: The dual-nanoparticle group with 0.75% ZnO and 1.25% TiO₂ demonstrated the best color stability (ΔE = 0.86 ± 0.50) and strongest antifungal activity (inhibition zone: 7.8 ± 3.8 mm) compared to the control (ΔE = 2.31 ± 0.62; no inhibition). Single-nanoparticle groups showed moderate improvements. A significant Association (r = 0.89, p < 0.01) was found between nanoparticle dispersion and material performance. Conclusions: Incorporating ZnO and TiO₂ nanoparticles into maxillofacial silicone elastomers significantly enhances color stability and antifungal efficacy. The combined formulation showed a synergistic effect, offering promising potential for improving the longevity and hygiene of maxillofacial prostheses. Full article

Candida parapsilosis has emerged as a prominent cause of nosocomial candidemia, particularly among critically ill patients. The increasing prevalence of fluconazole-resistant C. parapsilosis (FR-Cp) poses major therapeutic challenges, especially in resource-limited settings. We conducted a retrospective study of 144 patients with C. parapsilosis candidemia admitted to two post-surgical ICUs at a Brazilian tertiary cardiothoracic hospital between 2016 and August 2024. Demographic, clinical, microbiological, and therapeutic data were analyzed. Predictors of 30-day mortality were identified through multivariate logistic regression. The incidence density of C. parapsilosis candidemia ranged from 2.93 to 8.31 per 1000 hospitalizations. Fluconazole resistance was identified in 81% of isolates. Overall 30-day mortality was 55%. Independent risk factors for mortality included cardiopathy (OR: 19.36, p = 0.006), higher SOFA scores (OR: 1.54, p = 0.003), parenteral nutrition (OR: 29.77, p = 0.013), and dialysis (OR: 6.59, p = 0.043), while longer treatment duration was protective (OR: 0.81, p < 0.001). Fluconazole resistance was not independently associated with increased mortality. In this cohort of critically ill patients, C. parapsilosis candidemia was associated with high mortality and a high prevalence of fluconazole resistance. Clinical outcomes were mainly driven by host-related and therapeutic factors rather than antifungal resistance alone. Full article

Progressive immune damage associated with Human Immunodeficiency Virus (HIV) alters mucosal homeostasis, favouring oral microbial imbalance and the development of opportunistic infections. The aim of this study was to characterize the composition and structure of the oral microbiota in different clinical conditions of HIV infection. A cross-sectional study was conducted in 99 Mexican men divided into five groups: HIV-negative controls, newly diagnosed without antiretroviral treatment, virally suppressed, with oral candidiasis, and with HPV infection. Metagenomic DNA was obtained from salivary samples, and the V1–V3 region of the 16S rRNA gene was massively sequenced. Taxonomic profiles, alpha/beta diversity, differential abundance, microbial co-occurrence networks and degree of dysbiosis were analysed. The results showed distinctive profiles between the groups. Alpha and beta diversity was significantly higher in the groups with oral Candida and HPV lesions, reflecting a disturbance of microbial balance. Differential abundance analysis revealed an increase in Streptococcus, Veillonella, Lactobacillus and Actinomyces genera in HIV patients, while healthy subjects showed higher abundance of Neisseria, Treponema, and Rothia, associated with a eubiotico state. The group of patients with HPV lesions had the highest number of taxa with differential abundance, suggesting an ecological environment altered by the lesion. Analysis of co-occurrence networks revealed a progressive pattern of microbial complexity: controls presented simple networks with weak positive correlations, while HIV groups showed increased connection density and appearance of structured nuclei. The group of patients with HPV lesions presented the highest connectivity, with multiple strongly correlated cores and core nodes such as Prevotella melaninogenica and Shuttleworthia. The dysbiosis score increased progressively from healthy subjects to those with HPV lesions, indicating a gradient of oral microbial disruption. These findings suggest that HIV immunosuppression and the presence of oral lesions are associated with enhanced dysbiosis, although their individual contributions could not be independently assessed due to the absence of non-HIV lesion controls. The integration of microbial networks and dysbiosis scores could be useful for assessing mucosal and immune health in people with HIV and used as biomarkers of clinical progression. Full article

Background: Nephrolepis exaltata (sword fern) possesses a considerable amount of phytochemicals and different biological activities. The current study investigates the anti-biofilm potential of greenly synthesized bimetallic nanoparticles of Nephrolepis exaltata leaf methanol extract (NEME-MnO₂-MgO BNPs). Methods: The NEME was subjected to UPLC/MS analysis, followed by characterization of its NPs by size, zeta potential, FTIR, entrapment efficiency, and release. Then, antioxidant, antimicrobial and antibiofilm assays were employed, followed by in silico studies. Results: The UPLC/MS analysis of NEME led to the tentative identification of 27 metabolites, mostly phenolics. The MnO₂-MgO BNPs presented a uniform size and distribution and exhibited IC₅₀ values of 350 and 215.6 μg/mL, in the DPPH and ABTS assays, respectively. Moreover, the NPs exhibited antimicrobial and anti-biofilm efficacies against Pseudomonas aeruginosa, Klebsiella pneumonia (ATCC-9633), Staphylococcus aureus (ATCC-6538), Escherichia coli, Bacillus cereus, and C. albicans, with MIC values of 250–500 μg/mL. The MnO₂-MgO BNPs inhibited Candida albicans biofilms with a % inhibition of 66.83 ± 2.45% at 1/2 MIC. The network pharmacology highlighted epigallocatechin and hyperoside to be the major compounds responsible for the anti-biofilm potential. The ASKCOS facilitated the prediction of the redox transformations that occurred in the green synthesis, while the docking analysis revealed enhanced binding affinities of the oxidized forms of both compounds towards the outer membrane porin OprD of P. aeruginosa, with binding scores of −4.6547 and −5.7701 kcal/mol., respectively. Conclusions: The greenly synthesized Nephrolepis exaltata bimetallic nanoparticles may provide a promising, eco-friendly, and sustainable source for antimicrobial agents of natural origin with potential biofilm inhibition. Full article

Introduction/objectives: Peritonitis resulting from Candida spp. is common among critically ill patients and has been associated with adverse clinical outcomes. This study aimed to determine the effects of isolates of Candida species in patients with peritonitis on in-hospital mortality, general hospital stay, and intensive care unit (ICU) stays. Methods: This retrospective cohort study was conducted in two highly complex hospitals in Bogotá, Colombia, specifically by reference to patients who were hospitalized in the ICU between 2016 and 2022 with a clinical and microbiological diagnosis of peritonitis. For the analysis conducted for this research, two groups were established: patients with isolates of Candida spp. in the peritoneum and patients who had at least one bacterial microorganism in the culture. Multivariate logistic regression models and counting models featuring different mortality outcomes, different lengths of stay in the ICU, and different lengths of stay in the hospital were generated to evaluate the effect of the presence of Candida spp. and to account for potentially confounding variables. Results: A total of 373 patients, including 83 with Candida spp. and 290 with a bacterial etiology, were identified. Among the former group of patients, the most frequently identified species were C. albicans (50, 60.2%), C. tropicalis (18, 21.7%), and C. glabrata (7, 8.4%), whereas among the latter group, E. coli (186, 48.5%), K. pneumoniae (110, 29.8%), and E. faecalis (63, 16.9%) were most frequent. The 30-day mortality rate among patients with peritonitis and Candida isolates was 36.1%, and the corresponding rate among patients in the bacterial peritonitis group was 31.4% (p = 0.071). After adjustments were made to account for covariates, no significant differences were observed in mortality at 30 days (OR 0.75, 95% CI 0.20–1.18), length of hospital stay (iRR 1.11, 95% CI 0.90–1.40), or length of stay in the ICU (iRR 1.11, 95% CI 0.39) with respect to patients with peritonitis without fungal isolates. The Simplified Acute Physiology Score (SAPS2) (OR 1.04, 95% CI 1.03–1.06), World Society of Emergency Surgery (WSES) score (OR 1.11, (1.03–1.19), previous use of antifungals (OR 2.33, 1.21–4.52), and connective tissue disease (OR 3.71, 95% CI 1.30–10.99) were associated with 30-day mortality. Conclusions: The isolation of Candida species in peritoneal fluid from critically ill patients with peritonitis was not significantly associated with in-hospital mortality, length of hospital stay, or length of ICU stay after adjustments were made to account for other variables. Full article

Background:Candida auris (now Candidozyma auris) is an emerging pathogen that causes nosocomial candidemia, particularly in intensive care unit (ICU) settings. Its high resistance rates, prolonged environmental persistence, and outbreak potential underscore the need for robust comparative studies with non-auris Candida species (NACS). Methods: In this retrospective, case–control study, adult ICU patients with candidemia were enrolled between April 2022 and October 2024. Clinical data, risk factors, and mortality at 14, 30, and 90 days were compared between the C. auris and NACS groups. Univariate and multivariate logistic regression analyses were performed to identify mortality-associated factors. Results: Of the 182 patients analyzed, candidemia due to C. auris was identified in 33 (18.1%) cases, while 149 (81.9%) cases involved NACS. Fluconazole resistance (p < 0.001), prior antifungal exposure (p = 0.003), urinary catheter use (p = 0.040), and the length of ICU stay before the onset of candidemia (p < 0.001) were significantly higher in the C. auris cases. However, mortality rates at 14, 30, and 90 days were similar between the groups (p = 0.331, 0.108, and 0.273, respectively). The Sequential Organ Failure Assessment score was the only consistent independent predictor of mortality at all time points. In the NACS cases, the Pitt Bacteremia Score and sepsis also predicted 30- and 90-day mortality. While late recurrence was more frequent in the cases of C. auris, early recurrence and other risk factors were similar between the groups. Conclusions:C. auris candidemia was associated with higher fluconazole resistance, prior antifungal use, longer ICU stay, more frequent urinary catheterization, and later recurrence than the NACS cases. However, the mortality rates at 14, 30, and 90 days were comparable. Outcomes were primarily influenced by illness severity rather than the infecting Candida species, highlighting the importance of timely therapy, stewardship, and infection control. 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