Mario Fernández-Ruiz1, Celia Cardozo2, Miguel Salavert3, Manuela Aguilar-Guisado4, Laura Escolà-Vergé5, Patricia Muñoz6, Francesca Gioia7, Miguel Montejo8, Paloma Merino9, Guillermo Cuervo10, Carolina García-Vidal2, José María Aguado1. 1. Unit of Infectious Diseases, Hospital Universitario "12 de Octubre", Instituto de Investigación Hospital "12 de Octubre" (imas12), Universidad Complutense, Madrid, Spain. 2. Department of Infectious Diseases, Hospital Clinic, IDIBAPS (Institut d'Investigacions Biomèdiques Agust Pi i Sunyer), Universitat de Barcelona, Barcelona, Spain. 3. Unit of Infectious Diseases, Hospital Universitari i Politècnic "La Fe", Valencia, Spain. 4. Department of Infectious Diseases, Microbiology and Preventive Medicine, Hospital Universitario Virgen del Rocío, Instituto de Biomedicina de Sevilla (IBIS), Universidad de Sevilla, Sevilla, Spain. 5. Department of Infectious Diseases, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain. 6. Department of Clinical Microbiology and Infectious Diseases, Hospital General Universitario "Gregorio Marañón", Instituto de Investigación Sanitaria "Gregorio Marañón", Universidad Complutense, Madrid, Spain. 7. Department of Infectious Diseases, Hospital Universitario "Ramón y Cajal", IRYCIS (Instituto Ramón y Cajal de Investigación Sanitaria), Universidad de Alcalá, Madrid, Spain. 8. Unit of Infectious Diseases, Hospital Universitario Cruces, Barakaldo, Universidad del País Vasco, Bilbao, Spain. 9. Department of Clinical Microbiology, Hospital Universitario Clínico "San Carlos", Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, Spain. 10. Department of Infectious Diseases, Hospital Universitari de Bellvitge, IDIBELL (Institut D'Investigació Biomèdica de Bellvitge), Universitat de Barcelona, Barcelona, Spain.
Abstract
BACKGROUND: Despite being considered a high-risk population for invasive fungal disease, specific features of candidemia among solid organ transplant (SOT) recipients remain poorly characterized. METHODS: We compiled prospective data from two multicenter studies on candidemia performed over two consecutive periods in Spain: the CANDIPOP Study (2010-2011) and the CANDI-Bundle Study (2016-2018). Episodes diagnosed in adult SOT recipients in 10 participating centers were included. Risk factors for clinical failure (all-cause 7-day mortality and/or persistent candidemia for ≥72 hours) and 30-day mortality were investigated by univariate analysis. RESULTS: We included 55 episodes of post-transplant candidemia (32 and 23 of which occurred during the first and second periods). Kidney (38.2%) and liver recipients (30.9%) were the most common populations. Candida albicans accounted for 27.3% of episodes. The proportion of C glabrata increased over time (18.8% vs 30.4% for the first and second periods). There were no differences in the rate of fluconazole non-susceptible isolates (50.0% vs 60.0%, respectively). Clinical failure and 30-day mortality occurred in 25.5% and 27.3% of episodes and were associated with the severity of candidemia (Pitt score and severe sepsis/septic shock). Kidney transplantation (unadjusted odds ratio [uOR]: 0.17; 95% confidence interval [CI]: 0.03-0.85; P-value = .020), early catheter removal (uOR: 0.15; 95% CI: 0.03-0.76; P-value = .013), and appropriate early antifungal therapy (uOR: 0.14; 95% CI: 0.02-0.89; P-value = .041) were protective for 30-day mortality. CONCLUSIONS: High rates of non-albicans species and fluconazole non-susceptibility must be taken into account to optimize therapeutic management and outcomes in SOT recipients with candidemia.
BACKGROUND: Despite being considered a high-risk population for invasive fungal disease, specific features of candidemia among solid organ transplant (SOT) recipients remain poorly characterized. METHODS: We compiled prospective data from two multicenter studies on candidemia performed over two consecutive periods in Spain: the CANDIPOP Study (2010-2011) and the CANDI-Bundle Study (2016-2018). Episodes diagnosed in adult SOT recipients in 10 participating centers were included. Risk factors for clinical failure (all-cause 7-day mortality and/or persistent candidemia for ≥72 hours) and 30-day mortality were investigated by univariate analysis. RESULTS: We included 55 episodes of post-transplant candidemia (32 and 23 of which occurred during the first and second periods). Kidney (38.2%) and liver recipients (30.9%) were the most common populations. Candida albicans accounted for 27.3% of episodes. The proportion of C glabrata increased over time (18.8% vs 30.4% for the first and second periods). There were no differences in the rate of fluconazole non-susceptible isolates (50.0% vs 60.0%, respectively). Clinical failure and 30-day mortality occurred in 25.5% and 27.3% of episodes and were associated with the severity of candidemia (Pitt score and severe sepsis/septic shock). Kidney transplantation (unadjusted odds ratio [uOR]: 0.17; 95% confidence interval [CI]: 0.03-0.85; P-value = .020), early catheter removal (uOR: 0.15; 95% CI: 0.03-0.76; P-value = .013), and appropriate early antifungal therapy (uOR: 0.14; 95% CI: 0.02-0.89; P-value = .041) were protective for 30-day mortality. CONCLUSIONS: High rates of non-albicans species and fluconazole non-susceptibility must be taken into account to optimize therapeutic management and outcomes in SOT recipients with candidemia.
Authors: Alberto Ferrarese; Annamaria Cattelan; Umberto Cillo; Enrico Gringeri; Francesco Paolo Russo; Giacomo Germani; Martina Gambato; Patrizia Burra; Marco Senzolo Journal: World J Gastroenterol Date: 2020-12-21 Impact factor: 5.742
Authors: M Bertolini; R Vazquez Munoz; L Archambault; S Shah; J G S Souza; R C Costa; A Thompson; Y Zhou; T Sobue; A Dongari-Bagtzoglou Journal: mBio Date: 2021-08-17 Impact factor: 7.867