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Basem Alraddadi - One of the best experts on this subject based on the ideXlab platform.
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Antifungal Resistance in patients with Candidaemia: a retrospective cohort study
BMC infectious diseases, 2020Co-Authors: Namareq Aldardeer, Hadiel Albar, Majda Al-attas, Abdelmoneim Eldali, Mohammed Qutub, Ashraf Hassanien, Basem AlraddadiAbstract:Candidaemia is the most common form of invasive candidiasis. Resistant Candida blood stream infection (BSI) is rising, with limitations on the development of broader-spectrum Antifungal agents worldwide. Our study aimed to identify the occurrence of Antifungal-resistant candidaemia and the distribution of these species, determine the risk factors associated with Antifungal Resistance and evaluate the association of Antifungal-resistant candidaemia with the length of intensive care unit (ICU) and hospital stay and with 30-day mortality. A retrospective cohort study was conducted at King Faisal Specialist Hospital and Research Centre, Jeddah, Saudi Arabia. Adult patients diagnosed with candidaemia from January 2006 to December 2017 were included. A total of 196 BSIs were identified in 94 males (49.74%) and 95 females (50.26%). C. glabrata was the most commonly isolated Candida species, with 59 (30%), followed by C. albicans with 46 (23%). Susceptibility data were available for 122/189 patients, of whom 26/122 (21%) were resistant to one or more Antifungals. C. parapsilosis with available sensitivity data were found in 30/122 isolates, of which 10/30 (33%) were resistant to fluconazole. Risk factors significantly associated with Antifungal-resistant candidaemia included previous echinocandin exposure (odds ratio (OR) =1.38; 95% confidence interval (CI) (1.02–1.85); P = 0.006) and invasive ventilation (OR = 1.3; 95% CI (1.08–1.57); P = 0.005). The median length of ICU stay was 29 days [range 12–49 days] in the Antifungal-resistant group and 18 days [range 6.7–37.5 days] in the Antifungal-sensitive group (P = 0.28). The median length of hospital stay was 51 days [range 21–138 days] in the Antifungal-resistant group and 35 days [range 17–77 days] in the Antifungal-sensitive group (P = 0.09). Thirty-day mortality was 15 (57.7%) and 54 (56.25%) among the Antifungal-resistant and Antifungal-sensitive groups, respectively (OR = 1.01; 95% CI (0.84–1.21); P = 0.89). Our results indicate a high frequancy of non- C. albicans candidaemia. The rise in C. parapsilosis Resistance to fluconazole is alarming. Further studies are required to confirm this finding.
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Antifungal Resistance in Patients with Candidemia: A Retrospective Cohort Study
2019Co-Authors: Namareq Aldardeer, Hadiel Albar, Majda Al-attas, Abdelmoneim Eldali, Mohammed Qutub, Ashraf Hassanien, Basem AlraddadiAbstract:Abstract Background: Candidaemia is the most common form of invasive candidiasis. Resistant Candida blood stream infection (BSI) is rising , with limitations on the development of broader-spectrum Antifungal agents worldwide. Our study aimed to identify the occurrence of Antifungal-resistant candidaemia and the distribution of these species, determine the risk factors associated with Antifungal Resistance and evaluate the association of Antifungal-resistant candidaemia with the length of intensive care unit (ICU) and hospital stay and with 30-day mortality. Methods: A retrospective cohort study was conducted at King Faisal Specialist Hospital and Research Centre, Jeddah, Saudi Arabia. Adult patients diagnosed with candidaemia from January 2006 to December 2017 were included. Results: A total of 196 BSIs were identified in 94 males (49.74%) and 95 females (50.26%). C. glabrata was the most commonly isolated Candida species, with 59 (30%) , followed by C. albicans with 46 (23%). Susceptibility data were available for 122/189 patients , of whom 26/122 (21%) were resistant to one or more Antifungals. C. parapsilosis with available sensitivity data were found in 30/122 isolates, of which 10/30 (33%) were resistant to fluconazole. Risk factors significantly associated with Antifungal-resistant candidaemia included previous echinocandin exposure ( odds ratio (OR) =1.38; 95% confidence interval (CI) (1.02-1.85); P= 0.006) and invasive ventilation (OR=1.3; 95% CI (1.08-1.57); P= 0.005). The median length of ICU stay was 29 days [range 12 -49 days] in the Antifungal-resistant group and 18 days [range 6.7-37.5 days] in the Antifungal-sensitive group (P=0.28) . The median length of hospital stay was 51 days [range 21-138 days] in the Antifungal-resistant group and 35 days [range 17-77 days] in the Antifungal-sensitive group (P=0.09). Thirty-day mortality was 15 (57.7%) and 54 (56.25%) among the Antifungal-resistant and Antifungal-sensitive groups , respectively (OR=1.01; 95% CI (0.84-1.21); P= 0.89). Conclusions: Our results indicate a high frequancy of non- C. albicans candidaemia . The rise in C. parapsilosis Resistance to fluconazole is alarming. Further studies are required to confirm this finding
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Antifungal Resistance in Patients with Candidemia: A Retrospective Cohort Study
2019Co-Authors: Namareq Aldardeer, Hadiel Albar, Majda Al-attas, Abdelmoneim Eldali, Mohammed Qutub, Ashraf Hassanien, Basem AlraddadiAbstract:Abstract Background: Candidaemia is the most common form of invasive candidiasis. Resistant Candida blood stream infection (BSI) is rising, with limitations on the development of broader-spectrum Antifungal agents worldwide. Our study aimed to identify the rate of Antifungal-resistant candidaemia and the distribution of these species, determine the risk factors associated with Antifungal Resistance and evaluate the association of Antifungal-resistant candidaemia with the length of intensive care unit (ICU) and hospital stay and with 30-day mortality. Methods: A retrospective cohort study was conducted at King Faisal Specialist Hospital and Research Centre, Jeddah, Saudi Arabia. Adult patients diagnosed with candidaemia from January 2006 to December 2017 were included. Results: A total of 196 BSIs were identified in 94 males (49.74%) and 95 females (50.26%). C. glabrata was the most commonly isolated Candida species, with 59 (30%), followed by C. albicans with 46 (23%). Susceptibility data were available for 122/189 patients, of whom 26/122 (21%) were resistant to one or more Antifungals. C. parapsilosis with available sensitivity data were found in 30/122 isolates, of which 10/30 (33%) were resistant to fluconazole. Risk factors significantly associated with Antifungal-resistant candidaemia included previous echinocandin exposure (odds ratio (OR) =1.38; 95% confidence interval (CI) (1.02-1.85); P= 0.006) and invasive ventilation (OR=1.3; 95% CI (1.08-1.57); P= 0.005). The median length of ICU stay was 29 days [range 12-49 days] in the Antifungal-resistant group and 18 days [range 6.7-37.5 days] in the Antifungal-sensitive group. The median length of hospital stay was 51 days [range 21-138 days] in the Antifungal-resistant group and 35 days [range 17-77 days] in the Antifungal-sensitive group. Thirty-day mortality was 15 (57.7%) and 54 (56.25%) among the Antifungal-resistant and Antifungal-sensitive groups, respectively (OR=1.01; 95% CI (0.84-1.21); P= 0.89).Conclusions: Our results indicate an increase in the rate of non-C. albicans candidaemia. The rise in C. parapsilosis Resistance to fluconazole is alarming. Further studies are required to confirm this finding
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Antifungal Resistance in Patients with Candidemia: A Retrospective Cohort Study
2019Co-Authors: Namareq Aldardeer, Hadiel Albar, Majda Al-attas, Abdelmoneim Eldali, Mohammed Qutub, Ashraf Hassanien, Basem AlraddadiAbstract:Abstract Background Candidemia is the most common form of invasive candidiasis. Resistant Candida blood stream infection (BSI) is rising with limitation in the development of broader spectrum Antifungal agents worldwide. Our study aimed to identify rate of Antifungal Resistance candidemia and distribution for species, determine risk factors associated with Antifungal Resistance and evaluate the association of Antifungal Resistance candidemia with length of Intensive Care Unit (ICU) and hospital stay and with 30-day mortality. Methods A retrospective cohort study was conducted at King Faisal Specialist Hospital and Research Centre, Jeddah, Saudi Arabia. Adult patients diagnosed with candidemia from January 2006 to December 2017 were included. Results A total of 196 BSI was identified in 94 males (49.74%) and 95 females (50.26%). C.glabrata was the most common isolated Candida 59 (30%) followed by C. albicans 46 (23%). Susceptibility data were available for 122/189 patients in which 26/122 (21%) found to have one or more Antifungal Resistance. C. parapsilosis isolates with available sensitivity data were 31/122 in which 10/31 (32%) were resistant to fluconazole. Risk factors significantly associated with Antifungal Resistance candidemia include previous echinocandin exposure (Odd Ratio (OR) =1.38; 95% Confidence Interval (CI) (1.02-1.85); P= 0.006) and invasive ventilation (OR=1.3; 95% CI (1.08-1.57); P= 0.005). Median length of ICU stay was 29 days [range12-49 days] in Antifungal Resistance group and 18 days [range 6.7-37.5 days] in Antifungal sensitive group; Median length of hospital stay was 51days [range 21-138 days] in Antifungal Resistance group and 35 days [range 17-77 days] in Antifungal sensitive group. Thirty- day mortality was 15 (57.7%) and 54 (56.25%) among Antifungal Resistance and Antifungal sensitive group, respectively (OR=1.01; 95% CI (0.84-1.21); P= 0.89). Conclusions Our results indicate an increase in the rate of non-albicans candidemia. Candida parapsilosis Resistance to fluconazole is alarming. Further studies are required to confirm this finding.
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Epidemiology and Risk Factors for Antifungal Resistance in Patients with Candidemia
Open Forum Infectious Diseases, 2017Co-Authors: Namareq Aldardeer, Hadiel Albar, Majda Al-attas, Mohammed Qutub, Basem AlraddadiAbstract:Abstract Background Candida is a common nosocomial blood pathogen associated with high mortality. Data on Antifungal Resistance from Saudi Arabia is scarce. The objective of this study is to examine epidemiology, risk factors for Antifungal Resistance, and outcome among patients with candidemia. Methods A retrospective study conducted at King Faisal Specialist Hospital and Research Center-Jeddah branch (KFSHRC-J) The study included all patients 18 years and older with positive blood culture for candida over a 5-year period (2012–2016). Results We identified 92 cases of candidemia. The mean age was 59 years SD (18). Candida galabrata was the most prominent species 33 (36%) followed by Candida parapsilosis 22 (24%), Candida albican 20 (22%), Candida tropicalis 13 (14%), Candida krusei 2 (2%), and others 2 (2%). Resistance to fluconazole was identified in 14 (15%) cases, four of them were also Resistance to voriconazole. Among cases Resistance to fluconazole, seven (50%) cases were C. parapsilosis, two (14%) of each C. galabrata, C.krusei, and C. Albicans and one (7%) was C. tropicalis. In univariate analysis, previous exposure to echanicancdin and mechanical ventilation within 3 months were associated with fluconazole Resistance candidemia (12(15%) vs 7(50%), (P = 0.007), 28(36%) vs 10(71%), (P = 0.014), respectively). Patients with fluconazole Resistance candida had a longer length of intensive care unit stay (median 26 days (IQR 6–40) days and 12 days (IQR 7–36)), respectively. Length of hospital stay was longer in patients with fluconazole Resistance compared with nonResistance (median 83 days (IQR 29–199 days) and (31 days (IQR 17–75), respectively. Thirty-day mortality of patients fluconazole Resistance compared with non-Resistance cases was not significant 43 and 55%, respectively (P = 0.28). Conclusion In our cohort, Candida galabrata is the most common species causing candidemia. Increasing fluconazole Resistance candida parapsilosis is alarming. More regional epidemiological Antifungal Resistance studies are required to confirm this finding. Disclosures All authors: No reported disclosures.
Thomas F. Patterson - One of the best experts on this subject based on the ideXlab platform.
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The Emerging Threat of Antifungal Resistance in Transplant Infectious Diseases
Current Infectious Disease Reports, 2018Co-Authors: Ilan S. Schwartz, Thomas F. PattersonAbstract:Purpose of Review The global emergence of Antifungal Resistance among Candida spp. and Aspergillus spp. will disproportionately affect transplantation recipients, who are prone to invasive fungal disease. Recent Findings Invasive candidiasis is increasingly caused by non- albicans Candida species with reduced susceptibility to first-line Antifungals. Echinocandin Resistance in Candida glabrata is increasing in some settings. Candida auris has rapidly emerged as a global concern due to multidrug Resistance and efficient nosocomial spread in healthcare settings. Azole-resistant Aspergillus fumigatus is already an important concern in some European countries and is increasingly reported elsewhere, possibly driven by agricultural use of triazole fungicides. Summary Antifungal Resistance is anticipated to expand among these and other common fungal pathogens. Culture-independent detection methods will become more important for rapid diagnosis and to guide empiric therapy. Antifungal stewardship is of critical importance to conserve our limited Antifungal armamentarium for transplantation recipients and other vulnerable patients.
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The Emerging Threat of Antifungal Resistance in Transplant Infectious Diseases.
Current infectious disease reports, 2018Co-Authors: Ilan S. Schwartz, Thomas F. PattersonAbstract:The global emergence of Antifungal Resistance among Candida spp. and Aspergillus spp. will disproportionately affect transplantation recipients, who are prone to invasive fungal disease. Invasive candidiasis is increasingly caused by non-albicans Candida species with reduced susceptibility to first-line Antifungals. Echinocandin Resistance in Candida glabrata is increasing in some settings. Candida auris has rapidly emerged as a global concern due to multidrug Resistance and efficient nosocomial spread in healthcare settings. Azole-resistant Aspergillus fumigatus is already an important concern in some European countries and is increasingly reported elsewhere, possibly driven by agricultural use of triazole fungicides. Antifungal Resistance is anticipated to expand among these and other common fungal pathogens. Culture-independent detection methods will become more important for rapid diagnosis and to guide empiric therapy. Antifungal stewardship is of critical importance to conserve our limited Antifungal armamentarium for transplantation recipients and other vulnerable patients.
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Antifungal Resistance in pathogenic fungi
Clinical infectious diseases : an official publication of the Infectious Diseases Society of America, 2002Co-Authors: Sofia Perea, Thomas F. PattersonAbstract:Pathogenic fungi are the cause of life-threatening infections in an increasing number of immunocompromised patients. The intrinsic Resistance to Antifungal therapy observed in some genera, along with the development of Resistance during treatment in others, is becoming a major problem in the management of these diseases. We reviewed the epidemiology of the most common systemic fungal infections for which Antifungal Resistance is a potential problem, the mechanisms of Antifungal Resistance, the correlation between in vitro susceptibility testing and clinical outcome, and the clinical implications of Antifungal Resistance.
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Antifungal Resistance in pathogenic fungi
Clinical Infectious Diseases, 2002Co-Authors: Sofia Perea, Thomas F. PattersonAbstract:Pathogenic fungi are the cause of life-threatening infections in an increasing number of immunocompromised patients. The intrinsic Resistance to Antifungal therapy observed in some genera, along with the development of Resistance during treatment in others, is becoming a major problem in the management of these diseases. We reviewed the epidemiology of the most common systemic fungal infections for which Antifungal Resistance is a potential problem, the mechanisms of Antifungal Resistance, the correlation between in vitro susceptibility testing and clinical outcome, and the clinical implications of Antifungal Resistance. Several factors have contributed to the increase of life-threatening systemic fungal infections in recent years. Among them is the expansion of severely ill and/or immunocompromised patient population, including HIV-infected patients, patients with cancer who have chemotherapy-induced neutropenia,and transplant recipients who are receiving immunosuppressive therapy. Other factors that have also contributed are the frequent use of more-invasive medical procedures, treatmentwith broad-spectrum antibiotics and glucocorticoids, receipt of parenteral nutrition, and receipt of peritoneal dialysis or hemodialysis [1]. The majority of nosocomial fungal infections are caused by Candida species, with Candida albicans being the most common etiological agent of fungal bloodstream infections. Together with Candida infections, Aspergillus infections, which mostly affect granulocytopenic and other immunocompromised patients, account for 90% of all nosocomial fungal infection [2]. Cryptococcus neoformans has become also a major opportunistic fungal pathogen in immunocompromised individuals, mainly HIV-infected patients and those receiving immunosuppressive treatment for cancer, organ transplantation, and other serious medical conditions [3]. Several other less common fungi, many of which are intrinsically resistant to the available Antifungal drugs, are becoming increasingly recognized as sources of deep fungal infections, such as Zygomycetes
Namareq Aldardeer - One of the best experts on this subject based on the ideXlab platform.
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Antifungal Resistance in patients with Candidaemia: a retrospective cohort study
BMC infectious diseases, 2020Co-Authors: Namareq Aldardeer, Hadiel Albar, Majda Al-attas, Abdelmoneim Eldali, Mohammed Qutub, Ashraf Hassanien, Basem AlraddadiAbstract:Candidaemia is the most common form of invasive candidiasis. Resistant Candida blood stream infection (BSI) is rising, with limitations on the development of broader-spectrum Antifungal agents worldwide. Our study aimed to identify the occurrence of Antifungal-resistant candidaemia and the distribution of these species, determine the risk factors associated with Antifungal Resistance and evaluate the association of Antifungal-resistant candidaemia with the length of intensive care unit (ICU) and hospital stay and with 30-day mortality. A retrospective cohort study was conducted at King Faisal Specialist Hospital and Research Centre, Jeddah, Saudi Arabia. Adult patients diagnosed with candidaemia from January 2006 to December 2017 were included. A total of 196 BSIs were identified in 94 males (49.74%) and 95 females (50.26%). C. glabrata was the most commonly isolated Candida species, with 59 (30%), followed by C. albicans with 46 (23%). Susceptibility data were available for 122/189 patients, of whom 26/122 (21%) were resistant to one or more Antifungals. C. parapsilosis with available sensitivity data were found in 30/122 isolates, of which 10/30 (33%) were resistant to fluconazole. Risk factors significantly associated with Antifungal-resistant candidaemia included previous echinocandin exposure (odds ratio (OR) =1.38; 95% confidence interval (CI) (1.02–1.85); P = 0.006) and invasive ventilation (OR = 1.3; 95% CI (1.08–1.57); P = 0.005). The median length of ICU stay was 29 days [range 12–49 days] in the Antifungal-resistant group and 18 days [range 6.7–37.5 days] in the Antifungal-sensitive group (P = 0.28). The median length of hospital stay was 51 days [range 21–138 days] in the Antifungal-resistant group and 35 days [range 17–77 days] in the Antifungal-sensitive group (P = 0.09). Thirty-day mortality was 15 (57.7%) and 54 (56.25%) among the Antifungal-resistant and Antifungal-sensitive groups, respectively (OR = 1.01; 95% CI (0.84–1.21); P = 0.89). Our results indicate a high frequancy of non- C. albicans candidaemia. The rise in C. parapsilosis Resistance to fluconazole is alarming. Further studies are required to confirm this finding.
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Antifungal Resistance in Patients with Candidemia: A Retrospective Cohort Study
2019Co-Authors: Namareq Aldardeer, Hadiel Albar, Majda Al-attas, Abdelmoneim Eldali, Mohammed Qutub, Ashraf Hassanien, Basem AlraddadiAbstract:Abstract Background: Candidaemia is the most common form of invasive candidiasis. Resistant Candida blood stream infection (BSI) is rising , with limitations on the development of broader-spectrum Antifungal agents worldwide. Our study aimed to identify the occurrence of Antifungal-resistant candidaemia and the distribution of these species, determine the risk factors associated with Antifungal Resistance and evaluate the association of Antifungal-resistant candidaemia with the length of intensive care unit (ICU) and hospital stay and with 30-day mortality. Methods: A retrospective cohort study was conducted at King Faisal Specialist Hospital and Research Centre, Jeddah, Saudi Arabia. Adult patients diagnosed with candidaemia from January 2006 to December 2017 were included. Results: A total of 196 BSIs were identified in 94 males (49.74%) and 95 females (50.26%). C. glabrata was the most commonly isolated Candida species, with 59 (30%) , followed by C. albicans with 46 (23%). Susceptibility data were available for 122/189 patients , of whom 26/122 (21%) were resistant to one or more Antifungals. C. parapsilosis with available sensitivity data were found in 30/122 isolates, of which 10/30 (33%) were resistant to fluconazole. Risk factors significantly associated with Antifungal-resistant candidaemia included previous echinocandin exposure ( odds ratio (OR) =1.38; 95% confidence interval (CI) (1.02-1.85); P= 0.006) and invasive ventilation (OR=1.3; 95% CI (1.08-1.57); P= 0.005). The median length of ICU stay was 29 days [range 12 -49 days] in the Antifungal-resistant group and 18 days [range 6.7-37.5 days] in the Antifungal-sensitive group (P=0.28) . The median length of hospital stay was 51 days [range 21-138 days] in the Antifungal-resistant group and 35 days [range 17-77 days] in the Antifungal-sensitive group (P=0.09). Thirty-day mortality was 15 (57.7%) and 54 (56.25%) among the Antifungal-resistant and Antifungal-sensitive groups , respectively (OR=1.01; 95% CI (0.84-1.21); P= 0.89). Conclusions: Our results indicate a high frequancy of non- C. albicans candidaemia . The rise in C. parapsilosis Resistance to fluconazole is alarming. Further studies are required to confirm this finding
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Antifungal Resistance in Patients with Candidemia: A Retrospective Cohort Study
2019Co-Authors: Namareq Aldardeer, Hadiel Albar, Majda Al-attas, Abdelmoneim Eldali, Mohammed Qutub, Ashraf Hassanien, Basem AlraddadiAbstract:Abstract Background: Candidaemia is the most common form of invasive candidiasis. Resistant Candida blood stream infection (BSI) is rising, with limitations on the development of broader-spectrum Antifungal agents worldwide. Our study aimed to identify the rate of Antifungal-resistant candidaemia and the distribution of these species, determine the risk factors associated with Antifungal Resistance and evaluate the association of Antifungal-resistant candidaemia with the length of intensive care unit (ICU) and hospital stay and with 30-day mortality. Methods: A retrospective cohort study was conducted at King Faisal Specialist Hospital and Research Centre, Jeddah, Saudi Arabia. Adult patients diagnosed with candidaemia from January 2006 to December 2017 were included. Results: A total of 196 BSIs were identified in 94 males (49.74%) and 95 females (50.26%). C. glabrata was the most commonly isolated Candida species, with 59 (30%), followed by C. albicans with 46 (23%). Susceptibility data were available for 122/189 patients, of whom 26/122 (21%) were resistant to one or more Antifungals. C. parapsilosis with available sensitivity data were found in 30/122 isolates, of which 10/30 (33%) were resistant to fluconazole. Risk factors significantly associated with Antifungal-resistant candidaemia included previous echinocandin exposure (odds ratio (OR) =1.38; 95% confidence interval (CI) (1.02-1.85); P= 0.006) and invasive ventilation (OR=1.3; 95% CI (1.08-1.57); P= 0.005). The median length of ICU stay was 29 days [range 12-49 days] in the Antifungal-resistant group and 18 days [range 6.7-37.5 days] in the Antifungal-sensitive group. The median length of hospital stay was 51 days [range 21-138 days] in the Antifungal-resistant group and 35 days [range 17-77 days] in the Antifungal-sensitive group. Thirty-day mortality was 15 (57.7%) and 54 (56.25%) among the Antifungal-resistant and Antifungal-sensitive groups, respectively (OR=1.01; 95% CI (0.84-1.21); P= 0.89).Conclusions: Our results indicate an increase in the rate of non-C. albicans candidaemia. The rise in C. parapsilosis Resistance to fluconazole is alarming. Further studies are required to confirm this finding
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Antifungal Resistance in Patients with Candidemia: A Retrospective Cohort Study
2019Co-Authors: Namareq Aldardeer, Hadiel Albar, Majda Al-attas, Abdelmoneim Eldali, Mohammed Qutub, Ashraf Hassanien, Basem AlraddadiAbstract:Abstract Background Candidemia is the most common form of invasive candidiasis. Resistant Candida blood stream infection (BSI) is rising with limitation in the development of broader spectrum Antifungal agents worldwide. Our study aimed to identify rate of Antifungal Resistance candidemia and distribution for species, determine risk factors associated with Antifungal Resistance and evaluate the association of Antifungal Resistance candidemia with length of Intensive Care Unit (ICU) and hospital stay and with 30-day mortality. Methods A retrospective cohort study was conducted at King Faisal Specialist Hospital and Research Centre, Jeddah, Saudi Arabia. Adult patients diagnosed with candidemia from January 2006 to December 2017 were included. Results A total of 196 BSI was identified in 94 males (49.74%) and 95 females (50.26%). C.glabrata was the most common isolated Candida 59 (30%) followed by C. albicans 46 (23%). Susceptibility data were available for 122/189 patients in which 26/122 (21%) found to have one or more Antifungal Resistance. C. parapsilosis isolates with available sensitivity data were 31/122 in which 10/31 (32%) were resistant to fluconazole. Risk factors significantly associated with Antifungal Resistance candidemia include previous echinocandin exposure (Odd Ratio (OR) =1.38; 95% Confidence Interval (CI) (1.02-1.85); P= 0.006) and invasive ventilation (OR=1.3; 95% CI (1.08-1.57); P= 0.005). Median length of ICU stay was 29 days [range12-49 days] in Antifungal Resistance group and 18 days [range 6.7-37.5 days] in Antifungal sensitive group; Median length of hospital stay was 51days [range 21-138 days] in Antifungal Resistance group and 35 days [range 17-77 days] in Antifungal sensitive group. Thirty- day mortality was 15 (57.7%) and 54 (56.25%) among Antifungal Resistance and Antifungal sensitive group, respectively (OR=1.01; 95% CI (0.84-1.21); P= 0.89). Conclusions Our results indicate an increase in the rate of non-albicans candidemia. Candida parapsilosis Resistance to fluconazole is alarming. Further studies are required to confirm this finding.
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Epidemiology and Risk Factors for Antifungal Resistance in Patients with Candidemia
Open Forum Infectious Diseases, 2017Co-Authors: Namareq Aldardeer, Hadiel Albar, Majda Al-attas, Mohammed Qutub, Basem AlraddadiAbstract:Abstract Background Candida is a common nosocomial blood pathogen associated with high mortality. Data on Antifungal Resistance from Saudi Arabia is scarce. The objective of this study is to examine epidemiology, risk factors for Antifungal Resistance, and outcome among patients with candidemia. Methods A retrospective study conducted at King Faisal Specialist Hospital and Research Center-Jeddah branch (KFSHRC-J) The study included all patients 18 years and older with positive blood culture for candida over a 5-year period (2012–2016). Results We identified 92 cases of candidemia. The mean age was 59 years SD (18). Candida galabrata was the most prominent species 33 (36%) followed by Candida parapsilosis 22 (24%), Candida albican 20 (22%), Candida tropicalis 13 (14%), Candida krusei 2 (2%), and others 2 (2%). Resistance to fluconazole was identified in 14 (15%) cases, four of them were also Resistance to voriconazole. Among cases Resistance to fluconazole, seven (50%) cases were C. parapsilosis, two (14%) of each C. galabrata, C.krusei, and C. Albicans and one (7%) was C. tropicalis. In univariate analysis, previous exposure to echanicancdin and mechanical ventilation within 3 months were associated with fluconazole Resistance candidemia (12(15%) vs 7(50%), (P = 0.007), 28(36%) vs 10(71%), (P = 0.014), respectively). Patients with fluconazole Resistance candida had a longer length of intensive care unit stay (median 26 days (IQR 6–40) days and 12 days (IQR 7–36)), respectively. Length of hospital stay was longer in patients with fluconazole Resistance compared with nonResistance (median 83 days (IQR 29–199 days) and (31 days (IQR 17–75), respectively. Thirty-day mortality of patients fluconazole Resistance compared with non-Resistance cases was not significant 43 and 55%, respectively (P = 0.28). Conclusion In our cohort, Candida galabrata is the most common species causing candidemia. Increasing fluconazole Resistance candida parapsilosis is alarming. More regional epidemiological Antifungal Resistance studies are required to confirm this finding. Disclosures All authors: No reported disclosures.
Jesús Guinea - One of the best experts on this subject based on the ideXlab platform.
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MSH2 Gene Point Mutations Are Not Antifungal Resistance Markers in Candida glabrata.
Antimicrobial agents and chemotherapy, 2018Co-Authors: María Ángeles Bordallo-cardona, Caroline Agnelli, Ana Gómez-nuñez, Carlos Sánchez-carrillo, Emilio Bouza, Patricia Muñoz, Pilar Escribano, Jesús GuineaAbstract:The high rates of Antifungal Resistance in Candida glabrata may be facilitated by the presence of alterations in the MSH2 gene. We aimed to study the sequence of the MSH2 gene in 124 invasive C. glabrata isolates causing incident episodes of candidemia (n = 81), subsequent candidemia episodes (n = 9), endocarditis (n = 2), and in vitro-generated echinocandin-resistant isolates (n = 32) and assessed its relationship with genotypes, acquisition of Antifungal Resistance in vivo and in vitro, and patient prognosis. The MSH2 gene was sequenced, and isolates were genotyped using six microsatellite markers and multilocus sequence typing (MLST) based on six housekeeping genes. According to EUCAST, isolates causing candidemia (n = 90) were echinocandin susceptible, and four of them were fluconazole resistant (MIC ≥64 mg/liter). One isolate obtained from a heart valve was resistant to micafungin and anidulafungin (MICs, 2 mg/liter and 1 mg/liter, respectively). MSH2 gene mutations were present in 44.4% of the incident isolates, the most common being V239L. The presence of MSH2 mutations was not correlated with in vitro or in vivo Antifungal Resistance. Microsatellite and MLST revealed 27 genotypes and 17 sequence types, respectively. Fluconazole-resistant isolates were unrelated. Most MSH2 mutations were found in cluster isolates; conversely, some mutations were found in more than one genotype. No clinical differences, including previous Antifungal use, were found between patients infected by wild-type MSH2 gene isolates and isolates with any point mutation. The presence of MSH2 gene mutations in C. glabrata isolates causing candidemia is not correlated with specific genotypes, the promotion of Antifungal Resistance, or the clinical outcome.
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Antifungal Resistance to fluconazole and echinocandins is not emerging in yeast isolates causing fungemia in a spanish tertiary care center
Antimicrobial Agents and Chemotherapy, 2014Co-Authors: Laura Judith Marcoszambrano, Emilio Bouza, Patricia Muñoz, Pilar Escribano, Carlos Sanchez, Jesús GuineaAbstract:Accurate knowledge of fungemia epidemiology requires identification of strains to the molecular level. Various studies have shown that the rate of Resistance to fluconazole ranges from 2.5% to 9% in Candida spp. isolated from blood samples. However, trends in Antifungal Resistance have received little attention and have been studied only using CLSI M27-A3 methodology. We assessed the fungemia epidemiology in a large tertiary care institution in Madrid, Spain, by identifying isolates to the molecular level and performing Antifungal susceptibility testing according to the updated breakpoints of European Committee for Antimicrobial Susceptibility Testing (EUCAST) definitive document (EDef) 7.2. We studied 613 isolates causing 598 episodes of fungemia in 544 patients admitted to our hospital (January 2007 to December 2013). Strains were identified after amplification and sequencing of the ITS1-5.8S-ITS2 region and further tested for in vitro susceptibility to amphotericin B, fluconazole, posaconazole, voriconazole, micafungin, and anidulafungin. Resistance was defined using EUCAST species-specific breakpoints, and epidemiological cutoff values (ECOFFs) were applied as tentative breakpoints. Most episodes were caused by Candida albicans (46%), Candida parapsilosis (28.7%), Candida glabrata (9.8%), and Candida tropicalis (8%). Molecular identification enabled us to better detect cryptic species of Candida guilliermondii and C. parapsilosis complexes and episodes of polyfungal fungemia. The overall percentage of fluconazole-resistant isolates was 5%, although it was higher in C. glabrata (8.6%) and non-Candida yeast isolates (47.4%). The rate of Resistance to echinocandins was 4.4% and was mainly due to the presence of intrinsically resistant non-Candida species. Resistance mainly affected non-Candida yeasts. The rate of Resistance to fluconazole and echinocandins did not change considerably during the study period.
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Antifungal Resistance in patients with Candidaemia: a retrospective cohort study
BMC infectious diseases, 2020Co-Authors: Namareq Aldardeer, Hadiel Albar, Majda Al-attas, Abdelmoneim Eldali, Mohammed Qutub, Ashraf Hassanien, Basem AlraddadiAbstract:Candidaemia is the most common form of invasive candidiasis. Resistant Candida blood stream infection (BSI) is rising, with limitations on the development of broader-spectrum Antifungal agents worldwide. Our study aimed to identify the occurrence of Antifungal-resistant candidaemia and the distribution of these species, determine the risk factors associated with Antifungal Resistance and evaluate the association of Antifungal-resistant candidaemia with the length of intensive care unit (ICU) and hospital stay and with 30-day mortality. A retrospective cohort study was conducted at King Faisal Specialist Hospital and Research Centre, Jeddah, Saudi Arabia. Adult patients diagnosed with candidaemia from January 2006 to December 2017 were included. A total of 196 BSIs were identified in 94 males (49.74%) and 95 females (50.26%). C. glabrata was the most commonly isolated Candida species, with 59 (30%), followed by C. albicans with 46 (23%). Susceptibility data were available for 122/189 patients, of whom 26/122 (21%) were resistant to one or more Antifungals. C. parapsilosis with available sensitivity data were found in 30/122 isolates, of which 10/30 (33%) were resistant to fluconazole. Risk factors significantly associated with Antifungal-resistant candidaemia included previous echinocandin exposure (odds ratio (OR) =1.38; 95% confidence interval (CI) (1.02–1.85); P = 0.006) and invasive ventilation (OR = 1.3; 95% CI (1.08–1.57); P = 0.005). The median length of ICU stay was 29 days [range 12–49 days] in the Antifungal-resistant group and 18 days [range 6.7–37.5 days] in the Antifungal-sensitive group (P = 0.28). The median length of hospital stay was 51 days [range 21–138 days] in the Antifungal-resistant group and 35 days [range 17–77 days] in the Antifungal-sensitive group (P = 0.09). Thirty-day mortality was 15 (57.7%) and 54 (56.25%) among the Antifungal-resistant and Antifungal-sensitive groups, respectively (OR = 1.01; 95% CI (0.84–1.21); P = 0.89). Our results indicate a high frequancy of non- C. albicans candidaemia. The rise in C. parapsilosis Resistance to fluconazole is alarming. Further studies are required to confirm this finding.
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Antifungal Resistance in Patients with Candidemia: A Retrospective Cohort Study
2019Co-Authors: Namareq Aldardeer, Hadiel Albar, Majda Al-attas, Abdelmoneim Eldali, Mohammed Qutub, Ashraf Hassanien, Basem AlraddadiAbstract:Abstract Background: Candidaemia is the most common form of invasive candidiasis. Resistant Candida blood stream infection (BSI) is rising , with limitations on the development of broader-spectrum Antifungal agents worldwide. Our study aimed to identify the occurrence of Antifungal-resistant candidaemia and the distribution of these species, determine the risk factors associated with Antifungal Resistance and evaluate the association of Antifungal-resistant candidaemia with the length of intensive care unit (ICU) and hospital stay and with 30-day mortality. Methods: A retrospective cohort study was conducted at King Faisal Specialist Hospital and Research Centre, Jeddah, Saudi Arabia. Adult patients diagnosed with candidaemia from January 2006 to December 2017 were included. Results: A total of 196 BSIs were identified in 94 males (49.74%) and 95 females (50.26%). C. glabrata was the most commonly isolated Candida species, with 59 (30%) , followed by C. albicans with 46 (23%). Susceptibility data were available for 122/189 patients , of whom 26/122 (21%) were resistant to one or more Antifungals. C. parapsilosis with available sensitivity data were found in 30/122 isolates, of which 10/30 (33%) were resistant to fluconazole. Risk factors significantly associated with Antifungal-resistant candidaemia included previous echinocandin exposure ( odds ratio (OR) =1.38; 95% confidence interval (CI) (1.02-1.85); P= 0.006) and invasive ventilation (OR=1.3; 95% CI (1.08-1.57); P= 0.005). The median length of ICU stay was 29 days [range 12 -49 days] in the Antifungal-resistant group and 18 days [range 6.7-37.5 days] in the Antifungal-sensitive group (P=0.28) . The median length of hospital stay was 51 days [range 21-138 days] in the Antifungal-resistant group and 35 days [range 17-77 days] in the Antifungal-sensitive group (P=0.09). Thirty-day mortality was 15 (57.7%) and 54 (56.25%) among the Antifungal-resistant and Antifungal-sensitive groups , respectively (OR=1.01; 95% CI (0.84-1.21); P= 0.89). Conclusions: Our results indicate a high frequancy of non- C. albicans candidaemia . The rise in C. parapsilosis Resistance to fluconazole is alarming. Further studies are required to confirm this finding
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Antifungal Resistance in Patients with Candidemia: A Retrospective Cohort Study
2019Co-Authors: Namareq Aldardeer, Hadiel Albar, Majda Al-attas, Abdelmoneim Eldali, Mohammed Qutub, Ashraf Hassanien, Basem AlraddadiAbstract:Abstract Background: Candidaemia is the most common form of invasive candidiasis. Resistant Candida blood stream infection (BSI) is rising, with limitations on the development of broader-spectrum Antifungal agents worldwide. Our study aimed to identify the rate of Antifungal-resistant candidaemia and the distribution of these species, determine the risk factors associated with Antifungal Resistance and evaluate the association of Antifungal-resistant candidaemia with the length of intensive care unit (ICU) and hospital stay and with 30-day mortality. Methods: A retrospective cohort study was conducted at King Faisal Specialist Hospital and Research Centre, Jeddah, Saudi Arabia. Adult patients diagnosed with candidaemia from January 2006 to December 2017 were included. Results: A total of 196 BSIs were identified in 94 males (49.74%) and 95 females (50.26%). C. glabrata was the most commonly isolated Candida species, with 59 (30%), followed by C. albicans with 46 (23%). Susceptibility data were available for 122/189 patients, of whom 26/122 (21%) were resistant to one or more Antifungals. C. parapsilosis with available sensitivity data were found in 30/122 isolates, of which 10/30 (33%) were resistant to fluconazole. Risk factors significantly associated with Antifungal-resistant candidaemia included previous echinocandin exposure (odds ratio (OR) =1.38; 95% confidence interval (CI) (1.02-1.85); P= 0.006) and invasive ventilation (OR=1.3; 95% CI (1.08-1.57); P= 0.005). The median length of ICU stay was 29 days [range 12-49 days] in the Antifungal-resistant group and 18 days [range 6.7-37.5 days] in the Antifungal-sensitive group. The median length of hospital stay was 51 days [range 21-138 days] in the Antifungal-resistant group and 35 days [range 17-77 days] in the Antifungal-sensitive group. Thirty-day mortality was 15 (57.7%) and 54 (56.25%) among the Antifungal-resistant and Antifungal-sensitive groups, respectively (OR=1.01; 95% CI (0.84-1.21); P= 0.89).Conclusions: Our results indicate an increase in the rate of non-C. albicans candidaemia. The rise in C. parapsilosis Resistance to fluconazole is alarming. Further studies are required to confirm this finding
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Antifungal Resistance in Patients with Candidemia: A Retrospective Cohort Study
2019Co-Authors: Namareq Aldardeer, Hadiel Albar, Majda Al-attas, Abdelmoneim Eldali, Mohammed Qutub, Ashraf Hassanien, Basem AlraddadiAbstract:Abstract Background Candidemia is the most common form of invasive candidiasis. Resistant Candida blood stream infection (BSI) is rising with limitation in the development of broader spectrum Antifungal agents worldwide. Our study aimed to identify rate of Antifungal Resistance candidemia and distribution for species, determine risk factors associated with Antifungal Resistance and evaluate the association of Antifungal Resistance candidemia with length of Intensive Care Unit (ICU) and hospital stay and with 30-day mortality. Methods A retrospective cohort study was conducted at King Faisal Specialist Hospital and Research Centre, Jeddah, Saudi Arabia. Adult patients diagnosed with candidemia from January 2006 to December 2017 were included. Results A total of 196 BSI was identified in 94 males (49.74%) and 95 females (50.26%). C.glabrata was the most common isolated Candida 59 (30%) followed by C. albicans 46 (23%). Susceptibility data were available for 122/189 patients in which 26/122 (21%) found to have one or more Antifungal Resistance. C. parapsilosis isolates with available sensitivity data were 31/122 in which 10/31 (32%) were resistant to fluconazole. Risk factors significantly associated with Antifungal Resistance candidemia include previous echinocandin exposure (Odd Ratio (OR) =1.38; 95% Confidence Interval (CI) (1.02-1.85); P= 0.006) and invasive ventilation (OR=1.3; 95% CI (1.08-1.57); P= 0.005). Median length of ICU stay was 29 days [range12-49 days] in Antifungal Resistance group and 18 days [range 6.7-37.5 days] in Antifungal sensitive group; Median length of hospital stay was 51days [range 21-138 days] in Antifungal Resistance group and 35 days [range 17-77 days] in Antifungal sensitive group. Thirty- day mortality was 15 (57.7%) and 54 (56.25%) among Antifungal Resistance and Antifungal sensitive group, respectively (OR=1.01; 95% CI (0.84-1.21); P= 0.89). Conclusions Our results indicate an increase in the rate of non-albicans candidemia. Candida parapsilosis Resistance to fluconazole is alarming. Further studies are required to confirm this finding.
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Epidemiology and Risk Factors for Antifungal Resistance in Patients with Candidemia
Open Forum Infectious Diseases, 2017Co-Authors: Namareq Aldardeer, Hadiel Albar, Majda Al-attas, Mohammed Qutub, Basem AlraddadiAbstract:Abstract Background Candida is a common nosocomial blood pathogen associated with high mortality. Data on Antifungal Resistance from Saudi Arabia is scarce. The objective of this study is to examine epidemiology, risk factors for Antifungal Resistance, and outcome among patients with candidemia. Methods A retrospective study conducted at King Faisal Specialist Hospital and Research Center-Jeddah branch (KFSHRC-J) The study included all patients 18 years and older with positive blood culture for candida over a 5-year period (2012–2016). Results We identified 92 cases of candidemia. The mean age was 59 years SD (18). Candida galabrata was the most prominent species 33 (36%) followed by Candida parapsilosis 22 (24%), Candida albican 20 (22%), Candida tropicalis 13 (14%), Candida krusei 2 (2%), and others 2 (2%). Resistance to fluconazole was identified in 14 (15%) cases, four of them were also Resistance to voriconazole. Among cases Resistance to fluconazole, seven (50%) cases were C. parapsilosis, two (14%) of each C. galabrata, C.krusei, and C. Albicans and one (7%) was C. tropicalis. In univariate analysis, previous exposure to echanicancdin and mechanical ventilation within 3 months were associated with fluconazole Resistance candidemia (12(15%) vs 7(50%), (P = 0.007), 28(36%) vs 10(71%), (P = 0.014), respectively). Patients with fluconazole Resistance candida had a longer length of intensive care unit stay (median 26 days (IQR 6–40) days and 12 days (IQR 7–36)), respectively. Length of hospital stay was longer in patients with fluconazole Resistance compared with nonResistance (median 83 days (IQR 29–199 days) and (31 days (IQR 17–75), respectively. Thirty-day mortality of patients fluconazole Resistance compared with non-Resistance cases was not significant 43 and 55%, respectively (P = 0.28). Conclusion In our cohort, Candida galabrata is the most common species causing candidemia. Increasing fluconazole Resistance candida parapsilosis is alarming. More regional epidemiological Antifungal Resistance studies are required to confirm this finding. Disclosures All authors: No reported disclosures.