Invasive candidiasis (IC) is an emerging opportunistic fungal infection associated with high mortality among hospitalized patients. Although the epidemiology of IC is progressively changing worldwide, the trend in Afr...Invasive candidiasis (IC) is an emerging opportunistic fungal infection associated with high mortality among hospitalized patients. Although the epidemiology of IC is progressively changing worldwide, the trend in Africa still needs to be established. This review aimed to evaluate the epidemiology of IC in Western region of Africa. A comprehensive literature search was performed on major electronic databases to identify relevant articles. DerSimonian and Laird random-effects model was used to pool overall prevalence and estimated incidence data. We identified 1975 articles, among which 23 met our inclusion criteria for the systematic review. Available data showed that only 50% (8/16) of West African countries were reported data on IC and only 25% reported at least one laboratory confirmed IC case. The global prevalence of candidemia and non-candidemic deep-seated candidiasis were 0.35% [95% CI 0.23;0.47] and 0.32% [95% CI 0.00;2.03], respectively. Among clinical IC cases, only 5.21% were reported before 2010, while 50.08% were reported in the past 5 years. The pooled estimated incidence was 5.55/100,000 [95% CI 5.46;5.64] and 1.15/100,000 [95% CI 1.11;1.19, 95% CI]/inhabitants for candidemia, and Candida peritonitis, respectively. The case fatality rate was 57.58%. Low gestational age, exposure to broad-spectrum antibiotics and invasive procedures were associated with a higher risk of IC in newborn patients. Candida albicans (32.98%) was the most common causative species of IC followed by C. tropicalis (11.34%) and C. parapsilosis (6.19%). This study showed the scarcity of IC data in western region of Africa and the existence of undiagnosed IC cases.展开更多
Objective This study aimed to evaluate the epidemiological,clinical and mycological characteristics of invasive candidiasis(IC)in China.Methods A ten-year retrospective study including 183 IC episodes was conducted in...Objective This study aimed to evaluate the epidemiological,clinical and mycological characteristics of invasive candidiasis(IC)in China.Methods A ten-year retrospective study including 183 IC episodes was conducted in a tertiary hospital in Beijing,China.Results The overall incidence of IC from 2010–2019 was 0.261 episodes per 1,000 discharges.Candidemia(71.0%)was the major infective pattern;70.3%of the patients tested positive for Candida spp.colonization before IC and the median time to develop an invasive infection after colonization was13.5 days(interquartile range:4.5–37.0 days).Candida albicans(45.8%)was the most prevalent species,followed by Candida parapsilosis(19.5%),Candida glabrata(14.2%)and Candida tropicalis(13.7%).C.non-albicans IC was more common in patients with severe anemia(P=0.018),long-term hospitalization(P=0.015),hematologic malignancies(P=0.002),continuous administration of broad-spectrum antibiotics(P<0.001)and mechanical ventilation(P=0.012).In vitro resistance testing showed that11.0%of the Candida isolates were resistant/non-wild type(non-WT)to fluconazole,followed by voriconazole(9.6%),micafungin(3.8%),and caspofungin(2.9%).Fluconazole was the most commonly used drug to initiate antifungal therapy both before and after the proven diagnosis(52.6%and 54.6%,respectively).The 30-day and 90-day all-cause mortality rates were 24.5%and 32.7%,respectively.Conclusion The incidence of IC has declined in the recent five years.C.non-albicans contributed to more than half of the IC cases.Fluconazole can be used as first-line therapy if resistant strains are not prevalent.Prospective,multi-center surveillance of the clinical and mycological characteristics of IC is required.展开更多
<b><span style="font-family:Verdana;">Objective</span></b><span style="font-family:Verdana;">:</span><span style="font-family:""><span st...<b><span style="font-family:Verdana;">Objective</span></b><span style="font-family:Verdana;">:</span><span style="font-family:""><span style="font-family:Verdana;"> To evaluate the diagnostic value of (1 - 3)-</span><i><span style="font-family:Verdana;">β</span></i><span style="font-family:Verdana;">-D glucan and mannan assay for invasive candidiasis. </span><b><span style="font-family:Verdana;">Methods</span></b></span><span style="font-family:Verdana;">:</span><span style="font-family:""><span style="font-family:Verdana;"> A retrospective study was conducted on 32 cases in the disease group (18 proven invasive candidiasis and 14 probable invasive candidiasis) and 48 cases in the control group. The subjects were recruited from January 2018 to March 2019 in Clinical Laboratory of Hainan General Hospital. All subjects were detected by (1 - 3)-</span><i><span style="font-family:Verdana;">β</span></i><span style="font-family:Verdana;">-D glucan and mannan assay. </span><b><span style="font-family:Verdana;">Results</span></b></span><span style="font-family:Verdana;">:</span><span style="font-family:""><span style="font-family:Verdana;"> The mean concentration of (1 - 3)-</span><i><span style="font-family:Verdana;">β</span></i><span style="font-family:Verdana;">-D glucan in the disease group was 97.45 (43.23, 224.35) pg/ml and it was significantly higher than the mean concentration of the control group which was 49.85(41.91, 56.07) pg/ml (</span><i><span style="font-family:Verdana;">P</span></i><span style="font-family:Verdana;"> = 0.005). The mean concentration of mannan in the disease group and the control group were 161.36 (34.96, 224.49) pg/ml and 25.80 (25.00, 29.31) pg/ml, respectively, which were significantly different (</span><i><span style="font-family:Verdana;">P</span></i><span style="font-family:Verdana;"> < 0.001). The sensitivity, specificity, positive predictive value and negative predictive value of (1 - 3)-</span><i><span style="font-family:Verdana;">β</span></i><span style="font-family:Verdana;">-D glucan assay were 59.38%, 89.58%, 79.17%, 76.79%, respectively. The sensitivity, specificity, positive predictive value and negative predictive value of mannan assay were 65.63%, 95.83%, 91.30%, 80.70%, respectively. The sensitivity, specificity, positive predictive value and negative predictive value of combination of two types of assays were 81.25%, 85.42%, 78.79% and 87.23%, respectively. </span><b><span style="font-family:Verdana;">Conclusions</span></b></span><span style="font-family:Verdana;">:</span><span style="font-family:""><span style="font-family:Verdana;"> Combination of (1 - 3)-</span><i><span style="font-family:Verdana;">β</span></i><span style="font-family:Verdana;">-D glucan and mannan assay can improve diagnostic specificity and it has essential clinical diagnostic value for invasive candidiasis</span></span><span style="font-family:Verdana;">.展开更多
Invasive candidiasis was the most common nosocomial fungal infection with high morbidity and mortality, which is mainly occurring in immunodeficiency and critical patients. Echinocandins were recommended as first-line...Invasive candidiasis was the most common nosocomial fungal infection with high morbidity and mortality, which is mainly occurring in immunodeficiency and critical patients. Echinocandins were recommended as first-line drugs for the treatment and prevention of invasive candidiasis. In our study, we aimed to optimize the dosage of Rezafungin against <i><i><span style="font-family:Verdana;">Candida</span></i><span> <i><span style="font-family:Verdana;">spp.</span></i><span style="font-family:Verdana;"> </span></span></i><span style="font-family:Verdana;"> based on pharmacokinetic/pharmacodynamics (PK/PD) analysis. We collected the published data about pharmacokinetic parameters of rezafungin and the MIC distribution of <i></i></span><i><i><span style="font-family:Verdana;">Candida</span></i><span style="font-family:Verdana;"> <i>spp</i></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><i><span style="font-family:Verdana;">.</span></i></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;"> </span></span></span></i> on <span><span><span style="font-family:;" "=""><span style="font-family:Verdana;">rezafungin</span><i><span style="font-family:Verdana;">.</span></i><span style="font-family:Verdana;"> Monte Carlo simulation was used to calculate probability of target attainment and a cumulative fraction of response to assess the best dosing regimen. The optimal dosage regimen for <i></i></span><i><i><span style="font-family:Verdana;">C.</span></i><span style="font-family:Verdana;"> <i>albicans</i></span> <span style="font-family:Verdana;"></span></i></span><span style="font-family:Verdana;">and <i></i></span><i><i><span style="font-family:Verdana;">C.</span></i><span> <i><span style="font-family:Verdana;">glabrata </span></i><span style="font-family:Verdana;"></span></span></i></span></span><span style="font-family:Verdana;">was 50 mg IV, and the optimal dosage regimen for <i></i></span><i><i><span style="font-family:Verdana;">C.</span></i><span> <i><span style="font-family:Verdana;">parapsilosis</span></i><span style="font-family:Verdana;"></span></span></i><span style="font-family:Verdana;"> was 100 mg IV. Lastly, rezafungin has an excellent antifungal effect on <i></i></span><i><i><span style="font-family:Verdana;">C.</span></i><span> <i><span style="font-family:Verdana;">albicans</span></i><span style="font-family:Verdana;">, </span><i><span style="font-family:Verdana;">C.</span></i> <i><span style="font-family:Verdana;">glabrata</span></i><span style="font-family:Verdana;"></span></span></i> <span style="font-family:Verdana;">and <i></i></span><i><i><span style="font-family:Verdana;">C.</span></i><span style="font-family:Verdana;"> <i>parapsilosis.</i></span></i>展开更多
Background: Nosocomial infection remains an important contributing factor for morbidity and mortality in neonates. Coagulase-negative staphylococci have emerged as the predominant pathogens of late onset sepsis. This ...Background: Nosocomial infection remains an important contributing factor for morbidity and mortality in neonates. Coagulase-negative staphylococci have emerged as the predominant pathogens of late onset sepsis. This is followed by staphylococcus aurous, gram negative bacilli, and fungi. Old studies noted that mortality due to candidemia was higher in infants weigh less than 2000 g after being exposed to risk factors. The prophylactic use of fluconazole for the prevention of IC in extremely low birth weight was first reported in 2001. Methods: Current guidelines from Europe and North America that refer to the treatment of fungal infections are included. Literature search was performed using Medline, Scopus and Cochrane Central Register of Controlled Trials through March, 2016. Conclusion: Mortality was not different in early studies. However, recent studies concluded that mortality was reduced in the fluconazole arms. Risk-based approach towards fluconazole prophylaxis seems to be safe and effective.展开更多
Diverse pathogenic fungi can produce severe infections in immunocompromised patients, thereby justifying intensive care unit (ICU) admissions. In some cases, the infections can develop in immunocompromised patients wh...Diverse pathogenic fungi can produce severe infections in immunocompromised patients, thereby justifying intensive care unit (ICU) admissions. In some cases, the infections can develop in immunocompromised patients who were previously admitted to the ICU. Aspergillus spp., Pneumocystis jirovecii, Candida spp., and Mucorales are the fungi that are most frequently involved in these infections. Diagnosis continues to be challenging because symptoms and signs are unspecific. Herein, we provide an in-depth review about the diagnosis, with emphasis on recent advances, and treatment of these invasive fungal infections in the ICU setting.展开更多
文摘Invasive candidiasis (IC) is an emerging opportunistic fungal infection associated with high mortality among hospitalized patients. Although the epidemiology of IC is progressively changing worldwide, the trend in Africa still needs to be established. This review aimed to evaluate the epidemiology of IC in Western region of Africa. A comprehensive literature search was performed on major electronic databases to identify relevant articles. DerSimonian and Laird random-effects model was used to pool overall prevalence and estimated incidence data. We identified 1975 articles, among which 23 met our inclusion criteria for the systematic review. Available data showed that only 50% (8/16) of West African countries were reported data on IC and only 25% reported at least one laboratory confirmed IC case. The global prevalence of candidemia and non-candidemic deep-seated candidiasis were 0.35% [95% CI 0.23;0.47] and 0.32% [95% CI 0.00;2.03], respectively. Among clinical IC cases, only 5.21% were reported before 2010, while 50.08% were reported in the past 5 years. The pooled estimated incidence was 5.55/100,000 [95% CI 5.46;5.64] and 1.15/100,000 [95% CI 1.11;1.19, 95% CI]/inhabitants for candidemia, and Candida peritonitis, respectively. The case fatality rate was 57.58%. Low gestational age, exposure to broad-spectrum antibiotics and invasive procedures were associated with a higher risk of IC in newborn patients. Candida albicans (32.98%) was the most common causative species of IC followed by C. tropicalis (11.34%) and C. parapsilosis (6.19%). This study showed the scarcity of IC data in western region of Africa and the existence of undiagnosed IC cases.
基金the Major Infectious Diseases Such as AIDS and Viral Hepatitis Prevention and Control Technology Major Projects[2018ZX10712001-011]。
文摘Objective This study aimed to evaluate the epidemiological,clinical and mycological characteristics of invasive candidiasis(IC)in China.Methods A ten-year retrospective study including 183 IC episodes was conducted in a tertiary hospital in Beijing,China.Results The overall incidence of IC from 2010–2019 was 0.261 episodes per 1,000 discharges.Candidemia(71.0%)was the major infective pattern;70.3%of the patients tested positive for Candida spp.colonization before IC and the median time to develop an invasive infection after colonization was13.5 days(interquartile range:4.5–37.0 days).Candida albicans(45.8%)was the most prevalent species,followed by Candida parapsilosis(19.5%),Candida glabrata(14.2%)and Candida tropicalis(13.7%).C.non-albicans IC was more common in patients with severe anemia(P=0.018),long-term hospitalization(P=0.015),hematologic malignancies(P=0.002),continuous administration of broad-spectrum antibiotics(P<0.001)and mechanical ventilation(P=0.012).In vitro resistance testing showed that11.0%of the Candida isolates were resistant/non-wild type(non-WT)to fluconazole,followed by voriconazole(9.6%),micafungin(3.8%),and caspofungin(2.9%).Fluconazole was the most commonly used drug to initiate antifungal therapy both before and after the proven diagnosis(52.6%and 54.6%,respectively).The 30-day and 90-day all-cause mortality rates were 24.5%and 32.7%,respectively.Conclusion The incidence of IC has declined in the recent five years.C.non-albicans contributed to more than half of the IC cases.Fluconazole can be used as first-line therapy if resistant strains are not prevalent.Prospective,multi-center surveillance of the clinical and mycological characteristics of IC is required.
文摘<b><span style="font-family:Verdana;">Objective</span></b><span style="font-family:Verdana;">:</span><span style="font-family:""><span style="font-family:Verdana;"> To evaluate the diagnostic value of (1 - 3)-</span><i><span style="font-family:Verdana;">β</span></i><span style="font-family:Verdana;">-D glucan and mannan assay for invasive candidiasis. </span><b><span style="font-family:Verdana;">Methods</span></b></span><span style="font-family:Verdana;">:</span><span style="font-family:""><span style="font-family:Verdana;"> A retrospective study was conducted on 32 cases in the disease group (18 proven invasive candidiasis and 14 probable invasive candidiasis) and 48 cases in the control group. The subjects were recruited from January 2018 to March 2019 in Clinical Laboratory of Hainan General Hospital. All subjects were detected by (1 - 3)-</span><i><span style="font-family:Verdana;">β</span></i><span style="font-family:Verdana;">-D glucan and mannan assay. </span><b><span style="font-family:Verdana;">Results</span></b></span><span style="font-family:Verdana;">:</span><span style="font-family:""><span style="font-family:Verdana;"> The mean concentration of (1 - 3)-</span><i><span style="font-family:Verdana;">β</span></i><span style="font-family:Verdana;">-D glucan in the disease group was 97.45 (43.23, 224.35) pg/ml and it was significantly higher than the mean concentration of the control group which was 49.85(41.91, 56.07) pg/ml (</span><i><span style="font-family:Verdana;">P</span></i><span style="font-family:Verdana;"> = 0.005). The mean concentration of mannan in the disease group and the control group were 161.36 (34.96, 224.49) pg/ml and 25.80 (25.00, 29.31) pg/ml, respectively, which were significantly different (</span><i><span style="font-family:Verdana;">P</span></i><span style="font-family:Verdana;"> < 0.001). The sensitivity, specificity, positive predictive value and negative predictive value of (1 - 3)-</span><i><span style="font-family:Verdana;">β</span></i><span style="font-family:Verdana;">-D glucan assay were 59.38%, 89.58%, 79.17%, 76.79%, respectively. The sensitivity, specificity, positive predictive value and negative predictive value of mannan assay were 65.63%, 95.83%, 91.30%, 80.70%, respectively. The sensitivity, specificity, positive predictive value and negative predictive value of combination of two types of assays were 81.25%, 85.42%, 78.79% and 87.23%, respectively. </span><b><span style="font-family:Verdana;">Conclusions</span></b></span><span style="font-family:Verdana;">:</span><span style="font-family:""><span style="font-family:Verdana;"> Combination of (1 - 3)-</span><i><span style="font-family:Verdana;">β</span></i><span style="font-family:Verdana;">-D glucan and mannan assay can improve diagnostic specificity and it has essential clinical diagnostic value for invasive candidiasis</span></span><span style="font-family:Verdana;">.
文摘Invasive candidiasis was the most common nosocomial fungal infection with high morbidity and mortality, which is mainly occurring in immunodeficiency and critical patients. Echinocandins were recommended as first-line drugs for the treatment and prevention of invasive candidiasis. In our study, we aimed to optimize the dosage of Rezafungin against <i><i><span style="font-family:Verdana;">Candida</span></i><span> <i><span style="font-family:Verdana;">spp.</span></i><span style="font-family:Verdana;"> </span></span></i><span style="font-family:Verdana;"> based on pharmacokinetic/pharmacodynamics (PK/PD) analysis. We collected the published data about pharmacokinetic parameters of rezafungin and the MIC distribution of <i></i></span><i><i><span style="font-family:Verdana;">Candida</span></i><span style="font-family:Verdana;"> <i>spp</i></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><i><span style="font-family:Verdana;">.</span></i></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;"> </span></span></span></i> on <span><span><span style="font-family:;" "=""><span style="font-family:Verdana;">rezafungin</span><i><span style="font-family:Verdana;">.</span></i><span style="font-family:Verdana;"> Monte Carlo simulation was used to calculate probability of target attainment and a cumulative fraction of response to assess the best dosing regimen. The optimal dosage regimen for <i></i></span><i><i><span style="font-family:Verdana;">C.</span></i><span style="font-family:Verdana;"> <i>albicans</i></span> <span style="font-family:Verdana;"></span></i></span><span style="font-family:Verdana;">and <i></i></span><i><i><span style="font-family:Verdana;">C.</span></i><span> <i><span style="font-family:Verdana;">glabrata </span></i><span style="font-family:Verdana;"></span></span></i></span></span><span style="font-family:Verdana;">was 50 mg IV, and the optimal dosage regimen for <i></i></span><i><i><span style="font-family:Verdana;">C.</span></i><span> <i><span style="font-family:Verdana;">parapsilosis</span></i><span style="font-family:Verdana;"></span></span></i><span style="font-family:Verdana;"> was 100 mg IV. Lastly, rezafungin has an excellent antifungal effect on <i></i></span><i><i><span style="font-family:Verdana;">C.</span></i><span> <i><span style="font-family:Verdana;">albicans</span></i><span style="font-family:Verdana;">, </span><i><span style="font-family:Verdana;">C.</span></i> <i><span style="font-family:Verdana;">glabrata</span></i><span style="font-family:Verdana;"></span></span></i> <span style="font-family:Verdana;">and <i></i></span><i><i><span style="font-family:Verdana;">C.</span></i><span style="font-family:Verdana;"> <i>parapsilosis.</i></span></i>
文摘Background: Nosocomial infection remains an important contributing factor for morbidity and mortality in neonates. Coagulase-negative staphylococci have emerged as the predominant pathogens of late onset sepsis. This is followed by staphylococcus aurous, gram negative bacilli, and fungi. Old studies noted that mortality due to candidemia was higher in infants weigh less than 2000 g after being exposed to risk factors. The prophylactic use of fluconazole for the prevention of IC in extremely low birth weight was first reported in 2001. Methods: Current guidelines from Europe and North America that refer to the treatment of fungal infections are included. Literature search was performed using Medline, Scopus and Cochrane Central Register of Controlled Trials through March, 2016. Conclusion: Mortality was not different in early studies. However, recent studies concluded that mortality was reduced in the fluconazole arms. Risk-based approach towards fluconazole prophylaxis seems to be safe and effective.
文摘Diverse pathogenic fungi can produce severe infections in immunocompromised patients, thereby justifying intensive care unit (ICU) admissions. In some cases, the infections can develop in immunocompromised patients who were previously admitted to the ICU. Aspergillus spp., Pneumocystis jirovecii, Candida spp., and Mucorales are the fungi that are most frequently involved in these infections. Diagnosis continues to be challenging because symptoms and signs are unspecific. Herein, we provide an in-depth review about the diagnosis, with emphasis on recent advances, and treatment of these invasive fungal infections in the ICU setting.
