No abstract available.
Candidemia* ; Humans

No abstract available.
Candidemia* ; Saccharomycetales*

Candidemia is a major cause of nosocomial morbidity and mortality in neonates. Prompt diagnosis and treatment is crucial. Risk factor analyses have been conducted worldwide, but limited local data are available. This study was conducted to help pediatricians practicing locally decide when to suspect if a neonate has candidemia; therefore, helping them in the judicious use of empirical antifungal therapy. Objective: To determine if there was a difference in the risk factors among neonates with candidemia and those without it, who were admitted at the Neonatal Intensive Care Unit of the Philippine General Hospital from October 2003 to August 2006. Methods: Neonates admitted within the mentioned period, surviving at least on the third day of life, and had at least one blood culture on or after day 3 of life were included in the study. A retrospective review of records was performed to identify the presence or absence of known risk factors for candidemia. The outcome of interest was the presence of candidemia. Each variable was analyzed initially using the bivariate analysis chi-square. Cut-off value for inclusion into multivariate analysis was p<0.25. Multivariate analysis, through backward elimination, was done to narrow down independent variables (p value for retention <0.25). Results: One hundred thirty-eight neonates (69 cases and 69 controls) were included. Based on bivariate analysis, patients exhibiting the following characteristics showed increased risk for candidemia: birth weights of 1250 to 1499g (OR: 3.24; 95% CI: 1.04-10.07) and 1500 to 2449g (OR: 3.84; 95% CI 1.31-11.27); pediatric aging < 28 weeks (OR: 1.42; 95% CI: 1.07-8.5) and 28 to 32 weeks (OR: 1.89; 95% CI: 0.74-4.84); central vascular access (OR: 0.52; 95% CI: 0.26-1.03); prolonged broad-spectrum antibiotic use (OR: 2.0; 95% CI: 0.95-4.2); and increased hospital stay (OR: 0.5; 95% CI: 0.24-1.05). Intralipid use was also associated with candidemia, but was excluded due to insufficient data available. In the multivariate analysis, only patients with birth weights of 1500 to 2449g (OR: 3.65; 95% CI: 1.24-10.77) and 1250 to 1499g (OR: 3.24; 95% CI: 1.04-10.07) qualified. A clinical predictive model in diagnosing candidemia was not possible due to insufficient variables available. Conclusion: Based on the study, infants with lower birth weights (<2500 g) were at most risk for developing subsequent candida infection.
Human ; CANDIDEMIA ; SEPSIS

BACKGROUND: The frequency of bloodstream infection by Candida species has dramatically increased in recent years. Many of bloodstream infections caused by candida arise from an endogenous source of mucosal colonization, as well as exogenously from the hospital environment. We analyzed the prevalence of Candida species isolated from blood cultures, and compared it to those of all other clinical specimens, and those of the hospital environment. METHODS: Identification of Candida species was performed on isolates from blood cultures (159 strains), from cultures of clinical specimens other than bloods (1,609 strains) and from cultures of the hospital environment (30 strains). All candida isolates were recovered between January 1997 and June 1998 at Chonnam University Hospital. Candida surveillance cultures of the hands and nares of 77 medical personnel were performed using CHROMagar Candida. RESULTS: Among the Candida species isolated from the blood cultures, C. parapsilosis was the most frequently isolated (35.2%), followed by C. albicans (29.6%), C. glabrata (9.4%), and C. tropicalis (8.8%). The Candida species frequently isolated from clinical specimens other than bloods were C. albicans (52.6%), C. glabrata (19.1%), and C. tropicalis (15.3%). While C. parapsilosis was not frequently isolated from clinical specimens other than blood (3.4%), it was the most frequent Candida species isolated from the hands of medical personnel. Sixteen (20.8%) out of 77 medical personnel were found to harbor C. parapsilosis on their hands. CONCLUSION: These results suggest that it is possible that most of the Candida species causing bloodstream infections are from mucosal colonized strains, but that C. parapsilosis may be acquired from exogenous sources.
Candida* ; Candidemia ; Colon ; Hand ; Jeollanam-do ; Prevalence

BACKGROUND: CHROMagar Candida is a new differential medium that allows selective isolation and identification of clinically significant yeasts. We evaluated the use of this medium to identify Candida species directly from positive blood culture bottles. METHODS: A total of 152 positive blood culture bottles (51 Candida albicans, 29 Candida troficalis, 28 Candida parapsilosis, 26 Candida glabrata, 10 Candida krusei, 4 Candida pelliculosa. 1 Candida guilliermonidii, 3 C. albicans plus C. glabrata) were directly subcultures to CHROMagar (Hardy diagnostics. USA) and incubated for 48 h. Colony appearance on CHROMagar was assessed independently by three observers. RESULTS: CHROMagar correctly identified 95.4%, 92 1% and 91.4% of Candida app. from blood cultures by the three observers. respectively. There was 91.4% agree cent between the observers. Expected colony appearance on CHROMagar was 100% for C. albicans. 97.7% for C. tropicalis, 96.7% for C. krusei, 94 9% for C. glabrata but 88.1% for C. parapsilosis. Three mixed candidemias, not detected by conventional methods, were detected by CHROMagar. CONCLUSIONS: CHROMagar permits earlier recognition of major Cardida app. in positive blood cultures and more reliable detection of mixed candidemias.
Candida albicans ; Candida glabrata ; Candida* ; Candidemia ; Yeasts

BACKGROUND: Fluconazole and itraconazole, the azole-derivative antifungal agents, have been commonly used for the treatment of candidiasis. We studied the comparative activities of fluconazole and itraconazole against isolates of Candida species recovered from blood cultures in Chonnam National University Hospital between 1994 and 1998. METHODS: One hundred twenty-four bloodstream isolates of Candida species (32 C. albicans, 36 C. parapsilosis, 19 C. tropicalis, 12 C. glabrata, 10 C. pelliculosa, 7 C. guilliermondii, 5 C. lipolytica, and 3 others) from 124 patients were tested. Minimal inhibitory concentrations (MICs) of fluconazole (0.12~64microgram/mL) and itraconazole (0.03~16 microgram/mL) for each isolate were determined by the NCCLS broth macrodilution method. RESULTS: Fluconazole MICs were >64 microgram/mL for 4.8% (6/124) of the isolates and 16~32 microgram/mL for the 8.9% (11/124) isolates. Itraconazole MICs were >1 microgram/mL for 16% (16/124) and 0.25~0.5 microgram/mL for 21.0% (26/124) of the isolates. Candida species for which the fluconazole MICs were higher, were in general more resistant to itraconazole (P<0.05). There were species-related differences in MIC50:those for C. albicans, C. parapsilosis and C. tropicalis were lower than those for other species. MICs of fluconazole and itraconazole for each species did not change during the 5-year period, but resistance to fluconazole (>64 microgram/mL) or itraconazole (> 1 microgram/mL) was observed in 4.5% (2/44) of isolates obtained from 1994 to 1996, and increased to 17.5% (14/80) of isolates recovered in 1997 to 1998 (P<0.05). CONCLUSION: This data showed that itraconazole MICs were proportionally higher for Candida isolates with high fluconazole MICs, and Candida species with fluconazole or itraconazole resistance increased in the latter two years, although MICs of fluconazole and itraconazole for each species did not change during the 5-year span.
Antifungal Agents ; Candida* ; Candidemia ; Candidiasis ; Fluconazole ; Humans ; Itraconazole* ; Jeollanam-do

The survival rate after liver transplantation has greatly improved. However, complications such as infection and rejection remain major causes of mortality and morbidity. The fungal infections are associated with high mortality rates, despite having a relatively lower incidence, compared with bacterial and viral infections. Difficulty in establishing an early diagnosis, lack of effective therapy, difficult management of certain antifungal agent, limited data for antifungal prophylaxis presents remaining problems.3) We report our experience with one case of syatemic candidemia after orthotopic liver transplantation.
Candidemia* ; Early Diagnosis ; Incidence ; Liver Transplantation* ; Liver* ; Mortality ; Survival Rate

The survival rate after liver transplantation has greatly improved. However, complications such as infection and rejection remain major causes of mortality and morbidity. The fungal infections are associated with high mortality rates, despite having a relatively lower incidence, compared with bacterial and viral infections. Difficulty in establishing an early diagnosis, lack of effective therapy, difficult management of certain antifungal agent, limited data for antifungal prophylaxis presents remaining problems.3) We report our experience with one case of syatemic candidemia after orthotopic liver transplantation.
Candidemia* ; Early Diagnosis ; Incidence ; Liver Transplantation* ; Liver* ; Mortality ; Survival Rate

BACKGROUND: Fast identification of Candida glabrata is important, because empirical antifungal therapy for fungemia with C. glabrata and non-C. glabrata varies. We proposed an algorithm for rapid presumptive diagnosis to identify fungemia with C. glabrata using earlier or only growth from anaerobic bottles and longer time to positivity (TTP) in blood cultures. METHODS: Positivity and TTP using the BacT/Alert 3D system (bioMerieux Inc, USA) with resin bottles (FA Plus and FN Plus) were analyzed in 215 candidemia patients from June 2014 to June 2016 in a university-affiliated hospital in Korea. RESULTS: A higher proportion of earlier or only growth from anaerobic bottles was observed in C. glabrata (38.8%, 7/18) than in C. albicans (7.6%, 8/105), C. parapsilosis (10.5%, 4/138), and C. tropicalis (9.2%, 5/54) (P=0.006). The mean (±standard deviation) TTP for C. glabrata was 41.7 h (±16.3 h) compared with 26.7 h (±15.9 h) for C. albicans, 33.4 h (±8.4 h) for C. parapsilosis, and 23.1 h (±17.3 h) for C. tropicalis (P < 0.0001). We could predict fungemia with C. glabrata with a sensitivity of 94.4%, specificity of 63.9%, positive predictive value of 19.3%, and negative predictive value of 99.2% using a two-step algorithm: earlier or only growth from anaerobic bottles and TTP >31.4 h. CONCLUSION: This two-step algorithm in the BacT/Alert 3D system could be the basis for an initial empirical antifungal therapy for fungemia with C. glabrata prior to final identification.
Candida glabrata* ; Candida* ; Candidemia ; Diagnosis ; Fungemia* ; Humans ; Korea ; Sensitivity and Specificity

PURPOSE: To describe radiologic findings of burn-associated persistent candidemia of the thorax. MATERIALS AND METHODS: This study included 42 patients with major burns in whom blood culture had shown the presence for more than 24 hours of persistent candidemia. The duration of positive culture for candidiasis ranged from two to 67 days(mean, 15 days). Radiographic(n=42) and thin-section CT findings(n=13) were retrospectively analyzed. The onset, pattern, size, distribution and persistence of parenchymal abnormalities as well as the presence or absence of pleural effusions, mediastinal lymphadenopathy and cardiomegaly were assessed. RESULTS: On chest radiographs, positive findings were noticed in 61.9%(26/42) and on thin-section CT, in 76.9%(10/13). The most frequent radiographic finding was pulmonary nodule(s), observed in 14 patients(33.3%). in 13, these were bilateral. Bronchovascular bundle thickening(n=6, 14.3%), consolidation(n=4, 9.5%), cardiomegaly(n=6, 14.3%) and pleural effusion(n=4, 9.5%) were also observed. Those lesions appeared eight to 129 days(mean, 33days) after the burn. Radiographic abnormalities persisted for seven to 115 (mean, 35) days, regardless of the treatment. Thin-section CT showed parenchymal abnormalities in 10/13 patients(76.9%) and subpleural nodules of less than 1cm in diameter and without halo in all patients. Cardiomegaly, pleural effusion and mediastinal adenopathy were observed on CT in 5(38.5%), 4(30.8%) and 2(15.4%) of the 13 patients, respectively. CONCLUSION: In a high proportion of patients with burn-associated candidemia, chest radiograph and thin-section CT findings were positive. The most frequent radiographic parenchymal abnormality was multiple bilateral nodules.
Burns* ; Candidemia* ; Candidiasis ; Cardiomegaly ; Humans ; Lymphatic Diseases ; Pleural Effusion ; Radiography, Thoracic ; Retrospective Studies ; Thorax*