INTRODUCTIONWorldwide, Candida albicans is the most common Candida species implicated in bloodstream infections. However, the proportion of non-albicans bloodstream infections is increasing. Fluconazole resistance is known to be more common in non-albicans species, but is also reported in C. albicans. This retrospective study was performed to determine the species epidemiology of Candida bloodstream infections in Singapore hospitals, and to perform susceptibility testing to a range of antifungal drugs.

MATERIALS AND METHODSCandida spp. isolated from bloodstream infections from October 2004 to December 2006 were collected from 3 participating hospitals: a tertiary referral hospital (Singapore General Hospital), a secondary referral hospital (Changi General Hospital) and an obstetrics/paediatric hospital [KK Women's and Children's Hospital (KKWCH)]. Isolate collection was also retrospectively extended to January 2000 for KKWCH because of the limited number of cases from this hospital. Isolates were identified by a common protocol, and antifungal susceptibility testing was performed by microbroth dilution (Sensititre One, Trek Diagnostics, United Kingdom).

RESULTSThe most common isolates were C. albicans (37%), C. tropicalis (27%) and C. glabrata (16%). There were differences in species distribution between institutions, with C. parapsilosis and C. albicans predominant in KKWCH, and C. albicans and C. tropicalis predominant in the other 2 institutions. Fluconazole resistance was detected in 3.2% of all Candida spp., and 85.3% were classified as susceptible. All C. albicans and C. parapsilosis were susceptible to fluconazole and voriconazole, while susceptibility to fluconazole was much more variable for C. glabrata and C. krusei.

CONCLUSIONThis study shows that C. albicans remains the predominant Candida species isolated from bloodstream infections in the 3 participating hospitals. However, non-albicans species accounted for nearly two-thirds of all cases of candidaemia. Resistance to fluconazole was uncommon, and was generally confined to C. krusei and C. glabrata.

Antifungal Agents ; pharmacology ; Candida ; classification ; drug effects ; isolation & purification ; Candidiasis ; drug therapy ; epidemiology ; microbiology ; Cross Infection ; epidemiology ; microbiology ; Drug Resistance, Fungal ; drug effects ; Female ; Fungemia ; epidemiology ; microbiology ; Hospitals, University ; Humans ; Microbial Sensitivity Tests ; Retrospective Studies ; Singapore ; epidemiology

OBJECTIVETo explore the relationship between the prevalence of Candida albicans and early childhood caries(ECC) among 3-5 years old children of Uygur and Han nationalities in Kashi city, Xinjiang province.

METHODSTotally 397 generally healthy children(Uyghurs 256, Hans141) aged 3-5 years were recruited randomly in Kashi city using the stratified cluster random method. Dental plaque samples were collected from carious tooth tissues of children with ECC and from supragingival tooth sites of caries free(CF) children, respectively. Plaque samples were cultured and Candida albicans were isolated selectively by using CHROM agar candida medium. The isolates were further identified using methods of germ tubes test, Gram stain and PCR molecular biology. The data were analyzed using Pearson χ(2) test and Spearman analysis.

RESULTSThe prevalenses of Candida albicans were 44.5% (114/256) in Han children and 31.2%(44/141) in Urgur children, respectively(P=0.009). Candida albicans could be isolated from 48.8% (124/254) of ECC children, while 23.8% (34/143) of CF ones(P=0.000). The frequencies of Candida albicans acquisition of boys and girls of Uygur children were 51.2%(66/129) and 37.8%(48/127), respectively (P=0.031). The frequencies of Candida albicans acquisition increased with the decayed missing filled tooth (dmft) scores. For both Uygur and Hanchildren, the detection rates of Candida albicans were correlated with dmft scores(Uygur r=0.350, P=0.001; Han r=0.276, P=0.000).

CONCLUSIONSThe oral Candida albicans distributions were different in Uygur and Han ethnic groups. There were significant correlations between the presence of Candida albicans and ECC severityas well as score of dmft. There was a difference of the Candida albicans distributions between boys and girls among Uygur children. Candida albicans might be one of the important cariogenic microorganisms in ECC.

Candida albicans ; isolation & purification ; Candidiasis ; epidemiology ; Child, Preschool ; China ; epidemiology ; Dental Care ; Dental Caries ; epidemiology ; microbiology ; Dental Plaque ; epidemiology ; microbiology ; Ethnic Groups ; statistics & numerical data ; Female ; Humans ; Male ; Prevalence

OBJECTIVETo establish a rapid, sensitive and specific method based on multiplex fluorescent quantitative PCR for detection of deep infections with Candida albicans and Aspergillus flavus in patients with systemic lupus erythematosus (SLE).

METHODSTwo pairs of primers and Taqman probes were designed according to the gene sequences of Candida albicans and Aspergillus flavus available in American Type Culture Collection. The positivity rate, sensitivity and specificity of the multiplex fluorescent quantitative PCR-based method for detecting the fungal infection was tested in 20 specimens from SLE patients with Candida albicans and Aspergillus flavus infections, 20 specimens from SLE patients with suspected deep fungal infections, and 20 microbial samples other than Candida albicans or Aspergillus flavus.

RESULTSThe multiple fluorescence quantitative PCR-based method showed a positivity rate and specificity of both 100% for detecting Candida albicans and Aspergillus flavus infections in the SLE patients. This method resulted in a detection sensitivity of 75%, significantly higher than that of fugal culture method (40%, P<0.05).

CONCLUSIONSThe multiplex fluorescent real-time PCR-based method allows rapid, quantitative and simultaneous detection of deep Candida albicans and Aspergillus flavus infections with high sensitivity and specificity in SLE patients.

Adult ; Aspergillosis ; complications ; diagnosis ; microbiology ; Aspergillus ; genetics ; isolation & purification ; Candida albicans ; genetics ; isolation & purification ; Candidiasis ; complications ; diagnosis ; microbiology ; China ; epidemiology ; Female ; Fluorescence ; Humans ; Lupus Erythematosus, Systemic ; complications ; microbiology ; Male ; Mycoses ; complications ; diagnosis ; epidemiology ; Polymerase Chain Reaction ; methods ; Sensitivity and Specificity

BACKGROUND: At present, the clinical breakpoints (CBPs) of both fluconazole and voriconazole are available only for 3 common Candida species in the Clinical and Laboratory Standards Institute (CLSI) and the European Committee on Antimicrobial Susceptibility Testing (EUCAST) methods. Epidemiological cutoff values (ECVs) were recently applied to both methods to detect the emergence of acquired resistance (i.e., non-wild-type isolates) among 5 common Candida species. METHODS: We performed a nationwide study to determine the fluconazole and voriconazole susceptibility of Candida bloodstream isolates (BSIs) using both the CLSI and EUCAST methods. A total of 423 BSIs of 5 Candida species were collected from 8 hospitals. The azole susceptibilities were assessed on the basis of the species-specific CBPs and ECVs. RESULTS: Of the 341 BSIs of 3 common Candida species (i.e., C. albicans, C. tropicalis, and C. parapsilosis), 0.3% and 0.9%, 0.0% and 1.5% of isolates were categorized as fluconazole and voriconazole resistant according to the CLSI and EUCAST CBPs, respectively. Of 423 total BSIs, 1.4% and 2.6% had fluconazole minimum inhibitory concentrations (MICs) exceeding the ECVs according to the CLSI and EUCAST, respectively; 1.0% and 2.1% had voriconazole MICs exceeding the ECVs according to the CLSI and EUCAST, respectively. Categorical agreement between the methods using ECVs was 98.3% for fluconazole and 98.3% for voriconazole. CONCLUSIONS: The EUCAST and CLSI methods using ECVs provide highly concordant results. Moreover, non-wild-type isolates with possibly acquired azole resistance were rare among the BSIs of 5 common Candida species in Korea.
Antifungal Agents/*pharmacology ; Candida/*drug effects/isolation & purification ; Candidiasis/epidemiology/microbiology ; Drug Resistance, Fungal/drug effects ; Fluconazole/*pharmacology ; Humans ; Microbial Sensitivity Tests ; Pyrimidines/*pharmacology ; Republic of Korea ; Triazoles/*pharmacology

BACKGROUND: At present, the clinical breakpoints (CBPs) of both fluconazole and voriconazole are available only for 3 common Candida species in the Clinical and Laboratory Standards Institute (CLSI) and the European Committee on Antimicrobial Susceptibility Testing (EUCAST) methods. Epidemiological cutoff values (ECVs) were recently applied to both methods to detect the emergence of acquired resistance (i.e., non-wild-type isolates) among 5 common Candida species. METHODS: We performed a nationwide study to determine the fluconazole and voriconazole susceptibility of Candida bloodstream isolates (BSIs) using both the CLSI and EUCAST methods. A total of 423 BSIs of 5 Candida species were collected from 8 hospitals. The azole susceptibilities were assessed on the basis of the species-specific CBPs and ECVs. RESULTS: Of the 341 BSIs of 3 common Candida species (i.e., C. albicans, C. tropicalis, and C. parapsilosis), 0.3% and 0.9%, 0.0% and 1.5% of isolates were categorized as fluconazole and voriconazole resistant according to the CLSI and EUCAST CBPs, respectively. Of 423 total BSIs, 1.4% and 2.6% had fluconazole minimum inhibitory concentrations (MICs) exceeding the ECVs according to the CLSI and EUCAST, respectively; 1.0% and 2.1% had voriconazole MICs exceeding the ECVs according to the CLSI and EUCAST, respectively. Categorical agreement between the methods using ECVs was 98.3% for fluconazole and 98.3% for voriconazole. CONCLUSIONS: The EUCAST and CLSI methods using ECVs provide highly concordant results. Moreover, non-wild-type isolates with possibly acquired azole resistance were rare among the BSIs of 5 common Candida species in Korea.
Antifungal Agents/*pharmacology ; Candida/*drug effects/isolation & purification ; Candidiasis/epidemiology/microbiology ; Drug Resistance, Fungal/drug effects ; Fluconazole/*pharmacology ; Humans ; Microbial Sensitivity Tests ; Pyrimidines/*pharmacology ; Republic of Korea ; Triazoles/*pharmacology

OBJECTIVETo study the nosocomial fungal infections in the patient with severe hepatitis and analyze of risk factor.

METHODSAll 115 severe hepatitis with fungal infections inpatients was studied prospectively.

RESULTSWe identified 115 cases with fungal infections, the mean age of patients was 37.2+/-21.5 years, male: 49 cases, female 66 cases. Infection of abdominal cavity accounted for 40.9%, infectious rate in respiratory tract and digestive tract were 26.9%, 21.8%, respectively. Candida albicans accounted for 67.6%. Use of broad-spectrum antibiotic and corticosteroids, neutropenia, severity of liver disease, improper medical manipulations as significant risk factors for fungal infection. Death rate of study group and control group was 59.1%, 34.8%, respectively (x2=36.0). In multivariate analysis, neutropenia, disseminated infection and severity of liver diseases were independent prognostic factors.

CONCLUSIONIdentification of risk factors and predictors of a poor outcome in patients with severe hepatitis with fungal infections, it suggested that implications in prophylaxis of fungal infection, early diagnosis and appropriate therapy would be important for these patients.

Adult ; Candidiasis ; diagnosis ; epidemiology ; China ; epidemiology ; Cross Infection ; complications ; epidemiology ; Female ; Hepatitis, Viral, Human ; complications ; Humans ; Male ; Middle Aged ; Multivariate Analysis ; Mycoses ; epidemiology ; microbiology ; Prospective Studies ; Risk Factors ; Severity of Illness Index

INTRODUCTIONTreatment of acute lymphoblastic leukaemia (ALL) using intensive chemotherapy has resulted in high cure rates but also substantial morbidity. Infective complications represent a significant proportion of treatment-related toxicity. The objective of this study was to describe the microbiological aetiology and clinical outcome of episodes of chemotherapy-induced febrile neutropaenia in a cohort of children treated for ALL at our institution.

MATERIALS AND METHODSPatients with ALL were treated with either the HKSGALL93 or the Malaysia-Singapore (Ma-Spore) 2003 chemotherapy protocols. The records of 197 patients who completed the intensive phase of treatment, defined as the period of treatment from induction, central nervous system (CNS)-directed therapy to reinduction from June 2000 to January 2010 were retrospectively reviewed.

RESULTSThere were a total of 587 episodes of febrile neutropaenia in 197 patients, translating to an overall rate of 2.98 episodes per patient. A causative pathogen was isolated in 22.7% of episodes. An equal proportion of Gram-positive bacteria (36.4%) and Gram-negative bacteria (36.4%) were most frequently isolated followed by viral pathogens (17.4%), fungal pathogens (8.4%) and other bacteria (1.2%). Fungal organisms accounted for a higher proportion of clinically severe episodes of febrile neutropaenia requiring admission to the high-dependency or intensive care unit (23.1%). The overall mortality rate from all episodes was 1.5%.

CONCLUSIONFebrile neutropaenia continues to be of concern in ALL patients undergoing intensive chemotherapy. The majority of episodes will not have an identifiable causative organism. Gram-positive bacteria and Gram-negative bacteria were the most common causative pathogens identified. With appropriate antimicrobial therapy and supportive management, the overall risk of mortality from febrile neutropaenia is extremely low.

Candidiasis ; epidemiology ; Chemotherapy-Induced Febrile Neutropenia ; epidemiology ; microbiology ; Child ; Cohort Studies ; Escherichia coli Infections ; epidemiology ; Gram-Negative Bacterial Infections ; epidemiology ; Gram-Positive Bacterial Infections ; epidemiology ; Humans ; Influenza, Human ; epidemiology ; Klebsiella Infections ; epidemiology ; Mycoses ; epidemiology ; Precursor Cell Lymphoblastic Leukemia-Lymphoma ; drug therapy ; Pseudomonas Infections ; epidemiology ; Retrospective Studies ; Singapore ; epidemiology ; Staphylococcal Infections ; epidemiology ; Virus Diseases ; epidemiology

OBJECTIVETo investigate the risk factors for pulmonary Candida infection in association with mechanical ventilation and analyze the drug resistance profile of the Candida species that cause the infection.

METHODSA retrospective analysis was conducted 114 patients receiving mechanical ventilation for over 48 h. According to the presence of pulmonary Candida infections, these patients were divided into infected group (n=50, 43.9%) and non-infected group (64 cases). Univariate analysis and multivariate logistic regression analysis were performed to identify the risk factors for the infection, and drug sensitivity test was carried out to evaluate the drug resistance of the Candida species.

RESULTSUnivariate analysis and multivariate logistic regression showed that the presence of at least two underlying diseases (OR=4.758, P=0.009), frequent changes of antibiotics (OR=6.128, P=0.001), and blood albumin below 25 g (OR=15.829, P=0.011) were the independent risk factors for pulmonary Candida infection associated with mechanical ventilation, and prophylactic antifungal treatment (OR=0.062, P=0.012) was a protective factor. Drug sensitivity test showed that Candida albicans was sensitive to most of the antifungal agents (100.0%), but the non-albicans Candida species were resistant to fluconazol (50.0%) and Itraconazole (38.5%).

CONCLUSIONPoor general conditions and frequent changes of antibiotics are the major risk factors for pulmonary Candida infection in patients receiving mechanical ventilation. Drug resistant analysis is helpful in the treatment of the infections.

Adult ; Aged ; Aged, 80 and over ; Candidiasis ; etiology ; China ; epidemiology ; Drug Resistance, Fungal ; Female ; Humans ; Lung Diseases, Fungal ; epidemiology ; etiology ; Male ; Middle Aged ; Pneumonia, Ventilator-Associated ; epidemiology ; microbiology ; Respiration, Artificial ; adverse effects ; Retrospective Studies ; Risk Factors ; Young Adult

OBJECTIVETo investigate the rate of candidal infection in different condition of oral epithelia, that may imply the possibility of candida in the canceration of oral leukoplakia.

METHODSSaliva culture was used to detect the infection of candida in 100 cases of healthy control group, 110 cases of oral leukoplakia and 11 cases of oral squamous cell carcinoma, whose smoking condition were collected carefully. The results were analyzed by Crosstabs, Bivariate Correlations and Binary Logistic Regression analysis.

RESULTSWith Crosstabs and Bivariate Correlations analysis, there was significant correlation within malignant level of oral leukoplakias and candidal infection rates (r = 0.148, P = 0.032). With Crosstabs single factor analysis, there was significant correlation within saliva culture results and pathological types (chi(2) = 21.757, P = 0.010). With Binary Logistic Regression analysis, there was significant correlation within saliva culture results and both of subjects, ages (OR = 0.72, P = 0.000) and duration of smoking (OR = 0.37, P = 0.01).

CONCLUSIONCandidal infection may be one of the most important factors inducing dysplasia of epithelia and malignant transformation of oral leukoplakia. So saliva culture should be taken as a rule for patients with oral leukoplakia. The follow-up of oral leukoplakia patients with candidal infection should be enhanced.

Adolescent ; Adult ; Aged ; Aged, 80 and over ; Candida albicans ; isolation & purification ; Candidiasis, Oral ; epidemiology ; pathology ; Carcinoma, Squamous Cell ; epidemiology ; microbiology ; Case-Control Studies ; Female ; Humans ; Leukoplakia, Oral ; epidemiology ; pathology ; Male ; Middle Aged ; Mouth Mucosa ; pathology ; Mouth Neoplasms ; epidemiology ; microbiology ; Saliva ; microbiology ; Smoking

To analyze the clinical characteristics of continuous ambulatory peritoneal dialysis (CAPD) associated peritonitis in the tertiary hospitals and to discuss the preventive and therapeutic strategy.
 Methods: The clinical characteristics, pathogens, resistance and outcomes of 126 CAPD associated peritonitis in 104 patients from Jan, 2013 to June, 2016, were retrospectively analyzed.
 Results: Among the patients, the incidence rates of abdominal pain, fever, diarrhea and emesis were 104 (82.54%), 56 (44.44%), 49 (38.89%), and 31 (23.60%), respectively. Among them, 88 patients suffered peritonitis once, other 16 patients suffered multiple peritonitis or recurrent peritonitis for 38 times. Among the 38 times, the numbers for recurrent, repeated or catheter-associated peritonitis were 2, 2, or 3, respectively. Peritoneal fluids from 103 cases were cultured, and 64 cases were positive in bacteria, with a rate of 62.14%. A total of 70 strains of bacteria were separated, including 42 strains of gram-positive bacteria, 21 strains of gram-negative bacteria, and 7 strains of fungus. The most common gram-positive pathogens were Staphylococcus epidermidis, Enterococcus faecalis and Staphylococcus haemolyticus, while Escherichia coli, Klebsiella pneumoniae and Klebsiella pneumoniae were the most common gram-negative bacteria. Candida albicans was the major fungal pathogens. Gram-positive cocci showed resistance to gentamycin, levofloxacin, moxifloxacin, vancomycin and linezolid, with a rate at 20.00%, 36.11%, 5%, 0%, and 0%, respectively. The gram-negative bacilli were resistent to cefoperazone/sulbactam, gentamycin, cephazolin, and ceftazidime, with a rate at 6.25%, 10.53%, 64.29%, and 15.38%, respectively. There were no imipenem, amikacin, piperacillin/tazobactam-resistant strains were found.
 Conclusion: The most common pathogen causing CAPD associated peritonitis is gram-positive bacteria. It is crucial to take the anti-infection therapy for CAPD associated peritonitis early. The positive rates for bacterial culture need to be enhanced through improvement of methods. At the same time, doctors could improve the outcome of CAPD associated peritonitis by adjusting the medication according to the drug sensitivity results.
Abdominal Pain ; epidemiology ; Anti-Bacterial Agents ; Bacteria ; Bacterial Infections ; epidemiology ; microbiology ; Candidiasis ; epidemiology ; Catheters ; adverse effects ; microbiology ; Diarrhea ; epidemiology ; Drug Resistance, Bacterial ; Enterococcus faecalis ; Escherichia coli ; Fever ; epidemiology ; Gram-Negative Bacteria ; Gram-Positive Bacteria ; Humans ; Imipenem ; Klebsiella pneumoniae ; Microbial Sensitivity Tests ; Mycoses ; epidemiology ; Penicillanic Acid ; analogs & derivatives ; Peritoneal Dialysis ; Peritoneal Dialysis, Continuous Ambulatory ; adverse effects ; Peritonitis ; complications ; epidemiology ; microbiology ; Piperacillin ; Piperacillin, Tazobactam Drug Combination ; Recurrence ; Retrospective Studies ; Staphylococcus epidermidis ; Staphylococcus haemolyticus ; Vomiting ; epidemiology