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Invasive Candidiasis
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Invasive Candidiasis

A topical collection in Journal of Fungi (ISSN 2309-608X). This collection belongs to the section "Fungal Pathogenesis and Disease Control".

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Editor

Dr. Sofia Costa de Oliveira

E-Mail Website
Collection Editor
Division of Microbiology, Department of Pathology, Faculty of Medicine, University of Porto, Porto, Portugal
Interests: medical microbiology; infectious diseases; invasive candidiasis; septicemia; antimicrobial resistance; biomarkers; flow cytometry; microbiological diagnostic; epidemiology; public health
Special Issues, Collections and Topics in MDPI journals

Topical Collection Information

Dear Colleagues,

Invasive Candidiasis (IC) is a major threat in hospitalized patients, especially among intensive care unit patients, and covers both deep-seated and bloodstream infections (candidemia). The mortality rate associated with IC can range from 35 to 75%, and despite the efforts and the introduction of new antifungal agents, it has not decreased in the past two decades. Colonization of the skin, and mucous membranes and the alteration or disruption of natural host barriers, like wounds, surgery, and the insertion of indwelling intravascular catheters, are the main predisposing factors for Candida infections. The difficulty in achieving a diagnosis, due to the nonspecific clinical symptoms and delayed laboratory detection methods, alongside the subsequent delay in the initiation of adequate antifungal therapy, are also a catalyst for this trend. Although C. albicans is the yeast most frequently isolated from IC patients, non-Candida albicans strains such as C. parapsilosis and especially C. glabrata are equally challenging. In recent years, C. auris has emerged as a major pathogen that must be considered of global public health importance.

The risk of death owing to IC inherently puts significant pressure on health care services, leading to increased hospital costs and a shortage of intensive care resources.

This Topic Collection highlights the importance of new diagnostic tools and antifungal drugs in managing invasive candidiasis. Original research or review papers on host–pathogen interactions and antifungal resistance are also welcome.

Dr. Sofia Costa de Oliveira
Collection Editor

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Keywords

  • antifungal drugs
  • antifungal resistance
  • diagnostic tools
  • biofilms
  • candidemia
  • antifungal stewardship

Published Papers (7 papers)

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2024

Jump to: 2023

13 pages, 1446 KiB  
Article
Prevalence, Species Distribution and Resistance of Candidemia in Pediatric and Adult Patients in a Northeast Italy University Hospital
by Silvia Meneghello, Giulia Bernabè, Giuseppe Di Pietra, Sarah Di Sopra, Claudia Del Vecchio, Anna Maria Cattelan, Ignazio Castagliuolo and Paola Brun
J. Fungi 2024, 10(10), 707; https://doi.org/10.3390/jof10100707 - 10 Oct 2024
Viewed by 621
Abstract
Candidemia and invasive candidiasis (IC) are causes of morbidity and mortality in healthcare settings, with notable differences between children and adults. Understanding the species distribution and antimicrobial susceptibility profiles of clinical isolates can guide empiric therapy in patients at risk of IC. This [...] Read more.
Candidemia and invasive candidiasis (IC) are causes of morbidity and mortality in healthcare settings, with notable differences between children and adults. Understanding the species distribution and antimicrobial susceptibility profiles of clinical isolates can guide empiric therapy in patients at risk of IC. This study investigated the incidence and antifungal susceptibility patterns of yeasts involved in IC in pediatric and adult patients from 2019 to 2023. The average incidence of IC was 0.715 per 1000 patients, increasing over the study period; infants had the highest incidence rates. Over half of the IC episodes occurred in intensive care units (ICUs). Non-albicans Candida (NAC) species represented the most frequently isolated species in adults and children (55.96% and 50.0%, respectively), with the prevalence of C. parapsilosis (26.45% and 14.7%, respectively), N. glabratus (14.97% and 8.82%, respectively) and C. tropicalis (4.36% and 2.94%, respectively). C. lusitaniae was identified in 14.7% of pediatric IC cases. In NAC species, antifungal resistance has also increased over the five years of the study: 69.12% were resistant to azoles and 7.35% were resistant to micafungin. Resistance was higher in pediatric patients. Our study highlights differences in IC characteristics between pediatric and adult populations and emphasizes the importance of targeted antifungal stewardship in ICU patients with NAC invasive infections. Full article
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10 pages, 268 KiB  
Communication
Clinical Characteristics of Candidemia Due to Candida parapsilosis with Serial Episodes: Insights from 5-Year Data Collection at a Tertiary Hospital in Korea
by Eun Jeong Won, Heungsup Sung and Mi-Na Kim
J. Fungi 2024, 10(9), 624; https://doi.org/10.3390/jof10090624 - 1 Sep 2024
Viewed by 695
Abstract
Candida parapsilosis is a common cause of non-albicans Candida species causing candidemia, particularly invasive candidiasis. This study aimed to characterize candidemia due to the C. parapsilosis complex with serial episodes, including clinical and mycological features. Methods: Blood isolates of the C. parapsilosis complex [...] Read more.
Candida parapsilosis is a common cause of non-albicans Candida species causing candidemia, particularly invasive candidiasis. This study aimed to characterize candidemia due to the C. parapsilosis complex with serial episodes, including clinical and mycological features. Methods: Blood isolates of the C. parapsilosis complex were collected from February 2019 to January 2023 at a tertiary Korean hospital. Species identification was performed using Vitek 2 or matrix-assisted laser desorption/ionization time-of-flight mass spectrometry, and antifungal susceptibility testing was performed using the Sensititre YeastOne® system. Clinical information was collected, and characteristics were analyzed according to single or serial isolates. Results: A total of 586 blood isolates of the C. parapsilosis complex were recovered from 68 candidemia patients during the study period. Of them, only the first isolate per patient was investigated. The only two isolates were resistant to fluconazole and no isolate was resistant to echinocandins, amphotericin B, or 5-FC. A single episode of candidemia occurred in 35 patients, while serial episodes occurred in 33 patients. Underlying liver diseases, use of vasopressors, ICU admission, severe sepsis, and CVC use were more frequent in patients with serial episodes. There was no significant difference in the median MIC values of antifungal agents or the use of azoles or amphotericin B between single and serial episodes. However, patients with serial episodes more frequently received echinocandin therapy. Overall, there was no significant difference in the 30-day mortality rate between patients with single and serial episodes. Conclusion: Our data indicate that several factors related to the underlying conditions of the patients are associated with C. parapsilosis candidemia with serial episodes, rather than the characteristics of Candida itself. Full article
13 pages, 1568 KiB  
Article
Insights into Candida Colonization in Intensive Care Unit Patients: A Prospective Multicenter Study
by Teresa Nascimento, João Inácio, Daniela Guerreiro, Patrícia Patrício, Luís Proença, Cristina Toscano, Priscila Diaz and Helena Barroso
J. Fungi 2024, 10(6), 378; https://doi.org/10.3390/jof10060378 - 25 May 2024
Cited by 1 | Viewed by 1251
Abstract
The skin mycobiota plays a significant role in infection risk, pathogen transmission, and personalized medicine approaches in intensive care settings. This prospective multicenter study aimed to enhance our understanding of intensive care units’ (ICUs’) Candida colonization dynamics, identify modifiable risk factors, and assess [...] Read more.
The skin mycobiota plays a significant role in infection risk, pathogen transmission, and personalized medicine approaches in intensive care settings. This prospective multicenter study aimed to enhance our understanding of intensive care units’ (ICUs’) Candida colonization dynamics, identify modifiable risk factors, and assess their impact on survival risk. Specimens were taken from 675, 203, and 110 patients at the admission (D1), 5th (D5), and 8th (D8) days of ICU stay, respectively. The patient’s demographic and clinical data were collected. Candida isolates were identified by conventional culture-based microbiology combined with molecular approaches. Overall, colonization was 184/675 (27.3%), 87/203 (42.8%), and 58/110 (52.7%) on D1, D5, and D8, respectively. Candida colonization dynamics were significantly associated with ICU type (odds ratio (OR) = 2.03, 95% CI 1.22–3.39, p = 0.007), respiratory infection (OR = 1.74, 95% CI 1.17–2.58, p = 0.006), hemodialysis (OR = 2.19, 95% CI 1.17–4.10, p = 0.014), COVID-19 (OR = 0.37, 95% CI 0.14–0.99, p = 0.048), and with a poor 3-month outcome (p = 0.008). Skin Candida spp. colonization can be an early warning tool to generate valuable insights into the epidemiology, risk factors, and survival rates of critically ill patients, and should be considered for epidemiological surveillance. Full article
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11 pages, 537 KiB  
Review
A Mini-Review of In Vitro Data for Candida Species, Including C. auris, Isolated during Clinical Trials of Three New Antifungals: Fosmanogepix, Ibrexafungerp, and Rezafungin
by Ana Espinel-Ingroff and Nathan P. Wiederhold
J. Fungi 2024, 10(5), 362; https://doi.org/10.3390/jof10050362 - 20 May 2024
Viewed by 1384
Abstract
This mini-review summarizes the clinical outcomes and antifungal susceptibility results, where available, for three new antifungals, including fosmanogepix, ibrexafungerp, and rezafungin, against Candida isolates cultured from patients in clinical trials. When reported, most of the data were generated by the Clinical and Laboratory [...] Read more.
This mini-review summarizes the clinical outcomes and antifungal susceptibility results, where available, for three new antifungals, including fosmanogepix, ibrexafungerp, and rezafungin, against Candida isolates cultured from patients in clinical trials. When reported, most of the data were generated by the Clinical and Laboratory Standards Institute (CLSI) broth microdilution method or by both the CLSI and European Committee on Antimicrobial Susceptibility Testing (EUCAST) methodologies. For fosmanogepix, we summarize the in vitro data for C. auris isolates from 9 patients and for Candida spp. cultured from 20 patients in two clinical trials. Ibrexafungerp has also been evaluated in several clinical trials. From conference proceedings, a total of 176 Candida isolates were evaluated in the FURI and CARES studies, including 18 C. auris isolates (CARES study). However, MIC data are not available for all clinical isolates. Results from the ReSTORE rezafungin phase 3 clinical study also included in vitro results against Candida spp., but no patients with C. auris infections were included. In conclusion, this mini-review summarizes insights regarding clinical outcomes and the in vitro activity of three new antifungals against Candida spp. cultured from patients in clinical trials. Full article
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22 pages, 1164 KiB  
Systematic Review
Potential Environmental Reservoirs of Candida auris: A Systematic Review
by Isabel Silva, Isabel M. Miranda and Sofia Costa-de-Oliveira
J. Fungi 2024, 10(5), 336; https://doi.org/10.3390/jof10050336 - 8 May 2024
Cited by 2 | Viewed by 3314
Abstract
Candida auris, a multidrug-resistant yeast, poses significant challenges in healthcare settings worldwide. Understanding its environmental reservoirs is crucial for effective control strategies. This systematic review aimed to review the literature regarding the natural and environmental reservoirs of C. auris. Following the PRISMA [...] Read more.
Candida auris, a multidrug-resistant yeast, poses significant challenges in healthcare settings worldwide. Understanding its environmental reservoirs is crucial for effective control strategies. This systematic review aimed to review the literature regarding the natural and environmental reservoirs of C. auris. Following the PRISMA guidelines, published studies until October 2023 were searched in three databases: PubMed, Web of Science, and Scopus. Information regarding the origin, sampling procedure, methods for laboratory identification, and antifungal susceptibility was collected and analyzed. Thirty-three studies published between 2016 and 2023 in 15 countries were included and analyzed. C. auris was detected in various environments, including wastewater treatment plants, hospital patient care surfaces, and natural environments such as salt marshes, sand, seawater, estuaries, apples, and dogs. Detection methods varied, with molecular techniques often used alongside culture. Susceptibility profiles revealed resistance patterns. Phylogenetic studies highlight the potential of environmental strains to influence clinical infections. Despite methodological heterogeneity, this review provides valuable information for future research and highlights the need for standardized sampling and detection protocols to mitigate C. auris transmission. Full article
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2023

Jump to: 2024

16 pages, 1103 KiB  
Article
Virulence Traits and Azole Resistance in Korean Candida auris Isolates
by Seung A. Byun, Yong Jun Kwon, Ga Yeong Lee, Min Ji Choi, Seok Hoon Jeong, Dokyun Kim, Min Hyuk Choi, Seung-Jung Kee, Soo Hyun Kim, Myung Geun Shin, Eun Jeong Won and Jong Hee Shin
J. Fungi 2023, 9(10), 979; https://doi.org/10.3390/jof9100979 - 28 Sep 2023
Cited by 1 | Viewed by 1646
Abstract
We analyzed the virulence traits and azole resistance mechanisms of 104 Candida auris isolates collected from 13 Korean hospitals from 1996 to 2022. Of these 104 isolates, 96 (5 blood and 91 ear isolates) belonged to clade II, and 8 (6 blood and [...] Read more.
We analyzed the virulence traits and azole resistance mechanisms of 104 Candida auris isolates collected from 13 Korean hospitals from 1996 to 2022. Of these 104 isolates, 96 (5 blood and 91 ear isolates) belonged to clade II, and 8 (6 blood and 2 other isolates) belonged to clade I. Fluconazole resistance (minimum inhibitory concentration ≥32 mg/L) was observed in 68.8% of clade II and 25.0% of clade I isolates. All 104 isolates were susceptible to amphotericin B and three echinocandins. In 2022, six clade I isolates indicated the first nosocomial C. auris cluster in Korea. Clade II C. auris isolates exhibited reduced thermotolerance at 42 °C, with diminished in vitro competitive growth and lower virulence in the Galleria mellonella model compared to non-clade II isolates. Of the 66 fluconazole-resistant clade II isolates, several amino acid substitutions were identified: Erg11p in 14 (21.2%), Tac1Ap in 2 (3.0%), Tac1Bp in 62 (93.9%), and Tac1Bp F214S in 33 (50.0%). Although there were a limited number of non-clade II isolates studied, our results suggest that clade II C. auris isolates from Korean hospitals might display lower virulence traits than non-clade II isolates, and their primary fluconazole resistance mechanism is linked to Tac1Bp mutations. Full article
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11 pages, 302 KiB  
Article
Prognostic Trends and Current Challenges in Candidemia: A Comparative Analysis of Two Multicenter Cohorts within the Past Decade
by Caroline Agnelli, Thaís Guimarães, Teresa Sukiennik, Paulo Roberto Passos Lima, Mauro José Salles, Giovanni Luís Breda, Flavio Queiroz-Telles, Marcello Mihailenko Chaves Magri, Ana Verena Mendes, Luís Fernando Aranha Camargo, Hugo Morales, Viviane Maria de Carvalho Hessel Dias, Flávia Rossi and Arnaldo Lopes Colombo
J. Fungi 2023, 9(4), 468; https://doi.org/10.3390/jof9040468 - 13 Apr 2023
Cited by 7 | Viewed by 2693
Abstract
Candidemia remains a major public health challenge due to its high mortality rates, especially in developing countries. Monitoring epidemiological trends may provide insights for better clinical outcomes. This study aimed to describe trends in the epidemiology, therapeutic practices, and mortality in candidemia through [...] Read more.
Candidemia remains a major public health challenge due to its high mortality rates, especially in developing countries. Monitoring epidemiological trends may provide insights for better clinical outcomes. This study aimed to describe trends in the epidemiology, therapeutic practices, and mortality in candidemia through a retrospective comparative analysis between two surveillance cohorts of all candidemic adults at eleven tertiary hospitals in Brazil, from 2010–2011 (Period I) versus 2017–2018 (Period II). A total of 616 cases were diagnosed, with 247 being from Period II. These patients were more likely to have three or more coexisting comorbidities [72 (29.1%) vs. 60 (16.3%), p < 0.001], had a prior history of in-hospital admissions more often [102 (40.3%) vs. 79 (21.4%), p = 0.001], and presented with candidemia earlier after admission, within 15 days (0–328) vs. 19 (0–188), p = 0.01. Echinocandins were more frequently prescribed [102 (41.3%) vs. 50 (13.6%), p = 0.001], but time to antifungal initiation [2 days (0–14) vs. 2 (0–13), p = 0.369] and CVC removal within 48 h [90/185 (48.6%) vs. 148/319 (46.4%), p = 0.644] remained unchanged. Additionally, many patients went untreated in both periods I and II [87 (23.6%) vs. 43 (17.4%), p = 0.07], respectively. Unfortunately, no improvements in mortality rates at 14 days [123 (33.6%) vs. 93 (37.7%), p = 0.343] or at 30 days [188 (51.4%) vs. 120 (48.6%), p = 0.511] were observed. In conclusion, mortality rates remain exceedingly high despite therapeutic advances, probably associated with an increase in patients’ complexity and suboptimal therapeutic interventions. Management strategies should be tailored to suit epidemiological changes, expedite diagnosis to reduce the number of untreated eligible patients and guarantee early antifungal initiation and source control. Full article
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