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Clinical Impact of Antifungal Susceptibility, Biofilm Formation and Mannoside Expression of Candida Yeasts on the Outcome of Invasive Candidiasis in ICU: An Ancillary Study on the Prospective AmarCAND2 Cohort.

ABSTRACT: Background: The link between Candida phenotypical characteristics and invasive candidiasis (IC) prognosis is still partially unknown. Methods: Candida strains isolated during the AmarCAND2 study were centrally analyzed for species identification, antifungal susceptibility, biofilm formation, and expression of surface and glycoconjugate mannosides. Correlation between these phenotypical features and patient outcome was sought using a multivariable Cox survival model. Results: Candida albicans was predominant (65.4%, n = 285), with a mortality rate significantly lower than that in patients with non-albicans strains [HR 0.67 (0.46-1.00), p = 0.048]. The rate of fluconazole-resistant strains was low (C. albicans and Candida glabrata: 3.5 and 6.2%, respectively) as well as caspofungin-resistant ones (1 and 3.1%, respectively). Early biofilm formation was less frequent among C. albicans (45.4%) than among non-albicans (81.2%). While the strains of C. albicans showed variable levels of surface mannosides expression, strains isolated from candidemia exhibited a high expression of ?-man, which was correlated with an increased mortality (p = 0.02). Conclusion: Candida albicans IC were associated with lower mortality, and with strains that exhibited less frequently early biofilm formation than non-albicans strains. A high expression of ?-man was associated with increased IC mortality. Further studies are warranted to confirm this data and to evaluate other virulence factors in yeasts.

SUBMITTER: Gangneux JP

PROVIDER: S-EPMC6297146 | biostudies-literature | 2018

REPOSITORIES: biostudies-literature

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Clinical Impact of Antifungal Susceptibility, Biofilm Formation and Mannoside Expression of Candida Yeasts on the Outcome of Invasive Candidiasis in ICU: An Ancillary Study on the Prospective AmarCAND2 Cohort.

Gangneux Jean-Pierre JP Cornet Muriel M Bailly Sébastien S Fradin Chantal C Féger Céline C Timsit Jean-François JF Leroy Olivier O Sendid Boualem B Bougnoux Marie-Elisabeth ME

Frontiers in microbiology 20181211

Background: The link between Candida phenotypical characteristics and invasive candidiasis (IC) prognosis is still partially unknown. Methods: Candida strains isolated during the AmarCAND2 study were centrally analyzed for species identification, antifungal susceptibility, biofilm formation, and expression of surface and glycoconjugate mannosides. Correlation between these phenotypical features and patient outcome was sought using a multivariable Cox survival model. < ...[more]

PMID: 30619103

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Project description:Background(1,3)-?-D-Glucan has been widely used in clinical practice for the diagnosis of invasive Candida infections. However, such serum biomarker showed potential to guide antimicrobial therapy in order to reduce the duration of empirical antifungal treatment in critically ill septic patients with suspected invasive candidiasis.MethodsThis was a single-centre, randomized, open-label clinical trial in which critically ill patients were enrolled during the admission to the intensive care unit (ICU). All septic patients who presented invasive Candida infection risk factors and for whom an empirical antifungal therapy was commenced were randomly assigned (1:1) in those stopping antifungal therapy if (1,3)-?-D-glucan was negative ((1,3)-?-D-glucan group) or those continuing the antifungal therapy based on clinical rules (control group). Serum 1,3-?-D-glucan was measured at the enrolment and every 48/72?h over 14?days afterwards. The primary endpoint was the duration of antifungal treatment in the first 30?days after enrolment.ResultsWe randomized 108 patients into the (1,3)-?-D-glucan (n?=?53) and control (n?=?55) groups. Median [IQR] duration of antifungal treatment was 2?days [1-3] in the (1,3)-?-D-glucan group vs. 10?days [6-13] in the control group (between-group absolute difference in means, 6.29?days [95% CI 3.94-8.65], p?<?0.001). Thirty-day mortality was similar (28.3% [(1,3)-?-D-glucan group] vs. 27.3% [control group], p?=?0.92) as well as the overall rate of documented candidiasis (11.3% [(1,3)-?-D-glucan group] vs. 12.7% [control group], p?=?0.94), the length of mechanical ventilation (p?=?0.97) and ICU stay (p?=?0.23).ConclusionsIn critically ill septic patients admitted to the ICU at risk of invasive candidiasis, a (1,3)-?-D-glucan-guided strategy could reduce the duration of empirical antifungal therapy. However, the safety of this algorithm needs to be confirmed in future, multicentre clinical trial with a larger population.Trial registrationClinicalTrials.gov, NCT03117439 , retrospectively registered on 18 April 2017.

Dataset Information

Clinical Impact of Antifungal Susceptibility, Biofilm Formation and Mannoside Expression of Candida Yeasts on the Outcome of Invasive Candidiasis in ICU: An Ancillary Study on the Prospective AmarCAND2 Cohort.

Publications

Clinical Impact of Antifungal Susceptibility, Biofilm Formation and Mannoside Expression of <i>Candida</i> Yeasts on the Outcome of Invasive Candidiasis in ICU: An Ancillary Study on the Prospective AmarCAND2 Cohort.

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