Time to positivity of blood cultures causing candidemia and its relation to mortality
,
Abstract
Background and Objectives: Early diagnosis of candidemia is of vital importance in reducing mortality and morbidity. The main objective of the study was to determine the TTP (Time to Positivity) of different species of Candida causing bloodstream infection and to see whether TTP can help differentiate Candida glabrata which is frequently fluconazole resistant from Fluconazole sensitive Candida.
Materials and Methods: TTP (Time to positivity) and AAT (Appropriate Antifungal therapy) were noted for Blood cultures becoming positive for Candida. Presence of Risk factors for candidemia like prolonged ICU stay, neutropenia, Total Parenteral Nutrition (TPN), use of steroids , broad spectrum antibiotics, use of Central Venous Catheter, Foleys catheter were also analyzed.
Results: The most frequent isolates were Candida parapsilosis, Candida tropicalis and Candida albicans. The median TTP for all Candida isolates in our study was 34 hours. The diagnostic sensitivity of TTP for detecting C. glabrata and C. tropicalis in patients with candidemia was 88% and 85% respectively. TTP showed that there was no difference in survival between TTP <24 hrs. and > 24hrs. Initiation of antifungal therapy <24 hours and > 24hrs after onset of candidemia had no association with survival.
Conclusion: Longer TTP maybe predictive of C. glabrata while shorter TTP may be predictive of C. tropicalis. In our study we found that fluconazole resistant Candida causing blood stream infection is quite unlikely if the TTP of the isolate is <48hrs.
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6. Butler-Laporte G, Yansouni CP, Paquette K, Lawandi A, Stabler SN, Akhter M, et al. Real-world time to positivity of 2 widely used commercial blood culture systems in patients with severe manifestations of sepsis: An analysis of the FABLED study. Open Forum Infect Dis 2020; 7: ofaa371.
7. Verma AK, Prasad KN, Singh M, Dixit AK, Ayyagari A. Candidemia in patients of a tertiary health care hospital from North India. Indian J Med Res 2003; 117: 122-128.
8. Chen L-Y, Kuo S-C, Wu H-S, Yang S-P, Chan Y-J, Chen L-K, et al. Associated clinical characteristics of patients with candidemia among different Candida species. J Microbiol Immunol Infect 2013; 46: 463-468.
9. Marra AR, Edmond MB, Forbes BA, Wenzel RP, Bearman GM. Time to blood culture positivity as a predictor of clinical outcome of Staphylococcus aureus bloodstream infection. J Clin Microbiol 2006; 44: 1342-1346.
10. Martínez JA, Soto S, Fabrega A, Almela M, Mensa J, Soriano A, et al. Relationship of phylogenetic background, biofilm production, and time to detection of growth in blood culture vials with clinical variables and prognosis associated with Escherichia coli bacteremia. J Clin Microbiol 2006; 44: 1468-1474.
11. Peralta G, Rodríguez-Lera MJ, Garrido JC, Ansorena L, Roiz MP. Time to positivity in blood cultures of adults with Streptococcus pneumoniae bacteremia. BMC Infect Dis 2006; 6: 79.
12. Kim S-H, Yoon YK, Kim MJ, Sohn JW. Clinical impact of time to positivity for Candida species on mortality in patients with Candidaemia. J Antimicrob Chemother 2013; 68: 2890-2897.
13. Caggiano G, Coretti C, Bartolomeo N, Lovero G, De Giglio O, Montagna MT. Candida bloodstream infections in Italy: Changing epidemiology during 16 years of surveillance. Biomed Res Int 2015; 2015: 256580.
14. Lee J-S, Shin J-H, Lee K, Kim M-N, Shin B-M, Uh Y, et al. Species distribution and susceptibility to azole antifungals of Candida blood stream isolates from eight university hospital in Korea. Yonsei Med J 2007; 48: 779-786.
15. Chander J, Singla N, Sidhu SK, Gombar S. Epidemiology of Candida blood stream infections: experience of a tertiary care centre in North India. J Infect Dev Ctries 2013; 7: 670-675.
16. Chakrabarti A, Sood P, Rudramurthy SM, Chen S, Kaur H, Capoor M, et al. Incidence, characteristics and outcome of ICU-acquired candidemia in India. Intensive Care Med 2015; 41: 285-295.
17. Diekema DJ, Messer SA, Brueggemann AB, Coffman SL, Doern GV, Herwaldt LA, et al. Epidemiology of candidemia: 3-Year results from the emerging infections and the epidemiology of Iowa organisms study. J Clin Microbiol 2002; 40: 1298-1302.
18. Chang MR, Correia FP, Costa LC, Xavier PC, Palhares DB, Taira DL, et al. Candida bloodstream infection: data from a teaching hospital in matogrosso do sul, Brazil. Rev Inst Med Trop Sao Paulo 2008; 50: 265-268.
19. Lai C-C, Wang C-Y, Liu W-L, Huang Y-T, Hsueh P-R. Time to positivity of blood cultures of different Candida species causing fungaemia. J Med Microbiol 2012; 61: 701-704.
20. Ben-Ami R, Weinberger M, Orni-Wasserlauff R, Schwartz D, Itzhaki A, Lazarovitch T, et al. Time to blood culture positivity as a marker for catheter related candidemia. J Clin Microbiol 2008; 46: 2222-2226.
21. Park SH, Shim H, Yoon NS, Kim MN. Clinical relevance of time-to-positivity in BACTEC 9240 blood culture system. Korean J Lab Med 2010; 30: 276-283.
22. Butta H, Sardana R, Mendiratta L, Sibal A, Gupta V, Chawla R, et al. Time to detection of yeast isolates in pediatric and adult patients with fungemia and its relevance to clinical profile and outcome. Indian J Crit Care Med 2019; 23: 27-30.
23. Kaur H, Singh S, Rudramurthy SM, Ghosh AK, Jayashree M, Narayana Y, et al. Candidaemia in a tertiary care centre of developing country: Monitoring possible change in spectrum of agents and antifungal susceptibility. Indian J Med Microbiol 2020; 38: 110-116.
24. Nunes CZ, Marra AR, Edmond MB, da Silva Victor E, Pereira CA. Time to blood culture positivity as a predictor of clinical outcome in patients with Candida albicans bloodstream infection. BMC Infect Dis 2013; 13: 486.
25. Hirano R, Sakamoto Y, Kudo K, Ohnishi M. Retrospective analysis of mortality and Candida isolates of 75 patients with candidemia: a single hospital experience. Infect Drug Resist 2015; 8: 199-205.
26. Lotfali E, Kordbacheh P, Mirhendi H, Zaini F, Ghajari A, Mohammadi R, et al. Antifungal susceptibility analysis of clinical isolates of Candida parapsilosis in Iran. Iran J Public Health 2016; 45: 322-328.
27. Alexander BD, Johnson MD, Pfeiffer CD, Jiménez-Ortigosa C, Catania J, Booker R, et al. Increasing echinocandin resistance in Candida glabrata: clinical failure correlates with presence of FKS mutations and elevated minimum inhibitory concentrations. Clin Infect Dis 2013; 56: 1724-1732.
28. Coste AT, Kritikos A, Li J, Khanna N, Goldenberger D, Garzoni C, et al. Emerging echinocandin-resistant Candida albicans and glabrata in Switzerland. Infection 2020; 48: 761-766.
29. Khan Z, Ahmad S, Mokaddas E, Meis JF, Joseph L, Abdullah A, et al. Development of echinocandin resistance in Candida tropicalis following short-term exposure to caspofungin for empiric therapy. Antimicrob Agents Chemother 2018; 62(4): e01926-17.
2. Meyer E, Geffers C, Gastmeier P, Schwab F. No increase in primary nosocomial candidemia in 682 German intensive care units during 2006 to 2011. Euro Surveill 2013; 18: 20505.
3. González de Molina FJ, León C, Ruiz-Santana S, Saavedra P; CAVA I Study Group. Assessment of candidemia-attributable mortality in critically ill patients using propensity score matching analysis. Crit Care 2012; 16: R105.
4. Charles PE, Doise JM, Quenot JP, Aube H, Dalle F, Chavanet P, et al. Candidemia in critically ill patients: difference of outcome between medical and surgical patients. Intensive Care Med 2003; 29: 2162-2169.
5. Pappas PG, Kauffman CA, Andes D, Benjamin DK Jr, Calandra TF, Edwards JE Jr, et al. Clinical practice guidelines for the management of Candidiasis: 2009 update by the infectious diseases society of America. Clin Infect Dis 2009; 48: 503-535.
6. Butler-Laporte G, Yansouni CP, Paquette K, Lawandi A, Stabler SN, Akhter M, et al. Real-world time to positivity of 2 widely used commercial blood culture systems in patients with severe manifestations of sepsis: An analysis of the FABLED study. Open Forum Infect Dis 2020; 7: ofaa371.
7. Verma AK, Prasad KN, Singh M, Dixit AK, Ayyagari A. Candidemia in patients of a tertiary health care hospital from North India. Indian J Med Res 2003; 117: 122-128.
8. Chen L-Y, Kuo S-C, Wu H-S, Yang S-P, Chan Y-J, Chen L-K, et al. Associated clinical characteristics of patients with candidemia among different Candida species. J Microbiol Immunol Infect 2013; 46: 463-468.
9. Marra AR, Edmond MB, Forbes BA, Wenzel RP, Bearman GM. Time to blood culture positivity as a predictor of clinical outcome of Staphylococcus aureus bloodstream infection. J Clin Microbiol 2006; 44: 1342-1346.
10. Martínez JA, Soto S, Fabrega A, Almela M, Mensa J, Soriano A, et al. Relationship of phylogenetic background, biofilm production, and time to detection of growth in blood culture vials with clinical variables and prognosis associated with Escherichia coli bacteremia. J Clin Microbiol 2006; 44: 1468-1474.
11. Peralta G, Rodríguez-Lera MJ, Garrido JC, Ansorena L, Roiz MP. Time to positivity in blood cultures of adults with Streptococcus pneumoniae bacteremia. BMC Infect Dis 2006; 6: 79.
12. Kim S-H, Yoon YK, Kim MJ, Sohn JW. Clinical impact of time to positivity for Candida species on mortality in patients with Candidaemia. J Antimicrob Chemother 2013; 68: 2890-2897.
13. Caggiano G, Coretti C, Bartolomeo N, Lovero G, De Giglio O, Montagna MT. Candida bloodstream infections in Italy: Changing epidemiology during 16 years of surveillance. Biomed Res Int 2015; 2015: 256580.
14. Lee J-S, Shin J-H, Lee K, Kim M-N, Shin B-M, Uh Y, et al. Species distribution and susceptibility to azole antifungals of Candida blood stream isolates from eight university hospital in Korea. Yonsei Med J 2007; 48: 779-786.
15. Chander J, Singla N, Sidhu SK, Gombar S. Epidemiology of Candida blood stream infections: experience of a tertiary care centre in North India. J Infect Dev Ctries 2013; 7: 670-675.
16. Chakrabarti A, Sood P, Rudramurthy SM, Chen S, Kaur H, Capoor M, et al. Incidence, characteristics and outcome of ICU-acquired candidemia in India. Intensive Care Med 2015; 41: 285-295.
17. Diekema DJ, Messer SA, Brueggemann AB, Coffman SL, Doern GV, Herwaldt LA, et al. Epidemiology of candidemia: 3-Year results from the emerging infections and the epidemiology of Iowa organisms study. J Clin Microbiol 2002; 40: 1298-1302.
18. Chang MR, Correia FP, Costa LC, Xavier PC, Palhares DB, Taira DL, et al. Candida bloodstream infection: data from a teaching hospital in matogrosso do sul, Brazil. Rev Inst Med Trop Sao Paulo 2008; 50: 265-268.
19. Lai C-C, Wang C-Y, Liu W-L, Huang Y-T, Hsueh P-R. Time to positivity of blood cultures of different Candida species causing fungaemia. J Med Microbiol 2012; 61: 701-704.
20. Ben-Ami R, Weinberger M, Orni-Wasserlauff R, Schwartz D, Itzhaki A, Lazarovitch T, et al. Time to blood culture positivity as a marker for catheter related candidemia. J Clin Microbiol 2008; 46: 2222-2226.
21. Park SH, Shim H, Yoon NS, Kim MN. Clinical relevance of time-to-positivity in BACTEC 9240 blood culture system. Korean J Lab Med 2010; 30: 276-283.
22. Butta H, Sardana R, Mendiratta L, Sibal A, Gupta V, Chawla R, et al. Time to detection of yeast isolates in pediatric and adult patients with fungemia and its relevance to clinical profile and outcome. Indian J Crit Care Med 2019; 23: 27-30.
23. Kaur H, Singh S, Rudramurthy SM, Ghosh AK, Jayashree M, Narayana Y, et al. Candidaemia in a tertiary care centre of developing country: Monitoring possible change in spectrum of agents and antifungal susceptibility. Indian J Med Microbiol 2020; 38: 110-116.
24. Nunes CZ, Marra AR, Edmond MB, da Silva Victor E, Pereira CA. Time to blood culture positivity as a predictor of clinical outcome in patients with Candida albicans bloodstream infection. BMC Infect Dis 2013; 13: 486.
25. Hirano R, Sakamoto Y, Kudo K, Ohnishi M. Retrospective analysis of mortality and Candida isolates of 75 patients with candidemia: a single hospital experience. Infect Drug Resist 2015; 8: 199-205.
26. Lotfali E, Kordbacheh P, Mirhendi H, Zaini F, Ghajari A, Mohammadi R, et al. Antifungal susceptibility analysis of clinical isolates of Candida parapsilosis in Iran. Iran J Public Health 2016; 45: 322-328.
27. Alexander BD, Johnson MD, Pfeiffer CD, Jiménez-Ortigosa C, Catania J, Booker R, et al. Increasing echinocandin resistance in Candida glabrata: clinical failure correlates with presence of FKS mutations and elevated minimum inhibitory concentrations. Clin Infect Dis 2013; 56: 1724-1732.
28. Coste AT, Kritikos A, Li J, Khanna N, Goldenberger D, Garzoni C, et al. Emerging echinocandin-resistant Candida albicans and glabrata in Switzerland. Infection 2020; 48: 761-766.
29. Khan Z, Ahmad S, Mokaddas E, Meis JF, Joseph L, Abdullah A, et al. Development of echinocandin resistance in Candida tropicalis following short-term exposure to caspofungin for empiric therapy. Antimicrob Agents Chemother 2018; 62(4): e01926-17.
| Files | ||
| Issue | Vol 16 No 2 (2024) | |
| Section | Original Article(s) | |
| DOI | https://doi.org/10.18502/ijm.v16i2.15361 | |
| Keywords | ||
| Candida; Fluconazole; Susceptibility; Resistance; Sensitivity | ||
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How to Cite
1.
Sachu A, Sunny S, Mathew P, Kumar A, David A. Time to positivity of blood cultures causing candidemia and its relation to mortality. Iran J Microbiol. 2024;16(2):263-272.
