Enhanced Identification of Postoperative Infections among Inpatients

Monitoring antimicrobial exposure and diagnosis codes for certain procedures identifies more postoperative infections than routine surveillance methods

Candida parapsilosis Characterization in an Outbreak Setting

Candida parapsilosis is an important non-albicans species which infects hospitalized patients. No studies have correlated outbreak infections of C. parapsilosis with multiple virulence factors. We used DNA fingerprinting to determine genetic variability among isolates from a C. parapsilosis outbreak and from our clinical database. We compared phenotypic markers of pathogenesis, including adherence, biofilm formation, and protein secretion (secretory aspartic protease [SAP] and phospholipase). Adherence was measured as colony counts on silicone elastomer disks immersed in agar. Biofilms formed on disks were quantified by dry weight. SAP expression was measured by hydrolysis of bovine albumin; a colorimetric assay was used to quantitate phospholipase. DNA fingerprinting indicated that the outbreak isolates were clonal and genetically distinct from our database. Biofilm expression by the outbreak clone was greater than that of sporadic isolates (p < 0.0005). Adherence and protein secretion did not correlate with strain pathogenicity. These results suggest that biofilm production plays a role in C. parapsilosis outbreaks

Epidemiology and outcomes of invasive candidiasis due to non-albicans species of Candida in 2,496 patients: data from the Prospective Antifungal Therapy (PATH) registry 2004-2008.

This analysis describes the epidemiology and outcomes of invasive candidiasis caused by non-albicans species of Candida in patients enrolled in the Prospective Antifungal Therapy Alliance (PATH Alliance) registry from 2004 to 2008. A total of 2,496 patients with non-albicans species of Candida isolates were identified. The identified species were C. glabrata (46.4%), C. parapsilosis (24.7%), C. tropicalis (13.9%), C. krusei (5.5%), C. lusitaniae (1.6%), C. dubliniensis (1.5%) and C. guilliermondii (0.4%); 111 infections involved two or more species of Candida (4.4%). Non-albicans species accounted for more than 50% of all cases of invasive candidiasis in 15 of the 24 sites (62.5%) that contributed more than one case to the survey. Among solid organ transplant recipients, patients with non-transplant surgery, and patients with solid tumors, the most prevalent non-albicans species was C. glabrata at 63.7%, 48.0%, and 53.8%, respectively. In 1,883 patients receiving antifungal therapy on day 3, fluconazole (30.5%) and echinocandins (47.5%) were the most frequently administered monotherapies. Among the 15 reported species, 90-day survival was highest for patients infected with either C. parapsilosis (70.7%) or C. lusitaniae (74.5%) and lowest for patients infected with an unknown species (46.7%) or two or more species (53.2%). In conclusion, this study expands the current knowledge of the epidemiology and outcomes of invasive candidiasis caused by non-albicans species of Candida in North America. The variability in species distribution in these centers underscores the importance of local epidemiology in guiding the selection of antifungal therapy

Patient category and underlying conditions.

<p>*Other species include: <i>C. kefyr</i> (nine isolates), <i>C. famata</i> (four isolates), <i>C. rugosa</i> (three isolates), <i>C. utilis</i> (two isolates) and one isolate each of <i>C. fennica</i>, <i>C. fermentati</i>, <i>C. lipolytica</i>, and <i>Torulopsis</i> spp.</p>†<p>multiple species include <i>C. parapsilosis</i>+<i>C. glabrata</i> (n = 30), <i>C. tropicalis</i>+<i>C. glabrata</i> (n = 21), <i>C. krusei</i>+<i>C. glabrata</i> (n = 8), <i>C. dubliniensis</i>+<i>C. glabrata</i> (n = 3), <i>C. lusitaniae</i>+<i>C. glabrata</i> (n = 4), other <i>Candida</i> spp.+<i>C. glabrata</i> (n = 3), unknown <i>Candida</i> spp.+<i>C. glabrata</i> (n = 3), <i>C. guilliermondii</i>+<i>C. glabrata</i> (n = 2), <i>C. parapsilosis</i>+<i>C. krusei</i> (n = 5), <i>C. lusitaniae</i>+<i>C. krusei</i> (n = 2), <i>C. tropicalis</i>+<i>C. dubliniensis</i> (n = 1), <i>C. tropicalis</i>+<i>C. guilliermondii</i> (n = 1), <i>C. tropicalis</i>+<i>C. krusei</i> (n = 4), other <i>Candida</i> spp.+<i>C. guilliermondii</i> (n = 1), unknown <i>Candida</i> spp.+<i>C. dubliniensis</i> (n = 1), <i>C. glabrata</i>+<i>C. krusei</i>+<i>C. lusitaniae</i> (n = 1), <i>C. dubliniensis</i>+<i>C. glabrata</i>+<i>C. guilliermondii</i> (n = 1).</p><p>CMV = cytomegalovirus; GVHD = graft versus host disease; NICU = neonatal intensive care unit.</p

90-day survival stratified by non-<i>albicans Candida</i> species.

<p>90-day survival stratified by non-<i>albicans Candida</i> species.</p