The authors reply

International audienc

Antifungal Prevention of Systemic Candidiasis in Immunocompetent ICU Adults

International audienceObjectives: The aim of this study was to identify the impact of antifungal prevention in critically ill immunocompetent adult patients on mortality and subsequent infection. Data Sources: A systematic review and meta-analysis of randomized controlled trials comparing any antifungal use versus placebo to prevent candidiasis in ICU patients were performed. Study Selection: Searches were performed on PubMed, Embase, Scopus, main conference proceedings, and ClinicalTrials. gov, as well as reference lists. Data Extraction: The primary outcomes were mortality and invasive candidiasis. The secondary outcome was the rate of Candida albicans and nonalbicans strains after treatment. A random effect model was used, and sensitivity analysis was performed for both outcomes. Results are expressed as risk ratios and their 95% CIs. Data Synthesis: Nineteen trials (10 with fluconazole, four with ketoconazole, one with itraconazole, three with micafungin, and one with caspofungin) including 2,792 patients were identified. No individual trial showed a decreased mortality rate. Combined analysis showed that preventive antifungal did not decrease mortality (risk ratio, 0.88; 95% CI, 0.74-1.04; p = 0.14) but significantly decreased secondary fungal infections by 50% (risk ratio, 0.49; 95% CI, 0.35-0.68; p = 0.0001). No shift across nonalbicans strains was observed during treatment (risk ratio, 0.62; 95% CI, 0.19-1.97; p = 0.42). However, publication biases preclude any definite conclusions for prevention of infection. Conclusions: Antifungal prevention of systemic candidiasis in immunocompetent critically ill adults did not reduce mortality and may have decreased secondary fungal infection rates. However, significant publication bias was present

Development of Echinocandin Resistance in Clavispora lusitaniae during Caspofungin Treatment

International audienceClavispora lusitaniae is an opportunistic human pathogen responsible for 0.6 to 2% of candidemia. This species is intrinsically susceptible to echinocandins. Nevertheless, in this study, development of echinocandin resistance in C. lusitaniae isolates was observed during caspofungin treatment. This resistance resulted from missense mutation in the echinocandin target Fks1 gene

Evaluation of the (1,3)-beta-D-glucan assay for the diagnosis of neonatal invasive yeast infections

International audienceMost newborns in the neonatal intensive care unit (NICU) are premature and at risk of invasive fungal infections (IFIs). Invasive yeast infections (IYIs) are the most common fungal infections in this population. These infections are difficult to diagnose because symptoms are nonspecific, and the sensitivity of blood cultures is low. The serum (1,3)-beta-D-glucan (BDG) assay provides a reliable marker for the diagnosis of IFIs in adults with haematological malignancies. We assessed the diagnostic performance of this test in neonatal IYIs and its contribution to the monitoring of antifungal treatment. A retrospective study was performed in the NICU of the French University Hospital of Amiens from February 2012 to February 2014. Forty-seven neonates (33 males, 14 females) with a median gestational age of 30 weeks (IQR: 27-31) and median birth weight of 1200 g (IQR: 968-1700) were included and divided into three groups: 21 control neonates (CTRL), 20 neonates with probable IYI (PB), and six with proven IYI (PV). Median BDG levels were significantly higher in the global IYI group (PB + PV): 149 pg/ml (IQR: 85-364) vs. CTRL group: 39 pg/ml (IQR: 20-94) (P < .001). The optimal cut-off was 106 pg/ml (sensitivity 61.5%; specificity 81%). BDG levels decreased with antifungal treatment. BDG was detectable in cerebrospinal fluid, but the interest of this for diagnostic purposes remains unclear. Our results suggest that the BDG assay may be useful for the early identification of IYIs in neonates and for monitoring antifungal therapy efficacy

Painless Nodules on the Left Hand of a Kidney Transplant Recipient

International audienc

Production and Quantification of Virulence Factors in Malassezia Species

Abstract A total of 77 strains of Malassezia were included in this study. Biofilm production and hydrolytic enzymes were studied by using specific solid media. Real-time Reverse Transcriptase qPCR method was applied to determine overexpression of genes encoding extracellular enzyme. All included Malassezia species produced biofilms. No statistical significant difference was observed between biofilm formation of the Malassezia species (P = 0.567) . All Malassezia species produced lipase and 95% of M. globosa showed a strong enzymatic activity (Pz=0.55 ± 0.02). Statistical significant difference was observed between the mean keratinase indices of M. slooffiae and the others Malassezia species ( P = 0.005). The overexpression of one or more genes was observed in 100% of strains isolated from patients with folliculitis, in 87.5% for pityriasis versicolor isolates and in 57.14% for the control group isolates. A statistical significant difference of the lipase gene expression ( P = 0.072) was associated with the strains collected from patients with folliculitis vs group control. This investigation provides more information about the frequency of the production of the major enzymes considered to be virulence factors of Malassezia species. Interestingly, the overexpression of one or more genes was observed in strains isolated from patients with Malassezia disorder.</jats:p