New echinocandin susceptibility patterns for nosocomial Candida albicans in Bogotá, Colombia, in ten tertiary care centres: an observational study

Giovanni Rodríguez-Leguizamón, Alessandro Fiori, Katrien Lagrou, María Antonia Gaona, Milciades Ibáñez, Manuel Alfonso Patarroyo, Patrick Van Dijck, Arley Gómez-López

Resultado de la investigación: Contribución a RevistaArtículo

2 Citas (Scopus)

Resumen

© 2015 Rodríguez-Leguizamón et al.; licensee BioMed Central.Background: Candida albicans remains as the first cause of nosocomial fungal infections in hospitals worldwide and its susceptibility pattern should be better described in our tertiary care hospitals. Methods: This study aimed at identifying the caspofungin susceptibility pattern regarding nosocomial Candida albicans infection in ten tertiary care hospitals using the methodology proposed by CLSI M27-A3 and CLSI M27-S4, and its association with risk factors and clinical outcome. The approach involved descriptive research concerning the diagnosis of nosocomial infection during a 7-month period in 10 hospitals in Bogotá, Colombia. Associations were established using exact non-parametric statistical tests having a high statistical power (>95%), suitable for small samples. The exact Mann Whitney test or Kruskall-Wallis non-parametric ANOVA tests were used for distributions which were different to normal or ordinal variables when comparing three or more groups. Multivariate analysis involved using binomial, multinomial and ordinal exact logistical regression models (hierarchical) and discrimination power was evaluated using area under the ROC curve. Results: 101 nosocomial infections were found in 82,967 discharges, for a Candida spp. infection rate of 12.2 per 10,000 discharges, 30.7% caused by C. albicans, 22.8% by C. tropicalis, 20.8% by C. parapsilosis, 19.8% by other Candida, 3% by C. krusei and 3% by C. glabrata. Statistically significant associations between mortality rate and the absence of parenteral nutrition were found in multivariate analysis (OR = 39.746: 1.794-880.593 95% CI: p = 0.020). The model's predictive power was 83.9%, having an 85.9% significant prediction area (69.5%-100 95% CI; p = 0.001). Conclusions: Significant differences were found regarding susceptibility results when comparing CLSI M27-A3 to CLSI M27-S4 when shifting clinical break-point values. However, one nosocomial strain was consistent in having reduced susceptibility when using both guidelines without having been directly exposed to echinocandins beforehand and no mutations were found in the FKS1 gene for hot spot 1 and/or hot spot 2 regions, thereby highlighting selective pressure regarding widespread antifungal use in tertiary healthcare centres. Nutritional conditions and low family income were seen to have a negative effect on survival rates.
Idioma originalEnglish (US)
Páginas (desde-hasta)108
Número de páginas1
PublicaciónBMC Infectious Diseases
DOI
EstadoPublished - ene 1 2015

Huella dactilar

Echinocandins
Colombia
Candida albicans
Tertiary Care Centers
Observational Studies
Tertiary Healthcare
Cross Infection
caspofungin
Candida
Multivariate Analysis
Mycoses
Parenteral Nutrition
Infection
ROC Curve
Area Under Curve
Analysis of Variance
Survival Rate
Guidelines
Mutation
Mortality

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@article{910ed64a71e947e284bed0b3801012ed,
title = "New echinocandin susceptibility patterns for nosocomial Candida albicans in Bogot{\'a}, Colombia, in ten tertiary care centres: an observational study",
abstract = "{\circledC} 2015 Rodr{\'i}guez-Leguizam{\'o}n et al.; licensee BioMed Central.Background: Candida albicans remains as the first cause of nosocomial fungal infections in hospitals worldwide and its susceptibility pattern should be better described in our tertiary care hospitals. Methods: This study aimed at identifying the caspofungin susceptibility pattern regarding nosocomial Candida albicans infection in ten tertiary care hospitals using the methodology proposed by CLSI M27-A3 and CLSI M27-S4, and its association with risk factors and clinical outcome. The approach involved descriptive research concerning the diagnosis of nosocomial infection during a 7-month period in 10 hospitals in Bogot{\'a}, Colombia. Associations were established using exact non-parametric statistical tests having a high statistical power (>95{\%}), suitable for small samples. The exact Mann Whitney test or Kruskall-Wallis non-parametric ANOVA tests were used for distributions which were different to normal or ordinal variables when comparing three or more groups. Multivariate analysis involved using binomial, multinomial and ordinal exact logistical regression models (hierarchical) and discrimination power was evaluated using area under the ROC curve. Results: 101 nosocomial infections were found in 82,967 discharges, for a Candida spp. infection rate of 12.2 per 10,000 discharges, 30.7{\%} caused by C. albicans, 22.8{\%} by C. tropicalis, 20.8{\%} by C. parapsilosis, 19.8{\%} by other Candida, 3{\%} by C. krusei and 3{\%} by C. glabrata. Statistically significant associations between mortality rate and the absence of parenteral nutrition were found in multivariate analysis (OR = 39.746: 1.794-880.593 95{\%} CI: p = 0.020). The model's predictive power was 83.9{\%}, having an 85.9{\%} significant prediction area (69.5{\%}-100 95{\%} CI; p = 0.001). Conclusions: Significant differences were found regarding susceptibility results when comparing CLSI M27-A3 to CLSI M27-S4 when shifting clinical break-point values. However, one nosocomial strain was consistent in having reduced susceptibility when using both guidelines without having been directly exposed to echinocandins beforehand and no mutations were found in the FKS1 gene for hot spot 1 and/or hot spot 2 regions, thereby highlighting selective pressure regarding widespread antifungal use in tertiary healthcare centres. Nutritional conditions and low family income were seen to have a negative effect on survival rates.",
author = "Giovanni Rodr{\'i}guez-Leguizam{\'o}n and Alessandro Fiori and Katrien Lagrou and Gaona, {Mar{\'i}a Antonia} and Milciades Ib{\'a}{\~n}ez and Patarroyo, {Manuel Alfonso} and {Van Dijck}, Patrick and Arley G{\'o}mez-L{\'o}pez",
year = "2015",
month = "1",
day = "1",
doi = "10.1186/s12879-015-0840-0",
language = "English (US)",
pages = "108",
journal = "BMC Infectious Diseases",
issn = "1471-2334",
publisher = "BioMed Central",

}

New echinocandin susceptibility patterns for nosocomial Candida albicans in Bogotá, Colombia, in ten tertiary care centres: an observational study. / Rodríguez-Leguizamón, Giovanni; Fiori, Alessandro; Lagrou, Katrien; Gaona, María Antonia; Ibáñez, Milciades; Patarroyo, Manuel Alfonso; Van Dijck, Patrick; Gómez-López, Arley.

En: BMC Infectious Diseases, 01.01.2015, p. 108.

Resultado de la investigación: Contribución a RevistaArtículo

TY - JOUR

T1 - New echinocandin susceptibility patterns for nosocomial Candida albicans in Bogotá, Colombia, in ten tertiary care centres: an observational study

AU - Rodríguez-Leguizamón, Giovanni

AU - Fiori, Alessandro

AU - Lagrou, Katrien

AU - Gaona, María Antonia

AU - Ibáñez, Milciades

AU - Patarroyo, Manuel Alfonso

AU - Van Dijck, Patrick

AU - Gómez-López, Arley

PY - 2015/1/1

Y1 - 2015/1/1

N2 - © 2015 Rodríguez-Leguizamón et al.; licensee BioMed Central.Background: Candida albicans remains as the first cause of nosocomial fungal infections in hospitals worldwide and its susceptibility pattern should be better described in our tertiary care hospitals. Methods: This study aimed at identifying the caspofungin susceptibility pattern regarding nosocomial Candida albicans infection in ten tertiary care hospitals using the methodology proposed by CLSI M27-A3 and CLSI M27-S4, and its association with risk factors and clinical outcome. The approach involved descriptive research concerning the diagnosis of nosocomial infection during a 7-month period in 10 hospitals in Bogotá, Colombia. Associations were established using exact non-parametric statistical tests having a high statistical power (>95%), suitable for small samples. The exact Mann Whitney test or Kruskall-Wallis non-parametric ANOVA tests were used for distributions which were different to normal or ordinal variables when comparing three or more groups. Multivariate analysis involved using binomial, multinomial and ordinal exact logistical regression models (hierarchical) and discrimination power was evaluated using area under the ROC curve. Results: 101 nosocomial infections were found in 82,967 discharges, for a Candida spp. infection rate of 12.2 per 10,000 discharges, 30.7% caused by C. albicans, 22.8% by C. tropicalis, 20.8% by C. parapsilosis, 19.8% by other Candida, 3% by C. krusei and 3% by C. glabrata. Statistically significant associations between mortality rate and the absence of parenteral nutrition were found in multivariate analysis (OR = 39.746: 1.794-880.593 95% CI: p = 0.020). The model's predictive power was 83.9%, having an 85.9% significant prediction area (69.5%-100 95% CI; p = 0.001). Conclusions: Significant differences were found regarding susceptibility results when comparing CLSI M27-A3 to CLSI M27-S4 when shifting clinical break-point values. However, one nosocomial strain was consistent in having reduced susceptibility when using both guidelines without having been directly exposed to echinocandins beforehand and no mutations were found in the FKS1 gene for hot spot 1 and/or hot spot 2 regions, thereby highlighting selective pressure regarding widespread antifungal use in tertiary healthcare centres. Nutritional conditions and low family income were seen to have a negative effect on survival rates.

AB - © 2015 Rodríguez-Leguizamón et al.; licensee BioMed Central.Background: Candida albicans remains as the first cause of nosocomial fungal infections in hospitals worldwide and its susceptibility pattern should be better described in our tertiary care hospitals. Methods: This study aimed at identifying the caspofungin susceptibility pattern regarding nosocomial Candida albicans infection in ten tertiary care hospitals using the methodology proposed by CLSI M27-A3 and CLSI M27-S4, and its association with risk factors and clinical outcome. The approach involved descriptive research concerning the diagnosis of nosocomial infection during a 7-month period in 10 hospitals in Bogotá, Colombia. Associations were established using exact non-parametric statistical tests having a high statistical power (>95%), suitable for small samples. The exact Mann Whitney test or Kruskall-Wallis non-parametric ANOVA tests were used for distributions which were different to normal or ordinal variables when comparing three or more groups. Multivariate analysis involved using binomial, multinomial and ordinal exact logistical regression models (hierarchical) and discrimination power was evaluated using area under the ROC curve. Results: 101 nosocomial infections were found in 82,967 discharges, for a Candida spp. infection rate of 12.2 per 10,000 discharges, 30.7% caused by C. albicans, 22.8% by C. tropicalis, 20.8% by C. parapsilosis, 19.8% by other Candida, 3% by C. krusei and 3% by C. glabrata. Statistically significant associations between mortality rate and the absence of parenteral nutrition were found in multivariate analysis (OR = 39.746: 1.794-880.593 95% CI: p = 0.020). The model's predictive power was 83.9%, having an 85.9% significant prediction area (69.5%-100 95% CI; p = 0.001). Conclusions: Significant differences were found regarding susceptibility results when comparing CLSI M27-A3 to CLSI M27-S4 when shifting clinical break-point values. However, one nosocomial strain was consistent in having reduced susceptibility when using both guidelines without having been directly exposed to echinocandins beforehand and no mutations were found in the FKS1 gene for hot spot 1 and/or hot spot 2 regions, thereby highlighting selective pressure regarding widespread antifungal use in tertiary healthcare centres. Nutritional conditions and low family income were seen to have a negative effect on survival rates.

U2 - 10.1186/s12879-015-0840-0

DO - 10.1186/s12879-015-0840-0

M3 - Article

SP - 108

JO - BMC Infectious Diseases

JF - BMC Infectious Diseases

SN - 1471-2334

ER -