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Los niños con patología oncohematológica suelen presentar candidemia como complicación del tratamiento de su patología de base. El manejo de la misma presenta certezas e incertidumbres que abordaremos en este artículo como la remoción o no del catéter, la búsqueda de focos secundarios de infección, el tratamiento y la evolución (AU)

Children with oncohematologic disease often experience candidemia as a complication of the treatment of their underlying disease. The management of candidemia presents certainties and uncertainties that we will address in this article, including whether or not to remove the catheter, investigation of secondary infection foci, treatment strategies, and patient outcomes (AU)

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Introducción La infección por presenta un patrón amplio en la tomografía computarizada de tórax, que incluye opacidades en vidrio deslustrado y consolidación, siendo el patrón miliar el menos frecuente. El patrón miliar no es exclusivo de la tuberculosis. Las infecciones pulmonares fúngicas son raras y potencialmente fatales. La colonización por asociada a deterioro de la inmunidad requiere iniciar terapia antifúngica empírica temprana y así mejorar la supervivencia. Caso clínico Paciente masculino de 48 años con tos productiva persistente, expectoración mucopurulenta, disnea de moderados esfuerzos, sudoración nocturna, sensación de temperatura elevada y pérdida de peso. Con estudio tomográfico de tórax que reveló enfermedad intersticial pulmonar tipo "miliar", se le indicó tratamiento antituberculoso. Discusión El patrón tomográfico de tipo miliar requiere un abordaje más amplio que permita un diagnóstico preciso. El caso reportado presentó candidiasis oral y deterioro de la inmunidad. La colonización previa asociada a deterioro de la inmunidad, son los factores más importantes encontrados para la candidiasis diseminada. Conclusión El patrón radiológico de tipo miliar no es exclusivo de la tuberculosis. Ello amerita un abordaje diagnóstico más preciso. Es importante diagnosticar la candidiasis diseminada para iniciar terapia antifúngica temprana, y con ello mejorar la supervivencia.

Introduction Candida albicans infection shows a wide range of patterns on chest computed tomography, including ground glass opacities and consolidation, with the miliary pattern being the least frequent. The miliary pattern is not exclusive to tuberculosis. Fungal lung infections are rare and potentially fatal. Colonization by Candida albicans, associated with impaired immunity, requires early empirical antifungal therapy to improve survival. Case report 48-year-old male patient with persistent productive cough, mucopurulent expectoration, dyspnea on moderate exertion, night sweats, elevated temperature, and weight loss. Chest tomography revealed miliary interstitial lung disease, and he was prescribed antituberculosis treatment. The pathologic result of the biopsy concluded the presence of moderately differentiated keratinized infiltrating squamous cell carcinoma. The patient died. Dicussion The miliary tomographic pattern requires a broader approach for accurate diagnosis. The reported case presented with oral candidiasis and impaired immunity. Previous colonization associated with impaired immunity is the most important factor found for disseminated candidiasis. Conclusion The miliary radiological pattern is not exclusive to tuberculosis, warranting a more precise diagnostic approach. It is important to diagnose disseminated candidiasis in order to initiate early antifungal therapy and thus improve survival.

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Introduction. Data on the prevalence of fungal coinfections/superinfections in patients with COVID-19 are limited. Objective. To describe the prevalence of fungal coinfections/superinfections in patients with COVID-19, as well as risk factors and demographic, clinical, and microbiological characteristics. Materials and methods. We included patients with a confirmed COVID-19 diagnosis and a confirmed fungal infection hospitalized in the ICU from March 2020 to December 2021. We collected data on age, sex, comorbidities, hospital length of stay (days), laboratory (ferritin) and microbiological results, treatment for COVID-19, antifungal therapy, and outcomes obtained from the clinical records. Results. Only 11 out of 740 patients met the inclusion criteria. The coinfection rate was 0.3% and the superinfection was 1.2%. The most affected population was male adults. The coinfections/superinfections diagnosed were candiduria and candidemia, caused by Candida albicans, C. tropicalis, C. glabrata, C. lusitaniae, and Kluyveromyces marxianus (C. kefyr). In addition, tracheobronchitis due to Aspergillus fumigatus was found. The most used antifungals were fluconazole and caspofungin. The lethality in patients with fungal coinfections was 50% and superinfections, 22%. The length of hospital stay was 11-65 days. Eight patients required mechanical ventilation and six received corticosteroids. The main comorbidity was diabetes mellitus (81.8%). Conclusions. The rate of fungal coinfections/superinfections in COVID-19 patients was low, but the lethality found urges for routine fungal screening in patients with severe COVID-19 to timely detect fungal infections that may further compromise the patient's life.

Introducción. Los datos sobre la prevalencia de coinfecciones o sobreinfecciones fúngicas en pacientes con COVID-19 son limitados. Objetivo. Describir la prevalencia de coinfecciones o sobreinfecciones fúngicas en pacientes con COVID-19, así como los factores de riesgo y las características demográficas, clínicas y microbiológicas. Materiales y métodos. Se incluyeron pacientes con diagnóstico confirmado de COVID-19, hospitalizados en la unidad de cuidados intensivos y con infección fúngica confirmada entre marzo del 2020 y diciembre del 2021. Del expediente clínico se obtuvieron datos sobre edad, sexo, comorbilidades, días de estancia hospitalaria, resultados de laboratorio (ferritina) y microbiológicos, tratamiento contra COVID-19, terapia antifúngica y desenlace. Resultados. Once de 740 pacientes cumplieron con los criterios de inclusión. La tasa de coinfección fue del 0,3 % y la de sobreinfección fue del 1,2 %. La población más afectada fue la de hombres adultos. Las coinfecciones o sobreinfecciones diagnosticadas fueron candiduria y candidemia, causadas por Candida albicans, C. tropicalis, C. glabrata, C. lusitaniae y Kluyveromyces marxianus (C. kefyr). Además, se encontró una traqueobronquitis por Aspergillus fumigatus. Los antifúngicos más administrados fueron fluconazol y caspofungina. La letalidad en pacientes con coinfecciones fue del 50 % y con sobreinfecciones fúngicas, del 22 %. El tiempo de estancia intrahospitalaria fue de 11 a 65 días. Ocho de los pacientes requirieron asistencia respiratoria mecánica y seis recibieron corticoides. La principal comorbilidad fue diabetes mellitus (81,8 %). Conclusiones. La tasa de coinfecciones o sobreinfecciones por hongos en pacientes con COVID-19 fue baja, pero la letalidad de estas requiere, con urgencia, la realización de pruebas de rutina para detectar hongos en pacientes con COVID-19 grave para diagnosticar oportunamente infecciones fúngicas que puedan comprometer aún más la vida del paciente.

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Background: Candida-associated bloodstream infections (BSI) are one of the major causes of nosocomial mortality. The changing spectrum of candidemia with respect to increased isolation of non-albicans Candida (NAC) along with the susceptibility pattern underlines the necessity of rapid and appropriate diagnosis of pathogenic Candida along with antifungal susceptibility to institute prompt and appropriate antifungal therapy. Aims and Objectives: The aim of the present study is to determine the prevalence of Candida isolates causing BSI along with the changing trend of its species- specific aetiology and susceptibility pattern in a tertiary care hospital in Kolkata. Materials and Methods: Candida species isolated from positive blood cultures were speciated conventionally as per standard laboratory protocol. Virulence factors were determined phenotypically on sabouraud dextrose agar with blood, egg yolk agar, and tween 80 agar. Adherence and biofilm production were also detected. Antifungal susceptibility was performed by the disk diffusion method as per clinical and laboratory standards institute guidelines. Results: Out of a total of 3987 blood samples collected during a period of 1 year, 73 (1.83%) showed growth of Candida, among which the majority was NAC (61.64%). Out of them, Candida tropicalis (23.28%) was the predominant species, followed by Candida guilliermondii (19.18%). Males (61.64%) outnumbered females. Age groups <10 years were most affected. Major risk factors were prolonged intensive care unit stays, diabetes, and the presence of a central venous catheter. 93.15% of Candida produced hemolysin, 83.56% phospholipase, and 68.49% esterase. 79.45% of species showed adherence, and 52.05% produced biofilm. Antifungal susceptibility showed lower resistance to amphotericin B, where a higher incidence of azole resistance among NAC species was observed. Conclusion: The detection of Candida species along with their antifungal susceptibility will help in better comprehension of the changing patterns of Candida for better management and prognosis of patients.

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Abstract: Introduction: In hospitalized patients, candidemia accounts for considerable morbidity and mortality. Knowledge of local species epidemiology and antifungal susceptibility is important when considering therapy. This study was performed to speciate Candida isolates from inpatients admitted with blood stream infections in our hospital and to assess their risk factors. Materials and Methods: This present study of 2 years' duration was performed from April 2022 to March 2024. BacT/Alert aerobic culture bottle (bioMérieux, France) was used for all routine blood cultures and incubated for 5 days at 37°C. Any blood culture growing yeast was identified by Gram stain and MALDI-TOF MS (Bruker Daltonics). Disk diffusion method was used for antifungal susceptibility testing and test was performed according to clinical laboratory standard institute (CLSI) guidelines. Results: About 132 Candida isolates from blood were isolated in 2 years. Predominance of males (59%) was noted with the median age of 52 years. Majority were nonalbicans Candida (81.06 %) with C. tropicalis (31.81%) and C. auris (13.63%). Susceptibility to fluconazole and voriconazole was 100% for both C. albicans and C. tropicalis isolates. Fluconazole resistance of 11.77% and 100% was observed in C. parapsilosis and C. auris isolates respectively. Conclusion: The predominance of non-albicans Candida with increasing fluconazole resistance and isolation of C. auris as the third most common non-albicans Candida species in this study is of concern. Accurate identification of non-albicans Candida specially C. auris and strict infection control policies should be in place to combat the spread of C. auris in the hospital.

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Introducción: La tasa de mortalidad de la candidemia es variable, pero puede estar influenciada por la patología de base, en especial aquella que condiciona la presencia de neutropenia. En niños con patología oncohematológica, son pocos los trabajos que han abordado la mortalidad relacionada a candidemias y sus factores asociados. Las preguntas que promueven esta revisión sistemática, son: ¿Cuáles son las características epidemiológicas, clínicas y de evolución de los pacientes pediátricos oncohematológicos con candidemia? ¿Cuál es la mortalidad relacionada con esta entidad? Materiales y métodos: Revisión sistemática de la literatura. Se utilizaron los siguientes términos de búsqueda: candidemia por Candida spp. y los siguientes filtros humanos, niños y adolescentes y patología oncohematológica. Se revisaron los artículos publicados en inglés, español o francés hasta el 21 de septiembre de 2023. Las referencias bibliográficas de los artículos incluidos se revisaron manualmente para identificar estudios relevantes adicionales. Resultados: Se encontraron 66 artículos. Del análisis cualitativo realizado en sus textos completos, quedaron finalmente 4 estudios que se consideró que cumplían con los criterios de inclusión. Todos los artículos seleccionados sumaron 191 pacientes con diversas patologías oncohematológicas. La presencia de accesos vasculares fue frecuente en esta serie y la no extracción del catéter venoso central fue el factor más prevalente entre los que fallecieron. El agente infectante predominante fue Candida no albicans y la mortalidad osciló entre el 11,3 y el 31% con una mediana de 25%. No fue posible establecer si la especie de Candida influía en la letalidad

Introduction: The mortality rate of candidemia is variable, but may be influenced by underlying diseases, especially those causing neutropenia. In children with cancer and blood disorders, few studies have addressed mortality related to candidemia and its associated factors. The questions that motivated this systematic review were: What are the epidemiological, clinical and outcome characteristics of pediatric cancer patients with candidemia? What is the mortality related to this condition? Materials and methods: Systematic review of the literature. The following search terms were used: Candida spp., candidemia, with the following filters: human, children and adolescents, and cancer and blood disorders. Articles published in English, Spanish, or French up to September 21, 2023 were reviewed. References of included articles were manually reviewed to identify additional relevant studies. Results: 66 articles were identified. From the qualitative analysis carried out on their full texts, 4 studies that were considered to meet the inclusion criteria were finally selected. The selected articles included a total of 191 patients with various types of cancer and blood disorders. The presence of vascular access was common in this series and failure to remove the central venous catheter was the most prevalent factor among those who died. The predominant infectious agent was non-albicans Candida and mortality ranged from 11.3% to 31% with a median of 25%. It was not possible to establish whether Candida species influenced mortality.

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ABSTRACT Candida glabrata is a yeast which incidence has increased in recent years and usually causes urogenital and bloodstream infections. Its resistance to fluconazole hinders C. glabrata infections treatment. This case report presents a case of candidemia and scrotal abscess caused by C. glabrata, which was successfully treated with liposomal amphotericin B. The primary treatment options for C. glabrata candidemia are echinocandins and amphotericin B formulations. However, echinocandins and lipid-based amphotericin B formulations do not properly pass through the urinary system. Amphotericin B deoxycholate has a high risk of side effects and is difficult to obtain. The treatment option for candidemia caused by fluconazole-resistant C. glabrata secondary to urinary tract infection is unclear and there are no sufficient studies. For treatment, liposomal amphotericin B may be considered, especially for scrotal and prostatic fluconazole-resistant fungal abscesses. More studies comparing the penetration of antifungals into scrotal and prostatic tissue and the success of antifungal treatment in these tissue infections are needed.

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Background: Resistance to fungal infections is increasing worldwide, which is highly relevant in immunosuppressed individuals. Candida fungi infection constitutes one of the most common causes of fungal infections in such patients, and it can lead to complications and death. The current study sought to examine the prevalence and species diversity of Candida in samples received by the Microbiology Laboratory over a two-year period. Methods: The study involved 674 immunocompromised patients. Candida was isolated from clinical samples using wet mount, gram stain, and SDA culture. To further identify the organisms, several tests were conducted, including the germ tube test, cornmeal agar morphology, sugar assimilation, fermentation tests, and BACT/ALERT 3D. Results: Candida species were found to be present in 6.5% of the population. Candida tropicalis was found to be the most common isolate 20 (45.45%), followed by Candida albicans 9 (20.45%), Candida glabrata 7 (15.9%), Candida parapsilosis 4 (9.09%), and Candida krusei 4 (9.09%). Diabetes, leukaemia, chronic kidney disease, and AIDS were the most common predisposing factors for candidiasis. Conclusion: Men had a relatively high candidemia prevalence of 68.18%. Uncontrolled diabetes mellitus (DM) and chronic kidney disease (CKD) have been found to be the most common co-morbidities with candidemia in people aged 51 to 70.

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Background: Candidemia is one of the common health care associated Blood Stream Infections (BSI). Frequency of isolation of various Candida species causing candidemia and their antifungal drug resistance trends in a health care setting can help in timely institution of appropriate empirical antifungal treatment. Aim and Objectives: To observe the species distribution of various Candida species isolated from suspected cases of BSI and their antifungal susceptibility pattern in a tertiary care hospital from western Uttar Pradesh. This study was conducted to speciate Candida isolates isolated from blood culture samples and their antifungal susceptibility testing. Material and Methods: This study was conducted in the Department of Microbiology, Subharti Medical College and associated Chhatrapati Shivaji Subharti Hospital, Meerut for a period of one year. Blood culture was done by BacT/Alert automated blood culture system from BioMerieux, France. Candida isolates recovered from blood culture were further processed for speciation using conventional morphological and biochemical characteristics and antifungal susceptibility testing by Kirby Bauer disk diffusion method. Results: Out of total 70 Candida isolates isolated during the study period C. tropicalis was the predominant isolate accounting for 34.28% followed by C. parapsilosis. The occurrence of candidemia was higher in Intensive Care Units (ICUs) patients (70.83%). Antifungal drug voriconazole was found to be sensitive against all the Candida isolates. Conclusion: Mycological shift towards the isolation of NAC species indicates a changing trend and changing antifungal drug resistance profile accordingly have to be considered before initiation of empirical antifungal treatment.

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In the healthcare setting, Candida bloodstream infections significantly increase morbidity and mortality. There is little proof that invasive infections in Saudi Arabia are brought on by Candida spp. To identify Candida species that cause bloodstream infections and ascertain the clinical outcome and risk factors for mortality in a Saudi Arabian tertiary hospital. This retrospective analysis covered all instances in which patients hospitalized to Ohud hospital, a tertiary care facility in Madinah, Saudi Arabia, between January 2019 and December 2021, had positive blood cultures for Candida. Anaerobic and aerobic Bactec bottles were inoculated with blood samples and then incubated at 35°C for five days. Identification-YST card kits from VITEK II (BioMerieux, France) for yeast and yeast-like organisms. Testing for antifungal susceptibility was done using AST YS07. A total of 78 patients (71% men, 29% women) were found to have candidemia. Candida albicans (51.3%), Candida parapsilosis (16.7%), and Candida tropicalis (16.7%) were the three Candida spp. that were most frequently isolated. Those with Saudi (51%; P = 0.500), leukopenia (40%; P = 0.001), neutrophilia (92%; P = 0.638), and thrombocytopenia (42%; P = 0.374) had a higher incidence of candidemia. Fluconazole sensitivity in non-albicans Candida species was 39.5%. Nonetheless, caspofungin was effective against all species. This study discovered an epidemiological shift toward more non-albicans Candida spp. in Saudi Arabia as well as a changing pattern in the Candida spp. causing bloodstream infections.

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Introdução: A infecção da corrente sanguínea (ICS) por leveduras, tem como principal gênero a Candida. As principais espécies que causam a candidemia no Brasil são Candida albicans, Candida parapsilosis e Candida tropicalis, sendo a C. albicans a mais prevalente. Todavia, nas últimas décadas tem aumentado a prevalência de espécies de Candidanão albicans (CNA) e principalmente a emergência de Candida auris, que possuem mecanismos de resistência aos antifúngicos mais usados, caracterizando um cenário de preocupação mundial. Objetivo: Avaliar a prevalência de candidemia e das principais espécies de Candida spp. isoladas de amostras de hemocultura e sua distribuição por setores de internação de um hospital de ensino. Material e Métodos: Trata-se de um estudo observacional e retrospectivo, em que foram analisadas, através de bancos de dados, hemoculturas positivas para Candida spp. de pacientes internados em um hospital de ensino da cidade de Juiz de Fora, Minas Gerais, no período de janeiro de 2021 a dezembro de 2022. Resultados: Foram analisadas 3.262 hemoculturas, sendo 1.059 (32,46%) positivas. Destas, 1.008 (95,18%) tiveram crescimento bacteriano e 51 (4,82%) tiveram crescimento de Candida spp. divididos em, 20 (39,22%) C. albicans e 31 (60,78%) CNA. Das CNA isolados, 14 foram C. tropicalis (45,16%), 10 C. parapsilosis(32,26%), 3 C. glabrata (9,68%), 2 Candida kefyr (6,45%) e 2 Candida lusitaniae (6,45%). Dos 51 isolados de Candida spp., 25 (49,02%) foram no centro de tratamento intensivo, 11 (21,57%) no bloco cirúrgico e 15 (29,41%) foram nas enfermarias. Conclusão: Candida albicans é a principal espécie relacionada a candidemia em pacientes hospitalizados, porém espécies do grupo CNA têm apresentado elevada prevalência em isolados de hemocultura, principalmente em pacientes de centro de tratamento intensivo.

Introduction: Bloodstream infection (BSI) by yeasts has Candida as its main genus. The main species that cause candidemia in Brazil are Candida albicans, Candida parapsilosis and Candida tropicalis, and C. albicans referred as the most prevalent. However, in recent decades, the prevalence of non-albicans Candida species (NAC) has increased and especially the emergence of Candida auris, which have mechanisms of resistance to the most used antifungals, characterizing a scenario of global concern. Objective: To evaluate the prevalence of candidemia and the main species of Candida spp. isolated from blood culture samples and their distribution by hospitalization sectors of a teaching hospital. Material and Methods: This is an observational and retrospective study, of positive blood cultures for Candida spp. of patients admitted to a teaching hospital in the city of Juiz de Fora, Minas Gerais, from January 2021 to December 2022. Results: Among 3262 blood cultures analyzed, 1059 (32.46%) of which were positive. Of these, 1008 (95.18%) had bacterial growth and 51 (4.82%) had Candida spp. divided into, 20 (39.22%) C. albicans and 31 (60.78%) NAC. Of the NAC isolated, 14 were C. tropicalis (45.16%), 10 C. parapsilosis (32.26%), 3 C. glabrata (9.68%), 2 Candida kefyr (6.45%) and 2 Candida lusitaniae (6.45%). Of the 51 Candida spp. isolates, 25 (49.02%) were in the intensive care unit, 11 (21.57%) in the operating room and 15 (29.41%) were in the wards. Conclusion: Candida albicans is the main species related to candidemia in hospitalized patients, but species from the NAC group have shown high prevalence in blood culture isolates, especially in the intensive care unit patients.

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Introducción: La candidemia es considerada el tipo de fungemia más frecuente asociada a pacientes en unidades de cuidados intensivos. Es una afección rápidamente progresiva con elevada mortalidad, la cual presenta dificultad en un diagnóstico precoz y capacidad de resistencia al tratamiento. Objetivos: Caracterizar aspectos epidemiológicos, clínicos y microbiológicos de las especies de Candida aisladas en niños hospitalizados en unidades de cuidados intensivos. Métodos: Se realizó un estudio descriptivo y transversal en 143 aislamientos de especies de Candida obtenidas en hemocultivos de pacientes menores de 18 años, en el laboratorio de Microbiología del Hospital Universitario Ginecobstétrico «Mariana Grajales», en el período de enero de 2009 a diciembre de 2018. Se utilizaron tablas de contingencia (prueba de Ji Cuadrado y V de Cramer); se utilizaron las variables: edad, sexo, factores de riesgo, especies y servicios hospitalarios. Resultados: Los mayores aislamientos de candidemia correspondieron a pacientes del sexo femenino de edades comprendidas entre 29 días y 18 años. Todos fueron sometidos al uso de antimicrobianos y con ventilación mecánica. El mayor número de aislamientos en pacientes de 9 años correspondió a Candida tropicalis, que fue la más aislada en la Unidad de Neonatología y Cuidados Intensivos Pediátricos, no así en Cuidados Intermedios donde predominó Candida sin precisar especie. Por estas razones se puede señalar que existe una relación entre las especies y los servicios hospitalarios. Conclusiones: Predominaron pacientes del sexo femenino mayores de 29 días y hasta 18 años hospitalizados en la Unidad de Cuidados Intensivos Pediátricos; la especie más aislada fue Candida tropicalis.

Introduction: candidemia is considered the most frequent type of fungemia associated with patients hospitalized in intensive care units. It is a rapidly progressive condition with high mortality, difficult to diagnose early and resistant to treatment. Objective: to characterize the epidemiological, clinical and microbiological aspects of Candida species isolated from children hospitalized in intensive care units. Methods: a descriptive and cross-sectional study was carried out on 143 isolates of Candida species corresponding to blood cultures from patients under 18 years of age and obtained in the Microbiology laboratory at "Mariana Grajales" Gynecological and Obstetric University Hospital, from January 2009 to December 2018. Contingency tables were used (Chi- square and Cramer's V tests); age, gender, risk factors, species and hospital services were the used variables. Results: the largest candidemia isolates corresponded to female patients aged between 29 days and 18 years. All were subjected to the use of antimicrobials and mechanical ventilation. The highest number of isolates in 9-year-old patients corresponded to Candida tropicalis, which was the most isolated species in the Neonatology and Pediatric Intensive Care Unit, but not in the Intermediate Care Unit where Candida predominated without specifying the species. For these reasons, it can be pointed out that there is a relationship between species and hospital services. Conclusions: female patients older than 29 days and up to 18 years hospitalized in the Pediatric Intensive Care Unit predominated; the most isolated species was Candida tropicalis.

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ABSTRACT Candidemia and other forms of invasive candidiasis (C/IC) are serious conditions, especially for immunosuppressed individuals with prolonged hospitalization in intensive care units (ICU). This study analyzed the incremental cost-effectiveness and budgetary impact (BI) of treatment for IC with anidulafungin compared to amphotericin B lipid complex (ABLC) and amphotericin B deoxycholate (ABD) or conventional amphotericin B (CAB), in the Brazilian Unified Health System (SUS). A decision model was conducted with a time horizon of two weeks from the perspective of SUS. The primary effectiveness endpoints were survival and treatment response rate. All patients were followed up until successful therapy or death. BI analysis was performed based on the measured demand method. A five-year time horizon was adopted based on the number of hospitalizations (per 1,000 hospitalizations). For effectiveness measured in the successful response rate (SRR), anidulafungin dominated the ABLC and ABD formulations. In the results of the analysis with the effectiveness measured according to survival, anidulafungin had a better cost-effectiveness ratio (R$988.26/survival) compared to ABD (R$16,359.50/survival). The BI estimate related to the incorporation of anidulafungin suggests savings of approximately 148 million reais in 5 years when comparing it to ABD. The economic evaluation of anidulafungin and its comparators found it to be cost-effective. The consensus of international scientific societies recommends it as a first-line drug for IC, and its incorporation by SUS would be important.

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Introduction: Coronavirus diasease 19 (COVID-19) is an infection caused by the new coronavirus - SARS-CoV-2 in 2019. The infection quickly spread throughout the world, establishing itself like a pandemic. Reports on secondary fungal co-infections in critically ill patients COVID-19 are still scarce and their dynamics are poorly understood. Candidemia is defined as the presence of Candida species in one or more blood cultures, being one of the most reported opportunistic fungal infections in intensive care units (ICU). Methods: Three databases were used for the literary search: Pubmed, Science Direct, and Scopus, including articles published between 2020 and 2021.Results: The incidence of candidemia in COVID-19 patients ranged up to 12% of COVID-19 reported cases.Candida albicans was the most prevalent species, followed by non-albicans species. The use of broad-spectrum antimicrobials, corticosteroids, central venous catheters, mechanical ventilation, parenteral nutrition, immunosuppressants such as tocilizumab and prolonged hospital stay were predisposing factors for the candidemia in COVID-19 patients. Conclusion: There are strongly established risk factors that influence the establishment of candidemia in critically ill COVID-19 patients, which contributes to increased mortality in these patients. Finally, active surveillance by the medical team should be maintained for previous signs of fungal co-infection associated with SARS-CoV-2 contamination.

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Candida auris is a deadly fungal pathogen able to cause fatal symptoms in immunocompromised patients. It may be misidentified and difficult to clinically diagnose. The guidelines are to employ Echinocandin and Amphotericin B in the treatment, but the following study elucidates successful treatment of infection by a combination of three classes of antifungal drugs; never reported before. We present a patient with fulminant acute disseminated encephalomyelitis and neutropenia who developed invasive candidiasis despite appropriate antifungal therapy. We successfully treated ongoing candidemia with three antifungal drugs which lead to the resolution of fungemia after 18 days of treatment. Isolation, segregation, waste disposal, and deep cleaning technique were also followed as recommended by the Infectious Diseases Society of America guidelines. First report ofCandidemia in an immunocompromised patient was successfully treated with three classes of antifungal drugs, IV Micafungin, Amphotericin B, and Posaconazole for nearly 18 days.

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Objective: To evaluate the prevalence of Candida species in cancer patients with candidemia around the world, and to identify related risk factors and their antifungal resistance, with an emphasis on non-albicans Candida species (NACs). Methods: The published papers related to the subject were systematically searched in databases of MEDLINE (including PubMed), Web of Science, Scopus, Science Direct, and Google Scholar between the 1 st January 2000 and 21 st April 2021. Results: Among the 4 546 records, 69 studies met the inclusion criteria. The pooled prevalence of NACs in cancer patients with candidemia was 62% (95% CI 58%-67%; I 2 =94.85%, P=0.00). Based on type of cancer, the pooled prevalence of NACs in hematologic and solid cancer patients were 68% (95% CI 65%-70%) and 52% (95% CI 49%-54%), respectively. Among NACs, Candida (C.) parapsilosis was the most frequently isolated organism followed by C. tropicalis and C. glabrata. In addition, the therapeutic usage of antibiotics was found as the most common risk factor, accounting for 85% (95% CI 81%-89%) and central venous catheter accounting for 69% (95% CI 62%-77%). Conclusions: The incidence of Candida bloodstream infections among cancer patients is a growing concern, especially when the etiologic agents of candidemia tend to shift towards NACs.

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Abstract Background Patients with severe Coronavirus Disease 2019 (COVID-19) are treated with corticosteroids. Aim We aimed to evaluate the role of corticosteroid treatment in candidemia development during the COVID-19 pandemic. Methods This retrospective study was conducted in a Greek ICU, from 2010 to August 2021, encompassing a pre-pandemic and a pandemic period (pandemic period: April 2020 to August 2021). All adult patients with candidemia were included. Results During the study period, 3,572 patients were admitted to the ICU, 339 patients during the pandemic period, of whom 196 were SARS-CoV-2-positive. In total, 281 candidemia episodes were observed in 239 patients, 114 in the pandemic period. The majority of candidemias in both periods were catheter-related (161; 50.4%). The incidence of candidemia in the pre-pandemic period was 5.2 episodes per 100 admissions, while in the pandemic period was 33.6 (p < 0.001). In the pandemic period, the incidence among COVID-19 patients was 38.8 episodes per 100 admissions, while in patients without COVID-19 incidence was 26.6 (p= 0.019). Corticosteroid administration in both periods was not associated with increased candidemia incidence. Conclusions A significant increase of candidemia incidence was observed during the pandemic period in patients with and without COVID-19. This increase cannot be solely attributed to immunosuppression (corticosteroids, tocilizumab) of severe COVID-19 patients, but also to increased workload of medical and nursing staff.

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SUMMARY OBJECTIVE: Parenteral nutrition is an important risk factor for candidemia. In this risk analysis study, the effect of previous antibiotic administration apart from the length of hospital stay, duration of Parenteral nutrition treatment, and Candida score parameters on developing candidemia was evaluated in the non-neutropenic patients receiving Parenteral nutrition treatment. METHODS: In this double center, retrospective, and cross-sectional study, the data of patients who received Parenteral nutrition treatment were collected. Patients with or without candidemia after the initiation of Parenteral nutrition treatment were compared in terms of demographic features, Candida score, length of hospital stay, duration of Parenteral nutrition treatment, and previous use of antibiotics. Then, predictor factors affecting the probability of candidemia during Candida growth time were determined by the Cox regression analysis. RESULTS: A total of 148 patients (59.5% males) were included and 16 (10.81%) of these had candidemia after initiation of parenteral nutrition treatment. The median (min-max) duration of parenteral nutrition treatment was 11 (4-72) days and the Candida growth time was 13 (7-29) days. Statistically significant differences were found between patients with or without candidemia groups in terms of length of hospital stay (p<0.001), duration of parenteral nutrition treatment (p<0.001), and Candida score (p<0.001). To determine the effect of these variables and antibiotics on candidemia, length of hospital stay [Hazard Ratio 1.030; p=0.021] and piperacillin-tazobactam (Hazard Ratio 5.626; p=0.030) were found significant and independent risk factors on the development of candidemia. CONCLUSION: There are some well-known risk factors including length of hospital stay, duration of Parenteral nutrition treatment, and Candida score; the potential impact of piperacillin-tazobactam administration should also be considered since they may be effective on the development of candidemia.

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En diciembre de 2019 se identificó en Wuhan, China, un nuevo coronavirus denominado SARS-CoV-2, agente causal de la epidemia de neumonía atípica COVID-2019, que el 11 de marzo de 2020 fue declarada pandemia por la OMS.Hasta el 30 de septiembre de 2020, en Argentina fueron confirmados 751.001 casos y más de 16.937 muertes.La frecuencia y el impacto de las coinfecciones que afectan a los pacientes infectados por SARS-Cov-2 se ha estudiado junto con el avance de la pandemia. Entre las debidas a hongos se encuentran las fungemias por Candida sp, la aspergilosis invasora, las micosis sistémicas endémicas y la neumocistosis. Presentamos las distintas coinfecciones micosis-COVID-19 que fueron asistidas en nuestra institución entre abril y septiembre de 2020, y se realiza un análisis de las características de estas infecciones en pacientes con y sin sida. En este período se internaron 2837 pacientes, 2287 tuvieron diagnóstico confirmado de COVID-19. La coinfección de COVID-19 con micosis pulmonares o sistémicas fue menor al 1%.Dieciocho pacientes presentaron infecciones fúngicas pulmonares o sistémicas. Ocho padecieron candidemias, cinco criptococosis meningeas, dos histoplasmosis, dos aspergilosis invasoras agudas probables y una aspergilosis pulmonar crónica. La estadía prolongada en terapia intensiva facilitó las fungemias por Candida sp, los casos de histoplasmosis y criptococosis parecen relacionarse con la enfermedad avanzada por VIH y no con COVID-19. Los enfermos con un componente inflamatorio basal alto con neumonía grave por coronavirus se relacionan más con micosis invasoras que los enfermos VIH positivos con niveles bajos de LTCD4+

On December 2019 a new coronavirus (SARS-CoV2) result in atypical pneumonía epidemic, it was identified in Wuhan China and it was called COVID-19. Then on March 11 was declared pandemic by the WHO.Until September 30, 2020 in Argentina 751,001 cases and more than 16,937 deaths have been confirmed. The frequency and impact of co-infections affecting SARS-Cov2 infected patients has been studied with the advance of the pandemic. Among those due to fungi are Candida sp fungemias, invasive aspergillosis, endemic systemic mycoses, and pneumocystosis.We present the different mycosis-COVID-19 co-infections that were assisted in F. J. Muñiz Hospital between April and September of this year and review the characteristics of these infections in patients with and without AIDS is carried out.In this period, 2,837 patients were admitted in the Muñiz hospital, 2,287 had a confirmed diagnosis of COVID-19.Co-infection of COVID-19 with pulmonary or systemic mycoses was less than 1%.Eighteen patients had pulmonary or systemic fungal infections. Eight suffered from candidemia, five meningeal cryptococcosis, two histoplasmosis, two probable acute invasive aspergillosis, and one chronic pulmonary aspergillosis.Prolonged stay in intensive care facilitated fungemia due to Candida sp. Histoplasmosis and cryptococcosis cases seem to be related to advanced HIV disease and not to COVID-19.Patients with a high baseline inflammatory component with severe coronavirus pneumonia are more associated with invasive mycoses than HIV-positive patients with low levels of LTCD4 +

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Candida auris es un hongo emergente, con gran relevancia en corto tiempo, como problema de salud pública mundial. Se reporta por primera vez en el Perú la presencia de Candida auris en 3 pacientes adultos internados en un hospital nacional de alta complejidad en el último trimestre del año 2020, durante la pandemia COVID-19. Los pacientes fueron hospitalizados en UCI; sin embargo, solo en 2 pacientes se aisló dicho germen durante su internamiento en UCI. Los pacientes tuvieron varias comorbilidades y tiempos prolongados de hospitalización desde su admisión hasta tener el primer cultivo positivo a C. auris. Todos los pacientes adquirieron una infección nosocomial bacteriana en algún momento de su hospitalización y recibieron antibióticos de amplio espectro. Todas las cepas aisladas fueron resistentes a fluconazol. El equipo de control de infecciones del hospital reforzó las medidas de contención y el Ministerio de Salud del Perú emitió una alerta epidemiológica.

Candida auris is an emerging fungus that has gained great relevance as a global public health problem in a short time. The presence of Candida auris in 3 adult patients admitted to a national hospital of high complexity in the last quarter of 2020 in the midst of the COVID-19 pandemic is reported for the first time in Peru. The patients were hospitalized in the ICU, however, this germ was isolated in only 2 patients while they were hospitalized in the ICU. The patients had various comorbidities and long hospitalization times from admission to having their first culture positive for C. auris. All patients acquired a bacterial nosocomial infection at some point during their hospitalization and received broad-spectrum antibiotics. All isolates were resistant to fluconazole. The hospital's infection control team reinforced containment measures and the Ministry of Health of Peru issued an epidemiological alert.