ABSTRACT
Invasive candidiasis is a life-threatening infection in patients with haematological malignancies. The objective of our study was to determine the incidence, microbiological characteristics and clinical outcome of candidaemia among hospitalized adult patients with haematological malignancies. This is a population-based, prospective, multicentre study of patients ≥ 18 years admitted to haematology and/or haematopoietic stem cell transplantation units of nine tertiary care Greek hospitals from January 2009 through to February 2012. Within this cohort, we conducted a nested case-control study to determine the risk factors for candidaemia. Stepwise logistic regression was used to identify independent predictors of 28-day mortality. Candidaemia was detected in 40 of 27,864 patients with haematological malignancies vs. 967 of 1,158,018 non-haematology patients for an incidence of 1.4 cases/1000 admissions vs. 0.83/1000 respectively (p <0.001). Candidaemia was caused predominantly (35/40, 87.5%) by non-Candida albicans species, particularly Candida parapsilosis (20/40, 50%). In vitro resistance to at least one antifungal agent was observed in 27% of Candida isolates. Twenty-one patients (53%) developed breakthrough candidaemia while receiving antifungal agents. Central venous catheters, hypogammaglobulinaemia and a high APACHE II score were independent risk factors for the development of candidaemia. Crude mortality at day 28 was greater in those with candidaemia than in control cases (18/40 (45%) vs. 9/80 (11%); p <0.0001). In conclusion, despite antifungal prophylaxis, candidaemia is a relatively frequent infection associated with high mortality caused by non-C. albicans spp., especially C. parapsilosis. Central venous catheters and hypogammaglobulinaemia are independent risk factors for candidaemia that provide potential targets for improving the outcome.
Subject(s)
Candida/classification , Candidemia/epidemiology , Candidemia/etiology , Hematologic Neoplasms/complications , Adolescent , Adult , Agammaglobulinemia/drug therapy , Aged , Aged, 80 and over , Antifungal Agents/therapeutic use , Candidemia/microbiology , Candidemia/mortality , Case-Control Studies , Central Venous Catheters/adverse effects , Female , Greece/epidemiology , Hospitalization , Humans , Logistic Models , Male , Middle Aged , Prospective Studies , Risk Factors , Young AdultABSTRACT
The objective of this study was to assess the feasibility of co-digesting grease sludge (GS) originating from domestic wastewater along with sewage sludge (SS) and to assess the effect of organic loading rate (OLR) and GS content on process performance. Three lab-scale semi-continuous fed mesophilic anaerobic digesters were operated under various OLRs and SS-GS mixtures. According to the results, addition of GS up to 60% of the total VS load of feed resulted in a 55% increase of biogas yield (700 vs. 452m(3)/tVSadded) for an OLR of 3.5kg VS/m(3)/d. A stable and satisfactory operation of anaerobic co-digestion units can be achieved for a GS-OLR up to 2.4kg VSGS/m(3)/d. For such values biogas yield is linearly proportional to the applied GS-OLR, whereas biogas yield is minimal for GS-OLR higher than this limit and acidification of the anaerobic digestion units is taking place.
