Biofilm formation is a risk factor for mortality in patients with Candida albicans bloodstream infection-Scotland, 2012-2013.
Biofilm formation is a risk factor for mortality in patients with Candida albicans bloodstream infection-Scotland, 2012-2013.
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DOI：
10.1016/j.cmi.2015.09.018
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发表时间：
2016-01
期刊：
影响因子：
--
通讯作者：
Ramage G
中科院分区：
文献类型：
--
作者：
Rajendran R;Sherry L;Nile CJ;Sherriff A;Johnson EM;Hanson MF;Williams C;Munro CA;Jones BJ;Ramage G
念珠菌引起的血流感染仍然是住院患者发病和死亡的重要原因。念珠菌形成的生物膜是疾病发病的重要毒力因素。对苏格兰（2012-2013）假丝酵母血液感染患者（n = 217）进行了前瞻性分析，以评估与患者死亡率相关的危险因素，特别是生物膜形成的影响。念珠菌血液分离株（n = 280）和157名患者的临床记录通过苏格兰11个不同的卫生委员会收集。采用标准生物量法评估临床分离菌体外形成的生物膜。通过在体外用固定浓度的不同种类的抗真菌药物处理预成型的生物膜，评估生物膜表型对治疗效果的作用。134例患者的现有死亡率数据显示，30天念珠菌血症病例死亡率为41%，诱发因素包括患者年龄和导管拔除。42例患者的多因素Cox回归生存分析显示，白色念珠菌感染的死亡率明显高于光秃念珠菌感染。生物膜形成能力与白色念珠菌死亡率显著相关（34例）。最后，体外抗真菌敏感性测试表明，低生物成膜性和高生物成膜性受到氮唑和棘白菌素的不同影响，而对多烯没有影响。这项研究提供了进一步的证据，证明生物膜表型代表了一个重要的临床实体，并且具有这种表型的分离株对体外抗真菌治疗有不同的反应。总的来说，这些发现表明，对于念珠菌生物膜感染，以及分离株异质性的含义，需要更多的临床理解。
Bloodstream infections caused by Candida species remain a significant cause of morbidity and mortality in hospitalized patients. Biofilm formation by Candida species is an important virulence factor for disease pathogenesis. A prospective analysis of patients with Candida bloodstream infection (n = 217) in Scotland (2012–2013) was performed to assess the risk factors associated with patient mortality, in particular the impact of biofilm formation. Candida bloodstream isolates (n = 280) and clinical records for 157 patients were collected through 11 different health boards across Scotland. Biofilm formation by clinical isolates was assessed in vitro with standard biomass assays. The role of biofilm phenotype on treatment efficacy was also evaluated in vitro by treating preformed biofilms with fixed concentrations of different classes of antifungal. Available mortality data for 134 patients showed that the 30-day candidaemia case mortality rate was 41%, with predisposing factors including patient age and catheter removal. Multivariate Cox regression survival analysis for 42 patients showed a significantly higher mortality rate for Candida albicans infection than for Candida glabrata infection. Biofilm-forming ability was significantly associated with C. albicans mortality (34 patients). Finally, in vitro antifungal sensitivity testing showed that low biofilm formers and high biofilm formers were differentially affected by azoles and echinocandins, but not by polyenes. This study provides further evidence that the biofilm phenotype represents a significant clinical entity, and that isolates with this phenotype differentially respond to antifungal therapy in vitro. Collectively, these findings show that greater clinical understanding is required with respect to Candida biofilm infections, and the implications of isolate heterogeneity.