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Clin Microbiol Infect. 2017 Jan;23(1):49.e1-49.e8. doi: 10.1016/j.cmi.2016.09.016. Epub 2016 Sep 24.

Evaluation of the possible influence of trailing and paradoxical effects on the clinical outcome of patients with candidemia.

Author information

1
Mycology Reference Laboratory, National Centre for Microbiology, Instituto de Salud Carlos III, Madrid, Spain.
2
Infectious Diseases Department, Hospital Universitari Vall d'Hebron, Medicine Department, Autonomous University of Barcelona, Barcelona, Spain.
3
Clinical Microbiology and Infectious Diseases, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain.
4
Mycology Reference Laboratory, National Centre for Microbiology, Instituto de Salud Carlos III, Madrid, Spain. Electronic address: ozaragoza@isciii.es.
5
Hospital General Universitario Gregorio Marañón, Madrid, Spain.
6
Hospital Universitario La Paz, Madrid, Spain.
7
Hospital Universitario Ramón y Cajal, Madrid, Spain.
8
Hospital Infanta Leonor, Madrid, Spain.
9
Hospital Universitario La Princesa, Madrid, Spain.
10
Hospital Universitario del Niño Jesús, Madrid, Spain.
11
Hospital Universitario "12 de Octubre", Madrid, Spain.
12
Hospital Clínico San Carlos, Madrid, Spain.
13
Fundación Jiménez Díaz, Madrid, Spain.
14
Hospital de Alcorcón, Madrid, Spain.
15
Hospital Universitario Puerta de Hierro-Majadahonda, Madrid, Spain.
16
Centro Nacional de Microbiología, Instituto de Salud Carlos III, Majadahonda, Madrid, Spain.
17
Hospital Universitario Virgen Macarena, Sevilla, Spain.
18
Hospital Universitario Virgen de Valme, Sevilla, Spain.
19
Hospital Universitario Virgen del Rocío, Sevilla, Spain.
20
Hospital Quirón Sagrado Corazón, Sevilla, Spain.
21
Hospital San Juan de Dios de Aljarafe, Sevilla, Spain.
22
Hospital Universitari La Fe, Valencia, Spain.
23
Hospital Clínico Universitario de Valencia, Valencia, Spain.
24
Hospital Universitario Dr. Peset, Valencia, Spain.
25
Consorcio Hospital General Universitario de Valencia, Valencia, Spain.
26
Hospital de Basurto, Bilbao, Spain.
27
Hospital Universitario de Cruces, Bilbao, Spain.
28
Hospital de Galdakano, Bilbao, Spain.
29
Hospital Universitari Vall d'Hebron, Barcelona, Spain.
30
Hospital Clínic-IDIBAPS, Barcelona, Spain.
31
Hospital Universitari de Sant Pau i Santa Creu, Barcelona, Spain.
32
Hospital de Barcelona, Barcelona, Spain.
33
Hospital del Mar, Barcelona, Spain.
34
Hospital Sant Joan de Déu, Esplugues de Llobregat, Barcelona, Spain.

Abstract

OBJECTIVE:

Paradoxical growth (PG) and trailing effect (TE) are frequently observed during antifungal susceptibility testing (AFST). These two phenomena interfere with the determination of the minimal inhibitory concentration (MIC). The aim of this study was to assess the clinical impact of TE and PG.

METHODS:

We analysed the frequency of TE and PG of 690 Candida isolates collected from a population-based study performed in Spain (CANDIPOP) and correlated the results with clinical outcome of the patients.

RESULTS:

Around 70% (484/690) of the isolates exhibited TE to azoles. Candida tropicalis showed the highest presence of TE (39/53 isolates exhibited residual growth >25% of control). No TE was seen in most of the isolates from the psilosis complex. PG was mainly associated with echinocandins. In patients treated with fluconazole within the first 48 hours after blood sampling (n = 221), the presence of TE to azoles tended to be associated with lower 30-day mortality (odds ratio (OR) 0.55, 95% confidence interval (CI) 0.25-1.00) but not with clinical failure (OR 0.85, 95% CI 0.45-1.54). In the subgroup of 117 patients treated with echinocandins, the presence of PG was not associated with patient's response to antifungal treatment (OR for 30-day mortality 1.63, 95% CI 0.76-4.03; OR for clinical failure 1.17, 95% CI 0.53-2.70).

CONCLUSIONS:

TE or PG are widely expressed among Candida spp., although they do not seem to influence clinical outcome.

KEYWORDS:

Azoles; Candida; Echinocandins; Paradoxical growth; Trailing effect

PMID:
27677697
DOI:
10.1016/j.cmi.2016.09.016
[Indexed for MEDLINE]
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