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A 96 Well Microtiter Plate-based Method for Monitoring Formation and Antifungal Susceptibility Testing of Candida albicans Biofilms
Published on: October 21, 2010
Antifungal Susceptibility and Clinical Outcome in Neonatal Candidiasis
Julie Autmizguine1,2,3, Sylvia Tan4, Michael Cohen-Wolkowiez5
1From the Department of Pharmacology and Physiology, Université de Montréal, Montréal, Canada.
Background:
Invasive candidiasis is an important cause of sepsis in extremely low birth weight infants (ELBW, < 1000 g), is often fatal, and frequently results in neurodevelopmental impairment (NDI) among survivors. We sought to assess the antifungal minimum inhibitory concentration (MIC) distribution for Candida in ELBW infants and evaluate the association between antifungal resistance and death or NDI.
Methods:
This was a secondary analysis of a National Institute of Child Health and Human Development Neonatal Research Network study. MIC values were determined for fluconazole, amphotericin B and micafungin. NDI was assessed at 18-22 months adjusted age using the Bayley Scales of Infant Development. An infant was defined as having a resistant Candida isolate if ≥ 1 positive cultures from normally sterile sites (blood, cerebrospinal fluid, or urine) were resistant to ≥ 1 antifungal agent. In addition to resistance status, we categorized fungal isolates according to MIC values (low and high). The association between death/NDI and MIC level was determined using logistic regression, controlling for gestational age and Bayley Scales of Infant Development (II or III).
Results:
Among 137 ELBW infants with IC, MICs were determined for 308 isolates from 110 (80%) infants. Three Candida isolates from 3 infants were resistant to fluconazole. None were resistant to amphotericin B or micafungin. No significant difference in death, NDI, or death/NDI between groups with low and high MICs was observed.
Conclusions:
Antifungal resistance was rare among infecting Candida isolates, and MIC level was not associated with increased risk of death or NDI in this cohort of ELBW infants.
Insights
Antifungal resistance in invasive candidiasis was rare in extremely low birth weight infants. Minimum inhibitory concentration levels did not significantly impact the risk of death or neurodevelopmental impairment in this vulnerable population.
Area of Science:
- Neonatal Medicine
- Infectious Diseases
- Mycology
Background:
- Invasive candidiasis (IC) is a critical cause of sepsis in extremely low birth weight (ELBW) infants, often leading to mortality and neurodevelopmental impairment (NDI).
- Understanding antifungal resistance patterns is crucial for managing IC in this high-risk group.
Purpose of the Study:
- To determine the distribution of antifungal minimum inhibitory concentrations (MICs) for Candida species in ELBW infants.
- To evaluate the association between antifungal resistance and outcomes such as death or NDI in ELBW infants.
Main Methods:
- Secondary analysis of a Neonatal Research Network study involving ELBW infants with IC.
- MIC values for fluconazole, amphotericin B, and micafungin were determined for Candida isolates.
- NDI was assessed using Bayley Scales; antifungal resistance was defined by specific MIC thresholds. Logistic regression was used to analyze associations with death/NDI.
Main Results:
- Among 137 ELBW infants with IC, 308 isolates were analyzed from 110 infants.
- Antifungal resistance was rare: only 3 isolates showed resistance to fluconazole; none were resistant to amphotericin B or micafungin.
- No significant difference in death, NDI, or combined death/NDI was observed between infants with low and high MIC values.
Conclusions:
- Antifungal resistance among Candida isolates causing invasive candidiasis in ELBW infants is uncommon.
- The level of antifungal minimum inhibitory concentration was not associated with an increased risk of death or neurodevelopmental impairment in this cohort.
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