Related Experiment Video
Updated: Jul 26, 2025
An Ex vivo Assay to Study Candida albicans Hyphal Morphogenesis in the Gastrointestinal Tract
Published on: July 1, 2020
Breakthrough candidemia with hematological disease: Results from a single-center retrospective study in Japan,
Ruriko Nishida1, Yoshihiro Eriguchi1, Noriko Miyake1
1Department of Medicine and Biosystemic Science, Kyushu University Graduate School of Medical Science, Fukuoka, Japan.
Insights
Breakthrough candidemia in hematologic patients is often caused by Candida guilliermondii complex and Candida parapsilosis, which show reduced echinocandin susceptibility. Hematopoietic stem cell transplant patients face higher mortality rates from this infection.
Area of Science:
- Medical Mycology
- Infectious Diseases
- Hematology
Background:
- Breakthrough candidemia (BrC) poses a significant threat to immunocompromised individuals, especially those with hematological disorders.
- Echinocandin antifungal agents are frequently used in treating BrC, but emerging resistance is a concern.
Purpose of the Study:
- To characterize BrC in hematologic patients treated with novel antifungal agents.
- To investigate the impact of antifungal resistance and patient characteristics on outcomes.
Main Methods:
- Retrospective analysis of 40 BrC cases in patients with hematologic disease from 2009-2020.
- Clinical and microbiological data collection, including antifungal susceptibility testing and genetic analysis (FKS polymorphisms).
Main Results:
- Candida guilliermondii complex (32.5%) and Candida parapsilosis (30%) were the most common isolates.
- These species exhibited reduced echinocandin susceptibility due to FKS gene polymorphisms, despite in vitro susceptibility.
- Patients receiving hematopoietic stem cell transplant (HSCT)-related therapy had a significantly higher 30-day mortality rate (55.2%) compared to those not receiving it (18.2%).
- C. guilliermondii complex BrC in HSCT patients treated with echinocandins had a high mortality rate (53.8%) and risk of persistent infection.
Conclusions:
- Candida guilliermondii complex breakthrough candidemia is a potentially fatal condition in HSCT patients, particularly when treated with echinocandins.
- The prevalence of echinocandin-reduced-susceptible strains like C. guilliermondii complex may be linked to widespread echinocandin use.
- Further research into optimal treatment strategies for resistant candidemia in immunocompromised patients is warranted.
Abstract:
Breakthrough candidemia (BrC) is a significant problem in immunocompromised patients, particularly those with hematological disorders. To assess the characteristics of BrC in patients with hematologic disease treated with novel antifungal agents, we collected clinical and microbiological information on said patients from 2009 to 2020 in our institution. Forty cases were identified, of which 29 (72.5%) received hematopoietic stem cell transplant (HSCT)-related therapy. At BrC onset, the most administered class of antifungal agents were echinocandins, administered to 70% of patients. Candida guilliermondii complex was the most frequently isolated species (32.5%), followed by C. parapsilosis (30%). These two isolates were echinocandin-susceptible in vitro but had naturally occurring FKS gene polymorphisms that reduced echinocandin susceptibility. Frequent isolation of these echinocandin-reduced-susceptible strains in BrC may be associated with the widespread use of echinocandins. In this study, the 30-day crude mortality rate in the group receiving HSCT-related therapy was significantly higher than in the group not receiving it (55.2% versus 18.2%, P = .0297). Most patients affected by C. guilliermondii complex BrC (92.3%) received HSCT-related therapy and had a 30-day mortality rate of 53.8%; despite treatment administration, 3 of 13 patients had persistent candidemia. Based on our results, C. guilliermondii complex BrC is a potentially fatal condition in patients receiving HSCT-related therapy with echinocandin administration.
More Related Videos
Related Concept Videos
01:22Bone Marrow Sampling and Transplants
The transplant begins with high doses of chemotherapy and radiation treatment, which aim to destroy...
02:56Treatment Resistant Cancers
01:25Immunodeficiency Diseases
There are three main causes of immunodeficiency...
01:28Antimicrobial Effectiveness
01:26Factors Affecting the Risk of Infection
The integrity and count of the white blood cells help the body resist pathogens and fight infection. When impaired, it reduces the body's resistance to pathogens. The acidic pH levels of the gastrointestinal, genitourinary tracts, and skin...
01:28Acute Pyelonephritis II: Diagnostic Studies and Management