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Published in: Infection 2/2014

01-04-2014 | Review

An Italian consensus for invasive candidiasis management (ITALIC)

Authors: L. Scudeller, C. Viscoli, F. Menichetti, V. del Bono, F. Cristini, C. Tascini, M. Bassetti, P. Viale

Published in: Infection | Issue 2/2014

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Abstract

Introduction

Invasive candidiasis (IC) has primarily been studied in intensive care unit (ICU) patients, although, in reality, a vast majority of these infections occur outside of the ICU. The recent publication of the European Society of Clinical Microbiology and Infectious Diseases (ESCMID) guidelines also deal with the non-ICU population, but many uncertainties remain on the management of IC, particularly in non-critically ill patients.

Methods

The Italian Society of Antimicrobial Therapy, Società Italiana di Terapia Antimicrobica (SITA), produced practical, hospital-wide recommendations on the management of Candida infection in non-immunocompromised patients in the hospital ward.

Results and discussion

Our focus is on patient stratification in terms of risk factors for IC and of clinical severity, emphasising a high index of suspicion to ensure early diagnosis, early treatment and de-escalation when a patient is clinically stable, in order to optimise resource allocation.
Appendix
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Literature
1.
go back to reference Kollef M, Micek S, Hampton N, Doherty JA, Kumar A. Septic shock attributed to Candida infection: importance of empiric therapy and source control. Clin Infect Dis. 2012;54:1739–46. doi:10.1093/cid/cis305.PubMed Kollef M, Micek S, Hampton N, Doherty JA, Kumar A. Septic shock attributed to Candida infection: importance of empiric therapy and source control. Clin Infect Dis. 2012;54:1739–46. doi:10.​1093/​cid/​cis305.PubMed
3.
go back to reference Pfaller MA, Jones RN, Doern GV, Sader HS, Hollis RJ, Messer SA. International surveillance of bloodstream infections due to Candida species: frequency of occurrence and antifungal susceptibilities of isolates collected in 1997 in the United States, Canada, and South America for the SENTRY Program. The SENTRY Participant Group. J Clin Microbiol. 1998;36:1886–9.PubMedCentralPubMed Pfaller MA, Jones RN, Doern GV, Sader HS, Hollis RJ, Messer SA. International surveillance of bloodstream infections due to Candida species: frequency of occurrence and antifungal susceptibilities of isolates collected in 1997 in the United States, Canada, and South America for the SENTRY Program. The SENTRY Participant Group. J Clin Microbiol. 1998;36:1886–9.PubMedCentralPubMed
4.
go back to reference Weinstein MP, Towns ML, Quartey SM, Mirrett S, Reimer LG, Parmigiani G, et al. The clinical significance of positive blood cultures in the 1990s: a prospective comprehensive evaluation of the microbiology, epidemiology, and outcome of bacteremia and fungemia in adults. Clin Infect Dis. 1997;24:584–602.PubMed Weinstein MP, Towns ML, Quartey SM, Mirrett S, Reimer LG, Parmigiani G, et al. The clinical significance of positive blood cultures in the 1990s: a prospective comprehensive evaluation of the microbiology, epidemiology, and outcome of bacteremia and fungemia in adults. Clin Infect Dis. 1997;24:584–602.PubMed
5.
go back to reference Edmond MB, Wallace SE, McClish DK, Pfaller MA, Jones RN, Wenzel RP. Nosocomial bloodstream infections in United States hospitals: a three-year analysis. Clin Infect Dis. 1999;29:239–44. doi:10.1086/520192.PubMed Edmond MB, Wallace SE, McClish DK, Pfaller MA, Jones RN, Wenzel RP. Nosocomial bloodstream infections in United States hospitals: a three-year analysis. Clin Infect Dis. 1999;29:239–44. doi:10.​1086/​520192.PubMed
6.
go back to reference Nguyen MH, Peacock JE Jr, Morris AJ, Tanner DC, Nguyen ML, Snydman DR, et al. The changing face of candidemia: emergence of non-Candida albicans species and antifungal resistance. Am J Med. 1996;100:617–23 (pii:S0002934395000100).PubMed Nguyen MH, Peacock JE Jr, Morris AJ, Tanner DC, Nguyen ML, Snydman DR, et al. The changing face of candidemia: emergence of non-Candida albicans species and antifungal resistance. Am J Med. 1996;100:617–23 (pii:S0002934395000100).PubMed
7.
go back to reference Rocco TR, Reinert SE, Simms HH. Effects of fluconazole administration in critically ill patients: analysis of bacterial and fungal resistance. Arch Surg. 2000;135:160–5.PubMed Rocco TR, Reinert SE, Simms HH. Effects of fluconazole administration in critically ill patients: analysis of bacterial and fungal resistance. Arch Surg. 2000;135:160–5.PubMed
10.
go back to reference Garey KW, Rege M, Pai MP, Mingo DE, Suda KJ, Turpin RS, et al. Time to initiation of fluconazole therapy impacts mortality in patients with candidemia: a multi-institutional study. Clin Infect Dis. 2006;43:25–31. doi:10.1086/504810.PubMed Garey KW, Rege M, Pai MP, Mingo DE, Suda KJ, Turpin RS, et al. Time to initiation of fluconazole therapy impacts mortality in patients with candidemia: a multi-institutional study. Clin Infect Dis. 2006;43:25–31. doi:10.​1086/​504810.PubMed
11.
go back to reference Hsu DI, Nguyen M, Nguyen L, Law A, Wong-Beringer A. A multicentre study to evaluate the impact of timing of caspofungin administration on outcomes of invasive candidiasis in non-immunocompromised adult patients. J Antimicrob Chemother. 2010;65:1765–70. doi:10.1093/jac/dkq216.PubMed Hsu DI, Nguyen M, Nguyen L, Law A, Wong-Beringer A. A multicentre study to evaluate the impact of timing of caspofungin administration on outcomes of invasive candidiasis in non-immunocompromised adult patients. J Antimicrob Chemother. 2010;65:1765–70. doi:10.​1093/​jac/​dkq216.PubMed
12.
go back to reference Pappas PG, Kauffman CA, Andes D, Benjamin DK Jr, Calandra TF, Edwards JE Jr, et al. Clinical practice guidelines for the management of candidiasis: 2009 update by the Infectious Diseases Society of America. Clin Infect Dis. 2009;48:503–35. doi:10.1086/596757.PubMed Pappas PG, Kauffman CA, Andes D, Benjamin DK Jr, Calandra TF, Edwards JE Jr, et al. Clinical practice guidelines for the management of candidiasis: 2009 update by the Infectious Diseases Society of America. Clin Infect Dis. 2009;48:503–35. doi:10.​1086/​596757.PubMed
13.
go back to reference Cornely OA, Bassetti M, Calandra T, Garbino J, Kullberg BJ, Lortholary O, et al. ESCMID* guideline for the diagnosis and management of Candida diseases 2012: non-neutropenic adult patients. Clin Microbiol Infect. 2013;18:19–37. doi:10.1111/1469-0691.12039. Cornely OA, Bassetti M, Calandra T, Garbino J, Kullberg BJ, Lortholary O, et al. ESCMID* guideline for the diagnosis and management of Candida diseases 2012: non-neutropenic adult patients. Clin Microbiol Infect. 2013;18:19–37. doi:10.​1111/​1469-0691.​12039.
14.
go back to reference Clancy CJ, Nguyen MH. Finding the “missing 50%” of invasive candidiasis: how nonculture diagnostics will improve understanding of disease spectrum and transform patient care. Clin Infect Dis. 2013;56:1284–1292. doi:10.1093/cid/cit006.PubMed Clancy CJ, Nguyen MH. Finding the “missing 50%” of invasive candidiasis: how nonculture diagnostics will improve understanding of disease spectrum and transform patient care. Clin Infect Dis. 2013;56:1284–1292. doi:10.​1093/​cid/​cit006.PubMed
18.
go back to reference Jaeschke R, Guyatt GH, Dellinger P, Schünemann H, Levy MM, Kunz R, et al. Use of GRADE grid to reach decisions on clinical practice guidelines when consensus is elusive. BMJ. 2008;337:a744.PubMed Jaeschke R, Guyatt GH, Dellinger P, Schünemann H, Levy MM, Kunz R, et al. Use of GRADE grid to reach decisions on clinical practice guidelines when consensus is elusive. BMJ. 2008;337:a744.PubMed
21.
go back to reference National Institute for Health and Clinical Excellence (NICE). The guidelines manual. Last updated January 2009. National Institute for Health and Clinical Excellence (NICE). The guidelines manual. Last updated January 2009.
22.
go back to reference Lortholary O, Desnos-Ollivier M, Sitbon K, Fontanet A, Bretagne S, Dromer F. Recent exposure to caspofungin or fluconazole influences the epidemiology of candidemia: a prospective multicenter study involving 2,441 patients. Antimicrob Agents Chemother. 2011;55:532–8. doi:10.1128/AAC.01128-10.PubMedCentralPubMed Lortholary O, Desnos-Ollivier M, Sitbon K, Fontanet A, Bretagne S, Dromer F. Recent exposure to caspofungin or fluconazole influences the epidemiology of candidemia: a prospective multicenter study involving 2,441 patients. Antimicrob Agents Chemother. 2011;55:532–8. doi:10.​1128/​AAC.​01128-10.PubMedCentralPubMed
25.
26.
go back to reference American College of Chest Physicians/Society of Critical Care. Medicine consensus conference: definitions for sepsis and organ failure and guidelines for the use of innovative therapies in sepsis. Crit Care Med. 1992;20:864–74. American College of Chest Physicians/Society of Critical Care. Medicine consensus conference: definitions for sepsis and organ failure and guidelines for the use of innovative therapies in sepsis. Crit Care Med. 1992;20:864–74.
27.
go back to reference Pittet D, Monod M, Suter PM, Frenk E, Auckenthaler R. Candida colonization and subsequent infections in critically ill surgical patients. Ann Surg. 1994;220:751–8.PubMedCentralPubMed Pittet D, Monod M, Suter PM, Frenk E, Auckenthaler R. Candida colonization and subsequent infections in critically ill surgical patients. Ann Surg. 1994;220:751–8.PubMedCentralPubMed
28.
go back to reference Paphitou NI, Ostrosky-Zeichner L, Rex JH. Rules for identifying patients at increased risk for candidal infections in the surgical intensive care unit: approach to developing practical criteria for systematic use in antifungal prophylaxis trials. Med Mycol. 2005;43:235–43.PubMed Paphitou NI, Ostrosky-Zeichner L, Rex JH. Rules for identifying patients at increased risk for candidal infections in the surgical intensive care unit: approach to developing practical criteria for systematic use in antifungal prophylaxis trials. Med Mycol. 2005;43:235–43.PubMed
29.
go back to reference Ostrosky-Zeichner L, Sable C, Sobel J, Alexander BD, Donowitz G, Kan V, et al. Multicenter retrospective development and validation of a clinical prediction rule for nosocomial invasive candidiasis in the intensive care setting. Eur J Clin Microbiol Infect Dis. 2007;26:271–6. doi:10.1007/s10096-007-0270-z.PubMed Ostrosky-Zeichner L, Sable C, Sobel J, Alexander BD, Donowitz G, Kan V, et al. Multicenter retrospective development and validation of a clinical prediction rule for nosocomial invasive candidiasis in the intensive care setting. Eur J Clin Microbiol Infect Dis. 2007;26:271–6. doi:10.​1007/​s10096-007-0270-z.PubMed
30.
go back to reference León C, Ruiz-Santana S, Saavedra P, Almirante B, Nolla-Salas J, Alvarez-Lerma F, et al. A bedside scoring system (“Candida score”) for early antifungal treatment in nonneutropenic critically ill patients with Candida colonization. Crit Care Med. 2006;34:730–7. doi:10.1097/01.CCM.0000202208.37364.7D.PubMed León C, Ruiz-Santana S, Saavedra P, Almirante B, Nolla-Salas J, Alvarez-Lerma F, et al. A bedside scoring system (“Candida score”) for early antifungal treatment in nonneutropenic critically ill patients with Candida colonization. Crit Care Med. 2006;34:730–7. doi:10.​1097/​01.​CCM.​0000202208.​37364.​7D.PubMed
31.
go back to reference León C, Ruiz-Santana S, Saavedra P, Galván B, Blanco A, Castro C, et al. Usefulness of the “Candida score” for discriminating between Candida colonization and invasive candidiasis in non-neutropenic critically ill patients: a prospective multicenter study. Crit Care Med. 2009;37:1624–33. doi:10.1097/CCM.0b013e31819daa14.PubMed León C, Ruiz-Santana S, Saavedra P, Galván B, Blanco A, Castro C, et al. Usefulness of the “Candida score” for discriminating between Candida colonization and invasive candidiasis in non-neutropenic critically ill patients: a prospective multicenter study. Crit Care Med. 2009;37:1624–33. doi:10.​1097/​CCM.​0b013e31819daa14​.PubMed
33.
go back to reference Posteraro B, De Pascale G, Tumbarello M, Torelli R, Pennisi MA, Bello G, et al. Early diagnosis of candidemia in intensive care unit patients with sepsis: a prospective comparison of (1 → 3)-beta-d-glucan assay, Candida score, and colonization index. Crit Care. 2011;15:R249. doi:10.1186/cc10507.PubMedCentralPubMed Posteraro B, De Pascale G, Tumbarello M, Torelli R, Pennisi MA, Bello G, et al. Early diagnosis of candidemia in intensive care unit patients with sepsis: a prospective comparison of (1 → 3)-beta-d-glucan assay, Candida score, and colonization index. Crit Care. 2011;15:R249. doi:10.​1186/​cc10507.PubMedCentralPubMed
34.
go back to reference Ostrosky-Zeichner L, Pappas PG, Shoham S, Reboli A, Barron MA, Sims C, et al. Improvement of a clinical prediction rule for clinical trials on prophylaxis for invasive candidiasis in the intensive care unit. Mycoses. 2009;54:46–51. doi:10.1111/j.1439-0507.2009.01756.x. Ostrosky-Zeichner L, Pappas PG, Shoham S, Reboli A, Barron MA, Sims C, et al. Improvement of a clinical prediction rule for clinical trials on prophylaxis for invasive candidiasis in the intensive care unit. Mycoses. 2009;54:46–51. doi:10.​1111/​j.​1439-0507.​2009.​01756.​x.
36.
go back to reference Hermsen ED, Zapapas MK, Maiefski M, Rupp ME, Freifeld AG, Kalil AC. Validation and comparison of clinical prediction rules for invasive candidiasis in intensive care unit patients: a matched case–control study. Crit Care. 2011;15:R198. doi:10.1186/cc10366.PubMedCentralPubMed Hermsen ED, Zapapas MK, Maiefski M, Rupp ME, Freifeld AG, Kalil AC. Validation and comparison of clinical prediction rules for invasive candidiasis in intensive care unit patients: a matched case–control study. Crit Care. 2011;15:R198. doi:10.​1186/​cc10366.PubMedCentralPubMed
37.
go back to reference Leroy O, Gangneux JP, Montravers P, Mira JP, Gouin F, Sollet JP, et al. Epidemiology, management, and risk factors for death of invasive Candida infections in critical care: a multicenter, prospective, observational study in France (2005–2006). Crit Care Med. 2009;37:1612–8. doi:10.1097/CCM.0b013e31819efac0.PubMed Leroy O, Gangneux JP, Montravers P, Mira JP, Gouin F, Sollet JP, et al. Epidemiology, management, and risk factors for death of invasive Candida infections in critical care: a multicenter, prospective, observational study in France (2005–2006). Crit Care Med. 2009;37:1612–8. doi:10.​1097/​CCM.​0b013e31819efac0​.PubMed
38.
go back to reference Charles PE, Castro C, Ruiz-Santana S, León C, Saavedra P, Martín E. Serum procalcitonin levels in critically ill patients colonized with Candida spp.: new clues for the early recognition of invasive candidiasis? Intensive Care Med. 2009;35:2146–50. doi:10.1007/s00134-009-1623-0.PubMed Charles PE, Castro C, Ruiz-Santana S, León C, Saavedra P, Martín E. Serum procalcitonin levels in critically ill patients colonized with Candida spp.: new clues for the early recognition of invasive candidiasis? Intensive Care Med. 2009;35:2146–50. doi:10.​1007/​s00134-009-1623-0.PubMed
39.
go back to reference Berenguer J, Buck M, Witebsky F, Stock F, Pizzo PA, Walsh TJ. Lysis-centrifugation blood cultures in the detection of tissue-proven invasive candidiasis. Disseminated versus single-organ infection. Diagn Microbiol Infect Dis. 1993;17:103–9 (pii:0732-8893(93)90020-8).PubMed Berenguer J, Buck M, Witebsky F, Stock F, Pizzo PA, Walsh TJ. Lysis-centrifugation blood cultures in the detection of tissue-proven invasive candidiasis. Disseminated versus single-organ infection. Diagn Microbiol Infect Dis. 1993;17:103–9 (pii:0732-8893(93)90020-8).PubMed
40.
go back to reference Ellis M, Al-Ramadi B, Bernsen R, Kristensen J, Alizadeh H, Hedstrom U. Prospective evaluation of mannan and anti-mannan antibodies for diagnosis of invasive Candida infections in patients with neutropenic fever. J Med Microbiol. 2009;58:606–15. doi:10.1099/jmm.0.006452-0.PubMed Ellis M, Al-Ramadi B, Bernsen R, Kristensen J, Alizadeh H, Hedstrom U. Prospective evaluation of mannan and anti-mannan antibodies for diagnosis of invasive Candida infections in patients with neutropenic fever. J Med Microbiol. 2009;58:606–15. doi:10.​1099/​jmm.​0.​006452-0.PubMed
41.
go back to reference Mikulska M, Calandra T, Sanguinetti M, Poulain D, Viscoli C. The use of mannan antigen and anti-mannan antibodies in the diagnosis of invasive candidiasis: recommendations from the Third European Conference on Infections in Leukemia. Crit Care. 2010;14:R222. doi:10.1186/cc9365.PubMedCentralPubMed Mikulska M, Calandra T, Sanguinetti M, Poulain D, Viscoli C. The use of mannan antigen and anti-mannan antibodies in the diagnosis of invasive candidiasis: recommendations from the Third European Conference on Infections in Leukemia. Crit Care. 2010;14:R222. doi:10.​1186/​cc9365.PubMedCentralPubMed
42.
go back to reference Tokunaga S, Ohkawa M, Takashima M. Diagnostic value of determination of serum mannan concentrations in patients with candiduria. Eur J Clin Microbiol Infect Dis. 1993;12:542–5.PubMed Tokunaga S, Ohkawa M, Takashima M. Diagnostic value of determination of serum mannan concentrations in patients with candiduria. Eur J Clin Microbiol Infect Dis. 1993;12:542–5.PubMed
43.
go back to reference Verduyn Lunel FM, Donnelly JP, van der Lee HA, Blijlevens NM, Verweij PE. Circulating Candida-specific anti-mannan antibodies precede invasive candidiasis in patients undergoing myelo-ablative chemotherapy. Clin Microbiol Infect. 2009;15:380–6. doi:10.1111/j.1469-0691.2008.02654.x.PubMed Verduyn Lunel FM, Donnelly JP, van der Lee HA, Blijlevens NM, Verweij PE. Circulating Candida-specific anti-mannan antibodies precede invasive candidiasis in patients undergoing myelo-ablative chemotherapy. Clin Microbiol Infect. 2009;15:380–6. doi:10.​1111/​j.​1469-0691.​2008.​02654.​x.PubMed
46.
go back to reference Laín A, Elguezabal N, Moragues MD, García-Ruiz JC, del Palacio A, Pontón J. Contribution of serum biomarkers to the diagnosis of invasive candidiasis. Expert Rev Mol Diagn. 2008;8:315–25. doi:10.1586/14737159.8.3.315.PubMed Laín A, Elguezabal N, Moragues MD, García-Ruiz JC, del Palacio A, Pontón J. Contribution of serum biomarkers to the diagnosis of invasive candidiasis. Expert Rev Mol Diagn. 2008;8:315–25. doi:10.​1586/​14737159.​8.​3.​315.PubMed
48.
go back to reference Obayashi T, Negishi K, Suzuki T, Funata N. Reappraisal of the serum (1 → 3)-beta-d-glucan assay for the diagnosis of invasive fungal infections—a study based on autopsy cases from 6 years. Clin Infect Dis. 2008;46:1864–70. doi:10.1086/588295.PubMed Obayashi T, Negishi K, Suzuki T, Funata N. Reappraisal of the serum (1 → 3)-beta-d-glucan assay for the diagnosis of invasive fungal infections—a study based on autopsy cases from 6 years. Clin Infect Dis. 2008;46:1864–70. doi:10.​1086/​588295.PubMed
49.
go back to reference Odabasi Z, Mattiuzzi G, Estey E, Kantarjian H, Saeki F, Ridge RJ, et al. Beta-d-glucan as a diagnostic adjunct for invasive fungal infections: validation, cutoff development, and performance in patients with acute myelogenous leukemia and myelodysplastic syndrome. Clin Infect Dis. 2004;39:199–205. doi:10.1086/421944.PubMed Odabasi Z, Mattiuzzi G, Estey E, Kantarjian H, Saeki F, Ridge RJ, et al. Beta-d-glucan as a diagnostic adjunct for invasive fungal infections: validation, cutoff development, and performance in patients with acute myelogenous leukemia and myelodysplastic syndrome. Clin Infect Dis. 2004;39:199–205. doi:10.​1086/​421944.PubMed
50.
go back to reference Ostrosky-Zeichner L, Alexander BD, Kett DH, Vazquez J, Pappas PG, Saeki F, et al. Multicenter clinical evaluation of the (1 → 3) beta-d-glucan assay as an aid to diagnosis of fungal infections in humans. Clin Infect Dis. 2005;41:654–9. doi:10.1086/432470.PubMed Ostrosky-Zeichner L, Alexander BD, Kett DH, Vazquez J, Pappas PG, Saeki F, et al. Multicenter clinical evaluation of the (1 → 3) beta-d-glucan assay as an aid to diagnosis of fungal infections in humans. Clin Infect Dis. 2005;41:654–9. doi:10.​1086/​432470.PubMed
54.
go back to reference Meersseman W, Lagrou K, Spriet I, Maertens J, Verbeken E, Peetermans WE, et al. Significance of the isolation of Candida species from airway samples in critically ill patients: a prospective, autopsy study. Intensive Care Med. 2009;35:1526–31. doi:10.1007/s00134-009-1482-8.PubMed Meersseman W, Lagrou K, Spriet I, Maertens J, Verbeken E, Peetermans WE, et al. Significance of the isolation of Candida species from airway samples in critically ill patients: a prospective, autopsy study. Intensive Care Med. 2009;35:1526–31. doi:10.​1007/​s00134-009-1482-8.PubMed
55.
go back to reference Gadea I, Cuenca-Estrella M, Martín E, Pemán J, Pontón J, Rodríguez-Tudela JL. Microbiological procedures for diagnosing mycoses and for antifungal susceptibility testing. Enferm Infecc Microbiol Clin. 2007;25:336–40; 13102270 [pii].PubMed Gadea I, Cuenca-Estrella M, Martín E, Pemán J, Pontón J, Rodríguez-Tudela JL. Microbiological procedures for diagnosing mycoses and for antifungal susceptibility testing. Enferm Infecc Microbiol Clin. 2007;25:336–40; 13102270 [pii].PubMed
56.
go back to reference Richardson M, Ellis M. Clinical and laboratory diagnosis. Hosp Med. 2000;61:610–4.PubMed Richardson M, Ellis M. Clinical and laboratory diagnosis. Hosp Med. 2000;61:610–4.PubMed
57.
go back to reference Ruhnke M, Rickerts V, Cornely OA, Buchheidt D, Glöckner A, Heinz W, et al. Diagnosis and therapy of Candida infections: joint recommendations of the German Speaking Mycological Society and the Paul-Ehrlich-Society for Chemotherapy. Mycoses. 2011;54:279–310. doi:10.1111/j.1439-0507.2011.02040.x.PubMed Ruhnke M, Rickerts V, Cornely OA, Buchheidt D, Glöckner A, Heinz W, et al. Diagnosis and therapy of Candida infections: joint recommendations of the German Speaking Mycological Society and the Paul-Ehrlich-Society for Chemotherapy. Mycoses. 2011;54:279–310. doi:10.​1111/​j.​1439-0507.​2011.​02040.​x.PubMed
58.
go back to reference Clinical and Laboratory Standards Institute (CLSI). Principles and procedures for blood cultures; Approved guideline. CLSI document M47-A. Wayne, PA: CLSI; 2007. Clinical and Laboratory Standards Institute (CLSI). Principles and procedures for blood cultures; Approved guideline. CLSI document M47-A. Wayne, PA: CLSI; 2007.
60.
go back to reference Washington JA 2nd. Blood cultures: principles and techniques. Mayo Clin Proc. 1975;50:91–8.PubMed Washington JA 2nd. Blood cultures: principles and techniques. Mayo Clin Proc. 1975;50:91–8.PubMed
61.
go back to reference Cockerill FR 3rd, Wilson JW, Vetter EA, Goodman KM, Torgerson CA, Harmsen WS, et al. Optimal testing parameters for blood cultures. Clin Infect Dis. 2004;38:1724–30. doi:10.1086/421087.PubMed Cockerill FR 3rd, Wilson JW, Vetter EA, Goodman KM, Torgerson CA, Harmsen WS, et al. Optimal testing parameters for blood cultures. Clin Infect Dis. 2004;38:1724–30. doi:10.​1086/​421087.PubMed
62.
go back to reference Mermel LA, Allon M, Bouza E, Craven DE, Flynn P, O’Grady NP, et al. Clinical practice guidelines for the diagnosis and management of intravascular catheter-related infection: 2009 update by the Infectious Diseases Society of America. Clin Infect Dis. 2009;49:1–45. doi:10.1086/599376.PubMed Mermel LA, Allon M, Bouza E, Craven DE, Flynn P, O’Grady NP, et al. Clinical practice guidelines for the diagnosis and management of intravascular catheter-related infection: 2009 update by the Infectious Diseases Society of America. Clin Infect Dis. 2009;49:1–45. doi:10.​1086/​599376.PubMed
63.
go back to reference Karageorgopoulos DE, Vouloumanou EK, Ntziora F, Michalopoulos A, Rafailidis PI, Falagas ME. Beta-d-glucan assay for the diagnosis of invasive fungal infections: a meta-analysis. Clin Infect Dis. 2011;52:750–70. doi:10.1093/cid/ciq206.PubMed Karageorgopoulos DE, Vouloumanou EK, Ntziora F, Michalopoulos A, Rafailidis PI, Falagas ME. Beta-d-glucan assay for the diagnosis of invasive fungal infections: a meta-analysis. Clin Infect Dis. 2011;52:750–70. doi:10.​1093/​cid/​ciq206.PubMed
64.
65.
go back to reference Del Bono V, Delfino E, Furfaro E, Mikulska M, Nicco E, Bruzzi P, et al. Clinical performance of the (1,3)-beta-d-glucan assay in early diagnosis of nosocomial Candida bloodstream infections. Clin Vaccine Immunol. 2011;18:2113–7. doi:10.1128/CVI.05408-11.PubMedCentralPubMed Del Bono V, Delfino E, Furfaro E, Mikulska M, Nicco E, Bruzzi P, et al. Clinical performance of the (1,3)-beta-d-glucan assay in early diagnosis of nosocomial Candida bloodstream infections. Clin Vaccine Immunol. 2011;18:2113–7. doi:10.​1128/​CVI.​05408-11.PubMedCentralPubMed
67.
go back to reference Presterl E, Parschalk B, Bauer E, Lassnigg A, Hajdu S, Graninger W. Invasive fungal infections and (1,3)-beta-d-glucan serum concentrations in long-term intensive care patients. Int J Infect Dis. 2009;13:707–12. doi:10.1016/j.ijid.2008.10.013.PubMed Presterl E, Parschalk B, Bauer E, Lassnigg A, Hajdu S, Graninger W. Invasive fungal infections and (1,3)-beta-d-glucan serum concentrations in long-term intensive care patients. Int J Infect Dis. 2009;13:707–12. doi:10.​1016/​j.​ijid.​2008.​10.​013.PubMed
68.
go back to reference Digby J, Kalbfleisch J, Glenn A, Larsen A, Browder W, Williams D. Serum glucan levels are not specific for presence of fungal infections in intensive care unit patients. Clin Diagn Lab Immunol. 2003;10:882–5.PubMedCentralPubMed Digby J, Kalbfleisch J, Glenn A, Larsen A, Browder W, Williams D. Serum glucan levels are not specific for presence of fungal infections in intensive care unit patients. Clin Diagn Lab Immunol. 2003;10:882–5.PubMedCentralPubMed
70.
go back to reference Takesue Y, Kakehashi M, Ohge H, Imamura Y, Murakami Y, Sasaki M, et al. Combined assessment of beta-d-glucan and degree of candida colonization before starting empiric therapy for candidiasis in surgical patients. World J Surg. 2004;28:625–30. doi:10.1007/s00268-004-7302-y.PubMed Takesue Y, Kakehashi M, Ohge H, Imamura Y, Murakami Y, Sasaki M, et al. Combined assessment of beta-d-glucan and degree of candida colonization before starting empiric therapy for candidiasis in surgical patients. World J Surg. 2004;28:625–30. doi:10.​1007/​s00268-004-7302-y.PubMed
71.
go back to reference Mohr JF, Sims C, Paetznick V, Rodriguez J, Finkelman MA, Rex JH, et al. Prospective survey of (1 → 3)-beta-d-glucan and its relationship to invasive candidiasis in the surgical intensive care unit setting. J Clin Microbiol. 2011;49:58–61. doi:10.1128/JCM.01240-10.PubMedCentralPubMed Mohr JF, Sims C, Paetznick V, Rodriguez J, Finkelman MA, Rex JH, et al. Prospective survey of (1 → 3)-beta-d-glucan and its relationship to invasive candidiasis in the surgical intensive care unit setting. J Clin Microbiol. 2011;49:58–61. doi:10.​1128/​JCM.​01240-10.PubMedCentralPubMed
72.
go back to reference Koo S, Bryar JM, Page JH, Baden LR, Marty FM. Diagnostic performance of the (1 → 3)-beta-d-glucan assay for invasive fungal disease. Clin Infect Dis. 2009;49:1650–9. doi:10.1086/647942.PubMed Koo S, Bryar JM, Page JH, Baden LR, Marty FM. Diagnostic performance of the (1 → 3)-beta-d-glucan assay for invasive fungal disease. Clin Infect Dis. 2009;49:1650–9. doi:10.​1086/​647942.PubMed
73.
go back to reference Acosta J, Catalan M, Del Palacio-Pérez-Medel A, Montejo JC, De-La-Cruz-Bértolo J, Moragues MD, et al. Prospective study in critically ill non-neutropenic patients: diagnostic potential of (1,3)-beta-d-glucan assay and circulating galactomannan for the diagnosis of invasive fungal disease. Eur J Clin Microbiol Infect Dis. 2011;31:721–31. doi:10.1007/s10096-011-1365-0.PubMed Acosta J, Catalan M, Del Palacio-Pérez-Medel A, Montejo JC, De-La-Cruz-Bértolo J, Moragues MD, et al. Prospective study in critically ill non-neutropenic patients: diagnostic potential of (1,3)-beta-d-glucan assay and circulating galactomannan for the diagnosis of invasive fungal disease. Eur J Clin Microbiol Infect Dis. 2011;31:721–31. doi:10.​1007/​s10096-011-1365-0.PubMed
74.
go back to reference Lamoth F, Cruciani M, Mengoli C, Castagnola E, Lortholary O, Richardson M, et al. beta-Glucan antigenemia assay for the diagnosis of invasive fungal infections in patients with hematological malignancies: a systematic review and meta-analysis of cohort studies from the Third European Conference on Infections in Leukemia (ECIL-3). Clin Infect Dis. 2012;54:633–43. doi:10.1093/cid/cir897.PubMed Lamoth F, Cruciani M, Mengoli C, Castagnola E, Lortholary O, Richardson M, et al. beta-Glucan antigenemia assay for the diagnosis of invasive fungal infections in patients with hematological malignancies: a systematic review and meta-analysis of cohort studies from the Third European Conference on Infections in Leukemia (ECIL-3). Clin Infect Dis. 2012;54:633–43. doi:10.​1093/​cid/​cir897.PubMed
75.
go back to reference Nguyen MH, Wissel MC, Shields RK, Salomoni MA, Hao B, Press EG, et al. Performance of Candida real-time polymerase chain reaction, beta-d-glucan assay, and blood cultures in the diagnosis of invasive candidiasis. Clin Infect Dis. 2012;54:1240–8. doi:10.1093/cid/cis200.PubMed Nguyen MH, Wissel MC, Shields RK, Salomoni MA, Hao B, Press EG, et al. Performance of Candida real-time polymerase chain reaction, beta-d-glucan assay, and blood cultures in the diagnosis of invasive candidiasis. Clin Infect Dis. 2012;54:1240–8. doi:10.​1093/​cid/​cis200.PubMed
78.
go back to reference Sendid B, Poirot JL, Tabouret M, Bonnin A, Caillot D, Camus D, et al. Combined detection of mannanaemia and antimannan antibodies as a strategy for the diagnosis of systemic infection caused by pathogenic Candida species. J Med Microbiol. 2002;51:433–42.PubMed Sendid B, Poirot JL, Tabouret M, Bonnin A, Caillot D, Camus D, et al. Combined detection of mannanaemia and antimannan antibodies as a strategy for the diagnosis of systemic infection caused by pathogenic Candida species. J Med Microbiol. 2002;51:433–42.PubMed
79.
go back to reference Nihtinen A, Anttila VJ, Richardson M, Ruutu T, Juvonen E, Meri T, et al. Factors influencing the performance level of Candida mannan antigen testing in allogeneic stem cell transplant recipients not receiving fluconazole prophylaxis. Transpl Infect Dis. 2011;13:266–72. doi:10.1111/j.1399-3062.2010.00593.x.PubMed Nihtinen A, Anttila VJ, Richardson M, Ruutu T, Juvonen E, Meri T, et al. Factors influencing the performance level of Candida mannan antigen testing in allogeneic stem cell transplant recipients not receiving fluconazole prophylaxis. Transpl Infect Dis. 2011;13:266–72. doi:10.​1111/​j.​1399-3062.​2010.​00593.​x.PubMed
80.
go back to reference Maaroufi Y, Heymans C, De Bruyne JM, Duchateau V, Rodriguez-Villalobos H, Aoun M, et al. Rapid detection of Candida albicans in clinical blood samples by using a TaqMan-based PCR assay. J Clin Microbiol. 2003;41:3293–8.PubMedCentralPubMed Maaroufi Y, Heymans C, De Bruyne JM, Duchateau V, Rodriguez-Villalobos H, Aoun M, et al. Rapid detection of Candida albicans in clinical blood samples by using a TaqMan-based PCR assay. J Clin Microbiol. 2003;41:3293–8.PubMedCentralPubMed
81.
go back to reference Moreira-Oliveira MS, Mikami Y, Miyaji M, Imai T, Schreiber AZ, Moretti ML. Diagnosis of candidemia by polymerase chain reaction and blood culture: prospective study in a high-risk population and identification of variables associated with development of candidemia. Eur J Clin Microbiol Infect Dis. 2005;24:721–6. doi:10.1007/s10096-005-0041-7.PubMed Moreira-Oliveira MS, Mikami Y, Miyaji M, Imai T, Schreiber AZ, Moretti ML. Diagnosis of candidemia by polymerase chain reaction and blood culture: prospective study in a high-risk population and identification of variables associated with development of candidemia. Eur J Clin Microbiol Infect Dis. 2005;24:721–6. doi:10.​1007/​s10096-005-0041-7.PubMed
83.
go back to reference Falcone M, Barzaghi N, Carosi G, Grossi P, Minoli L, Ravasio V, et al. Candida infective endocarditis: report of 15 cases from a prospective multicenter study. Medicine (Baltimore). 2009;88:160–8. doi:10.1097/MD.0b013e3181a693f8. Falcone M, Barzaghi N, Carosi G, Grossi P, Minoli L, Ravasio V, et al. Candida infective endocarditis: report of 15 cases from a prospective multicenter study. Medicine (Baltimore). 2009;88:160–8. doi:10.​1097/​MD.​0b013e3181a693f8​.
84.
go back to reference Shoham S, Shaffer R, Sweet L, Cooke R, Donegan N, Boyce S. Candidemia in patients with ventricular assist devices. Clin Infect Dis. 2007;44:e9–12. doi:10.1086/509640.PubMed Shoham S, Shaffer R, Sweet L, Cooke R, Donegan N, Boyce S. Candidemia in patients with ventricular assist devices. Clin Infect Dis. 2007;44:e9–12. doi:10.​1086/​509640.PubMed
85.
go back to reference Pierrotti LC, Baddour LM. Fungal endocarditis, 1995–2000. Chest. 2002;122:302–10.PubMed Pierrotti LC, Baddour LM. Fungal endocarditis, 1995–2000. Chest. 2002;122:302–10.PubMed
86.
go back to reference Andes DR, Safdar N, Baddley JW, Playford G, Reboli AC, Rex JH, et al. Impact of treatment strategy on outcomes in patients with candidemia and other forms of invasive candidiasis: a patient-level quantitative review of randomized trials. Clin Infect Dis. 2012;54:1110–22. doi:10.1093/cid/cis021.PubMed Andes DR, Safdar N, Baddley JW, Playford G, Reboli AC, Rex JH, et al. Impact of treatment strategy on outcomes in patients with candidemia and other forms of invasive candidiasis: a patient-level quantitative review of randomized trials. Clin Infect Dis. 2012;54:1110–22. doi:10.​1093/​cid/​cis021.PubMed
87.
go back to reference Rodríguez-Adrián LJ, King RT, Tamayo-Derat LG, Miller JW, Garcia CA, Rex JH. Retinal lesions as clues to disseminated bacterial and candidal infections: frequency, natural history, and etiology. Medicine (Baltimore). 2003;82:187–202. doi:10.1097/01.md.0000076008.64510.f1. Rodríguez-Adrián LJ, King RT, Tamayo-Derat LG, Miller JW, Garcia CA, Rex JH. Retinal lesions as clues to disseminated bacterial and candidal infections: frequency, natural history, and etiology. Medicine (Baltimore). 2003;82:187–202. doi:10.​1097/​01.​md.​0000076008.​64510.​f1.
88.
go back to reference Parke DW 2nd, Jones DB, Gentry LO. Endogenous endophthalmitis among patients with candidemia. Ophthalmology. 1982;89:789–96.PubMed Parke DW 2nd, Jones DB, Gentry LO. Endogenous endophthalmitis among patients with candidemia. Ophthalmology. 1982;89:789–96.PubMed
89.
92.
go back to reference Jaijakul S, Vazquez JA, Swanson RN, Ostrosky-Zeichner L. (1,3)-beta-d-Glucan as a prognostic marker of treatment response in invasive candidiasis. Clin Infect Dis. 2012;55:521–6. doi:10.1093/cid/cis456.PubMed Jaijakul S, Vazquez JA, Swanson RN, Ostrosky-Zeichner L. (1,3)-beta-d-Glucan as a prognostic marker of treatment response in invasive candidiasis. Clin Infect Dis. 2012;55:521–6. doi:10.​1093/​cid/​cis456.PubMed
93.
go back to reference Pazos C, Moragues MD, Quindós G, Pontón J, del Palacio A. Diagnostic potential of (1,3)-beta-d-glucan and anti-Candida albicans germ tube antibodies for the diagnosis and therapeutic monitoring of invasive candidiasis in neutropenic adult patients. Rev Iberoam Micol. 2006;23:209–15 (pii:200623209).PubMed Pazos C, Moragues MD, Quindós G, Pontón J, del Palacio A. Diagnostic potential of (1,3)-beta-d-glucan and anti-Candida albicans germ tube antibodies for the diagnosis and therapeutic monitoring of invasive candidiasis in neutropenic adult patients. Rev Iberoam Micol. 2006;23:209–15 (pii:200623209).PubMed
94.
go back to reference Eggimann P, Francioli P, Bille J, Schneider R, Wu MM, Chapuis G, et al. Fluconazole prophylaxis prevents intra-abdominal candidiasis in high-risk surgical patients. Crit Care Med. 1999;27:1066–72.PubMed Eggimann P, Francioli P, Bille J, Schneider R, Wu MM, Chapuis G, et al. Fluconazole prophylaxis prevents intra-abdominal candidiasis in high-risk surgical patients. Crit Care Med. 1999;27:1066–72.PubMed
95.
go back to reference Garbino J, Lew DP, Romand JA, Hugonnet S, Auckenthaler R, Pittet D. Prevention of severe Candida infections in nonneutropenic, high-risk, critically ill patients: a randomized, double-blind, placebo-controlled trial in patients treated by selective digestive decontamination. Intensive Care Med. 2002;28:1708–17. doi:10.1007/s00134-002-1540-y.PubMed Garbino J, Lew DP, Romand JA, Hugonnet S, Auckenthaler R, Pittet D. Prevention of severe Candida infections in nonneutropenic, high-risk, critically ill patients: a randomized, double-blind, placebo-controlled trial in patients treated by selective digestive decontamination. Intensive Care Med. 2002;28:1708–17. doi:10.​1007/​s00134-002-1540-y.PubMed
96.
go back to reference Shorr AF, Chung K, Jackson WL, Waterman PE, Kollef MH. Fluconazole prophylaxis in critically ill surgical patients: a meta-analysis. Crit Care Med. 2005;33:1928–35; quiz 36 (pii:00003246-200509000-00005).PubMed Shorr AF, Chung K, Jackson WL, Waterman PE, Kollef MH. Fluconazole prophylaxis in critically ill surgical patients: a meta-analysis. Crit Care Med. 2005;33:1928–35; quiz 36 (pii:00003246-200509000-00005).PubMed
97.
go back to reference Eggimann P, Garbino J, Pittet D. Epidemiology of Candida species infections in critically ill non-immunosuppressed patients. Lancet Infect Dis. 2003;3:685–702 (pii:S1473309903008016).PubMed Eggimann P, Garbino J, Pittet D. Epidemiology of Candida species infections in critically ill non-immunosuppressed patients. Lancet Infect Dis. 2003;3:685–702 (pii:S1473309903008016).PubMed
99.
go back to reference McKinnon PS, Goff DA, Kern JW, Devlin JW, Barletta JF, Sierawski SJ, et al. Temporal assessment of Candida risk factors in the surgical intensive care unit. Arch Surg. 2001;136:1401–8; discussion 9 (pii:soa1025).PubMed McKinnon PS, Goff DA, Kern JW, Devlin JW, Barletta JF, Sierawski SJ, et al. Temporal assessment of Candida risk factors in the surgical intensive care unit. Arch Surg. 2001;136:1401–8; discussion 9 (pii:soa1025).PubMed
100.
go back to reference Blumberg HM, Jarvis WR, Soucie JM, Edwards JE, Patterson JE, Pfaller MA, et al. Risk factors for candidal bloodstream infections in surgical intensive care unit patients: the NEMIS prospective multicenter study. The National Epidemiology of Mycosis Survey. Clin Infect Dis. 2001;33:177–86. doi:10.1086/321811.PubMed Blumberg HM, Jarvis WR, Soucie JM, Edwards JE, Patterson JE, Pfaller MA, et al. Risk factors for candidal bloodstream infections in surgical intensive care unit patients: the NEMIS prospective multicenter study. The National Epidemiology of Mycosis Survey. Clin Infect Dis. 2001;33:177–86. doi:10.​1086/​321811.PubMed
101.
go back to reference Playford EG, Webster AC, Sorrell TC, Craig JC. Antifungal agents for preventing fungal infections in non-neutropenic critically ill and surgical patients: systematic review and meta-analysis of randomized clinical trials. J Antimicrob Chemother. 2006;57:628–38. doi:10.1093/jac/dki491.PubMed Playford EG, Webster AC, Sorrell TC, Craig JC. Antifungal agents for preventing fungal infections in non-neutropenic critically ill and surgical patients: systematic review and meta-analysis of randomized clinical trials. J Antimicrob Chemother. 2006;57:628–38. doi:10.​1093/​jac/​dki491.PubMed
102.
go back to reference Pelz RK, Hendrix CW, Swoboda SM, Diener-West M, Merz WG, Hammond J, et al. Double-blind placebo-controlled trial of fluconazole to prevent candidal infections in critically ill surgical patients. Ann Surg. 2001;233:542–8.PubMedCentralPubMed Pelz RK, Hendrix CW, Swoboda SM, Diener-West M, Merz WG, Hammond J, et al. Double-blind placebo-controlled trial of fluconazole to prevent candidal infections in critically ill surgical patients. Ann Surg. 2001;233:542–8.PubMedCentralPubMed
103.
go back to reference Faiz S, Neale B, Rios E, Campos T, Parsley E, Patel B, et al. Risk-based fluconazole prophylaxis of Candida bloodstream infection in a medical intensive care unit. Eur J Clin Microbiol Infect Dis. 2009;28:689–92. doi:10.1007/s10096-008-0666-4.PubMed Faiz S, Neale B, Rios E, Campos T, Parsley E, Patel B, et al. Risk-based fluconazole prophylaxis of Candida bloodstream infection in a medical intensive care unit. Eur J Clin Microbiol Infect Dis. 2009;28:689–92. doi:10.​1007/​s10096-008-0666-4.PubMed
104.
go back to reference Vardakas KZ, Samonis G, Michalopoulos A, Soteriades ES, Falagas ME. Antifungal prophylaxis with azoles in high-risk, surgical intensive care unit patients: a meta-analysis of randomized, placebo-controlled trials. Crit Care Med. 2006;34:1216–24. doi:10.1097/01.CCM.0000208357.05675.C3.PubMed Vardakas KZ, Samonis G, Michalopoulos A, Soteriades ES, Falagas ME. Antifungal prophylaxis with azoles in high-risk, surgical intensive care unit patients: a meta-analysis of randomized, placebo-controlled trials. Crit Care Med. 2006;34:1216–24. doi:10.​1097/​01.​CCM.​0000208357.​05675.​C3.PubMed
106.
go back to reference Schuster MG, Edwards JE Jr, Sobel JD, Darouiche RO, Karchmer AW, Hadley S, et al. Empirical fluconazole versus placebo for intensive care unit patients: a randomized trial. Ann Intern Med. 2008;149:83–90; 149/2/83 [pii].PubMed Schuster MG, Edwards JE Jr, Sobel JD, Darouiche RO, Karchmer AW, Hadley S, et al. Empirical fluconazole versus placebo for intensive care unit patients: a randomized trial. Ann Intern Med. 2008;149:83–90; 149/2/83 [pii].PubMed
107.
go back to reference Parkins MD, Sabuda DM, Elsayed S, Laupland KB. Adequacy of empirical antifungal therapy and effect on outcome among patients with invasive Candida species infections. J Antimicrob Chemother. 2007;60:613–8. doi:10.1093/jac/dkm212.PubMed Parkins MD, Sabuda DM, Elsayed S, Laupland KB. Adequacy of empirical antifungal therapy and effect on outcome among patients with invasive Candida species infections. J Antimicrob Chemother. 2007;60:613–8. doi:10.​1093/​jac/​dkm212.PubMed
108.
go back to reference Kumar A, Ellis P, Arabi Y, Roberts D, Light B, Parrillo JE, et al. Initiation of inappropriate antimicrobial therapy results in a fivefold reduction of survival in human septic shock. Chest. 2009;136:1237–48. doi:10.1378/chest.09-0087.PubMed Kumar A, Ellis P, Arabi Y, Roberts D, Light B, Parrillo JE, et al. Initiation of inappropriate antimicrobial therapy results in a fivefold reduction of survival in human septic shock. Chest. 2009;136:1237–48. doi:10.​1378/​chest.​09-0087.PubMed
112.
go back to reference Karthaus M, Rüping MJ, Cornely OA, Steinbach A, Groll AH, Lass-Flörl C, et al. Current issues in the clinical management of invasive candida infections—the AGIHO, DMykG, ÖGMM and PEG web-based survey and expert consensus conference 2009. Mycoses. 2011;54:e546–56. doi:10.1111/j.1439-0507.2010.01988.x.PubMed Karthaus M, Rüping MJ, Cornely OA, Steinbach A, Groll AH, Lass-Flörl C, et al. Current issues in the clinical management of invasive candida infections—the AGIHO, DMykG, ÖGMM and PEG web-based survey and expert consensus conference 2009. Mycoses. 2011;54:e546–56. doi:10.​1111/​j.​1439-0507.​2010.​01988.​x.PubMed
113.
go back to reference Shah DN, Yau R, Weston J, Lasco TM, Salazar M, Palmer HR, et al. Evaluation of antifungal therapy in patients with candidaemia based on susceptibility testing results: implications for antimicrobial stewardship programmes. J Antimicrob Chemother. 2011;66:2146–51. doi:10.1093/jac/dkr244.PubMed Shah DN, Yau R, Weston J, Lasco TM, Salazar M, Palmer HR, et al. Evaluation of antifungal therapy in patients with candidaemia based on susceptibility testing results: implications for antimicrobial stewardship programmes. J Antimicrob Chemother. 2011;66:2146–51. doi:10.​1093/​jac/​dkr244.PubMed
114.
go back to reference Kourkoumpetis TK, Velmahos GC, Ziakas PD, Tampakakis E, Manolakaki D, Coleman JJ, et al. The effect of cumulative length of hospital stay on the antifungal resistance of Candida strains isolated from critically ill surgical patients. Mycopathologia. 2011;171:85–91. doi:10.1007/s11046-010-9369-3.PubMed Kourkoumpetis TK, Velmahos GC, Ziakas PD, Tampakakis E, Manolakaki D, Coleman JJ, et al. The effect of cumulative length of hospital stay on the antifungal resistance of Candida strains isolated from critically ill surgical patients. Mycopathologia. 2011;171:85–91. doi:10.​1007/​s11046-010-9369-3.PubMed
115.
go back to reference Shah DN, Yau R, Lasco TM, Weston J, Salazar M, Palmer HR, et al. Impact of prior inappropriate fluconazole dosing on isolation of fluconazole-nonsusceptible Candida species in hospitalized patients with candidemia. Antimicrob Agents Chemother. 2012;56:3239–43. doi:10.1128/AAC.00019-12.PubMedCentralPubMed Shah DN, Yau R, Lasco TM, Weston J, Salazar M, Palmer HR, et al. Impact of prior inappropriate fluconazole dosing on isolation of fluconazole-nonsusceptible Candida species in hospitalized patients with candidemia. Antimicrob Agents Chemother. 2012;56:3239–43. doi:10.​1128/​AAC.​00019-12.PubMedCentralPubMed
117.
go back to reference Ben-Ami R, Olshtain-Pops K, Krieger M, Oren I, Bishara J, Dan M, et al. Antibiotic exposure as a risk factor for fluconazole-resistant Candida bloodstream infection. Antimicrob Agents Chemother. 2012;56:2518–23. doi:10.1128/AAC.05947-11.PubMedCentralPubMed Ben-Ami R, Olshtain-Pops K, Krieger M, Oren I, Bishara J, Dan M, et al. Antibiotic exposure as a risk factor for fluconazole-resistant Candida bloodstream infection. Antimicrob Agents Chemother. 2012;56:2518–23. doi:10.​1128/​AAC.​05947-11.PubMedCentralPubMed
118.
go back to reference Tortorano AM, Prigitano A, Dho G, Grancini A, Passera M. Antifungal susceptibility profiles of Candida isolates from a prospective survey of invasive fungal infections in Italian intensive care units. J Med Microbiol. 2012;61:389–93. doi:10.1099/jmm.0.037895-0.PubMed Tortorano AM, Prigitano A, Dho G, Grancini A, Passera M. Antifungal susceptibility profiles of Candida isolates from a prospective survey of invasive fungal infections in Italian intensive care units. J Med Microbiol. 2012;61:389–93. doi:10.​1099/​jmm.​0.​037895-0.PubMed
119.
go back to reference van der Voort PH, Boerma EC, Yska JP. Serum and intraperitoneal levels of amphotericin B and flucytosine during intravenous treatment of critically ill patients with Candida peritonitis. J Antimicrob Chemother. 2007;59:952–6. doi:10.1093/jac/dkm074.PubMed van der Voort PH, Boerma EC, Yska JP. Serum and intraperitoneal levels of amphotericin B and flucytosine during intravenous treatment of critically ill patients with Candida peritonitis. J Antimicrob Chemother. 2007;59:952–6. doi:10.​1093/​jac/​dkm074.PubMed
120.
go back to reference Mora-Duarte J, Betts R, Rotstein C, Colombo AL, Thompson-Moya L, Smietana J, et al. Comparison of caspofungin and amphotericin B for invasive candidiasis. N Engl J Med. 2002;347:2020–9. doi:10.1056/NEJMoa021585.PubMed Mora-Duarte J, Betts R, Rotstein C, Colombo AL, Thompson-Moya L, Smietana J, et al. Comparison of caspofungin and amphotericin B for invasive candidiasis. N Engl J Med. 2002;347:2020–9. doi:10.​1056/​NEJMoa021585.PubMed
121.
go back to reference Kuse ER, Chetchotisakd P, da Cunha CA, Ruhnke M, Barrios C, Raghunadharao D, et al. Micafungin versus liposomal amphotericin B for candidaemia and invasive candidosis: a phase III randomised double-blind trial. Lancet. 2007;369:1519–27. doi:10.1016/S0140-6736(07)60605-9.PubMed Kuse ER, Chetchotisakd P, da Cunha CA, Ruhnke M, Barrios C, Raghunadharao D, et al. Micafungin versus liposomal amphotericin B for candidaemia and invasive candidosis: a phase III randomised double-blind trial. Lancet. 2007;369:1519–27. doi:10.​1016/​S0140-6736(07)60605-9.PubMed
122.
go back to reference Reboli AC, Shorr AF, Rotstein C, Pappas PG, Kett DH, Schlamm HT, et al. Anidulafungin compared with fluconazole for treatment of candidemia and other forms of invasive candidiasis caused by Candida albicans: a multivariate analysis of factors associated with improved outcome. BMC Infect Dis. 2011;11:261. doi:10.1186/1471-2334-11-261.PubMedCentralPubMed Reboli AC, Shorr AF, Rotstein C, Pappas PG, Kett DH, Schlamm HT, et al. Anidulafungin compared with fluconazole for treatment of candidemia and other forms of invasive candidiasis caused by Candida albicans: a multivariate analysis of factors associated with improved outcome. BMC Infect Dis. 2011;11:261. doi:10.​1186/​1471-2334-11-261.PubMedCentralPubMed
123.
go back to reference Pappas PG, Rotstein CM, Betts RF, Nucci M, Talwar D, De Waele JJ, et al. Micafungin versus caspofungin for treatment of candidemia and other forms of invasive candidiasis. Clin Infect Dis. 2007;45:883–93. doi:10.1086/520980.PubMed Pappas PG, Rotstein CM, Betts RF, Nucci M, Talwar D, De Waele JJ, et al. Micafungin versus caspofungin for treatment of candidemia and other forms of invasive candidiasis. Clin Infect Dis. 2007;45:883–93. doi:10.​1086/​520980.PubMed
124.
go back to reference Glöckner A. Treatment and prophylaxis of invasive candidiasis with anidulafungin, caspofungin and micafungin: review of the literature. Eur J Med Res. 2011;16:167–79.PubMedCentralPubMed Glöckner A. Treatment and prophylaxis of invasive candidiasis with anidulafungin, caspofungin and micafungin: review of the literature. Eur J Med Res. 2011;16:167–79.PubMedCentralPubMed
125.
go back to reference Reboli AC, Rotstein C, Pappas PG, Chapman SW, Kett DH, Kumar D, et al. Anidulafungin versus fluconazole for invasive candidiasis. N Engl J Med. 2007;356:2472–82. doi:10.1056/NEJMoa066906.PubMed Reboli AC, Rotstein C, Pappas PG, Chapman SW, Kett DH, Kumar D, et al. Anidulafungin versus fluconazole for invasive candidiasis. N Engl J Med. 2007;356:2472–82. doi:10.​1056/​NEJMoa066906.PubMed
126.
127.
go back to reference Gafter-Gvili A, Vidal L, Goldberg E, Leibovici L, Paul M. Treatment of invasive candidal infections: systematic review and meta-analysis. Mayo Clin Proc. 2008;83:1011–21. doi:10.4065/83.9.1011.PubMed Gafter-Gvili A, Vidal L, Goldberg E, Leibovici L, Paul M. Treatment of invasive candidal infections: systematic review and meta-analysis. Mayo Clin Proc. 2008;83:1011–21. doi:10.​4065/​83.​9.​1011.PubMed
129.
go back to reference Pfaller MA, Moet GJ, Messer SA, Jones RN, Castanheira M. Candida bloodstream infections: comparison of species distributions and antifungal resistance patterns in community-onset and nosocomial isolates in the SENTRY Antimicrobial Surveillance Program, 2008–2009. Antimicrob Agents Chemother. 2010;55:561–6. doi:10.1128/AAC.01079-10.PubMedCentralPubMed Pfaller MA, Moet GJ, Messer SA, Jones RN, Castanheira M. Candida bloodstream infections: comparison of species distributions and antifungal resistance patterns in community-onset and nosocomial isolates in the SENTRY Antimicrobial Surveillance Program, 2008–2009. Antimicrob Agents Chemother. 2010;55:561–6. doi:10.​1128/​AAC.​01079-10.PubMedCentralPubMed
130.
go back to reference Pfaller MA, Messer SA, Moet GJ, Jones RN, Castanheira M. Candida bloodstream infections: comparison of species distribution and resistance to echinocandin and azole antifungal agents in Intensive Care Unit (ICU) and non-ICU settings in the SENTRY Antimicrobial Surveillance Program (2008–2009). Int J Antimicrob Agents. 2011;38:65–9. doi:10.1016/j.ijantimicag.2011.02.016.PubMed Pfaller MA, Messer SA, Moet GJ, Jones RN, Castanheira M. Candida bloodstream infections: comparison of species distribution and resistance to echinocandin and azole antifungal agents in Intensive Care Unit (ICU) and non-ICU settings in the SENTRY Antimicrobial Surveillance Program (2008–2009). Int J Antimicrob Agents. 2011;38:65–9. doi:10.​1016/​j.​ijantimicag.​2011.​02.​016.PubMed
131.
go back to reference Cantón E, Pemán J, Quindós G, Eraso E, Miranda-Zapico I, Álvarez M, et al. Prospective multicenter study of the epidemiology, molecular identification, and antifungal susceptibility of Candida parapsilosis, Candida orthopsilosis, and Candida metapsilosis isolated from patients with candidemia. Antimicrob Agents Chemother. 2011;55:5590–6. doi:10.1128/AAC.00466-11.PubMedCentralPubMed Cantón E, Pemán J, Quindós G, Eraso E, Miranda-Zapico I, Álvarez M, et al. Prospective multicenter study of the epidemiology, molecular identification, and antifungal susceptibility of Candida parapsilosis, Candida orthopsilosis, and Candida metapsilosis isolated from patients with candidemia. Antimicrob Agents Chemother. 2011;55:5590–6. doi:10.​1128/​AAC.​00466-11.PubMedCentralPubMed
132.
go back to reference Blanchard E, Lortholary O, Boukris-Sitbon K, Desnos-Ollivier M, Dromer F, Guillemot D. Prior caspofungin exposure in patients with hematological malignancies is a risk factor for subsequent fungemia due to decreased susceptibility in Candida spp.: a case–control study in Paris, France. Antimicrob Agents Chemother. 2011;55:5358–61. doi:10.1128/AAC.00690-11.PubMedCentralPubMed Blanchard E, Lortholary O, Boukris-Sitbon K, Desnos-Ollivier M, Dromer F, Guillemot D. Prior caspofungin exposure in patients with hematological malignancies is a risk factor for subsequent fungemia due to decreased susceptibility in Candida spp.: a case–control study in Paris, France. Antimicrob Agents Chemother. 2011;55:5358–61. doi:10.​1128/​AAC.​00690-11.PubMedCentralPubMed
133.
go back to reference Spreghini E, Orlando F, Tavanti A, Senesi S, Giannini D, Manso E, et al. In vitro and in vivo effects of echinocandins against Candida parapsilosis sensu stricto, Candida orthopsilosis and Candida metapsilosis. J Antimicrob Chemother. 2012;67:2195–202. doi:10.1093/jac/dks180.PubMed Spreghini E, Orlando F, Tavanti A, Senesi S, Giannini D, Manso E, et al. In vitro and in vivo effects of echinocandins against Candida parapsilosis sensu stricto, Candida orthopsilosis and Candida metapsilosis. J Antimicrob Chemother. 2012;67:2195–202. doi:10.​1093/​jac/​dks180.PubMed
134.
go back to reference Betts RF, Nucci M, Talwar D, Gareca M, Queiroz-Telles F, Bedimo RJ, et al. A multicenter, double-blind trial of a high-dose caspofungin treatment regimen versus a standard caspofungin treatment regimen for adult patients with invasive candidiasis. Clin Infect Dis. 2009;48:1676–84. doi:10.1086/598933.PubMed Betts RF, Nucci M, Talwar D, Gareca M, Queiroz-Telles F, Bedimo RJ, et al. A multicenter, double-blind trial of a high-dose caspofungin treatment regimen versus a standard caspofungin treatment regimen for adult patients with invasive candidiasis. Clin Infect Dis. 2009;48:1676–84. doi:10.​1086/​598933.PubMed
135.
go back to reference Dupont BF, Lortholary O, Ostrosky-Zeichner L, Stucker F, Yeldandi V. Treatment of candidemia and invasive candidiasis in the intensive care unit: post hoc analysis of a randomized, controlled trial comparing micafungin and liposomal amphotericin B. Crit Care. 2009;13:R159. doi:10.1186/cc8117.PubMedCentralPubMed Dupont BF, Lortholary O, Ostrosky-Zeichner L, Stucker F, Yeldandi V. Treatment of candidemia and invasive candidiasis in the intensive care unit: post hoc analysis of a randomized, controlled trial comparing micafungin and liposomal amphotericin B. Crit Care. 2009;13:R159. doi:10.​1186/​cc8117.PubMedCentralPubMed
136.
go back to reference Mistro S, Maciel Ide M, de Menezes RG, Maia ZP, Schooley RT, Badaró R. Does lipid emulsion reduce amphotericin B nephrotoxicity? A systematic review and meta-analysis. Clin Infect Dis. 2012;54:1774–7. doi:10.1093/cid/cis290.PubMed Mistro S, Maciel Ide M, de Menezes RG, Maia ZP, Schooley RT, Badaró R. Does lipid emulsion reduce amphotericin B nephrotoxicity? A systematic review and meta-analysis. Clin Infect Dis. 2012;54:1774–7. doi:10.​1093/​cid/​cis290.PubMed
137.
go back to reference Ullmann AJ, Sanz MA, Tramarin A, Barnes RA, Wu W, Gerlach BA, et al. Prospective study of amphotericin B formulations in immunocompromised patients in 4 European countries. Clin Infect Dis. 2006;43:e29–38. doi:10.1086/505969.PubMed Ullmann AJ, Sanz MA, Tramarin A, Barnes RA, Wu W, Gerlach BA, et al. Prospective study of amphotericin B formulations in immunocompromised patients in 4 European countries. Clin Infect Dis. 2006;43:e29–38. doi:10.​1086/​505969.PubMed
139.
go back to reference Anaissie EJ, Darouiche RO, Abi-Said D, Uzun O, Mera J, Gentry LO, et al. Management of invasive candidal infections: results of a prospective, randomized, multicenter study of fluconazole versus amphotericin B and review of the literature. Clin Infect Dis. 1996;23:964–72.PubMed Anaissie EJ, Darouiche RO, Abi-Said D, Uzun O, Mera J, Gentry LO, et al. Management of invasive candidal infections: results of a prospective, randomized, multicenter study of fluconazole versus amphotericin B and review of the literature. Clin Infect Dis. 1996;23:964–72.PubMed
140.
go back to reference Rex JH, Bennett JE, Sugar AM, Pappas PG, van der Horst CM, Edwards JE, et al. A randomized trial comparing fluconazole with amphotericin B for the treatment of candidemia in patients without neutropenia. Candidemia Study Group and the National Institute. N Engl J Med. 1994;331:1325–30. doi:10.1056/NEJM199411173312001.PubMed Rex JH, Bennett JE, Sugar AM, Pappas PG, van der Horst CM, Edwards JE, et al. A randomized trial comparing fluconazole with amphotericin B for the treatment of candidemia in patients without neutropenia. Candidemia Study Group and the National Institute. N Engl J Med. 1994;331:1325–30. doi:10.​1056/​NEJM199411173312​001.PubMed
141.
go back to reference Phillips P, Shafran S, Garber G, Rotstein C, Smaill F, Fong I, et al. Multicenter randomized trial of fluconazole versus amphotericin B for treatment of candidemia in non-neutropenic patients. Canadian Candidemia Study Group. Eur J Clin Microbiol Infect Dis. 1997;16:337–45.PubMed Phillips P, Shafran S, Garber G, Rotstein C, Smaill F, Fong I, et al. Multicenter randomized trial of fluconazole versus amphotericin B for treatment of candidemia in non-neutropenic patients. Canadian Candidemia Study Group. Eur J Clin Microbiol Infect Dis. 1997;16:337–45.PubMed
142.
go back to reference Oude Lashof AM, Sobel JD, Ruhnke M, Pappas PG, Viscoli C, Schlamm HT, et al. Safety and tolerability of voriconazole in patients with baseline renal insufficiency and candidemia. Antimicrob Agents Chemother. 2012;56:3133–7. doi:10.1128/AAC.05841-11.PubMedCentralPubMed Oude Lashof AM, Sobel JD, Ruhnke M, Pappas PG, Viscoli C, Schlamm HT, et al. Safety and tolerability of voriconazole in patients with baseline renal insufficiency and candidemia. Antimicrob Agents Chemother. 2012;56:3133–7. doi:10.​1128/​AAC.​05841-11.PubMedCentralPubMed
144.
go back to reference Tuil O, Cohen Y. Itraconazole IV solution in the treatment of candidemia in non-neutropenic patients. Crit Care. 2003;7:P131.PubMedCentral Tuil O, Cohen Y. Itraconazole IV solution in the treatment of candidemia in non-neutropenic patients. Crit Care. 2003;7:P131.PubMedCentral
148.
go back to reference Riddell J 4th, Comer GM, Kauffman CA. Treatment of endogenous fungal endophthalmitis: focus on new antifungal agents. Clin Infect Dis. 2011;52:648–53. doi:10.1093/cid/ciq204.PubMed Riddell J 4th, Comer GM, Kauffman CA. Treatment of endogenous fungal endophthalmitis: focus on new antifungal agents. Clin Infect Dis. 2011;52:648–53. doi:10.​1093/​cid/​ciq204.PubMed
149.
go back to reference Hariprasad SM, Mieler WF, Holz ER, Gao H, Kim JE, Chi J, et al. Determination of vitreous, aqueous, and plasma concentration of orally administered voriconazole in humans. Arch Ophthalmol. 2004;122:42–7. doi:10.1001/archopht.122.1.42.PubMed Hariprasad SM, Mieler WF, Holz ER, Gao H, Kim JE, Chi J, et al. Determination of vitreous, aqueous, and plasma concentration of orally administered voriconazole in humans. Arch Ophthalmol. 2004;122:42–7. doi:10.​1001/​archopht.​122.​1.​42.PubMed
150.
go back to reference Kujath P, Lerch K, Kochendörfer P, Boos C. Comparative study of the efficacy of fluconazole versus amphotericin B/flucytosine in surgical patients with systemic mycoses. Infection. 1993;21:376–82.PubMed Kujath P, Lerch K, Kochendörfer P, Boos C. Comparative study of the efficacy of fluconazole versus amphotericin B/flucytosine in surgical patients with systemic mycoses. Infection. 1993;21:376–82.PubMed
152.
go back to reference Kullberg BJ, Sobel JD, Ruhnke M, Pappas PG, Viscoli C, Rex JH, et al. Voriconazole versus a regimen of amphotericin B followed by fluconazole for candidaemia in non-neutropenic patients: a randomised non-inferiority trial. Lancet. 2005;366:1435–42. doi:10.1016/S0140-6736(05)67490-9.PubMed Kullberg BJ, Sobel JD, Ruhnke M, Pappas PG, Viscoli C, Rex JH, et al. Voriconazole versus a regimen of amphotericin B followed by fluconazole for candidaemia in non-neutropenic patients: a randomised non-inferiority trial. Lancet. 2005;366:1435–42. doi:10.​1016/​S0140-6736(05)67490-9.PubMed
153.
154.
go back to reference Schwartz S, Ruhnke M, Ribaud P, Corey L, Driscoll T, Cornely OA, et al. Improved outcome in central nervous system aspergillosis, using voriconazole treatment. Blood. 2005;106:2641–5. doi:10.1182/blood-2005-02-0733.PubMed Schwartz S, Ruhnke M, Ribaud P, Corey L, Driscoll T, Cornely OA, et al. Improved outcome in central nervous system aspergillosis, using voriconazole treatment. Blood. 2005;106:2641–5. doi:10.​1182/​blood-2005-02-0733.PubMed
155.
go back to reference Boucher HW, Groll AH, Chiou CC, Walsh TJ. Newer systemic antifungal agents: pharmacokinetics, safety and efficacy. Drugs. 2004;64:1997–2020 (pii:64181).PubMed Boucher HW, Groll AH, Chiou CC, Walsh TJ. Newer systemic antifungal agents: pharmacokinetics, safety and efficacy. Drugs. 2004;64:1997–2020 (pii:64181).PubMed
156.
go back to reference Lutsar I, Roffey S, Troke P. Voriconazole concentrations in the cerebrospinal fluid and brain tissue of guinea pigs and immunocompromised patients. Clin Infect Dis. 2003;37:728–32. doi:10.1086/377131.PubMed Lutsar I, Roffey S, Troke P. Voriconazole concentrations in the cerebrospinal fluid and brain tissue of guinea pigs and immunocompromised patients. Clin Infect Dis. 2003;37:728–32. doi:10.​1086/​377131.PubMed
157.
go back to reference Black KE, Baden LR. Fungal infections of the CNS: treatment strategies for the immunocompromised patient. CNS Drugs. 2007;21:293–318 (pii:2144).PubMed Black KE, Baden LR. Fungal infections of the CNS: treatment strategies for the immunocompromised patient. CNS Drugs. 2007;21:293–318 (pii:2144).PubMed
158.
go back to reference Bennett JE, Dismukes WE, Duma RJ, Medoff G, Sande MA, Gallis H, et al. A comparison of amphotericin B alone and combined with flucytosine in the treatment of cryptoccal meningitis. N Engl J Med. 1979;301:126–31. doi:10.1056/NEJM197907193010303.PubMed Bennett JE, Dismukes WE, Duma RJ, Medoff G, Sande MA, Gallis H, et al. A comparison of amphotericin B alone and combined with flucytosine in the treatment of cryptoccal meningitis. N Engl J Med. 1979;301:126–31. doi:10.​1056/​NEJM197907193010​303.PubMed
159.
go back to reference Fan-Havard P, O’Donovan C, Smith SM, Oh J, Bamberger M, Eng RH. Oral fluconazole versus amphotericin B bladder irrigation for treatment of candidal funguria. Clin Infect Dis. 1995;21:960–5.PubMed Fan-Havard P, O’Donovan C, Smith SM, Oh J, Bamberger M, Eng RH. Oral fluconazole versus amphotericin B bladder irrigation for treatment of candidal funguria. Clin Infect Dis. 1995;21:960–5.PubMed
162.
go back to reference Schilling A, Seibold M, Mansmann V, Gleissner B. Successfully treated Candida krusei infection of the lumbar spine with combined caspofungin/posaconazole therapy. Med Mycol. 2008;46:79–83. doi:10.1080/13693780701552996.PubMed Schilling A, Seibold M, Mansmann V, Gleissner B. Successfully treated Candida krusei infection of the lumbar spine with combined caspofungin/posaconazole therapy. Med Mycol. 2008;46:79–83. doi:10.​1080/​1369378070155299​6.PubMed
163.
go back to reference Kaldau NC, Brorson S, Jensen PE, Schultz C, Arpi M. Bilateral polymicrobial osteomyelitis with Candida tropicalis and Candida krusei: a case report and an updated literature review. Int J Infect Dis. 2012;16:e16–22. doi:10.1016/j.ijid.2011.10.001.PubMed Kaldau NC, Brorson S, Jensen PE, Schultz C, Arpi M. Bilateral polymicrobial osteomyelitis with Candida tropicalis and Candida krusei: a case report and an updated literature review. Int J Infect Dis. 2012;16:e16–22. doi:10.​1016/​j.​ijid.​2011.​10.​001.PubMed
166.
go back to reference McMullan R, Metwally L, Coyle PV, Hedderwick S, McCloskey B, O’Neill HJ, et al. A prospective clinical trial of a real-time polymerase chain reaction assay for the diagnosis of candidemia in nonneutropenic, critically ill adults. Clin Infect Dis. 2008;46:890–6. doi:10.1086/528690.PubMed McMullan R, Metwally L, Coyle PV, Hedderwick S, McCloskey B, O’Neill HJ, et al. A prospective clinical trial of a real-time polymerase chain reaction assay for the diagnosis of candidemia in nonneutropenic, critically ill adults. Clin Infect Dis. 2008;46:890–6. doi:10.​1086/​528690.PubMed
Metadata
Title
An Italian consensus for invasive candidiasis management (ITALIC)
Authors
L. Scudeller
C. Viscoli
F. Menichetti
V. del Bono
F. Cristini
C. Tascini
M. Bassetti
P. Viale
Publication date
01-04-2014
Publisher
Springer Berlin Heidelberg
Published in
Infection / Issue 2/2014
Print ISSN: 0300-8126
Electronic ISSN: 1439-0973
DOI
https://doi.org/10.1007/s15010-013-0558-0

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