Evaluation of the possible influence of trailing and paradoxical effects on the clinical outcome of patients with candidemia C. Rueda, M. Puig-Asensio,

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Transcripción de la presentación:

Evaluation of the possible influence of trailing and paradoxical effects on the clinical outcome of patients with candidemia C. Rueda, M. Puig-Asensio, J. Guinea, B. Almirante, M. Cuenca-Estrella, O. Zaragoza B. Padilla, P. Muñoz, J. Guinea, J.R. Paño Pardo, J. García-Rodríguez, C. García Cerrada, J. Fortún, P. Martín, E. Gómez, P. Ryan, C. Campelo, I. de los Santos Gil, V. Buendía, B.P. Gorricho, M. Alonso, F.S. Sanz, J.M. Aguado, P. Merino, F. González Romo, M. Gorgolas, I. Gadea, J.E. Losa, A. Delgado-Iribarren, A. Ramos, Y. Romero, I. Sánchez Romero, O. Zaragoza, M. Cuenca-Estrella, J. Rodriguez-Baño, A. Isabel Suarez, A. Loza, A.I. Aller García, E. Martín-Mazuelos, M.R. Pérez de Pipaón, J. Garnacho, C. Ortiz, M. Chávez, F.L. Maroto, M. Salavert, J. Pemán, J. Blanquer, D. Navarro, J.J. Camarena, R. Zaragoza, V. Abril, C. Gimeno, S. Hernáez, G. Ezpeleta, E. Bereciartua, J.L. Hernández Almaraz, M. Montejo, R.A. Rivas, R. Ayarza, A.M. Planes, I.R. Camps, B. Almirante, J. Mensa, M. Almela, M. Gurgui, F. Sánchez-Reus, J. Martinez- Montauti, M. Sierra, J.P. Horcajada, L. Sorli, J. Gómez, A. Gené, M. Urrea, M. Valerio, A. Díaz-Martín, F. Puchades, A. Mularoni C. Rueda, M. Puig-Asensio, J. Guinea, B. Almirante, M. Cuenca-Estrella, O. Zaragoza B. Padilla, P. Muñoz, J. Guinea, J.R. Paño Pardo, J. García-Rodríguez, C. García Cerrada, J. Fortún, P. Martín, E. Gómez, P. Ryan, C. Campelo, I. de los Santos Gil, V. Buendía, B.P. Gorricho, M. Alonso, F.S. Sanz, J.M. Aguado, P. Merino, F. González Romo, M. Gorgolas, I. Gadea, J.E. Losa, A. Delgado-Iribarren, A. Ramos, Y. Romero, I. Sánchez Romero, O. Zaragoza, M. Cuenca-Estrella, J. Rodriguez-Baño, A. Isabel Suarez, A. Loza, A.I. Aller García, E. Martín-Mazuelos, M.R. Pérez de Pipaón, J. Garnacho, C. Ortiz, M. Chávez, F.L. Maroto, M. Salavert, J. Pemán, J. Blanquer, D. Navarro, J.J. Camarena, R. Zaragoza, V. Abril, C. Gimeno, S. Hernáez, G. Ezpeleta, E. Bereciartua, J.L. Hernández Almaraz, M. Montejo, R.A. Rivas, R. Ayarza, A.M. Planes, I.R. Camps, B. Almirante, J. Mensa, M. Almela, M. Gurgui, F. Sánchez-Reus, J. Martinez- Montauti, M. Sierra, J.P. Horcajada, L. Sorli, J. Gómez, A. Gené, M. Urrea, M. Valerio, A. Díaz-Martín, F. Puchades, A. Mularoni Clinical Microbiology and Infection Volume 23, Issue 1, Pages 49.e1-49.e8 (January 2017) DOI: 10.1016/j.cmi.2016.09.016 Copyright © 2016 European Society of Clinical Microbiology and Infectious Diseases Terms and Conditions

Fig. 1 Flowchart of analysis performed. Diagram shows total number of isolates and patients used in this study; it also summarizes cohort of patients used to investigate clinical relevance of TE to azoles or PG to echinocandins. PG, paradoxical growth; TE, trailing effect. Clinical Microbiology and Infection 2017 23, 49.e1-49.e8DOI: (10.1016/j.cmi.2016.09.016) Copyright © 2016 European Society of Clinical Microbiology and Infectious Diseases Terms and Conditions

Fig. 2 TE throughout 690 Candida spp. isolates studied. Percentage of TE after 24 hours of incubation at 37°C of Candida spp. was determined during treatment with amphotericin B, 5-fluorocitosine, fluconazole, itraconazole, voriconazole, posaconazole, caspofungin, micafungin and anidulafungin. Isolates exhibiting TE were classified as follows: TE moderate, %ΔOD relative to control between 6% and 24% (grey bars), TE strong, %ΔOD relative to control between 25% and 49% (black bars) and TE due to antifungal resistance, %ΔOD relative to control over 50% (white bars). %ΔOD, percentage difference in optical density; PG, paradoxical growth; TE, trailing effect. Clinical Microbiology and Infection 2017 23, 49.e1-49.e8DOI: (10.1016/j.cmi.2016.09.016) Copyright © 2016 European Society of Clinical Microbiology and Infectious Diseases Terms and Conditions

Fig. 3 Presence of PG among 690 Candida spp. isolates studied. Percentage of PG after 24 hours (a) and 120 hours (b) of incubation at 37°C of Candida spp. was determined during treatment with amphotericin B, 5-fluorocitosine, fluconazole, itraconazole, voriconazole, ravuconazole, posaconazole, caspofungin, micafungin and anidulafungin. PG effect was grouped as follows: PG weak, ΔOD between 0.1–0.2 (grey bars) and PG strong ΔOD ≥0.2 (black bars). ΔOD, difference in optical density; PG, paradoxical growth; TE, trailing effect. Clinical Microbiology and Infection 2017 23, 49.e1-49.e8DOI: (10.1016/j.cmi.2016.09.016) Copyright © 2016 European Society of Clinical Microbiology and Infectious Diseases Terms and Conditions