CANDIRES
Candida is a yeast (a type of fungus) that normally lives on the skin and in the gut, without causing any harm. If it grows out of control, Candida can cause infections like thrush. If it enters the bloodstream or some internal organs, Candida can cause serious infections. The risk of serious infection with Candida is higher for people admitted to the ICU and those with a suppressed immune system.
Around 1 in 20 people admitted to the ICU will develop a bloodstream infection from Candida. Candida infections are treated with antifungal medications. Some types of Candida can become resistant to antifungal drugs, making treatment more difficult. Just like with antibiotics, the overuse of antifungal medications is one of the drivers of higher resistance to these drugs.
We do not have much information about how Candida develops resistance in the ICU, and about the impact of antifungal drugs on this development. It is hope that the results of this study will help to improve tools to identify drug resistance, identify whether a treatment for Candida is working in a given patient, and establish a way to assess whether treatment for a Candida bloodstream infection is working. This could allow researchers to better study antifungal drugs within clinical trials.
INCLUSION CRITERIA
1. Age >18
2. Documented Candidaemia
3. One or more of the following Candida risk factors:
-abdominal surgery in the last 4 weeks
-upper GI/mediastinal perforation or surgery in the last 4 weeks
-liver failure
-haematological malignancy
-previous bone marrow or solid organ transplant
-neutropenia (neutrophils<0.5 * 10-9/L)
-receipt of an immunosuppressive drug (including corticosteroids, chemotherapy, immuno-modulators)
-TPN
-renal replacement therapy
-ECMO
EXCLUSION CRITERIA
Expected ICU length of stay <48h
Study Information
Participants will undergo:
- a baseline blood sample (for beta-D-glucan)
- twice weekly oral and perianal skin swab for Candida spp.
Participants who develop suspected or confirmed invasive candidiasis will have additional serial sampling:
- Serial blood sampling for participants with candidaemia (for BDG, culture, Candida quantification, drug level)
- Serial drain fluid sample for participants with deep-seated candidiasis and a drain inserted for clinical reasons.
- Serial urine samples for participants with deep-seated candidiasis and a urinary catheter for clinical reasons.
For each participant, the end of the study is defined as date of ICU discharge or D30 from study enrolment (whichever is later).
​
Primary outcome measure
Colonisation and invasive infection with azole or echinocandin-resistant Candida spp. (e.g. C. glabrata; C. parapsilosis; C. auris) measured using MALDI-ToF mass spectrometry and resistance profiling at the end of follow up
Home
