Cargando…

1151. Candida Colonization Alters Pathogenic Pulmonary Infection in Pediatric Patients with Cystic Fibrosis

BACKGROUND: Isolation of Candida from the respiratory tract of patients with cystic fibrosis (CF) is common, but its clinical significance remains unclear. We evaluated whether pediatric Candida colonization is associated with specific risk factors, co-pathogens, and degree of respiratory disease. M...

Descripción completa

Detalles Bibliográficos
Autores principales: Parsons, Emily, Colburn, Zach, Friedman, Nicholas, Caboot, Jason, Kunz, Anjali, Sainato, Rebecca
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Oxford University Press 2020
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7777006/
http://dx.doi.org/10.1093/ofid/ofaa439.1337
_version_ 1783630806558703616
author Parsons, Emily
Colburn, Zach
Friedman, Nicholas
Caboot, Jason
Kunz, Anjali
Sainato, Rebecca
author_facet Parsons, Emily
Colburn, Zach
Friedman, Nicholas
Caboot, Jason
Kunz, Anjali
Sainato, Rebecca
author_sort Parsons, Emily
collection PubMed
description BACKGROUND: Isolation of Candida from the respiratory tract of patients with cystic fibrosis (CF) is common, but its clinical significance remains unclear. We evaluated whether pediatric Candida colonization is associated with specific risk factors, co-pathogens, and degree of respiratory disease. METHODS: Using the Military Healthcare System database, we identified 273 pediatric patients with CF who were followed for 938 person-years between 2012 and 2017. To determine whether prevalence was associated with different categorical variables, Fisher’s exact tests were performed on 1000 random samples with the constraint that exactly one interval was selected from each individual to generate each sample. When appropriate, follow-up binomial tests were performed to identify species differences. Individuals with a specific Candida species isolated in ≥50% of their respiratory cultures were considered colonized. Those with C. albicans were analyzed separately from all other Candida species. FEV(1) values < 80% predicted were used as a surrogate for degree of respiratory disease. RESULTS: Candida colonization was not associated with degree of respiratory disease, exocrine pancreatic insufficiency, co-existing diabetes, or the presence of a homozygous F508del CFTR mutation. C. albicans colonization differed by age, and was least prevalent amongst 0-2 year olds (p=0.031) (Fig 1). Compared to those either not colonized with Candida, or colonized with a species other than C. albicans, patients colonized with C. albicans had lower rates of co-infection with Aspergillus (p = 0.041) (Fig 2). Significant differences in Candida colonization between groups was also notable for those colonized with Stenotrophomonas (p=0.014) and Nontuberculous Mycobacterium (p < 0.01), but not for Staphylococcus aureus or Pseudomonas (all p > 0.1). Figure 1. C. albicans prevalence differed by age group (p<0.01). Specifically, prevalence was lower in the 0-2 year old age group (p=0.031). [Image: see text] Figure 2. Individuals were grouped into those without a Candida infection (None), those with non-C. albicans colonization (Other), and those with C. albicans colonization. No differences were found with respect to co-infection with MRSA, MSSA, or Pseudomonas. Significant differences were found with respect to Stenotrophomonas (p=0.014), Aspergillus (p < 0.01), and NTM (p < 0.01). The prevalence of Aspergillus in those individuals with C. albicans was lower compared to those with a different Candida infection or no Candida infection (p=0.041). The prevalence of co-infection with Stenotrophomonas was somewhat elevated among those with a non-C. albicans infection (p=0.052). [Image: see text] CONCLUSION: C. albicans likely plays a role in influencing the airway microbiome of patients with CF. The significance of colonization with other Candida species warrants further exploration. Our data suggests that further studies are needed to evaluate whether Candida may be seen as protective against certain pathogens and therefore this may influence recommendations to treat patients who have CF with antifungals. DISCLOSURES: All Authors: No reported disclosures
format Online
Article
Text
id pubmed-7777006
institution National Center for Biotechnology Information
language English
publishDate 2020
publisher Oxford University Press
record_format MEDLINE/PubMed
spelling pubmed-77770062021-01-07 1151. Candida Colonization Alters Pathogenic Pulmonary Infection in Pediatric Patients with Cystic Fibrosis Parsons, Emily Colburn, Zach Friedman, Nicholas Caboot, Jason Kunz, Anjali Sainato, Rebecca Open Forum Infect Dis Poster Abstracts BACKGROUND: Isolation of Candida from the respiratory tract of patients with cystic fibrosis (CF) is common, but its clinical significance remains unclear. We evaluated whether pediatric Candida colonization is associated with specific risk factors, co-pathogens, and degree of respiratory disease. METHODS: Using the Military Healthcare System database, we identified 273 pediatric patients with CF who were followed for 938 person-years between 2012 and 2017. To determine whether prevalence was associated with different categorical variables, Fisher’s exact tests were performed on 1000 random samples with the constraint that exactly one interval was selected from each individual to generate each sample. When appropriate, follow-up binomial tests were performed to identify species differences. Individuals with a specific Candida species isolated in ≥50% of their respiratory cultures were considered colonized. Those with C. albicans were analyzed separately from all other Candida species. FEV(1) values < 80% predicted were used as a surrogate for degree of respiratory disease. RESULTS: Candida colonization was not associated with degree of respiratory disease, exocrine pancreatic insufficiency, co-existing diabetes, or the presence of a homozygous F508del CFTR mutation. C. albicans colonization differed by age, and was least prevalent amongst 0-2 year olds (p=0.031) (Fig 1). Compared to those either not colonized with Candida, or colonized with a species other than C. albicans, patients colonized with C. albicans had lower rates of co-infection with Aspergillus (p = 0.041) (Fig 2). Significant differences in Candida colonization between groups was also notable for those colonized with Stenotrophomonas (p=0.014) and Nontuberculous Mycobacterium (p < 0.01), but not for Staphylococcus aureus or Pseudomonas (all p > 0.1). Figure 1. C. albicans prevalence differed by age group (p<0.01). Specifically, prevalence was lower in the 0-2 year old age group (p=0.031). [Image: see text] Figure 2. Individuals were grouped into those without a Candida infection (None), those with non-C. albicans colonization (Other), and those with C. albicans colonization. No differences were found with respect to co-infection with MRSA, MSSA, or Pseudomonas. Significant differences were found with respect to Stenotrophomonas (p=0.014), Aspergillus (p < 0.01), and NTM (p < 0.01). The prevalence of Aspergillus in those individuals with C. albicans was lower compared to those with a different Candida infection or no Candida infection (p=0.041). The prevalence of co-infection with Stenotrophomonas was somewhat elevated among those with a non-C. albicans infection (p=0.052). [Image: see text] CONCLUSION: C. albicans likely plays a role in influencing the airway microbiome of patients with CF. The significance of colonization with other Candida species warrants further exploration. Our data suggests that further studies are needed to evaluate whether Candida may be seen as protective against certain pathogens and therefore this may influence recommendations to treat patients who have CF with antifungals. DISCLOSURES: All Authors: No reported disclosures Oxford University Press 2020-12-31 /pmc/articles/PMC7777006/ http://dx.doi.org/10.1093/ofid/ofaa439.1337 Text en © The Author 2020. Published by Oxford University Press on behalf of Infectious Diseases Society of America. http://creativecommons.org/licenses/by-nc-nd/4.0/ This is an Open Access article distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs licence (http://creativecommons.org/licenses/by-nc-nd/4.0/), which permits non-commercial reproduction and distribution of the work, in any medium, provided the original work is not altered or transformed in any way, and that the work is properly cited. For commercial re-use, please contact journals.permissions@oup.com
spellingShingle Poster Abstracts
Parsons, Emily
Colburn, Zach
Friedman, Nicholas
Caboot, Jason
Kunz, Anjali
Sainato, Rebecca
1151. Candida Colonization Alters Pathogenic Pulmonary Infection in Pediatric Patients with Cystic Fibrosis
title 1151. Candida Colonization Alters Pathogenic Pulmonary Infection in Pediatric Patients with Cystic Fibrosis
title_full 1151. Candida Colonization Alters Pathogenic Pulmonary Infection in Pediatric Patients with Cystic Fibrosis
title_fullStr 1151. Candida Colonization Alters Pathogenic Pulmonary Infection in Pediatric Patients with Cystic Fibrosis
title_full_unstemmed 1151. Candida Colonization Alters Pathogenic Pulmonary Infection in Pediatric Patients with Cystic Fibrosis
title_short 1151. Candida Colonization Alters Pathogenic Pulmonary Infection in Pediatric Patients with Cystic Fibrosis
title_sort 1151. candida colonization alters pathogenic pulmonary infection in pediatric patients with cystic fibrosis
topic Poster Abstracts
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7777006/
http://dx.doi.org/10.1093/ofid/ofaa439.1337
work_keys_str_mv AT parsonsemily 1151candidacolonizationalterspathogenicpulmonaryinfectioninpediatricpatientswithcysticfibrosis
AT colburnzach 1151candidacolonizationalterspathogenicpulmonaryinfectioninpediatricpatientswithcysticfibrosis
AT friedmannicholas 1151candidacolonizationalterspathogenicpulmonaryinfectioninpediatricpatientswithcysticfibrosis
AT cabootjason 1151candidacolonizationalterspathogenicpulmonaryinfectioninpediatricpatientswithcysticfibrosis
AT kunzanjali 1151candidacolonizationalterspathogenicpulmonaryinfectioninpediatricpatientswithcysticfibrosis
AT sainatorebecca 1151candidacolonizationalterspathogenicpulmonaryinfectioninpediatricpatientswithcysticfibrosis