Management of catheter/biofilm related infections

M. Ghannoum1, C. Antachopoulos2

Author address: 

1University Hospitals Case Medical Center, Cleveland, USA and 2Aristotle University of Thessaloniki, Greece

Abstract: 

Nosocomial bloodstream infections caused by Candida species are associated with significant morbidity and mortality. The use of central venous catheters or other implantable prosthetic devices is a recognized risk factor for development of candidemia. Biofilm formation is a stable but strain-specific characteristic that can vary among Candida albicans or non-albicans strains, and plays an important role in persistence of catheter related infections. Yeast cells embedded in biofilms have reduced susceptibility to conventional antifungal therapy as well as to host immune defenses. Therefore, according to current IDSA guidelines for treatment of candidemia, intravenous catheter removal is strongly recommended (nonneutropenic patients, neonates) or should be considered (neutropenic patients). Lately however, a body of data is accumulating that increases our understanding of Candida biofilm formation, biological behavior and treatment. Factors that promote biofilm formation (such as the lipid emulsions) have been identified, while information on gene expression of yeast cells embedded in biofilms is emerging. In addition, the possibility of coexistence of Candida organisms with other microbial populations in the biofilms (such as Staphylococcus or Pseudomonas species) has been recognized and a better understanding of these interspecies interactions is being pursued. The echinocandins and lipid formulations of amphotericin B have been shown to exert better activity against Candida biofilms as compared to the azoles. Still, inter-species differences in susceptibility to these agents have been reported. Several other compounds (EDTA, ethanol, terpenes) also are active against these biofilms and a synergistic effect between the antifungals and some of these agents has been demonstrated. These findings may be useful in optimizing systemic or catheter lock therapy for management of catheter related candidemia. The development of catheters coated with compounds that prevent biofilm formation (such as chitosan, silver) is also under investigation.
2009

abstract No: 

M14

Full conference title: 

4th Trends in Medical Mycology
    • TIMM 4th (2012)