Association between Antimicrobial Peptide Histatin 5 Levels and Prevalence of Candida in Saliva of Patients with Down Syndrome

There are no studies on Candida colonization and micropeptides of saliva in any patient. Therefore, we studied the effects of the salivary antimicrobial peptide histatin 5 on oral fungal colonization; subjects were subdivided into Down syndrome (D) and normal (N) groups by age: N-1 and D-1, age <20 years; N-2 and D-2, age >40 years. Histatin 5 concentration in saliva was measured by enzyme-linked immunosorbent assay. Oral Candida species were identified using CHROMagar Candida. Candida colonization was significantly enhanced in the D-1 and D-2 groups compared to the N-1 and N-2 groups. There was no predominant difference in salivary histatin 5 concentration between the D-1 and N-1 groups, but it was significantly lower in the D-2 group than in the N-2 group. Only in the N-2 group was there a correlation between the concentration of histatin 5 and total protein, while no correlation was found in the other groups. In elderly patients with Down syndrome, the decrease in histatin 5 shown in this study may lead to oral Candida colony formation. Therefore, the results of this study suggest that a deficiency of the antimicrobial peptide histatin 5 could possibly induce oral Candida infection in DS.

Candida–Acinetobacter–Pseudomonas Interaction Modelled within 286 ICU Infection Prevention Studies

Background: Whether Candida interacts to enhance the invasive potential of Acinetobacter and Pseudomonas bacteria cannot be resolved within individual studies. There are several anti-septic, antibiotic, anti-fungal, and non-decontamination-based interventions to prevent ICU acquired infection. These effective prevention interventions would be expected to variably impact Candida colonization. The collective observations within control and intervention groups from numerous ICU infection prevention studies simulates a multi-centre natural experiment with which to evaluate Candida, Acinetobacter and Pseudomonas interaction (CAPI). Methods: Eight Candidate-generalized structural equation models (GSEM), with Candida, Pseudomonas and Acinetobacter colonization as latent variables, were confronted with blood culture and respiratory tract isolate data derived from >400 groups derived from 286 infection prevention studies. Results: Introducing an interaction term between Candida colonization and each of Pseudomonas and Acinetobacter colonization improved model fit in each case. The size of the coefficients (and 95% confidence intervals) for these interaction terms in the optimal Pseudomonas (+0.33; 0.22 to 0.45) and Acinetobacter models (+0.32; 0.01 to 0.5) were similar to each other and similar in magnitude, but contrary in direction, to the coefficient for exposure to topical antibiotic prophylaxis (TAP) on Pseudomonas colonization (−0.45; −0.71 to −0.2). The coefficient for exposure to topical antibiotic prophylaxis on Acinetobacter colonization was not significant. Conclusions: GSEM modelling of published ICU infection prevention data supports the CAPI concept. The CAPI model could account for some paradoxically high Acinetobacter and Pseudomonas infection incidences, most apparent among the concurrent control groups of TAP studies.

Association between gastric Candida colonization and surgical site infections after high-level hepatobiliary pancreatic surgeries: the results of prospective observational study

Aim High-level hepatobiliary pancreatic (HBP) surgeries are highly associated with surgical site infections (SSIs), in which microorganisms have a significant role. In the present study, we investigated whether gastric Candida colonization had a significant role in SSIs after high-level HBP surgeries. Methods Between May 2016 and February 2017, the 66 patients who underwent high-level HBP surgeries were enrolled in the present study. The gastric juice was prospectively collected through nasogastric tube after general anesthesia induction and was incubated onto the CHROMagar Candida plate for the cultivation of various Candida species. First of all, we compared the incidence of SSIs according to the presence or absence of Candida species in gastric juice. Secondly, we evaluated the variables contributing to the development of SSIs by multivariate analysis. The protocol was approved by the medical ethics committee of Mie University Hospital (No.2987). Results Gastric Candida colonization was identified in 21 patients (group GC) and was not identified in the other 45 patients (group NGC). There were no differences in preoperative variables including compromised status, such as age, nutritional markers, complications of diabetes mellitus, and types of primary disease between the two groups. SSIs occurred in 57.1% (12/21) of group GC and in 17.8% (8/45) of group NGC, showing a significant difference (p = 0.001). Multivariate analysis revealed gastric Candida colonization as a significant risk factor of SSIs (OR 6.17, p = 0.002). Conclusion Gastric Candida colonization, which is not a result of immunocompromised status, is highly associated with SSIs after high-level HBP surgeries. Trial registration Japan Primary Registries Network; UMIN-CTR ID: UMIN000040486 (retrospectively registered on 22nd May, 2020).

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. 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. FEV1 values &lt; 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 &lt; 0.01), but not for Staphylococcus aureus or Pseudomonas (all p &gt; 0.1). Figure 1. C. albicans prevalence differed by age group (p&lt;0.01). Specifically, prevalence was lower in the 0-2 year old age group (p=0.031). 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 &lt; 0.01), and NTM (p &lt; 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). 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

Oropharyngeal Candida Colonization in Patients with Acute Myeloid Leukemia

Objectives: Oral candidiasis has increased in recent years because of the increasing number of high-risk populations. The prevalence of Candida species is different worldwide because of the difference between population characteristics, sampling protocols, and geographic regions. Therefore, determining the more prevalent Candida species in different geographic regions seems essential. This study aimed to determine the more prevalent Candida species in acute myeloid leukemia (AML) patients in comparison with healthy individuals in Iran in 2016. Materials and Methods: Fifty-one patients with AML and 62 healthy controls participated in this cross-sectional study. Samples were collected using a swab rubbed softly on the dorsal surface of the tongue and the oropharynx. The samples were cultured on CHROMagar Candida for 2 to 4 days. For differentiation between albicans and non-albicans species, positive samples were linearly inoculated on Corn Meal Agar with Tween-80. Candida species were identified using a microscope. Data were analyzed using chi-square and Fisher’s exact tests. Results: Candida colonization was more frequent in AML patients (41.2%) in comparison with healthy participants (38.7%). Candida glabrata (C. glabrata; 27.5%) and Candida albicans (C. albicans; 32.3%) were the most common isolated species in the AML patients and the controls, respectively. There was a significant decrease in the frequency of C. albicans (P=0.022) and a significant increase in the frequency of C. glabrata (P=0.002) in the AML patients in comparison with the controls. Conclusion: AML patients are more susceptible to candidiasis. C. glabrata is the dominant Candida species in AML patients.