Candida biofilm related catheter bloodstream infections
Abstract:
Background: Use of mixed-oil intravenous fat emulsion (MO-IFE) was shown to inhibit C. albicans biofilm formation and overall rate of catheter-related bloodstream infections (CR-BSIs) compared to soybean-oil IFE (SO-IFE). We aimed to delineate this inhibitory mechanism and impact of IFE choice on distribution of fungal CR-BSIs.
Methods: Transcriptional profiling was conducted on C. albicans grown in SO-IFE, MO-IFE, or SO-IFE+capric acid. Overexpression strains of shared downregulated genes were constructed using a tetracycline-off system to assess hypha and biofilm formation in IFEs. A 5-year retrospective multi-center cohort study was performed to assess differences in CR-BSIs caused by Candida species based on IFE formulation received in pediatric patients.
Results: Genes significantly downregulated in MO-IFE and SO-IFE+capric acid included CDC11, HGC1, and UME6. Overexpression of HGC1 or UME6 enabled filamentation in capric acid and MO-IFE. Interestingly, only overexpression of UME6 was sufficient to rescue biofilm growth in MO-IFE. MO-IFE administration was associated with a higher proportion of non-albicans Candida vs. C. albicans CR-BSIs (42% vs 33%; OR 1.22, 95% CI 0.46 to 3.26).
Conclusions: MO-IFE impacts C. albicans biofilm formation and hyphal growth via a UME6-dependent mechanism. A numerical, but not statistically significant difference in distribution of Candida spp. among CR-BSIs was observed.
Reference:
Alvira-Arill GR, Willems HME, Fortwendel JP, Yarbrough A, Tansmore J, Sierra CM, Bashqoy F, Stultz JS, Peters BM. Impact of intravenous fat emulsion choice on Candida biofilm, hyphal growth, and catheter-related bloodstream infections in pediatric patients. J Infect Dis. 2023 Nov 24:jiad527. doi: 10.1093/infdis/jiad527. Epub ahead of print. PMID: 38001054.