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Combination of Systemic and Lock-Therapies with Micafungin Eradicate Catheter-Based Biofilms and Infections Caused by <i>Candida albicans</i> and <i>Candida parapsilosis</i> in Neutropenic Rabbit Models
oleh: Ruta Petraitiene, Vidmantas Petraitis, Myo H. Zaw, Kaiser Hussain, Rodolfo J. Ricart Arbona, Emanuel Roilides, Thomas J. Walsh
Format: | Article |
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Diterbitkan: | MDPI AG 2024-04-01 |
Deskripsi
Vascular catheter-related infections, primarily caused by <i>Candida albicans</i> and <i>Candida parapsilosis</i>, pose significant challenges due to the formation of biofilms on catheters, leading to refractory disease and considerable morbidity. We studied the efficacy of micafungin in systemic and lock therapies to eliminate catheter-based biofilms and deep tissue infections in experimental central venous catheter (CVC)-related candidemia in neutropenic rabbits. Silastic CVCs in rabbits were inoculated with 1 × 10<sup>3</sup> CFU/mL of <i>C. albicans</i> or <i>C. parapsilosis</i>, establishing catheter-based biofilm, and subjected to various treatments. Neutropenic rabbits treated with a combination of lock therapy and systemic micafungin demonstrated the most significant reduction in fungal burden, from 5.0 × 10<sup>4</sup> to 1.8 × 10<sup>2</sup> CFU/mL of <i>C. albicans</i> and from 5.9 × 10<sup>4</sup> to 2.7 × 10<sup>2</sup> CFU/mL of <i>C. parapsilosis</i> (<i>p</i> ≤ 0.001), in the CVC after 24 h, with full clearance of blood cultures after 72 h from treatment initiation. The combination of lock and systemic micafungin therapy achieved eradication of <i>C. albicans</i> from all studied tissues (0.0 ± 0.0 log CFU/g) vs. untreated controls (liver 7.5 ± 0.22, spleen 8.3 ± 0.25, kidney 8.6 ± 0.07, cerebrum 6.3 ± 0.31, vena cava 6.6 ± 0.29, and CVC wash 2.3 ± 0.68 log CFU/g) (<i>p</i> ≤ 0.001). Rabbits treated with a combination of lock and systemic micafungin therapy demonstrated a ≥2 log reduction in <i>C. parapsilosis</i> in all treated tissues (<i>p</i> ≤ 0.05) except kidney. Serum (1→3)-β-D-glucan levels demonstrated significant decreases in response to treatment. The study demonstrates that combining systemic and lock therapies with micafungin effectively eradicates catheter-based biofilms and infections caused by <i>C. albicans</i> or <i>C. parapsilosis</i>, particularly in persistently neutropenic conditions, offering promising implications for managing vascular catheter-related candidemia and providing clinical benefits in cases where catheter removal is not feasible.