Cited by 228Antifungal resistance and susceptibilityFungal Infections and StudiesFungal and yeast genetics research

Biofilm formation is a risk factor for mortality in patients with Candida albicans bloodstream infection—Scotland, 2012–2013

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Rajendran, R., Sherry, L., Nile, C.J., Sherriff, A., Johnson, E.M., Hanson, M.F., Williams, C., Munro, C.A. +2 more·2016·Clinical Microbiology and Infection

Abstract

Bloodstream infections caused by Candida species remain a significant cause of morbidity and mortality in hospitalized patients. Biofilm formation by Candida species is an important virulence factor for disease pathogenesis. A prospective analysis of patients with Candida bloodstream infection (n = 217) in Scotland (2012-2013) was performed to assess the risk factors associated with patient mortality, in particular the impact of biofilm formation. Candida bloodstream isolates (n = 280) and clinical records for 157 patients were collected through 11 different health boards across Scotland. Biofilm formation by clinical isolates was assessed in vitro with standard biomass assays. The role of biofilm phenotype on treatment efficacy was also evaluated in vitro by treating preformed biofilms with fixed concentrations of different classes of antifungal. Available mortality data for 134 patients showed that the 30-day candidaemia case mortality rate was 41%, with predisposing factors including patient age and catheter removal. Multivariate Cox regression survival analysis for 42 patients showed a significantly higher mortality rate for Candida albicans infection than for Candida glabrata infection. Biofilm-forming ability was significantly associated with C. albicans mortality (34 patients). Finally, in vitro antifungal sensitivity testing showed that low biofilm formers and high biofilm formers were differentially affected by azoles and echinocandins, but not by polyenes. This study provides further evidence that the biofilm phenotype represents a significant clinical entity, and that isolates with this phenotype differentially respond to antifungal therapy in vitro. Collectively, these findings show that greater clinical understanding is required with respect to Candida biofilm infections, and the implications of isolate heterogeneity.

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  • C. albicans biofilms exhibit high tolerance to antifungal drugs, posing a substantial challenge in clinical treatment.

    “Once established, these biofilms exhibit a high tolerance to antifungal drugs, posing a substantial challenge in clinical treatment [54,55,56,57].”

    From Disruption of the UPC2 Gene Enhances Fluconazole Antifungal Activity by Inhibiting HAC1 mRNA Splicing in Candida albicans (2026) · cites this paper as [54]

    The Results section (‘Biofilm sensitivity to antifungals’) reports that voriconazole was ineffective against mature C. albicans biofilms, supporting a treatment challenge for that drug. It also reports that caspofungin and amphotericin B were effective against both groups tested, so the source does not support high tolerance to antifungal drugs generally; these susceptibility findings were measured in vitro. (LLM, conf=0.86)

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Authors
Rajendran, R., Sherry, L., Nile, C. J., Sherriff, A., Johnson, E. M., Hanson, M. F., Williams, C., Munro, C. A., Jones, B. J., & Ramage, G.
Affiliations
  • University of Glasgow (GB)
  • Public Health England (GB)
  • NHS Lothian (GB)
  • University of the West of Scotland (GB)
  • University of Aberdeen (GB)
  • Glasgow Royal Infirmary (GB)
Corresponding author
Ramage, G.
Venue
Clinical Microbiology and Infection
Publisher
Elsevier BV
Published
2016-01
Volume
22
Issue
1
Pages
87-93
ISSN
1198-743X (ISSN-L)
OpenAlex
W1960109612
Cited by
228
References
25
Citations by year
2026: 14 · 2025: 16 · 2024: 18 · 2023: 22 · 2022: 25 · 2021: 17 · 2020: 25 · 2019: 22 · 2018: 24 · 2017: 29 · 2016: 16
FWCI
17.91
Type
journal article
Language
en
Open access
Locations
  • Clinical Microbiology and Infection (publishedVersion, cc-by)
  • PubMed Central (publishedVersion, cc-by)
  • PubMed (publishedVersion)
  • ENLIGHTEN (Jurnal Bimbingan dan Konseling Islam) (acceptedVersion)
  • The UWS Academic Portal (University of the West of Scotland) (submittedVersion, cc-by)
  • Aberdeen University Research Archive (Aberdeen University) (submittedVersion)
  • Newcastle University ePrints (Newcastle Univesity) (cc-by)
Funders
  • Wellcome Trust (097377/Z/11/Z)
  • Pfizer
  • Gilead Sciences
Topics
  • Health Sciences › Medicine › Infectious Diseases › Antifungal resistance and susceptibility
  • Health Sciences › Medicine › Epidemiology › Fungal Infections and Studies
  • Life Sciences › Biochemistry, Genetics and Molecular Biology › Molecular Biology › Fungal and yeast genetics research
Keywords
Candida albicans, Candida glabrata, biofilm formation, candidemia, bloodstream infection, mortality risk factors, antifungal susceptibility, echinocandins, azoles, polyenes, virulence factors, catheter removal
MeSH terms
Adult, Aged, Aged, 80 and over, Antifungal Agents, Candida albicans, Female, Humans, Male, Middle Aged, Mortality, Retrospective Studies, Scotland, Incidence, Biofilms, Risk Assessment, Candida glabrata, Candidemia

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