Receipt of parenteral nutrition (PN) remains an independent risk factor for developing catheter-related blood stream infections (CR-BSI) caused by fungi, including the polymorphic fungus Candida albicans that is notoriously adept at forming drug-resistant biofilm structures” Willems et al 92019).
Abstract:
Receipt of parenteral nutrition (PN) remains an independent risk factor for developing catheter-related blood stream infections (CR-BSI) caused by fungi, including the polymorphic fungus Candida albicans that is notoriously adept at forming drug-resistant biofilm structures. Among a variety of macronutrients, PN solutions contain lipid emulsions to supply daily essential fats and are often delivered via central venous catheters (CVC). Therefore, using an in vitro biofilm model system, we sought to determine whether various clinical lipid emulsions differentially impacted biofilm growth in C. albicans We observed that lipid emulsions Intralipid® and Omegaven® both stimulated C. albicans biofilm formation during growth in minimal medium or a macronutrient PN solution. Conversely, Smoflipid® inhibited C. albicans biofilm formation by approximately 50%. Follow up studies revealed that while Smoflipid did not impair C. albicans growth, it did significantly inhibit hypha formation and hyphal elongation. Moreover, growth inhibition could be recapitulated in Intralipid® when supplemented with capric acid-a fatty acid present in Smoflipid® but absent in Intralipid®. Capric acid was also found to dose-dependently inhibit C. albicans biofilm formation in PN solutions. This is the first study to directly compare different clinical lipid emulsions for their capacity to affect C. albicans biofilm growth. Results derived from this study necessitate further research regarding different lipid emulsions and rates of fungal-associated CR-BSIs.
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Reference:
Willems, H.M.E., Stultz, J.S., Coltrane, M.E., Fortwendel, J.P. and Peters, B.M. (2019) Disparate Candida albicans biofilm formation in clinical lipid emulsions due to capric acid mediated inhibition. Antimicrobial Agents and Chemotherapy. August 12th. doi: 10.1128/AAC.01394-19. [Epub ahead of print].