{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,23]],"date-time":"2026-10-23T02:00:19Z","timestamp":1792720819602,"version":"4.5.0"},"reference-count":75,"publisher":"Public Library of Science (PLoS)","issue":"2","license":[{"start":{"date-parts":[[2022,2,3]],"date-time":"2022-02-03T00:00:00Z","timestamp":1643846400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100010654","name":"universidad san francisco de quito","doi-asserted-by":"publisher","award":["COCIBA Research Grant 2018-2019 through project ID: 12260 entitled \u201cAdhesi\u00f3n inicial y resistencia antimicrobiana de Candida sp. aisladas de la microbiota humana\u201d MAE-DNB-CM-2016-0046"],"award-info":[{"award-number":["COCIBA Research Grant 2018-2019 through project ID: 12260 entitled \u201cAdhesi\u00f3n inicial y resistencia antimicrobiana de Candida sp. aisladas de la microbiota humana\u201d MAE-DNB-CM-2016-0046"]}],"id":[{"id":"10.13039\/501100010654","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS ONE"],"abstract":"<jats:sec id=\"sec001\">\n<jats:title>Context<\/jats:title>\n<jats:p><jats:italic>Candida<\/jats:italic>-related infections are nowadays a serious Public Health Problem emerging multidrug-resistant strains. <jats:italic>Candida<\/jats:italic> biofilm also leads bloodstream infections to invasive systemic infections.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec002\">\n<jats:title>Objective<\/jats:title>\n<jats:p>The present meta-analysis aimed to analyze <jats:italic>Candida<\/jats:italic> biofilm rate, type, and antifungal resistance among hospitalized patients between 1995 and 2020.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec003\">\n<jats:title>Data sources<\/jats:title>\n<jats:p>Web of Science, Scopus, PubMed, and Google Scholar databases were searched for English papers using the following medical subject heading terms (MESH): \u201cinvasive candidiasis\u201d; \u201cbloodstream infections\u201d; \u201cbiofilm formation\u201d; \u201cbiofilm-related infections\u201d; \u201cmortality\u201d; and \u201cprevalence\u201d.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec004\">\n<jats:title>Study selection<\/jats:title>\n<jats:p>The major inclusion criteria included reporting the rate of biofilm formation and the prevalence of biofilm-related to <jats:italic>Candida<\/jats:italic> species, including observational studies (more exactly, cohort, retrospective, and case-control studies). Furthermore, data regarding the mortality rate, the geographical location of the study set, and the use of anti-fungal agents in clinical isolates were also extracted from the studies.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec005\">\n<jats:title>Data extraction<\/jats:title>\n<jats:p>Independent extraction of articles by 2 authors using predefined data fields, including study quality indicators.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec006\">\n<jats:title>Data synthesis<\/jats:title>\n<jats:p>A total of 31 studies from publicly available databases met our inclusion criteria. The biofilm formation in the data set varied greatly from 16 to 100% in blood samples. Most of the studies belonged to Europe (17\/31) and Asia (9\/31). Forest plot showed a pooled rate of biofilm formation of 80.0% (CI: 67\u201390), with high heterogeneity (Q = 2567.45, I<jats:sup>2<\/jats:sup> = 98.83, \u03c4<jats:sup>2<\/jats:sup> = 0.150) in random effects model (<jats:italic>p<\/jats:italic> &lt; 0.001). The funnel plot and Egger\u2019s linear regression test failed to find publication bias (<jats:italic>p<\/jats:italic> = 0.896). The mortality rate in <jats:italic>Candida<\/jats:italic>-related bloodstream infections was 37.9% of which 70.0% were from biofilm-associated infections. Furthermore, <jats:italic>Candida<\/jats:italic> isolates were also characterized in low, intermediate, or high biofilm formers through their level of biofilm mass (crystal violet staining or XTT assays) after a 24h growth. When comparing between countries, statistical differences were obtained (<jats:italic>p<\/jats:italic> = 0.0074), showing the lower and higher biofilm prevalence values in Italy and Spain, respectively. The prevalence of low, intermediate, and high biofilms were 36.2, 18.9, and 35.0% (<jats:italic>p<\/jats:italic> &lt; 0.0001), respectively. <jats:italic>C<\/jats:italic>. <jats:italic>tropicalis<\/jats:italic> was the prevalent species in high biofilm formation (67.5%) showing statistically significant differences when compared to other <jats:italic>Candida<\/jats:italic> species, except for <jats:italic>C<\/jats:italic>. <jats:italic>krusei<\/jats:italic> and <jats:italic>C<\/jats:italic>. <jats:italic>glabrata<\/jats:italic>. Finally, the rates of antifungal resistance to fluconazole, voriconazole, and caspofungin related to biofilm were 70.5, 67.9 and 72.8% (<jats:italic>p<\/jats:italic> &lt; 0.001), respectively.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec007\">\n<jats:title>Conclusions<\/jats:title>\n<jats:p>Early detection of biofilms and a better characterization of <jats:italic>Candida<\/jats:italic> spp. bloodstream infections should be considered, which eventually will help preserve public health resources and ultimately diminish mortality among patients.<\/jats:p>\n<\/jats:sec>","DOI":"10.1371\/journal.pone.0263522","type":"journal-article","created":{"date-parts":[[2022,2,3]],"date-time":"2022-02-03T18:47:49Z","timestamp":1643914069000},"page":"e0263522","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":102,"title":["Prevalence of biofilms in Candida spp. bloodstream infections: A meta-analysis"],"prefix":"10.1371","volume":"17","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-5232-7900","authenticated-orcid":true,"given":"Mar\u00eda Bel\u00e9n","family":"Atiencia-Carrera","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3064-7089","authenticated-orcid":true,"given":"Fausto 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