Early Candida colonisation impact on patients and healthcare professionals in an intensive care unit

Objectives Candida spp. is an opportunistic pathogen that causes superficial and invasive infections with nosocomial outbreaks without strict hygiene protocols. Herein, we assessed oral colonisation by Candida spp. in 209 Intensive Care Unit (ICU) patients between July 2021 and April 2022, conductin...

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Published in:	Mycoses Vol. 67; no. 8; pp. e13786 - n/a
Main Authors:	Dalben, Yago R., Pimentel, Jhully, Maifrede, Simone B., Carvalho, Jamile A., Bessa‐Neto, Francisco O., Gomes, Jean Fabrício S., Leite, Gustavo R., Rodrigues, Anderson M., Cayô, Rodrigo, Grão‐Velloso, Tânia Regina, Gonçalves, Sarah S.
Format:	Journal Article
Language:	English
Published:	Germany Wiley Subscription Services, Inc 01-08-2024
Subjects:	Adult Aged Aged, 80 and over Amplified fragment length polymorphism Amplified Fragment Length Polymorphism Analysis Antifungal Agents - pharmacology Antifungal Agents - therapeutic use Candida Candida - classification Candida - drug effects Candida - genetics Candida - isolation & purification Candidiasis Candidiasis, Invasive - epidemiology Candidiasis, Invasive - microbiology Candidiasis, Oral - epidemiology Candidiasis, Oral - microbiology colonisation Colonization Cross Infection - epidemiology Cross Infection - microbiology Dentures Epidemiology Female Gene polymorphism Genetic analysis Health care Health Personnel healthcare professionals Horizontal transmission (disease) Hospitals Humans Hygiene Intensive care Intensive Care Units Invasive species Male Medical personnel Microbial Sensitivity Tests Middle Aged Mouth - microbiology Opportunist infection outbreak Patients Physical characteristics susceptibility testing yeast outbreak colonisation susceptibility testing healthcare professionals yeast
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Summary:	Objectives Candida spp. is an opportunistic pathogen that causes superficial and invasive infections with nosocomial outbreaks without strict hygiene protocols. Herein, we assessed oral colonisation by Candida spp. in 209 Intensive Care Unit (ICU) patients between July 2021 and April 2022, conducting clinical, epidemiological, and microbiological characterisation of those developing oral or invasive candidiasis. Methods Initial oral swabs were collected within 24 h of admission in the ICU, followed by collections on Days 2, 4, 6 and 8. Swabs from denture‐wearing patients, abiotic surfaces, healthcare professionals' hands, and retroauricular regions were also obtained. Recovered yeasts and filamentous fungi were identified using MALDI‐TOF MS and morphological characteristics, respectively. Genetic similarity of Candida spp. isolates was evaluated using Amplified fragment length polymorphism (AFLP), and the antifungal susceptibility profile was determined by broth microdilution. Results In the study, 64.11% of patients were orally colonised by Candida spp. Of these, 80.59% were colonised within the first 24 h. Oral colonisation also occurred on subsequent days: 50%/Day 2, 26.92%/Day 4, and 11.53%/Days 6 and 8. Of the patients, 8.61% had oral candidiasis, mainly pseudomembranous. Among orally colonised patients, 2.23% developed invasive candidiasis. Besides, 89.47% of healthcare professionals evaluated were colonised. MALDI‐TOF MS identified different yeast species, and C. albicans (45.34%), C. tropicalis (15.7%), and C. parapsilosis sensu stricto (9.88%) were the most prevalent. AFLP analysis indicated a high genetic correlation (≥97%) between C. parapsilosis sensu stricto isolates from patients and professionals. Three resistant C. albicans isolates were also found. Conclusion This study reported a diversity of yeast and filamentous fungi species in ICU patients and highlighted early Candida spp. colonisation risks for invasive candidiasis, as well as the potential horizontal transmission in the nosocomial setting, emphasising the need for effective infection control measures.
Bibliography:	ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 23
ISSN:	0933-7407 1439-0507 1439-0507
DOI:	10.1111/myc.13786