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

IF 4.1 2区医学 Q1 DERMATOLOGY

Mycoses Pub Date : 2024-08-01 DOI:10.1111/myc.13786

Yago R Dalben, Jhully Pimentel, Simone B Maifrede, Jamile A Carvalho, Francisco O Bessa-Neto, Jean Fabrício S Gomes, Gustavo R Leite, Anderson M Rodrigues, Rodrigo Cayô, Tânia Regina Grão-Velloso, Sarah S Gonçalves

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引用次数: 0

Abstract

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.

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念珠菌早期定植对重症监护病房患者和医护人员的影响。

目的：念珠菌属是一种机会性病原体，可导致表皮感染和侵袭性感染，在没有严格卫生规范的情况下会在医院内爆发。在此，我们评估了 2021 年 7 月至 2022 年 4 月期间 209 名重症监护病房（ICU）患者的念珠菌口腔定植情况，对发生口腔念珠菌病或侵袭性念珠菌病的患者进行了临床、流行病学和微生物学鉴定：在重症监护室入院后 24 小时内收集初始口腔拭子，然后在第 2、4、6 和 8 天收集拭子。此外，还从佩戴义齿的患者、非生物表面、医护人员的手和耳后区域采集拭子。回收的酵母菌和丝状真菌分别使用 MALDI-TOF MS 和形态特征进行鉴定。利用扩增片段长度多态性（AFLP）评估了念珠菌属分离物的遗传相似性，并通过肉汤微量稀释法测定了抗真菌药敏谱：研究结果：64.11%的患者口腔内有念珠菌定植，其中 80.59%在最初 24 小时内定植：50%/第 2 天，26.92%/第 4 天，11.53%/第 6 天和第 8 天。患者中有 8.61% 患有口腔念珠菌病，主要是假膜性念珠菌病。在口腔定植的患者中，有 2.23% 患有侵袭性念珠菌病。此外，在接受评估的医护人员中，89.47%的人带有菌落。MALDI-TOF MS 鉴定出了不同的酵母菌种，其中白念珠菌（45.34%）、热带念珠菌（15.7%）和严格意义上的副丝状念珠菌（9.88%）最为普遍。AFLP 分析表明，从患者和专业人员中分离出的严格副银屑病菌具有高度的遗传相关性（≥97%）。此外，还发现了三种耐药的白僵菌分离株：本研究报告了重症监护病房患者中酵母菌和丝状真菌种类的多样性，强调了念珠菌属早期定植导致侵袭性念珠菌病的风险，以及在医院环境中的潜在水平传播，强调了采取有效感染控制措施的必要性。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Mycoses 医学-皮肤病学

CiteScore

10.00

自引率

8.20%

发文量

143

审稿时长

6-12 weeks

期刊介绍： The journal Mycoses provides an international forum for original papers in English on the pathogenesis, diagnosis, therapy, prophylaxis, and epidemiology of fungal infectious diseases in humans as well as on the biology of pathogenic fungi. Medical mycology as part of medical microbiology is advancing rapidly. Effective therapeutic strategies are already available in chemotherapy and are being further developed. Their application requires reliable laboratory diagnostic techniques, which, in turn, result from mycological basic research. Opportunistic mycoses vary greatly in their clinical and pathological symptoms, because the underlying disease of a patient at risk decisively determines their symptomatology and progress. The journal Mycoses is therefore of interest to scientists in fundamental mycological research, mycological laboratory diagnosticians and clinicians interested in fungal infections.