Colonization by Candida in a neonatal intensive care unit
Main Article Content
Keywords
Candida, Critical care neonatal, Infant newborn
Abstract
Background: Candida infections have increased in the last few decades. Previous colonization is the most important risk factor for the development of fungemia. Understanding local epidemiology is necessary in order to select the optimal anti-fungal treatment. The purpose of this study was to establish colonization by Candida in patients, staff and medical devices in a neonatal intensive care unit.
Methods: A prospective cohort study was conducted. Cultures were obtained from different anatomic sites, from medical devices and from the hands of healthcare staff at admission and every 7 days until discharge of the unit. Identification and susceptibility tests to amphotericin B, fluconazole, itraconazole, voriconazole and caspofungin were performed.
Results: Out of 98 patients, 24 % were already colonized at admission, 15 % became colonized during their stay at the hospital. Out of 738 samples obtained from devices, 2 % were positive. Out of 89 cultures obtained from hands, 55 % were positive. A total of 124 Candida strains were retrieved; Candida parapsilosis was the most common species (59 %), followed by Candida albicans (26 %). Resistance to itraconazole was only found in 13 %.
Conclusions: Colonization in neonatal intensive care-admitted patients was 40 %, and it was a common event in the hands of the healthcare staff. Candida parapsilosis was the predominant species. Resistance was found only to itraconazole.
References
Rodríguez D, Almirante B, Park BJ, Cuenca-Estrella M, Planes AM, Sánchez F, et al. Candidemia in neonatal intensive care units. Pediatr Infect Dis J. 2006;25(3):224-9.
Celebi S, Hacimustafaoglu M, Koksal N, Ozkan H, Cetinkaya M, Ener B. Neonatal candidiasis: Results of an 8 year study. Pediatr Int. 2012;54(3):341-9.
Abi-Said D, Anaissie E, Uzun O, Raad I, Pinzcowski H, Vartivarian S. The epidemiology of hematogenous candidiasis caused by different Candida species. Clin Infect Dis. 1997;24(6):1122-8. Texto libre en http://cid.oxfordjournals.org/content/24/6/1122.long
Beck-Sague CM, Jarvis WR. Secular trends in the epidemiology of nosocomial fungal infections in the United States, 1980-1990. J Infect Dis. 1993; 167(5):1247-51.
Rangel-Frausto MS, Wiblin T, Blumberg HM, Saiman L, Patterson J, Rinaldi M, et al. National epidemiology of mycoses survey (NEMIS): Variations in rates of bloodstream infections due to Candida species in seven surgical intensive care units and six neonatal intensive care units. Clin Infect Dis. 1999;29(2):253-8. Texto libre en http://cid.oxfordjournals.org/content/29/2/253.long
Sánchez-Huerta G, Díaz-Ponce H, Díaz-Ramos R, Solórzano-Santos F, Jiménez-Galicia C, Miranda-Novales G. Epidemiología de las infecciones sistémicas por Candida en el Hospital de Pediatría del Centro Médico Nacional Siglo XXI. Bol Med Hosp Infant Mex. 2004;61(4):289-96.
Hope WW, Castagnola E, Groll AH, Roilides E, Akova M, Arendrup MC, et al. ESCMID* guideline for the diagnosis and management of Candida diseases 2012: Prevention and management of invasive infections in neonates and children caused by Candida spp. Clin Microbiol Infect. 2012;18(Supl 7):38-52.
Nguyen MH, Peacock JE Jr, Morris AJ, Tanner DC, Nguyen ML, Snydman DR, et al. The changing face of candidemia: Emergence of non-Candida albicans species and antifungal resistance. Am J Med. 1996;100(6):617-23.
Farmaki E, Evdoridou J, Pouliou T, Bibashi E, Panagopoulou P, Filioti J, et al. Fungal colonization in the neonatal intensive care unit: Risk factors, drug susceptibility and association with invasive fungal infections. Am J Perinatol. 2007;24(2):127-35.
Caramalac DA, Da Silva-Ruiz L, de Batista GC, Birman EG, Duarte M, Hahn R, Paula CR. Candida isolated from vaginal mucosa of mothers and oral mucosa of neonates: Occurrence and biotypes concordance. Pediatr Infect Dis. 2007;26(7):553-7.
Bliss J, Basavegowda P, Watson WJ, Sheik AU, Ryan RM. Vertical and horizontal transmission of Candida albicans in very low weight infants using DNA fingerprint techniques. Pediatr Infect Dis J. 2008;27 (3):231-5.
Mendiratta DK, Rawat V, Thamke D, Chaturvedi P, Chhabra S, Narang P. Candida colonization in preterm babies admitted to neonatal intensive care unit in the rural setting. Ind J Med Microbiol. 2006; 24(4):263-7. Texto libre en http://www.ijmm.org/article.asp?issn=0255-0857;year=2006;volume=24;issue=4;spage=263;epage=267;aulast=Mendiratta
Reyna FJ, Fragoso DA, Ortiz IF, Soriano BD, Bermúdez G, Plazola CN. Epidemiología hospitalaria de candidiasis en el Instituto Nacional de Perinatología en un periodo de 5 años. Enf Inf Microbiol. 2007;27(4):110-3.
Messer SA, Jones RN, Fritsche TR. International surveillance of Candida spp. and Aspergillus spp. Report from the SENTRY antimicrobial surveillance program (2003). J Clin Microbiol. 2006;44(5):1782-7. Texto libre en http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1479200/
González GM, Elizondo M, Ayala J. Trends in species distribution and susceptibility of bloodstream isolates of Candida collected in Monterrey, Mexico, to seven antifungal agents: Results of a 3-year (2004-2007) surveillance study. J Clin Microbiol. 2008; 46(9):2902-5. Texto libre en http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2546732/
Abelson JA, Moore T, Bruckner D, Deville J, Nielsen K. Frequency of fungemia in hospitalized pediatric inpatients over 11 years at a tertiary care institution. Pediatrics. 2005;116(1):61-7. Texto libre en http://pediatrics.aappublications.org/content/116/1/61.long
Larru B, Zaoutis TE. Newer antifungal agents. Curr Opin Pediatr. 2013;25(1):110-5.
Brunetti L, De Caro F, Boccia G, Cavallo P, Capunzo M. Surveillance of nosocomial infections: A preliminary study on yeast carriage on hands of health care workers. J Prev Med Hyg. 2008;49(2):63-8.
National Committee for Clinical Laboratory Standards. 2002 Reference method for broth dilution antifungal susceptibility testing of yeasts. Approved standard M27-A2. Second edition. Wayne, PA: National Committee for Clinical Laboratory Standards; 2002.
Pfaller M, Messer S, Boyken L, Rice C, Tendolkar S, Hollis R, et al. Further standarization of broth microdilution methodology for in vitro susceptibility testing of caspofungin against Candida species by use of an international collection of more than 3,000 clinical isolates. J Clin Microbiol. 2004;42(7):3117-9. Texto libre en http://www.ncbi.nlm.nih.gov/pmc/articles/PMC446304/
Pfaller MA, Diekema DJ, Rex JH, Espinel-Ingroff A, Johnson EM, Andes D, et al. Correlation of MIC with outcome for Candida species tested against voriconazole: Analysis and proposal for interpretive breakpoints. J Clin Microbiol. 2006;44(3):819-26. Texto libre en http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1393146/
Roilides E, Farmaki E, Evdoridou J, Francesconi A, Kasai M, Filioti J, et al. Candida tropicalis in a neonatal intensive care unit: Epidemiologic and molecular analysis of an outbreak of infection with an uncommon neonatal pathogen. J Clin Microbiol. 2003; 41(2):735-41. Texto libre en http://www.ncbi.nlm.nih.gov/pmc/articles/PMC149715/
Manzoni P, Farina D, Galletto P, Leonessa M, Priolo C, Arisio R, et al. Type and number of sites colonized by fungi and risk of progression to invasive fungal infection in preterm neonates in intensive care unit. J Perinatol Med. 2007;35(3):220-6.
Singhi S, Rao R, Chakrabarti A. Candida colonization and candidemia in a pediatric intensive care unit. Pediatr Crit Care Med. 2008;9(1):91-5.
St-Germain G, Laverdière M, Pelletier R, Bourgault AM, Libman M, Lemieux C, et al. Prevalence and antifungal susceptibility of 442 Candida isolates from blood and other normally sterile sites: Results of a 2-year (1996-1998) multicenter surveillance study in Quebec, Canada. J Clin Mirobiol. 2001;39(3):949-53. Texto libre en http://www.ncbi.nlm.nih.gov/pmc/articles/PMC87855/
Silva V, Díaz MC, Febré N; Chilean Invasive Fungal Infections Group. Invasive fungal infections in Chile: A multicenter study of fungal prevalence and susceptibility during 1-year period. Med Mycol. 2004;42(4):333-9.
Pooli L, Nocetti M, Pereda R, Rial MJ, Califano G. Candidemia en una unidad de cuidados intensivos neonatales: identificación de factores de riesgo. Arch Argent Pediatr. 2006;104(5):393-8.
Yildirim M, Sahin I, Kucukbayrak A, Ozdemir D, Tevfik Yavuz M, Oksuz S, et al. Hand carriage of Candida species and risk factors in hospital personnel. Mycoses. 2007;50(3):189-92.
Strausbaugh LJ, Sewell DL, Tjoelker RC, Heitzman T, Webster T, Ward TT, et al. Comparison of three methods for recovery of yeast from hands of health-care workers. J Clin Microbiol. 1996;34(2):471-3. Texto libre en http://www.ncbi.nlm.nih.gov/pmc/articles/ PMC228825/
Strausbaugh LJ, Sewell DL, Ward TT, Pfaller MA, Heitzman T, Tjoelker R. High frequency of yeast carriage on hands of hospital personnel. J Clin Microbiol. 1994;32(9):2299-300. Texto libre en http://www.ncbi.nlm.nih.gov/pmc/articles/PMC263988/
Bonassoli LA, Bertoli M, Svidzinski TI. High frequency of Candida parapsilosis on the hands of healthy hosts. J Hosp Infect. 2005;59(2):159-62.
Traoré O, Springthorpe V, Sattar SA. A quantitative study of the survival of two species of Candida on porous and non-porous environmental surfaces and hands. J Appl Microbiol. 2002;92(3):549-55.
Rangel-Frausto MS, Houston AK, Bale MJ, Fu C, Wenzel RP. An experimental model for study of Candida survival and transmission in human volunteers. Eur J Clin Microbiol Infect Dis. 1994;13(7):590-5.
Diekema DJ, Messer SA, Boyken LB, Hollis RJ, Kroeger J, Tendolkar S, et al. In vitro activity of seven systemically active antifungal agents against a large global collection of rare Candida species as determined by CLSI broth microdilution methods. J Clin Microbiol. 2009;47(10):3170-7. Texto libre en http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2756931/