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Epidemiology of yeast colonization in the intensive care unit
S A Hedderwick1, M J Lyons, M Liu
1Division of Infectious Diseases, Ann Arbor Veterans Affairs Healthcare System, University of Michigan Medical School, 48105, USA.
Abstract:
In order to investigate the epidemiology of colonization and possible transmission of yeasts among patients and healthcare workers in adult intensive care units (ICUs), 194 patients were followed for a mean of 9 +/- 11 days and 63 healthcare workers were followed for a mean of 132 +/- 52 days. Among the patients, 142 (73%) were colonized by yeast, with Candida albicans being the species most commonly recovered. Most patients (65%) were already colonized with yeast upon admission to the intensive care unit; only 17% became colonized after admission. Persistent colonization occurred in 51 (55%) of 92 patients who had more than three cultures performed; in 75% of them, colonization persisted with the same strain of Candida albicans or Candida glabrata. Bacterial infection in the month preceding entry into the ICU was the only risk factor significantly associated with yeast colonization. Among the healthcare workers, yeasts were isolated from 42 (67%). Candida albicans was most frequently recovered from the oropharynx (19% of occasions), and Candida parapsilosis was most frequently found on hands (8% of occasions). Persistent colonization of the oropharynx occurred in only six healthcare workers, and none had persistence of yeasts on hands. In this non-outbreak setting, 5 (4%) of 123 patient/healthcare worker interactions that were linked epidemiologically yielded the same strain of Candida albicans, providing evidence for possible cross-transmission. No similar link was found between healthcare worker-patient interactions and colonization with Candida glabrata or Candida parapsilosis.
Insights
High yeast colonization rates were found in intensive care unit (ICU) patients and healthcare workers. Evidence suggests possible yeast cross-transmission between patients and staff in ICUs, particularly Candida albicans.
Area of Science:
- Medical Microbiology
- Infectious Diseases Epidemiology
Background:
- Yeast colonization is a concern in intensive care units (ICUs).
- Understanding yeast epidemiology and transmission dynamics among patients and healthcare workers is crucial for infection control.
Purpose of the Study:
- To investigate the epidemiology of yeast colonization.
- To assess the potential transmission of yeasts between patients and healthcare workers in adult ICUs.
Main Methods:
- Prospective study following 194 patients and 63 healthcare workers in adult ICUs.
- Yeast colonization and species identification performed.
- Epidemiological linkage analysis of patient-healthcare worker interactions.
Main Results:
- 73% of patients were colonized by yeast, with Candida albicans most common.
- Bacterial infection preceding ICU admission was a risk factor for yeast colonization.
- 42% of healthcare workers harbored yeasts; Candida albicans and Candida parapsilosis were frequently isolated.
- Evidence of possible Candida albicans cross-transmission between patients and staff was observed.
Conclusions:
- High rates of yeast colonization exist in ICUs.
- Bacterial infections may predispose patients to yeast colonization.
- Limited evidence suggests potential yeast cross-transmission in non-outbreak settings.
- Further research on transmission routes and prevention strategies is warranted.