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A Catheter-Related Candida albicans Infection Model in Mouse
Published on: March 22, 2024
Invasive candidiasis in long-term patients at a multidisciplinary intensive care unit: Candida colonization index,
Christina Agvald-Ohman1, Lena Klingspor, Hans Hjelmqvist
1Department of Clinical Science, Intervention and Technology, Division of Anaesthesiology and Intensive Care, Karolinska University Hospital Huddinge, Karolinska Institutet, Stockholm, Sweden. christina.agvald@telia.com
Abstract:
The incidence of fungal infections in hospitalized patients has increased, and due to demographic changes and increasingly advanced medical methods, the intensive care units (ICU) have emerged as epicentres for fungal infections. The aim of the present study was to investigate Candida colonization pattern and colonization index (CI), in combination with other risk factors and its relation to invasive candida infection (ICI), in 59 consecutive patients with at least 7 d length of stay (LOS) at a multidisciplinary ICU. Surveillance samples were collected on d 7 and then weekly during the ICU stay. In addition, immunological status was monitored by measuring the histocompatibility leukocyte antigen-DR (HLA-DR). In the present study with a patient population burdened by several risk factors for ICI, 17% acquired an invasive infection. Overall ICU mortality was 30%. We could demonstrate that both a high colonization index and recent extensive gastroabdominal surgery were significantly correlated with ICI, while a decreased level of HLA-DR (< or = 70%) was not predictive for ICI in this high-risk population. The results indicate that ICU patients exposed to extensive gastroabdominal surgery would benefit from early antifungal prophylaxis.
Insights
Intensive care unit (ICU) fungal infections are rising. A high Candida colonization index and gastrointestinal surgery predict invasive infections, suggesting early antifungal use for at-risk patients.
Area of Science:
- Infectious Diseases
- Critical Care Medicine
- Mycology
Background:
- Fungal infections, particularly Candida, are increasing in hospitalized patients.
- Intensive care units (ICUs) are key sites for these infections due to patient demographics and advanced medical interventions.
Purpose of the Study:
- To investigate Candida colonization patterns and the colonization index (CI).
- To correlate CI and risk factors with invasive Candida infection (ICI) in ICU patients.
- To assess the predictive value of HLA-DR levels for ICI.
Main Methods:
- Surveillance of 59 ICU patients with >7-day length of stay (LOS).
- Weekly collection of surveillance samples and monitoring of HLA-DR levels.
- Analysis of colonization patterns, CI, and correlation with invasive infections and mortality.
Main Results:
- 17% of high-risk patients acquired invasive Candida infection (ICI).
- A high colonization index (CI) and extensive gastrointestinal surgery were significant predictors of ICI.
- Decreased HLA-DR levels (< or = 70%) did not predict ICI in this population.
Conclusions:
- Patients undergoing extensive gastrointestinal surgery in the ICU are at high risk for ICI.
- Early antifungal prophylaxis may benefit ICU patients with risk factors like recent gastrointestinal surgery.
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