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Outbreak of systemic Candida albicans in intensive care unit caused by cross infection
Abstract:
The first documented outbreak of systemic candidosis shown to be due to cross infection with a particular strain of Candida albicans is reported. Over nine months in an intensive care unit 13 patients developed definite and one probable systemic candidosis. Twenty five further patients had superficial candidal infections. The strain that caused the outbreak (serotype A, morphotype A1, biotype 0/(1)5 5/7) was responsible for all the cases of systemic candidosis acquired in the intensive care unit, 11 (44%) of the superficial candidal infections in the unit, and 17% of candidal infections outside the unit but in the same hospital. The strain was also isolated from oral swabs taken from four nurses working in the unit and the hands of one of these nurses. Two out of 17 nurses were shown to have acquired the strain on their hands when examined immediately after nursing systemically infected patients. No environmental source could be identified. The strain also showed enhanced survival in handwashing experiments and was relatively resistant to Hibiscrub. Management of patients with systemic candidosis might include measures to prevent cross infection and handwashing with disinfectants that are active against candida.
Insights
A specific Candida albicans strain caused a hospital outbreak of systemic candidosis and superficial infections. Enhanced survival and disinfectant resistance highlight the need for improved infection control measures.
Area of Science:
- Medical Microbiology
- Infectious Diseases
- Hospital Epidemiology
Background:
- Systemic candidosis is a serious hospital-acquired infection.
- Candida albicans is a common cause of both superficial and invasive fungal infections.
- Identifying the source and transmission routes of Candida outbreaks is crucial for effective control.
Purpose of the Study:
- To report the first documented outbreak of systemic candidosis caused by cross-infection with a specific Candida albicans strain.
- To investigate the transmission dynamics and characteristics of the outbreak strain.
- To inform strategies for preventing and managing candidal cross-infections in healthcare settings.
Main Methods:
- Epidemiological investigation of systemic and superficial candidosis cases over nine months in an intensive care unit.
- Molecular typing (serotype, morphotype, biotype) of Candida albicans isolates.
- Microbiological analysis of patient, healthcare worker (oral and hand swabs), and environmental samples.
- In vitro experiments assessing strain survival during handwashing and disinfectant resistance.
Main Results:
- A specific Candida albicans strain (serotype A, morphotype A1, biotype 0/(1)5 5/7) was identified as the causative agent for all intensive care unit-acquired systemic candidosis cases.
- This strain was also responsible for a significant proportion of superficial candidal infections within and outside the intensive care unit.
- The strain was isolated from nurses' oral swabs and hands, with evidence of transmission during patient care; no environmental source was found.
- The outbreak strain demonstrated enhanced survival in handwashing simulations and relative resistance to a common disinfectant (Hibiscrub).
Conclusions:
- Cross-infection with a specific, resilient Candida albicans strain was the cause of a significant outbreak in an intensive care unit.
- Healthcare worker hands likely served as a vector for transmission, facilitated by the strain's resistance properties.
- Implementing enhanced infection control measures, including effective hand hygiene protocols and disinfectants active against Candida, is essential for managing such outbreaks.