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Enhancing ICU Candida spp. surveillance: a cost-effective approach focused on Candida auris detection
Teresa Nascimento1, João Inácio2, Daniela Guerreiro1
1Microbiology, Egas Moniz Center for Interdisciplinary Research (CiiEM), Egas Moniz School of Health & Science, Almada, Portugal.
Introduction:
Candida auris is an emerging pathogen that represents a worldwide health problem due to its global expansion, multidrug resistance, and difficult laboratory identification. Among the risk factors for colonization/infection by C. auris, a stay in an intensive care unit (ICU) stands out. This prospective multicenter study aimed to monitor the trend of the local epidemiology of Candida spp. and unveil the prevalence of C. auris.
Methods:
From 2020 to 2022, axillar/inguinal swabs were collected from adult patients at three points: upon admission (D1) and on the fifth (D5) and eighth (D8) days of their ICU stay. We employed culture-based screening methods combined with molecular techniques to identify Candida spp. down to the species level. Specific screening for Candida auris was conducted using a real-time PCR assay in combination with an improved selective culture medium, mannitol salt agar auris (MSAA). To validate the effectiveness of MSAA, a collection of reference C. auris strains representing the four major geographical clades was used.
Results:
We enrolled 675 patients, and 355 Candida isolates were retrieved from the 988 swab samples collected. From those, 185/355 (52.1%) were identified as C. albicans and 170/355 (47.9%) as non-albicans Candida (NAC). MSAA medium showed a specificity of 94.8%, albeit C. auris was not detected in this cohort. The dynamics of Candida spp. colonization by ICU were significant at the three collection points. Upon admission, C. albicans was associated with the Beatriz Ângelo Hospital ICU (p=0.003) and C. tropicalis with the general Hospital Professor Doutor Fernando Fonseca (FFH) ICU (p=0.006). C. parapsilosis and C. lusitaniae were associated with FFH ICUs, with the general ICU at D5 (p=0.047) and surgical ICU at D8 (p=0.012). The dynamics of NAC colonization by ICU were significantly different at D1 (p=0.011), D5 (p=0.047), and D8 (p=0.012).
Conclusion:
We developed and implemented a screening protocol for C. auris while uncovering the colonization patterns of Candida in the ICU. Our findings contribute to the optimization of overall patient management, ensuring that ICU protocols are resilient and adaptive to emerging fungal threats.
Insights
This study monitored Candida colonization in intensive care units (ICUs) from 2020-2022, finding significant dynamics in non-albicans Candida species. While Candida auris was not detected, the developed screening protocol aids in managing emerging fungal threats.
Area of Science:
- Medical Mycology
- Infectious Diseases
- Epidemiology
Background:
- Candida auris is a growing global health concern due to its resistance and identification challenges.
- Intensive care unit (ICU) stays are a significant risk factor for Candida auris colonization and infection.
Purpose of the Study:
- To monitor local Candida species epidemiology and assess Candida auris prevalence in ICUs.
- To develop and validate a screening protocol for Candida auris detection.
Main Methods:
- Prospective multicenter study involving axillar/inguinal swabs from ICU patients at three time points (D1, D5, D8).
- Culture-based methods and molecular techniques for Candida species identification.
- Real-time PCR and an improved selective culture medium (mannitol salt agar auris - MSAA) for specific Candida auris screening.
Main Results:
- 355 Candida isolates were recovered from 988 samples; 52.1% were Candida albicans, and 47.9% were non-albicans Candida (NAC).
- MSAA demonstrated 94.8% specificity, but Candida auris was not detected in the study cohort.
- Significant dynamics in Candida species colonization were observed throughout the ICU stay, with specific species associated with different ICUs and time points.
Conclusions:
- A screening protocol for Candida auris was developed and implemented, revealing colonization patterns of Candida species in the ICU.
- Findings aid in optimizing patient management and enhancing ICU protocol resilience against emerging fungal threats.
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