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Candida albicans Horizontal Transmission in COVID-19 Patients Hospitalized in Intensive Care Unit
Magdalena Skóra1, Katharina Rosam2, Magdalena Namysł3,4
1Chair of Microbiology, Faculty of Medicine, Jagiellonian University Medical College, Czysta 18 Street, 31-121 Krakow, Poland.
Background:
Invasive candidiasis is a predominant mycosis in hospitalized patients, and Candida albicans is the species most often responsible for this infection. Most candidiasis cases originate from endogenous mycobiota; therefore, Candida strains can easily be transferred among hospital patients and personnel. The aim of this study was to assess the possible horizontal transmission of C. albicans in patients with severe COVID-19 infection requiring hospitalization in the intensive care unit.
Methods:
In total, 59 C. albicans strains from 36 patients were collected from blood and lower-respiratory samples. The strains were genotyped using the RAPD method with the OPA-18 primer (5'-AGCTGACCGT-3'). Antifungal susceptibility testing was performed for amphotericin B (AMB), fluconazole (FCZ), voriconazole (VCZ), and anidulafungin (ANF) using the EUCAST method.
Results:
C. albicans strains were separated into 13 different groups according to their RAPD pattern. Two predominant clonal clusters of 17 strains isolated from 12 patients and 12 strains from 7 patients were identified, followed by clusters with 6, 4, and 8 strains isolated from 5, 4, and 3 patients, respectively. C. albicans strains were sensitive to AMB, FCZ, VCZ, and ANF, and antifungal susceptibility profiles were similar in all genetic clusters.
Conclusions:
Our study indicates that C. albicans strains can spread horizontally. The routes of transmission for strains in the ward have not been explained due to there being insufficient data. The transmission could have been caused by the unintentional spread of pathogens by medical personnel.
Insights
Horizontal transmission of Candida albicans occurs in intensive care units. Strains spread among patients, potentially via healthcare workers, showing consistent antifungal susceptibility across different genetic groups.
Area of Science:
- Medical Mycology
- Infectious Diseases
- Intensive Care Medicine
Background:
- Invasive candidiasis, primarily caused by Candida albicans, is a significant nosocomial infection.
- Candida albicans often originates from a patient's endogenous flora, facilitating hospital-acquired transmission.
- Patients with severe COVID-19 in intensive care units are particularly vulnerable to invasive fungal infections.
Purpose of the Study:
- To investigate the potential for horizontal transmission of Candida albicans among patients with severe COVID-19 in an intensive care unit setting.
- To analyze the genetic relatedness of Candida albicans strains isolated from these patients.
- To assess the antifungal susceptibility profiles of the circulating Candida albicans strains.
Main Methods:
- Collection of 59 Candida albicans strains from blood and respiratory samples of 36 patients.
- Genotyping of strains using the Random Amplified Polymorphic DNA (RAPD) method with the OPA-18 primer.
- Antifungal susceptibility testing using the European Committee on Antimicrobial Susceptibility Testing (EUCAST) method for key antifungal agents.
Main Results:
- Thirteen distinct genetic groups of Candida albicans were identified based on RAPD patterns.
- Two major clonal clusters were observed, with one comprising 17 strains from 12 patients and another with 12 strains from 7 patients.
- All tested Candida albicans strains demonstrated sensitivity to amphotericin B, fluconazole, voriconazole, and anidulafungin, with similar susceptibility profiles across genetic clusters.
Conclusions:
- The study provides evidence for horizontal transmission of Candida albicans within the intensive care unit.
- The exact transmission routes remain unclear due to limited data, but unintentional spread by healthcare personnel is a possibility.
- Consistent antifungal susceptibility across different genetic clusters suggests a common source or successful adaptation of circulating strains.
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