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Possible transmission of Candida albicans on an intensive care unit: intensive care unit:
Linköping University, Department of Clinical and Experimental Medicine. Linköping University, Faculty of Health Sciences.
Microbiology Laboratory, Department of Laboratory Services, Division of Medical Services, Ryhov County Hospital, Jönköping, Sweden.
Department of Surgery, Ryhov County Hospital, Sweden.
Linköping University, Department of Clinical and Experimental Medicine, Infectious Diseases. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart and Medicine Centre, Department of Infectious Diseases in Östergötland.
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(English)Manuscript (preprint) (Other academic)
Abstract [en]

Background: Nosocomial transmission of Candida spp. has not fully been explored and previous studies have shown conflicting results.

Aim: To evaluate the possible nosocomial transmission of Candida spp. on an intensive care unit (ICU).

Methods: We conducted a prospective study over 19 month, including all patients on our ICU with growth of Candida spp. from surveillance and directed cultures. Molecular typing, with rep-PCR (DiversiLab) was used to define genotype relationships between the C. albicans and C. glabrata isolates. Candida isolates obtained from blood cultures taken from patients in our county outside the ICU, were used as a reference. Temporal cluster analysis was performed to evaluate genotype distribution over time.

Findings: Seventy-seven patients with 78 ICU stays, representing twelve per cent of all ICU stays, were found to harbour 180 isolates of Candida spp. Molecular typing revealed 27 C. albicans genotypes and ten of C. glabrata. Possible clustering, indicated by overlapping stays of patients with indistinguishable candida genotypes was observed on seven occasions with C. albicans and on two occasions with C. glabrata. Two C. albicans genotypes were found significantly more often in the ICU group compared to the reference group. Moreover, C. albicans genotypes isolated from more than one patient were significantly more often found in the ICU group. Temporal cluster analysis revealed a significantly increased number of pairs with indistinguishable genotypes at a 21-dayinterval, indicating clustering.

Conclusion: This study indicates transmission of C. albicans between ICU patients based on genotyping and temporal cluster analysis.

Keyword [en]
Candida, Molecular typing, Intensive care unit, nosocomial infections
National Category
Medical and Health Sciences
URN: urn:nbn:se:liu:diva-89953OAI: diva2:610563
Available from: 2013-03-12 Created: 2013-03-12 Last updated: 2013-03-12Bibliographically approved
In thesis
1. Preventing Infections Related to Central Venous and Arterial Catheters
Open this publication in new window or tab >>Preventing Infections Related to Central Venous and Arterial Catheters
2013 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Central venous catheters (CVCs) are indispensable in modern medical practice. Serious complications associated with CVC use include catheter-related infection (CRI) and catheter related-bloodstream infection (CRBSI) both of which contribute to morbidity, mortality and healthcare costs. Several studies have shown that implementation of basic hygiene routines, for CVC insertion and care, can significantly reduce the number of CRBSIs. However, there are limited data on the long-term effects after such an intervention. CVC infections, in terms of incidences and microorganisms, vary between different units and countries. Studies from Scandinavian hospitals are rare and not published recently. It has been stated that arterial catheters (ACs) are less prone to be responsible for CRI and CRBSI when compared with CVCs. However, recent studies outside Scandinavia have shown that they cause infections in significant numbers. The general view has been that nosocomial Candida infections in ICU patients evolve from the patient’s endogenous flora. However, a few studies have indicated that transmission of Candida spp. can occur between patients on an ICU as is well-described for certain bacteria. Candida spp. are among the most common microorganisms responsible for CRI/CRBSI.

The aim of this thesis was to study the incidences of, and microorganisms related to CVC (Study 1) and AC (Study 2) infections after implementation of evidence-based routines for insertion and care. The populations studied were patients with CVCs treated throughout the entire hospital (Studies 1 and 4) and patients with ACs treated on the ICU (Study 2). The aim was further to analyse risk factors contributing to these infections (Studies 1, 2 and 4). We also evaluated the long-term effects and endurance, of evidence-based routines, assessed as temporal variations in CVC colonisation and infections over a six-year period (Study 4). As we found that Candida spp. were common causes of CRI/CRBSI in Study 1, we decided to see if transmission of Candida spp. possibly occurred between patients on our ICU (Study 3).

We found low incidence rates, compared to international studies, for CRI and CRBSI related to the 495 CVCs studied over a short period (16 months, Study 1) and the 2045 CVCs studied over long-term follow-up (six years, Study 4). We found no cases of AC-CRBSI but a low number of AC-CRI in the 600 ACs studied. The type of microorganisms responsible for infections related to CVCs and ACs were similar to those found in international studies. However, the proportion of Candida spp. was high in Studies 1 and 4 evaluating CVC infections. There was no difference in the CVC-catheterisation time for CRI/CRBSI caused by Candida spp. as compared to CRI/CRBSI caused by bacteria. Risk factors for CRI associated with CVCs were chronic haemodialysis (Study 1), all haemodialysis in general (Study 4) and CVCs inserted via the internal jugular vein as compared to the subclavian vein (Study 4). Risk factors for CRI related to ACs were colonisation or infection of a simultaneous CVC and immunosuppression. Genotypes of Candida albicans and Candida glabrata had a heterogeneous distribution between ICU patients over time. Comparison with a reference group and cluster analysis indicated that transmission of Candida spp. between ICU patients is possible.

In, conclusion, we have found, after implementation of evidence-based routines for CVC and AC insertion and care, low incidences of CRI and CRBSI associated with these catheters. Furthermore, we found that transmission of Candida spp. between patients on the ICU is possible.

Place, publisher, year, edition, pages
Linköping: Linköping University Electronic Press, 2013. 71 p.
Linköping University Medical Dissertations, ISSN 0345-0082 ; 1360
National Category
Medical and Health Sciences
urn:nbn:se:liu:diva-89955 (URN)978-91-7519-661-9 (ISBN)
Public defence
2013-04-12, Originalet, Qulturum, Länssjukhuset Ryhov, Jönköping, 13:00 (Swedish)
Available from: 2013-03-12 Created: 2013-03-12 Last updated: 2013-03-12Bibliographically approved

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Hammarskjöld, FredrikHanberger, HåkanMalmvall, Bo-Erik
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Department of Clinical and Experimental MedicineFaculty of Health SciencesInfectious DiseasesDepartment of Infectious Diseases in Östergötland
Medical and Health Sciences

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