Risk Factor For Candida Colonization Research Articles

Second trimester vaginal Candida colonization among pregnant women attending antenatal care in Bukavu, Democratic Republic of the Congo: prevalence, clinical correlates, risk factors and pregnancy outcomes

IntroductionVaginal Candida colonization (CC) can lead to vulvovaginal candidiasis, the second most prevalent vaginal condition worldwide, and has been associated with adverse birth outcomes. However, no data on CC in the Democratic Republic of the Congo are available. We investigated the prevalence, Candida species, clinical correlates, risk factors and pregnancy outcomes in women with CC in the second trimester of pregnancy.Material and methodsIn Bukavu, the Democratic Republic of the Congo, pregnant women were recruited during antenatal care between 16 and 20 weeks of gestation from January 2017 to October 2017 and followed until delivery. Sociodemographics, sexual behavioral, hygienic and clinical characteristics, microbiological data and pregnancy outcomes were collected. Candida detection and speciation was performed with microscopy (Gram-stained smears and wet-mount) and/or quantitative PCR. Multivariate regression models were used to estimate the different associations with CC.ResultsThe prevalence of CC by wet mount, microscopy of Gram-stain smears and qPCR was 27.9%, 28.1% and 38.2%, respectively. C. albicans was the most prevalent Candida species (91.0%). Previous genital infections, an intermediate vaginal microbiota, bacterial vaginosis, and the use of pit toilets were risk factors for CC. Clinically, CC was associated with itching only. Women with CC had twice the odds for preterm birth, if Candida concentration was high, the odds were four times higher.ConclusionsIn Bukavu, the Democratic Republic of the Congo, the prevalence of CC was high and associated with microbiological and modifiable risk factors. Screening and treatment for CC during antenatal care should be investigated as a possible strategy to reduce preterm birth.

IDENTIFIKASI FAKTOR RISIKO TERJADINYA KOLONISASI SPESIES CANDIDA DI RONGGA MULUT PADA INDIVIDU SEHAT (PENELITIAN PADA MAHASISWA & MAHASISWI FKG UI)

Introduction : Cases of oral candidiasis are commonly found, both in healthy individuals and immunecompromise patients, however publications of Candida carrier in the oral cavity of healthy population and risk factors for colonization in Indonesia are hardly available. Objective : This study was aimed to analyze the type and number of Candida colonies and identify risk factors in the oral cavity of apparenthly health FKG UI students. Material and methods : the specimens were taken from 195 subjects with oral rinse technique for identification using culture medium CHROMagar® and Sabaraoud dextrose agar. Results and discussion : Candida species were found in the 107 subjects oral cavity (54.87%), being Candida albicans was is the predominant species (52.33%). Some 88 subjects (82.24%) was dominant in the number of colonies less than 400 CFU/ml, while the rest had colony of more than 400 CFU/ml (17.76%). Candida colony grew dominantly in single colony (90.65%), and the others showed multi-species colonies (9.34%). Risk factors identified included age; gender; hormonal; blood type O; denture; orthodontic appliances; unstimulated salivary flow; pH of saliva; smoking, alcohol and oral cleaning habit; and oral health status. By using a statistical Pearson chi-square test, no significant relationship was found between risk factors and number of Candida colonies in the oral cavity p less than 0.05. Conclusion : there was no one single risk factor for Candida colonization, but combination of various risk factors for demographis, local and systemic was observed

Nötropenik Olmayan Yoğun Bakım Hastalarında Kandida Kolonizasyonu ve Enfeksiyonu İçin Risk Faktörlerinin Değerlendirilmesi

Objective: In patients who are followed in intensive care unit (ICU), colonization and/or invasive infections with Candida species occur in the presence of various risk factors. Difficulties in diagnosis cause delays in antifungal therapy and this is related with increased mortality. Material and Methods: In this retrospective case control study, patients were classified as colonized, infected and control group and independent risk factors for Candida colonization and invasive Candida infections were evaluated. Patients followed in Anesthesiology-Reanimation and Medical ICUs of Ankara University Ibn-i Sina Hospital between June 2013 and June 2015 were retrospectively screened. A total of 225 patients, who stayed more than 48 hours in ICU, who were non-neutropenic and above 18 years were included. All demographics and risk factors were recorded. Results: Central venous catheter and sepsis/septic shock were found to be the independent risk factors for Candida colonization; presence of central venous catheter, total parenteral nutrition (TPN) use and sepsis/septic shock were found to be the independent risk factors for Candida infection. Conclusion: In high risk patients, early and appropriate antifungal therapy decreases mortality. Therefore, for doctors, who works with intensive care, identifying high risk patients for invasive Candida infections is important. Presence of central venous catheter, sepsis/septic shock and TPN use should be considered in intensive care patients.

Microbial Etiology and Prognostic Factors of Ventilator-associated Pneumonia: A Multicenter Retrospective Study in Shanghai.

The microbial etiology and mortality risk factors of ventilator-associated pneumonia (VAP) have not been investigated extensively in Shanghai. VAP cases were identified from the patients hospitalized during the period from 1 January 2013 to 30 December 2017 in Shanghai. The relevant data were reviewed and analyzed retrospectively. One hundred ninety-four VAP cases were included in this analysis. The overall mortality rate was 32.47%. The respiratory pathogens isolated from these patients included 212 bacterial strains and 54 fungal strains. The leading pathogens were Acinetobacter baumannii (33.96%), Klebsiella pneumoniae (23.58%), Pseudomonas aeruginosa (19.81%), and Staphylococcus aureus (7.08%). Candida colonization was associated with higher mortality of VAP patients compared to those without Candida colonization (45.45% vs 28.67%, P < .05). The VAP patients with Candida colonization also showed higher prevalence of P. aeruginosa, carbapenem-resistant P. aeruginosa (CRPA), K. pneumoniae, carbapenem-resistant K. pneumoniae (CRKP), A. baumannii, and carbapenem-resistant A. baumannii (CRAB) (P < .05). VAP nonsurvivors had higher prevalence of CRPA, K. pneumoniae, CRAB, and Candida than VAP survivors (P < .05). Multivariate analysis showed that prior antibiotic use was a significant risk factor for Candida colonization, while hypertension and length of hospital stay were significant risk factors of VAP mortality (P < .05). The top pathogens of VAP patients in Shanghai tertiary teaching hospitals are A. baumannii, K. pneumoniae, and P. aeruginosa, with high prevalence of carbapenem resistance. Carbapenem-resistant bacterial pathogens and Candida may predict poor outcome.

Vulvovaginal Candidiasis in Pregnant Women and its Importance for Candida Colonization of Newborns.

Vulvovaginal candidiasis is the second most common cause of vaginitis worldwide (after bacterial candidiasis). Maternal vulvovaginal candidiasis is a major risk factor for Candida colonization and infection of the infant where prognosis depends on different predisposing factors. The aim of this study was to determine the incidence and the etiological structure of vulvovaginal candidiasis in pregnant women and its impact on Candida colonization of newborns. Samples of vaginal secretions from 80 healthy pregnant women who were clinically suspicious for Candida vaginitis were collected within 48 hours before delivery. Samples for probable Candida colonization from the oral mucosa and feces were collected from their newborns within 47-72 hours after birth. Samples were plated on Sabouraud agar, followed by species identification by API Candida yeast assay. Twenty-three (28.75 ± 5.06%) of the evaluated pregnant women were positive for Candida spp. Positive samples for Candida colonization were found in 18 (22.22 ± 4.62%) of the examined 81 newborns (one pair of twins) from mothers who were clinically suspicious for vaginal candidiasis. Isolates of the newborns were 100% identical to those of the mothers' vaginal secretion. Candida albicans was the predominant species identified in the pregnant women (91.67 ± 0.06%) and in the neonates (83.33±8.78%).

Risk factors for Candida colonization and Co-colonization with multi-drug resistant organisms at admission.

IntroductionCandida species are major causes of healthcare-associated infections with colonization preceding infection. Understanding risk factors for colonization by Candida species is important in prevention. However, data on risk factors for colonization by Candida species alone or with other healthcare-associated pathogens is limited.MethodsFrom 2002 to 2006, 498 patients were enrolled into a prospective cohort study at our institution. Surveillance perirectal, nasal and skin swab samples were obtained upon enrollment. Samples were cultured for the presence of Candida species, Methicillin Resistant Staphylococcus aureus, Vancomycin Resistant Enterococcus, and Resistant Gram Negative organisms. Data on demographics, comorbidities, device use, and antibiotic use were also collected for each subject and analyzed using univariate and multivariate logistic regression.ResultsFactors associated with Candida colonization at admission in univariate analysis included ambulatory status, a history of Candida colonization and the use of antibiotics prior to enrollment. In multivariate analysis, ambulatory status (odds ratio; OR = 0.45, 95 % CI: 0.27–0.73) and fluroquinolone use (OR = 3.01, 95 % CI: 1.80–5.01) were associated with Candida colonization at admission. Factors predicting Candida co-colonization with one or more MDROs at admission in univariate analysis included, older age, malnutrition, days spent in an ICU in the 2 years prior to enrollment, a history of MRSA colonization, and using antibiotics prior to enrollment. In multivariate analysis malnutrition (OR = 3.97, 95 % CI: 1.80–8.78) a history of MRSA (OR = 5.51, 95 % CI: 1.89–16.04) and the use of macrolides (OR = 3.75, 95 % CI: 1.18–11.93) and other antibiotics (OR = 4.94, 95 % CI: 1.52–16.03) were associated with Candida co-colonization at admission.DiscussionAntibiotic use was associated with an increased risk of colonization by Candida species alone and in conjunction with other multidrug-resistant organisms (MDROs). Antibiotic stewardship may be an important intervention for preventing colonization and subsequent infection by Candida and other MDROs.

Occurrence of oral Candida colonization and its risk factors among patients with malignancies in China.

Oral colonization of Candida could lead to later development of oropharyngeal candidiasis or candidemia among the immunocompromised patients. This study aims to describe the occurrence and risk factors of oral Candida colonization in patients with malignancies. From October 2012 to March 2013, 78 patients with pulmonary cancer (group I), 101 patients with gastrointestinal tract tumor (group II), 79 patients with hematopoietic system malignant tumor (group III), and 101 healthy controls were consecutively recruited in a hospital in Beijing, China. The oral rinse samples were taken and Candida species were identified; the enzymes activities were tested. In total, 110 and 27 Candida strains were isolated from 91 patients and 26 controls, respectively. The oral colonization rate with Candida albicans in group III (12.7 %) was significant lower than that in group I (30.8 %), group II (33.7 %), and control group (25.7 %). The oral colonization rates with non-albicans Candida species in group I, group II, and group III were 15.4, 10.9, and 12.7 %, respectively, while only one non-albicans Candida strain was identified in control group. The non-albicans Candida species exhibited a lower virulence than C. albicans. Age was an independent risk factor for Candida colonization in patients with pulmonary cancer and digestive tract malignant tumor, "Teeth brush <1 time/day" was an independent risk factor for Candida colonization in patients with hematopoietic system tumor. The differences of risk factors for oral Candida colonization in patients with different cancers require different strategies for the prevention and control of Candida infection. Old aged patients with pulmonary cancer and digestive tract malignant tumor are high-risk population for Candida colonization. Increasing frequency of teeth brush might be helpful for preventing Candida colonization.

Evaluation of Candida Colonization in Intensive Care Unit Patients and the Use of Candida Colonization Index

Parallel to the developments in the field of diagnosis and treatment, an increase in the incidence of fungal infections and the number of patients who are in the risk group for the development of opportunistic fungal infections have been observed in the recent years. Among the hospitalized patients, those most at risk in terms of fungal infections are intensive care unit (ICU) patients. The rate of Candida colonization of mucous membranes in hospitalized patients may reach to 80%, and this may predispose to the establishment of severe infections especially in patients under risk. The aim of this study was to evaluate the rate of Candida colonization and to use Candida colonization index in the intensive care unit patients in Ankara Training and Research Hospital, Ankara, Turkey. A total of 100 adult patients (46 female, 54 male; age range: 18-93 years, mean age: 65.28 ± 17.53 years) who were hospitalized for ≥ 7 days in the neurology (n= 56), anesthesia-reanimation (n= 24) and neurosurgery (n= 20) intensive care units between September 2008 to February 2009, were included in the study. Throat, nose, skin (axilla), urine, rectal swab cultures and additionally when necessary tracheal aspirates, drain and central vascular catheter cultures were taken weekly from each patient. Candida colonies were identified by using germ tube test, CHROMagar Candida Medium (Becton Dickinson, Germany) and ID 32 C (BioMeriux, France) yeast identification kit. Candida colonization index (CI) was calculated for each patient, and CI was defined as the ratio of the number of culture-positive distinct body sites to the total number of body sites cultured. Patients with CI > 0.2 were considered as Candida colonized. In our study, Candida colonization was found in 42 of 100 (42%) patients, of them 8 were heavily colonized (CI ≥ 0.50), and 34 were slightly colonized (C I < 0.50). The highest Candida colonization was detected in throat, urine and rectal swab samples, while none of the tracheal aspirate samples yielded Candida spp. growth. Invasive Candida infections subsequently developed in 21.4% (9/42) of the colonized patients, namely candidemia in five and Candida associated urinary tract infections in four cases. Our data indicated that, the number of colonized patients were higher in the surgical (anesthesia-reanimation and neurosurgery) intensive care units (p< 0.05), in patients staying in the ICU for longer periods (p= 0.000) and in patients with higher number of application of invasive instruments (p< 0.05) compared to those of non-colonized cases. Additionally Candida colonization emerged more often in patients with bacterial sepsis and in those exposed to broad spectrum antibiotics (p< 0.05). Use of broad spectrum antibiotics in the ICU, length of stay in the ICU and having central venous catheter were found as independent risk factors for Candida colonization. The sensitivity, specificity, positive and negative predictive values of colonization index for the detection of developing Candida infections in colonized patients were estimated as 100%, 64%, 21% and 100%, respectively. In conclusion, Candida colonization and Candida colonization index may be used as useful parameters to predict invasive Candida infections.

Risk factors of Candida colonization in the oropharynx of patients admitted to an intensive care unit

Candida colonization is an important precursor for candidiasis. However, there is little information about its risk factors in critically ill patients. We aimed to identify risk factors for oropharyngeal Candida colonization in critically ill patients. This is a prospective observational study of 110 patients admitted to a medical intensive care unit (MICU). Oropharyngeal swabs were obtained on day one and day four. Characteristics of patients colonized with Candida species at admission or not colonized were compared. In addition, patients becoming colonized during their ICU stay were compared to patients who did not. Independent risk factors for a positive Candida sample at the time of admission were: a history of proton pump inhibitor (PPI) use before admission (OR: 5.24, 95% CI: 1.36-20.19), the presence of diabetes mellitus (OR: 2.84, 95%CI: 1.02-7.92) and a lower BMI (OR: 0.9, 95% CI: 0.84-0.97). Chronic kidney disease was associated with a decreased frequency of Candida colonization (OR: 0.26, 95% CI: 0.01-0.46). No independent risk factors could be identified for patients who gained Candida during their ICU hospitalization. Patients with Candida colonization frequently had abnormal oral bacterial flora. Diabetes mellitus, PPI use and a lower BMI are risk factors for Candida colonization in critically ill patients being admitted to the MICU.

Candida Colonization in Urine Samples of ICU Patients: Determination of Etiology, Antifungal Susceptibility Testing and Evaluation of Associated Risk Factors

The presence of Candida in urine presents a therapeutic challenge for the physician as it is often asymptomatic, and management guidelines have not been clearly laid down on this issue. The presence of Candida in urine may represent contamination of clinical sample, actual colonization of the lower urinary tract or may be a true indicator of invasive infection of lower and/or upper urinary tract. In a clinical setting like the ICU, multiple risk factors for Candida colonization may be present in the same patient, thereby increasing the chances of candiduria, manifold. In the present study on 80 patients in ICU, high rate of Candida colonization (57.5%) was found in urine samples of ICU patients with C. tropicalis (57.3%) being the predominant species. We also isolated 8 strains of Trichosporon species, all of these presented as a mixed infection along with Candida species. Among the various risk factors studied, urinary catheterization and previous antibiotic therapy were identified as statistically significant (P value <0.05). The minimum inhibitory concentration of the isolates was determined for amphotericin B, fluconazole and itraconazole by E-test. Most of the isolates were susceptible to amphotericin B. The C. parapsilosis strains did not show any drug resistance; however, resistance to fluconazole was observed 18.6, 27.27, 50 and 25% in C. tropicalis, C. albicans, C. glabrata and Trichosporon species, respectively.

Early-onset neutropenia is a risk factor for Candida colonization in very low-birth-weight neonates

Neutropenia is a major risk factor for bacterial colonization and sepsis in preterm neonates in the neonatal intensive care unit (NICU), but little is known about its relationships with candidal colonization (CC) in these settings. We performed a case-control study on neonates with birth weight of <1500 g admitted to our NICU during a 7-year period (1996–2003, N = 585). Through database search, infants with early-onset neutropenia (EON) ( n = 68, group A) were identified and 1:1 matched with controls without EON ( n = 68, group B). Microbiologic data from weekly surveillance cultures were examined to determine the presence and intensity of CC. Groups A and B were similar clinically and demographically. All group A neonates recovered from EON before the 8th day of life. Incidence of CC in the 1st month of life (at least 1 site) was significantly higher in group A (61.8% versus 35.3%, P = 0.002) and was not modified by treatment with recombinant granulocyte colony-stimulating factor. The same was true of CC intensity, expressed as the number of sites affected ( P = 0.002). Incidence of candidal sepsis, mortality rates, and relative frequencies of the various subspecies of Candida among the isolates did not significantly differ between the 2 groups. In conclusion, EON in preterm neonates is a significant, independent risk factor for CC. Larger, prospective, adequately powered studies should verify whether increased CC related to neutropenia may translate into a similar increased occurrence of candidal sepsis in these settings.

Risk Factors for Mammary Candidosis Among Lactating Women

To document the occurrence of Candida colonization and mammary candidosis among lactating women, risk factors for Candida colonization, and the relationship between Candida colonization and breastfeeding at 9 weeks postpartum. Prospective cohort study. Private practice clinic in Reno, Nevada. 100 lactating women and their infants, and 40 nonpregnant, nonlactating women (controls). At 2 weeks postpartum, skin and milk samples were collected from the lactating women and oral samples were collected from their infants. Skin samples were collected from control subjects. All samples were cultured for Candida species. Lactating women were recontacted by phone at 9 weeks postpartum to assess infant feeding practices. Colonization with Candida species. None of the control subjects tested positive for Candida colonization. Of the lactating women, 23% tested positive for Candida and 20% had mammary candidosis. Risk factors for colonization of the mother were bottle use in the first 2 weeks postpartum and pregnancy duration of > 40 weeks. Of the 100 infants, 20% tested positive for Candida. Risk factors for colonization of the infant were bottle use in the first 2 weeks postpartum and presence of siblings. Among women who tested positive at 2 weeks, 43% were still breastfeeding at 9 weeks postpartum compared to 69% of the women who did not test positive (p < .05). Avoidance of bottle use early postpartum may reduce the risk of mammary candidosis. Mammary candidosis is related to early termination of breastfeeding.

Risk factors for Candida species colonization of neonatal intensive care unit patients

Candida spp. are increasingly important pathogens in neonatal intensive care units (NICU). Prior colonization is a major risk factor for candidemia, but few studies have focused on risk factors for colonization, particularly in NICU patients. A prospective, multicenter cohort study was performed in six NICUs to determine risk factors for Candida colonization. Infant gastrointestinal tracts were cultured on admission and weekly until NICU discharge and health care worker hands were cultured monthly for Candida spp. The prevalence of Candida spp. colonization was 23% (486 of 2157 infants); 299 (14%), 151 (7%) and 74 (3%) were colonized with Candida albicans, Candida parapsilosis and other Candida spp., respectively. Multiple logistic regression analysis adjusting for length of stay, birth weight < or = 1000 g and gestational age < 32 weeks revealed that use of third generation cephalosporins was associated with either C. albicans (155 incident cases) or C. parapsilosis (104 incident cases) colonization. Use of central venous catheters or intravenous lipids were risk factors for C. albicans, whereas delivery by cesarean section was protective. Use of H2 blockers was an independent risk factor for C. parapsilosis. Of 2989 cultures from health care workers' hands, 150 (5%) were positive for C. albicans and 575 (19%) for C. parapsilosis, but carriage rates did not correlate with NICU site-specific rates for infant colonization. We speculate that NICU patients acquire Candida spp., particularly C. parapsilosis, from the hands of health care workers. H2 blockers, third generation cephalosporins and delayed enteral feedings alter gastrointestinal tract ecology, thereby facilitating colonization.