Candida and Bacterial Skin Colonisation of Critically-ill Patients in Two Tertiary Healthcare Facilities in Zambia
Background: Healthcare-associated bacterial and fungal infections pose a significant public health concern in Southern Africa, with high rates of antimicrobial resistance. Compared to bacterial infections, the epidemiology of fungal infections remains poorly described in most Southern African countr...
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| Main Authors: | , , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
| Published: |
Elsevier
2025-03-01
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| Series: | International Journal of Infectious Diseases |
| Online Access: | http://www.sciencedirect.com/science/article/pii/S1201971224005848 |
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| Summary: | Background: Healthcare-associated bacterial and fungal infections pose a significant public health concern in Southern Africa, with high rates of antimicrobial resistance. Compared to bacterial infections, the epidemiology of fungal infections remains poorly described in most Southern African countries, including Zambia. Colonisation of the skin of critically-ill inpatients by Candida species and multidrug-resistant bacteria often precedes invasive infections. This study aimed to investigate the prevalence of Candida and bacterial colonisation in critically ill patients in Zambia. Methods: In a Point-prevalence survey (PPS) for Candida and bacterial skin colonisation conducted on October 2 and 3, 2023, skin swab samples (composite axilla/groin) were collected from critically-ill patients who were admitted for at least 48 hours to two tertiary hospitals in Zambia. The flocked swabs were immediately placed in Amies transport medium and processed at a local laboratory. Candida and bacteria were isolated in culture on Candida Plus chromogenic agar and a combination of blood and MacConkey agar, respectively. Species identification was performed using MALDI-TOF (Bruker) at the National Institute for Communicable Diseases in South Africa. Antifungal susceptibility testing for Candida parapsilosis and C. glabrata isolates was determined using Sensititre YeastOne (Thermo Fisher Scientific) and Etest (bioMerieux) adhering to Clinical and Laboratory Standards Institute guidelines. Results: Of the 139 patients swabbed, 73% (101/139) were admitted to a neonatal intensive care unit (ICU), 14% (19/139) to a kangaroo mother and child care unit, 5% (7/139) to an adult ICU and 4% (5/139) to a paediatric ICU. Candida colonisation was detected in 17% (23/139) of the samples, with Candida albicans being the most predominant (65%, 15/23), followed by C. glabrata (17%, 4/23), C. parapsilosis (17%, 4/23), and a rare species, C. allociferrii (4%, 1/23). One non-Candida rare yeast species, Kluyveromyces marxianus, was also isolated. C. parapsilosis and C. glabrata isolates were both pan-susceptible. Notably, 94% (131/139) of patients showed colonisation by one or more bacterial species, with K. pneumoniae being the most prevalent (11%, 37/349), followed by E. faecium (8%, 28/349), A. baumannii (3%, 10/349), and Enterobacter species (3%, 9/349). Discussion: The results show a significant difference in the rates of fungal and bacterial colonization. Given the prevalence of multidrug-resistant organisms, the dominance of bacterial colonization in these settings presents serious challenges for infection control. In high-risk intensive care unit settings where horizontal transmission can result in severe outbreaks, this study emphasises the need for continuous surveillance and effective infection prevention strategies. Conclusion: The survey highlights the high prevalence bacterial colonization over fungal colonization among critically-ill patients in ICU patients. The data support the necessity of heightened preventative measures and ongoing surveillance to mitigate these pathogens' impact. Future national surveys are planned to offer insights for developing targeted interventions in hospital environments. |
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| ISSN: | 1201-9712 |