Surveillance for Infection and Colonization due to Candida spp. at a Tertiary Referral Hospital in Botswana: 2022-2024
Introduction: Candida spp. are a common cause of healthcare-associated infections globally and Candida bloodstream infections (BSI) are associated with ∼30% mortality. Candida auris, a multidrug-resistant yeast which can be challenging to detect using traditional laboratory methods, was first report...
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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/S1201971224008051 |
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| Summary: | Introduction: Candida spp. are a common cause of healthcare-associated infections globally and Candida bloodstream infections (BSI) are associated with ∼30% mortality. Candida auris, a multidrug-resistant yeast which can be challenging to detect using traditional laboratory methods, was first reported in Botswana in 2022. This study aimed to analyze surveillance data to characterize patterns of Candida BSI and colonization among hospitalized patients in Botswana. Methods: We reviewed microbiology surveillance records over a 16-month period (October 2022 – January 2024) from a 530-bed tertiary referral hospital in Botswana. Blood cultures were collected per routine work-up for sepsis, incubated in an automated system (BacT/ALERT, bioMérieux), and identified using a combination of manual and automated methods (e.g. VITEK 2). Colonization samples (skin and perirectal swabs) were collected during twice-monthly point prevalence surveys in the hospital's intensive care unit (ICU) and neonatal intensive care unit (NICU), transported in ESwab media (COPAN Diagnostics), and cultured with chromogenic media (CHROMagar, Candida Plus). Identification of preserved presumptive Candida spp. isolates from both BSIs and colonization samples was confirmed using matrix-assisted laser desorption/ionization time-of-flight mass spectrometry (MALDI-TOF-MS) at the National Institute for Communicable Diseases, South Africa. Results: A total of 70 Candida BSI were detected during the surveillance period, making it the 6th leading cause of BSI (995 all-cause BSIs detected from a total of 6895 blood cultures). Of 43 preserved BSI isolates which underwent confirmation, C. albicans was most commonly identified species (20%), followed by C. auris (17%), C. krusei (15%), C. parapsilosis (10%) and C. glabrata (10%) (Figure 1). Among 190 samples collected from ICU, Candida colonization was identified from 181 (95%) patient samples, most commonly C. albicans (35% of 181), followed by C. auris (32% of 181). Among 116 samples collected from ICU, Candida colonization was identified from 103 (89%) patient samples, most commonly C. albicans (56% of 103), followed by C. parapsilosis (17% of 103). The relative frequency of Candida spp. causing BSI [data not shown] roughly aligned with the species identified through concurrent colonization screening, with the exception of C. krusei, which can be attributed to a neonatal C. krusei outbreak linked to contaminated medication (Figure 2). Discussion: Candida spp. accounted for a significant portion of BSIs at this hospital and were responsible for at least one hospital outbreak during this time period. The repeated detection of C. auris among hospitalized patients, including neonates, over several months demonstrates the potential for sustained transmission. Conclusion: Routine colonization screening may serve as an early signal for disease transmission and help in the development of targeted containment strategies by infection prevention/control teams. Further analysis with whole genome sequencing could be used to produce a phylogenetic comparison with other clinical isolates in the southern African region. |
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| ISSN: | 1201-9712 |