Comparative Analysis of Epidemiological and Clinical Characteristics Between Invasive Candida Infection versus Colonization in Critically Ill Patients in a Tertiary Hospital in Anhui, China

Abstract

Objective Invasive infections due to Candida spp. have unique epidemiology, strain distribution, antimicrobial susceptibility, and clinical features. This study aimed to compare and evaluate these characteristic variables between invasive Candida infection and colonization of critically ill patients in local China to potentially improve differential diagnosis and therapy. Methods A total of 193 critically ill patients were recruited and followed up for the study, and 133 Candida isolates were obtained from invasive Candida -infected or -colonized subjects. The strains were identified to species level through matrix-assisted laser desorption/ionization–time-of-flight mass spectrometry, assisted by DNA sequencing. Candida susceptibility to common antifungals, including azoles, was determined by microbroth ATB Fungus 3 methodology. Azole resistance–related gene sequencing and homologous 3D-structure modeling were employed. Patient demographics and clinical risk factors were documented and comparatively analyzed from the hospital information-management system. Results Non– C. albicans Candida (56%) principally caused invasive Candida infections, while C. albicans (55.17%) contributed more to Candida colonization in critically ill patients. Additional risk factors exerted significant impact on both Candida cohorts, primarily including invasive interventions, cancers, and concurrent infections in common. Most colonized Candida spp. harbored relatively higher sensitivity to azoles. ERG11 gene mutations of T348A and A1309G, A395T and C461T, and a novel G1193T to our knowledge were identified in azole-resistant C. albicans , C. tropicalis , and C. parapsilosis respectively, and their corresponding homologous 3D-structure modeling was putatively achieved. Conclusion Distinct epidemiological and clinical characteristics existed between invasive Candida infection and colonization in critically ill patients. Multiple risk factors significantly involved both the Candida cohorts. Colonized Candida exhibited generally higher azole sensitivity than invasively infectious counterparts. ERG11 point mutations had mechanistically potential ties with local Candida resistance to azoles.

Clinical Distribution and Drug Susceptibility Characterization of Invasive Candida Isolates in a Tertiary Hospital of Xinjiang Province

“…Some multi-center studies of Urumqi reported by Yi 22 and Abibai 23 found that the most common Candida species of invasive candidiasis were C. tropicalis and C. parapsilosis ,respectively. Similarly, a study conducted in a tertiary hospital in Anhui province and reported by Xia 24 identified C. glabrata as the most common isolates in invasive candidiasis. These findings indicated that the epidemiologic distribution of invasive Candida strains varied by region and time and was influenced by factors such as the source of the sample, the affected population, and the use of medications.…”

“…20,21 Within the scope of this study, C. albicans constituted the most frequently isolated pathogen, followed by C. glabrata, C. tropicalis, and C. krusei. Some multi-center studies of Urumqi reported by Yi 22 and Abibai 23 found that the most common Candida species of invasive candidiasis were 24 identified C. glabrata as the most common isolates in invasive candidiasis. These findings indicated that the epidemiologic distribution of invasive Candida strains varied by region and time and was influenced by factors such as the source of the sample, the affected population, and the use of medications.…”

Species Identification of Candida Isolates from Critically Ill Patients by Rapid Commercial and Genotypic Methods

“…Therefore, treating infections caused by NAC spp. can be challenging to physicians which could increase mortality rates especially among ICUs patients 27 .…”

Does Candida auris colonize the oral cavity? A retrospective institutional experience

“…It is well established that critically ill hospitalized patients are at risk of developing systemic Candida infection with high morbidity and mortality, particularly immunocompromised and immunosenescent individuals (Qiao et al, 2023). Despite the lack of C. auris recovery from the oral cavity in our study, it is advocated that hospitals establish surveillance protocols that include testing of oral samples, in addition to the currently implemented screening for skin colonization.…”