Department of Anaesthesia and Intensive Care, Ryhov County Hospital, Jönköping, Sweden.
J Hosp Infect. 2013 Sep;85(1):60-5. doi: 10.1016/j.jhin.2013.06.002. Epub 2013 Aug 5.
Nosocomial transmission of Candida spp. has not been fully explored and previous studies have shown conflicting results.
To evaluate the possible nosocomial transmission of Candida spp. on an intensive care unit (ICU).
A prospective study was conducted for a period of 19 months, including all patients on our ICU with growth of Candida spp. from surveillance and directed cultures. Molecular typing with repetitive sequence-based polymerase chain reaction was used to define genotype relationships between the Candida albicans and Candida 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.
Seventy-seven patients with 78 ICU stays, representing 12% of all ICU stays, were found to harbour 180 isolates of Candida spp. Molecular typing revealed 27 C. albicans genotypes and 10 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 with 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-day interval, indicating clustering.
This study indicates possible transmission of C. albicans between ICU patients based on genotyping and temporal cluster analysis.
医院内传播念珠菌尚未得到充分探索，先前的研究结果存在矛盾。
评估重症监护病房（ICU）中念珠菌属医院内传播的可能性。
进行了一项为期 19 个月的前瞻性研究，包括 ICU 中所有因监测和定向培养而生长出念珠菌属的患者。采用重复序列基序聚合酶链反应进行分子分型，以定义白念珠菌和光滑念珠菌分离株的基因型关系。从我们县 ICU 外的患者血培养中获得的念珠菌分离株用作参考。进行时间聚类分析，以评估基因型随时间的分布。
在 77 名患者的 78 次 ICU 住院中，有 180 株念珠菌属分离株。分子分型显示 27 种白念珠菌基因型和 10 种光滑念珠菌。在七个白念珠菌和两个光滑念珠菌的场合，观察到可能的聚集，即具有相同念珠菌基因型的患者重叠住院。两种白念珠菌基因型在 ICU 组中比参考组更常见。此外，在 ICU 组中发现从多个患者分离的白念珠菌基因型更常见。时间聚类分析显示，在 21 天的间隔内具有相同基因型的对的数量显著增加，表明存在聚集。
本研究表明基于基因分型和时间聚类分析，ICU 患者之间可能存在白念珠菌传播。
