1887

Abstract

The incidence of nosocomial yeast infections has increased markedly in recent decades, especially among the elderly. The present study was therefore initiated not only to determine the predictive value of oral colonization by yeasts for the onset of a nosocomial infection in elderly hospitalized patients (>65 years), but also to clarify the factors that promote infection and to establish a relationship between the intensity of oral carriage and the onset of yeast infection. During this prospective cohort study, 256 patients (156 women and 100 men with a mean age of 83±8 years) were surveyed for yeast colonization or infection. Samples were collected every 4 days from day 0 to day 16 from four sites in the mouth, and intrinsic and extrinsic factors that might promote infection were recorded for each patient. Pulsed field gel electrophoresis was performed on isolates from all infected patients. Poor nutritional status was observed in 81 % of the patients and hyposalivation in 41 %. The colonization level was 67 % on day 0 (59 % ) and a heavy carriage of yeasts (>50 c.f.u.) was observed for 51 % of the patients. The incidence of nosocomial colonization reached 6·9 % on day 4 (6·1 % on day 8 and 2·7 % on day 12), and that of nosocomial infection was 3·7 % on day 4 (6·8 % on day 8, 11·3 % on day 12 and 19·2 % on day 16). Of the 35 patients infected, 57 % were suffering from oral candidiasis. The principal risk factors for colonization were a dental prosthesis, poor oral hygiene and the use of antibiotics. The risk factors for infection, in addition to those already mentioned for colonization, were endocrine disease, poor nutritional status, prolonged hospitalization and high colony counts. Genotyping revealed person-to-person transmission in two patients. Thus, this study demonstrates a significant association between oral colonization and the onset of yeast infections in elderly hospitalized patients. Therefore, oral samples should be collected at admission and antifungal treatment should be administered in cases of colonization, especially in patients presenting a heavy carriage of yeasts. Genotyping of the strains confirmed the possibility of person-to-person transmission.

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2006-02-01
2019-11-19
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References

  1. Akpan, A. & Morgan, R. ( 2002; ). Oral candidiasis. Postgrad Med J 78, 455–459.[CrossRef]
    [Google Scholar]
  2. Aly, F. Z., Blackwell, C. C., MacKenzie, D. A., Weir, D. M., Elton, R. A., Cumming, C. G., Sofaer, J. A. & Clarke, B. F. ( 1991; ). Chronic atrophic oral candidiasis among patients with diabetes mellitus – role of secretor status. Epidemiol Infect 106, 355–363.[CrossRef]
    [Google Scholar]
  3. Beck-Sague, C. & Jarvis, W. R. ( 1993; ). Secular trends in the epidemiological fungal infections in the United States, 1980–1990. National Nosocomial Infections Surveillance System. J Infect Dis 167, 1247–1251.[CrossRef]
    [Google Scholar]
  4. Boccia, S., Posteraro, B., La Sorda, M., Vento, G., Matassa, P. G., Tempera, A., Petrucci, S. & Fadda, G. ( 2002; ). Genotypic analysis by 27A DNA fingerprinting of Candida albicans strains isolated during an outbreak in a neonatal intensive care unit. Infect Control Hosp Epidemiol 23, 281–284.[CrossRef]
    [Google Scholar]
  5. Bodey, J. P. (editor) ( 1993; ). Candidiasis: Pathogenesis, Diagnosis and Treatment. New York: Raven Press.
  6. Bonassoli, L. A. & Svidzinski, T. I. ( 2002; ). Influence of the hospital environment on yeast colonization in nursing students. Med Mycol 40, 311–313.[CrossRef]
    [Google Scholar]
  7. Boussarie, M., Fanello, S., Foucault, J. P., Roquelaure, Y. & Morel Cardinal, S. ( 1996; ). Nosocomial and community infections incidence survey among elderly patients. Santé Publique 2, 105–116 (in French).
    [Google Scholar]
  8. Defontaine, A., Coarer, M. & Bouchara, J.-P. ( 1996; ). Contribution of various techniques of molecular analysis to strain identification of Candida glabrata. Microb Ecol Health Dis 9, 27–33.[CrossRef]
    [Google Scholar]
  9. Eggimann, P., Garbino, J. & Pittet, D. ( 2003; ). Epidemiology of Candida species infections in critically ill non-immunosuppressed patients. Lancet Infect Dis 3, 685–702.[CrossRef]
    [Google Scholar]
  10. Ellis, M., Richardson, M. & de Pauw, B. ( 2000; ). Epidemiology. Hosp Med 61, 605–609.[CrossRef]
    [Google Scholar]
  11. Fanello, S., Foucault, S., Delbos, V. & Jousset, N. ( 2000; ). Assessment of nutritional state of elderly patients in hospital. Santé Publique 12, 83–90 (in French).
    [Google Scholar]
  12. Fanello, S., Bouchara, J.-P., Jousset, N., Delbos, V. & LeFlohic, A.-M. ( 2001; ). Nosocomial Candida albicans acquisition in a geriatric unit: epidemiology and evidence for person-to-person transmission. J Hosp Infect 47, 46–52.[CrossRef]
    [Google Scholar]
  13. Fridkin, S. K. & Jarvis, W. R. ( 1996; ). Epidemiology of nosocomial fungal infections. Clin Microbiol Rev 9, 499–511.
    [Google Scholar]
  14. Grimoud, A. M., Marty, N., Bocquet, H., Andrieu, S., Lodter, J. P. & Chabanon, G. ( 2003; ). Colonization of the oral cavity by Candida species: risk factors in long-term geriatric care. J Oral Sci 45, 51–55.[CrossRef]
    [Google Scholar]
  15. Jarvis, W. R. ( 1995; ). Epidemiology of nosocomial fungal infections, with emphasis on Candida species. Clin Infect Dis 20, 1526–1530.[CrossRef]
    [Google Scholar]
  16. Khan, Z. U., Chandy, R. & Metwali, K. F. ( 2003; ). Candida albicans strain carriage in patients and nursing staff of an intensive care unit: a study of morphotypes and resistotypes. Mycoses 46, 479–486.[CrossRef]
    [Google Scholar]
  17. Lizioli, A., Privitera, G., Alliata, E. & 7 other authors ( 2003; ). Prevalence of nosocomial infections in Italy: result from the Lombardy survey in 2000. J Hosp Infect 54, 141–148.[CrossRef]
    [Google Scholar]
  18. Lupetti, A., Tavanti, A., Davini, P., Ghelardi, E., Corsini, V., Merusi, I., Boldrini, A., Campa, M. & Senesi, S. ( 2002; ). Horizontal transmission of Candida parapsilosis candidemia in a neonatal intensive care unit. J Clin Microbiol 40, 2363–2369.[CrossRef]
    [Google Scholar]
  19. Odds, F. C. ( 1979; ). Candida and Candidosis. Leicester: Leicester University Press.
  20. Pelz, R. K., Hendrix, C. W., Swoboda, S. M., Diener-West, M., Merz, W. G., Hammond, J. & Lipsett, P. A. ( 2001; ). Double-blind placebo-controlled trial of fluconazole to prevent candidal infections in critically ill surgical patients. Ann Surg 233, 542–548.[CrossRef]
    [Google Scholar]
  21. Pfaller, M. A. ( 1996; ). Nosocomial candidiasis: emerging species, reservoirs, and modes of transmission. Clin Infect Dis 22 (Suppl. 2), S89–S94.[CrossRef]
    [Google Scholar]
  22. Shay, K., Truhlar, M. R. & Renner, R. P. ( 1997; ). Oropharyngeal candidosis in the older patient. J Am Geriatr Soc 45, 863–870.[CrossRef]
    [Google Scholar]
  23. Taylor, G. D., Buchanan-Chell, M., Kirkland, T., McKenzie, M. & Wiens, R. ( 1994; ). Trends and sources of nosocomial fungaemia. Mycoses 37, 187–190.[CrossRef]
    [Google Scholar]
  24. Vazquez, J. A., Sanchez, V., Dmuchowski, C., Dembry, L. M., Sobel, J. D. & Zervos, M. J. ( 1993; ). Nosocomial acquisition of Candida albicans: an epidemiologic study. J Infect Dis 168, 195–201.[CrossRef]
    [Google Scholar]
  25. Wenzel, R. P. ( 1995; ). Nosocomial candidemia: risk factors and attributable mortality. Clin Infect Dis 20, 1531–1534.[CrossRef]
    [Google Scholar]
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