Healthcare-associated infections caused by Candida spp. in critical infants: a look at environmental surfaces
DOI:
https://doi.org/10.17058/reci.v14i4.19358Keywords:
Invasive Fungal Infections, Cross Infection, Infection Control, Infant HealthAbstract
Background and Objectives: invasive fungal infections entail high morbidity and mortality rates in Neonatal Intensive Care Units (NICUs) and are accompanied by an increasing prevalence of resistant isolates, highlighting hospital environments as the primary sources of contamination. This study identified Candida species in infants in a Brazilian NICU, assessed their clinical and laboratory conditions and characterized the isolates. Methods: Candida isolates from newborns (NBs) and environments were identified and analyzed for antifungal resistance, virulence factors, and molecular relationships. Results: four NBs presented invasive candidiasis, such as C. albicans (2 NBs), C. glabrata (1 NB), and C. parapsilosis sensu stricto (1 NB). All NBs were extremely premature (<29 weeks) and had used at least one invasive device. Two clinical isolates demonstrated resistance, one to fluconazole (C. parapsilosis sensu stricto) and the other to micafungin (C. glabrata). Five environmental isolates were identified as C. parapsilosis sensu stricto, and one of them showed to be fluconazole susceptible-dose dependent. Biofilm was the only virulence factor produced by all nine isolates. Molecular analysis revealed high similarity between one environmental isolate and one clinical isolate of C. parapsilosis sensu stricto. Conclusions: the results indicated the presence of Candida species in infants and NICU environments, with some demonstrating in vitro resistance to fluconazole and micafungin. All isolates produced biofilm. A notable genetic similarity was observed between some environmental and clinical isolates, suggesting the environment as a possible source of infection.
Downloads
References
Rakshit P, Nagpal N, Sharma S, et al. Effects of implementation of healthcare associated infection surveillance and interventional measures in the neonatal intensive care unit: Small steps matter. Indian Journal of Medical Microbiology. 2023; 44:100369. https://doi.org/10.1016/j.ijmmb.2023.100369.
Miyake A, Gotoh K, Iwahashi J, et al. Characteristics of Biofilms Formed by C. parapsilosis Causing an Outbreak in a Neonatal Intensive Care Unit. Journal of Fungi. 2022; 8(7). https://doi.org/10.3390/jof8070700.
Menezes RP, Melo SGO, Bessa MAS, et al. Candidemia by Candida parapsilosis in a neonatal intensive care unit: human and environmental reservoirs, virulence factors, and antifungal susceptibility. Braz J Microbiol. 2020; 51(3):851–60. https://doi.org/10.1007/s42770-020-00232-1.
Hsiao-Chuan L, Hsiang-Yu L, Bai-Hong S, et al. Reporting an outbreak of Candida pelliculosa fungemia in a neonatal intensive care unit. Journal of microbiology, immunology, and infection. 2013; 46(6):456-62. http://dx.doi.org/10.1016/j.jmii.2012.07.013
Riera FO, Caeiro JP, Angiolini SC, et al. Invasive Candidiasis: Update and Current Challenges in the Management of This Mycosis in South America. Antibiotics. 2022; 11(7). https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9312041/.
Elkady MA, Bakr WMK, Ghazal H, et al. Role of environmental surfaces and hands of healthcare workers in perpetuating multi-drug-resistant pathogens in a neonatal intensive care unit. Eur J Pediatr. 2022; 181(2):619–28. https://doi.org/10.1007/s00431-021-04241-6.
Daneshnia F, Júnior JNA, Ilkit M, et al. Worldwide emergence of fluconazole-resistant Candida parapsilosis: current framework and future research roadmap. The Lancet Microbe. 2023; 4(6):e470–80. https://doi.org/10.1016/ S2666-5247(23)00067-8.
Nagarathnamma T, Chunchanur SK, Rudramurthy SM, et al. Outbreak of Pichia kudriavzevii fungaemia in a neonatal intensive care unit. Journal of Medical Microbiology. 2017; 66(12):1759–64. https://doi.org/10.1099/jmm.0.000645.
Qi L, Fan W, Xia X, et al. Nosocomial outbreak of Candida parapsilosis sensu stricto fungaemia in a neonatal intensive care unit in China. Journal of Hospital Infection. 2018; 100(4):e246–52. https://doi.org/10.1016/j.jhin.2018.06.009.
Riceto ÉBM, Menezes RP, Penatti MPA, et al. Enzymatic and hemolytic activity in different Candida species. Revista Iberoamericana de Micología. 2015; 32(2):79–82. https://dx.doi.org/10.1016/j.riam.2013.11.003.
Zhang Z, Cao Y, Li Y, Chen X, et al. Risk factors and biofilm formation analyses of hospital-acquired infection of Candida pelliculosa in a neonatal intensive care unit. BMC Infect Dis. 2021; 21(1):1–11. https://doi.org/10.1186/s12879-021-06295-1,
O’Leary EN, Edwards JR, Srinivasan A, et al. National Healthcare Safety Network 2018 Baseline Neonatal Standardized Antimicrobial Administration Ratios. Hosp Pediatr. 2022; 12(2):190–8. https://doi.org/10.1542/hpeds.2021-006253.
Menezes RP, Marques LA, Silva FF, et al. Inanimate Surfaces and Air Contamination with Multidrug Resistant Species of Staphylococcus in the Neonatal Intensive Care Unit Environment. Microorganisms. 2022; 10(3):567. https://doi.org/10.3390/microorganisms10030567.
Suleyman G, Alangaden G, Bardossy AC. The Role of Environmental Contamination in the Transmission of Nosocomial Pathogens and Healthcare-Associated Infections. Curr Infect Dis Rep. 2018; 20(6):1–11. https://doi.org/10.1007/s11908-018-0620-2.
Clinical and Laboratory Standards Institute (CLSI). Reference Method for Broth Dilution Antifungal Susceptibility Testing of Yeasts; Fourth Informational Supplement. Document M27-S4. Clinical and Laboratory Standards Institute; 2012. https://clsi.org/media/1897/m27ed4_sample.pdf
Clinical and Laboratory Standards Institute (CLSI). Reference Method for Broth Dilution Antifungal Susceptibility Testing of Yeasts. Approved standard-M27-A3-S3. Clinical and Laboratory Standards Institute; 2008. https://clsi.org/media/1461/m27a3_sample.pdf
NCCLS. Método de Referência para Testes de Diluição em Caldo para a Determinação da Sensibilidade a Terapia Antifúngica das Leveduras; Norma Aprovada—Segunda Edição. NCCLS document M27-A2 [ISBN 1-56238-469-4]. 2o ed. EUA; 2002. https://bvsms.saude.gov.br/bvs/publicacoes/metodo_ref_testes_diluicao_modulo2.pdf
Stefan S, Peter S, Shabbir S, et al. Assessing the antimicrobial susceptibility of bacteria obtained from animals. Veterinary Microbiology. 2010; 141(1–2):1–4. https://doi.org/10.1016/j.vetmic.2009.12.013.
Clinical and Laboratory Standards Institute (CLSI). Performance Standards for Antifungal Susceptibility Testing of Yeasts. 1st ed. CLSI supplement M60. 1o ed. Wayne: CLSI; 2017. https://clsi.org/media/1895/m60ed1_sample.pdf
Clinical and Laboratory Standards Institute (CLSI). Epidemiological cutoff values for antifungal susceptibility testing. 2nd ed. CLSI supplement, M59. 2o ed. Clinical and Laboratory Standards Institute; 2018. https://clsi.org/media/1934/m59ed2_sample-updated.pdf
Pfaller MA, Diekema DJ. Progress in Antifungal Susceptibility Testing of Candida spp. by Use of Clinical and Laboratory Standards Institute Broth Microdilution Methods, 2010 to 2012. Journal of Clinical Microbiology. 2012; 50(9). https://doi.org/10.1128/jcm.00937-12.
Costa-Orlandi CB, Sardi JCO, Santos CT, et al. In vitro characterization of Trichophyton rubrum and T. mentagrophytes biofilms. Biofouling 2014; 30:6, 719-727. https://doi.org/10.1080/08927014.2014.919282.
Pierce CG, Uppuluri P, Tristan AR, et al. A simple and reproducible 96-well plate-based method for the formation of fungal biofilms and its application to antifungal susceptibility testing. Nat Protoc. 2008;3(9):1494–500. https://doi.org/10.1038/nprot.2008.141.
Marcos-Zambrano L, Pilar E, Emilio B, et al. Production of biofilm by Candida and non-Candida spp. isolates causing fungemia: comparison of biomass production and metabolic activity and development of cut-off points. International journal of medical microbiology : IJMM. 2014; 304(8). https://doi.org/10.1016/j.ijmm.2014.08.012.
Menezes PR, Silva FF, Melo SGO, et al. Characterization of Candida species isolated from the hands of the healthcare workers in the neonatal intensive care unit. Med Mycol. 2019; 57(5):588–94. https://doi.org/10.1093/mmy/myy101.
Riceto ÉBM, Menezes RP, Röder DVDB, et al. Molecular profile of oral Candida albicans isolates from hiv-infected patients and healthy persons. International Journal of Development Research (IJDR). 2017:14432–6. https://www.journalijdr.com/sites/default/files/issue-pdf/9523.pdf.
Furin WA, Tran LH, Chan MY, et al. Sampling efficiency of Candida auris from healthcare surfaces: culture and nonculture detection methods. Infection Control & Hospital Epidemiology. 2022; 43(10):1492–4. https://doi.org/10.1017/ice.2021.220.
Downloads
Published
Issue
Section
License
Copyright (c) 2025 Priscila Guerino Vilela, Isadora Caixeta da Silveira Ferreira, Ralciane de Paula Menezes, Mário Paulo Amante Penatti, Reginaldo dos Santos Pedroso, Denise Von Dolinger de Brito Röder

This work is licensed under a Creative Commons Attribution 4.0 International License.
The author must state that the paper is original (has not been published previously), not infringing any copyright or other ownership right involving third parties. Once the paper is submitted, the Journal reserves the right to make normative changes, such as spelling and grammar, in order to maintain the language standard, but respecting the author’s style. The published papers become ownership of RECI, considering that all the opinions expressed by the authors are their responsibility. Because we are an open access journal, we allow free use of articles in educational and scientific applications provided the source is cited under the Creative Commons CC-BY license.