J Med Microbiol 55 (2006), 223-228; DOI: 10.1099/jmm.0.46155-0
© 2006 Society for General Microbiology
ISSN 0022-2615
Predictive value of oral colonization by Candida yeasts for the onset of a nosocomial infection in elderly hospitalized patients
S. Fanello1,
J. P. Bouchara2,
M. Sauteron1,
V. Delbos1,
E. Parot1,
A. Marot-Leblond2,
E. Moalic3,
A. M. Le Flohicc3 and
B. Brangerd4
1 Department of Public Health, Faculty of Medicine, 49045 Angers Cedex 01, France
2 Host–parasite Interactions Study Group (UPRES-EA 3142), Laboratory of Parasitology and Mycology, Angers University Hospital, 49933 Angers Cedex 9, France
3 Department of Microbiology, Morvan University Hospital, 29609 Brest Cedex, France
4 CCLIN OUEST, Pontchaillou University Hospital, 35033 Rennes Cedex, France
Correspondence
S. Fanello
sefanello{at}chu-angers.fr
Received 12 May 2005
Accepted 29 September 2005
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 Candida 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 Candida albicans 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 % C. albicans) 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.
Copyright © 2006 Society for General Microbiology.
