Percorrer por autor "Diaz, Priscila"
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- Can chlorhexidine gluconate baths reduce fungal colonisation in intensive care unit patients?Publication . Nascimento, Teresa; Inácio, João; Guerreiro, Daniela; Patrício, Patrícia; Proença, Luís; Toscano, Cristina; Diaz, Priscila; Barroso, HelenaBackground: Chlorhexidine Gluconate (CHG) bathing is widely used in Intensive Care Units (ICUs) to reduce bacterial colonisation, yet its efficacy against fungal skin colonisation, particularly Candida spp., is not well understood. This study aimed to evaluate the impact of daily CHG bathing on Candida colonisation among ICU patients. Methods: From 2020 to 2022, axillary/inguinal swabs were collected from 675 ICU patients across three units on admission (Day 1, D1), Day 5 (D5) and Day 8 (D8). Patients received daily CHG bathing (either 2% impregnated wipes or 4% liquid solution) from D1 to D5, followed by soap-and-water bathing from Day 6 to D8. Standard and molecular microbiological methods were used to identify fungal species, and colony-forming units (CFUs) were quantified. Colonisation rates and fungal burden were compared across time points and bathing protocols. Results: A total of 988 swabs from 675 patients were collected, 675 on D1, 203 on D5 and 110 on D8. CHG bathing had no significant impact on Candida burden at individual time points, (D1, p = 0.223; D5, p = 0.939 and D8, p = 0.669). No significant differences in colonisation or fungal burden were observed between the use of 4% CHG solution and 2% CHG-impregnated wipes upon ICU admission. However, in the subgroup of 89 patients monitored longitudinally, a transient reduction in colonisation was observed during the CHG bathing period (D1–D5), followed by a significant increase during the soap-and-water period (D6–D8) (p = 0.005; between periods: p < 0.001). Among the 329 positive swabs, 274 yielded > 100 CFU/ml. High colony counts of C. albicans (> 1000 CFU/mL) were observed, with no significant association between colonisation levels and specific Candida species (p = 0.940). Conclusions: CHG bathing demonstrated only a limited and transient impact on Candida colonisation in ICU patients. Colonisation rates rebounded after cessation of CHG use, suggesting ongoing acquisition during ICU stay. These findings highlight the need for additional or alternative infection control measures targeting fungal pathogens in critical care settings.
- Candida spp. colonization among intensive care unit patients : preliminary resultsPublication . Nascimento, Teresa; Inácio, João; Ferreira, Isabel; Diaz, Priscila; Freitas, Paulo; Barroso, HelenaCandida spp. colonization is recognized as a major risk factor for invasive candidiasis. To assess patient colonization, upon admission and during their stay in intensive care units (ICU), a surveillance study has been conducted since January 2020, in the Lisbon area of Portugal. A total of 219 swab samples were obtained from 113 ICU patients. The yeast identification was conducted by microbiological conventional and molecular methods. Upon admission to the ICU, 27% of patients were already colonized, and 17% became colonized during their ICU stay. Candida albicans was the most isolated species. These results may offer an opportunity for prevention of candidemia.
- Enhancing ICU Candida spp. surveillance : a cost-effective approach focused on Candida auris detectionPublication . Nascimento, Teresa; Inácio, João; Guerreiro, Daniela; Diaz, Priscila; Patrício, Patrícia; Proença, Luís; Toscano, Cristina; Barroso, HelenaIntroduction: Candida auris is an emerging pathogen that represents a worldwide health problem due to its global expansion, multidrug resistance, and difficult laboratory identification. Among the risk factors for colonization/infection by C. auris, a stay in an intensive care unit (ICU) stands out. This prospective multicenter study aimed to monitor the trend of the local epidemiology of Candida spp. and unveil the prevalence of C. auris. Methods: From 2020 to 2022, axillar/inguinal swabs were collected from adult patients at three points: upon admission (D1) and on the fifth (D5) and eighth (D8) days of their ICU stay. We employed culture-based screening methods combined with molecular techniques to identify Candida spp. down to the species level. Specific screening for Candida auris was conducted using a real-time PCR assay in combination with an improved selective culture medium, mannitol salt agar auris (MSAA). To validate the effectiveness of MSAA, a collection of reference C. auris strains representing the four major geographical clades was used. Results: We enrolled 675 patients, and 355 Candida isolates were retrieved from the 988 swab samples collected. From those, 185/355 (52.1%) were identified as C. albicans and 170/355 (47.9%) as non-albicans Candida (NAC). MSAA medium showed a specificity of 94.8%, albeit C. auris was not detected in this cohort. The dynamics of Candida spp. colonization by ICU were significant at the three collection points. Upon admission, C. albicans was associated with the Beatriz Ângelo Hospital ICU (p=0.003) and C. tropicalis with the general Hospital Professor Doutor Fernando Fonseca (FFH) ICU (p=0.006). C. parapsilosis and C. lusitaniae were associated with FFH ICUs, with the general ICU at D5 (p=0.047) and surgical ICU at D8 (p=0.012). The dynamics of NAC colonization by ICU were significantly different at D1 (p=0.011), D5 (p=0.047), and D8 (p=0.012). Conclusion: We developed and implemented a screening protocol for C. auris while uncovering the colonization patterns of Candida in the ICU. Our findings contribute to the optimization of overall patient management, ensuring that ICU protocols are resilient and adaptive to emerging fungal threats.
- Insights into Candida colonization in intensive care unit patients : a prospective multicenter studyPublication . Nascimento, Teresa; Inácio, João; Guerreiro, Daniela; Patrício, Patrícia; Proença, Luís; Toscano, Cristina; Diaz, Priscila; Barroso, HelenaThe skin mycobiota plays a significant role in infection risk, pathogen transmission, and personalized medicine approaches in intensive care settings. This prospective multicenter study aimed to enhance our understanding of intensive care units’ (ICUs’) Candida colonization dynamics, identify modifiable risk factors, and assess their impact on survival risk. Specimens were taken from 675, 203, and 110 patients at the admission (D1), 5th (D5), and 8th (D8) days of ICU stay, respectively. The patient’s demographic and clinical data were collected. Candida isolates were identified by conventional culture-based microbiology combined with molecular approaches. Overall, colonization was 184/675 (27.3%), 87/203 (42.8%), and 58/110 (52.7%) on D1, D5, and D8, respectively. Candida colonization dynamics were significantly associated with ICU type (odds ratio (OR) = 2.03, 95% CI 1.22–3.39, p = 0.007), respiratory infection (OR = 1.74, 95% CI 1.17–2.58, p = 0.006), hemodialysis (OR = 2.19, 95% CI 1.17–4.10, p = 0.014), COVID-19 (OR = 0.37, 95% CI 0.14–0.99, p = 0.048), and with a poor 3-month outcome (p = 0.008). Skin Candida spp. colonization can be an early warning tool to generate valuable insights into the epidemiology, risk factors, and survival rates of critically ill patients, and should be considered for epidemiological surveillance.
- Protocolos em Medicina Interna - Serviço de Medicina lnterna do Hospital Central do FunchalPublication . Brazão, Maria Luz Reis; Chaves, Susana; Claude, Jean; Sousa, João Adriano Rodrigues; Cardoso, Álmada; Chaves, Susana; Pestana, Andreia; Costa, Ana Isabel; Spinola, Adelaide; Diaz, Priscila; Freitas, Sara; Silva, Joana Jacinto; Henriques, Tatiana; Malheiro, Alexandra; André, Teresa Raposo; Sales, Carolina; Gomes, Catarina; Freitas, Tiago; Correia, Luis; Correia, Inês; Silva, Ana Sofia; Capelo, Miriam; Jardim, Margarida; Nascimento, Rafael; Gonçalves, António Miguel; Nobrega, Sofia; Correia, João; Caldeira Ferreira, António; Noronha, Duarte; Rosa, Eva; Bebiano, Gil; Dias, Graça; Azevedo, Isabel; de Freitas, Herculano; França, José; Franco, José; Nobrega Araújo, Jorge; Barros, Manuela; Lélis, Manuela; Pestana, Ricardo; Freitas, Rafael
- Susceptibility patterns of Candida species collected from intensive care units in Portugal : a prospective study in 2020–2022Publication . Nascimento, Teresa; Inácio, João; Guerreiro, Daniela; Diaz, Priscila; Patrício, Patrícia; Proença, Luís; Toscano, Cristina; Barroso, HelenaBackground: For Candida infections antifungal therapy is often empirical and mainly depends on locally antifungal surveillance data, which differs between geographic regions. Aims: To monitor the epidemiology and antifungal susceptibility of Candida spp. from combined axillar-groin samples in intensive care unit (ICU) patients on admission (day1, D1), day 5 (D5) and day 8 (D8). Methods: From 2020 to 2022, 675 patients from three ICUs were enrolled. Candida isolates were identified by MALDI-TOF MS and PCR. In vitro antifungals susceptibility tests (AFST) were performed for fluconazole, voriconazole, amphotericin B and anidulafungin, by concentration gradient Etest® strip technique. Results: Out of 988 swabs, 355 isolates were identified as Candida species from 232 patients, being 89 isolates retrieved from patients that remained colonised at D5 and D8. AFST was conducted for all Candida isolates. The overall rate of resistance to fluconazole was 2.7%, with 3 out of 133 C. albicans, 2 out of 89 C. parapsilosis and 2 out of 24 C. glabrata isolates identified as resistant. Voriconazole susceptibility was observed in 99.2% of the isolates, with only one C. albicans isolate identified as resistant to this triazole. All isolates were susceptible to amphotericin B and 98.5% to anidulafungin. Three Candida spp. exhibited resistance to anidulafungin, C. albicans, C. tropicalis, and C. parapsilosis. Conclusions: This study highlights the importance of C. albicans as a frequent coloniser and showed that antifungal resistance remains uncommon among Candida isolates from ICUs in Portugal. The results may contribute to better management within institutions to guide therapeutic decision making.