# Insights into Candida Colonization in Intensive Care Unit Patients: A Prospective Multicenter Study

## TL;DR

This study explores how Candida fungi colonize ICU patients' skin, linking colonization patterns to survival risks and potential risk factors.

## Contribution

The study identifies specific modifiable risk factors and demonstrates that Candida colonization can serve as an early warning for patient outcomes in ICUs.

## Key findings

- Candida colonization rates increased from 27.3% on admission to 52.7% by the 8th day in ICU.
- Colonization was significantly associated with ICU type, respiratory infection, hemodialysis, and poor 3-month outcomes.
- Candida colonization is proposed as an early warning tool for epidemiological surveillance in critical care.

## Abstract

The 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.