{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,14]],"date-time":"2026-05-14T02:50:40Z","timestamp":1778727040387,"version":"3.51.4"},"reference-count":41,"publisher":"MDPI AG","issue":"6","license":[{"start":{"date-parts":[[2024,5,25]],"date-time":"2024-05-25T00:00:00Z","timestamp":1716595200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"FCT\/MCTES","award":["10.54499\/UIDB\/04585\/2020"],"award-info":[{"award-number":["10.54499\/UIDB\/04585\/2020"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JoF"],"abstract":"<jats:p>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\u2019 (ICUs\u2019) 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\u2019s 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\u20133.39, p = 0.007), respiratory infection (OR = 1.74, 95% CI 1.17\u20132.58, p = 0.006), hemodialysis (OR = 2.19, 95% CI 1.17\u20134.10, p = 0.014), COVID-19 (OR = 0.37, 95% CI 0.14\u20130.99, 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.<\/jats:p>","DOI":"10.3390\/jof10060378","type":"journal-article","created":{"date-parts":[[2024,5,27]],"date-time":"2024-05-27T09:33:31Z","timestamp":1716802411000},"page":"378","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":9,"title":["Insights into Candida Colonization in Intensive Care Unit Patients: A Prospective Multicenter Study"],"prefix":"10.3390","volume":"10","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-7695-8686","authenticated-orcid":false,"given":"Teresa","family":"Nascimento","sequence":"first","affiliation":[{"name":"Unidade de Microbiologia M\u00e9dica, Global Health and Tropical Medicine (GHTM), Instituto de Higiene e Medicina Tropical, Universidade Nova de Lisboa, 1349-008 Lisboa, Portugal"},{"name":"Egas Moniz Center for Interdisciplinary Research (CiiEM), Egas Moniz School of Health & Science, Caparica, 2829-511 Almada, Portugal"}]},{"given":"Jo\u00e3o","family":"In\u00e1cio","sequence":"additional","affiliation":[{"name":"School of Applied Sciences, University of Brighton, Brighton BN2 4GJ, UK"}]},{"ORCID":"https:\/\/orcid.org\/0009-0003-7181-4028","authenticated-orcid":false,"given":"Daniela","family":"Guerreiro","sequence":"additional","affiliation":[{"name":"Egas Moniz Center for Interdisciplinary Research (CiiEM), Egas Moniz School of Health & Science, Caparica, 2829-511 Almada, Portugal"}]},{"given":"Patr\u00edcia","family":"Patr\u00edcio","sequence":"additional","affiliation":[{"name":"Hospital Beatriz \u00c2ngelo, 2674-514 Loures, Portugal"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8482-5936","authenticated-orcid":false,"given":"Lu\u00eds","family":"Proen\u00e7a","sequence":"additional","affiliation":[{"name":"Egas Moniz Center for Interdisciplinary Research (CiiEM), Egas Moniz School of Health & Science, Caparica, 2829-511 Almada, Portugal"}]},{"given":"Cristina","family":"Toscano","sequence":"additional","affiliation":[{"name":"Centro Hospitalar Lisboa Ocidental Hospital Egas Moniz, 1349-019 Lisboa, Portugal"}]},{"given":"Priscila","family":"Diaz","sequence":"additional","affiliation":[{"name":"Hospital Prof. Doutor Fernando da Fonseca, 2720-276 Amadora, Portugal"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4098-5433","authenticated-orcid":false,"given":"Helena","family":"Barroso","sequence":"additional","affiliation":[{"name":"Egas Moniz Center for Interdisciplinary Research (CiiEM), Egas Moniz School of Health & Science, Caparica, 2829-511 Almada, Portugal"}]}],"member":"1968","published-online":{"date-parts":[[2024,5,25]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","unstructured":"Lamoth, F., Lewis, R.E., and Kontoyiannis, D.P. (2020). Role and Interpretation of Antifungal Susceptibility Testing for the Management of Invasive Fungal Infections. J. Fungi, 7.","DOI":"10.3390\/jof7010017"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"1087","DOI":"10.2147\/IDR.S375625","article-title":"Novel Therapeutic Approaches to Invasive Candidiasis: Considerations for the Clinician","volume":"16","author":"Lamoth","year":"2023","journal-title":"Infect. Drug Resist"},{"key":"ref_3","doi-asserted-by":"crossref","unstructured":"Poissy, J., Rouz\u00e9, A., Cornu, M., Nseir, S., and Sendid, B. (2022). The Changing Landscape of Invasive Fungal Infections in ICUs: A Need for Risk Stratification to Better Target Antifungal Drugs and the Threat of Resistance. J. Fungi, 8.","DOI":"10.3390\/jof8090946"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"18026","DOI":"10.1038\/nrdp.2018.26","article-title":"Invasive candidiasis","volume":"4","author":"Pappas","year":"2018","journal-title":"Nat. Rev. Dis. Primers"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"1367","DOI":"10.1093\/cid\/ciz1008","article-title":"Revision and Update of the Consensus Definitions of Invasive Fungal Disease From the European Organization for Research and Treatment of Cancer and the Mycoses Study Group Education and Research Consortium","volume":"71","author":"Donnelly","year":"2020","journal-title":"Clin. Infect. Dis."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"357","DOI":"10.1016\/j.ijid.2020.10.092","article-title":"Candida colonization as a predictor of invasive candidiasis in non-neutropenic ICU patients with sepsis: A systematic review and meta-analysis","volume":"102","author":"Alenazy","year":"2021","journal-title":"Int. J. Infect. Dis."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"345","DOI":"10.1016\/j.chest.2021.08.081","article-title":"Risk Factors for Invasive Candida Infection in Critically Ill Patients: A Systematic Review and Meta-analysis","volume":"161","author":"Schlattmann","year":"2022","journal-title":"Chest"},{"key":"ref_8","doi-asserted-by":"crossref","unstructured":"Fang, W., Wu, J., Cheng, M., Zhu, X., Du, M., Chen, C., Liao, W., Zhi, K., and Pan, W. (2023). Diagnosis of invasive fungal infections: Challenges and recent developments. J. Biomed. Sci., 30.","DOI":"10.1186\/s12929-023-00926-2"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"54","DOI":"10.1016\/j.mmcr.2018.05.004","article-title":"Candida auris colonization in an immunocompetent patient: A new threat in medical ICU","volume":"21","author":"Das","year":"2018","journal-title":"Med. Mycol. Case Rep."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"475","DOI":"10.1007\/s11046-016-9991-9","article-title":"The Correlation Between Candida Colonization of Distinct Body Sites and Invasive Candidiasis in Emergency Intensive Care Units: Statistical and Molecular Biological Analysis","volume":"181","author":"Li","year":"2016","journal-title":"Mycopathologia"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"721","DOI":"10.1093\/mmy\/myz112","article-title":"Comparison of risk factors and outcomes of Candida auris candidemia with non- Candida auris candidemia: A retrospective study from Pakistan","volume":"58","author":"Sayeed","year":"2020","journal-title":"Med. Mycol."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"1107","DOI":"10.1007\/s15010-021-01640-7","article-title":"Deciphering the epidemiology of invasive candidiasis in the intensive care unit: Is it possible?","volume":"49","author":"Soulountsi","year":"2021","journal-title":"Infection"},{"key":"ref_13","doi-asserted-by":"crossref","unstructured":"Martins-Santana, L., Rezende, C.P., Rossi, A., Martinez-Rossi, N.M., and Almeida, F. (2023). Addressing Microbial Resistance Worldwide: Challenges over Controlling Life-Threatening Fungal Infections. Pathogens, 12.","DOI":"10.3390\/pathogens12020293"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"1569","DOI":"10.1093\/jac\/dkad139","article-title":"Invasive candidiasis: Current clinical challenges and unmet needs in adult populations","volume":"78","author":"Soriano","year":"2023","journal-title":"J. Antimicrob. Chemother."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"1324","DOI":"10.1128\/JCM.03239-14","article-title":"Candida colonization as a risk marker for invasive candidiasis in mixed medical-surgical intensive care units: Development and evaluation of a simple, standard protocol","volume":"53","author":"Lau","year":"2015","journal-title":"J. Clin. Microbiol."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"87","DOI":"10.1007\/s11046-014-9809-6","article-title":"Host factors and clinical outcomes of Candida colonization in critically ill patients","volume":"179","author":"Jacobs","year":"2015","journal-title":"Mycopathologia"},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"689","DOI":"10.1007\/s42770-022-00715-3","article-title":"Mass spectrometry in research laboratories and clinical diagnostic: A new era in medical mycology","volume":"53","author":"Sarvestani","year":"2022","journal-title":"Braz. J. Microbiol."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"2445","DOI":"10.1128\/JCM.00630-17","article-title":"Rapid and Accurate Molecular Identification of the Emerging Multidrug-Resistant Pathogen Candida auris","volume":"55","author":"Kordalewska","year":"2017","journal-title":"J. Clin. Microbiol."},{"key":"ref_19","doi-asserted-by":"crossref","unstructured":"Arastehfar, A., Fang, W., Pan, W., Liao, W., Yan, L., and Boekhout, T. (2018). Identification of nine cryptic species of Candida albicans, C. glabrata, and C. parapsilosis complexes using one-step multiplex PCR. BMC Infect. Dis., 18.","DOI":"10.1186\/s12879-018-3381-5"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"1429","DOI":"10.1007\/s00134-014-3355-z","article-title":"Candida colonization index and subsequent infection in critically ill surgical patients: 20 years later","volume":"40","author":"Eggimann","year":"2014","journal-title":"Intensiv. Care Med."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"223","DOI":"10.1099\/jmm.0.46155-0","article-title":"Predictive value of oral colonization by Candida yeasts for the onset of a nosocomial infection in elderly hospitalized patients","volume":"55","author":"Fanello","year":"2006","journal-title":"J. Med. Microbiol."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"487","DOI":"10.1080\/1369378031000147458","article-title":"Epidemiology of Candida colonization in an intensive care unit of a teaching hospital in Kuwait","volume":"41","author":"Ahmad","year":"2003","journal-title":"Med. Mycol."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"393","DOI":"10.1007\/s00134-005-2571-y","article-title":"Candida spp. colonization significance in critically ill medical patients: A prospective study","volume":"31","author":"Charles","year":"2005","journal-title":"Intensiv. Care Med."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"233","DOI":"10.1007\/s10096-008-0618-z","article-title":"Fungal colonization and\/or infection in non-neutropenic critically ill patients: Results of the EPCAN observational study","volume":"28","author":"Nolla","year":"2009","journal-title":"Eur. J. Clin. Microbiol. Infect. Dis."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"320","DOI":"10.1016\/j.mycmed.2019.08.002","article-title":"Candidemia in a Portuguese tertiary care hospital: Analysis of a 2-year period","volume":"29","author":"Martins","year":"2019","journal-title":"J. Mycol. Med."},{"key":"ref_26","doi-asserted-by":"crossref","unstructured":"Boattini, M., Pinto, M.F., Christaki, E., Fasciana, T., Falces-Romero, I., Tofarides, A., Bianco, G., Cendejas-Bueno, E., Tricoli, M.R., and Tsiolakkis, G. (2023). Multicentre Surveillance of Candida Species from Blood Cultures during the SARS-CoV-2 Pandemic in Southern Europe (CANCoVEU Project). Microorganisms, 11.","DOI":"10.3390\/microorganisms11030560"},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"e13687","DOI":"10.1111\/myc.13687","article-title":"Understanding clinical outcomes and factors influencing mortality in intensive care unit patients with COVID-19-associated candidemia","volume":"67","author":"Mert","year":"2024","journal-title":"Mycoses"},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"2241","DOI":"10.1007\/s10096-014-2194-8","article-title":"Species distribution and in vitro antifungal susceptibility profiles of yeast isolates from invasive infections during a Portuguese multicenter survey","volume":"33","author":"Ricardo","year":"2014","journal-title":"Eur. J. Clin. Microbiol. Infect. Dis."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"147","DOI":"10.5799\/jmid.493851","article-title":"Epidemiology of Candida colonization and infection in medical surgical intensive care unit of a tertiary care hospital","volume":"8","author":"Afzal","year":"2018","journal-title":"J. Microbiol. Infect. Dis."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"1077","DOI":"10.1007\/s00134-015-3791-4","article-title":"Outcomes associated with routine systemic antifungal therapy in critically ill patients with Candida colonization","volume":"41","author":"Ferreira","year":"2015","journal-title":"Intensiv. Care Med."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"7038","DOI":"10.3390\/ijms12107038","article-title":"Candida colonization index in patients admitted to an ICU","volume":"12","author":"Caggiano","year":"2011","journal-title":"Int. J. Mol. Sci."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"107","DOI":"10.1007\/s10123-018-0014-1","article-title":"The continuous changes in the aetiology and epidemiology of invasive candidiasis: From familiar Candida albicans to multiresistant Candida auris","volume":"21","author":"Mateo","year":"2018","journal-title":"Int. Microbiol."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"597","DOI":"10.4103\/ijccm.IJCCM_181_18","article-title":"A Prospective Study of Fungal Colonization and Invasive Fungal Disease in Long-Term Mechanically Ventilated Patients in a Respiratory Intensive Care Unit","volume":"22","author":"Chakraborti","year":"2018","journal-title":"Indian J. Crit. Care Med."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"695","DOI":"10.1016\/j.ajic.2019.11.002","article-title":"The impact of Candida spp airway colonization on clinical outcomes in patients with ventilator-associated pneumonia: A systematic review and meta-analysis","volume":"48","author":"Huang","year":"2020","journal-title":"Am. J. Infect. Control"},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"ofad358","DOI":"10.1093\/ofid\/ofad358","article-title":"Mortality of Patients With Candidemia and COVID-19: A Systematic Review With Meta-analysis","volume":"10","author":"Colaneri","year":"2023","journal-title":"Open Forum Infect. Dis."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"508","DOI":"10.1111\/myc.13431","article-title":"Incidence and risk factors for COVID-19 associated candidemia (CAC) in ICU patients","volume":"65","author":"Kayaaslan","year":"2022","journal-title":"Mycoses"},{"key":"ref_37","doi-asserted-by":"crossref","unstructured":"Gutierrez, D., Weinstock, A., Antharam, V.C., Gu, H., Jasbi, P., Shi, X., Dirks, B., Krajmalnik-Brown, R., Maldonado, J., and Guinan, J. (2020). Antibiotic-induced gut metabolome and microbiome alterations increase the susceptibility to Candida albicans colonization in the gastrointestinal tract. FEMS Microbiol. Ecol., 96.","DOI":"10.1093\/femsec\/fiz187"},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"1221","DOI":"10.1007\/s10096-016-2658-0","article-title":"Invasive candidiasis: From mycobiome to infection, therapy, and prevention","volume":"35","author":"Lagunes","year":"2016","journal-title":"Eur. J. Clin. Microbiol. Infect. Dis."},{"key":"ref_39","doi-asserted-by":"crossref","unstructured":"Day, A.W., and Kumamoto, C.A. (2023). Interplay between host and Candida albicans during commensal gut colonization. PLoS Pathog., 19.","DOI":"10.1371\/journal.ppat.1011607"},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"15","DOI":"10.1007\/s12281-023-00455-3","article-title":"Candidiasis and Other Emerging Yeasts","volume":"17","author":"Sharma","year":"2023","journal-title":"Curr. Fungal. Infect. Rep."},{"key":"ref_41","first-page":"189","article-title":"Candida albicans the main opportunistic pathogenic fungus in humans","volume":"55","year":"2022","journal-title":"Rev. Argent. Microbiol."}],"container-title":["Journal of Fungi"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2309-608X\/10\/6\/378\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T14:48:35Z","timestamp":1760107715000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2309-608X\/10\/6\/378"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,5,25]]},"references-count":41,"journal-issue":{"issue":"6","published-online":{"date-parts":[[2024,6]]}},"alternative-id":["jof10060378"],"URL":"https:\/\/doi.org\/10.3390\/jof10060378","relation":{},"ISSN":["2309-608X"],"issn-type":[{"value":"2309-608X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,5,25]]}}}