On May 25, the School of Microbiology presented the results of the project titled “Development of a Personalized Medicine Strategy for the Comprehensive Management of Candidiasis in Adult Intensive Care Units in the Bucaramanga Metropolitan Area” (Project 1102-897-86269), developed under Call for Proposals 821-2021 from the Ministry of Science, Technology, and Innovation for Science, Technology, and Innovation (CTeI) projects.
The Industrial University of Santander was the project’s implementing entity, led by professors from the School of Microbiology: Clara Inés Sánchez Suárez, principal investigator, along with Luz Helena Sánchez Rodríguez and Giovanna Rincón Cruz, co-investigators. Additionally, professors from the School of Chemistry, William Hidalgo Bucheli and Daniel Ricardo Molina Velasco, participated.
The co-implementing entities were the Santo Tomás University, Bucaramanga campus, with the academic contribution of professors Yeny Castellanos Domínguez and Laura Viviana Herrera Sandoval; and the Santander University Hospital, represented by infectious disease specialist Agustín Vega Vera and head nurse Marisela Márquez Herrera.
The overall objective of the project was to develop a predictive model to guide the diagnosis and preventive treatment of candidiasis by integrating epidemiological, clinical, microbiological, and genetic variables in patients in the intensive care unit (ICU) in Bucaramanga.
To this end, six specific objectives were established to understand and prevent the development of candidiasis. These include identifying the healthcare determinants and the patient and Candida characteristics associated with the disease; establishing the value of conventional screening tools for risk assessment; analyzing three methods for identifying Candida; determining the antifungal susceptibility profile of the isolates obtained; identifying individual risk of infection using genetic markers; and developing a predictive model.
Key findings of the project:
*Colonization profile. The results provide a clear profile of the host factors and clinical determinants that influence Candida colonization in the ICU, offering key information for the implementation of strategies for the surveillance, prevention, and control of fungal infections in this highly complex setting.
*Risk factors. Hypertension, corticosteroid use, and the presence of a central venous catheter are factors that increase the likelihood of Candida colonization. Additionally, it was found that receiving corticosteroids, having a history of sepsis, and having an ICU stay longer than 9 days were associated with a higher probability of developing candidiasis.
*Species prevalence. The study population showed a significantly elevated prevalence of colonization by non-Candida albicans strains, with C. tropicalis standing out as the predominant species among the patients analyzed.
*Antifungal resistance. The findings reveal a growing and concerning resistance to azoles and echinocandins in non-Candida albicans species, such as C. parapsilosis against fluconazole and N. glabratus against caspofungin. These results highlight the need for strict monitoring of ICU patients to assess the presence of resistant strains.
*Genetic markers. Genetic variants associated with drug toxicity and susceptibility to infection can be used as predictors of the risk of kidney damage and Candida colonization.
*Data analysis and social approach. The development of the model allowed for the consolidation and effective utilization of information from the (initially fragmented) MIMIC-IV database through a structured, object-oriented approach and data mining techniques. This process facilitated the selection and refinement of relevant samples, as well as the identification of socio-environmental and clinical parameters associated with candidiasis in critically ill patients. Sociodemographic variables were interpreted as contextual indicators reflecting structural inequalities and differences in access to or quality of care, providing a broader understanding of infection risk.
Among the project’s main outputs are the creation of three multimedia and virtual resources; the publication of scientific articles in specialized journals, including studies on the identification of Lodderomyces elongisporus in intensive care unit patients and oral findings in the ICU; as well as two initiatives for the social dissemination of knowledge related to refresher workshops on the diagnosis of infectious agents and bioinformatics applications. In addition, four presentations were given at national and international conferences, two training sessions were held on the MALDI-TOF technique for identifying yeasts and filamentous fungi, and human resource development was strengthened through the participation of doctoral and master’s students, young researchers, and undergraduate students.
