Impact of Candida spp. isolation in the respiratory tract in patients with intensive care unit-acquired pneumonia

Abstract

In immunocompetent patients with nosocomial pneumonia, the relationship between Candida spp. isolation in respiratory samples and outcomes or association with other pathogens is controversial. We therefore compared the characteristics and outcomes of patients with intensive care unit-acquired pneumonia (ICUAP), with or without Candida spp. isolation in the respiratory tract. In this prospective non-interventional study, we assessed 385 consecutive immunocompetent patients with ICUAP, according to the presence or absence of Candida spp. in lower respiratory tract samples. Candida spp. was isolated in at least one sample in 82 (21%) patients. Patients with Candida spp. had higher severity scores and organ dysfunction at admission and at onset of pneumonia. In multivariate analysis, previous surgery, diabetes mellitus and higher Simplified Acute Physiology Score II at ICU admission independently predicted isolation of Candida spp. There were no significant differences in the rate of specific aetiological pathogens, the systemic inflammatory response, and length of stay between patients with and without Candida spp. Mortality was also similar, even adjusted for potential confounders in propensity-adjusted multivariate analyses (adjusted hazard ratio 1.08, 95% CI 0.57-2.05, p 0.80 for 28-day mortality and adjusted hazard ratio 1.38, 95% CI 0.81-2.35, p 0.24 for 90-day mortality). Antifungal therapy was more frequently prescribed in patients with Candida spp. in respiratory samples but did not influence outcomes. Candida spp. airway isolation in patients with ICUAP is associated with more initial disease severity but does not influence outcomes in these patients, regardless of the use or not of antifungal therapy.

Clinical predictors and microbiology of ventilator-associated pneumonia in the intensive care unit: a retrospective analysis in six Italian hospitals

“…However, this data should be interpreted cautiously, since according to recent works, Candida spp. isolation in respiratory samples in ICU patients affected by nosocomial pneumonia seems to be associated with more initial disease severity without influencing the final outcome of these patients, and the role of the antifungal therapy against these isolates in VAP patients has to be clarified yet [42,43]. On the other hand, Candida spp.…”

Neces-SARI-ly?

“…With this seasonal factor in mind it is notable that the recent influenza A (H1N1) pandemic which occurred in the spring and summer 2009 would not have been captured by this study [6]. Interestingly the low rate of viral illness reported in this study (7.7-13.7 %) is not in keeping with the reported seasonality of viral respiratory illness while the rate of fungal infections, almost 1/3 of ICU patients, is highly unexpected [7]. Both these observations will require confirmation.…”

Actualización de las infecciones respiratorias en Urgencias

“…Principalmente Aspergillus spp., por inhalación de esporas del medioambiente (polvo, muebles y plantas). La colonización por Candida también es frecuente 26 .…”