The relationship between Candida species cultured from the respiratory tract and systemic inflammation in critically ill patients with ventilator-associated pneumonia

Candida colonization in ventilated ICU patients: no longer a bystander!

“…In the univariate analysis, isolation of MDR bacteria was associated with antibiotic exposure. Since previous studies found an association between airway Candida colonization and previous antibiotic exposure [5,10,11], it is probable that the association between MDR bacteria and Candida colonization reported by Hamet et al [8] is more likely due to shared risk factors than causal association.…”

“…Indeed, the presence of Candida spp. in airways of ventilated patients with suspected VAP (but without actual infection) is associated with an increased systemic inflammation as compared to control patients [11]. Inflammation has been associated with an increased risk of infection and mortality during ARDS [15], at least in part because of the enhanced growth, and possibly virulence, of pathogenic bacteria [15,16].…”

Candida colonization of respiratory tract: to treat or not to treat, will we ever get an answer?

“…RT Cc increased the risk of hospital mortality (RR 1.63, 95 % CI 1.20-2.21, p = 0.003) Williamson et al [9] Prospective observational study 170 pts (21 with csVAP/RT Cc) RT Cc in csVAP was associated with lower number of ICU-free days and greater mortality (p \ 0.05) Heyland et al [10] Prospective observational study 57 pts (12 with csVAP/RT Cc) Trend to higher BG levels in RT Cc group (p = 0.09). BG positivity was associated with increased 28-day mortality (p = 0.03) Delisle et al [11] Retrospective exploratory analysis 274 pts (68 with Cc RT/VAP) Candida spp.…”

“…is not definitely an innocent bystander in the respiratory tract of ICU ventilated patients [3][4][5][6][7][8][9][10][11][12][13] (Table 1). Beta-glucan (BG), a component of yeast cell wall, may act as a lung proinflammatory agent causing alveolar macrophage and neutrophil dysfunction.…”

“…Live Candida albicans instillation in rats has been observed to increase the susceptibility to develop experimental Pseudomonas aeruginosa (PA), Escherichia coli (Ec), and Staphylococcus aureus (Sa) pneumonia, fostering the production of lung inflammatory cytokines (tumor necrosis factor alpha [TNF-alpha], interleukin-6 [IL-6], and interferon-gamma [INF-c]) and inhibiting alveolar macrophage phagocytosis [3,5]. From a clinical viewpoint, Candida airway colonization has been shown to be associated with prolonged duration of mechanical ventilation, ICU/hospital length of stay, and increased mortality [8][9][10][11]. One of the first reports of this possible relationship dates back to almost 10 years ago, when Azoulay et al [6] identified Candida bronchial isolation as an independent risk factor for the development of PA ventilator-associated pneumonia (VAP) (9 vs 4.8 % in non-colonized patients, p = 0.048).…”