title: Practices in non-neutropenic ICU patients with Candida-positive airway specimens.
abstract: OBJECTIVE
  To examine practices of French intensivists regarding the management of mechanically ventilated patients with Candida-positive airway specimens but no major risk factors for immunodepression. Design : Closed-item questionnaire with a clinical vignette.
  
  
  METHODS
  564 French intensive care units (ICUs).
  
  
  METHODS
  198 intensivists who have a special interest in infectious diseases and who answered the questionnaire (response rate, 35.1%).
  
  
  METHODS
  None.
  
  
  RESULTS
  The respondents recommended bronchoalveolar lavage (62.6% of respondents), protected distal sampling and protected specimen brush (59.1%), transbronchial biopsy (38.9%), and tracheal aspiration (12.1%) for the diagnosis of candidal pneumonia. A positive airway specimen was felt by most respondents (83.3%) to indicate colonisation; 66.7% of respondents recommended tests for systemic candidiasis in this situation, and 56.5% serial sampling to compute the colonisation index. Azole derivatives were the preferred antifungal medications. The clinical vignette described a patient with chronic obstructive lung disease who required mechanical ventilation for an acute exacerbation and who had a tracheal aspirate positive for Candida. Responses varied widely, with 37.8% of respondents diagnosing clinically insignificant colonisation but 24.2% recommending antifungal treatment and 61.6% serial testing to assess the Candida colonisation index. Intensivists with greater experience with severely immunocompromised patients were more aggressive in their diagnostic management.
  
  
  CONCLUSIONS
  Wide variations occur among practices of French intensivists regarding Candida-positive airway specimens in patients without major risk factors for immunodepression. Additional studies are needed to improve our understanding of the links between Candida colonisation and infection and to determine the indications for pre-emptive antifungal treatment in non-neutropenic critically ill patients.
authors.affiliation: Intensive Care Unit, Saint Louis Teaching Hospital, 1 Avenue Claude Vellefaux, 75010 Paris, France. elie.azoulay@sls.ap-hop-paris.fr
authors.forename: Elie
authors.initials: E
authors.lastname: Azoulay
authors.forename: Yves
authors.initials: Y
authors.lastname: Cohen
authors.forename: Jean-Ralph
authors.initials: JR
authors.lastname: Zahar
authors.forename: Maité
authors.initials: M
authors.lastname: Garrouste-Orgeas
authors.forename: Christophe
authors.initials: C
authors.lastname: Adrie
authors.forename: Pierre
authors.initials: P
authors.lastname: Moine
authors.forename: Arnaud
authors.initials: A
authors.lastname: de Lassence
authors.forename: Jean-François
authors.initials: JF
authors.lastname: Timsit
mesh_terms: D000935:Antifungal Agents / Q000627:therapeutic use; D002175:Candida / Q000187:drug effects / Q000302:isolation & purification*; D002177:Candidiasis / Q000175:diagnosis* / Q000188:drug therapy / Q000209:etiology; D005602:France; D006801:Humans; D007362:Intensive Care Units; D008172:Lung Diseases, Fungal / Q000175:diagnosis* / Q000188:drug therapy / Q000209:etiology; D011014:Pneumonia / Q000175:diagnosis / Q000188:drug therapy / Q000382:microbiology; D029424:Pulmonary Disease, Chronic Obstructive / Q000628:therapy; D012121:Respiration, Artificial / Q000009:adverse effects / Q000379:methods; D011795:Surveys and Questionnaires
chemical_list: D000935:Antifungal Agents