Candida spp. colonization significance in critically ill medical patients: a prospective study.
OBJECTIVE
Multiple-site colonization with Candida species is commonly recognized as a major risk factor for invasive fungal infection in critically ill patients. The fungal colonization density could be of predictive value for the diagnosis of systemic candidiasis in high-risk surgical patients. Little is known about it in the medical ICU setting.


METHODS
Prospective observational study in the eight-bed medical intensive care unit of a teaching hospital.


METHODS
92 consecutive nonneutropenic patients hospitalized for more than 7 days.


RESULTS
The colonization index (ratio of the number of culture-positive surveillance sites for Candida spp. to the number of sites cultured) was calculated weekly upon ICU admission until death or discharge. The 0.50 threshold was reached in 36 (39.1%) patients, almost exclusively in those with detectable fungal colonization upon ICU admission. The duration of broad-spectrum antibiotic therapy was found to be the main factor that independently promoted fungal growth as measured through the colonization index.


CONCLUSIONS
Candida spp. multiple-site colonization is frequently met among the critically ill medical patients. Broad-spectrum antibiotic therapy was found to promote fungal growth in patients with prior colonization. Since most of the invasive candidiasis in the ICU setting are thought to be subsequent to colonization in high-risk patients, reducing antibiotic use could be useful in preventing fungal infections.
Charles
Pierre Emmanuel
PE
Service de Réanimation Médicale, Dijon University Hospital, France. pierre-emmanuel.charles@chu-dijon.fr
Dalle
Frédéric
F
Aube
Hervé
H
Doise
Jean Marc
JM
Quenot
Jean Pierre
JP
Aho
Ludwig Serge
LS
Chavanet
Pascal
P
Blettery
Bernard
B
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D000935:Antifungal Agents / Q000627:therapeutic use; D002175:Candida / Q000302:isolation & purification*; D002177:Candidiasis / Q000175:diagnosis* / Q000188:drug therapy / Q000453:epidemiology / Q000382:microbiology*; D002405:Catheterization, Central Venous / Q000706:statistics & numerical data; D015169:Colony Count, Microbial; D003422:Critical Care / Q000706:statistics & numerical data*; D005260:Female; D005602:France / Q000453:epidemiology; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D017063:Outcome Assessment, Health Care; D011446:Prospective Studies; D012121:Respiration, Artificial / Q000706:statistics & numerical data; D012307:Risk Factors; D018805:Sepsis / Q000188:drug therapy / Q000453:epidemiology; D016019:Survival Analysis; D014546:Urinary Catheterization / Q000706:statistics & numerical data
D000900:Anti-Bacterial Agents; D000935:Antifungal Agents