title: Candida spp. colonization significance in critically ill medical patients: a prospective study.
abstract: 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.
authors.affiliation: Service de Réanimation Médicale, Dijon University Hospital, France. pierre-emmanuel.charles@chu-dijon.fr
authors.forename: Pierre Emmanuel
authors.initials: PE
authors.lastname: Charles
authors.forename: Frédéric
authors.initials: F
authors.lastname: Dalle
authors.forename: Hervé
authors.initials: H
authors.lastname: Aube
authors.forename: Jean Marc
authors.initials: JM
authors.lastname: Doise
authors.forename: Jean Pierre
authors.initials: JP
authors.lastname: Quenot
authors.forename: Ludwig Serge
authors.initials: LS
authors.lastname: Aho
authors.forename: Pascal
authors.initials: P
authors.lastname: Chavanet
authors.forename: Bernard
authors.initials: B
authors.lastname: Blettery
mesh_terms: 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
chemical_list: D000900:Anti-Bacterial Agents; D000935:Antifungal Agents