Candida colonization of the respiratory tract and subsequent pseudomonas ventilator-associated pneumonia.
BACKGROUND
Recovery of Candida from the respiratory tract of a critically ill patient receiving mechanical ventilation (MV) usually indicates colonization rather than infection of the respiratory tract. However, interactions between Candida and bacteria, particularly Pseudomonas, have been reported. Thus, Candida colonization of the respiratory tract may predispose to bacterial ventilator-associated pneumonia (VAP).


METHODS
In a multicenter study of immunocompetent critically ill patients receiving MV for > 2 days, we compared the incidence of pneumonia in patients with and without (exposed/unexposed) respiratory-tract Candida colonization, matched on study center, admission year, and MV duration.


RESULTS
Over the 4-year study period, of the 803 patients meeting study inclusion criteria in the six study centers, 214 patients (26.6%) had respiratory tract Candida colonization. Candida albicans was the most common species (68.7%), followed by Candida glabrata (20.1%) and Candida tropicalis (13.1%). Extrapulmonary Candida colonization was more common in exposed patients (39.7% vs 8.3%, p = 0.01). Exposed patients had longer ICU and hospital stays but similar mortality to unexposed patients. The matched exposed/unexposed nested cohort study identified bronchial Candida colonization as an independent risk factor for pneumonia (24.1% vs 17.6%; adjusted odds ratio [OR], 1.58; 95% confidence interval [CI], 0.94 to 2.68; p = 0.0860); the risk increase was greatest for Pseudomonas pneumonia (9% vs 4.8%; adjusted OR, 2.22; 95% CI, 1.00 to 4.92; p = 0.049).


CONCLUSIONS
Candida colonization of the respiratory tract is common in patients receiving MV for > 2 days and is associated with prolonged ICU and hospital stays, and with an increased risk of Pseudomonas VAP.
Azoulay
Elie
E
Medical ICU, Saint Louis Teaching Hospital, 1 Ave Claude Vellefaux, 75010 Paris, France. elie.azoulay@outcomerea.org
Timsit
Jean-François
JF
Tafflet
Muriel
M
de Lassence
Arnaud
A
Darmon
Michael
M
Zahar
Jean-Ralph
JR
Adrie
Christophe
C
Garrouste-Orgeas
Maité
M
Cohen
Yves
Y
Mourvillier
Bruno
B
Schlemmer
Benoît
B
D000368:Aged; D002175:Candida / Q000254:growth & development* / Q000302:isolation & purification; D002177:Candidiasis / Q000150:complications* / Q000382:microbiology; D015169:Colony Count, Microbial; D016001:Confidence Intervals; D006801:Humans; D015994:Incidence; D008875:Middle Aged; D016017:Odds Ratio; D018410:Pneumonia, Bacterial / Q000453:epidemiology / Q000209:etiology*; D011552:Pseudomonas Infections / Q000453:epidemiology / Q000209:etiology*; D012137:Respiratory System / Q000382:microbiology*; D012189:Retrospective Studies; D012307:Risk Factors; D012122:Ventilators, Mechanical / Q000009:adverse effects* / Q000382:microbiology