Impact of antifungal treatment on Candida-Pseudomonas interaction: a preliminary retrospective case-control study.
OBJECTIVE
A pathogenic interaction between Candida albicans and Pseudomonas aeruginosa has recently been demonstrated. In addition, experimental and clinical studies identified Candida spp. tracheobronchial colonization as a risk factor for P. aeruginosa pneumonia. The aim of this study was to determine the impact of antifungal treatment on ventilator-associated pneumonia (VAP) or tracheobronchial colonization due to P. aeruginosa.


METHODS
Retrospective observational case-control study conducted in a 30-bed ICU during a 1-year period.


METHODS
One hundred and two patients intubated and ventilated for longer than 48 h with tracheobronchial colonization by Candida spp. Routine screening for Candida spp. and P. aeruginosa was performed at ICU admission and weekly. Antifungal treatment was based on medical staff decisions. Patients with P. aeruginosa VAP or tracheobronchial colonization were matched (1:2) with patients without P. aeruginosa VAP or tracheobronchial colonization. In case and control patients, risk factors for P. aeruginosa VAP or tracheobronchial colonization were determined using univariate and multivariate analyses.


RESULTS
Thirty-six patients (35%) received antifungal treatment. Nineteen patients (18%) developed a P. aeruginosa VAP or tracheobronchial colonization, and all were successfully matched. Antifungal treatment [31% vs 60%; p=0.037, OR (95% CI)=0.67 (0.45-0.90)], and duration of antifungal treatment (7+/-11 vs 14+/-14 days; p=0.045, in case and control patients respectively) were significantly associated with reduced risk for P. aeruginosa VAP or tracheobronchial colonization. Antifungal treatment was the only variable independently associated with P. aeruginosa VAP or tracheobronchial colonization (OR=0.68, 95% CI=0.49-0.90, p=0.046).


CONCLUSIONS
In patients with Candida spp. tracheobronchial colonization, antifungal treatment may be associated with reduced risk for P. aeruginosa VAP or tracheobronchial colonization.
Nseir
Saad
S
Intensive Care Unit, Calmette Hospital, University Hospital of Lille, boulevard du Pr Leclercq, 59037, Lille cedex, France. s-nseir@chru-lille.fr
Jozefowicz
Elsa
E
Cavestri
Béatrice
B
Sendid
Boualem
B
Di Pompeo
Christophe
C
Dewavrin
Florent
F
Favory
Raphaël
R
Roussel-Delvallez
Micheline
M
Durocher
Alain
A
D000935:Antifungal Agents / Q000494:pharmacology* / Q000627:therapeutic use*; D001980:Bronchi / Q000382:microbiology*; D002175:Candida / Q000187:drug effects* / Q000302:isolation & purification / Q000472:pathogenicity*; D016022:Case-Control Studies; D005260:Female; D015725:Fluconazole / Q000494:pharmacology* / Q000627:therapeutic use*; D006801:Humans; D008297:Male; D008875:Middle Aged; D053717:Pneumonia, Ventilator-Associated / Q000188:drug therapy* / Q000382:microbiology*; D011550:Pseudomonas aeruginosa / Q000187:drug effects* / Q000302:isolation & purification / Q000472:pathogenicity*; D012189:Retrospective Studies; D014132:Trachea / Q000382:microbiology*
D000935:Antifungal Agents; D015725:Fluconazole