title: Impact of antifungal treatment on Candida-Pseudomonas interaction: a preliminary retrospective case-control study.
abstract: 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.
authors.affiliation: Intensive Care Unit, Calmette Hospital, University Hospital of Lille, boulevard du Pr Leclercq, 59037, Lille cedex, France. s-nseir@chru-lille.fr
authors.forename: Saad
authors.initials: S
authors.lastname: Nseir
authors.forename: Elsa
authors.initials: E
authors.lastname: Jozefowicz
authors.forename: Béatrice
authors.initials: B
authors.lastname: Cavestri
authors.forename: Boualem
authors.initials: B
authors.lastname: Sendid
authors.forename: Christophe
authors.initials: C
authors.lastname: Di Pompeo
authors.forename: Florent
authors.initials: F
authors.lastname: Dewavrin
authors.forename: Raphaël
authors.initials: R
authors.lastname: Favory
authors.forename: Micheline
authors.initials: M
authors.lastname: Roussel-Delvallez
authors.forename: Alain
authors.initials: A
authors.lastname: Durocher
mesh_terms: 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*
chemical_list: D000935:Antifungal Agents; D015725:Fluconazole