title: [Fungi as emergent etiologic agents in ventilator-associated pneumonia after cardiac surgery].
abstract: Evaluation of the fungal involvement in the etiology of ventilator-associated pneumonia (VAP) after cardiac surgery. The study had as target the patients diagnosed with VAP after cardiac surgery at the Institute of Cardiovascular Diseases in Iaşi, between April 2nd 2002 and December 31st 2009.
  
  
  METHODS
  Our study included only cases with fungal etiology of VAP. We examined quantitatively the tracheal aspirates with cytology quality score Q = 2+: microscopy and cultivation. The isolates with clinical significance (= 10(6)UFC/mL significantly associated to inflammatory cells) were identified by standard methods or based on the API system (bioMérieux) and tested by the breakpoints method for susceptibility to antifungal agents.
  
  
  RESULTS
  Among the 2167 operated patients, 35 of them were diagnosed with VAP through the clinical pulmonary infection score = 6. Fungi caused 15 of 44 VAP episodes. With a frequency of 30.19%, fungi are on 2nd place within the etiologic agents of VAP after non-fermenting Gram-negative bacilli (45.28%). The fungi involved in VAP were: Candida albicans (16.97%), Pneumocystis jirovecii (3.77%), while Candida glabrata, Candida sake, Candida krusei, Geotrichum capitatum and Cryptococcus humicola, amounted 1.89% each. The widespread use of broad spectrum antibiotics led to the emergence of fungi as a common cause of ventilator-associated pneumonia. The involvement in the VAP etiology of P. jirovecii, an un-cultivable fungus with special sensitivity to antibiotics, requires a careful microscopy of specimens.
authors.affiliation: Facultatea de Medicină, Disciplina de Chirurgie cardiovasculară, Universitatea de Medicină si Farmacie Gr.T. Popa Iaşi.
authors.forename: Raluca Ioana
authors.initials: RI
authors.lastname: Serban
authors.forename: Maria
authors.initials: M
authors.lastname: Dan
authors.forename: Carmen Valentina
authors.initials: CV
authors.lastname: Pânzaru
authors.forename: Diana
authors.initials: D
authors.lastname: Anghel
authors.forename: D
authors.initials: D
authors.lastname: Dăscălescu
authors.forename: Liliana
authors.initials: L
authors.lastname: Ciucu
authors.forename: I
authors.initials: I
authors.lastname: Serban
authors.forename: G
authors.initials: G
authors.lastname: Tinică
mesh_terms: D000293:Adolescent; D000328:Adult; D002175:Candida / Q000302:isolation & purification; D006348:Cardiac Surgical Procedures / Q000009:adverse effects / Q000295:instrumentation; D003454:Cryptococcus / Q000302:isolation & purification; D005658:Fungi / Q000302:isolation & purification*; D005848:Geotrichum / Q000302:isolation & purification; D006090:Gram-Negative Bacteria / Q000302:isolation & purification; D006801:Humans; D008499:Medical Records; D008875:Middle Aged; D045363:Pneumocystis carinii / Q000302:isolation & purification; D053717:Pneumonia, Ventilator-Associated / Q000175:diagnosis* / Q000453:epidemiology / Q000382:microbiology*; D015995:Prevalence; D012189:Retrospective Studies; D012307:Risk Factors; D012383:Romania / Q000453:epidemiology