title: Risk factors of Candida colonization in the oropharynx of patients admitted to an intensive care unit.
abstract: OBJECTIVE
  Candida colonization is an important precursor for candidiasis. However, there is little information about its risk factors in critically ill patients. We aimed to identify risk factors for oropharyngeal Candida colonization in critically ill patients.
  
  
  METHODS
  This is a prospective observational study of 110 patients admitted to a medical intensive care unit (MICU). Oropharyngeal swabs were obtained on day one and day four. Characteristics of patients colonized with Candida species at admission or not colonized were compared. In addition, patients becoming colonized during their ICU stay were compared to patients who did not.
  
  
  RESULTS
  Independent risk factors for a positive Candida sample at the time of admission were: a history of proton pump inhibitor (PPI) use before admission (OR: 5.24, 95% CI: 1.36-20.19), the presence of diabetes mellitus (OR: 2.84, 95%CI: 1.02-7.92) and a lower BMI (OR: 0.9, 95% CI: 0.84-0.97). Chronic kidney disease was associated with a decreased frequency of Candida colonization (OR: 0.26, 95% CI: 0.01-0.46). No independent risk factors could be identified for patients who gained Candida during their ICU hospitalization. Patients with Candida colonization frequently had abnormal oral bacterial flora.
  
  
  CONCLUSIONS
  Diabetes mellitus, PPI use and a lower BMI are risk factors for Candida colonization in critically ill patients being admitted to the MICU.
authors.affiliation: Department of Internal Medicine, Texas Tech University Health Sciences Center, Lubbock , TX United States.
authors.forename: H
authors.initials: H
authors.lastname: Mojazi Amiri
authors.forename: W
authors.initials: W
authors.lastname: Frandah
authors.forename: J
authors.initials: J
authors.lastname: Colmer-Hamood
authors.forename: R
authors.initials: R
authors.lastname: Raj
authors.forename: K
authors.initials: K
authors.lastname: Nugent
mesh_terms: D018806:APACHE; D000328:Adult; D015992:Body Mass Index; D002175:Candida / Q000302:isolation & purification*; D015897:Comorbidity; D016638:Critical Illness; D003428:Cross Infection / Q000453:epidemiology; D003920:Diabetes Mellitus / Q000453:epidemiology; D004198:Disease Susceptibility; D005260:Female; D006801:Humans; D016867:Immunocompromised Host; D007362:Intensive Care Units; D007674:Kidney Diseases / Q000453:epidemiology; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D009055:Mouth / Q000382:microbiology; D009960:Oropharynx / Q000382:microbiology*; D011446:Prospective Studies; D054328:Proton Pump Inhibitors / Q000009:adverse effects / Q000627:therapeutic use; D012307:Risk Factors
chemical_list: D054328:Proton Pump Inhibitors