title: Association of KPC-producing Klebsiella pneumoniae colonization or infection with Candida isolation and selection of non-albicans species.
abstract: Clinical specimens from 565 patients hospitalized in 2 intensive care units (ICUs A and B) during a 28-month period were cultured on appropriate media for isolation of Candida. Forty-nine (9%) patients had at least a Candida spp.-positive sample. Candida albicans was the predominant species isolated from 26 (53%) patients. Seventeen patients (3%) developed candidemia. Multivariate analysis showed that obesity, female gender, hospitalization during summer months, admission at ICU B, parenteral nutrition, administration of metronidazole, transplantation, and KPC-producing Klebsiella pneumoniae (KPC-Kp) infection were independently associated with Candida spp. isolation. Candidemia was associated with cortisone administration, KPC-Kp infection, and presence of colostomy or abdominal catheter. Administration of fluconazole was a protective factor for both Candida spp. isolation and infection, leading to selection of Candida non-albicans species. Among several risk factors, KPC-Kp infection and colonization are identified as statistically significant factors associated with Candida isolation, especially of non-albicans species.
authors.affiliation: Division of Infectious Diseases, School of Medicine, University of Patras, Patras, Greece.
authors.forename: Matthaios
authors.initials: M
authors.lastname: Papadimitriou-Olivgeris
authors.affiliation: Department of Microbiology, School of Medicine, University of Patras, Patras, Greece.
authors.forename: Anastasia
authors.initials: A
authors.lastname: Spiliopoulou
authors.affiliation: Division of Anaesthesiology and Intensive Care Medicine, School of Medicine, University of Patras, Patras, Greece.
authors.forename: Fotini
authors.initials: F
authors.lastname: Fligou
authors.affiliation: Intensive Care Unit, Saint Andrew's General Hospital of Patras, Patras, Greece.
authors.forename: Patroula
authors.initials: P
authors.lastname: Manolopoulou
authors.affiliation: Department of Microbiology, School of Medicine, University of Patras, Patras, Greece.
authors.forename: Iris
authors.initials: I
authors.lastname: Spiliopoulou
authors.affiliation: Division of Anaesthesiology and Intensive Care Medicine, School of Medicine, University of Patras, Patras, Greece.
authors.forename: Theofanis
authors.initials: T
authors.lastname: Vrettos
authors.affiliation: Intensive Care Unit, Saint Andrew's General Hospital of Patras, Patras, Greece.
authors.forename: Vasiliki
authors.initials: V
authors.lastname: Dodou
authors.affiliation: Division of Anaesthesiology and Intensive Care Medicine, School of Medicine, University of Patras, Patras, Greece.
authors.forename: Kriton S
authors.initials: KS
authors.lastname: Filos
authors.affiliation: Department of Microbiology, School of Medicine, University of Patras, Patras, Greece. Electronic address: edanastassiou@med.upatras.gr.
authors.forename: Evangelos D
authors.initials: ED
authors.lastname: Anastassiou
authors.affiliation: Division of Infectious Diseases, School of Medicine, University of Patras, Patras, Greece.
authors.forename: Markos
authors.initials: M
authors.lastname: Marangos
authors.affiliation: Department of Microbiology, School of Medicine, University of Patras, Patras, Greece.
authors.forename: Myrto
authors.initials: M
authors.lastname: Christofidou
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000935:Antifungal Agents / Q000627:therapeutic use; D002175:Candida / Q000145:classification / Q000302:isolation & purification*; D002177:Candidiasis / Q000453:epidemiology* / Q000382:microbiology; D002353:Carrier State / Q000382:microbiology; D016638:Critical Illness; D005260:Female; D015725:Fluconazole / Q000627:therapeutic use; D006801:Humans; D007362:Intensive Care Units; D007710:Klebsiella Infections / Q000150:complications* / Q000382:microbiology; D007711:Klebsiella pneumoniae / Q000201:enzymology* / Q000302:isolation & purification*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012307:Risk Factors; D016896:Treatment Outcome; D001618:beta-Lactamases / Q000378:metabolism*
chemical_list: D000935:Antifungal Agents; D015725:Fluconazole; D001618:beta-Lactamases
keywords: Candidemia; Critically ill patients; Intensive care unit