title: Candida spp. airway colonization: A potential risk factor for Acinetobacter baumannii ventilator-associated pneumonia.
abstract: This retrospective study was conducted to identify potential risk factors for Acinetobacter baumannii (A. baumannii) ventilator-associated pneumonia (VAP) and evaluate the association between Candida spp. airway colonization and A. baumannii VAP. Intensive care unit (ICU) patients who were on mechanical ventilation (MV) for ≥48 hours were divided into the following groups: patients with and without Candida spp. airway colonization; colonized patients receiving antifungal treatment or not; patients with A. baumannii VAP and those without VAP. Logistic regression analysis and propensity score matching were used to identify factors independently associated with A. baumannii VAP. Among 618 eligible patients, 264 (43%) had Candida spp. airway colonization and 114 (18%) developed A. baumannii VAP. Along with MV for ≥7 days (adjusted odds ratio [aOR] 8.9, 95% confidence intervals [95% CI] 4.9-15.8) and presence of a central venous catheter (aOR 3.2, 95% CI 1.1-9), Candida spp. airway colonization (aOR 2.6, 95% CI 1.6-4.3) was identified as an independent risk factor for A. baumannii VAP. Patients with Candida spp. airway colonization were more likely to develop A. baumannii VAP than non-colonized patients (23% vs 15%, P=.01 and 34% vs. 15%, P<.001 in propensity score-matched subgroups). Administration of antifungal agents was not associated with A. baumannii VAP (29% vs. 21%, P=.153) but with higher in-hospital mortality (53% vs. 39%, P=.037). Candida spp. airway colonization (43%) and A. baumannii VAP (18%) were common in ICU patients who were on mechanical ventilation for at least 48 hours. Candida spp. airway colonization was an independent risk factor for subsequent A. baumannii VAP.
authors.affiliation: Department of Respiratory Medicine, Huiqiao Medical Center, Nanfang Hospital, Southern Medical University, Guangzhou 510515, P. R. China txjzdk@126.com.
authors.forename: Xiaojiang
authors.initials: X
authors.lastname: Tan
authors.affiliation: Department of Respiratory Medicine, Huiqiao Medical Center, Nanfang Hospital, Southern Medical University, Guangzhou 510515, P. R. China.
authors.forename: Song
authors.initials: S
authors.lastname: Zhu
authors.affiliation: Department of Respiratory Medicine, Huiqiao Medical Center, Nanfang Hospital, Southern Medical University, Guangzhou 510515, P. R. China.
authors.forename: Dongxing
authors.initials: D
authors.lastname: Yan
authors.affiliation: Department of Respiratory Medicine, The People's Hospital of Qingyuan, Jinan University Hospital, Qingyuan 511518, P. R. China.
authors.forename: Weiping
authors.initials: W
authors.lastname: Chen
authors.affiliation: Department of Respiratory Medicine, Huiqiao Medical Center, Nanfang Hospital, Southern Medical University, Guangzhou 510515, P. R. China.
authors.forename: Ruilan
authors.initials: R
authors.lastname: Chen
authors.affiliation: Informatics Department, Nanfang Hospital, Southern Medical University, Guangzhou 510515, P. R. China.
authors.forename: Jian
authors.initials: J
authors.lastname: Zou
authors.affiliation: Informatics Department, Nanfang Hospital, Southern Medical University, Guangzhou 510515, P. R. China.
authors.forename: Jingdong
authors.initials: J
authors.lastname: Yan
authors.affiliation: Southern Medical University, Guangzhou 510515, P. R. China.
authors.forename: Xiangdong
authors.initials: X
authors.lastname: Zhang
authors.affiliation: Department of Medicine, Division of Infectious Diseases, Rhode Island Hospital, Warren Alpert Medical School of Brown University, Providence, Rhode Island 02903, USA.
authors.forename: Dimitrios
authors.initials: D
authors.lastname: Farmakiotis
authors.affiliation: Department of Medicine, Division of Infectious Diseases, Rhode Island Hospital, Warren Alpert Medical School of Brown University, Providence, Rhode Island 02903, USA emylonakis@lifespan.org.
authors.forename: Eleftherios
authors.initials: E
authors.lastname: Mylonakis
mesh_terms: D000151:Acinetobacter Infections / Q000453:epidemiology / Q000382:microbiology*; D040981:Acinetobacter baumannii / Q000302:isolation & purification*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002175:Candida / Q000302:isolation & purification*; D002177:Candidiasis / Q000150:complications*; D002353:Carrier State; D016022:Case-Control Studies; D005260:Female; D006801:Humans; D007362:Intensive Care Units; D008297:Male; D008875:Middle Aged; D053717:Pneumonia, Ventilator-Associated / Q000453:epidemiology / Q000382:microbiology*; D012121:Respiration, Artificial; D012189:Retrospective Studies; D012307:Risk Factors; D055815:Young Adult
keywords: Acinetobacter baumannii; Candida colonization; intensive care unit; ventilator-associated pneumonia