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01-08-2012 | Original

Candida spp. airway colonization could promote antibiotic-resistant bacteria selection in patients with suspected ventilator-associated pneumonia

Authors: Maël Hamet, Arnaud Pavon, Frédéric Dalle, André Pechinot, Sébastien Prin, Jean-Pierre Quenot, Pierre-Emmanuel Charles

Published in: Intensive Care Medicine | Issue 8/2012

Abstract

Objective

Candida spp. airway colonization could promote development of ventilator-associated pneumonia (VAP) caused by Pseudomonas aeruginosa, a potentially multidrug-resistant (MDR) bacteria, and worsen the outcome of VAP regardless of pathogen. We therefore address the question of the risk of MDR bacteria isolation within the airway of patients with suspected VAP, whether Candida spp. is present or not.

Design and setting

Prospective observational study in a teaching hospital.

Patients and methods

Consecutive patients with suspected VAP were included. Respiratory tract secretions were seeded on specific medium for yeast isolation in addition to standard culture. Outcome as well as presence of MDR bacteria were assessed according to fungal colonization.

Results

323 suspected VAP were analysed. Among these, 181 (56 %) cases presented with Candida spp. airway colonization. Colonized and noncolonized patients were similar regarding baseline characteristics, prior exposure to antibiotics and VAP severity. However, mortality rate was greater in patients with fungal airway colonization than in those without (44.2 versus 31.0 %, respectively; p = 0.02). In addition, MDR bacteria isolation was 31.5 % in patients with Candida spp. colonization versus 23.2 % in those without (p = 0.13). Moreover, Candida spp. airway colonization was one independent risk factor for MDR bacteria isolation [odds ratio (OR) = 1.79, 95 % confidence interval 1.05–3.05; p = 0.03], in addition to the time elapsed between intensive care unit (ICU) admission and VAP suspicion.

Conclusions

In patients with suspected VAP, Candida spp. airway colonization is frequent and associated with increased risk for MDR bacteria isolation. This could worsen outcome and should therefore be considered when choosing an empiric antibiotic therapy.

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Title: Candida spp. airway colonization could promote antibiotic-resistant bacteria selection in patients with suspected ventilator-associated pneumonia
Authors: Maël Hamet
Arnaud Pavon
Frédéric Dalle
André Pechinot
Sébastien Prin
Jean-Pierre Quenot
Pierre-Emmanuel Charles
Publication date: 01-08-2012
Publisher: Springer-Verlag
Published in: Intensive Care Medicine / Issue 8/2012
Print ISSN: 0342-4642
Electronic ISSN: 1432-1238
DOI: https://doi.org/10.1007/s00134-012-2584-2

At a glance: The STEP trials

Springer Medicine

Candida spp. airway colonization could promote antibiotic-resistant bacteria selection in patients with suspected ventilator-associated pneumonia

Abstract

Objective

Design and setting

Patients and methods

Results

Conclusions

At a glance: The STEP trials

Springer Medicine

Abstract

Objective

Design and setting

Patients and methods

Results

Conclusions

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