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01-07-2004 | Original

Practices in non-neutropenic ICU patients with Candida-positive airway specimens

Authors: Elie Azoulay, Yves Cohen, Jean-Ralph Zahar, Maité Garrouste-Orgeas, Christophe Adrie, Pierre Moine, Arnaud de Lassence, Jean-François Timsit

Published in: Intensive Care Medicine | Issue 7/2004

Abstract

Objective: To examine practices of French intensivists regarding the management of mechanically ventilated patients with Candida-positive airway specimens but no major risk factors for immunodepression. Design : Closed-item questionnaire with a clinical vignette. Setting: 564 French intensive care units (ICUs). Participants: 198 intensivists who have a special interest in infectious diseases and who answered the questionnaire (response rate, 35.1%). Intervention: None. Measurements and results: The respondents recommended bronchoalveolar lavage (62.6% of respondents), protected distal sampling and protected specimen brush (59.1%), transbronchial biopsy (38.9%), and tracheal aspiration (12.1%) for the diagnosis of candidal pneumonia. A positive airway specimen was felt by most respondents (83.3%) to indicate colonisation; 66.7% of respondents recommended tests for systemic candidiasis in this situation, and 56.5% serial sampling to compute the colonisation index. Azole derivatives were the preferred antifungal medications. The clinical vignette described a patient with chronic obstructive lung disease who required mechanical ventilation for an acute exacerbation and who had a tracheal aspirate positive for Candida. Responses varied widely, with 37.8% of respondents diagnosing clinically insignificant colonisation but 24.2% recommending antifungal treatment and 61.6% serial testing to assess the Candida colonisation index. Intensivists with greater experience with severely immunocompromised patients were more aggressive in their diagnostic management. Conclusions: Wide variations occur among practices of French intensivists regarding Candida-positive airway specimens in patients without major risk factors for immunodepression. Additional studies are needed to improve our understanding of the links between Candida colonisation and infection and to determine the indications for pre-emptive antifungal treatment in non-neutropenic critically ill patients.

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Title: Practices in non-neutropenic ICU patients with Candida-positive airway specimens
Authors: Elie Azoulay
Yves Cohen
Jean-Ralph Zahar
Maité Garrouste-Orgeas
Christophe Adrie
Pierre Moine
Arnaud de Lassence
Jean-François Timsit
Publication date: 01-07-2004
Publisher: Springer-Verlag
Published in: Intensive Care Medicine / Issue 7/2004
Print ISSN: 0342-4642
Electronic ISSN: 1432-1238
DOI: https://doi.org/10.1007/s00134-004-2316-3

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Practices in non-neutropenic ICU patients with Candida-positive airway specimens

Abstract

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

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