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01-01-2007 | Brief Report

Impact of antifungal treatment on Candida–Pseudomonas interaction: a preliminary retrospective case–control study

Authors: Saad Nseir, Elsa Jozefowicz, Béatrice Cavestri, Boualem Sendid, Christophe Di Pompeo, Florent Dewavrin, Raphaël Favory, Micheline Roussel-Delvallez, Alain Durocher

Published in: Intensive Care Medicine | Issue 1/2007

Abstract

Objective

A pathogenic interaction between Candida albicans and Pseudomonas aeruginosa has recently been demonstrated. In addition, experimental and clinical studies identified Candida spp. tracheobronchial colonization as a risk factor for P. aeruginosa pneumonia. The aim of this study was to determine the impact of antifungal treatment on ventilator-associated pneumonia (VAP) or tracheobronchial colonization due to P. aeruginosa.

Design and setting

Retrospective observational case–control study conducted in a 30-bed ICU during a 1-year period.

Patients and methods

One hundred and two patients intubated and ventilated for longer than 48 h with tracheobronchial colonization by Candida spp. Routine screening for Candida spp. and P. aeruginosa was performed at ICU admission and weekly. Antifungal treatment was based on medical staff decisions. Patients with P. aeruginosa VAP or tracheobronchial colonization were matched (1:2) with patients without P. aeruginosa VAP or tracheobronchial colonization. In case and control patients, risk factors for P. aeruginosa VAP or tracheobronchial colonization were determined using univariate and multivariate analyses.

Results

Thirty-six patients (35%) received antifungal treatment. Nineteen patients (18%) developed a P. aeruginosa VAP or tracheobronchial colonization, and all were successfully matched. Antifungal treatment [31% vs 60%; p = 0.037, OR (95% CI) = 0.67 (0.45–0.90)], and duration of antifungal treatment (7 ± 11 vs 14 ± 14 days; p = 0.045, in case and control patients respectively) were significantly associated with reduced risk for P. aeruginosa VAP or tracheobronchial colonization. Antifungal treatment was the only variable independently associated with P. aeruginosa VAP or tracheobronchial colonization (OR = 0.68, 95% CI = 0.49–0.90, p = 0.046).

Conclusion

In patients with Candida spp. tracheobronchial colonization, antifungal treatment may be associated with reduced risk for P. aeruginosa VAP or tracheobronchial colonization.

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Safdar N, Dezfulian C, Collard HR, Saint S (2005) Clinical and economic consequences of ventilator-associated pneumonia: a systematic review. Crit Care Med 33:2184–2193PubMedCrossRef

Sadikot RT, Blackwell TS, Christman JW, Prince AS (2005) Pathogen-host interactions in Pseudomonas aeruginosa pneumonia. Am J Respir Crit Care Med 171:1209–1223PubMedCrossRef

Chastre J, Fagon JY (2002) Ventilator-associated pneumonia. Am J Respir Crit Care Med 165:867–903PubMed

Safdar N, Maki DG (2002) The commonality of risk factors for nosocomial colonization and infection with antimicrobial-resistant Staphylococcus aureus, enterococcus, gram-negative bacilli, Clostridium difficile, and Candida. Ann Intern Med 136:834–844PubMed

Hogan DA, Kolter R (2002) Pseudomonas–Candida interactions: an ecological role for virulence factors. Science 296:2229–2232PubMedCrossRef

Hogan DA, Vik A, Kolter R (2004) A Pseudomonas aeruginosa quorum-sensing molecule influences Candida albicans morphology. Mol Microbiol 54:1212–1223PubMedCrossRef

Spinelli SL, Malik HS, Consaul SA, Phizicky EM (1998) A functional homolog of a yeast tRNA splicing enzyme is conserved in higher eukaryotes and in Escherichia coli. Proc Natl Acad Sci USA 95:14136–14141PubMedCrossRef

Azoulay E, Timsit JF, Tafflet M, de Lassence A, Darmon M, Zahar JR, Adrie C, Garrouste-Org M, Cohen Y, Mourvillier B, Schlemmer B (2006) Candida colonization of the respiratory tract and subsequent Pseudomonas ventilator-associated pneumonia. Chest 129:110–117PubMedCrossRef

Celum CL (2004) The interaction between herpes simplex virus and human immunodeficiency virus. Herpes 11 (Suppl 1):36A–45A

10.

Seki M, Higashiyama Y, Tomono K, Yanagihara K, Ohno H, Kaneko Y, Izumikawa K, Miyazaki Y, Hirakata Y, Mizuta Y, Tashiro T, Kohno S (2004) Acute infection with influenza virus enhances susceptibility to fatal pneumonia following Streptococcus pneumoniae infection in mice with chronic pulmonary colonization with Pseudomonas aeruginosa. Clin Exp Immunol 137:35–40PubMedCrossRef

11.

Neely AN, Law EJ, Holder IA (1986) Increased susceptibility to lethal Candida infections in burned mice preinfected with Pseudomonas aeruginosa or pretreated with proteolytic enzymes. Infect Immun 52:200–204PubMed

12.

Roux D, Ricard JD, Dreyfuss D, De Prost N, Grossin M, Saumon G (2006) Impact de la colonisation des voies aériennes à Candida albicans sur l'émergence d'une pneumopathie à Pseudomonas aeruginosa chez le rat. Réanimation 15: S43 (abstract)CrossRef

13.

Bauer TT, Torres A, Ferrer R, Heyer CM, Schultze-Werninghaus G, Rasche K (2002) Biofilm formation in endotracheal tubes. Association between pneumonia and the persistence of pathogens. Monaldi Arch Chest Dis 57:84–87PubMed

14.

Adair CG, Gorman SP, Feron BM, Byers LM, Jones DS, Goldsmith CE, Moore JE, Kerr JR, Curran MD, Hogg G, Webb CH, McCarthy GJ, Milligan KR (1999) Implications of endotracheal tube biofilm for ventilator-associated pneumonia. Intensive Care Med 25:1072–1076PubMedCrossRef

15.

Nseir S, Marquette CH (2003) Diagnosis of hospital-acquired pneumonia: postmortem studies. Infect Dis Clin North Am 17:707–716PubMedCrossRef

16.

Azoulay E, Cohen Y, Zahar JR, Garrouste-Org M, Adrie C, Moine P, de Lassence A, Timsit JF (2004) Practices in non-neutropenic ICU patients with Candida-positive airway specimens. Intensive Care Med 30:1384–1389PubMed

17.

Wood GC, Mueller EW, Croce MA, Boucher BA, Fabian TC (2006) Candida sp. isolated from bronchoalveolar lavage: clinical significance in critically ill trauma patients. Intensive Care Med 32:599–603PubMedCrossRef

18.

Eggimann P, Garbino J, Pittet D (2003) Management of Candida species infections in critically ill patients. Lancet Infect Dis 3:772–785PubMedCrossRef

19.

Piarroux R, Grenouillet F, Balvay P, Tran V, Blasco G, Millon L, Boillot A (2004) Assessment of preemptive treatment to prevent severe candidiasis in critically ill surgical patients. Crit Care Med 32:2443–2449PubMedCrossRef

20.

Leon C, Ruiz-Santana S, Saavedra P, Almirante B, Nolla-Salas J, Alvarez-Lerma F, Garnacho-Montero J, Leon MA (2006) A bedside scoring system (“Candida score”) for early antifungal treatment in nonneutropenic critically ill patients with Candida colonization. Crit Care Med 34:730–737PubMedCrossRef

Title: Impact of antifungal treatment on Candida–Pseudomonas interaction: a preliminary retrospective case–control study
Authors: Saad Nseir
Elsa Jozefowicz
Béatrice Cavestri
Boualem Sendid
Christophe Di Pompeo
Florent Dewavrin
Raphaël Favory
Micheline Roussel-Delvallez
Alain Durocher
Publication date: 01-01-2007
Publisher: Springer-Verlag
Published in: Intensive Care Medicine / Issue 1/2007
Print ISSN: 0342-4642
Electronic ISSN: 1432-1238
DOI: https://doi.org/10.1007/s00134-006-0422-0

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Impact of antifungal treatment on Candida–Pseudomonas interaction: a preliminary retrospective case–control study

Abstract

Objective

Design and setting

Patients and methods

Results

Conclusion

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Objective

Design and setting

Patients and methods

Results

Conclusion

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