BACKGROUND: The significance of Candida species in respiratory tract (RT) secretions in critically ill patients is unclear. METHODS: A retrospective analysis of the Canadian ventilator-associated pneumonia (VAP) trial was conducted. Only patients with suspected VAP whose initial cultures failed to grow any known pathogens were included. Using two fundamentally different statistical techniques that adjusted for important confounding variables, the clinical outcomes of patients with Candida species recovered from RT cultures were compared with patients whose RT cultures were not positive for Candida species. RESULTS: RT cultures yielded no identifiable bacterial pathogens in 274 patients; 68 patients had Candida species in the RT alone, while 206 patients did not have Candida species recovered from any site. The unadjusted OR of hospital mortality for patients with Candida species was 2.9 (95% CI 1.6 to 5.2; P<0.001). The hazard ratio of time to hospital discharge was 0.54 (95% CI 0.38 to 0.77; P=0.001). Logistic regression analysis demonstrated that age, Acute Physiology score and Chronic Health Evaluation (APACHE) II score, primary diagnosis of respiratory failure, two or more comorbidities and Candida species were independently associated with increased hospital mortality. Similar trends were observed with time to hospital discharge. The association between Candida species and increased mortality remained after controlling for potential confounders using both propensity score stratification and multivariable modelling approaches. CONCLUSIONS: Patients with suspected VAP, in whom no bacterial pathogen was identified and in whom Candida species were isolated from RT cultures, exhibited a greater burden of illness compared with similar patients without Candida. Whether Candida species colonization of RT secretions is a marker of disease severity or actually contributes to poorer clinical outcomes remains unclear.
RCT Entities:
BACKGROUND: The significance of Candida species in respiratory tract (RT) secretions in critically illpatients is unclear. METHODS: A retrospective analysis of the Canadian ventilator-associated pneumonia (VAP) trial was conducted. Only patients with suspected VAP whose initial cultures failed to grow any known pathogens were included. Using two fundamentally different statistical techniques that adjusted for important confounding variables, the clinical outcomes of patients with Candida species recovered from RT cultures were compared with patients whose RT cultures were not positive for Candida species. RESULTS: RT cultures yielded no identifiable bacterial pathogens in 274 patients; 68 patients had Candida species in the RT alone, while 206 patients did not have Candida species recovered from any site. The unadjusted OR of hospital mortality for patients with Candida species was 2.9 (95% CI 1.6 to 5.2; P<0.001). The hazard ratio of time to hospital discharge was 0.54 (95% CI 0.38 to 0.77; P=0.001). Logistic regression analysis demonstrated that age, Acute Physiology score and Chronic Health Evaluation (APACHE) II score, primary diagnosis of respiratory failure, two or more comorbidities and Candida species were independently associated with increased hospital mortality. Similar trends were observed with time to hospital discharge. The association between Candida species and increased mortality remained after controlling for potential confounders using both propensity score stratification and multivariable modelling approaches. CONCLUSIONS:Patients with suspected VAP, in whom no bacterial pathogen was identified and in whom Candida species were isolated from RT cultures, exhibited a greater burden of illness compared with similar patients without Candida. Whether Candida species colonization of RT secretions is a marker of disease severity or actually contributes to poorer clinical outcomes remains unclear.
Authors: M el-Ebiary; A Torres; N Fàbregas; J P de la Bellacasa; J González; J Ramirez; D del Baño; C Hernández; M T Jiménez de Anta Journal: Am J Respir Crit Care Med Date: 1997-08 Impact factor: 21.405
Authors: Pierre Emmanuel Charles; Frédéric Dalle; Hervé Aube; Jean Marc Doise; Jean Pierre Quenot; Ludwig Serge Aho; Pascal Chavanet; Bernard Blettery Journal: Intensive Care Med Date: 2005-02-12 Impact factor: 17.440
Authors: G Christopher Wood; Eric W Mueller; Martin A Croce; Bradley A Boucher; Timothy C Fabian Journal: Intensive Care Med Date: 2006-02-14 Impact factor: 17.440
Authors: Martin Albert; David Williamson; John Muscedere; Francois Lauzier; Coleman Rotstein; Salmaan Kanji; Xuran Jiang; Mark Hall; Daren Heyland Journal: Intensive Care Med Date: 2014-07-01 Impact factor: 17.440
Authors: Kathryn M Pendleton; Robert P Dickson; Duane W Newton; Timothy C Hoffman; Gregory A Yanik; Gary B Huffnagle Journal: Clin Pulm Med Date: 2018-11
Authors: Robert Krause; Bettina Halwachs; Gerhard G Thallinger; Ingeborg Klymiuk; Gregor Gorkiewicz; Martin Hoenigl; Jürgen Prattes; Thomas Valentin; Katharina Heidrich; Walter Buzina; Helmut J F Salzer; Jasmin Rabensteiner; Florian Prüller; Reinhard B Raggam; Andreas Meinitzer; Christine Moissl-Eichinger; Christoph Högenauer; Franz Quehenberger; Karl Kashofer; Ines Zollner-Schwetz Journal: PLoS One Date: 2016-05-20 Impact factor: 3.240