Jean-Francois Timsit1,2, Carole Schwebel3, Lenka Styfalova4, Muriel Cornet5,6, Philippe Poirier7, Christiane Forrestier8, Stéphane Ruckly9,4, Marie-Christine Jacob10,11, Bertrand Souweine12. 1. Medical and Infectious Diseases ICU, Bichat-Claude Bernard Hospital, APHP, Paris, France. jean-francois.timsit@bch.aphp.fr. 2. INSERM, IAME UMR 1137, Paris-Diderot Sorbonne-Paris Cité University, Paris, France. jean-francois.timsit@bch.aphp.fr. 3. Medical ICU, Albert Michallon University Hospital, Grenoble, France. 4. OUTCOMEREA Network, Aulnay Sous Bois, France. 5. Univ. Grenoble Alpes, CNRS, CHU Grenoble Alpes, Grenoble INP, TIMC-IMAG, 38000, Grenoble, France. 6. Institute of Engineering, Univ. Grenoble Alpes, Grenoble, France. 7. Laboratoire de Parasitologie-Mycologie, CHU Clermont-Ferrand, CNRS, Université Clermont Auvergne, 63000, Clermont-Ferrand, France. 8. Université Clermont Auvergne, UMR CNRS 6023, Clermont-Ferrand, France. 9. INSERM, IAME UMR 1137, Paris-Diderot Sorbonne-Paris Cité University, Paris, France. 10. Department of Immunology, Grenoble-Alpes University Hospital (CHUGA) 38700 Grenoble, France. 11. INSERM U1209, CNRS UMR 5309, Institute for Advanced Biosciences,, Université Grenoble Alpes,, 38700, Grenoble, France. 12. Medical ICU, Gabriel-Montpied University Hospital,, Clermont-Ferrand,, France.
Abstract
INTRODUCTION: Respiratory tract Candida spp. colonization is associated with more frequent bacterial ventilator-associated pneumonia (VAP). However, this colonization could be causally related to VAP or simply reflect the immune paralysis associated with multiple organ failure. OBJECTIVE: To prospectively evaluate the relationship between Candida spp. colonization and bacterial VAP in mechanically ventilated patients with multiple organ failure. INCLUSION: Patients receiving mechanical ventilation for > 4 days and presenting multiple organ failure were included. Tracheal colonization with Candida spp. was evaluated at inclusion (day 0, D0) and every 4 days until extubation. Quantitative proximal and tracheal cultures were performed at each VAP episode. Monocyte human leukocyte antigen-DR isotype (mHLA-DR) expression and the ratio of polymononuclear leukocytes to lymphocytes were used to evaluate immunoparalysis at D0 and D7. The relationship between fungal colonization and VAP was modelled using cause-specific models for repeated events with adjustment for time-dependent confounders and immune factors. RESULTS: A total of 213 patients, with a median age of 64, simplified acute physiology score II (SAPS II) score 55 and sequential organ failure assessment (SOFA) score 10, mainly admitted for medical reasons (n = 197, 92%), were enrolled in 2012-2015. The median ICU stay was 24 days and the mortality rate was 32% (69 cases). Median mHLA-DR was 5916 Ab-bound/cell [3863-8934]; median lymphocyte count, 0.9Giga/L [0.6-1.3]; neutrophil-to-lymphocyte ratio, 10.9 [6.5-19.7]. Overall, 146 cases (68.5%) had tracheal colonization with Candida spp. An episode of VAP occurred (either for the first or only time) in 62 (29.1%) cases 5.5 days (median) after D0; a second episode occurred in 12 (5.6%) cases, 15.5 days (median) after D0. After adjustment, bronchial colonization with Candida was not associated with VAP [adjusted cause-specific hazard ratio = 0.98 (0.59-1.65), p = 0.95]. CONCLUSION: In patients with mechanical ventilation for more than 4 days and multiple organ failure, bronchial colonization with Candida spp. was not associated with VAP, even after adjustment for immune function.
INTRODUCTION: Respiratory tract Candida spp. colonization is associated with more frequent bacterial ventilator-associated pneumonia (VAP). However, this colonization could be causally related to VAP or simply reflect the immune paralysis associated with multiple organ failure. OBJECTIVE: To prospectively evaluate the relationship between Candida spp. colonization and bacterial VAP in mechanically ventilated patients with multiple organ failure. INCLUSION: Patients receiving mechanical ventilation for > 4 days and presenting multiple organ failure were included. Tracheal colonization with Candida spp. was evaluated at inclusion (day 0, D0) and every 4 days until extubation. Quantitative proximal and tracheal cultures were performed at each VAP episode. Monocyte human leukocyte antigen-DR isotype (mHLA-DR) expression and the ratio of polymononuclear leukocytes to lymphocytes were used to evaluate immunoparalysis at D0 and D7. The relationship between fungal colonization and VAP was modelled using cause-specific models for repeated events with adjustment for time-dependent confounders and immune factors. RESULTS: A total of 213 patients, with a median age of 64, simplified acute physiology score II (SAPS II) score 55 and sequential organ failure assessment (SOFA) score 10, mainly admitted for medical reasons (n = 197, 92%), were enrolled in 2012-2015. The median ICU stay was 24 days and the mortality rate was 32% (69 cases). Median mHLA-DR was 5916 Ab-bound/cell [3863-8934]; median lymphocyte count, 0.9Giga/L [0.6-1.3]; neutrophil-to-lymphocyte ratio, 10.9 [6.5-19.7]. Overall, 146 cases (68.5%) had tracheal colonization with Candida spp. An episode of VAP occurred (either for the first or only time) in 62 (29.1%) cases 5.5 days (median) after D0; a second episode occurred in 12 (5.6%) cases, 15.5 days (median) after D0. After adjustment, bronchial colonization with Candida was not associated with VAP [adjusted cause-specific hazard ratio = 0.98 (0.59-1.65), p = 0.95]. CONCLUSION: In patients with mechanical ventilation for more than 4 days and multiple organ failure, bronchial colonization with Candida spp. was not associated with VAP, even after adjustment for immune function.
Authors: David R Williamson; Martin Albert; Marc M Perreault; Marie-Soleil Delisle; John Muscedere; Coleman Rotstein; Xuran Jiang; Daren K Heyland Journal: Can J Anaesth Date: 2010-12-14 Impact factor: 5.063
Authors: W Meersseman; K Lagrou; I Spriet; J Maertens; E Verbeken; W E Peetermans; E Van Wijngaerden Journal: Intensive Care Med Date: 2009-04-09 Impact factor: 17.440
Authors: Thomas P Hellyer; Daniel F McAuley; Timothy S Walsh; Niall Anderson; Andrew Conway Morris; Suveer Singh; Paul Dark; Alistair I Roy; Gavin D Perkins; Ronan McMullan; Lydia M Emerson; Bronagh Blackwood; Stephen E Wright; Kallirroi Kefala; Cecilia M O'Kane; Simon V Baudouin; Ross L Paterson; Anthony J Rostron; Ashley Agus; Jonathan Bannard-Smith; Nicole M Robin; Ingeborg D Welters; Christopher Bassford; Bryan Yates; Craig Spencer; Shondipon K Laha; Jonathan Hulme; Stephen Bonner; Vanessa Linnett; Julian Sonksen; Tina Van Den Broeck; Gert Boschman; Dw James Keenan; Jonathan Scott; A Joy Allen; Glenn Phair; Jennie Parker; Susan A Bowett; A John Simpson Journal: Lancet Respir Med Date: 2019-12-03 Impact factor: 102.642