Yuetian Yu1,2, Jia Li1, Suli Wang1, Yuan Gao2, Hui Shen3, Liangjing Lu1. 1. Department of Rheumatology, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai 200001, China. 2. Department of Critical Care Medicine, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai 200001, China. 3. Department of Laboratory Medicine, Shanghai East Hospital, Tongji University School of Medicine, Shanghai 200123, China.
Abstract
BACKGROUND: To investigate the effect of Candida albicans airway colonization on hospital-acquired bacterial pneumonia (HABP) in patients with systemic lupus erythematosus (SLE). METHODS: SLE patients with HAP were enrolled in this retrospective cohort study from January 2015 to December 2018. According to the culture results of respiratory tract secretions and antifungal treatment, patients were divided into non-C. albicans colonization group (NCG), C. albicans colonization with antifungal treatment group (CTG) and C. albicans colonization without antifungal treatment group (CNTG). Twenty-eight days of all-cause mortality after the onset of HABP of each group was assessed, total duration of antibiotic treatment, changes of inflammatory cytokines and markers of immune status were documented. RESULTS: A total of 269 SLE patients with HABP were finally included in the study. Among them, 69.1% (186/269) were found C. albicans airway colonization, and 36.1% (97/269) received antifungal treatment. No difference of 28 days of all-cause mortality after HABP onset was found among the three groups (10.8% vs. 13.4% vs. 15.7%, P>0.05). Duration of antibiotic treatment of HABP due to Acinetobacter baumannii was shorter in CTG (11.21±2.45 days) than that in CNTG (12.89±3.87 days) as well as HABP due to Pseudomonas aeruginosa (10.57±2.66 vs. 12.56±3.04 days) (P<0.05, respectively). Antifungal treatment could decrease the level of interleukin-1β, interleukin-6, tumor necrosis factor-α and interferon-γ in CTG than in CNTG (P<0.05, respectively). In addition, it could regulate immune function by decrease the concentration of interleukin-17 and elevate the counts of CD4+Th lymphocyte as well (P<0.05, respectively). CONCLUSIONS: C. albicans airway colonization was not associated with HABP mortality in SLE patients. Antifungal therapy in these patients might shorten the duration of antibiotics in treating HABP due to A. baumannii and P. aeruginosa. 2019 Annals of Translational Medicine. All rights reserved.
BACKGROUND: To investigate the effect of Candida albicans airway colonization on hospital-acquired bacterial pneumonia (HABP) in patients with systemic lupus erythematosus (SLE). METHODS: SLE patients with HAP were enrolled in this retrospective cohort study from January 2015 to December 2018. According to the culture results of respiratory tract secretions and antifungal treatment, patients were divided into non-C. albicans colonization group (NCG), C. albicans colonization with antifungal treatment group (CTG) and C. albicans colonization without antifungal treatment group (CNTG). Twenty-eight days of all-cause mortality after the onset of HABP of each group was assessed, total duration of antibiotic treatment, changes of inflammatory cytokines and markers of immune status were documented. RESULTS: A total of 269 SLE patients with HABP were finally included in the study. Among them, 69.1% (186/269) were found C. albicans airway colonization, and 36.1% (97/269) received antifungal treatment. No difference of 28 days of all-cause mortality after HABP onset was found among the three groups (10.8% vs. 13.4% vs. 15.7%, P>0.05). Duration of antibiotic treatment of HABP due to Acinetobacter baumannii was shorter in CTG (11.21±2.45 days) than that in CNTG (12.89±3.87 days) as well as HABP due to Pseudomonas aeruginosa (10.57±2.66 vs. 12.56±3.04 days) (P<0.05, respectively). Antifungal treatment could decrease the level of interleukin-1β, interleukin-6, tumor necrosis factor-α and interferon-γ in CTG than in CNTG (P<0.05, respectively). In addition, it could regulate immune function by decrease the concentration of interleukin-17 and elevate the counts of CD4+Th lymphocyte as well (P<0.05, respectively). CONCLUSIONS: C. albicans airway colonization was not associated with HABP mortality in SLE patients. Antifungal therapy in these patients might shorten the duration of antibiotics in treating HABP due to A. baumannii and P. aeruginosa. 2019 Annals of Translational Medicine. All rights reserved.
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