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Candida spp. isolation from critically ill patients' respiratory tract. Does antifungal treatment affect survival?
Petros Ioannou1, Alexandra Vouidaski2, Nikolaos Spernovasilis3
1MD, MSc, PhD Department of Internal Medicine & Infectious Diseases, University Hospital of Heraklion, Stavrakia and Voutes crossroad, Heraklion, PC 71110, Crete, Greece.
Introduction:
Isolation of Candida spp. from bronchial samples of patients on mechanical ventilation is common. Even though it may not always reflect infection, it may induce immunological changes that can facilitate bacterial pneumonia. In this case, antifungal treatment is of uncertain value. This study examined the impact of antifungal treatment on the outcome of intensive care unit (ICU)-acquired respiratory tract infection (RTI) of critically ill, immunocompetent patients, with Candida isolation from their respiratory tract.
Methods:
This is a retrospective cohort study of adult patients hospitalized in the ICU of the University Hospital of Heraklion, Greece, from 2014 through 2016 with ICU-acquired RTI and Candida spp. isolated from their bronchial secretions. Data regarding medical history, demographics (gender, age), reason for ICU admission, previous antimicrobial use or hospitalization, SOFA and APACHE II score, clinical outcomes (primary clinical outcome: overall mortality during hospitalization; secondary clinical outcome: mortality during the ICU stay and duration of ICU and hospital stay) at the end of their ICU stay and at the end of their hospital stay were recorded and consequently evaluated. A logistic regression analysis model evaluated the effect of the recorded parameters in association with ICU mortality and overall mortality during hospitalization.
Results:
A total of 90 individuals were enrolled. Of them, 47 (52.2%) were treated with antifungals during their hospitalization around the time of Candida isolation. Patients treated with antifungals had higher SOFA and APACHE II scores, longer duration of stay in the ICU, more days on ventilator and higher total mortality during hospitalization. Multivariate logistic regression analysis identified antifungal use to be independently associated with total mortality during hospitalization.
Conclusions:
Antifungal use in patients with ICU-acquired RTI was associated with higher overall mortality as compared to those not receiving such agents.
Insights
Antifungal treatment in intensive care unit (ICU)-acquired respiratory tract infections (RTI) with Candida isolation was linked to increased overall mortality. This suggests caution is needed when prescribing antifungals in these critically ill patients.
Area of Science:
- Critical Care Medicine
- Infectious Diseases
- Pulmonology
Background:
- * *Candida* species isolation from respiratory samples is common in mechanically ventilated patients.
- * While not always indicative of infection, *Candida* may influence immune responses, potentially leading to bacterial pneumonia.
- * The value of antifungal treatment in such cases remains uncertain.
Purpose of the Study:
- * To investigate the impact of antifungal treatment on outcomes of ICU-acquired respiratory tract infections (RTI) in critically ill, immunocompetent patients with *Candida* isolation.
- * To evaluate the association between antifungal use and mortality in this patient population.
Main Methods:
- * Retrospective cohort study of adult patients in an ICU from 2014-2016.
- * Data collected included demographics, ICU admission reasons, prior treatments, severity scores (SOFA, APACHE II), and clinical outcomes (mortality, ICU/hospital stay duration).
- * Logistic regression analysis was used to assess the impact of various parameters on ICU and overall mortality.
Main Results:
- * 90 patients were included; 47 (52.2%) received antifungal treatment.
- * Patients treated with antifungals exhibited higher SOFA and APACHE II scores, longer ICU stays, and more ventilator days.
- * Antifungal use was independently associated with higher total mortality during hospitalization.
Conclusions:
- * Antifungal administration in ICU-acquired RTI with *Candida* isolation correlated with increased overall mortality.
- * Findings suggest a potential negative impact of antifungal therapy in this specific clinical context.
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