Effects of Candida colonization on patients with ventilator-associated pneumonia and pathogenic microorganisms:
Yushan Liu1, Tingting Xu1, Qiwen Tan1
1Department of Infectious Disease, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022 Hubei, PR China.
Background:
In the intensive care unit (ICU), patients undergoing mechanical ventilation (MV) often exhibit Candida colonization. This study aims to systematically review and analyze the effects of Candida colonization on the outcomes of mechanically ventilated patients and its relationship with bacterial pathogens associated with ventilator-associated pneumonia (VAP).
Methods:
We conducted a comprehensive search across PubMed, Embase, Web of Science (WOS), and the Cochrane Central Register of Controlled Trials (CENTRAL) without language restrictions to identify eligible studies. Inclusion criteria involved patients undergoing MV for >2 days, encompassing those with clinically suspected VAP (csVAP), and confirmed VAP patients. We assessed the impact of Candida colonization on patient prognosis, length of ICU stay, bacterial pathogens responsible for VAP, and inflammatory markers. The study protocol was registered with PROSPER (CRD42024580547).
Results:
Thirteen studies involving 3,802 patients were included in our analysis. The prevalence of Candida colonization among MV patients ranged from 10 % to 56 %. Our findings indicated that Candida airway colonization was associated with poorer patient prognosis (95 % CI 1.13-1.52, p < 0.05, I² = 39 %). Among patients who developed VAP, Candida colonization correlated with increased detection rates of Pseudomonas aeruginosa (RR = 1.37, 95 % CI 1.07-1.75, p = 0.01, I² = 3 %) and Acinetobacter baumannii (RR= 1.48, 95 % CI 1.17-1.86, p < 0.01, I² = 27 %). Additionally, an association with antibiotic resistance was observed, although the quality of evidence was low. In studies that recorded patients' inflammatory markers, no significant effect of Candida colonization on inflammatory markers (procalcitonin, interleukin-6) was observed.
Conclusion:
Candida airway colonization is highly prevalent among mechanically ventilated patients and should be considered a marker of poor prognosis when it occurs. Antibiotics should be used more carefully when Candida colonization is detected in the respiratory tract of mechanically ventilated patients.
Insights
Candida airway colonization is common in mechanically ventilated patients and signals a worse prognosis. Careful antibiotic use is advised when Candida is detected in respiratory tracts.
Area of Science:
- Critical Care Medicine
- Infectious Diseases
- Microbiology
Background:
- Mechanical ventilation (MV) patients frequently develop Candida colonization.
- This study investigates Candida's impact on MV patient outcomes and its link to VAP pathogens.
Approach:
- Systematic review of PubMed, Embase, WOS, and CENTRAL databases.
- Included studies focused on MV patients (>2 days), including those with suspected or confirmed VAP.
- Assessed effects on prognosis, ICU stay, VAP pathogens, and inflammatory markers.
Key Points:
- Thirteen studies (3,802 patients) revealed Candida colonization prevalence from 10-56%.
- Candida colonization correlated with poorer prognosis (OR 1.32, 95% CI 1.13-1.52) and increased Pseudomonas aeruginosa and Acinetobacter baumannii VAP rates.
- Association with antibiotic resistance was noted (low evidence quality); no impact on inflammatory markers.
Conclusions:
- Candida airway colonization is prevalent in MV patients, indicating a poor prognosis.
- Respiratory Candida colonization warrants careful consideration for antibiotic therapy in MV patients.
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