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The risk of positive cultures for Candida in the critically ill patient
Abstract:
It is frequently stated that a positive fungal culture is of little clinical significance unless the culture is obtained on repetitive blood specimens. We analyzed the mortality associated with a positive culture for Candida species in ICU patients from several locations over a 3-month period. Criteria for inclusion in this study were: (1) residence in the ICU for at least 4 days, (2) no GI tract alimentation during this period, and (3) administration of at least one antibiotic during this period. Forty-four patients fit these criteria; 23 had positive Candida cultures from at least one site and 12 (52%) died. Four of 21 patients (19%) who did not grow Candida died. Cultures of urine and sputum were most likely to be positive. Positive cultures from the urine, sputum, or wound were associated with at least a 50% mortality. This suggests that routine sputum and urine cultures may be of substantial clinical therapeutic and prognostic significance. Two patients had positive blood cultures and both died. No single class of antibiotics, surgical complications or underlying disease predisposed to these results. It is concluded that the presence of a single positive culture for Candida from any site in the critically ill surgical patient kept without GI alimentation and on any antibiotic is a grave prognostic sign which requires further attention.
Insights
A single positive Candida culture in ICU patients, even from urine or sputum, indicates a grave prognosis. This finding suggests routine cultures hold significant clinical and prognostic value for critically ill patients.
Area of Science:
- Critical Care Medicine
- Infectious Diseases
- Medical Microbiology
Background:
- Positive fungal cultures, particularly Candida, are often dismissed unless from blood.
- The clinical significance of non-blood Candida cultures in intensive care unit (ICU) patients remains debated.
Purpose of the Study:
- To analyze the mortality associated with positive Candida cultures from any site in ICU patients.
- To evaluate the prognostic significance of routine cultures (urine, sputum) for Candida infections.
Main Methods:
- Retrospective analysis of ICU patients over a 3-month period.
- Inclusion criteria: ICU stay ≥ 4 days, no gastrointestinal alimentation, and antibiotic administration.
- Comparison of mortality rates between patients with and without positive Candida cultures.
Main Results:
- Twenty-three of forty-four eligible patients had positive Candida cultures; 52% of these died compared to 19% of those without Candida.
- Positive urine and sputum cultures were most common and associated with ≥ 50% mortality.
- Two patients with positive blood cultures both died.
Conclusions:
- A single positive Candida culture from any site in critically ill surgical patients is a grave prognostic sign.
- Routine urine and sputum cultures for Candida may have substantial clinical, therapeutic, and prognostic importance.
- Further attention and investigation are warranted for positive Candida cultures in this patient population.