Candida colonization of the respiratory tract and subsequent pseudomonas ventilator-associated pneumonia
Candida colonization of the respiratory tract and subsequent pseudomonas ventilator-associated pneumonia
复制标题
DOI：
10.1378/chest.129.1.110
复制
发表时间：
2006-01-01
期刊：
影响因子：
9.6
通讯作者：
Schlemmer, B
中科院分区：
文献类型：
--
作者：
Azoulay, E;Timsit, JF;Schlemmer, B
背景：接受机械通气(MV)的危重患者呼吸道中念珠菌的恢复通常表明呼吸道定植而不是感染。然而，念珠菌与细菌，特别是假单胞菌之间的相互作用已有报道。因此，呼吸道念珠菌定植可能易患细菌性呼吸机相关肺炎(VAP)。方法：在一项多中心研究中，免疫功能正常的危重患者接受MV治疗2天，比较有和无呼吸道念珠菌定植(暴露/未暴露)患者的肺炎发生率，在研究中心、入院年份和MV持续时间上匹配。结果：在4年的研究期间，在6个研究中心符合研究纳入标准的803名患者中，214名患者(26.6%)有呼吸道念珠菌定植。白色念珠菌最常见(68.7%)，其次为光滑念珠菌(20.1%)和热带念珠菌(13.1%)。肺外念珠菌定植在暴露患者中更为常见(39.7%比8.3%，p=0.01)。暴露的患者有更长的ICU和住院时间，但死亡率与未暴露的患者相似。匹配的暴露/未暴露的巢式队列研究确定支气管菌定植是肺炎的独立危险因素(24.1%vs 17.6%；调整后的优势比[OR]1.58；95%可信区间[CI]0.94至2.68；p=0.0860)；假单胞菌肺炎的风险增加最大(9%vs 4.8%；调整后的OR为2.22；95%CI为1.00~4.92；p=0.049)。2天，并与ICU和住院时间延长以及假单胞菌VAP风险增加有关。
Background: Recovery of Candida from the respiratory tract of a critically ill patient receiving mechanical ventilation (MV) usually indicates colonization rather than infection of the respiratory tract. However, interactions between Candida and bacteria, particularly Pseudomonas, have been reported. Thus, Candida colonization of the respiratory tract may predispose to bacterial ventilator-associated pneumonia (VAP).Methods: In a multicenter study, of immunocompetent critically ill patients receiving MV for > 2 days, we compared the incidence of pneumonia in patients with and without (exposed/unexposed) respiratory-tract Candida colonization, matched on study center, admission year, and MV duration.Results: Over the 4-year study period, of the 803 patients meeting study inclusion criteria in the six study centers, 214 patients (26.6%) had respiratory tract Candida colonization. Candida albicans was the most common species (68.7%), followed by Candida glabrata (20.1%) and Candida tropicalis (13.1%). Extrapulmonary Candida colonization was more common in exposed patients (39.7% vs 8.3%, p = 0.01). Exposed patients had longer ICU and hospital stays but similar mortality to unexposed patients. The matched exposed/unexposed nested cohort study identified bronchial Candida colonization as an independent risk factor for pneumonia (24.1% vs 17.6%; adjusted odds ratio [OR], 1.58; 95% confidence interval [CI], 0.94 to 2.68; p = 0.0860); the risk increase was greatest for Pseudomonas pneumonia (9% vs 4.8%; adjusted OR, 2.22; 95% CI, 1.00 to 4.92; p = 0.049).Conclusions: Candida colonization of the respiratory tract is common in patients receiving MV for > 2 days and is associated with prolonged ICU and hospital stays, and with an increased risk of Pseudomonas VAP.