Significance of the isolation of Candida species from respiratory samples in critically ill, non-neutropenic patients - An immediate postmortem histologic study
Significance of the isolation of Candida species from respiratory samples in critically ill, non-neutropenic patients - An immediate postmortem histologic study
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DOI：
10.1164/ajrccm.156.2.9612023
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发表时间：
1997-08-01
影响因子：
24.7
通讯作者：
deAnta, MTJ
中科院分区：
文献类型：
--
作者：
ElEbiary, M;Torres, A;deAnta, MTJ
肺念珠菌病的诊断仍有争议。我们对25例死于ICU的非血小板减少、机械通气（> 72 h）患者进行了一项前瞻性研究，旨在评估从尸检肺活检和不同呼吸道采样技术的定量培养物中分离出念珠菌的发生率和意义。从所有患者中立即采集死后呼吸道样本（气管内抽吸物、保护标本刷[PSB]、支气管肺泡灌洗[BAL]、盲法活检[平均14/患者]和双侧支气管镜引导活检[每例患者2份]）。肺组织标本进行组织学检查。呼吸道样本被分类为念珠菌或其他。10例（40%）患者至少有一次肺活检产生念珠菌属。在这10例念珠菌分离株患者中，只有2例确诊为肺念珠菌病。从所有25名患者的375份肺活检样本中的280份（77%）中分离出总计470种微生物。念珠菌属占分离株的9%（n = 40），对应于10例患者（40%）。在10例从肺活检中分离出念珠菌属的患者中，这总是与从其中一种采样方法中分离出相同的微生物有关。不同采样方法的念珠菌属定量培养物相互之间相关性很好，但不能区分是否存在念珠菌肺炎。根据抗生素的存在、抗生素治疗天数、机械通气时间、年龄、ARDS、肠外营养和性别调整的logistic回归模型未显示任何导致念珠菌属阳性肺样本的独立风险因素。在死亡的重症机械通气、非血小板减少患者中，从肺活检分离念珠菌的发生率很高（40%）。但确诊念珠菌性肺炎的发生率为8%。我们还发现，念珠菌定植是均匀的整个不同的肺区域，呼吸道样本中的念珠菌的存在，独立于定量培养，是不是一个很好的标志念珠菌肺炎的危重病，非血小板减少症，非艾滋病患者。
The diagnosis of pulmonary candidiasis is still controversial. We undertook a prospective study on 25 non-neutropenic, mechanically ventilated (> 72 h) patients who died in our ICU with the aim of assessing the incidence and significance of the isolation of Candida species from quantitative cultures of immediate postmortem lung biopsies and different respiratory sampling techniques. Immediate postmortem respiratory samples (endotracheal aspirate, protected specimen brush [PSB], bronchoalveolar lavage [BAL], blind biopsies [average 14/patient], and bilateral bronchoscopically guided biopsies [two per patient]) were taken from all patients. Lung tissue specimens were histologically examined. Respiratory samples were classified as having Candida or otherwise. Ten (40%) patients had at least one pulmonary biopsy yielding Candida spp. Among these 10 patients with Candida isolates, only two had definite pulmonary candidiasis. A total of 470 microorganisms were isolated from 280 of 375 (77%) lung biopsy samples in all 25 patients. Candida species represented 9% (n = 40) of the isolates, corresponding to 10 patients (40%). In the 10 patients in whom Candida species was isolated from pulmonary biopsies, this was always associated with the isolation of the same microorganism from one of the sampling methods. Quantitative cultures of Candida species from different sampling methods correlated well among each other but could not discriminate the presence from absence of Candida pneumonia. A logistic regression model adjusted for the presence of antibiotics, days of antibiotic treatment, mechanical ventilation period, age, ARDS, parenteral nutrition, and gender did not show any independent risk factor for developing positive pulmonary samples for Candida species. The incidence of Candida isolation from pulmonary biopsies in critically ill mechanically ventilated, non-neutropenic patients who die is high (40%). However, the incidence of definite Candida pneumonia was 8%. We also found that Candida colonization is uniform throughout the different lung regions, and that the presence of Candida in respiratory samples, independently of quantitative cultures, is not a good marker of Candida pneumonia in critically ill, non-neutropenic, non-AIDS patients.