Candida spp. airway colonization could promote antibiotic-resistant bacteria selection in patients with suspected ventilator-associated pneumonia
Candida spp. airway colonization could promote antibiotic-resistant bacteria selection in patients with suspected ventilator-associated pneumonia
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DOI：
10.1007/s00134-012-2584-2
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发表时间：
2012-08-01
影响因子：
38.9
通讯作者：
Charles, Pierre-Emmanuel
中科院分区：
文献类型：
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作者：
Hamet, Mael;Pavon, Arnaud;Charles, Pierre-Emmanuel
假丝酵母菌呼吸道定植可促进铜绿假单胞菌引起的呼吸机相关肺炎(VAP)的发生，使VAP的预后恶化。因此，我们解决了疑似VAP患者的呼吸道内多药耐药细菌分离的风险问题，无论是念珠菌。一家教学医院的前瞻性观察研究。包括疑似VAP的连续患者。除常规培养外，将呼吸道分泌物接种于特定的培养基上进行酵母菌分离。根据真菌定植情况评估预后和耐多药细菌的存在。323名疑似VAP患者被分析。其中181例(56%)以念珠菌为主。呼吸道定植。移居和非移居的患者在基线特征、既往抗生素暴露和VAP严重程度方面相似。然而，有真菌定植的患者的死亡率高于无真菌定植的患者(分别为44.2%和31.0%；p=0.02)。念珠菌多药耐药菌分离率为31.5%。移居率为23.2%(p=0.13)。此外，假丝酵母属(Candida spp.)呼吸道定植是耐多药细菌分离的一个独立危险因素[优势比(OR)=1.79，95%可信区间1.05~3.05；p=0.03]，此外还有从重症监护病房(ICU)到怀疑VAP的时间。呼吸道定植频繁，与耐多药细菌分离的风险增加相关。这可能会恶化结果，因此在选择经验性抗生素治疗时应该考虑到这一点。
Candida spp. airway colonization could promote development of ventilator-associated pneumonia (VAP) caused by Pseudomonas aeruginosa, a potentially multidrug-resistant (MDR) bacteria, and worsen the outcome of VAP regardless of pathogen. We therefore address the question of the risk of MDR bacteria isolation within the airway of patients with suspected VAP, whether Candida spp. is present or not.Prospective observational study in a teaching hospital.Consecutive patients with suspected VAP were included. Respiratory tract secretions were seeded on specific medium for yeast isolation in addition to standard culture. Outcome as well as presence of MDR bacteria were assessed according to fungal colonization.323 suspected VAP were analysed. Among these, 181 (56 %) cases presented with Candida spp. airway colonization. Colonized and noncolonized patients were similar regarding baseline characteristics, prior exposure to antibiotics and VAP severity. However, mortality rate was greater in patients with fungal airway colonization than in those without (44.2 versus 31.0 %, respectively; p = 0.02). In addition, MDR bacteria isolation was 31.5 % in patients with Candida spp. colonization versus 23.2 % in those without (p = 0.13). Moreover, Candida spp. airway colonization was one independent risk factor for MDR bacteria isolation [odds ratio (OR) = 1.79, 95 % confidence interval 1.05-3.05; p = 0.03], in addition to the time elapsed between intensive care unit (ICU) admission and VAP suspicion.In patients with suspected VAP, Candida spp. airway colonization is frequent and associated with increased risk for MDR bacteria isolation. This could worsen outcome and should therefore be considered when choosing an empiric antibiotic therapy.