Significance of the Isolation of Candida Species from Respiratory Samples in Critically Ill, Non-neutropenic Patients

Am J Respir Crit Care Med Vol. 156. pp. 583–590, 1997 Significance of the Isolation of Candida Species from Respiratory Samples in Critically Ill, Non-neutropenic Patients An Immediate Postmortem Histologic Study MUSTAFA EL-EBIARY, ANTONI TORRES, NEUS FÀBREGAS, JORGE PUIG de la BELLACASA, JULIÀ GONZÁLEZ, JOSEP RAMIREZ, DOLORES del BAÑO, CARMEN HERNÁNDEZ, and M. T. JIMÉNEZ de ANTA Serveis de Pneumologia i Al.lèrgia Respiratòria, Anestesia, Microbiologia, Anatomia Patologica, Hospital Clínic, Departament de Medicina, Universitat de Barcelona, Spain 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 as- sessing 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], bronchoal- veolar 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 exam- ined. 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 5 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 re- gions, 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. El-Ebiary M, Torres A, Fàbregas N, de la Bellacasa JP, González J, Ramirez J, del Baño D, Hernández C, Jiménez de Anta MT. Significance of the isolation of Candida species from respiratory samples in critically ill, non-neutropenic patients: an immediate postmortem histologic study. AM J RESPIR CRIT CARE MED 1997;156:583–590. Fungal infections account for nearly 8% of all nosocomial infections; Candida is the responsible agent in 80% of the cases (1). This microorganism once considered as a minor pathogen is now among the most commonly cultured microorganisms in intensive care units (ICU). This fact is in part attributable to the prolonged antibiotic therapy, the more frequent use of surgery, instrumentation, and the greater number of immuno- compromised patients being hospitalized, as well as the exten- sive use of intensive care facilities. Now ICU physicians have to routinely include Candida in their differential diagnoses when dealing with nosocomial infections. (Received in original form December 2, 1996 and in revised form February 25, 1997) Supported in part by grants CIRIT/Fundació Clínic (Comissió Interdepartamental per a la Recerca i Tecnologia), and FIS (Fondo de Investigación Sanitaria) 94/ 0583 and I 1 D 96/0024. Dr. del Baño was a Research Fellow from Residencia Sanitaria Virgen de la Arrix- aca, Murcia, Spain. Correspondence and requests for reprints should be addressed to Dr. A. Torres, Servei de Pneumologia, Hospital Clínic, c/Villarroel 170, 08036 Barcelona, Spain.

Significance of the Isolation of Candida Species from Respiratory Samples in Critically Ill, Non-neutropenic Patients

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