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- Title
Impact of antifungal treatment on Candida-Pseudomonas interaction: a preliminary retrospective case-control study.
- Authors
Nseir, Saad; Jozefowicz, Elsa; Cavestri, Béatrice; Sendid, Boualem; Di Pompeo, Christophe; Dewavrin, Florent; Favory, Rapha+ACYAIw-x00EB;l; Roussel-Delvallez, Micheline; Durocher, Alain; Cavestri, Béatrice; Favory, Raphaël
- Abstract
A pathogenic interaction between Candida albicans and Pseudomonas aeruginosa has recently been demonstrated. In addition, experimental and clinical studies identified Candida spp. tracheobronchial colonization as a risk factor for P. aeruginosa pneumonia. The aim of this study was to determine the impact of antifungal treatment on ventilator-associated pneumonia (VAP) or tracheobronchial colonization due to P. aeruginosa. Retrospective observational case–control study conducted in a 30-bed ICU during a 1-year period. One hundred and two patients intubated and ventilated for longer than 48 h with tracheobronchial colonization by Candida spp. Routine screening for Candida spp. and P. aeruginosa was performed at ICU admission and weekly. Antifungal treatment was based on medical staff decisions. Patients with P. aeruginosa VAP or tracheobronchial colonization were matched (1:2) with patients without P. aeruginosa VAP or tracheobronchial colonization. In case and control patients, risk factors for P. aeruginosa VAP or tracheobronchial colonization were determined using univariate and multivariate analyses. Thirty-six patients (35%) received antifungal treatment. Nineteen patients (18%) developed a P. aeruginosa VAP or tracheobronchial colonization, and all were successfully matched. Antifungal treatment [31% vs 60%; p = 0.037, OR (95% CI) = 0.67 (0.45–0.90)], and duration of antifungal treatment (7 ± 11 vs 14 ± 14 days; p = 0.045, in case and control patients respectively) were significantly associated with reduced risk for P. aeruginosa VAP or tracheobronchial colonization. Antifungal treatment was the only variable independently associated with P. aeruginosa VAP or tracheobronchial colonization (OR = 0.68, 95% CI = 0.49–0.90, p = 0.046). In patients with Candida spp. tracheobronchial colonization, antifungal treatment may be associated with reduced risk for P. aeruginosa VAP or tracheobronchial colonization.
- Subjects
PSEUDOMONAS aeruginosa; CANDIDA albicans; MULTIVARIATE analysis; ANTIFUNGAL agents; PNEUMONIA; TRACHEA intubation; MECHANICAL ventilators; BRONCHI; CANDIDA; PSEUDOMONAS; TRACHEA; RETROSPECTIVE studies; CASE-control method; FLUCONAZOLE; IMPACT of Event Scale; VENTILATOR-associated pneumonia; PHARMACODYNAMICS; THERAPEUTICS
- Publication
Intensive Care Medicine, 2007, Vol 33, Issue 1, p137
- ISSN
0342-4642
- Publication type
journal article
- DOI
10.1007/s00134-006-0422-0