Fungal colonization, invasive fungal disease, mechanical ventilation, respiratory Intensive Care Unit
Citation Information :
Jaiswal A, Chakraborti A, Verma P, Singhal R. A prospective study of fungal colonization and invasive fungal disease in long-term mechanically ventilated patients in a respiratory intensive care unit. Indian J Crit Care Med 2018; 22 (8):597-601.
Background: Long-term mechanical ventilation in an Intensive Care Unit (ICU) exposes the patient to fungal colonization and invasive fungal disease due to the presence of indwelling catheters, administration of broad-spectrum antibiotics, and intravenous corticosteroids. A study is hence required to study the risk factors and incidence of fungal infection in these patients.
Methods: A prospective observational study was carried out in the respiratory ICU of a tertiary care hospital for a period of approximately 1 year in which patients on mechanical ventilation (>7 days) were enrolled. Blood, urine, and endotracheal aspirate (ETA) of these patients were sent for fungal culture on day 1 and day 7 of mechanical ventilation. Fiberoptic bronchoscopy was done on day 7 and bronchoalveolar lavage along with transbronchial lung biopsy (TBLB) were sent for fungal culture.
Results: During 7 days of ventilation, there was a statistically significant increase in the proportion of culture-positive ETA and urine samples. Overall, Candida albicans emerged as the most common colonizer. Blood candidemia was seen in 10% of patients on day 7 of mechanical ventilation. Fungal invasion of the lung, as evidenced by fungal culture-positive TBLB specimens, was seen in 17% of patients. Diabetes was found to be a statistically significant risk factor for respiratory and urinary tract colonization as well as invasive fungal disease.
Conclusion: Long-term mechanical ventilation (>7 days) is strongly associated with fungal colonization of the respiratory tract and urinary tract. Appropriate prophylactic antifungals may be given and infection control practices to be observed to ensure minimum colonization and therefore infection in such settings.
Samonis G, Gikas A, Toloudis P, Maraki S, Vrentzos G, Tselentis Y, et al. Prospective study of the impact of broad-spectrum antibiotics on the yeast flora of the human gut. Eur J Clin Microbiol Infect Dis 1994;13:665-7.
Eggimann P, Garbino J, Pittet D. Epidemiology of Candida species infections in critically ill non-immunosuppressed patients. Lancet Infect Dis 2003;3:685-702.
Garey KW, Rege M, Pai MP, Mingo DE, Suda KJ, Turpin RS, et al. Time to initiation of fluconazole therapy impacts mortality in patients with candidemia: A multi-institutional study. Clin Infect Dis 2006;43:25-31.
Forbes BA, Sahm DF, Weissfeld AS. Bailey and Scott's Diagnostic Microbiology. 11th ed. St. Louis: Mosby, Inc.; 2002. p. 711-97.
León C, Ruiz-Santana S, Saavedra P, Galván B, Blanco A, Castro C, et al. Usefulness of the “Candida score” for discriminating between Candida colonization and invasive candidiasis in non-neutropenic critically ill patients: A prospective multicenter study. Crit Care Med 2009;37:1624-33.
Charles PE, Dalle F, Aube H, Doise JM, Quenot JP, Aho LS, et al. Candida spp. Colonization significance in critically ill medical patients: A prospective study. Intensive Care Med 2005;31:393-400.
León C, Alvarez-Lerma F, Ruiz-Santana S, León MA, Nolla J, Jordá R, et al. Fungal colonization and/or infection in non-neutropenic critically ill patients: Results of the EPCAN observational study. Eur J Clin Microbiol Infect Dis 2009;28:233-42.
Azoulay E, Timsit JF, Tafflet M, de Lassence A, Darmon M, Zahar JR, et al. Candida colonization of the respiratory tract and subsequent pseudomonas ventilator-associated pneumonia. Chest 2006;129:110-7.
Kothavade RJ, Kura MM, Valand AG, Panthaki MH. Candida tropicalis: Its prevalence, pathogenicity and increasing resistance to fluconazole. J Med Microbiol 2010;59:873-80.
Kaur R, Goyal R, Dhakad MS, Bhalla P, Kumar R. Epidemiology and virulence determinants including biofilm profile of Candida infections in an ICU in a tertiary hospital in India. J Mycol 2014:303491.
Bougnoux ME, Kac G, Aegerter P, d'Enfert C, Fagon JY, CandiRea Study Group., et al. Candidemia and candiduria in critically ill patients admitted to Intensive Care Units in France: Incidence, molecular diversity, management and outcome. Intensive Care Med 2008;34:292-9.
Sardi JC, Scorzoni L, Bernardi T, Fusco-Almeida AM, Mendes Giannini MJ. Candida species: Current epidemiology, pathogenicity, biofilm formation, natural antifungal products and new therapeutic options. J Med Microbiol 2013;62:10-24.
Kousha M, Tadi R, Soubani AO. Pulmonary aspergillosis: A clinical review. Eur Respir Rev 2011;20:156-74.
Das I, Nightingale P, Patel M, Jumaa P. Epidemiology, clinical characteristics, and outcome of candidemia: Experience in a tertiary referral center in the UK. Int J Infect Dis 2011;15:e759-63.
Clancy CJ, Nguyen MH. Finding the “missing 50%” of invasive candidiasis: How nonculture diagnostics will improve understanding of disease spectrum and transform patient care. Clin Infect Dis 2013;56:1284-92.
Leroy O, Gangneux JP, Montravers P, Mira JP, Gouin F, Sollet JP, et al. Epidemiology, management, and risk factors for death of invasive candida infections in critical care: A multicenter, prospective, observational study in France (2005-2006). Crit Care Med 2009;37:1612-8.
Kosmidis C, Denning DW. The clinical spectrum of pulmonary aspergillosis. Thorax 2015;70:270-7.
Muskett H, Shahin J, Eyres G, Harvey S, Rowan K, Harrison D, et al. Risk factors for invasive fungal disease in critically ill adult patients: A systematic review. Crit Care 2011;15:R287.
Biswas D, Agarwal S, Sindhwani G, Rawat J. Fungal colonization in patients with chronic respiratory diseases from Himalayan region of India. Ann Clin Microbiol Antimicrob 2010;9:28.
León C, Ruiz-Santana S, Saavedra P, Galván B, Blanco A, Castro C, et al. Usefulness of the “Candida score” for discriminating between candida colonization and invasive candidiasis in non-neutropenic critically ill patients: A prospective multicenter study. Crit Care Med 2009;37:1624-33.