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Intensive Care Medicine

, Volume 33, Issue 1, pp 137–142 | Cite as

Impact of antifungal treatment on CandidaPseudomonas interaction: a preliminary retrospective case–control study

  • Saad Nseir
  • Elsa Jozefowicz
  • Béatrice Cavestri
  • Boualem Sendid
  • Christophe Di Pompeo
  • Florent Dewavrin
  • Raphaël Favory
  • Micheline Roussel-Delvallez
  • Alain Durocher
Brief Report

Abstract

Objective

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.

Design and setting

Retrospective observational case–control study conducted in a 30-bed ICU during a 1-year period.

Patients and methods

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.

Results

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).

Conclusion

In patients with Candida spp. tracheobronchial colonization, antifungal treatment may be associated with reduced risk for P. aeruginosa VAP or tracheobronchial colonization.

Keywords

Pseudomonas aeruginosa Candida spp. Antifungal treatment Interaction Ventilator-associated pneumonia Tracheobronchial colonization 

Supplementary material

134_2006_422_MOESM1_ESM.doc (66 kb)
Electronic Supplementary Material (DOC 66K)

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Copyright information

© Springer-Verlag 2006

Authors and Affiliations

  • Saad Nseir
    • 1
    • 2
  • Elsa Jozefowicz
    • 1
  • Béatrice Cavestri
    • 1
  • Boualem Sendid
    • 3
  • Christophe Di Pompeo
    • 2
  • Florent Dewavrin
    • 1
  • Raphaël Favory
    • 1
  • Micheline Roussel-Delvallez
    • 4
  • Alain Durocher
    • 1
    • 2
  1. 1.Intensive Care Unit, Calmette HospitalUniversity Hospital of LilleLille cedexFrance
  2. 2.Medical Assessment LaboratoryLille II UniversityLilleFrance
  3. 3.Parasitology and Mycology Laboratory, Inserm U799, Calmette HospitalUniversity Hospital of LilleLille cedexFrance
  4. 4.Bacteriology Laboratory, Calmette HospitalUniversity Hospital of LilleLille cedexFrance

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