Intensive Care Medicine

, Volume 35, Issue 9, pp 1526–1531 | Cite as

Significance of the isolation of Candida species from airway samples in critically ill patients: a prospective, autopsy study

  • W. MeerssemanEmail author
  • K. Lagrou
  • I. Spriet
  • J. Maertens
  • E. Verbeken
  • W. E. Peetermans
  • E. Van Wijngaerden



Recovery of Candida from the respiratory tract is common. Large series on the incidence of histologically proven Candida pneumonia in intensive care unit (ICU) patients are lacking.


A two-year prospective study of all autopsies performed on patients who died in the ICU was conducted. For autopsy-proven cases of Candida pneumonia, we required microscopic demonstration of yeast invasion in lung autopsy specimens that showed inflammation. We looked for differences in incidence in patients with and without respiratory samples positive for Candida species pre-mortem.


Of 1,587 patients admitted to the ICU, 301 (19%) died of whom 232 (77%) were autopsied. Of those, 135 patients (58%) had histopathological evidence of pneumonia. A total of 77 cases (57%) with pneumonia at autopsy had positive tracheal aspirate and/or BAL cultures for Candida spp. performed during the preceding two weeks. No cases of Candida pneumonia were identified amongst those 77 cases. In the other 58 patients with autopsy-proven pneumonia and no Candida isolation pre-mortem, no Candida pneumonia was observed either.


Despite frequent isolation of Candida spp. from the airways, over a two-year period no single case of Candida pneumonia was found among the patients with evidence of pneumonia on autopsy. This study indicates that Candida pneumonia is an extremely rare occurrence in ICU patients and provides further evidence against the common use of antifungal therapy triggered by a microbiology report of Candida isolation from the respiratory tract.


Candida Pneumonia Intensive care unit Autopsy 



W. M., I. S., J. M., K. L. and E. V. W. have received research support and honoraria from Pfizer and Merck. This study was not funded by the industry

Conflicts of interest statement

Dr Meersseman reports receiving lecture fees from Pfizer and Merck and grant support from Pfizer; Mrs Spriet reports receiving lecture fees from Merck and Pfizer; Dr Maertens reports receiving lecture fees from Pfizer, Merck, and Schering-Plough and grant support from Merck; Dr Lagrou reports receiving lecture fees from Pfizer, Merck, and Schering-Plough; Dr Van Wijngaerden reports receiving lecture fees from Merck and Pfizer.


  1. 1.
    Baum GL (1960) The significance of Candida albicans in human sputum. N Engl J Med 263:70–73PubMedCrossRefGoogle Scholar
  2. 2.
    Pappas PG, Rex JH, Sobel JD, Filler SG, Dismukes WE, Walsh TJ, Edwards JE, Infectious Diseases Society of America (2004) Guidelines for treatment of candidiasis. Clin Infect Dis 38:161–189PubMedCrossRefGoogle Scholar
  3. 3.
    Bodey GP (1984) Candidiasis in cancer patients. Am J Med 77:13–19PubMedGoogle Scholar
  4. 4.
    Boktour MR, Kontoyiannis DP, Hanna HA, Hachem RY, Girgway E, Bodey GP, Raad II (2004) Multiple-species candidemia in patients with cancer. Cancer 101:1860–1865PubMedCrossRefGoogle Scholar
  5. 5.
    Murray PR, Van Scoy RE, Roberts GD (1977) Should yeasts in respiratory secretions be identified? Mayo Clin Proc 52:42–45PubMedGoogle Scholar
  6. 6.
    Kontoyiannis DP, Reddy BT, Torres HA, Luna M, Lewis RE, Tarrand J, Bodey GP, Raad II (2002) Pulmonary candidiasis in patients with cancer: an autopsy study. Clin Infect Dis 34:400–403PubMedCrossRefGoogle Scholar
  7. 7.
    Chastre J, Fagon JY (2002) Ventilator-associated pneumonia. Am J Respir Crit Care Med 165:867–903PubMedGoogle Scholar
  8. 8.
    Azoulay E, Cohen Y, Zahar JR, Garrouste-Orgeas M, Adrie C, Moine P, de lassence A, Timsit JF (2004) Practices in non-neutropenic ICU patients with Candida-positive airway specimens. Intensive Care Med 30:1384–1389PubMedGoogle Scholar
  9. 9.
    Roux D, Gaudry S, Dreyfuss D, El-Benna J, de Prost N, Denamur E, Saumon G, Ricard JD (2009) Candida albicans impairs macrophage function and facilitates Pseudomonas aeruginosa pneumonia in rat. Crit Care Med 37:1062–1067PubMedCrossRefGoogle Scholar
  10. 10.
    International Classification of Diseases, 1975 Revision (vol 1). Geneva, Switzerland: World Health Organization, 1978Google Scholar
  11. 11.
    International Classification of Diseases, 1975 Revision (vol 2). Geneva, Switzerland: World Health Organization, 1978Google Scholar
  12. 12.
    Fernandez-Segoviano P, Lázaro A, Esteban E, Rubio JM, Iruretagoyena JR (1988) Autopsy as quality assurance in the intensive care unit. Crit Care Med 16:683–685PubMedCrossRefGoogle Scholar
  13. 13.
    el-Ebiary M, Torres A, Fabregas N, de la Bellcasa JP, Gonzalez J, Ramirez J, del Bano D, Hernandez C, Jimenez de Anta MT (1997) Significance of the isolation of Candida species from respiratory samples in critically ill, non-neutropenic patients. Am J Respir Crit Care Med 156:583–590PubMedGoogle Scholar
  14. 14.
    Fagon JY, Lavarde V, Novara A (1994) Nosocomial Candida infections of the lower respiratory tract in ICU patients. Am J Respir Crit Care Med A650Google Scholar
  15. 15.
    Rello J, Esandi ME, Mariscal D, Gallego M, Domingo C, Valles J (1998) The role of Candida sp isolated from bronchoscopic samples in nonneutropenic patients. Chest 114:146–149PubMedCrossRefGoogle Scholar
  16. 16.
    Blumberg HM, Jarvis WR, Soucie JM, Edwards JE, Patterson JE, Pfaller MA, Rangel-Frausto MS, Rinaldi MG, Saiman L, Wiblin RT, Wenzel RP, National Epidemiology of Mycoses Survey (NEMIS) Study Group (2001) Risk factors for candidal bloodstream infections in surgical intensive care unit patients: the NEMIS Prospective Multicenter study. Clin Infect Dis 33:177–186PubMedCrossRefGoogle Scholar
  17. 17.
    Barenfanger J, Arakere P, Dela Cruz R, Imran A, Drake C, Lawhorn J, Verhulst SJ, Khardori N (2003) Improved outcomes associated with limiting identification of Candida spp. in respiratory secretions. J Clin Microbiol 41:5645–5649PubMedCrossRefGoogle Scholar
  18. 18.
    Vincent JL, Bihari DJ, Suter PM, Bruining HA, White J, Nicolas-Chanoin MH, Wolff M, Spencer RC, Hemmer M (1995) The prevalence of nosocomial infection in intensive care units in Europe: results of the European Prevalence of Infection in Intensive Care (EPIC) study. JAMA 274:639–644PubMedCrossRefGoogle Scholar
  19. 19.
    Azoulay E, Timsit JF, Tafflet M, de Lassence A, Darmon M, Zahar JR, Adrie C, Garrouste-Orgeas M, Cohen Y, Mourvillier B, Schlemmer B, Outcomerea Study Group (2006) Candida colonization of the respiratory and subsequent Pseudomonas ventilator-associated pneumonia. Chest 129:110–117PubMedCrossRefGoogle Scholar
  20. 20.
    Haron E, Vartivarian S, Anaissie E, Dekmezian R, Bodey GP (1993) Primary Candida pneumonia. Experience at a large cancer center and review of the literature. Medicine 72:137–142PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag 2009

Authors and Affiliations

  • W. Meersseman
    • 1
    Email author
  • K. Lagrou
    • 1
  • I. Spriet
    • 1
  • J. Maertens
    • 1
  • E. Verbeken
    • 1
  • W. E. Peetermans
    • 1
  • E. Van Wijngaerden
    • 1
  1. 1.LouvainBelgium

Personalised recommendations