Intensive Care Medicine

, Volume 41, Issue 6, pp 1077–1088 | Cite as

Outcomes associated with routine systemic antifungal therapy in critically ill patients with Candida colonization

  • David Ferreira
  • Frederic Grenouillet
  • Gilles Blasco
  • Emmanuel Samain
  • Thierry Hénon
  • Alain Dussaucy
  • Laurence Millon
  • Mariette Mercier
  • Sebastien Pili-Floury
Original
First Online:
Received:
Accepted:

Abstract

Purpose

To assess the evolution of patient deep colonization by Candida spp. in a surgical ICU over an 8-year period.

Methods

This retrospective, observational study included all patients hospitalized for more than 2 days in a surgical and trauma ICU of a university hospital, from 2005 to 2012. Mycological samples were monitored weekly from five sites (oropharyngeal, rectal, gastric, tracheal and urinary). Preemptive fluconazole therapy was started in patients highly colonized with Candida albicans. The evolution in Candida spp. involved in the deep colonization sites distribution over the study period (main outcome measure, trend chi-square and time-series analysis), antifungal consumption, ICU-acquired candidemia and mortality were determined.

Results

Among the 3029 patients with ICU stay >48 h, 2651 had at least one set of mycological sampling. Thirty percent of the 31,171 samples were positive to Candida spp. Caspofungin consumption increased over the years, whereas fluconazole consumption decreased. No trend in C. albicans colonization was observed, after adjusting on colonization risk-factors. A significant increase of acquired C. glabrata colonization was observed, whereas the clearing of C. parapsilosis colonization significantly decreased. No significant shift of colonization to other Candida spp. and mortality was observed.

Conclusions

Preemptive strategy of antifungal drug prescriptions in highly colonized ICU patients induced an increase in C. glabrata colonization without significant shift of colonization to other Candida spp. in surgical ICU patients. However, the potential detrimental impact of fluconazole on Candida ecology in ICU and/or on Candida susceptibility to antifungal drugs should be considered, and deserves further studies.

Keywords

Candida colonization Antifungal drug Drug utilization 
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Notes

Acknowledgments

We thank Dr E Farah for helpful discussion and B. Renaud for his help in data extraction from the pharmacy database. The study data were generated as part of routine work at our Institution. The financial cost of data analysis and manuscript preparation was supported by the Department of Anesthesiology and Intensive Care Medicine, University Hospital of Besancon, F-25000 Besancon, France.

Conflicts of interest

David Ferreira: none to declare, Frederic Grenouillet: none to declare, Gilles Blasco: none to declare, Emmanuel Samain: paid consultancies for drug companies: Nycomed, Baxter, and Leo Pharma, Thierry Hénon: none to declare, Alain Dussaucy: none to declare, Laurence Millon: none to declare, Mariette Mercier: none to declare, Sebastien Pili-Floury: none to declare.

Supplementary material

134_2015_3791_MOESM1_ESM.doc (36 kb)
Supplementary material 1 (DOC 36 kb)
134_2015_3791_MOESM2_ESM.doc (82 kb)
Supplementary material 2 (DOC 82 kb)

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Copyright information

© Springer-Verlag Berlin Heidelberg and ESICM 2015

Authors and Affiliations

  • David Ferreira
    • 1
  • Frederic Grenouillet
    • 2
    • 3
  • Gilles Blasco
    • 1
  • Emmanuel Samain
    • 1
    • 4
  • Thierry Hénon
    • 5
  • Alain Dussaucy
    • 6
  • Laurence Millon
    • 2
    • 3
  • Mariette Mercier
    • 7
    • 8
  • Sebastien Pili-Floury
    • 1
    • 4
  1. 1.Department of Anesthesiology and Intensive Care MedicineUniversity Hospital of BesanconBesanconFrance
  2. 2.Department of Parasitology-MycologyUniversity Hospital of BesanconBesanconFrance
  3. 3.UMR CNRS 6249University of Franche ComtéBesanconFrance
  4. 4.EA 3920, INSERM SFR 4232University of Franche-ComteBesanconFrance
  5. 5.Department of PharmacyUniversity Hospital of BesanconBesanconFrance
  6. 6.Department of Medical Information SystemsUniversity HospitalBesanconFrance
  7. 7.Department of BiostatisticsUniversity Hospital of BesanconBesanconFrance
  8. 8.EA 3181, INSERM SFR 4232University of Franche-ComteBesanconFrance

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