Significance of the Isolation of Candida Species from Respiratory Samples in Critically Ill, Non-neutropenic Patients
Abstract
The diagnosis of pulmonary candidiasis is still controversial. We undertook a prospective study on 25 non-neutropenic, mechanically ventilated (> 72 h) patients who died in our ICU with the aim of assessing the incidence and significance of the isolation of Candida species from quantitative cultures of immediate postmortem lung biopsies and different respiratory sampling techniques. Immediate postmortem respiratory samples (endotracheal aspirate, protected specimen brush [PSB], bronchoalveolar lavage [BAL], blind biopsies [average 14/patient], and bilateral bronchoscopically guided biopsies [two per patient]) were taken from all patients. Lung tissue specimens were histologically examined. Respiratory samples were classified as having Candida or otherwise. Ten (40%) patients had at least one pulmonary biopsy yielding Candida spp. Among these 10 patients with Candida isolates, only two had definite pulmonary candidiasis. A total of 470 microorganisms were isolated from 280 of 375 (77%) lung biopsy samples in all 25 patients. Candida species represented 9% (n = 40) of the isolates, corresponding to 10 patients (40%). In the 10 patients in whom Candida species was isolated from pulmonary biopsies, this was always associated with the isolation of the same microorganism from one of the sampling methods. Quantitative cultures of Candida species from different sampling methods correlated well among each other but could not discriminate the presence from absence of Candida pneumonia. A logistic regression model adjusted for the presence of antibiotics, days of antibiotic treatment, mechanical ventilation period, age, ARDS, parenteral nutrition, and gender did not show any independent risk factor for developing positive pulmonary samples for Candida species. The incidence of Candida isolation from pulmonary biopsies in critically ill mechanically ventilated, non-neutropenic patients who die is high (40%). However, the incidence of definite Candida pneumonia was 8%. We also found that Candida colonization is uniform throughout the different lung regions, and that the presence of Candida in respiratory samples, independently of quantitative cultures, is not a good marker of Candida pneumonia in critically ill, non-neutropenic, non-AIDS patients.
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Diagnoses of Candida pneumonia that are based solely on microbiological data are often incorrect.
“Thus, diagnoses of Candida pneumonia that are based solely on microbiological data are often incorrect [183, 184] (B-III).”
From Guidelines for Treatment of Candidiasis (2004) · cites this paper as [184]
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- Authors
- EL-EBIARY, M., TORRES, A., FÁBREGAS, N., de la BELLACASA, J. P., GONZÁLEZ, J., RAMIREZ, J., del BAÑO, D., HERNÁNDEZ, C., & JIMÉNEZ de ANTA, M. T.
- Affiliations
- Hospital Clínic de Barcelona (ES)
- Serveis de Pneumologia i Al.lèrgia Respiratòria, Anestesia, Microbiologia, Anatomia Patologica, Hospital Clínic, Departament de Medicina, Universitat de Barcelona, Spain
- Venue
- American Journal of Respiratory and Critical Care Medicine
- Publisher
- Oxford University Press (OUP)
- Published
- 1997-08-01
- Volume
- 156
- Issue
- 2
- Pages
- 583-590
- ISSN
- 1073-449X (ISSN-L)
- 1535-4970
- OpenAlex
- W1886994037
- Cited by
- 271
- References
- 30
- Citations by year
- 2026: 3 · 2025: 5 · 2024: 3 · 2023: 6 · 2022: 4 · 2021: 9 · 2020: 7 · 2019: 5 · 2018: 4 · 2017: 9 · 2016: 7 · 2015: 8 · 2014: 16 · 2013: 12 · 2012: 11
- FWCI
- 3.50
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- American Journal of Respiratory and Critical Care Medicine (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Infectious Diseases › Antifungal resistance and susceptibility
- Health Sciences › Medicine › Critical Care and Intensive Care Medicine › Nosocomial Infections in ICU
- Health Sciences › Medicine › Epidemiology › Fungal Infections and Studies
- Keywords
- Candida pneumonia, pulmonary candidiasis, Candida colonization, protected specimen brush, bronchoalveolar lavage, tracheal aspirate, mechanically ventilated patients, critically ill patients, non-neutropenic patients, diagnostic biomarkers, risk factors
- MeSH terms
- Adult, Aged, Autopsy, Biopsy, Candida, Candidiasis, Cross Infection, Female, Humans, Lung, Lung Diseases, Fungal, Male, Middle Aged, Neutropenia, Prospective Studies, Respiration, Artificial, Incidence, Critical Illness
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