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The Role of Candida sp Isolated From Bronchoscopic Samples in Nonneutropenic Patients
Abstract
Study objectives To determine the clinical significance of Candida sp isolated from bronchoscopic samples in patients with suspected pneumonia.Design A retrospective chart review was performed in all nonneutropenic adult patients with Candida sp isolates from respiratory secretions obtained by bronchoscopy over a 5-year period (1991 to 1995). Potential risk factors, therapeutic decisions, and outcome were recorded. Microbiological findings, chest radiograph reports, and pathologic material were reviewed. Isolates were classified as definite, probable, or indeterminate contamination, or as definite pulmonary candidiasis, on the basis of histologic findings, therapeutic decisions, and outcome.Setting A 600-bed teaching hospital with 16 beds in a medical-surgical ICU.Patients Thirty-seven consecutive patients with positive cultures for Candida sp from respiratory samples obtained by bronchoscopy were evaluated. Thirty-two of these 37 patients (86.5%) received antibiotic therapy prior to sampling, and 23 (62.2%) were intubated.Results Contamination was classified as definite in 3 patients (8.1%) and probable in 30 others (81.0%). Contamination was indeterminate in two cases (5.4%). Two additional patients (5.4%) received antifungal agents for systemic candidiasis. No cases of pulmonary candidiasis could be demonstrated, although 24 of 28 patients showed protected specimen brush cultures > or = 10(3) cfu/mL.Conclusions Nonneutropenic patients with isolation of Candida sp from bronchoscopic samples, even in high concentrations, are unlikely to have invasive candidiasis. Indication for initiation of antifungal therapy should be based on histologic evidence or identification from sterile specimens.
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“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 [183]
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Pappas, P. G., Kauffman, C. A., Andes, D. R., Clancy, C. J., Marr, K. A., Ostrosky-Zeichner, L., Reboli, A. C., Schuster, M. G., Vazquez, J. A., Walsh, T. J., et al. (2016) · Clinical Infectious Diseases · doi:10.1093/cid/civ933 · Cited by 4,200
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Chastre, J. E., & Fagon, J.-Y. (2002) · American Journal of Respiratory and Critical Care Medicine · doi:10.1164/ajrccm.165.7.2105078 · Cited by 2,884
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Metadata
- Authors
- Rello, J., Esandi, M.-E., Diaz, E., Mariscal, D., Gallego, M., & Vallès, J.
- Venue
- Chest
- Publisher
- Elsevier BV
- Published
- 1998-07
- Volume
- 114
- Issue
- 1
- Pages
- 146-149
- ISSN
- 0012-3692 (ISSN-L)
- OpenAlex
- W2068020847
- Cited by
- 155
- References
- 17
- Citations by year
- 2026: 1 · 2025: 2 · 2023: 1 · 2021: 1 · 2020: 1 · 2019: 3 · 2017: 3 · 2016: 7 · 2015: 9 · 2014: 4 · 2013: 5 · 2012: 7
- FWCI
- 5.40
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- CHEST Journal (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 › Infectious Diseases › Fungal Infections and Studies
- Keywords
- Candida, pulmonary candidiasis, non-neutropenic patients, suspected pneumonia, antifungal therapy, protected specimen brush, invasive candidiasis, intubation, antibiotic therapy
- MeSH terms
- Adult, Aged, Aged, 80 and over, Anti-Bacterial Agents, Antifungal Agents, Bronchi, Bronchoscopy, Candida, Candidiasis, Decision Making, Evaluation Studies as Topic, Female, Humans, Male, Middle Aged, Neutropenia, Pneumonia, Radiography, Retrospective Studies, Risk Factors, Sputum, Treatment Outcome
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