Impact of antifungal treatment on Candida-Pseudomonas 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, Saad Nseir, Elsa Jozefowicz, Béatrice Cavestri, Boualem Sendid, Christophe Di Pompeo, Florent Dewavrin, Raphaël Favory, Micheline Roussel-Delvallez, Alain Durocher

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.

References

    1. Safdar N, Dezfulian C, Collard HR, Saint S. Clinical and economic consequences of ventilator-associated pneumonia: a systematic review. Crit Care Med. 2005;33:2184–2193. doi: 10.1097/01.CCM.0000181731.53912.D9.
    1. Sadikot RT, Blackwell TS, Christman JW, Prince AS. Pathogen-host interactions in Pseudomonas aeruginosa pneumonia. Am J Respir Crit Care Med. 2005;171:1209–1223. doi: 10.1164/rccm.200408-1044SO.
    1. Chastre J, Fagon JY. Ventilator-associated pneumonia. Am J Respir Crit Care Med. 2002;165:867–903.
    1. Safdar N, Maki DG. The commonality of risk factors for nosocomial colonization and infection with antimicrobial-resistant Staphylococcus aureus, enterococcus, gram-negative bacilli, Clostridium difficile, and Candida. Ann Intern Med. 2002;136:834–844.
    1. Hogan DA, Kolter R. Pseudomonas–Candida interactions: an ecological role for virulence factors. Science. 2002;296:2229–2232. doi: 10.1126/science.1070784.
    1. Hogan DA, Vik A, Kolter R. A Pseudomonas aeruginosa quorum-sensing molecule influences Candida albicans morphology. Mol Microbiol. 2004;54:1212–1223. doi: 10.1111/j.1365-2958.2004.04349.x.
    1. Spinelli SL, Malik HS, Consaul SA, Phizicky EM. A functional homolog of a yeast tRNA splicing enzyme is conserved in higher eukaryotes and in Escherichia coli. Proc Natl Acad Sci USA. 1998;95:14136–14141. doi: 10.1073/pnas.95.24.14136.
    1. Azoulay E, Timsit JF, Tafflet M, de Lassence A, Darmon M, Zahar JR, Adrie C, Garrouste-Org M, Cohen Y, Mourvillier B, Schlemmer B. Candida colonization of the respiratory tract and subsequent Pseudomonas ventilator-associated pneumonia. Chest. 2006;129:110–117. doi: 10.1378/chest.129.1.110.
    1. Celum CL. The interaction between herpes simplex virus and human immunodeficiency virus. Herpes. 2004;11(Suppl 1):36–45.
    1. Seki M, Higashiyama Y, Tomono K, Yanagihara K, Ohno H, Kaneko Y, Izumikawa K, Miyazaki Y, Hirakata Y, Mizuta Y, Tashiro T, Kohno S. Acute infection with influenza virus enhances susceptibility to fatal pneumonia following Streptococcus pneumoniae infection in mice with chronic pulmonary colonization with Pseudomonas aeruginosa. Clin Exp Immunol. 2004;137:35–40. doi: 10.1111/j.1365-2249.2004.02481.x.
    1. Neely AN, Law EJ, Holder IA. Increased susceptibility to lethal Candida infections in burned mice preinfected with Pseudomonas aeruginosa or pretreated with proteolytic enzymes. Infect Immun. 1986;52:200–204.
    1. Roux D, Ricard JD, Dreyfuss D, De Prost N, Grossin M, Saumon G. Impact de la colonisation des voies aériennes à Candida albicans sur l'émergence d'une pneumopathie à Pseudomonas aeruginosa chez le rat. Réanimation. 2006;15:S43. doi: 10.1016/j.reaurg.2005.12.003.
    1. Bauer TT, Torres A, Ferrer R, Heyer CM, Schultze-Werninghaus G, Rasche K. Biofilm formation in endotracheal tubes. Association between pneumonia and the persistence of pathogens. Monaldi Arch Chest Dis. 2002;57:84–87.
    1. Adair CG, Gorman SP, Feron BM, Byers LM, Jones DS, Goldsmith CE, Moore JE, Kerr JR, Curran MD, Hogg G, Webb CH, McCarthy GJ, Milligan KR. Implications of endotracheal tube biofilm for ventilator-associated pneumonia. Intensive Care Med. 1999;25:1072–1076. doi: 10.1007/s001340051014.
    1. Nseir S, Marquette CH. Diagnosis of hospital-acquired pneumonia: postmortem studies. Infect Dis Clin North Am. 2003;17:707–716. doi: 10.1016/S0891-5520(03)00075-8.
    1. Azoulay E, Cohen Y, Zahar JR, Garrouste-Org M, Adrie C, Moine P, de Lassence A, Timsit JF. Practices in non-neutropenic ICU patients with Candida-positive airway specimens. Intensive Care Med. 2004;30:1384–1389.
    1. Wood GC, Mueller EW, Croce MA, Boucher BA, Fabian TC. Candida sp. isolated from bronchoalveolar lavage: clinical significance in critically ill trauma patients. Intensive Care Med. 2006;32:599–603. doi: 10.1007/s00134-005-0065-6.
    1. Eggimann P, Garbino J, Pittet D. Management of Candida species infections in critically ill patients. Lancet Infect Dis. 2003;3:772–785. doi: 10.1016/S1473-3099(03)00831-4.
    1. Piarroux R, Grenouillet F, Balvay P, Tran V, Blasco G, Millon L, Boillot A. Assessment of preemptive treatment to prevent severe candidiasis in critically ill surgical patients. Crit Care Med. 2004;32:2443–2449. doi: 10.1097/01.CCM.0000147726.62304.7F.
    1. Leon C, Ruiz-Santana S, Saavedra P, Almirante B, Nolla-Salas J, Alvarez-Lerma F, Garnacho-Montero J, Leon MA. A bedside scoring system (“Candida score”) for early antifungal treatment in nonneutropenic critically ill patients with Candida colonization. Crit Care Med. 2006;34:730–737. doi: 10.1097/01.CCM.0000202208.37364.7D.

Source: PubMed

Szponzorok és közreműködők

Egészségi állapot

Kábítószer-beavatkozások

3
Iratkozz fel