Candida airway colonization is associated with worse outcomes

Introduction

Candida airway colonization is common in mechanically ventilated ICU patients. Its significance and impact on outcomes are not well defined. We aimed to describe Candida airway colonization and assess clinical outcomes of patients with a clinical suspicion of ventilator-associated pneumonia (VAP) colonized with Candida.

Methods

A retrospective post-hoc analysis of the prospective, multicentre VAP study, which enrolled patients with a clinical suspicion of VAP, admitted to an ICU for > 96 hours and on mechanical ventilation (MV) for > 48 hours. Airway cultures were done on randomization. Patients with positive Candida cultures from other sites were excluded. The remaining patients were divided into two groups according to their Candida airway culture status. Demographics, admission diagnosis, comorbidities, PaO₂/FiO₂ ratio and APACHE II score were recorded at randomization. The length of MV, ICU and hospital stay were compared, as well as hospital, ICU and 28-day mortality. Appropriate parametric statistical tests were applied according to data.

Results

Of the 739 patients enrolled in the VAP study, 639 were included for analysis: 114 had Candida airway colonization (C) and 525 did not (NC). No significant differences were noted in demographics and APACHE II score (20 ± 6 vs 20 ± 6, P = 0.37) except more frequent admission for sepsis (7.0% vs 2.1%, P = 0.005) and respiratory conditions (21.9% vs 14.3%, P = 0.04) in group C. More colonized patients were on antibiotics at randomization (81.6% vs 56.7%, P < 0.001). A trend for increased ICU (21.1% vs 13.9%, P = 0.06) and 28-day mortality (23.7% vs 16.4%, P = 0.08) and a significant difference in hospital mortality (34.2% vs 21.1%, P = 0.003) was observed in group C. A trend was found for increased median length of ICU stay (14.1 vs 11.6 days, P = 0.07) and duration of MV (10.9 vs 8.1, P = 0.06). Hospital stay was significantly longer (59.9 vs 38.6 days, P = 0.006) in group C.

Conclusion

Respiratory tract Candida colonization in patients with clinical suspicion of VAP is associated with an increased burden of illness. Whether Candida colonization is responsible for worse outcomes remains to be established.