Comparison between mortality and airway colonisation versus noncolonisation with Candida species in critically ill adults

Introduction

Candida airway colonisation in patients with a clinical suspicion of ventilator-associated pneumonia has been associated with increased mortality in the published literature. The aim of this study was to investigate whether there is an association between the presence of Candida spp. in the respiratory secretions of critically ill adults and ICU mortality, irrespective of the confirmed presence of ventilator-associated pneumonia.

Methods

A retrospective analysis was performed on patients admitted to a large mixed ICU in Northern Ireland over a 1-year period. Data were analysed to determine mortality in patients whose respiratory secretions had cultured Candida spp. (both with and without coexisting bacteria), compared with those in whom cultures were negative for Candida spp. but positive for bacterial pathogens. Patients with persistently culture-negative respiratory specimens were excluded from analysis. Statistical significance of observed differences was evaluated by chi-square testing.

Results

In total, 287 patients were analysed. Of these, 202 (70%) were male. Bacteria only were cultured from respiratory secretions of 208 (72%) patients (the 'non-Candida' group). The 'Candida' group consisted of 79 (28%) patients; of these, 39 had Candida spp. only and 40 had Candida spp. plus bacterial pathogens. Within the 'non-Candida' group, 39 patients died during the ICU episode; in the 'Candida' group, 17 died (18.8% vs 21.5%, P = 0.597).

Conclusion

The presence of Candida spp. in the respiratory secretions of this critically ill cohort was not associated with a significant increase in ICU mortality. It appears, therefore, that airway colonisation with Candida spp. in the absence of ventilator-associated pneumonia may not be regarded as a reliable predictor of ICU mortality.