Risk factors for lung colonization by Candida albicansin a general ICU

Introduction

Although a substantial proportion of patients become colonized with Candida sp. during a hospital stay, only few develop severe infection. Invasive candidiasis occurs in only 1–8% of patients admitted to hospitals, but in 10% of patients housed in the ICU where candida infections represent up to 15% of all nosocomial infections [1]. Candida sp. isolates from bronchoalveolar lavage (BAL) cultures in immunocompetent patients are through contaminants rather than pathogens. The objective of this study is to research the most important risk factors for lung colonization by Candida albicans in ICU patients.

Methods

Immunocompetent patients admitted to the ICU with C. albicans isolates from BAL in a 20-month period were retrospectively studied. Patients without any microbiological growth from BAL were also included. The clinical course, therapeutic decision, potential risk factors and outcome were recorded.

Results

The population object of this study is composed of 20 (33.3%) patients with C. albicans isolated from BAL (BAL+) and of 12 (20%) patients with absent growth in BAL (BAL-). Significant differences between patients with BAL(+) and patients with BAL(-) are observed: 80% BAL(+) versus 8.3% BAL(-) was treated with parenteral nutrition (OR = 44), 90% versus 33.3% were mechanically ventilated (OR = 20), 65% versus 8.3% received corticosteroid therapy (OR = 18). See Table 1.

Table 1

Conclusion

Total parenteral nutrition, mechanical ventilation and treatment with corticosteroids are important risk factors for lung colonization by C. albicans. The higher risk is attributable to parenteral nutrition: the risk is twice as high compared with ventilation and corticosteroid-associated risk.