Article Reviews

Significance of the isolation of Candida species from airway samples in critically ill patients: a prospective, autopsy study

by Neil Orford - Biography

15th Nov, 2009

Reviewer’s summary

A very interesting addition to the literature. The issue of whether to prescribe fluconazole to non-neutropaenic, ventilated patients in the ICU with candida albicans in their sputum is a great one for bedside debate. More so in patients who may be failing to respond to empiric antibacterial VAP therapy. The answer from this study is “no”….if your intention is to treat candida pneumonia. There are of course caveats. These results applies to non-neutropaenic patients, there could have been patients with candida pneumonia who were treated and did not die, and it has not answered the question “does treating candida colonization of the airway in non-neutropaenic ventilated patients prevent secondary bacterial infection and VAP?”.

The Paper

Title: Significance of the isolation of Candida species from airway samples in critically ill patients: a prospective, autopsy study

Authors: Meersseman W, Lagrou K, Spriet I, Maertens J, Verbeken E, Peetermans W, Van Wijngaerden E.

Journal: Intensive Care Medicine.  2009:35:1526-1531

Overview: Positive candida cultures in the respiratory tract of ventilated patients are common. In non-neutropaenic patients the clinical significance, relationship to candida pneumonia, and indication and efficacy of treatment is debated. This 2-year prospective study performed 232 autopsies on 301 patients who died in ICU, from 1587 admissions. Of these, 135 (58%) had histopathological evidence of pneumonia, of which 77 (58%) had a positive tracheal aspirate or BAL culture for candida spp. performed in the preceding 2 weeks. No cases of candida pneumonia were identified in these 77 cases, or the other 58 cases of pneumonia that were candida culture negative. To identify candida pneumonia lungs were inflated with 10% formalin to 35cmH2O pressure, and fixed in 10% formalin. After 48 hrs they were cut into slices 1 cm thick. Samples were taken for microscopic analysis form each pulmonary lobe and areas with macroscopic injuries. Histological criteria for diagnosis of candida pneumonia included the presence of intense neutrophil alveolar or interstitial infiltrate with evidence of yeast invasion

In summary in patients who died in ICU, no cases of candida pneumonia were identified post-mortem, even in those with positive candida spp. culture.