Abstract
Multiple-site colonization with Candida spp. is commonly recognized as a risk factor for invasive fungal infection in critically ill patients. We carried out a study to determine the relationship between Candida colonization and invasive infection in neurological patients admitted to an ICU. At admission (T0) and every three days for two weeks, different samples (pharynx swab, tracheal secretions, stomach contents, etc.) were collected for mycological surveillance. Candida mannan antigen and Candida anti-mannan antibodies were assayed. The Colonization Index (CI) and Corrected Colonization Index were calculated for each time point. Of all patients 70% was already colonized by Candida spp. at T0 and six of them had CI ≥ 0.5. Three patients developed candidemia; they had CI ≥ 0.5 before infection. Positive values of Candida mannan antigen and anti-mannan antibodies were found only in the patients with candidemia. The sensitivity and specificity of the Candida mannan test were 66.6% and 100%, respectively, while the sensitivity and specificity of the anti-mannan antibody test were 100%. In accordance with other authors, we find the surveillance cultures are useful to monitor the Candida colonization in ICU patients. In addition, the sequential observation of anti-mannan antibodies could contribute to early diagnosis of candidiasis more than Candida mannan antigen in immunocompetent patients.
Highlights
Invasive fungal infections are an important cause of morbidity and mortality in immunocompromised subjects such as patients with severe neutropenia or cancer and in patients admitted to ICU, intensive care of neonatology or pediatric intensive care units [1,2,3]
Multiple-site colonization with Candida spp. is commonly recognized as a major risk factor for invasive fungal infection in critically ill patients and the colonization density could be a predictive value for the diagnosis of systemic candidiasis [10,11,12], the distinction between colonization and infection is often difficult [13]
During the observation period three patients developed Candida bloodstream infection, they presented Colonization Index (CI) ≥ 0.5. These results are in accordance to data of other researchers that show Candida colonization often precedes an invasive fungal infection and that the risk is correlated to CI [6,20]
Summary
Invasive fungal infections are an important cause of morbidity and mortality in immunocompromised subjects such as patients with severe neutropenia or cancer and in patients admitted to ICU, intensive care of neonatology or pediatric intensive care units [1,2,3]. Chemotherapy, intravascular catheter, prolonged stays in ICUs, immunosuppressive therapy for organ transplantation, abdominal surgery and Candida colonization are recognized as risk factors for invasive mycoses [4,5]. Multiple-site colonization with Candida spp. is commonly recognized as a major risk factor for invasive fungal infection in critically ill patients and the colonization density could be a predictive value for the diagnosis of systemic candidiasis [10,11,12], the distinction between colonization and infection is often difficult [13]. Multiple surveillance cultures are often performed daily for critically ill patients, the clinical importance of positive Candida spp. cultures is difficult to define. Candida colonization is present in 5–15% of patients but it can achieve peaks of
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