Risk factors of Candida colonization in the oropharynx of patients admitted to an intensive care unit

Abstract

Candida colonization is an important precursor for candidiasis. However, there is little information about its risk factors in critically ill patients. We aimed to identify risk factors for oropharyngeal Candida colonization in critically ill patients. This is a prospective observational study of 110 patients admitted to a medical intensive care unit (MICU). Oropharyngeal swabs were obtained on day one and day four. Characteristics of patients colonized with Candida species at admission or not colonized were compared. In addition, patients becoming colonized during their ICU stay were compared to patients who did not. Independent risk factors for a positive Candida sample at the time of admission were: a history of proton pump inhibitor (PPI) use before admission (OR: 5.24, 95% CI: 1.36-20.19), the presence of diabetes mellitus (OR: 2.84, 95%CI: 1.02-7.92) and a lower BMI (OR: 0.9, 95% CI: 0.84-0.97). Chronic kidney disease was associated with a decreased frequency of Candida colonization (OR: 0.26, 95% CI: 0.01-0.46). No independent risk factors could be identified for patients who gained Candida during their ICU hospitalization. Patients with Candida colonization frequently had abnormal oral bacterial flora. Diabetes mellitus, PPI use and a lower BMI are risk factors for Candida colonization in critically ill patients being admitted to the MICU.