Wood G Christopher, Mueller Eric W, Croce Martin A, Boucher Bradley A, Fabian Timothy C
College of Pharmacy, Department of Pharmacy, University of Tennessee Health Science Center, 26 South Dunlap, Memphis, Tennessee 38163, USA.
Intensive Care Med. 2006 Apr;32(4):599-603. doi: 10.1007/s00134-005-0065-6. Epub 2006 Feb 14.
Based on limited data, Candida sp. isolates from bronchoalveolar lavage (BAL) cultures in immunocompetent patients are thought to be contaminants rather than pathogens. The objective of this study was to determine the clinical significance of Candida sp. isolated from BAL cultures in critically ill trauma patients.
Retrospective study in a level 1 trauma intensive care unit.
All patients with Candida sp. isolated from BAL cultures over a 3-year period; 85 Candida positive BAL cultures from 62 patients were studied.
The primary outcomes were the incidence of Candida sp. in BAL, antifungal use, course of the possible infection, and mortality. Of 1077 BAL cultures 85 (8%) grew Candida sp., representing 64 episodes of possible Candida sp. ventilator-associated pneumonia. No colony counts exceeded the diagnostic threshold for bacterial VAP (>or=10(5) cfu/ml). Only 2 of 64 episodes (3%) were treated with systemic antifungals. Three other episodes (5%) were treated because of concomitant therapy for Candida sp. at other sites. The majority of episodes were not treated with antifungals and were considered contaminants (59/64, 92%). No patients developed subsequent candidemia, and most follow-up BALs (74%) were negative for Candida sp. Overall mortality (17%) was similar to previous patients with similar severity of injury at the study center (18%).
The results of this study suggest that isolation of Candida sp. from BAL in quantities below the diagnostic threshold for VAP in this population does not require antifungal therapy.
基于有限的数据，免疫功能正常患者支气管肺泡灌洗（BAL）培养物中分离出的念珠菌属菌株被认为是污染物而非病原体。本研究的目的是确定从重症创伤患者的BAL培养物中分离出的念珠菌属菌株的临床意义。
在一级创伤重症监护病房进行的回顾性研究。
在3年期间从BAL培养物中分离出念珠菌属菌株的所有患者；对62例患者的85份念珠菌阳性BAL培养物进行了研究。
主要结局为BAL中念珠菌属菌株的发生率、抗真菌药物的使用、可能感染的病程及死亡率。在1077份BAL培养物中，85份（8%）培养出念珠菌属菌株，代表64例可能的念珠菌属呼吸机相关性肺炎。没有菌落计数超过细菌性呼吸机相关性肺炎的诊断阈值（≥10⁵cfu/ml）。64例中有2例（3%）接受了全身性抗真菌治疗。另外3例（5%）因其他部位念珠菌属的伴随治疗而接受治疗。大多数病例未接受抗真菌治疗，被认为是污染物（59/64，92%）。没有患者发生随后的念珠菌血症，大多数后续BAL（74%）念珠菌属呈阴性。总体死亡率（17%）与该研究中心先前伤情严重程度相似的患者（18%）相近。
本研究结果表明，在该人群中，从BAL中分离出数量低于VAP诊断阈值的念珠菌属菌株不需要抗真菌治疗。
