Department of Infectious Disease, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022 Hubei, PR China.
Department of Infectious Disease, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022 Hubei, PR China; Department of Nosocomial Infection Management, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022 Hubei, PR China.
Diagn Microbiol Infect Dis. 2025 Jan;111(1):116580. doi: 10.1016/j.diagmicrobio.2024.116580. Epub 2024 Oct 26.
In the intensive care unit (ICU), patients undergoing mechanical ventilation (MV) often exhibit Candida colonization. This study aims to systematically review and analyze the effects of Candida colonization on the outcomes of mechanically ventilated patients and its relationship with bacterial pathogens associated with ventilator-associated pneumonia (VAP).
We conducted a comprehensive search across PubMed, Embase, Web of Science (WOS), and the Cochrane Central Register of Controlled Trials (CENTRAL) without language restrictions to identify eligible studies. Inclusion criteria involved patients undergoing MV for >2 days, encompassing those with clinically suspected VAP (csVAP), and confirmed VAP patients. We assessed the impact of Candida colonization on patient prognosis, length of ICU stay, bacterial pathogens responsible for VAP, and inflammatory markers. The study protocol was registered with PROSPER (CRD42024580547).
Thirteen studies involving 3,802 patients were included in our analysis. The prevalence of Candida colonization among MV patients ranged from 10 % to 56 %. Our findings indicated that Candida airway colonization was associated with poorer patient prognosis (95 % CI 1.13-1.52, p < 0.05, I² = 39 %). Among patients who developed VAP, Candida colonization correlated with increased detection rates of Pseudomonas aeruginosa (RR = 1.37, 95 % CI 1.07-1.75, p = 0.01, I² = 3 %) and Acinetobacter baumannii (RR= 1.48, 95 % CI 1.17-1.86, p < 0.01, I² = 27 %). Additionally, an association with antibiotic resistance was observed, although the quality of evidence was low. In studies that recorded patients' inflammatory markers, no significant effect of Candida colonization on inflammatory markers (procalcitonin, interleukin-6) was observed.
Candida airway colonization is highly prevalent among mechanically ventilated patients and should be considered a marker of poor prognosis when it occurs. Antibiotics should be used more carefully when Candida colonization is detected in the respiratory tract of mechanically ventilated patients.
在重症监护病房（ICU）中，接受机械通气（MV）的患者常常发生念珠菌定植。本研究旨在系统地回顾和分析念珠菌定植对机械通气患者结局的影响，以及其与呼吸机相关性肺炎（VAP）相关的细菌病原体之间的关系。
我们对 PubMed、Embase、Web of Science（WOS）和 Cochrane 对照试验中心注册库（CENTRAL）进行了全面检索，不限制语言，以确定符合条件的研究。纳入标准包括 MV 治疗＞2 天的患者，包括临床疑似 VAP（csVAP）和确诊 VAP 患者。我们评估了念珠菌定植对患者预后、ICU 住院时间、引起 VAP 的细菌病原体和炎症标志物的影响。研究方案已在 PROSPER（CRD42024580547）中注册。
纳入了 13 项共 3802 例患者的研究。MV 患者中念珠菌定植的发生率为 10％至 56％。我们的研究结果表明，气道念珠菌定植与患者预后较差相关（95％CI 1.13-1.52，p＜0.05，I²＝39％）。在发生 VAP 的患者中，念珠菌定植与铜绿假单胞菌（RR＝1.37，95％CI 1.07-1.75，p＝0.01，I²＝3％）和鲍曼不动杆菌（RR＝1.48，95％CI 1.17-1.86，p＜0.01，I²＝27％）检出率增加相关。此外，还观察到与抗生素耐药性有关，尽管证据质量较低。在记录患者炎症标志物的研究中，未观察到念珠菌定植对炎症标志物（降钙素原、白细胞介素-6）有显著影响。
机械通气患者中念珠菌气道定植非常普遍，当发生时应视为预后不良的标志物。当机械通气患者的呼吸道检测到念珠菌定植时，应更谨慎地使用抗生素。
