Article type: Original article



Article type: Original article

Impact of Candida spp. isolation in the respiratory tract in patients with intensive care unit-acquired pneumonia

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Silvia Terraneo, MD 1,2, Miquel Ferrer, MD, PhD 1,3, Ignacio Martín-Loeches, MD, PhD 4, Mariano Esperatti, MD 1, Marta Di Pasquale, MD 1,2, Valeria Giunta, MD 1, Mariano Rinaudo, MD 1, Francesca de Rosa, MD 1,4, Gianluigi Li Bassi, MD, PhD 1,3, Stefano Centanni, MD, PhD 2, Antoni Torres, MD, PhD 1,3.

1Servei de Pneumologia, Institut del Torax, Hospital Clinic, IDIBAPS, Universitat de Barcelona, Barcelona, Spain. 2 Respiratory Unit, San Paolo Hospital, Dipartimento di Scienze della Salute, Università degli Studi di Milano, Milan, Italy. 3 Centro de Investigación Biomedica En Red-Enfermedades Respiratorias (CibeRes, CB06/06/0028). 4 St. James’s Hospital, Multidisciplinary Intensive Care Research Organization (MICRO), Trinity Centre for Health Sciences, Dublin, Ireland. 5Department of Pathophysiology and Transplantation, Università degli Studi di Milano, IRCCS Fondazione Ospedale Maggiore Policlinico Cà Granda Milano, Italy,

Corresponding author: Dr. Miquel Ferrer. UVIR, Servei de Pneumologia, Hospital Clínic, Villarroel 170. 08036 Barcelona, Spain. Phone/Fax: +34 93 227 55 49: E-mail: miferrer@clinic.ub.es

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EXTENDED METHODS

Study population

This prospective non-interventional study was conducted in 6 specialized medical and surgical ICUs: general medical, general surgical, respiratory, cardiology, cardiovascular, and medical-surgical digestive ICU, with overall 45 beds of an 800-bed university hospital. Data were collected daily from January-2007 to July-2012. During this period, approximately 8,600 patients were screened during daily rounds. Patients older than 18 years, without immunosuppression (neutropenia after chemotherapy or hematopoietic transplant, drug-induced immune-suppression in solid-organ transplant or cytotoxic therapy, human immunodeficiency virus infection, and long-term high-dose steroid treatment), admitted to ICUs for 48 hours or more, with clinical suspicion of ICUAP were consecutively included into the study. Exclusion criteria were absence of lower respiratory tract sample collected, macroscopic bronchial aspiration, and previous or concomitant invasive Candida spp. infection assessed by isolation of this fungal species in normally sterile samples.

The institution’s Internal Review Board approved the study (Comite Etic d’Investigacio Clinica, registry number 2009/5427), and written informed consent was obtained from patients or relatives.

Definition of pneumonia, microbiologic processing, and antimicrobial treatment

The clinical suspicion of pneumonia was based on clinical criteria: new or progressive radiologic pulmonary infiltrate together with at least two of the following: temperature >38º C or 12,000/mm3 or ................
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